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More Sign Posts on the Road To Connected Health Adoption

March 23, 2015


Just three weeks ago, I wrote about sign posts on the road to connected health adoption. That post was meant to help readers appreciate the subtleties of a changing environment. A turn of phrase by a senior executive or thought leader can easily be missed if you’re not listening carefully. In this case, a senior executive I work with signaled a change in thinking from ‘healthy skeptic’ to ‘fear of missing out (FOMO)’, by making the statement, “We know [connected health] is going to be a big part of care delivery so we had better start our plans to scale it.”

The healthy skeptic demands data incessantly, to the point where you suspect the ‘more data’ requests are really a polite way to say no. When convincing the healthy skeptic, you bring reams of data. You build logical arguments. When approaching the FOMO attitude, it’s more about enabling experience, assuming that the concept is valid and that eventually we’ll get the economics right. Let’s plan more pilots. Let’s learn by doing.

This is such a liberating signal for any innovator — and I’ve been hearing it a lot lately. I got this same signal from a homecare executive recently. In another example, the CEO of a company I advise intimated to me that his potential customers are no longer asking for clinical proof points as part of their due diligence on his product.

As William Gibson said, “The future is here, but it’s not evenly distributed.” As a bit of a reality check, I also received an email from a colleague who oversees innovation at one of the larger health plans. His query to me: “How do you get doctors to adopt remote patient monitoring?” and adding, “We’re not making much progress with this.”

I in no way mean to declare victory and announced my retirement, but this change in the conversation is worth paying attention to.

What might be driving this change? Many factors, I’m sure.

More signposts_Mobile Tech_Kvedar

There is the ubiquity of mobile technology in general. When all decision makers see the power of the tool in their hand every day (not to mention the addictive nature of the technology), it is much harder to be skeptical.

More signposts_Payment Models_Kvedar

There has also been a lot in the news lately about both connected health and new payment models, the latter being a driver for adoption of the former.

The Secretary of U.S. Health and Human Services (HHS) is on record saying that by 2018, 50% of Medicare payments would be risk-based. Just a few weeks later, she announced a new ACO model that will become available in 2016. The details are sparse, but notably, there will be the opportunity to take more risk, but reap more reward. Also, there will be more opportunities to encourage the use of telehealth. Health leaders know that 2018 is not far away, so we had better get planning now!

The other announcement from the Centers for Medicare and Medicaid (CMS) that will drive telehealth adoption was the new chronic care management code that came out in January 2015. This code allows physicians to bill for 20 minutes per month of non-face-to-face time spent on chronic care management. This is an ideal set up for encouraging population health and remote patient monitoring.

More signposts_Wearables_Kvedar

Yet another recent announcement contributing to FOMO was last week’s flurry of activity from Apple. By now, most folks believe that the Apple Watch will probably not have immediate ‘care of illness’ implications, as it seems more targeted to fitness and health. However, wearables is now a hot concept. This paves the way for thinking around monitoring of vital signs in the home, as well as mobile communication with patients.

More signposts_ResearchKit_Kvedar

And then there is the highly touted Apple ResearchKit. I’m not sure how this will shake out. My colleague Kamal Jethwani astutely noted that the lack of rigor around which individuals can sign up for which studies may significantly add to the burden of data analysis. Another bright commentator noted that patient self-reported data is subject to all kinds of bias. So it’s too early to tell.

But, think for a minute like an executive. You have information coming at you in an avalanche. You are used to reading headlines and instinctively sensing trends. If you read the headlines about ResearchKit (not to mention the brand-name institutions that have already signed on to use it) and didn’t think too hard about it, you’d have to conclude, “This is a big deal. We’d better get on the stick.” Next thing you know, that organization is scrambling to quickly develop a strategy for mobile health and patient engagement.

Suddenly, we are buzzing past all of that skepticism and the endless requests for data, and instead are focusing on how we’d better get moving – faster.

Perhaps these recent events are more than sign posts, but are putting us on the fast track on the road to adoption!

Sign Posts on the Road to Connected Health Adoption

March 2, 2015


Everett Rogers is credited with the seminal text book on adoption, The Diffusion of Innovations. It is required reading for anyone who is interested in how new ideas become integrated into the fabric of life’s activities. I read this text back in the mid 90’s when we started working in telehealth and it influenced my view of adoption. Understanding adoption is an important skill because it enables us to predict the future to some degree; it is a useful tool in developing strategy from pilot to scale; and perhaps most importantly, it enables patience during those times when the thing to do is so obvious to you and no one else seems to get it.

As I’ve traveled the road of adoption for connected health for two decades, I’ve paid attention to the major sign posts — defining moments when the dialogue changes in such a way that the whole organizational strategy changes with it. I’m also privileged to work at an organization that is generally ahead of the adoption curve as it pertains to connected health, so writing about these sign posts should enable others to take advantage of them in corresponding environments around the world.

I generally think of the adoption road as a three lane highway (bear with me lest the analogy gets tortured), with the lanes being provider adoption, consumer/patient adoption and payer adoption.

Connected Health Adoption_Kvedar

Consumers/patients are by far the easiest group to adopt connected health as a model of care. They thrive on the self-empowerment and convenience. Who could argue with improved access to your provider, less travel to the doctor’s office, more flexibility, etc.? The main barriers with consumers/patients are ease-of-use of technology, out-of-pocket costs and privacy/accountability concerns.

Providers take their fiduciary duty to patients quite seriously, so their first concern is about quality. If your innovation changes the way care is delivered, will it risk lapses in quality or possibly result in sub-standard care? This message was loud and clear up until about five years ago. That meant for 15 years, our work was very much focused on gathering the evidence for a model of care delivery supported by connected health. Lots of trials, control groups, papers, P values and the like. I took a page from the pharmaceutical industry and went into any discussion with doctors or nurses armed with reprints from the literature and graphs or charts of evidence from our own system to support each innovation I was promoting.

Then one day, I passed a sign post. I was talking to the primary care leaders at Massachusetts General Hospital about our Blood Pressure Connect and Diabetes Connect programs and started my talk with slides showing recent data on these programs. Two minutes into my presentation, the leader of the group interrupted me saying, “We get it, Joe. These programs work. Now figure out how to get them into our workflow and how to get us paid.”

Connected Health Adoption_Kvedar_2

 

Armed with that input from the front line, we worked diligently on integrating our programs into our core clinical systems (the workflow piece). The reimbursement piece lagged because, though our organization was contemplating sharing risk with our payers, we were really in pilot mode with that type of reimbursement until recently. All we could do was promise our providers that we’d figure out a way to reward them for connected health-driven care, but we could do little more than that.

The next sign post came recently when the Centers for Medicare and Medicaid Services (CMS) announced the new CPT code for chronic care management (see also Five Accelerants to the Adoption of Connected Health). This now gives us a framework to make financial calculations about work units, value, etc. We’re currently working with such a reimbursement framework for internal deployment at Partners HealthCare.

Connected Health Adoption_Kvedar_3

 

The final hurdle in provider adoption is capacity. Certain groups of providers are so busy with face-to-face patient interactions (dermatology is one example, which I know firsthand), all of the above criteria could be met and there will still be little adoption. This is a supply and demand problem. Since I trained in the mid 80’s, the demand for dermatology has been on a logarithmic growth curve and the supply has increased linearly. Thus, even with image sharing by iPhones, etc, we have little adoption of teledermatology. In a market with tight supply, suppliers have the upper hand.

The sign post I past most recently triggered my idea for this post. As Partners HealthCare has taken on more risk (we are a pioneer ACO with about 500,000 lives at risk, have risk-bearing contracts with all local payers and self insure for our 60,000 or so employees), we’ve started looking at how we might incorporate connected health into the fabric of care delivery. The reverse psychology here is that when payers only pay for face-to-face care, there is no financial incentive to adopt connected health. When we take on risk payments centrally and are rewarded for keeping people healthy, the face-to-face barrier is removed.

For the better part of the last three years, we’ve looked at the cost of connected health deployments and spent lots of time on ROI analyses, all for an executive team that are healthy skeptics. Our rigor at this level makes for good fiscal discipline and has forced us to innovate on the supply/operations side. None of that is a bad thing. But in two recent meetings, two different senior executives said something that made my ears perk up. Both suggested that connected health as part of the care delivery process is inevitable. The follow-on comment, in both discussions, was that we had better get as much experience as we can, as fast as we can, so that we don’t get left behind.

Connected Health Adoption_Kvedar_4

That is an amazing leap of faith. It says we’ll get the ROIs right, but we should work on experience and deployment so that we stay ahead of that adoption curve. That is an impetus for a real change in strategy at Partners Connected Health.

Could I have imagined this day twenty years ago? Well, actually yes — or else I would not have undertaken my commitment to connected health with such zeal. What I didn’t appreciate back then was that it would take twenty years. Good thing or I might have moved on to something with more short term gratification. However, understanding Rogers’ book and theory helped give me the patience to continue to move forward and watch for the sign posts.

The Wow of Wearables

February 19, 2015


The hype around wearables is deafening.  I say this from the perspective of someone who saw their application in chronic illness management 15 years ago. Of course, at that time, it was less about wearables and more about sensors in the home, but the concept was the same.

Over the years, we’ve seen growing signs that wearables were going to be all the rage. In 2005, we adopted the moniker ‘Connected Health’ and the slogan, “Bring health care into the day-to-day lives of our patients,” shortly thereafter.  About 18 months ago, we launched Wellocracy, in an effort to educate consumers about the power of self-tracking as a tool for health improvement.  All of this attention to wearables warms my heart.  In fact, Fitbit (the Kleenex of the industry) is rumored to be going public in the near future.

So when the headline, “Here’s Proof that Pricey Fitness Wearables Really Aren’t Worth It,” came through on the Huffington Post this week, I had to click through and see what was going on.  Low and behold this catchy headline was referring to a study by some friends (and very esteemed colleagues) from the University of Pennsylvania, Mitesh Patel and Kevin Volpp.  Other authors were Meredith Case and Holland Burwick.  Also notable was that the study was published in JAMA.  In this research letter, the authors compared several fitness wearables to smartphone-based apps as tools to track activity.  They asked healthy volunteers to walk either 500 steps or 1,500 steps on a treadmill, and compared step counts on multiple devices as well as on smartphone pedometer apps.  It is worth spending some time reviewing their data tables.

The first take-home for me was that steps counted on the wearable devices and the mobile apps, when walking on a treadmill, are pretty accurate.  I was somewhat chagrined to learn this. I have a treadmill desk and this time of year spend many evenings walking while reading email.  It always seems like I’m walking farther than the Fitbit tells me, but now I know I’m probably just tired at that hour.

Kvedar_treadmill desk

Their main point, however, is that smartphone apps are as accurate as these wearable devices.  This makes sense intuitively, as we’ve known that smartphones have embedded accelerometers, which can be used to track the movement of the phone.  For years, there have been apps that can take this data and, by applying some software algorithms, show activity that the phone has traveled as steps walked by the owner.  I believe they were initially not so accurate. However, a bigger problem in the early days was that these apps drained the phone’s battery because the processor always needed to be on while tracking the accelerometer’s activity. This has been remedied in the most recent generation of mobile phones, as they now have separate processors dedicated to this sort of continuous tracking.

Thus, we have plentiful pedometer apps (a search on the Apple App store produced too many to count). We’ve also solved how to run these apps in the background without disrupting the phone tasks or draining the battery. So, is it time to ask, “do we really need fitness wearables anymore?

I’d frame the question a different way. Is the future of patient-generated data migrating to the mobile phone (the proverbial digital Swiss Army Knife of life) or will it be migrating to the realm of micro-sized wearable seeds, ingestibles, injectables, bandaids and the like?  I was a fellow panelist with tech guru and futurist Nicholas Negroponte, and in an off-handed comment, he said that wearables are just a temporary fad and that the future is in ingestibles.

On the one hand, it’s tempting to think about a world where all of your health-related data are generated on and analyzed by software resident on your mobile device. One big challenge to this vision is that we don’t always have our phones on our person. Some folks carry them in a bag, etc. This latter point calls into question the experiment that our friends at Penn did and, more impressively, that JAMA chose to publish it. The quality of the science is quite high but the applicability is questionable.

Also, there are many other health sensing applications than just pure activity tracking. What about continuous heart rate or blood pressure monitoring. It’s hard to imagine getting those done without some sort of sensor.

Going back to the eye-catching headline from the Huffington Post and channeling Mark Twain, I’d have to say that reports of the death of wearables have been greatly exaggerated. The power of sensor-generated data in personal health and chronic illness management is simply too powerful to ignore.

The last point to be made, however, is that wearables and their attendant feedback loops are relatively weak motivators on their own. In fact, the same group from Penn came out with an opinion piece, also in JAMA one week earlier, thoughtfully talking about this point.  Our Connected Health research team at Partners HealthCare has shown repeatedly that the motivational messaging that puts these feedback loops in context is the true driver of behavior change.

That will no doubt be delivered via your smartphone!

Five Accelerants to the Adoption of Connected Health

January 28, 2015


I’m often asked, ‘If you could snap your fingers and do some things to accelerate the adoption of connected health, what would they be?’  I’ve resisted responding, thinking that things are not so simple and reducing the keys to adoption to a list is unrealistic.  However, I have been thinking lately about the cultural and business phenomena that are currently shaping and accelerating the adoption of connected health and, in that context, came up with five accelerants.  The best part of the story is that four of the five are already going on and we can see their early-stage effects.

So, at the risk of ‘dumbing down’ adoption, here is my list of five accelerants.  If we could make these go faster, the adoption of connected health would accelerate too.

1. Increase value-based reimbursement for providers.

Virtual Visits_Homebase program

The more providers are financially rewarded for outcomes/quality and efficiency, the more they will be receptive to virtual care.  This is more acute in situations where providers take on downside risk, i.e., they lose money if they do not achieve the targets mentioned above.  Virtual care enables improved efficiency by allowing us to scale our human resources across more individuals/patients.  It enables improved quality by enhancing ‘just-in-time’ decision-making.  And, patients are almost universally in favor of it.  For instance, a recent survey showed that 64% of consumers were receptive to virtual visits with their doctor.

2. Create more mechanisms for provider reimbursement for non face-to-face care (like the new CMS CPT code that just took effect).

Reimbursement reform_cHealth Blog

This may seem counterintuitive given the first accelerant, but even when providers go at risk, they still need ways to document their effort.  We could just put everyone on a salary, but even then, it seems administrators need evidence of actual units of work.  The Centers for Medicare and Medicaid Services’ newest CPT code includes reimbursement for telemedicine services, which is exciting because it enables clinicians to envision a mechanism where they can be financially rewarded for providing chronic care management.  More codes like this would be a tremendous accelerant.

 3. Accelerate consumer choice in the marketplace as well as ‘consumer-driven health care’ (i.e., high deductible plans, health savings accounts (HSAs), etc.).

Supermarket interior, empty red shopping cart.

It’s been fun to watch how health insurance exchanges have affected the dynamic between insurers and consumers.  Insurers were used to selling to employers (human resource professionals) and having the employers do the work selling the plans.  Health plans must now go direct to consumer, forcing them to explain in plain English what health insurance means and how it works.  On the consumer side, it has put the cost of health care in the consciousness of consumers.  The cost-conscious consumer will likely prefer virtual care because it keeps care out of the high cost part of the system.  High deductible plans and health savings accounts (HSAs) draw consumers into the conversation of health care costs. If we offer a virtual service for two-thirds the cost of a face-to-face service, you can bet consumers will flock, if they have a deductible to spend down or if it’s coming out of their HSA.

4. Make the consumer-facing technology truly frictionless.

Frictionless technology_cHealth Blog_Kvedar

This includes a mix of wish-list items, all designed to make it effortless for consumers to participate in connected health.  We’ve found that even the effort to find an app in the app store, download it and create an account can impede adoption.  It seems that people will do it for Snapchat or Trivia Crack, but not to improve their health.  Likewise with all of the effort required to set up wearables and sensors so that their data flows to the right place.  This needs to be simplified. Standards have a role to play here. My favorite example of this is USB.  If you lived through the time where printers had one cable, your mouse/keyboard had another and other peripherals still another, you appreciate how powerful standards can be. USB allows us to easily connect and plug them in without extra effort.  Bluetooth Low Energy is becoming that important connection for wearables, but it has a ways to go.

 5. Create a universal privacy/security technology and make it a public good.

Man looking through keyhole

This is the most pie-in-the-sky idea.  I believe it is important to solve the problem of privacy and security within that same envelope of frictionless technology.  There are products on the market today that add layers of security in connected health, but they require the consumer to take extra steps and they are expensive.  The scandals with the NSA, the multiple credit card breaches and the periodic stories on how Facebook is secretly manipulating your data are all a big setback for the adoption of connected health.  We have to create a system in which consumers can share their health data with minimal extra effort, but also with minimal worry about whether it will be hacked.

I came up with these five accelerants in a moment of creativity. Do you agree? What did I miss?

Buckle Your Safety Belt, Connected Health is Taking Off in 2015

January 6, 2015


While so many folks were writing about their impressions of 2014, I was enjoying the holidays with my family.  During that time I was thinking about the notable events of 2014 in connected health, but more importantly how they will set the stage for 2015, which is poised to be a breakout year.

One year ago, Gregg Meyer, MD rejoined the Partners HealthCare network as Chief Clinical Officer.  One of his initial moves was to bring the Center for Connected Health under his jurisdiction.  For 19 years we were part of the IT apparatus at Partners.  We thrived under that leadership, but the perception within our system and of the rest of the world was that we offered a set of IT tools.  I had said some years ago that as connected health matured, our leadership would adopt the vision that connected health is really about changing the way that care is delivered.  Technology plays a supporting, not a leading role.  Gregg shares that vision and after consultation with our CEO, Gary Gottlieb, brought connected health into the clinical fold. Connected health now shares the stage along with his other major initiatives, namely, QSV (Quality, Safety and Value), Population Health, and Partners eCare. It has been tremendously rewarding for me to work with Gregg over this year as well as with my colleagues in these other areas.  We are creating a strategy that will integrate connected health into the fabric of everyday care delivery in multiple ways over the next several years.

Supporting this strategy, and underscoring the increasingly important role connected health will play at Partners and throughout health care, Partners made the decision to create a new position on the executive team, Vice President, Connected Health, and asked me to fill it.  It is with humility and excitement that I look out at 2015 and the opportunities these developments bring.

It’s clear connected health has turned a corner, making the transition from ‘curiosity’ and ‘future’ to everyday use. Provider organizations large and small are spending energy on how to integrate sensors, mobile devices and virtual visits into their care delivery.  Some are doing so because they are entering into value-based payment relationships, or are more motivated to think differently after seeing their Medicare readmissions penalties. Some are simply realizing they have to be part of the 21st century, responding consumers and patients asking for more virtual care.

On the commercial side we saw large companies moving into the connected health space.  Big announcements, especially from Apple, but also from Samsung, Microsoft and others portend a big push in consumer involvement.  As you cruise through Staples, Best Buy or the Apple Store, you can’t help but notice the plethora of consumer connected health devices and their prominent placement in these stores.  We’ll be sensing everything, all of the time, before long.

Image Source: DailyTech  http://www.dailytech.com/Fitbits+249+Surge+Fitness+Watch+Packs+7Day+Battery+Life+Two+Other+Models+Also+Air/article36782.htm

Image Source: DailyTech

Of course sensing is only part of the magic.  Particularly when addressing the chronically ill, a focus on motivation, engagement and behavioral health is key.  This is much harder, it turns out, than sensor performance, connectivity, etc., and something our research team is actively working on.  Our designs need to incorporate personalization, integrate into everyday life and reinforce social connections.

Passengers Using Mobile Devices On Bus Journey

In 2014, we also saw the first concrete evidence that the pharmaceutical industry is serious about incorporating connected health into therapeutic offerings.  In fact, we’re proud that we are executing a collaborative research and development agreement with Daichi Sankyo that will bring a bundled connected health/therapeutic product to market.  Others will surely follow suit.

Topping the year off was the announcement by CMS that they will begin to reimburse for chronic care management (CCM) in 2015.  This is the first acknowledgement from CMS that connected health is mainstreamable.  The interesting thing about the new CCM code is that it acknowledges the value of care management that is not face-to-face and that is delivered by non-physician providers. While it does not specifically call out remote monitoring as a tool, remote monitoring is an ideal use case for this new code.  It will enable us to engage with providers, particularly primary care physicians who have modernized their practices using a team-based (or patient-centered medical home) approach.  This code enables us to approach this market with an ROI-based business proposition rather than some of the hand-waving we’ve employed in the past.   It is still early going and I plan to write a more lengthy post on this development soon, but I predict this will bring a big lift to connected health as a tool for chronic illness management.

Partners HealthCare Center for Connected Health's 2010 Progress Report, Forward Currents

As I look back at my previous 20 years worth of New Year thoughts, I can’t remember a year where we saw more tangible movement toward mainstream adoption.  Those of us who deliver services into this market had better strap on our safety belts because 2015 promises to be a fast ride – unlike any we’ve seen to date.

From Denial to Responsibility – Connected Health Can Make Us All Accountable for Our Care

December 2, 2014


My dad was a wonderful guy who could fill the room with his personality.  He grew up during the Great Depression and was a World War II veteran.  I was thinking of him recently while considering how much health care delivery has changed in the last 100 years.

OLYMPUS DIGITAL CAMERA

When asked about his health, my dad would always say, “I feel great.  I don’t have any aches or pains.”  This is telling. His generation equated pain with the need to seek care from an expert.  After all, he grew up before Penicillin was discovered.  During that time, given what we knew about health and disease and what we could offer for treatment, it makes sense that people sought the care of a physician when they ‘weren’t feeling well.’

OLYMPUS DIGITAL CAMERA

We’re now in an era where chronic illness management and prevention accounts for 70% of health care costs.  Of the forces responsible for illness — bad luck, bad genes and lifestyle — lifestyle is the predominant cause of chronic illness.

Our public health officials understand this important change, but consumers by and large still do not.  They still mostly seek care when there is some symptom or acute need. This is problematic because so much lifestyle-driven illness is silent for years (hypertension, pre-diabetes, obesity) and only generates symptoms when things are pretty far along.

The other interesting aspect of my father’s adage is the denial underneath it.  He was really saying, at some level, “If I don’t have any symptoms, I’d just as soon avoid the doctor so I won’t get any bad news.”  This psychology too is quite prevalent among consumers today, adding to the challenge of raising awareness of lifestyle-driven illness.  It is easy and human nature, to live in denial.

Another childhood memory I have is how kind my mom was whenever I was under the weather. She gave us extra love, as if that would help the illness improve more rapidly.  Given that most childhood illnesses are viral infections, I suspect her added affection didn’t change the course of any illness, but she made it tolerable to be sick.

We all want to be cared for.  This enables a child-like approach to the health care system.  It is common for patients to come to see us joking about non-compliance and begging, “Don’t yell at me.”  Likewise, they boast about their doctors, implying that they can put all of their worries aside:  “She’ll make sure I am ok.  I trust her.”

This triad of not thinking about health until symptoms arise, not wanting to hear bad news and abdicating responsibility for care to a health care provider accounts for a big part of why it is so difficult for physicians to get folks’ attention before they get sick.

Connected health can help us counteract these challenges.  The vast array of sensors now available and their attendant feedback loops make it hard to ignore when we’re not on track with our health.  Even if we don’t feel symptoms, we can be reminded several times per day of how we’re doing with respect to a given health parameter.  When these data are shared with a health care provider, it becomes more difficult for individuals to ‘abdicate responsibility,’ something we’ve called the sentinel effect. When patients know their objective health data is being shared with a provider, they naturally up their game to appear to be compliant and interested in their health.  No one wants to look like a slacker in front of their doctor.

But we still have challenges when it comes to denial and individuals abdicating responsibility for their health.  This is magnified because we live in a libertarian society.  It is our right to ignore our health if we choose to; and because our politicians want to offer us ‘coverage,’ we can still get our bills paid in the face of unhealthy lifestyle and behaviors.

What tools do we have to deal with this challenge?

Rewards Football (American) Referee

  1. Incentives/rewards.  We can offer individuals rewards for achieving health goals.  Our connected health sensors can be the source of objective data to automate decision-making around those goals.
  2. Penalties.  As a colleague recently said to me, “There is a continuum.  You start with encouraging your workforce not to smoke and offering them rewards for not smoking.  Next, you give them notice that those who continue to smoke will pay a higher insurance premium.  Finally, you institute a policy to not hire smokers.”

Should we follow this approach with other lifestyle/habits such as physical activity and diet?  Does it seem to invasive?  What do you think?

Sensors Offer New Power to Improve Health

November 10, 2014


Have you ever thought about how we evolved and the implications for health care? For millennia, we sought the help of a physician when we sensed something awry in our daily sensations. Sometimes this is as subtle as ‘I just don’t feel right,’ but sometimes it is as dramatic as an athletic injury or a tooth ache. Those latter circumstances are strong motivators to seek health care services because of the associated pain. Somewhere along the evolutionary road, we developed a nervous system with pain receptors, vital sensors that can help prevent injury. These benefits are most obvious in people with various forms of neuropathy. It is common for them to develop serious burns that they aren’t aware of; pressure ulcers, etc.

By contrast, we did not develop sensations for some equally serious health-related phenomena. For instance, the elevation of blood pressure is virtually undetectable until it gets to acute-crisis levels (hence the term ‘the silent killer’). Most folks can tolerate a blood glucose level of 150 to 200 (normal is around 100) or even higher without having much in the way of symptoms. This is why so many cases of type II diabetes go undetected years before they are picked up because of some other downstream symptom.

When you get into the realm of preventative care, it is even more curious. Though current evidence overwhelmingly supports daily cardiovascular exercise, most of us feel a very strong pull toward the easy chair or the sofa. Likewise, we can overeat slightly or overtly for years and ‘suddenly’ notice that we’ve gained 10 lbs. There is no symptom of high cholesterol, though we now know it to be a precursor of serious cardiac disease. Somehow our knowledge of pathophysiology seems to be ahead of our evolutionary development.

These latter challenges have become the bane of health care policy makers. We can’t get people to pay attention to diet, exercise and other preventative tasks because there is no symptom associated with unhealthy behavior — until it’s often too late. In fact in many cases, it seems that the unhealthy behaviors are in themselves psychologically rewarding so we are really swimming upstream here.

Enter the modern era of wearables and sensors. Sensor technology is going through a sort of Moore’s law type period, with personal health technologies experiencing exponential improvements. The technology is becoming cheaper, smaller, easier to power, etc. The most mainstream example of how this can affect health care are the systems that combine continuous glucose monitoring with insulin pumps in type I diabetes (so-called artificial pancreas).

The sensor industry is exploding with interesting innovations. Boston-based MC10 can put sensors and associated electronics into a flexible substrate allowing for devices the size and thickness of a postage stamp to be employed in vital sign sensing.

MC10

OMsignal is weaving sensors into fabrics enabling a t-shirt that can sense all manner of vital signs.

OMsignal

Quanttus has technology enabling continuous blood pressure monitoring in a wrist-worn device. Proteus Digital Health has an ingestible radio chip that enables true tracking of medication adherence.

Proteus

With all of the attention to nano technologies, it is not farfetched to imagine sensing of phenomena such as the level of cholesterol in the blood.

Are there examples of products on the market today that bring this vision to life? I can think of three. The Muse, by InteraXon, is a wearable EEG device that enables biofeedback and enhanced mindfulness training.

Muse

BioBeats senses your heartbeat and uses software algorithms to create music that relieves stress.

BioBeats

HeartMath uses a wearable sensor to give you biofeedback on your heart rate and improves focus, mindfulness and stress response.

HeartMath

So what if high blood pressure was like a broken arm? Think how health care delivery and prevention would change. With the evolution of new sensors, we will be finding out in our lifetimes. Imagine, with me, how this is going to change health and wellness in the future.

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