Health startups: are you collecting enough data?

Misha David Chellam Co-Founder and COO, Scanadu

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Many of us in the health startup community are excited by the prospect of leveraging technology to improve health - in particular, some of us envision a future where we combine continuous monitoring and artificial intelligence to build tight feedback loops that can fundamentally change health behaviors. And there is a lot to be excited about for the moment: private investment dollars, public grants, funded competitions, startup incubators, new low-power standards, etc.  But there is also a long way to go before we achieve this goal.I was reminded of this the other day when I met Alex Gourley, Founder of a great startup called BitGym. Alex was skinny, excited about his product, prone to making insightful statements without fanfare – and he dropped an idea on me that bears paraphrasing here:

Health startups are typically founded by fitness junkies who are excited about enabling their fit lifestyles.  They represent 5% of the population, build a tool that they love, and then scratch their heads when their product doesn’t go mainstream. 

Alex’s point was that his company, by contrast, was started by exercise-hating hackers, and that if they could nail an exercise experience that was fun for them, they would succeed in building a mainstream product.

This got me thinking about the current wellness landscape, and whether the devices and applications that fitness lovers love will generate enough data to allow data miners to kick off a virtuous cycle – more data yields more meaning, which in turn yields more data.

RunKeeper’s HealthGraph is a clear attempt to capture this market, and with 10 million+ users it is certainly making good progress [for context, approximately 24 million Americans jog at least once per week]. But while RunKeeper has a large set of running data, generated from its free iPhone app, will its users additionally feed the system via Quantified Self devices like the FitBit, Zeo, Withings, and UP? Will large numbers of users pay for these devices?

I have my doubts about this, but even if the answer is yes, then we only have part of the data puzzle solved, because we will have tackled wellness, but not medicine. I believe that to make meaningful observations on health behavior, we need both pieces.

There are all sorts of complications when we move toward medical. 

The first is getting the sensors to actually work. It is reasonably easy to calibrate accelerometer data - although there has been doubt about the accuracy of devices like FitBit and the BodyBug - but much more difficult to get a galvanic skin response sensor or optical blood flow sensor to give proper reads.  Is this why the Basis Watch shipments continue to be delayed? The human body is a highly complex system, and environmental factors complicate things further.  I remember a recent conversation with a biosensing expert at NASA who talked about the difficulty of preparing sensors for sweat on an astronaut’s skin.

Beyond tech challenges, there are market challenges. When we move toward medical, the FDA gets involved, and this means more time and money to get a product to market. This raises capital requirements, which in turn reduces the number of companies that are innovating in the space.  There is also a question of consumer demand – do users want biosensors pressed up against their skin, and what value do they get in return for the discomfort?

There is undeniable promise in the direction that mainstream consumer health technologies are heading, but we will have to solve a serious chicken-and-egg problem along the way: without a lot of data, it is hard to find meaningful behavior trends, and without meaningful behavior trends, it is hard to frame a compelling value proposition that will sell a lot of devices that will generate a lot of data.

Website http://www.scanadu.com
Twitter https://twitter.com/#!/scanadu
Facebook http://www.facebook.com/pages/Scanadu/105997389490082

Mobile health: thoughts from a mobile health startup

Jim Huang Co-Founder, Influ Technologies
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For millions of people worldwide,  a mobile device may be more affordable than health care. Mobile health has the potential to be a scalable (http://mobihealthnews.com/12192/mobile-to-help-create-high-definition-health-system/#more-12192) and affordable health care solution that allows people to track their
own health and act preventively according to their own needs. This post summarizes some of the  challenges and open questions we’ve come across in Mobile Health at Influ Technologies (http://influtech.com), where we’ve designed our real-time mobile service for preventive reporting and tracking of infectious diseases on mobile devices.

The health graph: static VS. dynamic

In a previous blog post here on healthystartups.com, Jason described the idea of a health graph, or the set of relationships between people that are implied by health status and exercise habits of individuals, for example.  I’d like to expand on this idea to distinguish between two types of health graph.

The first would be that of a static graph that is not varying fast in time, like the set of similarities between cancer patients.

The second would be that of a dynamic health graph, which includes people you may never meet, but that can still have an impact on your health simply by being located near you. This graph changes as a user moves from one place to the next and as the people around him move as well.  

Depending on the type of health service you would like to offer, one of the above views of the health graph might
be a better fit than the other in terms of design considerations and implementation. Influ is an example of a service that makes use of the dynamic health graph, leveraging real-time, spatial information about disease transmission as reports are submitted by users. What if other types of health information could be shared along with spatial location data to provide health care for individuals?

Health services in real-time

Mobile Health has the potential to make health-care truly personalized. Imagine health care provided on-demand in the same way we get entertainment. Imagine the ability to provide preventive health care services in real-time. Given the costs in time and energy associated with illness, doctors’ visits, medication, procedures, Mobile Health seems well positioned to provide a cheap, effective, preventive alternative to the current health care paradigm.

Many health services look like they’re ready-made for this paradigm: health monitoring and behavior-changing
apps seem like compelling as real-time services.

Privacy

Leaving aside questions of data ownership, how do users feel about having their identities attached to sensitive medical information?

Unlike social networking, Mobile Health is arguably not a good fit for the information-sharing paradigms that have worked so well for Facebook, Twitter, and many others. There are simply too many types of sensitive
information that users would not share if identities are also shared. For example, would you share the fact that you’ve got Crohn’s disease with any stranger on the Internet? Or even your friends on Facebook or
followers on Twitter, for that matter?

We’ve seen many health (mobile or otherwise) services that try to leverage social networking, with the idea being that your friends’'impact on your behavior will be useful for providing health services. In our experience, this has the problem of creating more disincentives than incentives for people to try out the service. With Influ, we
decided sidestep the issue by making the service completely anonymous, to encourage users to report on their health status. Users don’t need personalized accounts, so no information that is publicly displayed can ever be traced to any one individual. What other Mobile Health services might benefit from this privacy model?

The existing health care infrastructure

The existing health care service infrastructure consists largely of insurance, provider, pharmaceutical companies, device makers and public health organizations, many of which have a disincentive to adopt IT-like models. The current system in the US is incentivized towards more doctor visits, procedures and drug prescriptions, not
less.

This means preventive services mainly benefit the individual and not care providers. Insurers and public health care organizations, on the other hand, have incentives to adopt IT practices and services, as these have the potential to reduce prevalence of disease and improve clinical outcomes for people.

How does one build a business model in mobile health that accounts for all of the above players? Does the model have to include the above players, or can it circumvent them altogether? In our view, Mobile Health is positioned to do more of the latter than the former, given the rate of innovation and the rate of technology adoption in existing health care systems.


Other important issues that I might cover in a future post as Influ evolves: the role of regulation, and choice of technological platforms. Any thoughts?

About the author

Jim Huang is an entrepreneur with experience in statistical machine learning and bioinformatics research and development. Jim has a Ph.D. from the University of Toronto in Canada and has published over 20 technical papers in prestigious journals and conferences  that have earned him a Best Paper and several academic excellence awards. Jim has worked previously at Microsoft Research.

About Influ Technologies LLC

Influ Technologies empowers people with valuable real-time spatial disease information to prevent the spread of infectious disease. Influ® is a mobile health service that allow users to report on and track real-time movements of human disease using mobile devices. Influ has won the People’s Choice Award in the Flu App Challenge sponsored by the Centers for Disease Control and Prevention (CDC).

Website http://www.influtech.com
Twitter http://www.twitter.com/#%21/influtech
Download the app for free for iOS and Android at http://influtech.com/download

Startup your fitness with Vitogo

Erica Virtue Co-Founder, Vitogo
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It’s no secret that strength training is a crucial component of a fit and healthy lifestyle. Whether your goal is to build muscle, lose weight, firm and tone, or just get healthy, strength training (along with proper nutrition and cardiovascular exercise) will help you achieve your fitness goal.

The problem is that strength training can be confusing and intimidating. Any time you walk into a gym, you can see numerous “lost” members who fall into three categories. First, there are the “cardio bunnies”, who will jump on the elliptical or the stairmaster and not leave until their workout is done (or an episode of the Biggest Loser is over). They might try to do a few sets on a machine or two, but wouldn’t dream of going near the free weights!

Next, there are the “wanderers”. Wanderers roam about the gym, observing what other people seem to be doing, and piecing together a routine. Wanderers are usually too intimidated to ask for help, and tend to go to the gym intermittently, never achieving any real results.

Finally, there are the “researchers,” who will buy books, magazines, and videos, and search the internet for exercises and strength training programs. The problem that researchers face is that the programs that they find in books and on websites aren’t tailored to their personal fitness data and goals. It’s easy to find a “15-day Ab Buster” strength training program online, but what do you do once those 15 days are over?

From frustration to startup

Like most people, we at Vitogo were frustrated at how difficult it was to find strength training programs without signing up for expensive personal training sessions, or doing an incredible amount of research. We were especially frustrated with how much difficulty our friends and family members were having achieving their fitness goals and wanted to create a way to guide people through the maze that is personal fitness.

Having an idea is one thing, actually building something is another. Being based in Boston has been helpful for us: there are organizations like Dart Boston that throw big networking parties that have really helped us meet the right people, and get some great advice.

What is Vitogo?

Vitigo is “your strength training architect”, it is an iPhone app and website that takes users’ personal fitness data and goals and builds them a personalized strength training program. Users can take their iPhone to the gym with them and Vitogo will walk them through their strength training program, showing them how to do their exercises through videos and descriptions, counting them down through each exercise, and sending all the data back to the Vitogo website.

On the website, users will be able to see detailed graphs and analytics for their own strength training activity and share this information with their friends. Game mechanics, like badges and a leaderboard, are built into Vitogo to help keep users motivated. After 5-6 weeks of completing their exercise program with Vitogo, users will automatically progress to a new program.

How are we Different?

Vitogo is different from other strength training and fitness apps out there because:

• Vitogo actually builds personalized programs from a large database of exercises based on the data and goals that users enter into the app on sign-up. Most other strangth training apps only provide a list of exercises for users to choose from which is no different that bringing an A - Z text book of strength training exercises with you to the gym.
  
• Vitigo incorporates game mechanics and the support of friends to keep users motivated.
• Vitogo gives users detailed graphs and analytics of each exercise they complete, tracks their progress and shows how close they are to achieving their goals.
• Vitigo helps users progress by giving them an updated program every 5-6 weeks. This is critical to ensure that users don't plateau or get bored with their current program. As far as we know, there is no other app that provides this service.
  

What about the Health Graph?

We hate having to enter information more than once, so we are integrating with RunKeeper’s Health Graph so that when you workout with Vitogo, everything about your workout gets pushed to RunKeeper, and when you exercise with RunKeeper, your Vitogo gets updated. This is great, because we hate not getting credit for strength training on our RunKeeper profiles. We especially hate getting those RunKeeper emails asking if we are taking a break from working out, when we have been in the gym every day, but not out running. More integration is better.

Friends, Support and Games

We believe that a support network is critical to helping you achieve anything in life, especially fitness goals. Having someone encourage you to go to the gym, or for a run when you really don’t want to at the end of the day, not bringing junk food into the house, or just having someone help you push out an extra repetition a the gym makes a huge difference in your fitness and health.

A positive and encouraging environment at every stage of your fitness is going to ensure your success. That is why Vitogo is built from the ground up with full social integration, and rewards. Social integration keeps you honest and connected to your friends who are also keeping fit and awards give you something for keeping at it and hitting a personal best. Any encouragement we can give you we will.

So when is this going to happen?

We found some great developers and designers and are building the first version of our product right now. These are exciting times, and things are going really well. We are expecting to launch this Fall and will continue to iterate and expand on our product from there. We’ve been asked why we are focusing on iOS to start, and the simple reason is money. As a bootstrapped startup, all revenue helps and right now iOS is better at selling apps than Android. We also have iPhones and want to use Vitogo when it’s ready. We will expand into Android and other platforms when we are ready.

About Vitogo

The Vitogo team is Arel English and Erica Virtue. Arel and Erica both have degrees from the University of Victoria in Canada. Arel spent years coaching sailing and rowed crew in high school and university. Arel also worked for the Canadian Olympic Women’s Rowing Team. Erica has a Juris Doctor from Northeastern University, spent years as a competitive cyclist, and learned a lot about the fitness industry from working at a high end cycling shop.

Website http://www.myvitogo.com
Twitter https://twitter.com/#!/myvitogo
Facebook http://www.facebook.com/pages/Vitogo/226303434074308