This article was featured in Xconomy on December 10, 2012
Patient monitoring outside the hospital has been a hot topic (and also a not so hot topic) for the past 15 years. Starting back in the late 1990s with companies like Health Hero Network, a company whose products for patient home monitoring are still in use today, company after company has sought to bring a successful product to market. The holy grail: finding an easy, non-intrusive, and continuously reliable way to predict patients’ potentially serious medical problems when it is early enough to do something about them and prevent an acute and expensive episode of illness. Some of the newer companies are focused more on the wellness and tracking side of the equation, such as helping individuals see progress from an exercise or other preventive/health-inducing regimen.
So far this whole area has been a very tough nut for businesses to crack in the US in particular. While some studies have shown great positive effect, others have not. Insurance payment for these programs has been spotty at best and non-existent at worst; most of the current vendors are stuck in pilot hell without significant long term and widespread commitments from payers. There is a belief, veracity unknown as yet, that the proliferation of risk-based entities such as Accountable Care Organizations will change this and lead to broad adoption of ambulatory patient monitoring tools, angels will sing and a large number of hospitalizations and rehospitalizations will be avoided. That may be true, but remains to be seen.
Yet due to the growing belief (wish?) that the broadening risk base will create massive monitoring market growth, fed by the advent of smart phones and miniaturized, inexpensive mobile sensors, the number of companies focused on this opportunity has grown faster than Rapunzel’s hair. And these patient monitoring tools are showing up everywhere. There are sensors that plug into home appliances that let you know grandma woke up and turned on her coffee pot; sensors in phones that can remind you to take blood pressure and glucose readings and send those readings off to be tracked; sensors in beds that help measure body parameters and whether patients are moving or about to fall. Even sensors in clothing, although none yet that detect hipness.
I saw an article this week in the Wall Street Journal that really made me wonder where this is all going and when and how we will determine when the sensor craze has jumped the shark. The article, entitled “A Car That Takes Your Pulse,” was about a growing trend among auto-makers to create “technology that could feed your heart rate, blood pressure and other biometric responses into the car’s computers, the better to determine when you’re drowsy or overwhelmed with distracting media” among other things.
Car manufacturers such as Mercedes, Lexus and Ford have already begun building biosensors into their vehicles. Experiments are underway there and elsewhere using built-in passive sensors to measure respiration, sweaty palms, pulse rate and other signs of stress and distress that could lead you to have a car accident. I actually test drove a Mercedes that had the sensor to detect driver drowsiness in it. When it perceives you are getting to tired to drive it shows you a cute little coffee pot and suggests you stop for a rest. No word on whether they have done a joint promotion with Starbucks.
Here’s my favorite example from the WSJ story:
Sports car maker Ferrari SpA, for one, has filed a patent application that indicates the company is evaluating technology that would embed wireless electrodes in a car seat’s headrest to monitor drivers’ brain waves for stress as they pilot machines capable of roaring up to 200 miles per hour. Depending on what the sensors detect, the car might try to mitigate the driver’s risk by cutting power to the motor or automatically stabilizing the vehicle. As Ferrari researchers put it in the patent filing: “drivers tend to miscalculate—in particular, overestimate—their driving skill and, more important, their psychophysical condition.”
I am pretty sure this technology is redundant. As the police and everyone else know without sensors, the Ferrari driver is definitely under extremes stress because their mid-life crisis drove them to buy a Ferrari in the first place, for goodness sake. They are worried no one will ever say they are young and hot again, and keeping up appearances is exhausting. Plus they are constantly being pulled over for speeding and worried about making the next payment. Stress? You betcha. Indication of poor driving in the moment? Who knows?
Ford is also working on a stress sensor program that, when it identifies extreme stress or distraction, will turn off the drivers’ cell phone ringer. If they think that is the cure for distraction, I think they will be disappointed. A better solution will be to require drivers to turn their phones off completely or new technology that makes in-car cell phone use impossible at all times, because one does not have to be stressed to be distracted by the phone. We all see the texting, phoning idiot drivers on the road now, and most of them look just fine until they hit the light pole. This isn’t a personal stress monitoring issue; it is a public safety issue. I really wonder about the value of this approach.
And sensors for sweaty palms as a meaningful stress indicator to suggest getting off the road? Have these scientists met teenagers? How are they going to factor in sweat baselines for those heading out on a first date or going to a job interview?
But while I can generally understand the idea of sensors that impact driving ability very directly, particularly sensors that detect blood alcohol level or falling asleep, its the sensors designed for general health management that really give me pause. I know smart people are thinking about this so maybe there is merit, but I wonder how effective of a tool this really can be. Its hard not to think about all this without harkening back to KITT, the car in Knight Rider, which monitors Michael Knight’s heart rate and other vital signs and displays them on monitors. KITT was very sophisticated and could identify not just biometric distress, but injuries, poisoning, and other factors key to crime fighting success. Same goes for the Batmobile, as I recall. So is the real audience for these products the senior market, for whom they are currently being developed, or the middle-aged vigilante crime fighter driving a muscle car? Very different demographic.
A key idea behind biometric sensors in cars is to extend the driving lives of senior citizens who might otherwise, at least in theory, be unable to drive safely if their condition wasn’t closely monitored. Yikes, is all I can say to that. There are both inherent risks in letting people drive who might pose a risk to themselves and others, and a question in my mind as to whether monitoring would prevent problems fast enough to prevent dangerous outcomes. A sensor that detects heart attacks and immediately stops the car? Uh, too late, and by the way, not a problem limited to senior citizens.
Also, let’s just say your car can measure your glucose level and let you know you are in danger. I would wager that most diabetics who follow their proper regimen don’t need this and the ones that do may or may not pay attention, just like they don’t now. And let’s say that data is being shown on the car display. Isn’t that, combined with the worry of constantly being watched and getting dashboard feedback about biometric parameters going to itself be a huge distraction?
Plus, who is going to pay for this monitoring? As everyone in healthcare ought to know by now, the presence of data isn’t valuable, its what is done with data that creates value. If you need a risk management or care coordination system to sit behind the sensor data stream in order to let drivers know they need to get some insulin or take their blood pressure medicine, some analytics system is probably going to have to sit behind that to put real-time data into context of the driver’s existing health situation. So are we going to see Lexus SUVs integrated with the Epic EMR?
Moreover, remotely collected data that doesn’t have human intervention to back it up hasn’t been all that successful to date in achieving good outcomes in the monitoring game. Programs that combine monitoring with clinician engagement with the patient are far more effective. So how might this work? Is Healthways going to start an automotive division? Is Ford going to start hiring car managers to triage at-risk patients from those who stopped at Dunkin Donuts and had a glucose spike? Maybe Tom and Ray Magliozzi can start a whole new career after retiring from Car Talk where, instead of diagnosing mechanical issues, they diagnose acute exacerbations of chronic illness via OnStar. And by the way, if history is any indicator (and it always is), if someone pays for biometric sensors to be installed in cars, they are also going to want in on the savings from avoided incidents–how does this all work? Is Toyota or BMW going to be the third wheel in some newfangled Accountable Care Organization (Automotive Care Organization)?
One of the issues that is not discussed enough in any discussion of passive patient monitoring is the consumer’s view of the experience. Some welcome it but some are unwilling to be watched 24 hours per day, whether it’s Big Brother, their own adult child or Herbie the talking Volkswagen who is doing the watching. The WSJ article includes this quote:
Dick Myrick, a 63-year-old retired electrical engineer from Arlington, Mass., participated in AgeLab experiments in biometrically monitored driving. His says he would be interested in a car that kept tabs on his condition as part of its safety technology, but only if he was in control of the system. “I need to know that the function is on, and have it not on when I want,” he says.
Having the ability to turn the system off kind of defeats the purpose but makes clear my point. Finding the right balance between privacy and monitoring is not entirely obvious, but I can imagine plenty of people do not want to be videotaped constantly while driving, illness or not. In fact I imagine the sense of paranoia some might feel from constant surveillance could increase driver stress levels, particularly if they know they are being watched, have a runny nose and lack available Kleenex. As the saying goes, just because you are paranoid doesn’t mean they aren’t watching.
As I reflected on the WSJ car sensor article, I took a moment to read some of the reader comments, always the best part of any on-line story. If you are a real marketer with a mission to sell product, they say that you must always listen to your customer, and customers were talking ( or typing as the case may be). Instead of or in addition to biometric monitors, drivers suggested the car companies invest in onboard auto technologies that administer espresso to sleepy drivers rather than just point out the sleepiness; another suggested that rather than technology that shuts off cell phones, how about gear that drowns out the sound of whiny kids asking “are we there yet?” Now that’s noise-canceling technology we can all appreciate.
Besides, isn’t this all about to become slightly moot if Google has their way and cars drive themselves? I guess when that comes to pass the auto manufacturers will have to outfit new cars with backseat driver monitoring technologies instead.