At RIoT, we often refer to the current industrial revolution as the Data Economy– where every industry stands to transform based on emerging technology capabilities to collect, analyze and automate decision-making with real-time data.
Healthcare is one such industry poised for a significant digital transformation. With scientific and technological advancements, the ideal future of healthcare is highly personalized, precise and accessible.
Each individual has unique genetic makeup, socio-economic factors, behavioral predispositions and environmental influences that impact everyday and long term health outcomes. Truly personalized healthcare considers this entire picture throughout the healthcare lifecycle — from access, to diagnosis, to treatment. Throughout history we have not had the ability to capture or draw actionable meaning from all of this complexity. IoT and data analytics technologies are reaching a maturity that enables this future.
Guest column: Customer-first healthcare could be the next big disruption
Raleigh-based Valencell is an example of what’s possible today. Valencell invented many of the optical sensing capabilities to accurately capture biometric measurement of heart rate, respiration rate and blood pressure found in many wearables. The longstanding reality of getting our vitals taken at an annual doctor’s appointment can be replaced with persistent monitoring of a wide range of health metrics throughout the year.
Of course, technology is also advancing institutional healthcare. EHR data is becoming more accessible – passed through to the patient via digital technologies like patient portals. In 2022, 3 in 5 individuals reported that they accessed their online health records through a patient portal, representing a 50% increase since 2020.
Despite institutional advances, health data is a rapidly growing consumer trend. The reality is that personal health data is increasingly coming from consumer devices, not from healthcare providers. Fitness trackers, smart watches and other health wearables and apps, are a primary means for consumers to access personalized health data.
It is this democratized access to data that will drive a more personalized future for healthcare– and a different relationship between patient and provider. We can imagine a world in which everyone is armed with tailored knowledge of how to prevent their negative predisposed health outcomes all together. First, a few critical considerations must lay the foundation for what’s next:
The inevitable influence of technology solutions
When it comes to patients accessing their own health metrics, it is the resulting patient behavior and decision-making, independent of their provider, that must be carefully influenced. It is not a matter of if a user is influenced, but when and how. We’re becoming more privy to the ways our smartphones drive everyday behaviors – notifications wreak havoc on our attention, driving us to context-switch every time we hear a buzz. We know that social media apps are specifically designed to keep us scrolling. Most Big Tech prioritizes engagement to drive revenue. What’s the equivalent in the consumer health space? What behaviors might knowing our sleep score or having an awareness of our heart rate at all times ultimately drive?
The hope, of course, is that consumer health applications drive positive behaviors that are in service to healthy lifestyles. But product design, interpretation of data and solution recommendations collide with human bias and decision-making, sometimes with unintended consequences (or worse, the intentional trumping of profit over people). Technology innovators and solution designers have critical responsibility and should be accountable to certain regulations.
Theranos is a glaring example of the many risks that come to reality when tech founders have selfish motivations and lack of oversight. The once-hyped finger-prick technology that claimed to diagnose a massive panel of diseases with a very small blood sample had an alarming fall from grace when coverups surfaced that the tech was simply not feasible or scalable. This was after countless cases of harmful patient impact – one woman was given a false miscarriage diagnosis after a Theranos blood test. (She later testified against Theranos CEO Elizabeth Holmes.)
While data validity problems in high-stakes healthcare scenarios are an obvious non-starter, other more subtle aspects of tech solutions can have profound implications on human behavior. Assuming accurate and robust data inputs, the way that data is visualized, when and how often it is presented to the end user, and what end user behaviors the solution either requires or recommends all play into ultimate outcomes. Some health tech companies are taking innovative approaches that consider these behavioral aspects:
The behavioral design difference
Fitbit, one of the first mainstream fitness trackers, ultimately achieved the positive outcome of getting users up and moving. The initial focus of Fitbit’s step-counting devices were centered around the somewhat arbitrary 10,000 step goal. Early versions of Fitbit didn’t even count steps all that accurately. In this low-risk case, it didn’t matter. The goal gave users a simple barometer for whether they were getting enough physical activity in their day, and the wearable provided enough concrete and social awareness to encourage more walking.
Weight has long been regarded by the general public as a priority health metric to pay attention to, and is often falsely substituted for an overall indicator of health. Shapa has taken the approach that we should, quite literally, not care about the number on the scale, but instead simply understand if we are in a healthy weight range for our individual bodies (protecting against negative psychological impacts of over-focusing on the pounds). They have created a numberless scale that instead employs a 5-color system to signal that users are within their unique, healthy weight range. They are now pursuing clinical trials to support early detection of eating disorders.
FDA-cleared Natural Cycles became the first birth control app in 2018, tracking users’ fertility via body temperature – a huge advancement for women seeking non-hormonal options. They are now working on eliminating friction to a necessary behavior in their system – the software-only solution relies on users consistently taking their temperature for accuracy. In 2022, they announced partnership with Oura Ring, a wearable that continuously monitors body temperature through 1,440 data points daily, removing the behavioral barrier to reliability.
Underpinning these solutions is accurate sensing, robust data, quality analysis, thoughtful data visualizations and careful recommendations. These factors all have to come together to have a positive impact on end user behavior and decision-making. This requires rigorous testing, appropriate consent, and keeping the “human in the loop.” These must be fundamental aspects of the innovation process.
First do no harm
In last week’s column, Tom Snyder raised the question of if these products will continue to slide by as “lifestyle AI” (by expressly not claiming to offer diagnosis or recommendations), or if they should instead be more seriously regulated akin to medical devices that must gain FDA approval.
Democratizing health data and increasing healthcare access by way of consumer devices brings a host of questions around equity, ethics, regulation and affordability.
Even if everyone were able to access these tools (which can require a significant amount of discretionary income), there’s the underlying question of how much personal health data about ourselves is constructive? Furthermore, when and how health data is presented to an end user can have profound impact on how it is interpreted and acted upon (and that’s assuming the data is accurate in the first place). And does this level of access empower the individual to make the right, healthy decisions, or should power remain in the hands of expert professional healthcare providers? These are the messy, gray-area questions we must grapple with to enable a future healthcare system that is both driven by precise, individualized data and accessible, equitable, and ethical for all.
Technology companies are not held to the same standards as our healthcare providers, who uphold the Hippocratic Oath that says, “First do no harm.” Regulatory burdens must be defined to hold tech founders accountable to ethical standards with at least FDA-equivalency. Technology companies must pay extreme attention to the behaviors they are driving, how human end users interact with their solutions and account for unintended outcomes.
When access to health data is married with thoughtfully designed solutions that reliably influence behavior for good, then the path to personalized healthcare accelerates. A more empowered and educated patient, leads to agency and self-advocacy, which leads to better healthcare. The tech companies are designing and delivering influential solutions, and we’d better make sure it’s for the better.
If you’d like to join this conversation (along with Valencell and other NC innovators), I invite you to join our next RIoT event: The Path to Personalized Healthcare For All at Cary Founded, Tuesday, April 16 at 5 p.m.
