January 11, 2012, CES Digital Health Summit, Las Vegas—A panel looked at the issues of digital health data in an ever changing operation and legal environment. Ray Maker from DC Rainmaker moderated the panel. Panel members included Ian Andes from 4iiiInnovations, Karl-Johan Dahlstrom from Sony-Ericsson, Chris Fickle from A&D Medical, and Mike Stashak from Wahoo Fitness.

The main issue for the panel was data liberation: making health data intelligible to the consumer and mostly addressed personal health fitness data. One aspect is that data generation is becoming much easier to create and the volumes of data are becoming overwhelming. In the relatively recent past, you only had time, distance, and possibly heart rate. Now sensors measure temperature, elevation, level of exertion, and many other parameters.

Ian responded that as data volume increases, it becomes necessary to change the displays and simplify the information. The technology is available to abstract data to very simple indicators like a red-yellow-green light to indicate over-, marginal-, and in-range performance.

How to apply these principles to medical data?

Chris answered that for areas like chronic care; therapy, disease management, etc, simplified indicators may not be optimal. For wellness, however, simplification offers the potential to maintain, motivate, and monitor users.

This only applies to monitors? How to develop feedback and what is the cost for monitoring?

Ian suggested that the industry needs to get data on efficacy and determine what and how to display the information.
Mike added that wellness requires coaching, but the industry is not ready to handle this task well. The platforms and media are not constant, so understanding the data will require simplification of the data and evolution of new formats. Patient education is another part of this change, and the education has to include some correlation of the data and behavior or treatment. Monitoring has to tell the consumer what to do as a result of those data.

Challenges of data silos?

Mike noted that data is based on the devices and there is no interoperability. Data has to be integrated to become useful to the user. Interoperability raises some regulatory issues.

Is this lack of interoperability exacerbated by proprietary data and formats? What is the role of standards?

Chris questioned who will pay for this effort. Wellness programs have different views for the user to use the data.

Proprietary informant and exportability?

Karl-Johan noted that the Android OS is an open platform. They stated with basic phone functions and services. Adding new functions to the OS raised the quality of services which raised the value of the phones. It's all about the user experience. Now it's easier to get to the data due to the increases in connectivity. The technology exists, so the question is do we do this or not. In general, we should have data interoperability across platforms and devices. The data should be open.

So baseline data should be out for free and other data could be for a fee?

Mike stated that sensors are moving data into the smart phones and apps. Users need data accessibility and portability to be able to use those data on any platform. For example, analytics could analyze personal data, but aggregated, anonymous data could be from all users could be available for baseline or comparison. A pedometer would not only collect steps, but could feed data to a wellness program to gauge quality. The analysis for the baseline would be in the cloud.

Ian wondered who are we trying to collect data for? We need to get the data to the user in a format that is useful: level of use, experience, fitness, alarms and limits for the "walking wounded" and others. Who else is going to use the data? The user, caretakers, medical providers, friends and family, etc. Then there is the presentation issue, how much attention does it take to read the data. Is the display visible, is the data scalable from top-level athlete down to a beginner? The industry has to attack the education issues.

Consumers range from high-level training to those needing monitoring for limits and alarms?

Ian considered starting from the jock and moving down.

Karl-Johan added that the whole fitness health audience is involved, making the general population the target group. The whole area is attracting more people as health concerns increase, especially for the boomer generation.

Some of the side benefits of a smart phone related to medical issues include the data volume for the providers and carriers.

Chris suggested that software should be set up to manage by exception, and task responders to only respond to outliers. As functions move into wellness programs, providers just collect the data and other apps or software will generate alerts from the reading trends and outliers.

Karl-Johan added that apps could help people with the repetitive functions.

Mike demurred that apps vary in functions, formats and responses. Eventually, apps will cover all situations.

Health and fitness versus sports training and how to transfer those data to the general population.

Ian suggested that we leverage the data and use the halo effect from the athletes to influence the general population. The ill are looking for help, so adding generic data and analysis to their data makes them become informed consumers. Dynamic programs could adjust thresholds with use and experience.

Sports versus health and the education for the users. Real-time monitoring.

Mike noted that people always have their phones with them. Smart phones are a good platform for data repositories and can act as a data hub for Web and phone actions. The phones can also provide the data for the apps.

Smart phone versus smart watch. Interim step or end device, device plus phone or self-contained?

Karl-Johan opined that the watch is an accessory to the phone. The phone creates a personal area network and connects to the cloud. It is the most personal device.

Chris added that users can always add an additional module for other functions. there are technology and power issues for connected devices, so there will be an increase in stand-alone devices.

Protocols and technologies

Mike stated that we will see increasing fragmentation in the health areas. In-home functions are based on exception cases in a 24/7 or short-term monitoring situation. Fitness is different, because it is voluntary. Integrating wireless into stand-alone devices depends upon the ability to integrate the functions versus the cost of a wireless connection. Batteries, size, and weight make connectivity something that is not easily scalable.

Wireless standards like M+ and Bluetooth, compatibility

Mike- M+ is designed for interoperability for more than 20 years. Msmart is one of a series of standards.

Data interoperability and standards, regulations

The timing and existence of capabilities are waiting for consumer desire for the interoperability. Data for providers and consumers will eventually requires this.
Chris responded that there are many other issues. Connectivity is one, and what to do with the data. The user interface is a questions as seen in the Google health app. There is no use pull for interoperability.

Mike agrees that users need to ask for interoperability or the device makers will continue to make proprietary formats.

Ian noted that technologies like 1-button data collection can be transferred to care providers or hospitals, so the providers will have to respond and will call for better interfaces and interoperability. Companies need to educate the market and people.