mHealth masters: Death of the quantified self?

From the mHealthNews archive
By Eric Wicklund

Jack Kriendler, MD, is co-founder and chairman of the board at Sentrian. A physician, physiologist and "serial entrepreneur," he has been instrumental in the design, architecture and leadership of innovative technology ventures in healthcare and the social web including Douglas Adams’ (acquired by the BBC) and Vielife (acquired by CIGNA). In 2007 he founded the Center for Health and Human Performance in London, dedicated to helping athletes, celebrities and "complex cases" take on extreme challenges.

Marty Kohn, MD, MS, FACEP, FACPE, is Sentrian's chief medical scientist. He is a board-certified emergency physician with more than 30 years of hospital-based practice and management experience. An alumnus of MIT, Harvard Medical School, Stanford and NYU and a Fellow of the American College of Emergency Physicians and the American College of Physician Executives, he is board certified in clinical informatics through the American Board of Preventive Medicine. Prior to joining Sentrian, he was the chief medical scientist for Care Delivery Systems in IBM Research, where he led IBM’s support for the transformation of healthcare, including development of personalized care, outcomes-based models and payment reform, including the use of the Watson supercomputer in healthcare.

Q. What's the one promise of mHealth that will drive the most adoption over the coming year?

JK: The promise that “my doctors will listen to it.” If we can help medicine as an industry understand the individual, then I think that will catalyze huge change. There are two aspects to mHealth adoption: first, there are the individuals who are excited to learn about their health and who will become early adopters; the second aspect is, can they make sense of the data, can it be accepted by clinicians from a regulatory perspective, and what does that data mean? That, to me, is going to be the big crux of adoption. Getting data into the hands of clinicians, and clinicians being able to do something with that data.

If you make the data understandable to the clinician, that will drive adoption on their side. If you make it understandable to the patient, that will drive adoption from the consumer or the patient side. And if you can get both constituencies working together bridging that gap between patients and professionals, that’s going to drive adoption from both sides. I think ultimately if the payer can see that this collaboration will reduce near-term costs – what greater driver can there be than if you say this will lower your premiums? 

MK: I wouldn’t put a one-year threshold on this. We have to show that mHealth makes a difference for the patient, for the care provider, basically for everybody. One of the limitations or obstacles to information technology in healthcare has been a distinct lack of demonstration of real value. Using new tools requires some learning and perhaps some inconvenience. And most people have not yet been motivated to take on that learning challenge, the necessary inconvenience and the additional burden of using information technology.

If we show – and we will – that mHealth makes a difference, makes it easier to make the right decision, makes it easier to care for patients, makes it easier for patients to manage their own healthcare, that is what will precipitate its adoption. But that link is very important. You need to show actual value; that it makes an actual palpable difference for all the people involved in healthcare.

Q. What mHealth technology will become ubiquitous in the next 5 years? Why?

JK: For the absolutely healthy person it will be the smartphone and the smart wearables. For those with chronic conditions, there are a myriad of connected devices in the home that measure environmental factors, your weight, your medication adherence, and devices that are passively, quietly and continuously measuring vital signs just as a team of clinicians would be listening to you if you were in the hospital.

I think in the next five years it will be seen as negligent to send someone home who is ill without having such cheap and high fidelity sensors helping to listen to their bodies and monitor their behaviors.

The smartphone that we in the West today have as our main mobile communication and digital assistance device is actually very similar to what the people in the poorest countries have in the most remote locations. For me it’s really interesting that mHealth for the first time in history has enabled a kind of equality between people worldwide. I know the degree of actual medicine and intervention will always be hugely different across locations but thanks to the smart phone I think we’ll be surprised at how similar the actual technology will be for putting health in the hands of pretty much everyone on the planet.

MK: Predicting what’s going to be important five years from now is very difficult. It is possible that the smartphone is going to be replaced by something else. If you consider the short history of smartphones and how quickly they’ve evolved, five years is an eternity in technology. So I would not be at all surprised if a fundamentally different method or style of communication comes up in five years. And that will be the interface with which people interact with everything and everybody. I expect five years from now the value of prevention and the importance of wellness will become more ubiquitous and we will be more aggressively focusing on it.

Right now I would argue that a lot of the stuff well people use to track themselves is more novelty than something of value because we don’t know what to do with that information. They collect a lot of things, but what does it matter? We will know a lot more in five years and look for patterns in that information. That will help us identify real insights for healthy people, to identify things that provide support and advice on how to stay healthy. I think there will be a recognition that collecting numbers of unknown value is useless and we’re going to be more focused on actually helping people stay healthier. I’m not sure what that method of communication will be. But it will be a more profound recognition that wellness itself requires effort and insight.

Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?

MK: Two things. One is the utility of monitoring devices to be used at home, making them more affordable, less intrusive and giving us more information. It’s one of the things that allows the mHealth industry to get started that these things are now more approachable.

The second one is progress with big data analytics  the improved understanding of how we can use it and the opportunities and limitations of big data and within that the natural language processing.

Q. What mHealth tool or trend will likely die out or fail?

JK: One of the things that will die out is “quantified self” being something that only rests in the hands of the fit and well. I think the tools will still exist for triathletes and for people that really care about what’s going on with their health. But I honestly think we will see a movement toward much more integration with that data with incentivized organizations that can act upon that data and not just leave things in the hands of individuals who are interested in improving themselves. I think what we will see is paradoxically the death of quantified self not because quantified self will die but it will expand into those individuals who are not even interested in directly and meticulously and sometimes obsessively measuring metrics about ourselves. I think it will become more natural, more passive, more acceptable and applied by many, many more people.

We will move from quantified self to “contextualized us.” We will move from simply collecting data into divining meaning. And from “me” into mass scale machine learning of data on millions of individuals. Helping individuals with chronic disease to improve their health and improve their outcomes based not just on the quantified data but also quantifiable data with true meaning behind why those data are changing.

MK: Any component of mHealth, like all other applications of information technology, will have to show value if it is to become a routine part of the healthcare environment. I suspect that some of the commercial “tracking tools” that collect information and display it for you, but do not provide any real analytic insight, will have limited value. How long will it be before knowing how many steps I took yesterday becomes uninteresting? If such information can be integrated with other data to provide useful insight in improving health and health choices the devices will become part of a sustained system. Otherwise, I would not be surprised if they become limited to people who value targeting some measurement as part of something like an athletic training program.