Would you trust the "wisdom of the crowd" over your own doctor? CrowdMed thinks you might. The San Francisco start-up has an audacious plan to use crowdsourcing techniques to tap the "collective wisdom" of strangers to help diagnose patients - particularly those who've bounced from doctor to doctor for years trying to understand uncommon symptoms. 

While many may worry that healthcare is too important to trust to strangers, I think this is awesome. 

After all, crowdsourcing is already used to help find missing persons, track down terrorists, answer life's vexing questions, pick stocks - and to select our President. SETI uses crowdsourcing to search for extraterrestrial life. Why not employ crowdsourcing to help our multi-trillion-dollar healthcare industry? 

CrowdMed recently received $1.1 million in seed financing from some of Silicon Valley's top venture capital firms, including NEA, Greylock Partners, Y Combinator and Andreessen Horowitz. 

Ask Your Doctor? No. Ask the Crowd.

CrowdMed works like this: Patients pay a $199 fee to list their case on CrowdMed. They fill out a "patient questionnaire" that details their symptoms, case history and personal information. Though CrowdMed founder Jared Heyman declined to say exactly how many patients have enrolled so far, he claimed that there has been "pretty strong demand." Without the fee, Heyman explained, the site would be overwhelmed with patients who might not get diagnosed.

Once a case is posted, the crowd, what CrowdMed somewhat coyly terms "MDs" - for "medical detectives" - can review the patient's information and offer up what they believe is the correct - or most likely - diagnosis. 

According to Heyman, "close to 3,000 people have signed up as medical detectives." He said CrowdMed's "MDs" include doctors, residents and "regular people that like solving medical mysteries." Why sign up to be a medical detective? First, there's the chance to help patients. Second, CrowdMed awards its detectives "points" for the diagnoses they correctly predict. 

CrowdMed utilizes a so-called prediction market methodology to help glean the correct diagnosis. For example, when a detective selects a case to review, they use up some of their points. They use up still more when they suggest a diagnosis or vote up (or down) other suggested diagnoses. Essentially, it "costs" to play. The more accurate their predictions, however, the more points they are ultimately awarded. 

Points do not have any cash value, however. For now, they can be exchanged only for donations to Watsi, an organization that helps fund medical treatments in the developing world. Heyman did not say how much CrowdMed is donating.

While it's true that CrowdMed's detectives may not always correctly diagnose a particular patient, if they can narrow the likelihood of someone's illness to, say, two or three likely options - those that garner the most points, for example - that could speed up decision making and help point to which tests should be perfomed. 

In Crowd We Trust?

The obvious question: Can a crowd of strangers with unknown amounts of medical expertise be trusted to safely and correctly diagnose baffling medical problems? CrowdMed claims that after "four years of development" it possess a patented "unique technology" specifically designed to optimize group intelligence for medical diagnostic purposes. From its site:

Groups hold far more knowledge collectively than any individual member, no matter how brilliant. With hundreds of minds working in parallel, groups can process information much faster than individuals.

Heyman told me that his sister suffered for three years from a rare disease. Once it was finally correctly diagnosed, doctors were able to significantly ease her symptoms. CrowdMed used her case to help validate its model - Heyman says it accurately diagnosed her within days. 

What Do Real MDs Think?

The first rule of medicine is primum non nocere, Latin for "first, do no harm." It does not necessarily apply to the crowd. Not surprisingly, the CrowdMed approach bothers many real doctors.

Dr. Hubert Chen, the Associate Medical Director for biotech pioneer Genentech, said, "I want to be enthusiastic, but I have concerns about it." Dr. Chen's primary concern was the potential for numerous "false positives" that CrowdMed's "detectives" might generate: "I've seen many patients misled by the Web. Doctors often have to un-educate them."

Dr. Aaron Roland, wo runs a family practice in northern California and is an associate clinical professor at UC San Francisco, had different concerns. "I wouldn't pay $200," Rolan said. He also wondered whether CrowdMed could attract the scale it needs. "Crowdsourcing is good when there's a lot of people in the crowd," he said, "but until you get that crowd, I'm suspicious."

Industry Connections

To help attract the required crowd, Heyman recruited Clare Martorana, the long-time editor of WebMD, to help support CrowdMed's outreach efforts. 

Not surprisingly, Martorana was very positive about the concept. There are many "experts," she said, not necessarily doctors, who may have suffered from a particular disease, or have a family member who has suffered, and whom can now contribute to the site.

She hopes to "reach out" to staffers - not just doctors - at medical research, counseling and support organizations that concentrate on specific issues - think, autism, for example, or Parkinson's dioease - and encourage them to participate in CrowdMed.

Martorana also suggested crowdsourcing diagnoses could be a boon for health insurance companies: "If you are insured and going to multiple specialists, but not getting relief, that costs a lot of money - you, your employer, your insurer all must bear those costs. At some point, there probably will be a pretty significant revenue stream for CrowdMed coming from insurance companies. Right now, their cost numbers are staggering."

Staggering Potential

The relatively paltry $1.1 million CrowdMed has raised so far suggest that investors remain unsure of the idea's potential risks and rewards. But connecting patients with chronic medical symptoms to experts, regardless of their titles, clearly holds massive disruptive potential. CrowdMed's ambitious, even inspiring idea is to use connectivity, collaboration and collective intelligence to help people avoid needless suffering. Despite the risks, it seems like it's a worth a try to me.

See also

• Social Revolution: Crowdsourcing For Change
• The Problem With Crowdsourcing Crime Reporting In The Mexican Drug War
• The Key To Crowdsourcing: Smarter Crowds

Lead image courtesy of Shutterstock. Images of Jared Heyman and Carly Heyman courtesy of CrowdMed. Image of Clare Martorana via LinkedIn.

I suffer from panic attacks. At least, I used to - I've not had a single one since I got my iPhone. And I'm convinced these two things are related.

You may not know this, but panic attacks are surprisingly common. According to a study backed by the National Institutes For Health (NIH), 1 in 8 Americans will experience a panic attack at least once during their lifetime. 

Perhaps any smartphone would help, or even any device capable of creating both distractions and social connections. For me, though, having my iPhone always nearby, always on, its many features and functions ready to occupy my mind, my eyes, ears and fingertips, is often enough to reduce the onset of an attack. The device seems to draw out, bit by bit, all those fears, worries and repetitive patterns that used to conspire to throw me into despair, fear and then panic.

If it really is the iPhone that's helped mitigate my symptoms, and I believe it is, then perhaps others who suffer from similar attacks - and own a smartphone - can also find some relief.

What Is A Panic Attack?

The Mayo Clinic defines a panic attack as:

A sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

In a panic attack, the overwhelming sense of fear, as real as it is inexplicable, wreaks havoc not only on your psyche but on your daily contribution to the world. An attack can strike seemingly at random: at home, with friends at a bar, at work, standing in line at Starbucks; anywhere, anytime. That's what makes them so debilitating. 

Twice, I went to the hospital, convinced my symptoms meant an impending drop-dead heart attack. Both times I was told I was not having a heart attack. Eventually, I was diagnosed as suffering from anxiety disorder - which can lead to panic attacks. 

To treat anxiety, doctors recommend exercise, meditation, more sleep and visualization techniques. For those who suffer full-blown panic attacks, professional help is suggested, as is medication. I was prescribed Prozac. Since getting an iPhone, however - though my case absolutly may not be typical - I have been able to gradually reduce my daily Prozac to its lowest available dosage. I expect to soon be off it entirely. I have also stopped seeing a therapist.

Using The iPhone To Improve My (Mental) Health

The potential for the iPhone to aid physical healthcare delivery and diagnostics is well documented. The market for smartphone tools that aid mental health is far less robust. But they do exist. For example, the iPhone app Viary, leverages traditional cognitive behavior therapy techniques:

Together with a therapist, Viary’s clients choose specific actions that will help them achieve a desired goal. For example a client may decide that exercising, eating healthier food, and listening to classical music makes them feel less depressed. Viary sets reminders for these behaviors - walk for 15 minutes every morning, take a vegetarian lunch, tune into some Beethoven etc, - and the app then collects data on these completed actions. Therapists or coaches can then monitor a client’s progress in real time and even respond. 

For me, however, I'm convinced that simply possessing an iPhone has improved my mental health. No matter what symptom crops up, using the iPhone helps calm me down and makes me feel more connected. If I feel inexplicably worried, no matter where I am, no matter who I am with - and this is out of necessity - I pull out my iPhone and start texting. I later apologize to those I am with.

If I feel alone, I call someone. If I get angry, I play a game - preferably online, with friends. When I am bored, I read on my Kindle app. When I can't get a song out of my head, I take to Twitter. If my breathing seems off, I make reminder lists of what I need to do for the day, the week, the rest of my life. If the feelings persist, I open Evernote and scroll through all the notes that have a "thankful" tag attached to them.

If I feel like I can't leave the house, I check my Fitbit app, find out how many steps I've taken that day, then tell myself I will go outside just long enough to add 1,000 more to my total. This usually works. 

Sometimes, when things get really dark, I scroll through my photos, which makes me happy. If that's not enough, I make notes to myself of everything I am grateful for - then email them, knowing my wife can later access the account. 

And when I feel good, good enough even to help others, I sit in the sun, pull out my iPhone and write a blog post. Like now.

Image courtesy of Shutterstock. 

Let's get all the snickering out of the way first: yes, Bill Gates is funding condom research. But the reasoning behind the new initiative is more important than improving awkward experiences by the glow of the dashboard light: this is about saving lives and enhancing quality of life in developing nations.

First off, it's not just Bill Gates that's funding the research: the proposed initial funding of $100,000 is being provided by the Bill and Melinda Gates Foundation, which has a well-established record of seeking solutions for health issues that many of us in Western nations take for granted.

Condoms are one such issue in developing nations, where they are needed to control transmission of sexually transmitted diseases and the HIV virus that causes AIDS. Their success as a birth control method, which can be a hot button issue in some cultures, is nonetheless undisputed.

Cultural issues aside, one of the perceived problems (from the male perspective) is "that condoms decrease pleasure as compared to no condom, creating a trade-off that many men find unacceptable, particularly given that the decisions about use must be made just prior to intercourse," according to the Grand Challenges in Global Health announcement.

"Likewise, female condoms can be an effective method for prevention of unplanned pregnancy or HIV infection, but suffer from some of the same liabilities as male condoms, require proper insertion training and are substantially more expensive than their male counterparts," the program added.

To help solve the problem, the Bill and Melinda Gates Foundation is offering $100,000 in initial funding (and up to $1 million) for anyone who can come up with the "next generation condom."

"We are looking for a Next Generation Condom that significantly preserves or enhances pleasure, in order to improve uptake and regular use. Additional concepts that might increase uptake include attributes that increase ease-of-use for male and female condoms, for example better packaging or designs that are easier to properly apply. In addition, attributes that address and overcome cultural barriers are also desired," according to the Challenge.

Issues like this, which carry various ranges of cultural taboos, depending on your stance, are nothing new for the Foundation. Last August, the Foundation announced the winners of its $100,000 prize to come up with a better toilet. The lack of proper sanitation facilities is a huge problem for billions, and coming up with a cheap and effective means of waste disposal was important enough to weather the inevitable jokes.

There is little doubt that reactions to this latest health initiative will contain similar jokes, because birth control is outside a lot of people's comfort zones. But there are also serious cultural and theological issues to keep in mind as well, more so than the sanitation program ever started. It will be interesting to see if there can really be a solution that can beat this challenge.

I needed a new meditation timer app for my iPhone, and I was not looking forward to browsing for one. The search for "meditation" in the App Store turns up a lot of garbage, and the app I had settled on before still had too much going on. But in the middle of the pack, my eyes fell on Mind, which had a striking, simple design that stood out from the rest.

It was free, so of course I grabbed it, and I was shocked to see how perfect it was for my needs. How could the meditation apps on the store all be so bad except one, and that one happens to be free?

As it turns out, Mind was a simple labor of love with an atypical App Store story. It was built by Fred Oliveira, just @f on Twitter, a full-stack developer and designer. He's also an O'Reilly author and a mentor at 500 Startups. So I had to hear the rest of the Mind story.

"I built Mind mostly for myself," Oliveira says. "I looked around for a timer app (for meditation as well as a Pomodoro Technique tool) that was as simple as it could be. The App Store was packed with apps that looked bad, were poorly designed or were just too complex."

"So since building mobile and Web apps is what I do by trade, I just created my own."

Keep It Simple

Meditation apps are a funny category. App-making is a business. Meditation is a practice of letting go of busyness. These two drives come into conflict surprisingly often.

It's immediately obvious when a meditation app is just about making money; it costs too much for what it is (or it's free and full of distracting ads), and the design shows no care at all. There are plenty of apps in this category.

But even in the apps that are carefully designed, there's often a problem on the opposite extreme. In order to justify charging for such a simple app, many developers feel a need to pack in as many features as they can. These commonly include tons of configurable chime sounds; multiple presets for lengths of time; crazy, changing artwork; and even analytics of your meditation performance over time.

But these features actually detract from meditation apps even more than mere bad design does. The quality of the apps is higher, so it draws people in, but all the bells and whistles — especially the analytics — create pressure to do everything "properly," to make sure you don't miss your daily stats, to fiddle with the chime sounds, and otherwise be distracted from what should be the simplest of all activities.

"Meditation isn't about configuring a bunch of parameters. It's about sitting," Oliveira says. "I didn't need a complex UI, a number of buttons, to help me track how long I sit."

Mind Is A Tool

So Mind is the simplest meditation app it could possibly be, and that's why it works. It has one screen. You swipe the colored time slider left and right to set the duration anywhere between one minute and one hour. Then you hit the button, the app prompts you to relax and focus on your breathing, and when it's done, it chimes three times. It remembers your last session duration for next time. That's all there is to it.

My favorite thing about Mind is that even the imagery is minimal. Meditators come to the practice from different traditions and with different aesthetics, so apps that commit to a particular kind of Buddhist imagery — or worse, some kind of fake pastiche of New Age-y Zen/Hindu/Hippie fusion — are disturbing to me. Mind, from its name to its icon to its full-spectrum colors, is a simple foundation built for anyone.

"I never intended to make money from it," Oliveira says, "which is why it's free today and will probably stay that way forever. It was easy to build, and is easy to maintain. The emails and thanks I get from people who use it are payment enough, to be honest."

"I guess in the last few years I realized I'm a tool maker. Making tools is a calling. Mind is one of those tools. But I've built others before, and will continue building tools in the future. It makes me happy."

Wearable devices like the Nike+ FuelBand, Jawbone UP, larklife, and future products like the Misfit Shine and Google Glass have been the subject of much discussion, for good reason: They give us access to information about our physical bodies and the physical environment we inhabit, a phenomenon we call Smart Body, Smart World. (Self-proclaimed quantified self-ers have been early adopters of tracking sensors, but they're new to most consumers.)

Though at Forrester we think the market for fitness wearables is relatively small, the broader potential for wearables is huge. Body-generated data could be applied to any domain, such as relationships, productivity, gaming, shopping, personal safety and identity validation, just to name a few possibilities.

I recently participated in a panel in San Francisco hosted by service design agency Fjord, along with Adam Gazzaley, Director of the Neuroscience Imaging Center at the University of California San Francisco (UCSF); Bill Geiser, CEO of MetaWatch; Sonny Vu, CEO of Misfit Wearables; and Olof Schybergson, CEO of Fjord. With perspectives from science, research, product and design all represented, we had diverse points of view but all saw the same challenges ahead for wearables: designing for the human brain.

No, I'm not talking about sensors implanted in your brain (although that's certainly possible, and already happening in research and medical settings). I'm talking about designing for the nuanced way our brains process the experience of wearing a device.

In particular, we all saw a need for wearables that:

Support rather than distract from goal-oriented behavior. Dr. Gazzaley’s research at UCSF explicitly focuses on this topic: how goal-oriented behavior is affected by distraction. On the panel, he joked, “I’m the guy reporters call when they want someone to say distraction is bad.”

But it’s not that simple: Dr. Gazzaley noted that if devices are designed with the brain’s limitations in mind, they could be used to support rather than distract from goal-oriented behavior. For example, he said, we know that humans are not very good at staying alert while driving. If a wearable could be designed to detect when we’re falling asleep at the wheel and alert us before we do, that could literally save lives.

Increase self-awareness, but not to the point of self-consciousness. As I’ve tested various wearable devices, I’ve found that wearing an activity tracker like the UP does have a positive effect on my activity during the day - I’m more aware of my sedentary behavior and more likely to walk when I can, like pacing the platform while waiting for the train instead of standing still.

But I’ve found that wearing a tracker to sleep introduces an unwelcome element of self-consciousness into my bedroom: I’m paying attention (and not in a good way) to how long it takes me to fall asleep.

And what about sex? Should some elements of our lives remain untracked? (I argue yes; others may disagree.)

Fjord CEO Olof Schybergson predicted that we’ll need new rules of engagement when wearables like Google Glass allow us to record our surroundings invisibly. In business meetings or on dates, for example, self-consciousness could detract from trust in our relationships.

Give feedback, but avoid “chart fatigue.” All the panelists agreed that feedback is an important element of why wearables work: That’s why the Misfit Shine has LEDs that light up to show your progress toward your daily activity goal. In Dr. Gazzaley’s lab experiments, he often uses gamification strategies precisely for this reason - achievements, progression, and competition are powerful and addictive incentives to keep doing something.

But Schybergson noted that the novelty of data quickly wears off and erodes into “chart fatigue.” For wearables to keep our attention over the long term, they need to be “living services,” evolving as we evolve.

Lead image by Dane Frederiksen, picturing Bill Geiser, Sonny Vu and Olof Schybergson (left to right).

You know it's flu season when everyone on Twitter is talking about runny noses, germ-filled subway rides and obsessing over the effectiveness of their Purell.

While potentially annoying, these kinds of tweets may help predict and monitor how illnesses like influenza are moving across the country. A new study published in the Journal of Medical Internet Research (yes, that's real) from Brigham Young University's Computer Science department has been able to track illness trends by analyzing the location data of tweets referencing illness. 

Location, Location, Location...

The BYU team did not track any certain sickness during this trial, instead concentrating on location data. The ultimate goal of the study was to encourage the creation of a program that health organizations like the Centers for Disease Control (CDC), the National Institutes of Health (NIH) and even smaller city-based organizations could use to track the progression of any disease across the nation. This would give health officials a heads up if a outbreak is headed their way.  

Other online services track disease too, such Google Flu Trends, which uses search terms and results, as well as data from the CDC to specifically track the flu. Another site, MappyHealth, uses location data from Twitter to track illnesses ranging from pertussis to STDs. While these sites are similar to the work done at BYU, the research team mainly sees them as validation to what it originally thought was possible with tweet tracking.

Associate Professor of Computer Science at BYU and lead researcher Christophe Giraud-Carrier said in an email that the method his research team developed can pick up epidemics up to two weeks before the CDC can. "That kind of lead time would greatly help put the resources where they are most needed and in a more timely fashion."

Those two weeks can make a big difference. The influenza vaccine takes about two weeks to be effective at preventing the flu. If health officials were have that kind of lead time, vaccinations could be targeted at areas that seem to be outbreak locations. 

Why Twitter? 

With all of the different types of social media, why choose Twitter? Tweets are public by default, which makes them easier to monitor. The site provides independent researchers a way to monitor users without having to engage them, require them to remember anything or take a test. No one was asked to turn on the location option for their tweets, so the location data that is gathered should be an accurate portrayal of the country.

The site's terms and conditions when it comes to its application programming interface (API) also made it very easy for the research team to follow tweets en masse: 24 million tweets by 10 million different users were tracked by the research team. 

Location data wasn't gathered from tweets themselves. Only about 2% of users actually tagged their location in their tweets. Researchers found a better option to decipher location: User profiles. About 17% of the tweets monitored had users that provided location data on their profile. While some users had fake locations like "a cube world in Minecraft," 88% of the time the provided location data was accurate and useful because it provided a distribution of geolocated tweets across the country. This correlated with the overall distribution of the overall U.S. population. 

Of the tweets tracked, 15% contained specific location data. This may not seem like much, but Giraud-Carrier explained that this percentage is actually very good: "15% is indeed relatively small. But with over 312 million Americans, it still gives us a lot of people to look at/listen to. The fact that the distribution is consistent with the population is also encouraging. We do not want to overstate what is possible, but there seems to be a critical mass here that should allow useful things to be done."

Giraud-Carrier wants the study to serve as proof of the quality and value of geolocation data on Twitter, adding that social media should be used not only as a means of prevention, but also intervention. 

Image courtesy of Brigham Young University.

Sadly, it's going to take a long, long time before we can shrink people and submarines small enough to be injected into an ill patient, a la Fantastic Voyage. But it turns out that shrinking the people isn’t necessary to realize the idea.

Easy-To-Swallow Diagnostics

A team of doctors and researchers at Massachusetts General Hospital have created a pill-sized, tethered lab that patients swallow, and they are preparing to commercialize it. The 1-inch glass bead, in the shape of a typical multivitamin, can take better-than-high-def video and stills (what, no audio?) of a person’s entire esophagus, that tubular organ that starts at the back of your mouth and ends at the entry to your stomach.

The esophagus view. This is big news for anyone who has problems with their esophagus, notably the one-in-five Americans who suffer from acid reflux disease - which can lead to lesions known as Barrett’s Esophagus, which can lead to highly fatal stomach cancer.

The Old Way Hurts

Today, such patients periodically undergo an upper endoscopy, a $1,500 procedure in which they are anesthetized so that a specially trained physician can slide a long, flexible, black video camera and remote tool kit down their throat. Ouch!

Over the course of about 40 minutes, the team watches a video screen for signs of trouble - seeing only what’s on the surface of the surrounding esophagus. Along the way, the doctor can use tools near the lens to snip off bits of flesh for later examination.

No Knockout Juice Needed

About 18 months ago, the team, led by Dr. Gary Tearney, at Massachusetts General’s Wellman Center for Photomedicine, was kicking around ideas for simplifying the procedure. This is what they came up with:

You pour a cup of water in your mouth, put the device (attached to the end of a tether) in your mouth and swallow the water and probe at, say 2pm (this is important). No knockout juice.

The thin tether, containing a fiber-optic cable, dangles from your mouth as a doctor - or even a technician - lightly holds on. The same rhythmic muscle contractions that deliver swallowed coffee to your stomach even if you stand on your head does all the work, pushing the bead along.

“We were skeptical,” said Tearney. “We thought the bead would be loose in the esophagus.” Picture a small elevator in a big shaft. For it to work, the device had to be in contact with tissue. “I was shocked and amazed that the esophagus clamped down on the probe, giving us full contact all the way around. “I had no idea it would work this well.”

A Better Picture

The fiber optic cable shoots near-infrared light onto a tiny, rapidly spinning prism that reflects it out a microscope lens. The focused light scatters inside the tissue and, using sonar-like principles, software written by Tearney’s team builds a picture of features within the lining based on how long it takes the light to rebound. The information hits the prism and races back up the same cable to be reconstructed as a real-time, deep-tissue image, showing healthy and damaged flesh in minute detail.

The technician can pull the probe back at any point, but after shooting the whole esophagus, that little glass bead likely will exit your mouth at 2:06pm. Six minutes after the start of the procedure.

The probe has been tested on 13 patients so far, and has returned detailed images quickly, less expensively and without sedation. If doctors spot dodgy cells, they schedule a traditional upper endoscopy, with the snaking camera, anesthesia and snipping tools.

Still In Testing

Tearney declined to predict how much the tool, which requires purpose-built electronics, would cost. He did say the new procedure could be done in a doctor’s office, not in a much more expensive hospital room.

ReadWrite's Taylor Hatmaker is right about one thing: 2013 should indeed be a unusual year for the Consumer Electronics Show (CES), as the industry struggles to find the next big thing.

(Read CES 2013: 5 Things You Won't See.)

Rattled by declining prices and lingering worries over the "fiscal cliff," gadget makers are likely to be more conservative than ever, focusing on extending tried-and-true trends rather than breaking out brand new ideas.

In fact, it's likely that CES 2013 is going to be, well, boring. As a 20-year veteran of the show, here's what I am expecting to see in Vegas this year:

1. Microsoft

No, I'm not totally disagreeing with Taylor here. As she correctly notes, 2012 was the last year that Microsoft plans to appear at the Consumer Electronics Show, although Consumer Electronics Association chief Gary Shapiro portrayed the company's absence as a "hiatus." Right.

Microsoft may not have bought booth space, but it will be represented by its manufacturing partners, which plan to show off Windows 8 PCs, tablets, all-in-ones and convertibles. The personal computer is simply too big to ignore, but I hear that the number of pitches for Windows 8 PC unveilings at CES is down, and that many companies are focusing on trivial matters, such as new colors. (Colors!?) Even the Surface Pro isn't expected to show up at CES, even though it's due out soon.

2. Tablets - From Off Brands

Yes, Taylor's right that a veritable flood of tablets were launched at the 2012 CES, but history tells us that where the big names tread, the smaller names are sure to follow. Amazon and Google, as well as Apple, have shown that there's a market for smaller, more manageable tablet form factors, and second- and third-tier providers are likely to try and bleed cost further out of the equation. You'll still see a number of Android tablets, mostly from by manufacturers you've never heard of.

Plus, I think we'll see more purpose-built tablets and peripherals. Last year, Razer showed off Project Fiona, a gaming tablet that ended up being vaporware. But I still believe that some manufacturer will throw out a Nexus 7-sized tablet with a Microsoft-style touch keyboard cover attached to it, and see if anyone will bite. Also look for tablet makers to try and shoehorn their products into some sort of software/hardware ecosystem.

By the way, Taylor's right: most major smartphone announcements are being delayed until Barcelona's Mobile World Congress in February.

3. TVs That People Will Actually Buy

People aren't buying 3D televisions. And while manufacturers will likely show off 4K, UltraHD TV technology, Taylor correctly points out that high prices and a lack of content make UltraHD pointless for most people right now. UltraHD doesn't make sense until cameras, cable and TVs all support it. (Still, while I may not buy the mammoth 110-inch UHDTV Westinghouse will show off at CES, that doesn't mean I don't want it.)

What people will buy, however, are connected televisions - and ways to connect their TVs - especially if they're cheap. Westinghouse just announced a television that supports its Streaming Stick, a $100 plastic stick that plugs into compliant televisions. There's still too much confusion here, which is why peripheral manufacturers like Roku and the small Google TV ecosystem just won't go away.

4. Connected Content

This is a catch-all category, encompassing everything from connected cars to second-screen apps that fling content to TVs and other devices, as well as peripherals that stream audio from Pandora and other services. This may sound like old news, but connected services creeping into more and more mundane devices is actually a game changer.

I'm hoping for more on the automotive front, but everything I've heard points to more autonomous automotive safety features, rather than suites of connected services. Blame the carriers' data caps for this: Streaming high-bandwidth media into your car might quickly blow through your data plan. Sending maps and other low-bandwidth data services makes more sense .

5. Digital Health/Fitness

They will never equal the splash of a new big-screen TV or smartphone, but digital fitness products should have an, er, healthy presence at CES. Consumers want things to both track their progress and distract them while exercising, and technology manufacturers are stepping up.

6. Crap

Seriously, I've seen enough smartphone cases to last a lifetime. USB keys, external hard drives, notebook sleeves, USB lights, fans, stickers and the like dominate huge swaths of CES's show floor. Sure there's a market for some of this stuff, but there's a fine line between junk and innovation. 

You know what I'm really hoping to see? Personal drones. Yes, the ones that we'd otherwise use to spy on enemy soldiers. I'd like to see a whole corner of the show floor devoted to those things, as a tool for tracking game, scouting inaccessible locations, and otherwise just having fun.

Would it be controversial? Absolutely. And that's just what CES needs. Otherwise, I'm afraid this year's show may end up being the dullest one in years.

For more, check out CES 2013: 5 Things You Won't See.

Image source: Flickr/PrimeImageMedia.com.

The Consumer Electronics Show (CES) starts January 8, and as usual it, there will likely be all sorts of news about some truly unbelievable products: UltraHD televisions? Come on. 3D printers? Yeah, right. Like that will ever happen. 

But in 2013, you can forget all that. The most amazing news at this year's CES will come from a company called Extraterrestrial Technology (no, really, that's its name): Say hello to the QuantumVet TriCorder Plus, which promises to diagnose and heal your pet through the power of a “quantum computer” unlocked by your smartphone. Apparently, the device claims to downloads a cure to your pet's brain.

No, really, that's what it claims to do. 

The company has purchased booth space at CES to show off its wares. But ReadWrite has been unable to reach company executives for comment. According to Google, ET's address maps to a Post Office branch in Honolulu: Calls to the company were picked up and presumably relayed by an answering service. Unfortunately, we haven’t heard back.

How Extraterrestrial Technology's Tech "Works"

As described on its website, though, the company’s “technology" is a gold mine of pseudoscience. As best we can determine, Extraterrestrial Technology is a business that was formed by the Zurich Alpine Group (ZAG), a private humanitarian medical research group that has been working “cooperatively and quietly” around the world to develop a “radical new quantum information technology.” This technology, according to the company, has been developed to counteract the “toxicity” in which chemical-based medicines interact with the human body.

But here’s the real innovation:

“ZAG understands that quantum problems require a quantum solution and has found a way to transfer bioinformation from its quantum computer via quantum teleportation to the brain, also a quantum computer, to reprogram the brain to effect positive medical changes within the body and mind," the company says. "These technological advancements have thus given birth to the world's first downloadable medicines.”

So basically what happens is that the company’s technology connects your brain (or in this case, your pet’s brain) to a remote quantum computer owned by the company, which downloads the requisite medicine directly, reprogramming the target brain to heal itself - without any side effects.

Mind = Blown

One possible concern that leaps to mind is how patients can be assured that the information being downloaded is legitimate, and not the product of a malicious hacker armed with his own quantum computer. You can’t be too careful. ET itself warns that users should “beware of impostors.” (Good advice, we think.)

Fortunately, there is a solution. Extraterrestrial Technologies has developed a Portal Access Key, or PAK, that securely facilitates the transaction. This PAK is essentially a “dose” of the downloadable "drug."

Normally, ET would download this information directly to your brain, allegedly curing all sorts of diseases. After all, the site mentions there are about 170 different possible cures in all, including a common cold vaccine, quantum weight-management control, as well as the unfortunately named “Heaven’s Gate” aphrodisiac. 

For your pet, however, you’ll need a special solution: your smartphone, tablet or PC. With the QuantumVet TriCorder Plus, ET promises that you can download PAKs to your portable device (prices start at $30 for six PAK doses).

ET even offers step-by-step instructions: 

1. Open a portal with the purchase of one or more QuantumVET Portal Access Keys (PAK) via your cell phone (also PC, laptop or tablet) from the company’s QuantumMANsite.com.
2. Data then teleports from a remote quantum computer to your pet’s brain, also a quantum computer.
3. QuantumVET then accesses your pet’s neural network to run a diagnostic of what is causing your pet’s symptoms.
4. QuantumVET then accesses the necessary master programs to restore your pet’s health.
5. QuantumVET repeatedly uploads these master programs to your pet over a 5 day period.

The best part is that you can’t overdose, meaning that you can download as many PAKs as you want!

Cats require 12 doses every 30 days of treatment (or every five days); dogs require 18 doses.

And here's an important warning: "When dosing you must be directly touching the animal prior to, and during, clicking the 'unlock and launch portal' button and remain in contact with the animal until you are informed the upload dosing is 'completed.' " God only knows what happens if the download is interrupted mid-stream.

We’re reasonably sure that no government or other medical agency has given the thumbs-up to the claims of this new-age technology. In fact, we're pretty confident  that ET's claims have not been verified by any reputable third party.  

But one thing is definitely true: If you’re looking for the weirdest product to be displayed at CES next week, the QuantumVET Tricorder has got to be at the top of your list. 

Humans are wont to misbehave when no one is watching. Hence the psychology of the New Year's resolution: Kick off the New Year with a public declaration of the stuff you want to fix about yourself. The problem is that during those long, listless winter months, it's easy for your attention, and your resolve, to drift away from your self-improvement goals.

Sound familiar?

Whether you're looking to get happy, get in shape or get just about anything else, though, it turns out that smartphone apps can help keep you on track, mostly by tracking your behavior and reminding you - and sometimes your friends - how you're doing. 

These 11 excellent apps can help turn sadly failed resolutions into proudly achieved goals:

Write It All Down

Day One (iOS or Mac), Diaro (Android)

Being accountable to Facebook friends is great, but making any kind of life change is best paired with a bit of introspection. Journal-keeping apps can be a great way to check in with yourself, no matter what your goals are. Keeping a basic daily record of even simple stuff (have a headache Monday? Feel energized after your Tuesday workout?) can be a powerful glimpse into health and mood patterns that have a big say in breaking bad habits and building new ones. 

Get Fit With Friends

Fitocracy (iOS), RunKeeper (iOS or Android), MyFitnessPal (iOS or Android), Endomondo (iOS or Android) 

These hybrid social/fitness apps do it all - and they don't even yell at you for more reps. There are a ton of social fitness apps in the various app stores, so it's best to experiment and see which ones emphasizes the aspect of that whole health thing that resonates with you. These four a great place to start your search: Designed around data and sharing, they all have the social boost you might be lacking built right in. 

Start Saving Money Right Now

Mint (iOS or Android)

The hardest part of saving money can be that first peek at your bank account - and Mint is the perfect solution. Elegantly designed, Mint keeps a rich record of your expenditures and breaks it all down into categories that help you figure out your spending habits. If you love data, you'll be strangely thrilled to pore over your weekly bank statements. Personal finance has never looked so good. 

Tackle Any Challenge

Unstuck (iPad)

Can't even bring yourself to get started on your resolutions? Unstuck is all about the first step. The app (for iPad only) asks you a series of questions and sculpts your path to action. It's surprisingly effective at dissolving the barriers between planning and action, with a fresh user interface that can even make paying off a bill feel like fun. 

Getting Healthy, Gamified

SuperBetter (iOS and Web)

SuperBetter, designed by gaming advocate Jane McGonigal, is an experiment in gamifying health. McGonigal applies her deep understanding of the psychology of games to a wide array of health goals. The app (for iOS only, unfortunately) is a companion to the SuperBetter website, where most of the action happens. SuperBetter's holistic approach puts equal emphasis on happiness and de-stressing, and its playful, video game-like achievement system really works. 

Quit Smoking For Real This Time

Livestrong: My Quit Coach for iOS, Quit Smoking: Cessation Nation for Android

Quitting smoking tops a lot of resolution lists for a reason: namely, it's really, really hard. You can use one of the general-purpose apps on this list to help you cut out the cancer sticks, but this duo of apps is designed to target smoker-specific challenges and milestones. With features like social support, time tracking and a savings calculator, these apps tackle the nasty habit from all angles.

Tracking your behavior and tapping into a networks of folks all working on working on themselves is a surefire way to make those resolutions last at least a little bit longer into 2013. Worst case scenario, you'll still have tucked away some cool aggregated data about yourself.

Best case? Maybe you'll pay off the interest on that interest.

Lead image courtesy of Shutterstock.

When “Queen of the Net” Mary Meeker landed at Kleiner Perkins she added a new initiative: Help people understand how certain trends were negatively impacting America. Her first report, USA Inc. contained a 468-slide presentation detailing these shifts. Meeker provided an update on October 24 in San Francisco, and it was yet another eye-opener.

In true Meeker style, USA Inc. is a meticulously crafted, chart-heavy presentation. This one, though, paints a bleak picture. Most startling: America’s entitlement costs accounted for 56% of spending in fiscal 2011, 40 years ago it was just 25%. Here is more food for thought:

• Expenses have exceeded revenue in all but five of the past 47 years.
• 1 in 50 Americans needed Medicaid when it was created in 1965. Today, 1 in 6 do.
• Unfunded and underfunded entitlement liabilities now total $66 trillion.

Meeker joined Kleiner Perkins Caufield & Byers in January 2011 and was put in charge of a new $1 billion Digital Growth Fund. On Feb. 25, she issued her first epic report, called USA Inc.: A Basic Summary of America’s Financial Statements

USA Inc. offers four recommendations to help spread its message:

1. Create a deep, widely held perception of the problem’s reality and stakes involved
2. Reassure citizens that there are practical solutions
3. Develop support among key constituencies
4. Determine the right time to deliver solutions.

Meeker is clearly addressing No. 1 by shining a bright light on the topic whenever she can, but what about the other recommendations?

Kleiner Perkins' Investment Strategies

KPCB’s fund specialties include typical investment sectors: digital, green tech, life sciences and China. There was a Digital Growth Fund and a Green Growth Fund, but no “USA Growth Fund.”

Among recently funded companies, KPCB’s digital list numbers 71 companies, excluding Chinese firms. There were also 33 companies in the green-tech portfolio and 18 in life sciences, both included below:

Cleantech is clearly a pro-future investment strategy. But when I examined company descriptions and compared them against Meeker’s recommendations, I found just one that indirectly addressed USA Inc.’s future needs: CodeAcademy, an education innovator.

What Kleiner Perkins and Others Could Be Doing

USA Inc. recommends that the reality of America’s fiscal crisis be communicated to the public. There are a number of ways to address this objective, but a good tactic would be to start with the basics: clarity of data.

While government agencies produce reams of raw information, access to it is not particularly easy. Many economists and analysts use a data front-end provided by the Federal Reserve Bank of St. Louis, called “FRED,” which features a wealth of information: 61,000 economic time series from 48 sources. But using FRED requires learning complicated database queries.

Kleiner Perkins should identify entities that progress the human-machine interface to databases like FRED. A straightforward method would be to use a drop-down-menu interface, à la KISSmetrics Power Report (PDF).

Another approach would be to provide a seamless connection to an intelligence platform like Tableau. The best interface would add a natural-language query layer like Siri.

To reassure citizens that practical solutions exist would require new-age infomediaries that specialize in connecting problems to solutions. Perhaps Biz Stone and Ev Williams could be persuaded to dedicate a Medium content collection to USA Inc. in exchange for a strategic investment. Their crowdsourcing concept would help redistribute this massive content effort.

Toward A "Healthy" Economy

Another clear challenge arising from Meeker’s presentation is the soaring cost of entitlement spending, most of it due to escalating health-care costs. KPCB has invested in two life-sciences companies that could be of help.

Essence Healthcare focuses on Medicare solutions and RedBrick Health aims to reduce avoidable health-care costs. More is needed, such as enterprise software that improves hospital management, given that most hospitals are poorly managed.

Another practical problem solver would be a service that forces competition by finally bringing transparency to health care and its opaque pricing schemes, as Harvard professor Regina Herzlinger proposes with an Securities and Exchange Commission-like oversight entity. Is there a way to reverse-engineer that idea?

With her thorough insights, Mary Meeker has done an outstanding job of circling the wagons around the digital and financial communities to signal that more needs to be done in order to preserve our pro-growth climate. I encourage everyone to give her a standing ovation and join in.

How would you advise Mary Meeker to spend the half-billion dollars still left in her Digital Growth Fund? Sound off in the comments.

Lead image courtesy of Shutterstock.

The Mobile Revolution continues to change how industry after industry goes about day-to-day business. Yet one industry has been surprisingly slow to embrace the benefits of mobile: healthcare. Many observers find that strange, since healthcare could clearly benefit from the power of smartphones and tablets attached to the cloud. 

Several things have slowed adoption of mobile in healthcare. Antiquated policies designed for a different era have been a major factor. For instance, what does it mean to be HIPAA compliant in a mobile world? HIPAA regulations rule how healthcare practitioners can store and transfer data on patients to protect both the privacy of the patient and the liability to doctors and nurses. HIPAA regulations are fairly complex and rigid (for a good reason, to be sure) and have scared off some mobile healthcare (mHealth) startups - at least until HIPAA can be updated to reflect the change in the technological landscape.

There's also the question of culture. For decades, the primary patient interface for doctors, technicians and nurses has been the paper chart attached to a clipboard. Digitizing of patient records is a long, arduous process that many clinics have declined to undertake. Doctors face significant blowback from administrators sitting in front of bookshelves crammed full manila folders of patient histories. 

(On a trip to my physician’s office a couple years back, I asked him if he used a smartphone to make his life easier. He showed me his BlackBerry and an app that helps him find the appropriate prescription for certain maladies. I asked him if he could digitize his entire file system and carry around an iPad or some such device to make his life easier. “I would love to,” he told me. “But I would lose half my staff if I ever changed how the system works.” )

We are starting to see progress in mHealth adoption: According to researchers, 62% of doctors use a tablet in some shape or form and 71% of nurses use a smartphone at work. The mHealth industry is forecast to be a $11.8 billion market by 2018.

Mobile healthcare is about more than just how doctors and nurses operate on a day-to-day basis. Mobile technology promises to contribute to wellness, preventative care, personal health records, communication with physicians, diet tracking, prescription reminders and many other health-related improvements. For instance, 30% of smartphone users are expected to use wellness apps in one form or another by 2015. By that year, analysts predict there will be nearly two billion smartphone users on the planet. You do the math.

Check out this infographic from mHeath consultancy  [x]Cube Labs for a cross section of the mHealth industry, where it has been and how it can help healthcare providers and consumers alike.

The Qualcomm Tricorder X Prize promises to turn everybody into a Doctor McCoy by 2016. It could change everything about the way we practice medicine. But are we ready for it?

If you're a redshirt thinking you might have a case of Rigelian Fever, where do you go for advice? Whether you're planet-side or in the sick bay, odds are you're going to start with a tricorder. In the Star Trek universe, the tricorder was a non-invasive, handheld device that scanned geological, meteorological, and biological data. When used by medical personnel, the tricorder could diagnose all but the rarest diseases.

The tricorder inspired X Prize Foundation Chairman Peter Diamandis, who wondered whether – with enough incentive – engineers could build a medical diagnostic tool that could monitor health and identify illness on the spot, without a doctor's assistance. Add in $10 million in total prize money from Qualcomm and you have the Qualcomm Tricorder X Prize, launched in January, 2012.

In an interview earlier this year, Diamandis described the ideal healthcare tricorder:

"A device that is easy and friendly to use that a consumer–whether that's a mom at home at 2:00 in the morning or someone on the road–can use to diagnose themselves without having to go to a doctor or a hospital. It's really about reinventing the future of healthcare."

It's a tall order, but X Prize isn't shying away. A successful tricorder will:

• Diagnose diseases
• Provide ongoing metrics of health (vitals)
• Allow monitoring or continuous use of sensors to diagnose and measure health
• Provide awareness of health state
• Give confirmation that everything is OK with a consumer
• Notify that something is not OK (a "check engine light")

Specifically, the tricorder will be able to identify the following 11 conditions:

1. Anemia
2. Urinary tract infection
3. Diabetes
4. Atrial fibrillation
5. Strep throat
6. Sleep apnea
7. Melanoma screen
8. Chronic obstructive pulmonary disease (COPD)
9. Abnormalities in a comprehensive metabolic panel
10. Hypothyroidism/hyperthyroidism
11. Leukocytosis

Any winning device will have to be able to diagnose these conditions routinely and accurately.

Sounds great, right? So is there a catch?

Maybe.

Some people in the medical industry are a bit concerned. The tricorder's goal is the "deskilling" of routine medical checks. Ultimately, for simpler ailments, it aims to remove doctors from the treatment equation altogether, down the line. Diamandis gets major points for going big in an industry as conservative as healthcare, but are we legally and physically prepared for the consequences?

There are plenty of things that could go wrong. What if a device misses a melanoma a visual inspection might have caught? Who's legally responsible for malfunctions? Will a false sense of security cause users to skip routine physical checkups?

The Thermometer Test

To get some perspective, I ran the tricorder idea past a friend of mine who's also an epidemiologist. He shared my enthusiasm, praising "any technology that gets people more involved managing their own health," but immediately applied some cautionary brakes. "It's a fantastic idea, and a big step when everyone is thinking incrementally. But it also kind of worries me."

The reason? It might not pass "the thermometer test."

To a doctor, the home thermometer is the single best piece of home medical equipment ever created. "It's a perfect triage device," my friend explained. "It provides accurate, objective information that medical personnel can use to make judgements. It's a pretty good barometer to judge the severity of many common ailments, but it also doesn't try to diagnose anything."

In other words, a thermometer tells you if you're running a fever, but it doesn't try to tell you why. It provides critical data to healthcare personnel, but leaves the decision-making in their hands.

That can make a world of difference, particularly in situations requiring counseling or judgement of the patient's mental state. "I'd hate to see physicians removed from the discussion. It's not a matter of job security. It's a matter of full-circle patient care." He went on to surmise that absent a doctor at the point of diagnosis, users might be more likely to pursue treatment options online, or a diagnosis might unhinge a mentally fragile patient who could do harm to himself or others.

Concerns notwithstanding, self-diagnostic technology is coming, in condition-specific devices like a bra that detects breast cancer and general-purpose machines like the tricorder.

The first-gen Scanadu Scout, which falls nicely within the thermometer test zone, should be hitting the market in late 2013.

Like all data, medical information is useful only if its used properly. Here's hoping that patients accept some responsibility along with their flashy new devices.

Lead image from Memory Alpha.

At the end of the Health 2.0 Conference earlier this month, I sat down with the event’s co-founders Matthew Holt and Indu Subaiya to discuss the big trends. I’d been impressed and excited by the innovation demonstrated at Health 2.0. It turns out much of it was driven by Big Data.

Healthcare is a huge, important industry and it’s being transformed by technology all across the board: from the personal health apps that many of us use on our smartphones, to the electronic health records in doctor practices and hospitals, to the emerging revolution of digitized genomic data.

What all of those things have in common is digital data, much of it on the Internet. Indeed there’s so much digital health data now that the term “Big Data” is commonly used to describe it. Another trend is that healthcare is moving beyond the doctor’s office and into the daily lives of consumers, via smartphone apps and new platforms that host health data.

Surprises

I began by asking Matthew and Indu what, if anything, surprised them over the few days of the conference.

Matthew noted the evolution of natural language processing tools, which combined with Big Data are leading to surprising innovations. An example is a startup called Treato, an impressive search engine for health data that I got an inside look at during the event. Treato effectively scans millions of pieces of unstructured health data on the Web and orders it - for example creating user reviews of medication.

Matthew also noted the rise of “small data making vital connections.” He pointed to one of two winners of the DCtoVC Startup Showcase, Beyond Lucid Technologies. This company offers an electronic health record (EHR) for emergency response agencies (such as ambulances). It’s an example of a health solution that delivers the right piece of information at the right time and place, enabling better on-the-spot decision making. This service potentially saves lives.

Indu commented that big data is also enabling a “new level of personalization and targeting.” She pointed to the winner of Health 2.0 Developers’ World Cup, New York City-based MedTurner. The service uses natural language processing to monitor tweets for health-related information. It then analyzes those tweets and “offers relevant advice and resources.” Use cases include monitoring for signs of depression or suicide, tracking CDC travelers’ health, rare disease clinical trial matching and Medline Plus drug safety and side effects alerting.

Personalized Medicine

One of the most exciting areas of health technology currently is what’s been termed ‘personalized medicine.’ MedTurner is one example, but the most interest is in consumer genomics companies like 23AndMe. The hope is that genomic data will lead to hyper-personalization of disease prevention and treatment.

As Indu remarked, the current era of personalized medicine is “the oppositie of patient social network PatientsLikeMe. There’s no one like me.”

Once again, Big Data is a key ingredient. Indu explained that “in order to have hyper-personalization, you need to tap the crowd and look for the pattern. It’s a kind of closed loop.”

If there is one major concern though, it’s that doctors aren’t adequately trained to use genomic data. Indu called this a “massive gap” in healthcare. However she mentioned there are a couple of apps that help physicians navigate genomics.

The Danger Of Information Overload

One of the challenges of Big Data is that it may lead to information overload for doctors. Particularly when genomics takes off (it’s still early in that era). I asked Indu and Matthew how doctors will cope.

Indu agreed that it’s “a massive problem [and] there is a firehose coming.” But she sees a lot of potential in dashboard tools that help doctors interpret and manage the data inflow. An example for the consumer audience is TicTrac, the winner of the startup Launch! segment during the Health 2.0 conference. TicTrac, currently in private beta, lets you track a variety of health data in one place.

What’s needed is a kind of advanced TicTrac for doctors. “The hope is in some of the organizational tools that are not going to make single dumps of data, but are going to send a pattern,” said Indu. “Or they’re going to allow somebody very quickly to look at millions of data points and visualize [that] this patient needs an intervention.”

Dashboard tools that do this kind of pattern visualization will become “the doctor’s best friend,” according to Indu.

Matthew agreed, adding that post-operative apps that enable healthcare organizations to monitor a patient’s condition after they leave the hospital will also help.

Technology Down The Stack

Which leads us to another trend in health technology: spreading the workload around. Indu noted that “putting technology all the way down the stack,” so that patients or nurses can actively monitor health data, allows doctors to "just deal with things that need [their] expertise.”

In particular, “the prevention part [of healthcare] is moving more to self-management tools” for consumers.

Matthew remarked that this will allow doctors to see fewer patients for longer time periods, because they will be focusing on the patients that need them the most. So for example, instead of a doctor seeing a lot of patients for 7 minutes each (which is the norm these days) they will be able to spend 45 minutes on 7–8 patients per day.

In summary, the Health 2.0 Conference showcased a lot of innovative health technology that will soon be not only in your physician’s hands - but yours too. Big Data is driving much of this innovation. The more health data we have and the better it is analyzed and structured using technology, the more effective our healthcare system will be.

Image courtesy of Shutterstock.

Today at the DC to VC: Health IT Startup Showcase, a collaboration between Morgenthaler Ventures and the Health 2.0 Conference, I saw firsthand how health IT startups are tackling big, real-world problems. Coming from a world where a photo-sharing mobile app gets bought for $1 Billion, it's refreshing to see startups trying to solve important issues in the world. For even more context on the digital health market, I spoke to a relative veteran in this space and a keynote speaker at DC to VC today, Jeff Tangney from physician network Doximity. It turns out that fax machines are problem number one!

Jeff Tangney is a 40-year old entrepreneur whose first company, Epocrates, did an IPO in 2011. The windfall from that made Tangney a wealthy man. But rather than go into retirement, he dived back into the digital health market with a new startup called Doximity. It's a "professional network for physicians," allowing them to collaborate and share information.

During his DC to VC keynote, Tangney announced that Doximity has reached 100,000 physicians on its network, which is 16% of all U.S. physicians. 15% of Doximity's physicians use the product at least weekly.

One quote from Tangney during his speech on stage really brought home how difficult the digital health space is. He said that "fax machines are the lingua franca of healthcare." According to Tangney, 15 billion pages of faxes are sent in the U.S. every year.

Indeed, when I asked Tangney after his keynote what are the main features of Doximity, he replied that eFaxing is one of the top ones. Even with a modern electronic tool like Doximity, faxing is ingrained in the workflow of physicians. Or as Tangney put it to me, "it's still an industry that runs by and large by the fax machine" - as well as doctors talking to each other on the phone. So moving physicians to digital communication and record-keeping is hard.

But who can blame doctors, because they're forced to be very vigilant about patient privacy and legal compliance risks every day. I asked Tangney about how these factors influence the adoption of Electronic Health Records (EHRs) by hospitals and physician practises, which has been generally slow. I described my own experience as a patient with diabetes type 1 - I said it's frustrating that I cannot share my daily blood sugar readings electronically with my doctor.

Tangney's reply highlighted the real-world issues that he and other digital health entrepreneurs face. While I can send my blood sugar readings to my doctor, as a CSV file by email for example, my doctor could potentially be sued if he sends it onto a specialist for an opinion. Those risks are a disincentive to adopt new digital technologies.

To tackle those kinds of barriers, Tangney thinks that the health IT market will "start to break off and create its own Internet" - because it needs security and authentication. There will be a highly secure Internet network for physicians to swap data, such as my blood sugar readings. The consumer Internet will intersect with health networks, but essentially the infrastructure and legal requirements for health data will require a much more secure environment.

So there are difficult challenges for health 2.0 entrepreneurs. But I got the sense that Tangney would be happy enough right now just to transition doctors from fax machines to the iPad!

I'm at the Health 2.0 Conference in San Francisco - and it reminds me a lot of the Web 2.0 Conferences of 2006-07. The second coming of the Web, coined "Web 2.0" by Tim O'Reilly and his company, was entering its peak around 2006. If I ever doubted that Web 2.0 was big business, I certainly didn't after I spotted IBM teaching it at the 2007 Web 2.0 Expo. What's more, the IBMers weren't sporting their traditional blue shirts. Instead they wore red polo shirts - talk about a paradigm shift!

Health 2.0 feels like it's at the same stage in 2012. The big companies are present at this event, all of them selling "platforms" for digital health. In a single panel today, four BigCos presented their versions of such a platform: AT&T, Microsoft, Qualcomm and Aetna. I sat down with AT&T's Chief Medical Officer after the panel, to see what it has to offer.

The panel I'm referring to was cheekily entitled 'Platforms for Unplatforms' and it was moderated by Matthew Holt, who co-founded the Health 2.0 conference with Indu Subaiya in 2007. The panel description made it clear that these BigCo platforms are a new phenomenon:

"For years at Health 2.0 we've been describing the mix of applications and devices working together as "unplatforms". In the past few months several major health care technology organizations have announced the launch of platforms and are trying to attract developers and health care technology companies to use them."

The panel itself was an interesting look at the platforms for each company, but to better understand why the BigCos are now entering this space I sat down with AT&T’s Chief Medical Information Officer, Dr. Geeta Nayyar, to talk about its new AT&T mHealth Platform.

As the name suggests, the AT&T mHealth Platform is mobile-focused. It aims to "provide a single environment where consumers can securely aggregate their data from across silos — insurance companies, doctor's offices, connected devices, applications — and other data sources for better and easier access." AT&T is partnering with startup health products like Fitbit, myZeo and the Withings WiFi Body Scale. It also plans to create an open platform, meaning that third party developers must make their data available for sharing across applications.

Currently the AT&T mHealth Platform is targeted to enterprises, as an offering for employees. 

An early AT&T health product, although not on the mHealth platform, is DiabetesManager. It was developed in partnership with diabetes software company WellDoc. AT&T tested this out on its own employees, in a pilot program for people with Type 2 diabetes. Dr. Nayyar reported back, in a blog post, that "72 percent rated DiabetesManager as a “highly useful” as a tool to help them manage their diabetes."

OK, the pilot was somewhat biased - an AT&T product tested on AT&T employees. But after meeting Dr. Nayyar today, I was impressed by her passion for health technology. As well as being AT&T's Chief Medical Information Officer, Dr. Nayyar is an iPad-toting Assistant Clinical Professor of Medicine for the Department of Rheumatology at George Washington University. She definitely walks the talk.

Dr. Nayyar explained that health data is distributed across many "data islands" currently, which is another theme I'm hearing regularly at the Health 2.0 Conference. The reason why AT&T built a platform - indeed the reason why each of the BigCos in the panel I mentioned built a platform - is to aggregate those data islands for users.

It's a noble goal and one we all want to see achieved, no matter which company - big or small - does it. The scale of technology and expertise of companies like AT&T, Qualcomm, Microsoft and Aetna gives them an advantage. That's why they're all building platforms. I do wonder though if AT&T's approach is too focused on its actual customers: enterprises. I have some doubts about the others too - for example, would you trust all of your health data to an insurance company (Aetna)? I wouldn't.

One thing is for sure: the digital health platform is a huge opportunity and the market is up for grabs right now. We don't know which of these, or other, BigCos will end up being the main players. But I for one welcome their entrance to the digital health market.

For Health 2.0 in 2012, just as it was for Web 2.0 in 2006/07, it's business time.

Top image: IBM at Web 2.0 Expo 2007; photo by Scott Beale / Laughing Squid

With the increasing digitization of healthcare, the trend of "Big Data" has been gathering steam. According to a new report from digital health consultancy DrBonnie360, there is an estimated 50 petabytes of data in the healthcare realm. That's predicted to grow, by a factor of 50, to 25,000 petabytes by 2020. The report, which I've summarized in this post, does an outstanding job of profiling the leading products utilizing Big Data in healthcare.

DrBonnie360 principal Dr. Bonnie Feldman, a former dentist, health consultant and sell-side equity analyst, identified six ways Big Data is being applied in healthcare:

• Support Research - Genomics and Beyond
• Transform Data to Information
• Support Self-Care
• Support Providers - Improve Patient Care
• Increase Awareness
• Pool Data to Build a Better Ecosystem

The report neatly outlines an "evolving ecosystem" of healthcare companies that are implementing these types of Big Data solutions.

An example of the first type ("Support Research - Genomics and Beyond") is GNS Healthcare, which I profiled on ReadWriteWeb earlier this year. GNS Healthcare builds cause-and-effect models, using large genetic data sets, to determine what drives diseases and cures.

Towards Personalized Medicine

Personalized medicine has been a catchphrase of digital health, for good reason: it puts the patient at the center of healthcare.

“Genetic information by itself is useless, unless we can put it into context for the patient," said Sultan Meghi, Vice President of Product Strategy at analytics company Appistry. Indeed, if you replace the word "genetic" with "health," you have a good summary of what all of these Big Data focused digital health companies offer.

One of the most exiting aspects of Big Data in healthcare is the potential to predict - and hopefully then prevent - disease. A company called Predixion Software offers "cloud-based predictive analytic software to hospitals [...] to reduce readmissions and prevent hospital-acquired conditions." It might also be used in the near future "as a tool for prevention of chronic disease – e.g., diabetes."

This wouldn't be a digital health story without mobile devices being mentioned. The fifth type of Big Data healthcare company is focused on "Increasing Awareness." A mobile app called Asthmapolis is an example of this type. A mobile sensor device is attached to an asthma inhaler, which then monitors where and when asthma attacks happen. The device wirelessly syncs with an iOS/Android app, allowing users to track their triggers and symptoms.

This short video from Asthmapolis shows how it works; and also succinctly demonstrates the value of Big Data in healthcare.

What About Privacy?

The report does a great job of showcasing current and future Big Data services in healthcare, but it also doesn't shy away from the elephant in the room: privacy. DrBonnie360 interviewed more than 30 companies for this report and all of them were concerned with privacy. The report states that each company declared "at the very least, adherence to HIPAA requirements, and many claim more."

The report identifies one company, behavioral analytics platform Ginger.io, as having "a particularly progressive view of data privacy, which includes the philosophy that patients own their own data, they can opt-in, choose when and how to share their data and can discontinue data sharing at any time."

Reading this excellent white paper reinforces that Big Data will be a big driver in digital health innovation. The full presentation is embedded below.

The adoption of Electronic Medical Records (EMR) by doctor practices and hospitals is one of the most exciting developments in health - and the iPad is playing a big part. Up till recently, the typical EMR system was a PC-based enterprise software suite deployed in a large, public hospital. But thanks mainly to the iPad, EMRs are finding their way into tens of thousands of small to medium medical practices. Today, EMR vendor drchrono is releasing a report about EMR adoption and impact. In a phone interview, I discussed the findings with drchrono CEO Michael Nusimow and COO Daniel Kivatonos.

The 2012 EMR Impact Report from drchrono surveys the usage and impact of EMRs in practices of 25 physicians or less. Drchrono surveyed 1,300 U.S. physicians who currently use EMRs, over a 30 day period. 77% of the practices surveyed were independent practices and over half (52.2%) had just one medical practitioner. Only 10.9% were practices with more than ten practitioners.

It should be noted that EMRs still have a fair way to go until they are commonly used by physicians. According to the National Center for Health Statistics, in 2011 55% of physicians had adopted an electronic health record (EHR) system. That indicates that drchrono's report is a study of relatively early adoptors. Indeed, the report notes that the majority of respondents (60.1%) had only used an EMR for less than one year.

But already, nearly 3/4 (74.5%) say that an EMR has increased the efficiency of their practice. The key efficiency metric, according to drchrono CEO Michael Nusimow and COO Daniel Kivatonos, is time savings.

Doctors are usually busy and harried individuals, as I witness firsthand whenever I go to see my own doctor. So an EMR system that saves a physician time every day is a top priority, Nusimow and Kivatonos told me. The report states that the average time saved using an EMR is 61.7 minutes per day.

Other benefits to physicians include reduced patient paperwork and reduced time spent charting.

What About The Patient?

I asked Nusimow and Kivatonos whether the patients themselves are seeing much benefit of EMRs at this time. The report indicates no, stating that patients are not yet "fully utilizing enhanced forms of patient communications enabled by EMRs." For example, only 10.9% of physicians reported that patients access test results online via their EMR platform. As a patient myself, with diabetes type 1, this is precisely the kind of data I want to access electronically.

Drchrono's focus at this time is very much on getting small to medium physician practices to adopt its iPad-based EMR for their own internal records keeping. Because this type of EMR is so new, Nusimow and Kivatonos told me, doctors might not be able to cope with patients pushing a lot of data to them.

However, they view usage from tech savvy patients as an important part of EMR adoption. In order to fully realise the potential of EMRs, patients must become more engaged with their own health data. So the aim of drchrono, said Nusimow and Kivatonos, is to build a great patient-doctor relationship.

Why drchrono Is Bullish On The iPad

In a study by Manhattan Research released in May 2012, 62% of physicians stated that they used a tablet for professional purposes. The iPad was "the dominant platform" in that figure. 62% of physicians using a tablet professionally is an impressive figure and it shows why the tablet - and in particular the market-leading iPad - is key to continued EMR adoption.

Drchrono is a vendor of iPad and iPhone EMR applications. It currently has around 30,000 registered providers and 1 million patients on its service. [note: in my July post about drchrono, I quoted a January 2012 article from the New York Times stating that 50,000 doctors used drchrono. In today's interview, I was told that the figure the NY Times used was incorrect and should've read 15,000.] Drchrono is one of a number of startups offering EMR software. Others include Practice Fusion, HealthFusion, CareCloud, Athenahealth, GloStream and ElationEMR.

It's clear to me that the tablet is going to be the defining platform for EMRs going forward. It's the perfect device for an EMR, since the physician can carry it around everywhere they go and the patient can monitor their own health data from home. I'm looking forward to the day when I can sit down with my doctor, iPad in hand, and discuss the EMR data that is so important to my health.

Earlier this month, I finally purchased a DNA test at 23andMe, the personal genetics company based in Silicon Valley. When the test kit arrived, I duly spat into the plastic tube and posted it back. It isn't cheap, US$299 plus postage, but the results promise to tell me about my ancestry, inherited traits, and any possible congenital risks. All of this is part of the service 23andMe provides, but the recent announcement of an API could lead to even more enlightenment and uses for your genetic data.

23andMe's API (application programming interface) allows authorized third-party developers to build applications that make use of your genetic data - if you give permission! The latter point will be a big concern for many people, because according to API specialist blog ProgrammableWeb, the 23andMe API gives access to personally identifiable data such as profile information. As a new 23andMe user myself, I'm going to want some reassurance from 23andMe before I give my permission. Giving third parties access to that kind of data could have big implications down the road, for example being refused access to medical insurance or losing out on a job.

But let's assume for a moment that the privacy protection gets tighter, or 23andMe is able to convince me and others that their genetic data is safe. What kind of things can we expect from the API?

At the Quantified Self Conference in Palo Alto earlier this month, 23andMe director of engineering Mike Polcari announced the API. Polcari told genetics news website BioInform that conference participants expressed "a lot of enthusiasm" about the API. He mentioned some examples of apps that might be developed:

[...] apps that would incorporate an individual’s DNA into his or her family tree; apps for running candidate gene studies using data from CureTogether — a community-based health site that 23andMe acquired this summer; and a sleep tracking app that would import SNPs associated with caffeine metabolism and circadian rhythms.

The API may also enable researchers "to perform linkage studies or genome-wide association studies using 23andMe data," Polcari told BioInform.

These potential genetic applications won't assuage the main concern people have with 23andMe and its DNA tests: do you really want to know about your genetic risks, given that it could cause more worry than good? A discussion on Q&A web service Quora has 30 mostly pro replies to that question. Jason Menayan found his results to be "incredibly useful" - for example, he discovered that he is a slow caffeine metabolizer and so "should limit my caffeine intake for my cardiovascular health."

Ultimately, it's your choice whether to do one of these tests. The price is still an obstacle for many, but that will continue to come down (it started out at $1000 when it launched at the end of 2007).

The results could potentially be of great benefit to my health. I'm pretty excited about that alone. And I'm cautiously excited about the future applications by third-party developers, because it will hopefully enable me to do useful things with my genetic data.

Have you had a DNA test done and if so, did you find it useful?

It's right there in fine print: "No human remains or body parts (excluding hair and teeth)."

This month the community sale site Etsy changed its sales policy and banned human skulls, bones, skeletons, organs and bodily fluids. That means, right up until an August 8 policy change, you could have bought and sold all that and more on the site.

Looks like people have to look elsewhere for blood and bones. 

But fret not, fetishists. Hair and teeth are still acceptable trade goods on Etsy. Why, exactly? 

In a recent blog post, Etsy cited a desire to maintain a safe community. Etsy wouldn't comment for this story, but the posts says the change was made to reflect the perspective of Etsy's shoppers and the company itself. Hmm. Does this mean people weren't buying the human skulls anymore, or maybe there was some kind of legal crackdown we're not aware of. In addition to the body part ban, the site also just cracked down on the sale of crack pipes - good job! Maybe the site's management felt like it was time to cleanse body and soul?

Etsy's staff is contacting violators and explaining the rule changes in an effort to shut down human body part traffickers. The site is also asking members to contact Etsy if they find banned items (which also include firearms and smoking products.)

All the same, Etsy isn't going after purveyors of animal parts, such as a preserved doe deer heart on sale for $75. Yup, a deer heart in a jar for less than a hundred bucks. What a steal!