5 Questions

Apple, Google, and the State of mHealth

June 30, 2014          

Episode Summary

In a perfect world our health information provider would be a non-profit that worked with every technology provider, creating a single open platform that was easy and available to all. In reality, health is becoming the battleground of the mega-corporations with two of the most important technology companies, Apple and Google, right at the center of it. Join us, in this episode of The Digital Life, as we discuss the state of mHealth, and the implications of the recent forays of Apple and Google into that complex software space.

Jon:
Welcome to episode 63 of the Digital Life, a show about our adventures in the world of design and technology. I’m your host, Jon. With me, a special co-host, Dirk. Welcome, Dirk.

Dirk:
Thanks, Jon. Good to be here.

Jon:
For those listeners who don’t know, Dirk was the founder of the Digital Life. I believe as we enter year four of the Digital Life, it’s nice to have Dirk back pinch hitting as he is right now for my co-host Erik Dahl who is our usual co-host but is unavailable this week.

Dirk:
Well, four years. That’s hard to believe it’s been that long. The show’s come a long way. You and Erik are doing a great job with it.

Jon:
Thanks. I think there’s been an evolution. What’s interesting to me is that the show has this slow and steady growth. I think we’re actually being featured in a new podcast player that will have its debut at Google IO conference coming up. We’ll be included in the list of podcasts that they’re featuring. I think that’s a good sign that at least people are still interested in what we’re talking about.

Dirk:
Very cool. Speaking of what we’re talking about, what did you have in mind for this week, Jon?

Jon:
This week, I thought we would touch on the state of mHealth. As you know, Apple and Google had both recently announced that they’re going to dive into the burgeoning territory of mobile health. Apple with its HealthKit and Google with its recently announced Fit which will be part of its Android operating system. I think both companies have this desire to be the godfather of your mobile health data. I thought it would be a good time for us to take stock of where we are in the mHealth sphere and to also dig in a little bit to these offerings from both Apple and Google, these mega corporations that could potentially be the aggregators of our health data and just ask a little bit what’s good, what’s bad about each of them and how are they likely to face off against each other.

Dirk:
You want to start by talking about what’s good and bad about them then?

Jon:
Yeah. I know that you had some strong opinions about Apple as the mHealth center of the universe. What was on your opinion on them and why do you think Apple might be a good or bad fit?

Dirk:
Yes, Apple. I guess they’ve announced their intent early in the year, word leaked out of Apple’s intent to work on this stuff. In short, I was concerned. I was very concerned. There’s three primary concerns from my perspective about having Apple be the arbiter of this stuff. The first is and this applies to Google as well, frankly, health information needs to be universal. Health information needs to be accessible. We are in a time where the mobile computing platforms are bifurcated primarily with Android, Google’s platform and Apple’s platform. You also have Microsoft with their own platform. I don’t know where their market share is. I don’t think it’s great.

You have these different players that are competing behemoths that have deep, deep invested interests in dominating, in being proprietary in doing things a certain way. For either Apple or Google or Microsoft, any of them, I think it makes no sense at all to have them be the arbiter for health. If you think about the use cases, this data is something not just for the user in which case to a certain degree, who cares? There’s some issues if you’re changing or whatever.

That’s less important. What’s more important is doctors. Do doctors have to learn two platforms, three platforms that behave differently, that have different data, that are bringing different things to the table, that have different protocols for health organizations to upload additional data into them? That same question is for nurses. The same question is for EMT and other medical professionals. We don’t want them to have to learn these different platforms. It doesn’t make sense in a certain way and it’s not good.

Really, the right organization to do it and sort of my starting point on all these stuff is there should be some kind of a nonprofit that part of their charter is making sure it’s accessible to all, for all, with common protocols, with the ability to interface with all of the different mallards of softwares being used by health care systems that Apple and Google pads are going to take us there. That’s the big flashing red sign for me right away.

The second thing from an Apple perspective is Apple makes crap software, as beautiful as their hardware is, software just isn’t very good. Do we want a company that isn’t making very good software trying to be the one that is making this big health platform? I’d much rather go with some of the smaller companies that have been doing this stuff for a while, that have been collecting and displaying health data. They aren’t all great at it but some of them are very good at it. Apple is not good at software. Whenever they go into software, it’s remarkable how much they resemble Microsoft, it’s kind of a bumble around at this point when it comes to software. They just aren’t good.

I don’t know. Those are at least my first two concerns maybe. What are your thoughts just in light of those comments?

Jon:
Yeah, I think when I heard about these, the Apple HealthKit and the Google Fit, I kind of wondered what it would take for Americans to care about mHealth. You and I and our colleagues play in this sort of early adopter realm. We have these … we have our fuel bonds or other quantified self monitoring systems that collect our data. Apple is offering or Google is offering to take these sensors that some early adopters are using, maybe a lot of early adopters and fitness freaks are using. I say fitness freaks in the nicest way. Taking it and making it all available on our smartphones. Right there, you’ve sort of made this stratification of who the people are going to care about aggregating this data in their smartphone.

For me, on two fronts, I had difficulty with that. I’m not sure that the wearables revolution is going to last that long. I’m glad that we’ve got these wonderful things that you can strap on to your wrist or to your arm or whatever. I think sensor technology is moving forward so quickly. I know just recently there were some sensor technology that used, I believe it was light, to see if you were having a problem with your heart. Monitoring your heart from 10 feet away using a beam of light to do what an EKG does now. That’s noninvasive, sort of like I don’t need to put on a wrist band, I don’t need to be fiddling with this smartphone in my pocket.

That seems like, it seems to me like Google and Apple are going for a commercial sort of money grab or something just to be on the health train. It doesn’t feel right to me. I have a problem with that. I also have a problem with the fact that they’re doing it and it’s all going to be focused on our devices. That seems wrong to me because there’s so many people who don’t have access to smartphones. I know that that’s … this wonderful piece of technology that we can leverage but there are a lot of people, the older generation. There are a lot of people who don’t have the funds to afford these kinds of things. Like the solution set just seems like this hipster, early adopter quantified self offering that bothers me.

I don’t know if that really matters. Maybe they’ll get lots of users and be able to monetize this in one way or another and our health is going to end up being the next thing where Google Ads show up. You’re having a heart attack, we’ll sell you a pill. I don’t know. It just … I think I’m coming at it from a slightly different angle but as you articulated with the wanting to have a nonprofit do it, it just doesn’t seem like the right direction. It seems like something that the tech community will jump on board because it gives us more opportunity to sell people a bunch of stuff. I don’t feel like it’s a good solution set.

Dirk:
You made a number of interesting and provocative comments. The one that really rang my bell the most was sort of attacking the smartphone as the platform for this. What platform would you use? To me, it seems like either you use the smartphone or you simply don’t have this kind of data. What’s the alternative in your mind?

Jon:
Yeah, I guess there are two ways to look at that. One is that behavior change in and of itself is more valuable than the data collection. My brother in law is in the military. They give, the military gives you an hour off every day to go work out. He’s not collecting any data about himself. I don’t even know if he owns a Nike Fuel band or any of those things. He’s getting more fit because he has the time to do it. Because his behavior has been modified by a smart policy. I think it’s a smart policy from the military which says your health is important so go spend some of your personal time on it in a way that’s going to be effective. On the one hand …

Dirk:
You spend some of your work time on it, right?

Jon:
Yes.

Dirk:
That’s time you’re getting compensated for.

Jon:
That’s a policy driven solution, that it’s not platform based. It’s policy and behavior change which I see as being a compelling example. From the other side, from the technology side, I’m not sure that I want to be responsible for the monitoring of these factors, like weather it’s how many steps I take or how many calories I burn. I’m wondering, this is probably not realistic in the short term but I’m wondering what sensors are available that can tell me what’s going on without me necessarily needing to attach a sensor to myself. In that case, the data is … could be resident on the smartphone but also could be resident in any number of other things in my environment, whether that’s just a Cloud based service that I always have access to that tells me, “Okay, you’ve eaten these kinds of foods and done these kinds of exercises,” because my home gym is outfitted with sensors, I don’t know.

I’ve taken this sort of none technology view point which is all centered around behavior change or the feeling that technology is not impinging on me, right? Advancing the sensor technology enough so it doesn’t feel like I have to report my life to my smartphone.

Dirk:
Your focus on policy is right on. The goal is to be healthier, the solution, mHealth solution is sort of a drop in the ocean. It’s really more about exercise. It’s more about marketing frankly. As long as McDonald’s and Chips Ahoy and all of these other companies are bombarding us, are psychologically manipulating us to make choices that make us unhealthy, we’re going to be unhealthy. At the policy level, you’re right. There’s a lot of bigger battlegrounds here to be fought if we really want to make a commitment as a culture or society to be healthy. On the technology side, you’re not selling me though. Instead of the smartphone have a room full of sensors, that seems like boiling the ocean in a certain way. At this point, I think it’s 60% of adult Americans have a smartphone. That leaves a big chunk that don’t, right? I’m not ignoring that issue. It’s not like that chunk that doesn’t is going to invest in sensors in their home either, right?

Jon:
Sure.

Dirk:
I think as long as there is a technology component to it, at least given the current state of technology, it seems like the smartphone is the correct enabling hardware to do this. You might have other arguments. I’m open to those. What I’ve heard so far isn’t swaying me away from the smartphone here.

Jon:
There’s an aspect to the quantification of our health data that I don’t find particularly valuable. At times, I mean, at least when I’ve experimented with it, it hasn’t been something that has … evokes much enthusiasm for me. I mean, the blisters from my arm from wearing one of the Go Wear Fit armbands is what I remember of that experience, not the quote, valuable data that was in there, questionably designed Cloud application. I do feel like we’re in an interesting transition stage for understanding our bodies frankly. This wonderful technology that we all have that we understand so little about and the insights that I gained from we’ll call it the wearables, this generation of wearables is not eliciting a lot of enthusiasm from me. It’s not to say that you can’t get valuable insight out of it.

I imagine if there’s advice or actionable tips ore things that are going to come out of these HealthKit or Fit systems, those things might be useful but there’s … it’s a far cry from, “Oh, you ran four miles too. Why don’t you… we see that you’re at the stairs, in the lobby of the building, you can take the stairs instead of the elevators. Why don’t you do that if you need your additional 500 steps for the day,” or something like that. I struggle a little bit with the experience that I had so far with this. It may just be the fact that it’s so early in the mHealth adoption curve.

Dirk:
Yeah, the hardware barriers you mentioned are right on. I mean, they’re definitely clumsy. I mean, the right solution in a certain way are probably embeddable chips, embeddable devices but that’s probably scares the shit out of some of our listeners. It might be ways away. That’s where the real long term … however, digital technology is evolving and our exploitation of it, like synthesizing into the physical self is, at this point, it’s a fiat accompli, unless the Antarctica melts and we have to totally get away from technology entirely. For me, the problem is on the software side. Like you, I’ve spent some time with these technologies and tried different services.

Ultimately, the value I got from it was one of awareness. That was gleaned pretty quickly and once I gleaned it then the service was, I would say was even psychologically unhealthy to some degree. What I mean by these things is it’s really useful for me to learn how many steps is 10,000 steps, right? I learned that 10,000 steps a day is a healthy target to go for which is good target to pick up. I internalized it through the use of the systems. That’s great. In doing so, I also started to understand what 10,000 looked like. Whether I had a damned device on my arm or not, I didn’t need it in a certain way if … as long as I was aware of my day and what I was doing. At the end of the day, I could say, “Okay, yeah, I probably got my steps in,” or “No, I probably didn’t get my steps in.”

There was a period of time, it was months, I don’t know, three to six months where all of this was sort of being inculcated into me. I actually thought that was pretty valuable. The problem for me was the … the problem for me was the guilt of not accomplishing what was necessary. On the day where I was really busy and just chained to my desk, that day and I do 2,000 steps or whatever the number was, then I feel bad. I don’t feel good about it. It’s sort of artificial. I’m feeling bad not because I was sitting on the coach eating potato chips but I’m feeling bad because this sort of natural of going through that day within the constraints of my life prevented me from hitting that target. Now, you can blame me because I wasn’t able to not feel bad. I wasn’t able to say, “Screw it. I’m going to look at this in a mature and balanced way and it’s not going to bother me that I didn’t do it.” The fact is that it did.

I think with the software on these services, one of the big things that they missed, we’re nowhere near solving for this although I sure as hell wish we were is that we’re all different, that the software is not designed for different personality types. The way that someone would exploit this software who is a runner versus the way someone like me would exploit it who is a knowledge worker behind a desk for many, many hours a day are just radically different. Not just because of those tasks that we choose to do but because of the type of people that we are that lead us to spending our time in our lives doing the things that we do. We have this one homogeneous piece of software that’s just cranking out sort of the same data in the same way and come what may.

What we need are solutions that are designed for the lifestyle of individuals. I could tell you Google and Apple are going to be nowhere near getting us closer to that for a decade plus. That’s where the hard stuff is, that’s where the usefulness quotient also cranks up although I want to make sure we’re not, for our listeners, conflating the sort of quantified self devised daily monitoring stuff with the bigger vision of what Google and Apple are trying to do because what they’re trying to do as tendrils into how far beyond sort of the quantified self kicking us.

Jon:
Yeah, I think I know they had not yet released the Google Fit SDK but I believe that’s coming at the end of July at the Google IO conference, I’m sorry, the end of this month, the end of June. I think this, you’re right, there’s this sense that they want to get involved in your health data in a much more substantial way than just simply aggregating the data from your different wearables. They are actually … I mean, I know that Apple health kit is actually built in IOS 8 which should tell you something, it’s not a separate piece now. It’s part of their mobile operating system. I suspect that Google Fit will have equally tight integration with Android if not be part of that system. For the life of me, I’m trying to figure out what it is about health data that they’re going to be making money on. Whenever, I see like these large companies get involved, I mean, I don’t know aside from selling me the phone, maybe having partnerships with other companies, what is it that they want to do because I don’t feel that it’s going to be even 50% altruistic, right? That raises a red flag for me. I don’t know about you, Dirk.

Dirk:
Yeah. No, I mean I have that concern too but I mean we’re dealing with that in our culture, like all of these companies offer and all of these things have … it would be way too cynical to say nefarious, have very selfish interest in mind. This is kind of pulling health right into that. That part I wish weren’t the case but it doesn’t disturb me as much because that’s kind of already the way it is. I mean, insurance companies have dragged us into health being that way. Health care professionals have dragged us into health being that way. The government has. I mean, that’s just kind of the paradigm that we’re in. I’m not happy about it but it kind of is what it.

Jon:
Dirk, what do you think the next steps are really for Apple’s HealthKit and Google Fit, do you see them … how do you see this service, set of services evolving? Where do you think we’re going to end up in the next year or so as this ecosystem shakes out?

Dirk:
I think it’s too early to tell on all of those fronts. I don’t know how they’ll roll it out. I think it’s going to take a lot longer than a year for the impact to really be felt. I think we’ll get some bleeding edgers who are getting into it early on and exploring it. I think that where these initiatives become big and important is at the point that they’re interfacing beyond just the user collecting metrics for their own use. The question is what’s the timeline. I don’t know. I don’t even have a guess. I’ll be horribly wrong if I try. What’s the timeline for insurance companies to be plugged in? What’s the timeline for doctors and hospitals to be plugged in? What’s the time for emergency response to be plugged in? That’s the point where it’s going to go from this thing that’s still just sort of on the fringe with the real progressive attack heads into something that’s big and really matters.

It does feel to me like this end, the use of the cellphone as the platform and a primary data collection hub, this is how they’re going to get there. I mean, Microsoft and Google competed for health data already and they both failed. I don’t remember the names of their initiatives anymore but this goes back more than a decade. I think Microsoft was in it first. They both crashed and burned. I think the confluence of technology that sort of encapsulated in a quantified self is what can get us there along with the prevalence of the smartphone because 60% plus of adult Americans having it, it’s a really big number. It’s unfortunate that there is a big percentage that would still be left behind but those people are already being left behind. I mean, in most cases, that’s part of the reason why they don’t have a smartphone to begin with. That would just be another symptom of the bigger problem, not the cause itself.

I don’t know what the time frame is. I think in a year, things still won’t be clear. I don’t know. Maybe I’m wrong. Maybe they’re going to execute really well. Maybe they’ve already made some big deals. I don’t know, what do you think, Jon?

Jon:
I think you put your finger on it, which is when the individual health data becomes available to clinicians and hospitals and insurance companies, that’s really going to be the point at which the system matures. What’s interesting is the previous offerings that you mentioned, the failures from Microsoft and Google were all based around the health care providers putting their data in whatever those Cloud services were. I think Microsoft was Health Vault and Google might have been Google Health, something like that. In these latest efforts, they’re circumventing these big institutional type players and they’re going right to the user, right? If we were in a corporate environment, it’s bring your own device, right? That’s the enterprise IT right now because everyone’s bringing their own tablets and phones and things to work.

This is bring your own device to health. Bring your own device to your doctor. Then force the system adoption that way which is more of a grassroots uprising, right? I think that’s what they might be going for. It would be interesting to see if that’s possible now that it’s going to be built to every … if it’s Android, it’s in all of those phones and in all of your IOS 8 phones. You can’t help but notice that maybe there’s a forcing functions there that as these systems get released forces change along. I think it would probably be a little tough to pin it down in terms of a timeline but there’s this national excitement around health right now that we’re all catching the ever a little bit. I think there’s going to be a level of adoption especially with this two big players in the mix.

Then the next question is does it do anything for our national health or does it kind of peter out like some of the other initiatives that we’ve seen?

Dirk:
I think that goes back to your point …

Jon:
I’m sorry, go ahead, Dirk.

Dirk:
Sure. I think that goes back to your point earlier that to really change health, we need a policy. We need policy change. These software, these initiatives by Apple and Google, they’re not going to make us healthy. I mean, most of the people, we got the obesity epidemic. I mean, most of the people who are suffering from this are … they’re not necessarily big go getters. They’re not necessarily people who have the … who have the motivation, who have the ability to pick themselves up and leverage some data and services into large scale lifestyle change and sort of a self Renaissance. It’s just not realistic. These services can be an important part of an ecosystem. They can even be the enabling technology of the ecosystem but if the goal, if the outcome is to have healthier people, healthier society, this isn’t going to get us there. It’s got to be something bigger, something more.

Jon:
I would agree with that for sure. Listeners, remember that while you’re listening to the show, you can follow along with the things that we’re mentioning here in real time. Just head over to thedigitalife.com. That’s just one L in the Digital Life. Go to the page for this episode. We’ve included links to pretty much everything mentioned by everyone. It’s a reach information resource to take advantage of while you’re listening or afterward if you’re trying to remember something that you liked. If you want to follow us outside of the show, you can follow me on Twitter @jonfollett. Of course, the whole show is brought to you by Involution Studios which you can check out at goinvo.com. Dirk?

Dirk:
You can follow me at Twitter, @dknemeyer. Email me at Dirk@Knemeyer.com or read me at dirk.knemeyer.com.

Jon:
That’s it for episode 63 of the Digital Life. For Dirk Knemeyer, I’m Jon Follett and we’ll see you next time.

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Dirk Knemeyer
@dknemeyer

Credits

Co-Host & Producer

Jonathan Follett @jonfollett

Co-Host

Erik Dahl@eadahl

Founder

Dirk Knemeyer @dknemeyer

Minister of Agit-Prop

Juhan Sonin @jsonin

Audio Engineer

Michael Hermes

Technical Support

Eric Benoit@ebenoit

Original Music

Ian Dorsch @iandorsch

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