Christopher Herot's Weblog

WiMM Labs May Finally Bring Video to the Wrist

2012-06-03T16:45:31-04:00

Remember the Dick Tracy 2-way wrist TV? WiMM Labs brought this capability one step closer with the WiMM One, an Android-based wrist device that retails for $199. In addition to serving as a watch (of course!) it can download applications from its own App Store, including a calendar that syncs to Google Calendar, a news reader, calculator, compass, pedometer, weather, timer, and stopwatch. The picture at right is just a simulaton (using the Gallery app), and the 667MHz ARM11 CPU is not quite enough to do real-time video, but with Bluetooth, WiFi, 2 GB of memory, we are pretty close.

It's not exactly a beautiful piece of jewelry, coming in a black plastic case 32mm x 36mm, and the battery doesn't even last for a full day, so this model is really just a developer platform, but it does have some cool features, such as a connection to your iPhone or Android phone that displays the incoming caller-ID along with a button for sending the call to voice mail. Just the thing for dealing with those calls that come in during a meeting.

WiMM will soon have some competition from Pebble, who recently raised $10M on Kickstarter and have already taken 85,000 orders for a watch to ship in 2013.

TEDMED 2011

2011-11-04T18:53:31-04:00

The TEDMED conference took place last week in San Diego but it took me this long to digest all of the content and follow up on all the connections I made there.

Both TED and TEDMED were founded by Richard Saul Wurman, who apparently experienced seller's remorse after he sold both conferences and each expanded well beyond his original vision. [Richard contacted me to point out that he did not receive any financial compensation as a result of the recent transfer ownership of TEDMED.] While the two events are now completely independent, they follow a similar formula: the red TED logo, speakers who are either famous or should be, polished presentations interspersed with some entertainment and long breaks, and a venue that is far enough off the beaten track that the speakers hang around for the entire event rather than helicopter in just for their talk. As at TED, the audience is sufficiently varied and interesting that any random conversation in the coffee line or at lunch will always result in an interesting conversation and often lead to a long-lasting connection. In addition to the expected practicing doctors, hospital executives and entrepreneurs I met a researcher at MIT building medical devices for the developing world and a number of designers, artists, and authors.

The Masters of Ceremony were Marc Hodosh, who had shared that role with Richard in past years, and Jay Walker who purchased the conference this year. Jay was the founder of Priceline.com and a long-term TED participant who seems to have found his calling on the TEDMED stage as he interspersed introductions and lively Q&A with showing materials from his extraordinary library of rare books.

The general theme of the conference can be summed up in two sentences:

There are amazing advances coming in medical technology.
These may or may not make it through the FDA approval process in time to save your life.

This was one of the few conferences where it made sense to go to every session. A representative sampling:

Eythor Bender of Ekso Bionics demonstrated an exoskeleton that allowed a paraplegic to walk.
Daniel Kraft showing what medicine can learn from other fields such as aviation.
Calvin Harley of Telome Health describing how we might halt the aging process by regrowing the DNA on the end of your chromosomes. (A Russian researcher on aging cautioned me that you might not want to rush out and start gobbling down the "nutritional supplement" quite yet - remember Vitamin E?)
Architech Michael Graves now in a wheel chair, decribing his frustration with poorly designed hospital rooms,
Lance Armstrong describing the decisions he and his doctor needed to make in treating his cancer.
Quyen Nguyen of UC San Diego, showing a video of a flourescent dye that binds to tumor cells to make them more visible during surgery (photo at right).
Diana Nyad describing her attempt to swim from Cuba to Florida and her encounters with box jellyfish.
Paul Stamets on medicines derived from mushrooms.
Gabor Forgacs of Organovo demonstrating an inkjet printer that was modified to "print" organs from a supply of cells.
Yoav Medan of InSightec describing one of the breakthroughs that did get FDA approval: a device that uses focused ultrasound to do surgery without making an incision in the patient.
Mehmood Kahn, Chief Scientifc Officer of PepsiCo arguing that we needed processed foods (albeit of higher quality) if we were to feed the earth's seven billion inhabitants. (Although e-Patient Dave tweeted that this does not explain high fructose cory syrup.)
Dean Kamen describing his frustration in trying to get FDA clearance for a robotic arm he developed for war veterans. (Photo at right).
Nate Ball, an engineer and beatbox artist demonstrating how he makes all those sounds. On stage. By having Dr. Nguyen thread fiber optics through his nose so we could see an image of his vocal cords as he made various sounds.
Charles Pell, Physcient describing a new model of retractor that uses force sensors to back-off before it damages bones or tissue.

Next year, the conference moves to Washington, DC. In a move that can only be described as audacious, Jay Walker plans to double the size of the conference and take on the DC establishment. If anyone has the enthusiasm and resources to do it, it would be Jay.

More photos here.

Health 2.0

2011-09-30T01:16:03-04:00

The Health 2.0 conference returned to San Francisco for the fifth year. Attendance continued to set records at 1500 this time around. The zeitgeist continues to be that of information technologists eager to fix all the problems of health care. With 35% doctors carrying iPads and 85% with smartphones, there is plenty of opportunity for technology, but this year there was also a closer attention to payment models and to incentives for use, both financial and psychological.

In his keynote, Mark Smith, President of the California Health Care Foundation, (photo at right) said that while technologies such as the Internet had transformed banking, travel and research, that medical consultations were still being done the same way as they had for the past fifty years. However, it is not enough to provide technology. He stressed that he wanted to fund projects that incorporated financial models that would encourage use. He said too much of what he’s seen in the past resembled the Underpants Gnomes of South Park, with business models consisting of 1. Invent Widget, 2. ????, 3. Profits!

Smith said that the most important element of any new initiative was that it reduce costs, not just by shifting them around but by reducing the “perverse incentives” that encourage volume above all else. Other opportunities lie in improving convenience to patients, rapid learning for providers on how to make sense of the increasing volume of data, and enrollment for the uninsured. As an example of how this could work, he cited how Kaiser-Permanente’s introduction of Electronic Health Records reduced specialist visits by 25%.

There was plenty of innovation on display on the stage and in the exhibit hall, such as:

A heart rate tracker from Basis that you wear like a wrist watch.
A web site from GoodRx that does comparison shopping for prescription drugs.
Consumer health management and social media systems from WellnessFX, Numera Social, HealthTap, OneRecovery
GE Intel Care Innovations home monitoring and communication system

One of the most interesting talks was from Alexandra Drane of Eliza. She used her company’s automated phone call system to conduct a survey of patients, asking them to rank the problems in their life in terms of how much those things mattered to them and how much they received support on those issues from the medical establishment. The ratio, which she called the Ostrich Index, was around 1.0 for typical medical issues such as obesity, but far higher for other sources of stress such as consumer debt. Furthermore, people with multiple issues that high Ostrich Indexes were far more likely to suffer from serious illness. Her message to the audience was that it needed to take a much broader perspective on issues that affected health and that “health is life, not what's measured in the doctor's office.”

A version of this post also appears on the SBR Health blog.

How to tell if we are in a bubble

2011-09-11T21:01:06-04:00

Groupon may have shelved its IPO, but with Zynga still looking to raise a billion and LinkedIn trading for almost double its IPO price there is once again talk of a tech bubble. Sure, the traffic is heavy again on US 101, there are parties every night in Silicon Valley and companies are building tree houses in the headquarters, but how do we know if this is the real thing?

Here are some of the more interesting ways to tell:

When companies invent new accounting metrics that ignore inconvenient costs. In the dot.com bubble we had proxy valuations, recently we had Groupon trying to push ACOSI as an alternative that ignored the cost of acquiring customers.
When founders take out vast quantities of cash while a company is still losing money.
When newly minted MBAs flocking to the field. Marc Andreessen recently argued that during the dot.com bubble MBAs flooded into tech companies for the parties and the hype. Then they all went to Wall Street in time for the most recent financial crisis. He says that hasn't happened yet in tech.
When corporations get into "strategic investing" which doesn't require that the ventures they invest in can turn a profit.
When Angel Boot Camps spring up like mushrooms.

But I think the best indication that we may be in a bubble is when everyone says we are not.

Joseph Ternullo on what's holding back telemedicine

2011-06-08T16:50:26-04:00

Telemedicine has been a field with a bright future for several decades now. Recently Joseph Ternullo, Associate Director of the Partners’ Center for Connected Health, shared his thoughts on what factors were at play. Joe was speaking at Monday's meeting of the New England Healthcare Executives Group and pointed out that while analysts have estimated the telemedicine market at$5B to $30B, that pales in comparison to the estimated $1.5 trillion that is spent in the US on healthcare.

Joe named six issues that were at work:

Technology
Gaps in offerings
Usability and Design
Behavioral issues
Cost
Policy

Joe said that technology was only 15% of the problem. We have plenty of things that work today, from videoconferencing to devices that automatically gather vital signs at home. While the technology will continue to improve, the problem today is more a matter of getting products into a form that is easily integrated into the delivery of healthcare. As William Gibson observed, "The future is already here – it's just not evenly distributed."

A more mundane but pressing problem is matching current offerings with the resources and practices of the health care sector. Joe pointed out how doctors, nurses, and patients were ill equipped to deal with the logistics of procuring, installing and maintaining telemedicine equipment. He saw an opportunity for low-cost middlement that could drop-ship a home monitoring system, integrate it into the patient's health record, and retrieve equipment when it was no longer needed or when it needed repair. Another problem is that most products are oriented to the management of one particular disease, while the patient population most in need of this technology are likley to have mutliple co-morbid conditions.

Usability and design have become an issue as technology becomes widely adopted. With users' expectations being set by devices such as the iPhone and iPad, what comes from the IT department looks clunky by comparison. For any new technology to be widely adopted these days it needs to be as easy to pick up and use as the consumer products people use in their daily life.

Influencing behavior was perhaps the most interesting. As Joe put it, “I wish there were a technology that motivated me.” We have plenty of technology that can measure physiological data and even tell us when we are engaging in unhealthy behavior, but the health care world has a lot to learn from the gaming industry how to get people to actually change what they do. In the panel discussion that followed, several people mentioned the work that BJ Fogg was doing at Stanford and the talk he gave at last year's Connected Health Symposium.

Joe said he was thinking of writing a paper on these points. I hope he does so and starts a conversation going.

UPDATE (11 June 2011): Joe says he will be doing more research on this topic over the Summer, gathering data on some controversial issues, such as the extent of co-morbidities and the need of dealing with them in patient monitoring.

Watch of the Future?

2011-04-21T17:47:53-04:00

Recently Phil McKinney, CTO for Hewlett-Packard's Personal Systems Group, showed the MetaWatch, a concept from Fossil that was inspired by some previous work at HP. Given the lackluster reception granted previous efforts such as the Microsoft SPOT, it's hardly surprising the the press yawned this time as well. Given the ubiquity of mobile phones, do we even need a wrist watch to tell time, much less to provide other communication and display functions?

Even though I could use my smart phone as a pocket watch, I still find a wristwatch to be a great convenience. It's easier (and more polite) to surreptitiously glance at a watch during a meeting than it would be to pull out a phone, even if that does happen more than it should. (See A Guide to Smartphone Manners.) And when biking or sailing, a wristwatch is waterproof and leaves both hands free for more urgent matters.

So when would an "always carry" device on the wrist be a superior alternative to a device in the pocket:

Providing a discrete alert via bluetooth from your smart phone when the latter's vibrate mode might not be noticed.
As a highly discrete picture taking device in environments where cameras were not welcome (art galleries, movie theaters, and defense plants beware.)
As a payment system in places where a wallet or phone was inconvenient, e.g. the beach.
If it could incorporate a DLP chip, a personal pico projector.
Monitoring various physiological parameters, from blood oxygen to miles walked.

Of course displaying the time is still the "killer app" for watches, and it wouldn't hurt if it looked nice on your wrist.

Why Americans Don't Live So Long

2011-01-27T16:35:13-05:00

During the great debate over health care reform, one recurring question was why the USA spends twice as much per capita on health care as other industrialized nations, yet our life expectancy ranks 28th in the world, behind the UK, Korea, Luxembourg and Malta. As the graph at right shows, the US (red dots) onced rank near the top, and while it has improved, the rest of the world has improved much more. The National Research Council took a close look at the data and came up with some surprising results. The report published this week, Explaining Divergent Levels of Longevity in High-Income Countries, listed all the usual suspects, such as obesity, sedentary lifestyle, and uneven access to health care, but surprisingly, the number one cause, accounting for 78% of the gap for women and 41% for men was smoking.

While anyone who has traveled to Europe or Asia might think people in those countries smoked far more than American's, back in the 1940's and 50's when today's aging population was growing up the USA was relatively wealthier than most of today's rich nations and had an agricultural environment uniquely suited to growing tobacco.The red line in the graph at right shows smoking in the USA, which was far higher than the rest of the world until it peaked in the 60s. If there is one cause for optimism, it is that the earlier decline in smoking should make for more rapid improvement in the future. Similarly, while Americans lead the world in obesity and sedentary lifestyle, the rest of the world is catching up - apparently there is a limit to how much you can eat if you never get up from in front of the TV.

The other piece of good news is that the health care system in the US is pretty good at fixing people up when we get sick. It's just that our unhealthy behavior gets us into more trouble than the health care system can fix.

SBR Health in Mass High Tech Startup Watch

2010-12-15T13:31:20-05:00

Even though we aren't quite out of stealth mode yet, SBR Health was voted into this week's Startup Watch: Five you should follow.

Historic Event

2010-12-14T16:00:28-05:00

Locating SBR Health at the Cambridge Innovation Center has many advantages, such as ready-made infrastructure, a community of entrepreneurial companies, the Venture Cafe, but today brought an unexpected surprise as a construction crew showed up outside my office to saw a hole in the wall. At first it looked like they were installing a dog door but further investigation revealed they were installing a plexiglass panel to expose the original floor strut that Governal Deval Patrick and MIT President Susan Hockfield helped install when the CIC expanded into the fourth floor space I know occupy. Who knew this was such an historic location?

Gaming the Algorithms

2010-11-28T19:44:09-05:00

In a brilliant two page article that illustrates why we need investigative reporting, New York Times writer David Segal details how Internet merchant Vitaly Borker (aliases Tony Russo and Stanley Bolds) discovered that complaints from his customers could be good for his business. As complaints about his DecorMyEyes eyeglass business poured in to sites such as Get Satisfaction, ComplaintsBoard.com and ConsumerAffairs.com, his Google page rank actually increased. While Googling "DecorMyEyes" by itself returned numerous complaints, Googling the name of an eyeglass designer such as "Lafont" prominently features Vitaly's own website, sans complaints. Apparently the links from the negative listings increased his Google Juice.

One could argue that the fault lay less with Google than with the complaint sites not using the "nofollow" attribute or consumers not being more thorough checking out a new merchant, but according to the article, just about every other institution that would be expected to help also shirked their responsibility. In a two page description of one consumer's experience, Segal tells how Citibank fell for a fake phone call, MasterCard and eBay cut off Borker only to have him re-register, and the New York Police were slow to act even after the consumer received threatening emails and harassing phone calls. It wasn't until the New York Times started nosing around that any of these places took definitive action.

While it's tempting to blame laziness or bureaucratic incompetence, I think there is something more insidious at work. All the institutions we count on to protect the consumer have replaced human judgement with algorithms, and the people who answer the phones at these places (when you can find a human at all) are just reading scripts and pressing the few limited buttons at their disposal. The Citibank representative actually told the consumer "Listen, this isn’t our problem. This has nothing to do with us." It is arguably true that removing humans from the process delivers better results overall, but a few sociopaths have figured out how to game the algorithms such as by keeping the volume of credit card chargebacks just under the threshold that would get them bounced from the system. In those cases, one wonders what would have happened if Segal, who also writes the Haggler series for the Times, hadn't gotten involved.

In this particular case Borker was arrested, MasterCard and eBay promised to keep him off their systems but the DecorMyEyes site is still promising "new and guaranteed authentic designer eyewear."

Smartphones as Building Blocks

2010-11-05T14:55:01-04:00

At yesterday's Future Forward retreat, Reed Sturtevant and Katie Rae organized a lunch table discussion on Smartphones as Building Blocks, i.e. what kinds of applications transcend the boundaries of an individual phone and become something large of which the phone is a part. When he was at Sun, John Gage famously said "the network is the computer." Now in the mobile world the computer, or more properly what we do with computers, may involve multiple devices of various sizes.

When Reed brought up this topic, my first thought was the way doctors want to use the IPhones and iPads they are already carrying to retrieve patient records, lab results and even real-time vital signs from wherever they happen to be. Other people brought up using the mobile phone as a controller for other systems, from games to TVs. After some more discussion, I proposed the following taxonomy of roles that a mobile device could play:

User Interface - bringing the screen to the app. Rather than putting a screen and keyboard on everything, why not use the ones that are already in your pocket. An early examples were "universal remotes" for your TV, such as L5, Flipr, Bobby and Sonos, but the phone can also be used to control toys and games, or to interact with a fixed object such as a kiosk or billboard.
Identity - A mobile phone can supply two factor identification: something you have (the phone) and something you know (a password you type into the phone.) This can be used to make purchases or unlock a door. OpenWays and Assa Abloy provide this capability to hotels, and Apple recently applied for a patent on Peer-to-peer transaction devices and methods.
Storage - this was the original use of the iPod - to store music
Connectivity - the phone is the obvious place to establish connectivity to the outside world, since it already contains a radio to connect to the cellular network, but many phones also include WiFi, Bluetooth, and Near Field Communications.
Docking Station - In addition to radio links, the phone usually includes a USB or proprietary connector that can be used to hook up anything from a headphone to a blood glucose meter.

Many interesting applications combine multiple roles, such as accepting data from something plugged into the USB port and passing that up along the wireless link. We are just at the beginning of seeing what's possible.

Connected Health Symposium

2010-10-29T22:49:44-04:00

Last week Boston was the site of the seventh annual Connected Health Symposium, bringing together 1,000 attendees, 100 speakers and 50 exhibitors to discuss how information technology could enable better health care by improving the communication among patients, caregivers, and healthcare providers.

The current state of the market was well represented among the exhibitors, who showed a variety of gizmos that would collect information on a patient at home and send it upstream to someone who could monitor anything from blood pressure to mental state. This was my first year at the symposium but veterans of previous events remarked that these systems had been available for years but that rollouts were still largely in the pilot stage. It sounded a bit like the Year of the LAN which computer industry pundits predicted for the good part of a decade before all computers did get networked together without anyone noticing. In the health care world the benefits of connectivity are becoming apparent in terms of outcomes, but the financial benefits are more diffused and may not necessarily accrue to the parties that are paying.

Those benefits were illustrated in a luncheon session sponsored by Robert Bosch Healthcare. While I usually avoid the sponsored sessions at most conferences - if I wanted a sales pitch I would talk to the vendor myself - I was glad a took a chance on this one. The Bosch people stayed in the background and let Sarah Pratt of Dartmouth Medical School and Gail Farrington of the Riverbend Community Mental Health Center present the results of a clinical trial of Bosch's Health Buddy in the treatment of psychiatric and co-morbid medical conditions with patients in a home setting.

The technology involved was very simple. The patients were provided with a Health Buddy unit (photo) that asked them some questions every day about their mental state and overall health. The results were sent over an ordinary phone line to a monitoring system. A missing response or answers that were out of range would trigger a phone call or a home visit. The researchers documented a reduction in emergency room visits which could lead to quantifiable cost savings, but what was equally compelling was the anecdotal evidence, including that from two patients who came to the conference and shared their stories. One of them suffered from depression and said that for the three days a week that he had a therapist appointment he would get out of bed and go, but for the other four days, logging into the Health Buddy was the one thing that made him get up. Indeed, some other data indicates that 95% of the phone calls that come into a health monitoring call center are "test" calls. Sometimes people just need someone to talk to. Conference organizer Joe Kvedar elaborated on this observation in his talk on Emotional Automation. Depending on whether you see the glass as half empty or half full, automated engagement mechanisms such as Tamaguchi and FarmVille are either interfering with our ability to bond with fellow humans or are filling an important need, but as Kvedar points out, systems like Karen the Virtual Coach can exhibit measurable improvements on things like adherence to exercise programs.

I'm a firm believer in real human-to-human interaction, hence SBR Health, but these automated systems do have a role to play. Stanford professor B.J. Fogg did a great job describing the science behind systems like Facebook and Twitter that engage people and change behavior.

For those who want to read more about the conference, I recommend some excellent analysis from David Harlow, John Moore and Vincent Fusaro. Also the live Twitter Stream.

MIT Media Lab 25th Anniversary

2010-10-18T12:28:10-04:00

When I was a student and later, faculty, at the MIT Architecture Machine Group we did a lot of things that were considered crazy and irresponsible at the time, such as giving powerful computers to mere undergraduates and building displays that allocated an entire bit of memory to a single pixel on the screen. Moore's Law is now accepted wisdom and the personal computer a part of every life, but the spirit of innovation lives on at what the Arch Mach's became, the Media Lab, which celebrated it's 25th anniversary last week.

What started as a small band of researchers on the fifth floor of Building 9 is now more than 500 faculty, staff, and sudents that fill two building at the East end of the campus. While the original mission of building tools for architects expanded into the general field of human-computer interaction, in some ways the Media Lab has returned to its roots of building computation into the three-dimensional environment in which we live, and doing so in a three-dimensional space that encourages interaction between multiple disciplines and research organizations. While the original building housed researchers in the kind of dark, enclosed spaces they needed for viewing dimly-lit computer screens, the new building is full of light and glass - more like an artist's studio than a computer lab. Much of the research has moved beyond the two dimensional computer screen to engage the physical world in form and motion, much as the Arch Mach's original Seek project did in 1970. (photo at right)

Some of the work that was on display:

A camera that can see around corners.
An inexpensive piece of plastic that turns an ordinary mobile phone into a device for measuring refractive errors in the eye.
A "bathroom mirror" and related video technology that can measure pulse rate, detect smiles, and measure moods.
Socially intelligent personal robots.
Endless forms of tangible media and user of materials to interact with computers through light, sound, touch, clothing and crafts of all types.

I also got a chance to chat with John Moore, an MD who is now working in the New Media Medicine Group building the next generation of tools to involve patients in their own health care. I saw more of what he presented at Health 2.0 a few weeks ago, which combines data visualization with communication tools to give patients a better idea of the consequences of their actions. For example, instead of hectoring patients to take their medication, it shows an animation of what's going on in their blood, and doing this on anything from a PC to a Furby. It will be really interesting to see how this works the the sensing technology coming from the Affective Computing group downstairs from them.

Some photos of the event here.

Pew: 19% of Americans have tried video calls

2010-10-13T17:41:21-04:00

A Pew Research Center survey released today found that 19% of American adults have tried video calling either online or via their cell phones. That's 23% of Internet users and 7% of cell phone users. Usage is much higher among the affluent (34% of those earning $75K+) and the young (29% of those 18-29). On a typical day, 4% of internet users participate in video calls, up from 2% a year earlier.

(Ar right, Hugo Gernsback modeling his TV Glasses for Life magazine.)

HTML5 - Be Afraid?

2010-10-13T10:24:43-04:00

The New York Times ran an article this week, New Web Code Draws Concern Over Privacy Risks, that warns of the "privacy risks" that are "integral part of the Web language that will soon power the Internet: HTML 5." It talks about "supercookies" and Samy Kamkar's Evercookie, but as often happens in the pulp press, provides few specifics, or even a link to Kamkar's site.

As it turns out, Slashdot and ars technica covered this a month ago, and it turns out the problem is not new to HTML5. While most people know that cookies can be used to store data that persists across browser sessions, and many know how to find the browser button that deletes them, there are many more places that a clever Web developer can stash data, including hiding them inside cached images. Flash has long had local shared objects which you can see using Adobe's settings panel. The latter is actually a Flash application that runs when you visit the Web site, so it's a little spooky despite the reassurance that "The list of websites above is stored on your computer only."

HTML5 compounds the issue by adding half a dozen new places where information can be stored, but the real problem is that a clever Javascript or Flash program can store information in multiple places and if you don't delete them all at once, use the one place you forgot to reconstruct the cookie, hence "Evercookie."

Future browsers will probably provide better tools for displaying and deleting information from these locations, but I doubt people will use them. Just try deleting all your cookies today and see how tedious is it to re-enter all your usernames and preferences at each web site you visit. Once Web sites start relying on local SQL storage the fun really begins.