mHealth App Adoption Indicates Motivation, Does Not Yet Drive Behavior Change
The number of mHealth apps is growing and shows no signs of slowing down. And their adoption has reached the point where researchers can ask: do they work?
mHealth apps have not yet proven effective at creating behavior change – but they do mark a patient’s intent to adopt healthier behaviors, according to a German research team...[whose] study was published in the Journal of Medical Internet Research.
The researchers conducted a population-based survey of 4,144 patients aged 35 or older. The survey measured sociodemographic information, chronic condition presence, health behaviors, quality of life, health literacy, and prior and current use of health IT (i.e. smartphones and mHealth apps).
Results are mixed, showing that use of an mHealth app does correlate with the desire to change behavior but not yet with an actual change in behavior.
There was a modest correlation between mHealth app type and behavior change goals, the researchers observed. Patients using planning, feedback, and monitoring apps usually had plans to improve physical activity. Feedback and monitoring apps also moderately correlated to adherence to clinician advice.
[Yet] despite the plethora of mHealth apps on the market and their widespread use, the researchers did not have enough evidence to conclude that mHealth apps currently drive behavior change in chronic disease patients.
Merely indication motivation to change should not be underestimated, however.
mHealth app use does mark a patient’s decision to make a wellness behavior change, a promising first step in self-management.
The real challenge that the data revealed: demographic chasms in who is using the mHealth apps.
There was a significant chasm between mHealth use and certain demographic factors including age, educational attainment, and health literacy. Thus, mHealth developers must consider unique needs of older patients, those with low health literacy, and those with chronic conditions to make apps both appealing and usable.
“The role of age in the use of health apps highlights that the relevance of new potential ways of supporting health topics is growing in the future. However, app developers should not forget about older people, especially because health issues become increasingly important in later years,” the researchers said.
The Longevity Network’s LivePitch Wrap
Day 1 of AARP’s Innovation@50+ wrapped up yesterday afternoon when the Judge’s Choice and Audience Choice Awards for best Caregiving Healthcare Tech companies were named! If you want to watch the full competition with fast pitches and questions from the judges, check out our videos below.
Round 1 of the pitch competition:
Round 2 and the winners' annoucement:
Here’s a quick wrap on each of the pitches and the questions judges and audience members posed to the entrepreneurs, starting with the two winners.
Winner of the 2017 Judge’s Choice Award: GoGoGrandparent
Justin Boogaard, co-founder of GoGoGrandparent, tells the audience that existing on-demand transportation services like Uber or Lyft would be perfect for older adults, except for two major problems: 1) 70% of users over 65 don’t have a smart phone, which is a prerequisite for using them 2) aging leads to certain kinds of slowing down, which means older users would miss certain changes and problems with using those prevalent transportation providers. GoGoGrandparent solves both these issues by coordinating access to their services using landline call-ins and by tracking and verifying all those changes that an older adult might miss—meaning that up to 25% of their users end up speaking to a real person on the other end of the GoGoGrandparent line.
An AARP member of the audience asked how the company planned to control for older adults having more and more access to smartphones. Answer: There are two major problems their app solves—one is access and it’s true that one is changing. But the other is declining capability of the elderly to adapt to unforeseen changes, such as a driver canceling a ride on Uber. And that will continue to be a need, said Boogaard “until we solve aging”).
Winner of the 2017 Audience Choice Award: Siren Care
Ran Ma, co founder and CEO of Siren Care, told listeners that their mission is to create smart textiles to empower people. Their first product is a smart sock to help diabetics prevent ulcers and amputation. If Siren Care is right, “the only wearables you need are the clothes you wear everyday.” They started with a product for diabetics because there are over 400 people living with it, and because missing an injury leads to loss of independence and rising healthcare costs. The sensors are integrated into the fabric of the sock and the data is sent directly to the Siren app.
Judges asked about market differentiation. Answer: Many current socks for diabetics are compression socks, which only prevent edema. But research shows that only temperature monitoring reduces foot ulcers, and all other temperature sensors require behavior changes by the user, for example, using a thermometer to take the temperature of each individual foot and record readings throughout the day.
Aegle Palette’s CEO and co-founder Yulin Li told the audience that their patented digital placemats use weights to determine and record nutritional info of meals for diabetics. Palette 1.0 captures primary data, like activity and stress levels, and correlates it with biomarkers, like blood glucose levels. This data is all stored in the Palette Vault, which is accessible to the medical team continuously. Palette 2.0 then analyzes that data and provides personalized recommendations to the patient, making it a B2B2C platform.
The judges wanted to know more about how the hardware in the placemat works. Answer: Through photo recognition of food items and a scale to determine quantity of nutrients, calories, etc.).
AgeWell’s CEO and Founder Mitch Besser opened with a quote from the US surgeon general from 2016: “isolation is the greatest health crisis facing America”. Their solution? Employ able seniors to travel around their communities checking on less able seniors in their homes. Empowered with only a smartphone and a simple set of screening questions, these able seniors—known as AgeWells—can “be the eyes and ears of the healthcare system” to reduce hospital readmissions, ER visits and the need for institutionalized care.
Judges asked for specifics on what kind of information the AgeWells are collecting through the app. Answer: Behavioral data like whether they are falling or sleeping, or information about whether they have all their meds and food in the fridge.)
BrainCheck’s COO, Wendy Fong, said it is the first evidence-based, self-administered test for measuring brain function. The company has already secured designation as a class 2 medical device and their “Sport” version has already been adopted by many schools and athletic teams to monitor head injuries for signs of concussion. They are hoping to “replicate the success of BrainCheck Sport in the memory market” by targeting mainly older adults and their caregivers.
Judges wanted to know what kind of tests are the current standard of care to assess memory and cognition in this population. Answer: There is typically a 6-8 month wait to see a specialist. In senior living centers where they use a pencil-and-paper screener, tests take 2+ hours and provide only a raw score without specifying memory vs. cognition scores.
CEO Dirk Soenksen of Ceresti Health says their target users are the unpaid caregivers for patients with Alzheimer’s Disease and Other Dementias (ADOD), stroke, and traumatic brain injury. This enormous market of patients, he says, are “unable to self-manage” because they can’t communicate or track their own behavior, medication, etc. Ceresti’s proprietary 12-week program proposes to solve a large part of this problem delivered as a tech-enabled solution for these unpaid caregivers that provides Education, Care Plans, Support, and Coaching
An AARP member of the audience posed a great question to Soenksen, wondering whether they were aiming to replace paid caregivers. Answer: Not necessarily. Their main target users are family members already providing unpaid care and who often cannot afford paid care. Cost savings come not from replacing paid caregivers but from reduced hospitalizations and ER visits.
iBeat’s founder and CEO, Ryan Howard says they offer two emergency response products. The $249 iBeat Watch which has a button on the watch which acts like a life alert as well as proprietary cardiac sensors monitoring function for emergency incidents. Cellular connectivity is included. Second, it includes the free Heart Hero mobile app that teaches you CPR and tests your proficiency. As part of the Heart Hero network, you will be notified if someone is having a heart incident nearby, so you can be the good Samaritan by either providing CPR or locating the nearest defibrillators whose locations are provided by the app.
A savvy audience member in the audience asked whether there would be a way the watch could predict a heart incident and not simply react to one. Answer: The watch cannot yet provide this incredibly valuable service but it is already collecting large amounts of data about this population and it is the vision to utilize that data to add predictive capability to the watch.
Co-founder of Kinto, Jeet Singh, explains that Kinto is an app to help manage communications and coordinate care among family, paid caregivers, and the medical team. It also aims to provide caregivers with a community of support and practical tools to help them deal with their caregiving responsibilities, including financial planning, cost tracking, home care coordination, and safety and insurance recommendations. It is set up to provide the service direct to consumers or to large employers looking to provide valuable benefits to their many employees who provide unpaid caregiving to family members.
Judges inquired about their market differentiation in what is an increasingly crowded marketplace. Answer: Most of the competitors are provider-focused whereas Kinto begins with caregiver needs –many of which are not medical.
Heidi Culbertson, CEO and founder, said Marvee provides a centralized portal for voice-activated caregiving solutions. It is currently integrated as a series of “skills” for Amazon’s Echo but is designed to be platform-agnostic so it could eventually integrate with any number of voice-activated home devices. Today, they have several services in market, including 1) “I’m ok” alerts; 2) engagement services like family news that Marvee can deliver when asked; 3) b2b services like turning paper into voice for answering ‘everyday questions’ in a senior living facility, where many residents cannot read paper handouts about what’s for lunch or what time today’s
An audience member asked for hard evidence on seniors’ willingness to adopt voice interface, given that voice-activated devices still malfunction. Answer: In the beta phase of testing Marvee, they saw a dramatic increase in usage at the 30-day mark, which shows the seniors were understanding the interface. They credit this adoption success at least in part to their “try this today” feature—which sends out, for example, a song from the era in which the user grew up. This feature builds an emotional connection to Marvee and improves adoption.
PillDrill, says Founder and CEO Peter Havas, simplifies and modernizing medication taking. Specifically, it does 3 things: 1) reminds you to take meds 2) tracks what you take through a quick bottle scan; 3) notifies family members / care givers of medication adherence. Its strengths are simplicity because it doesn’t require a smart phone, flexibility because you can program it for any regimen of medication adherence, and dignity because “in order for a product to become part of a person’s life, it cannot just be needed; it has to be loved.”
After learning the device costs $199 with no additional monthly subscription, judges were curious how they had reached this particular price point. Answer: Research about this kind of device shows that it needs to be to be over $100 in order for users to trust it but less than $200 in order to be accessible to the largest number of users.
AARP’s CEO Jo Ann Jenkins Addresses LivePitch Audience
When LivePitch emcee Lisa Suennen, Senior Managing Director of GE Ventures, took the stage this morning, she framed the day's conversation, saying, “As baby boomers age, we will challenge nearly every part of our economy.”
At the beginning of her keynote address to the LivePitch audience, AARP CEO Jo Ann Jenkins said that a 10-year-old child today has a 50% chance of living to 104. And that number will continue to rise. “This new longevity is one of the greatest human achievements of our time,” she said, but our social attitudes and institutions have not yet caught up to the new realities of living longer lives.
AARP—and particularly this annual LivePitch competition—has one purpose in mind, says Jenkins: to empower people to choose how they live and age by providing resources and opportunities to match their longer life spans.
HEALTH, WEALTH AND SELF
Genetics accounts for only 25% of our expected life span, Jenkins reported, meaning our health has more to do with the choices we make each day than it does with our occasional visits to the doctor’s office.
This also means that our innovators have an opportunity to address the other 75%, to help older adults make smarter, healthier choices and live longer, more independent lives. But research AARP has done shows that people deal with issues related to health, wealth and self all at once, not in silos. So they don’t want solutions that put them in silos either.
Innovators are answering the call, says Jenkins. because "innovation is the engine for disrupting [our outdated views on] aging.”
Moreover, she told the audience, it is a myth that aging adults are resistant to technology as a solution to their needs. They are in fact seeking those solutions. They just need them to be simple and intuitive to use.
The challenge to all of us is to take advantage of all the information and research on living well and turn it into solutions that people want, whether those people need care or are providing that care.
FIRESIDE CHAT WITH LISA SUENNEN
The most shocking fact I have, said Jenkins, is that on average, adults are now more likely to spend more time and resources caring for an older family member than they did caring for their kids. It’s a bipartisan issue—because nearly every lawmaker has a caregiving story.
At AARP, she added, we are asking, how do we care for the caregiver?
Jo Ann Jenkins herself just lost her father two weeks ago and recently experienced what it's like to coordinate care, along with her sister, long distance. When asked whether she learned anything in taking care of her own father that informs in a new way what she was already talking about everyday, she reported that near the end of her father's life, she learned he had decided to change his healthcare plan. This plan ended up not being adequate for his needs, and it was a decision was reached in conversation with his doctor, without any of the family's knowledge.
So when Jo Ann returned to AARP, that experience triggered a conversation about investigating how difficult it is to choose an adequate health plan—and how AARP could play a role in advocating for simplifying those choices and also starting a conversation about who has decision-making power.
Wait ‘Till You Hear This: Eversound
Childhood friends Matt Reiners and Jake Reisch have a lot in common: they were on the same Little League team, had high school lockers next to each other, and have fathers who are professors at Cornell.
In 2015, the 25 year-olds, who together had already launched one audio technology company (you’ll hear soon), shared another bond. Both Reiners’ grandmother and Reisch’s aunt have hearing loss that was preventing them from fully participating in events in their assisted living communities. The young entrepreneurs saw it as a challenge to solve.
It sounds like they have. Reisch, Reiners, and a third founder Devin Jamison, just age 20 at the time, started Eversound. It is the first wireless listening system developed for senior living communities. With special headphones, residents can hear better at group events such as movies, meetings, lectures, theatre, music performances and exercise classes.
Up to 130 long-term care residents at a time can wear the headphones, which can be individually and ergonomically adjusted. They also fit over a hearing aid. A compact wireless transmitter broadcasts the audio signal from any common audio source to all headphones within 300 feet.
Why Senior Communities Are Listening
Eversound has been snapped up by seven of the 20 largest U.S. long term care providers. It is in 100 communities in 18 states that provide various levels of care, including independent and assisted living, skilled nursing and memory.
Why such interest from providers? When residents can hear well there is better attendance, more engagement in the activity, less frustration and hopefully, a better quality of life. Put another way, hearing loss can lead to social isolation, depression and even mental decline.
A study conducted at two facilities using Eversound, one with dementia residents, found that engagement with the headphones increased 28%, with 17% fewer participants leaving the group or falling asleep during the group activity.
This is music to the ears of the founders, who realized that hearing is a huge problem--and market—that is growing rapidly as the baby boomers and older age.
Consider these hearing loss statistics:
- 18% of ages 45-64
- 30% of 65-74 year-olds
- 47% of age 75+
- 80% of age 85+
- More than 30 million age 65+ by 2050
- Only 20% ages 55-74 who could benefit from a hearing aid use one (the hassle of wearing it, the cost, which can be as much as $6,000 and is rarely covered by insurance)
“When I first heard about the system, I thought it would just magnify the volume, but it also eliminates background noise,” says Lucia Leber, executive director of The Residence at Otter Creek in Middlebury, Vermont. Her senior living community is a customer.
The company charges $269/month for 20 headphones, but providers can get more. There is an initial set up fee of $300.
Recently, a former fire chief and new resident from Otter Creek used Eversound at a lecture and a meeting. “For the first time in a long time, he was able to follow what was going on in the room,” recalls Leber. “It changed his life in one day!” Leber finds residents in memory care are more engaged with the system, too.
Adele Pierce, 95, a self-avowed “political freak,” goes to all the lectures on current events there. “I hate straining to listen or sit in the front row under the nose of the speaker. Now I really hear what they have to say,” she says. “I enjoy the event and think, ‘maybe I’ll go to the next one because this was so easy!’”
From Silent Disco to Senior Living
Both of Reisch’s and Reiners’ business ventures involve headphones, yet the audiences could not be more different. Their first company Party Headphones, created in 2013, when Reisch was a junior at Cornell, rents wireless sets to students, companies and organizations for “silent disco” events. Never heard of them? Everyone has headphones and listens to music from different DJs. Participants dance while blasting the tunes but no one can hear them (as in “silent”). Party Headphones and Eversound, which has 12 employees, share headquarters outside of Boston.
As of last year, 35,000 people have used their headphones for silent disco events. Among their clients: Twitter, Spotify and Red Bull.
Reisch thought of the concept after attending a silent disco party on the Cornell campus. The entrepreneurial management and marketing major called Reiners. He was working in sales for a large company--Reisch had taken time off from school--and convinced him to quit to help start Party Headphones.
As the two were building their company, they looked for other ways to apply the technology. Seeing their relatives in senior living challenged by hearing loss made them wonder why there was no alternative to hearing aids.
Reisch did some research. Over three months, he took his Party Headphones prototype to several continuing care communities for multiple visits, asking residents for their input on his model. “It allowed us to get a lot of feedback really quickly,” he says. Residents wanted the headphones to have ergonomic controls and be hearing aid-friendly.
Reisch, now CEO, recruited Cornell sophomore Jamison to help them start Eversound. Reisch calls him “the creative genius of design and product development.” Today he is in charge of the company’s brand.
After refining the prototype, the founders met Costas Papdopoulos, an engineer who had worked on wireless headset technology for the last 30 years—or, as Reisch points, out, longer than the founders have been alive! Papdopoulos, 72, who has some hearing loss, understood the issues loud and clear. He is Eversound’s Chief Technology Officer.
The founders may have distinct titles today, but as in most early stage companies, “at the beginning you need really hungry, driven people who are willing to fill in the gaps and not be assigned to a specific skill set,” says Reisch. “They need resilience to push through challenges.” What he finds most important though, is that team members must care about the product and the user.
Reiners, who heads up the company’s sales team, agrees: “It gives me goose bumps seeing the impact Eversound is having. I wake up excited knowing that we can help people.”
No more “what do you say?” “Speak up!” “I can’t hear you!” “Talk louder.”
What Role Should Robots Play for the Aging?: A Closer Look at ElliQ
There is no doubt machines--and the rapidly improving capabilities of artificial intelligence--will play a key role in the future of aging. In countries like Japan, where the population is a bit older than here in the United States, the extreme lack of caregivers has driven technological advance to produce caregiving robots.
Today The Smithsonian Magazine, with support from New America Media, the Gerontological Society of America and AARP, published a piece on a question we rarely pause to ask: what roles should machines play and what should be left to human beings, particularly when we consider older adults?
The relationship between humans and robots is a tricky thing. If the latter looks too much like the former, but is still clearly a machine, people think it’s creepy, even repulsive—a feeling that’s become known as the “uncanny valley.”
Or, as is sometimes the case, the human, with “Star Wars” or “The Jetsons” as his or her reference points, is disappointed by all the things the robot can’t yet do. Then, there is the matter of job insecurity—the fear of one day being replaced by a tireless, unflappable, unfailingly consistent device.
Human-robot interactions can be even more complicated for one group in particular—older adults. Many are not that comfortable with new technology, even less so if they feel it’s invading their privacy or a constant reminder of their own slipping cognitive skills.
10,000 Baby Boomers a day turn 65, but the first big wave of them is now turning 70, with much larger waves to come. The possible roles that robots could play is quite lengthy. But one need is clear: improving social engagement by augmenting and not diminishing real human connection.
“You have to walk this balance on where you are starting to impinge on somebody’s privacy versus tracking their safety and social engagement,” says David Lindeman, co-director of Health Care at the Center for Information Technology Research in the Interest of Society (CITRIS) at the University of California, Berkeley. “That’s the compelling challenge of the next decade. How do we maximize the use of this technology without having unintended consequences.”
Is ElliQ the next generation of a voice-activated companion?
ElliQ is an Israeli-designed talking device designed to walk that line--it is charming but not cutesey, and most importantly, its language learning is meant to be intuitive and its movements are meant to approximate human body language. For the past month or so, the device has been tested by a small group of older adults in San Francisco.
ElliQ [is] more desk lamp than archetypal robot—think of the hopping light at the beginning of Pixar movies. But while ElliQ is meant to sit on a table or nightstand...it also moves, leaning toward the person with whom it’s speaking. It lights up, too, as another means of engagement, and uses volume and sound effects to distinguish its messages.
“Most of the way we communicate as humans is non-verbal,”[explains Dor Skuler, CEO and founder of Intuition Robotics, the Israeli company behind the device]. “It’s our body language, our use of silence and tone, [and] the way we hold ourselves. But when it comes to working with a computer, we’ve adapted to the technology instead of the other way around. We felt that a machine having a physical presence, versus a digital presence, would go a long way in having what we call natural communication.”
Skuler described a typical interaction. The grandchildren of an ElliQ owner send her photos through a chatbot using Facebook Messenger. When ElliQ sees new pictures have come in, it tells the grandmother and asks if she wants to look at them. If she says yes, ElliQ brings them up on its separate screen component. As the woman looks at the photos, so does ElliQ, tilting its “head” toward the screen, and turning the moment into more of a shared experience. With the help of its image recognition software, it might add, “Aren’t those girls cute?”
“It’s not the same as your adult child coming over to you and showing you photos of your grandchildren on her phone,” says Skuler. “But it’s also very different from you just looking at the photos on a screen by yourself. You weren’t with another person, but you weren’t really alone, either. We call that an in-between stage.
“What we like about this,” he adds, “is that without the family sending the content, there is no content. ElliQ isn’t there to replace the family. I don’t think we want to live in a world where people have meaningful relationships with machines. What it can do, though, is make that content more accessible and allow you to share the experience.”
Given that older adults are intended as prime users of ElliQ, designers felt it was crucial to respect the intelligence of the users, even as some of their cognitive abilities might be diminishing.
A lot of research went into how ElliQ looks and behaves, says Yves Béhar, founder of fuseproject, the Swiss industrial design firm that worked with Intuition Robotics on the project. That included getting input from experts on aging. (“Our first hire was a gerontologist,” says Skuler.)
“One of the key premises behind ElliQ is that technology is complicated and perhaps too complex for aging people to use,” Béhar says. “But artificial intelligence (AI) can be used to engage with a person in a much simpler way. It can remind a person to take their meds, or connect with their family, or just tell them, ‘Hey, why not go outside. It’s nice out.’
“And we felt that EllliQ should be a table object, rather than a creepy robot that follows you around,” he adds. “By keeping it in one room, a person can interact with it like they would a familiar appliance in a familiar context.”
AI has gotten good enough, say ElliQ's designers, that the device can learn which techniques work best for a specific person, for example, prodding versus simply reminding.
As Skuler explains it, one of the first steps in establishing a relationship with this particular robot is to set some goals, such as how many times a week a person wants to go out for a walk or be reminded to see friends. Then, it’s up to ElliQ to determine the most effective way to do its job. In other words, it will learn that one person responds better to “It’s nice out, why don’t you go for a walk,” while another needs to be prodded more aggressively with “You’ve been on the couch watching TV for four hours. Time to get up and take a walk.”
“That’s where the emotive side kicks in,” he says. “ElliQ can set a whole different tone, and use different body language and gestures based on what works and what doesn’t work. The machine fine-tunes itself.”
Emotional dependency, says Béhar, is not the goal.
“We don’t want to create the kind of emotional dependency that social media sometimes does,” he says. “We need to make sure it complements their human relationships. It’s very important that we keep that in mind as we develop these interactions between humans and machines with artificial intelligence.”
The "Caregiving Cliff" and the Debate over "Connected Aging"
AARP says a "caregiving cliff" is coming in 2030 which is likely to precipitate our adoption of machines. Still, it is possible to be thoughtful about which roles machines play for aging adults.
AARP's [predicts that] by 2030, there will be only four family caregivers available for every person needing care, and that that will drop to three caregivers by mid-century.
“There’s always been this interesting paradox at the heart of it,” says [Richard Adler, a research associate at the Institute for the Future in Palo Alto]. “Of all the age groups, older adults stand to benefit the most from technology. In a lot of ways. But it also is the group that has the lowest level of adoption.”
He’s encouraged by the recent big leaps in voice recognition by machines because it allows older people to use technology without having to mess with smartphones or typing on small keyboards...[but] wary of machines taking too much control. “There’s the discussion of AI versus IA—intelligence augmented—where machines extend human capabilities instead of replacing them.”
That tension between what technology can now do and how much older people actually use it is at the heart of what’s become known as “connected aging”—the use of machines, from smartphones to sensors to wearable devices, that can enable adults to grow old in their own homes. David Lindeman, who is also director of the Center for Technology and Aging in California, has been studying how older adults interact with machines for a long time, and while he points out that researchers are still in the early stages of understanding how technology can affect social isolation, he sees a lot of potential.
“I think it’s better to err on the side of let’s get people engaged and see what works,” he says. “There are such deficits in terms of social engagement for a lot of people.” He points to software that makes it easier for older adults to share stories from their past, and the use of virtual reality to help them feel less isolated.
The Role of Sensors: Measuring a Baseline and Flagging Behavior Changes
“Motion sensors are the bread and butter because they can point to where a person is in the home,” says [Diane Cook, a researcher at Washington State University’s Center for Advanced Studies in Adaptive Systems]. “Location alone doesn’t let you know what’s going on, but when you combine it with the time of day, what happened right before, and where they were, then you can start to see patterns that make a lot of sense.”
The research has been augmented by assessments of the subjects’ mental and physical health every six months, and it turned out that Cook and her team were able to predict “with promising results” how people would score on the tests, based on what the sensor data showed about their behavior. Changes in sleep patterns, for instance, were found to be correlated with changes in cognitive health.
That, say longtime researchers like Lindeman, could be one of the greater benefits of technology when it comes to addressing the needs of an aging society. “We will be able to identify when people have differences in their gait, differences in their affect, differences in their interactions and the way they communicate, and that could help us pick up signs of depression and dementia much earlier.”
What Constitutes Advancement?: the Difference between Technological Success and Societal Success
At the end of the day, what role machines should play in the lives of aging adults is an ethical question. And to answer an ethical question, one needs a clear understanding of the desired goal.
[A]s with any technology, the rapid advances in AI and robotics can jump ahead of comprehending their impact. Guy Hoffman certainly understands this. Hoffman is a leading expert on human-robot interactions. A TED talk he did a few years ago, in which he showed robots improvising music, has been viewed almost 3 million times.
Now a researcher and visiting assistant professor at Cornell University, Hoffman served as an advisor on the ElliQ project.
Hoffman admits to having mixed feelings about [the way robots are better and better able to mimic empathetic behavior]. “There’s a bright side and a dark side to all of this. Do we want people to talk to robots when they feel lonely? Are we solving a problem or are we making it worse? Those are the questions we need to ask.
“I always remind people that success should not be measured by technological success, but by societal success. There is a distinction that needs to be made between what is possible to do and what is desirable to do with robotics.
“That is really one of the most important conversations we need to have about technology today,” Hoffman says. “In one way, technology is increasingly successful in addressing our social needs. But we do not want the technology to drive our human values. We want our human values to drive our technology.”
Breg Enters the Increasingly Crowded Virtual Rehab Field
With providers moving toward bundled payments and "value-based system" in healthcare, costly post-surgical services like physical therapy are finding themselves on the chopping block. One consequence is an accelerated move toward virtual rehabilitation. And companies like Breg who have developing products to enable this remote care are set to capitalize on their foresight.
“We are actively moving toward online physical therapy programs and our goal is to eliminate physical therapy for hips, only use in knees when we need it …,” said Richard Iorio, a hip and knee surgeon at NYU Langone Medical Center, at a panel discussion on orthopedic bundled payments last week at AAOS.
At the recently-concluded annual meeting of the American Academy of Orthpaedic Surgeons (AAOS), Breg executives were showing off a new sensor-device [called Flex] connected to a mobile app that can guide patients through their daily exercise routine following orthopedic surgery.
This is the first time the company has forayed into the digital health, Internet of Things space, confirmed Brad Lee, president and CEO, in a booth interview [with MedCity News] last week where demos of the Breg Flex system were being presented.
Breg's Flex is certainly not the only virtual rehab provider in the space. Differentiators among them are what device they require (smartphone vs. console), whether they offer clinical decision support and therefore require FDA clearance and how well they integrate with electronic health records.
[Flex includes a] chargeable Bluetooth wireless sensor, worn by patients to track progress with prescribed PT exercises with a companion mobile app.
The sensor and app work in concert to record range-of-motion that is key to better clinical outcomes. The data is also shared in real time with providers such that clinicians can tweak exercise protocols. The interactive patient app has a virtual avatar that guides patients through exercises. The system can also collect patient-reported outcomes that are key to getting reimbursed for certain orthopedic procedures such as joint replacement under bundled care programs.
...Flex also works with the electronic medical record of a practice or a hospital [and] is FDA-exempt because it simply monitors and tracks and does not offer clinical decision support.
Competitors include Reflexion Health's Vera and RespondWell, recently acquired by Zimmer-Biomet, an Indiana-based company that currently holds the largest market share of hip and knee replacements.
Reflexion Health’s Vera virtual rehab program...uses the Microsoft Kinect gaming console and the Vera avatar to guide patients through their at-home exercise regimen. The system received FDA clearance in 2015.
....RespondWell virtual rehab program...is...not FDA-cleared.
...Jintronics and Reflexion Health use the Kinect platform thereby tying joint replacement patients to a console or a TV to do their daily rehab. All Breg Flex needs is a cell phone, or tablet and a sensor-device. In other words, patients can be out and about, and still get their rehab done.
[T]he virtual rehab space is getting crowded with several companies vying to win. But Breg’s CEO shrugged it off. “There is a huge market and there will be a lot of good players in the space,” he said.
Photo: Breg Inc.
Aerospace Scientists Turn Their Attention to Tech Gadgets for Caregivers
Among the dossier of caregiver products under development by the Advanced Space and Technology Research Labs, located in Shoreview, Minnesota, are a smartphone app to locate dentures equipped with special antennas, a hands-free car wash for your teeth and a robotic toenail trimmer.
The idea has received a grant of about $200,000 from the National Institute of Dental and Craniofacial Research, a division of the National Institutes of Health. And a University of Minnesota professor is helping out because the devices have the potential to solve some troublesome problems for the elderly, people with motor skill ailments and their caregivers.
As its name suggests, Advanced Space and Technology Research Labs was primarily involved in aerospace technologies.
[They] sell nanosatellite components for spacecraft the size of a Kleenex box and does research in spacecraft and aerospace vehicle navigation, working with government agencies such as NASA and the departments of Defense and Homeland Security. Suneel Sheikh, company founder, CEO and chief research scientist, is a specialist in GPS technology.
That GPS expertise led Suneel to explore other applications, what it calls "medical and terrestrial" projects involving personal navigation, and recently, lost dentures.
That has included designing devices that would help a firefighter find his or her way through a smoke-filled building or help track the location of dementia patients before they wander out of a health care facility.
ASTER Labs also is collaborating with Stephen Shuman, a professor and director of the Oral Health Service for Older Adults Program at the University of Minnesota's School of Dentistry
Dentures frequently go missing in long-term care facilities housing people with dementia, according to Shuman. The false teeth get wrapped up in napkins at meals and tossed in the trash, or they end up in the laundry or they mistakenly are taken by a patient wandering into the wrong room.
Replacing the dentures can cost upwards of $3,000 and result in tensions among staff, patients and family members over who's at fault. Yet it's proven a difficult problem to solve.
"This has been rolling around in my head for 30 years," Shuman said of the problem of lost dentures. "If you can find a satellite in outer space, you should be able to find a denture in a nursing home."
Some prior attempts to solve the problem involved embedding a radio ID chip into a denture, similar to the systems used to identify lost pets. But that technique requires bringing a detecting sensor fairly close to the denture to get a reading, which would not help if a denture was lost in a large building.
ASTER Lab's proposal is to embed a tiny antenna in the denture that would be tuned to respond to a specific frequency. The antenna would be passive and safe to the wearer, requiring no power inside the denture.
But if the denture got lost, the care facility would use a small, handheld detector wand that would be connected to a smartphone app. The detector would emit a low-frequency radio wave that would be reflected back from the antenna in a missing set of dentures. Then the smartphone application would guide the caregiver to the area in the building where the dentures are hiding.
A prototype is under development using the grant money. Next would be "a $1 million clinical trial of the device at the U's dental geriatrics teaching clinic directed by Shuman at the Walker Methodist senior housing campus in Minneapolis."
If everything goes smoothly, the system could be ready for production in two or three years, with the antenna adding a few dollars to the cost of dentures and the detectors costing a few hundred dollars.
A second grant will be devoted to difficulties the elderly or disabled can have with grasping a toothbrush.
The official name is the Automated Dental Care Device for Persons with Oral Hygiene Disabilities.
Shuman and ASTER Labs envision a hands-free mouthpiece that could be inserted into your mouth. A set of little brushes in the mouthpiece then would start moving, cleaning all of your teeth at once.
The mouthpiece could be attached to a station that could pump a fluoride solution or other agents in and out of the mouthpiece. Sensors would adjust the firmness and speed of the bristle motion and wirelessly transmit information to caregivers, including warnings about any problems. LED lights would indicate when your teeth are clean.
Shuman and Sheikh said the device could significantly reduce the effort required by caregivers in the difficult chore of manually brushing the teeth of disabled individuals.
"There's an autonomy issue," Shuman said. "No one likes to have other people doing things for them."
Shuman said there's a severe shortage of caregivers, so "anything we can do to make caregiving easier and more effective through technology is a blessing for everyone involved."
The last product under development at ASTER Labs is a a hands-free robotic toenail trimming system.
According to ASTER Labs, an estimated one-third of people older than 65 are physically unable to cut their own toenails because of problems with reduced flexibility, diminished eyesight and manual dexterity.
Older people who aren't able to take care of their feet and toenails experience a heightened "risk of injury, pain, infection and other complications," along with a reduction in mobility and greater chance of falling, according to ASTER Labs.
Even if patients can get their toenails trimmed at a podiatry clinic, many people don't like the experience of having their feet handled or are embarrassed undergoing the procedure, said Chuck Hisamoto, ASTER Labs research scientist.
"Nail-related Medicare coverage equates to an estimated $96.8 million each year, and frequent professional non-Medicare-covered nail cutting services become increasingly costly and inconvenient for seniors," according to the company.
ASTER Lab's proposed solution, which it is developing with a $200,000 grant from the National Institute on Aging, is a hands-free device that you could put your foot into.
Optical and infrared cameras and ultrasonic sensors then would guide a rotary burr to gradually pare away excess toenails.
The imaging technology would be an adaptation of work ASTER Labs is pursuing with collaborators to develop an automated system to measure the density of leaves and fruit clusters in vineyards to determine the best time for pruning. But instead of identifying grapes, the machine vision would be looking for toes.
There would be safety features in the toenail trimming device to immediately stop the machine if desired by the patient or if the person's toes moved.
If the high-tech toenail trimmer comes to market, it would cost a few hundred dollars, according to ASTER Labs.
The ASTER Labs scientists see it being used in elder care facilities, but they also think it could be bought by individuals who want to use it in their own homes.
"We try to take things in your daily life that can become difficult due to aging or disability and produce devices to help you become more independent," Sheikh said.
Wearable mHealth for Monitoring Cardiac Conditions is Quickly Gaining Ground
Two cardiac mHealth companies have had a big week--with announcements for both involving Mayo Clinic. The AliveCor and BioSig deals are indicative of the rapid adoption trend around cardiac wearable devices with integrated AI capabilities.
San Francisco-based company [AliveCor] announced a Series D funding round of $30 million, led by Omron Healthcare with participation from the Mayo Clinic.
AliveCor, whose Kardia Mobile was among the first ECG wearables on the market, has announced the release of Kardia Pro, a platform that adds artificial intelligence capabilities to help doctors and patients identify atrial fibrillation, the most common cardiac arrhythmia and an indicator of potential stroke.
Separately, the Mayo Clinic announced a 10-year partnership with BioSig Technologies, a Minneapolis-based medical device company looking to develop its PURE EP cardiac signal acquisition and display platform for commercial use.
BioSig has been working to create a digital health device that can help electrophysiologists diagnose and treat patients with abnormal heart rates and rhythms, including those suffering from atrial fibrillation and ventricular tachycardia.
These power of these wearable products is that they provide baseline measurements of cardiac patterns, coupled with the individualized tracking and learning of AI.
“During the first month of usage of Kardia Mobile, we learn about a user’s individualized heart profile,” says AliveCor’s CEO, Vic Gundotra. “Your personalized heart profile can be used for two benefits. First, it helps keep the data clean. If a doctor is monitoring your health using Kardia Pro, he or she can be more confident that the data he/she is reviewing is truly her patient’s and not someone else's. Second, and even more exciting, is that in the future, a heart profile may be able to find, and flag to your doctor, important changes in your ECG.”
"These are the kinds of tools that in the future no cardiologist will want to not practice with," Gundotra adds. "AI will supplement a cardiologist’s service, really being able to provide a higher level of service to the patient."
It's no surprise, then, that cardiac mHealth devices are front and center in the rapid shift toward patient-centric and consumer-centric care.
Artificial intelligence and machine learning are making their way quickly into the healthcare space, led by tech giants like Microsoft and IBM, whose Watson Health unit is partnering with health systems and mHealth companies across the globe.
“It’s (advancing) personalized healthcare,” says Kyu Rhee, MD, MPP, IBM Watson Health’s chief health officer. “The potential of mHealth in empowering individuals and promoting populations is enormous.”
Echo Health Ventures Aims to Fix Today’s “Broken” Digital Health Venture Model
The data is in: digital health funding saw its highest levels ever in 2016. The question is--what does it indicate? One possible interpretation is that 2016 marks the turning point when generalist tech investors see enough signs that consumers are ready for the digital health revolution that they are in turn ready and willing to put capital behind good--or potentially good--ideas.
But there’s another theory that lies behind the recent launch of Echo Health Ventures, formed in November 2016, as a strategic collaboration between Cambia Health Solutions and Mosaic Health Solutions. Erica Garvin at HIT Consultant Media argues that, although the raw dollar numbers in digital health are indeed ramping up, the high failure rate of startups in this sector indicates that there is a fundamental flaw in the investment model.
Today’s digital health venture model is broken. That statement seems bold and contradictory to the fervor and flourish of funding that has poured into the space recently. However, most health-tech startups are predicted to fail within the first two years of operation—why?
In 2014, venture funding in digital health smashed records surpassing $4.1 billion; equally impressive was 2015’s total of $4.5 billion. As the ball dropped on 2016, so did those numbers; however, the space still saw $4.3 billion by the year’s end. Even more telling is the $6.5 billion in investments projected for stand-out digital health organizations by 2017. It’s clear there is at least enthusiasm for digital tech in healthcare, so what’s tripping up the promising startup?
Startups in general are certainly risky--90 fail, according to Fortune. But Matthew Karls of Echo Health Ventures believes digital health is unique in that the real problem lies in the lack of long-term commitment and collaboration from investors. It's a flaw EHV hopes to solve.
The top reason for [startup failure in general], according to 42 percent of startups polled by CB Insights, is a lack of market need for their product—but is that what’s happening in digital health?
“In healthcare, we often see early-stage companies struggle to convert pilots to commercial contracts and grow their top line, despite having secured an impressive base of early pilot partners and clients,” Karls said. “Many companies see rapid early growth, only to suddenly see the momentum stall and growth plateau, and it isn’t clear why…[At least part of the reason is that] this wave of funding has been driven by a herd of generalist and tech investors drawn by the extreme dysfunction in the healthcare system”.
The mantra for many of these generalist tech investors is quick return on investment, which can work in other sectors, but often fails in healthcare according to Karls, because of the complex “layers of process, regulations, and policies”.
Startups are stalling out before building their momentum because they need deeper insights from investors, which they don’t have—not when it comes to doing business in healthcare.
“Enthusiasm and optimism are always necessary for success, in all venture sectors,” said Karls. “What’s lacking is that kind of excitement with an accompanied appreciation for the complexity and magnitude of the current forces in digital health. To put it bluntly, healthcare is harder.”
Given this understanding of the market, Echo Health Ventures has adopted what it calls a “Stage-Agnostic Strategy”.
Building new companies that leverage technological innovation to transform the health care system requires much more than sufficient capital. Over the years, specialized healthcare venture managers have brought patient risk capital and thoughtful, long-term strategic partnership with their portfolio companies. However, these venture capitalists are harder and harder to find.
Enter Echo Health Ventures, hoping to leverage the extensive resources from Cambia Health Solutions and Mosaic Health Solutions in order to magnify the impact it can create for new companies.
The company manages both companies’ existing portfolios as well as pursues new, stage-agnostic investments in healthcare innovation.
“The Echo model is fundamentally a deeper, more engaging experience than most [accelerators] can provide given the level of long-term, not cohort-based, capital and resource commitment.”
Matthew Karls closes with some advice to startup entrepreneurs.
[Do] not be discouraged but..be considerate and conscious about the importance of [your] moves. “Figure out what problems you can solve, understand everything that touches it, and build on your strengths. Find partners that will accelerate your growth or can provide the network and resources you need to succeed. Then, you can relentlessly focus on delivery,” he said.
What will separate the successful startups from those destined to fail is the willingness to disrupt healthcare; as we’ve heard before, creating solutions to fix broken processes is pointless. “Incumbents preach innovation but sit with dead weight to resist change,” said Karls. “Radically altering the system requires an understanding of it. Innovators must know how the gears work and build solutions that are far more than window dressing. Disruption in health care must happen from the inside out.”
Apple Lags Far Behind Amazon, Google in Smart-home Market
While Apple has been a market leader in smartphone sales for over a decade, they have yet to even offer a voice-controlled device specifically for the home that could compete with Amazon’s Alexa or Alphabet’s Google Home.
Consumer electronics giant Apple (AAPL) is "losing badly" in the nascent smart-home market, despite having arguably the best user experience with its HomeKit technology, Edison Investment Research analyst Richard Windsor said in a note Tuesday.
Apple is a "very distant third" in the smart-home market..., Windsor said. [They have] been rumored to be working on a home appliance that uses its Siri voice-response personal assistant. But so far Siri is mostly an application on Apple's iPhone smartphones.
Siri of course can be voice-activated, but research shows the power of the home devices is that a user can have both hands fully occupied with some other task and still activate it.
"Usage of both Alexa and Google Home show that over 60% of all usage is generated when the user's hands are busy with another task, [said Windsor.] “This makes the use case of Siri on a device that needs to be removed from the pocket not as easy or as intuitive as Alexa or Google Home."
Still, Apple has made advances that neither of the other two tech giants have achieved.
Apple had done a better job of integrating home devices so users can give a single command when doing things like going to bed, leaving the home or returning home, Windsor said.
"This makes it easy to turn off all the lights, lock up, turn down the heating, and so on with a single button press, which is something that neither of the other two have come close to offering," Windsor said.
But consumer preference for the voice-activated home device may mean they miscalculated market priorities. If Apple is going to enter this burgeoning market, they are going to have a lot of catching up to do.
Amazon's Alexa grabbed 88% of the intelligent home speaker market in the fourth quarter, Strategy Analytics said Tuesday. Alphabet came in second with 10% market share after launching its Google Home speaker in November, the research firm said.
Some 4.2 million intelligent home speakers were shipped worldwide in the fourth quarter, up nearly 600% year over year, Strategy Analytics said.
"Amazon has had a near two-year head start over its rivals and has done an excellent job of building out an ecosystem of compatible devices and services or skills," Strategy Analytics analyst David Watkins said in a statement. "However, Google is hot on Amazon's heels and the search giant should be able to significantly cut Amazon's lead over the coming year thanks to its superior AI platform and well-established technology-licensing model, which has proved successful through its Chromecast built-in program."