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The battle to own digital health will escalate this week with Google expected to introduce a new service to collect data from fitness trackers and apps.
The tech giant’s addition to its mobile operating system, likely to be described in greater detail at the I/O conference in San Francisco, follows Apple's unveiling of HealthKit, Samsung's S.A.M.I. announcement and WebMD’s launch of Healthy Target.
Each is a play to become the consumer platform for health, a one-stop hub for a person’s own biometric data as well as personalized insights and health content. It’s the latest in a long line of fierce wars for the mobile customer, which have ranged across phone specs, developer loyalty, navigation services, music, media and more.
No one is quite sure how it will play out – but they all know for sure that they don't want to miss out. Health offers the next opening to differentiate operating systems, the next opportunity to tie consumers into ecosystems and the next source of information that can be tapped for consumer insights.
“Right now, they’re boring, underwhelming and inaccurate," said Esther Dyson, chair of EDventure Holdings. "But they'll make the data much more interesting and meaningful, and the wearables themselves will become better.”
They certainly should. Because despite feeble early efforts in the space, including the shuttering of Google Health in 2012 and stumbles in hardware, the broad potential here is shifting the premise of healthcare from treating disease to preventing it. And perhaps, with enough data from enough people, to help discover long-sought cures for deadly illnesses.
No Magic Bullet
An online survey by Endeavour Partners found that half of people who own a fitness tracker no longer use it, with about a third dropping off within the first six months.
Venture fund Rock Health, which has invested in the wearables space, suggested in a refreshingly clear-eyed report on the state of the devices that those numbers were likely too conservative. In its survey of 10 staff members – who, recall, work in digital health – usage plummeted below 25 percent within half a year.
To date, the sense is that most demand for health trackers and the data they provide comes from the barbell market of the ultra fit and the unhealthy: Those who want to scrupulously monitor their activities and progress, and those in real need of insight and motivation. Medical-grade devices for mobile phones like glucose meters and blood pressure cuffs are generally designed for those already dealing with signs of disease.
The rest of us only tend to think about health when we’re unhealthy, venturing off to WebMD when we’ve got that weird growth and forcing the subject into the back of our minds the rest of the time.
"How do you get those people motivated?" said Malay Gandhi, managing partner at Rock Health. "It's one of the largest fundamental challenges in health care. I don't think there's a magic bullet."
Indeed, the base assumption of fitness trackers and services is actually a fairly audacious one: that mainstream consumers will want to strap themselves to sensors 24 hours a day and adjust habits in hopes of avoiding diseases that might be decades away.
The sector’s stunning success in getting us all to text, tweet and slingshot disgruntled birds on our phones won’t automatically translate into getting us all to eat our vegetables in the real world.
But it is the right vision, especially in a nation dealing with epidemic levels of obesity and diabetes: To the degree that U.S. consumers start to think about their health in a farsighted way, it's a win for patients, physicians, employers and the healthcare system.
Smarter Sensors
To succeed, companies will have to figure out how to deliver something of real, perceivable value (which would seem like an obvious statement but for the litany of copycat devices cluttering the market today).
Fitness trackers that measure steps, sleep and calories are thoroughly commoditized at this point – and the data is a backwards look at activity, not a measure of one’s actual state of health.
No one is quite sure what the “killer app” of the space looks like yet, but most observers believe it starts with better sensors.
“It won't be one thing that measures all of your health,” Dr. Krishna Yeshwant, a general partner at Google Ventures and a physician. “It's something that will be narrow but that closes the loop in a real-time way and gets people to change their behavior.”
In May, Samsung showed off its concept for the Simband tracker, saying it could integrate third party sensors that would monitor heart rate, hydration, blood pressure, respiration and glucose concentrations, among other things.
Apple, which plans to unveil a smart watch later in October, appears to be working on an array of novel sensors, based on media reports and hiring patterns. Google X revealed it’s developing a smart contact lens that can measure glucose levels through tears.
Integrity Applications of Israel has already earned limited approval to sell a bloodless glucose monitor in certain parts of Europe that uses a clip-on earlobe sensor.
Others are working on wearables that monitor respiration, body position, brain activity and more.
Some of these sensors are further along than others, some will require the Food and Drug Administration’s sign off, and some can’t be packed into a device on the wrist.
But many point to a convenient and accurate bloodless glucose sensor as a breakthrough for healthcare and a critical entry point for the wearables space.
"It's been a holy grail for a long time," Yeshwant said.
The most obvious advantage is that it would allow diabetics to monitor their blood sugar levels, adjusting their diets or medications accordingly, without painful skin pricks. But it would also offer everyday consumers a way to understand how diet affects health in real time.
Yeshwant compares it to people driving in more fuel-efficient ways when dashboards show plummeting levels with every gunning of the gas pedal.
If consumers see that devouring a piece of cake immediately spikes their blood sugar, it makes them more cognizant of the effects of their actions, he said. They’ll start to think twice before indulging – especially people already at risk for developing diabetes.
Better Data
A major motivation for the platform plays described above is surely the rich data provided by devices that people wear around all day, every day.
Internet and mobile companies already have increasingly complete consumer profiles, packed with location, shopping patterns, search history, social graphs and more.
“You layer on top of that biometric data and it gets a lot more interesting," said Sonny Yu of Misfit Wearables, makers of the Shine activity monitor.
But, again, consumers won’t use these devices and hand over this data until they see how the information helps them.
So how might that happen?
The platforms themselves may help make the data more relevant, to the degree that they collect information from multiple sources and try to deliver unified insights from it, Dyson said.
Those better sensors should also mean more useful data. That becomes particularly true as more devices earn FDA approval, enabling them to move from making ill-defined "wellness" promises to delivering information with clinical validity that doctors and researchers can put to use.
Perhaps the most interesting detail in Apple's unveiling of HealthKit – which aggregates data from fitness trackers, medical devices, apps and the phone's own sensors — was the partnership with Mayo Health Clinic and Epic Systems, a major provider of digital health records. That suggests the data can feed into the official records for patients at clinics using Epic.
As digital wellness platforms merge with electronic medical records, through acquisitions, partnerships or otherwise, the digital picture of one’s health becomes increasingly detailed.
"Candidly, it's the easy stuff that they're doing right now," said Ryan Howard, CEO of Practice Fusion, one of the largest providers of online electronic health records. "But if I had, ‘James is a 30-year-old male in San Francisco,’ your past medical history and steps and blood sugar, all together, that becomes really, really interesting."
The Big Promise
Interesting in several ways.
For one, a real-time feed of medical data into clinics and hospitals means doctors can be alerted and respond in the event of alarming divergences. This model has already emerged with companies like Medtronic, which develops a heart monitor that can inform doctors in the case of a cardiac event.
Devices that can collect increasingly reliable data at home, including glucose levels, could also be a significant boost for telemedicine, saving people the cost and hassle of going into the physician’s office.
“That could really change the way people think about how care is delivered,” Yeshwant said.
Now throw in genomic data, thanks to plummeting prices of DNA sequencing. And maybe we all start to regularly test our pH levels and gut microbiome from home, a possibility raised by Larry Smarr, founding director of the California Institute for Telecommunications and Information Technology and perhaps the ultimate “Measured Man.”
At a minimum, what we could start to get is a detailed guide of how our activity and diet effect health, a clearer sense of our specific medical risks and earlier indictions when things start to go awry.
“Healthcare today is about: You get sick, and then you get health care,” Smarr said. “Instead, we're going to keep you healthy so you don't need healthcare."
Everyone will effectively be enrolled in a medical study on a length and scale that we’ve never seen.
Things that look like anomalies could reveal themselves as patterns. Genomic differences that make people more or less susceptible to diseases may light the path to better diagnoses and treatments.
Big data approaches are already being leveraged in research for cancer, Parkinson’s, Alzheimer’s and many other diseases. And most researchers I’ve spoken to believe it’s only a matter of time until the tools lead to medical breakthroughs.
So while there’s a long list of business, cultural, regulatory, liability and privacy challenges standing in the way of this long-term vision — there are even more reasons to tackle them all.
As Bill Maris of Google Ventures put it: “Medicine needs to come out of the Dark Ages now.”
