Digital Health Insights - 2015 by dacadoo

1/2015

DIGITAL HEALTH DIGITAL HEALTH

INSIGHTS INSIGHTS

HEALTH TO GO The future of quantification Interview with John Nosta

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Measuring Health Interview with Peter Ohnemus

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A high-maintenance monster called diabetes (Scott K. Johnson)

mySugr user experience

Outlook

About us

Who am I in numbers? It is possible to measure and track all kinds of data. But what data gives us an insight to our health status? What kind of data is relevant for doctors and insurance companies? In this spring edition of the Digital Health Insights, we have invited founders and experts to discuss the medical relevance and urgency of data acquisition and analysis. Furthermore, true tracking champions share their stories of how a simple tool helps them deal with a chronic conditon every

day. The benefits, they say, are not in digitising paperwork, but in finding new, individual solutions that integrate easily into their daily life. For three weeks, I quantified myself, using the Withings Activité Pop. It comes in all kinds of colours, ranging from a neutral “wild sand” (the one I used, very elegant), to “bright azure”. I liked the stylish approach and I am a fan of smartwatches anyway, Every day I wear a wrist watch, but I do not carry my phone everywhere. So I am one of those people who prefer having a wearable to having your phone include all kinds of sensors and abilities. The Pop can potentially track activities such as walking, running and swimming, it monitors your sleep and it includes a vibrating alarm clock. It is connected to the Health Mate App via Bluetooth 4.0. So far, so good. The first couple of days, the smartwatch felt too big, but I soon got used to that. If you share your bed with another person, the silent alarm is one of the greatest inventions for couple’s sanity. Unfortunately, I never figured out, how to turn it off, neither on the watch (I do not think that is possible), nor in the app. But it always stopped at some point and I should not

complain about the watch’s intense enthusiasm to wake me up. On a normal day, one should take around 10.000 steps to lead a healthy life. The watch indicates your progress with a small display, showing a clockhand moving from 0% to 100% and resetting at midnight. If you hit a goal, for example more than 10.000 steps a day, you get rewarded with a badge in the app. These badges are neither truly beautiful, nor meaningful enough to show them off, but they made me prouder than I would want to admit. I had no problem in reaching the goal of 10.000 steps even though I have an office job. However, I am sure that I had never met this goal before I was wearing the Pop. The tracker made me more aware of how sedentary my day is and I tried squeezing in some extra steps. I was no longer too tired to go for a walk, or too lazy to take the steps - I wanted to move to hit my goals. This awareness has stayed with me even after I have stopped using the Pop. The Pop also helped discover why I never feel relaxed, no matter how long I sleep. Having the proof after every night, that my sleep pattern does not include long enough phases of deep sleep, motivated me to make some changes and care about my health. Before, I found many reasons why I could not sleep and tracking narrowed it down to an experiment. New blinds - one hour more of sleep; different cushion - half an hour less of sleep; relaxing music in the evening...and so on. It was fun to experiment and see immediate results. Results, which I did not feel yet, but that became apparent when I took a look at the app in the morning. There is only one point of criticism: the clock was always off. Laura Beyer, XLHEALTH

www.XLHEALTH.de/en

The future of quantification: Interview with John Nosta, Digital Health philosopher Which kind of data is most valuable for an individual’s health? Data has to be defined in the context of disease. If I am losing weight, then probably the most important parameter is my weight or my BMI. But if I am of normal weight and have a risk of cardiovascular disease, cholesterol is my most important parameter. Therefore, the ability to track data is maybe less important than to customise data to our needs. I believe that we will find, through big data, new unseen patterns that will emerge to give us fundamental insights into health and humanity.

If we look at someone with high blood pressure, for example, collecting blood pressure data may not be the answer to an improved health through tracking. However, by tracking this parameter, the person may come to the conclusion, that the high blood pressure is related to sleep.

or his walking pattern, limps, or falls. It is not the overt acquisition of data, but the passive acquisition of data that will be the standard; therefore we should not call it quantified self, but quantified life.

Data has to be defined in the context of disease

It is a new and an important step forward. I believe that we all have a condition called information overload. The condition impacts all the stakeholders in medicine and health, not only patients and caregivers, but also clinicians and the pressure to be current with data and health information is immense. It is almost impossible to keep up, so what choices do patients and clinicians have, but to step to an information source that is curated. One of the problems with information overload is, not only is it a tsunami of information, but how do you know if it is correct. For example dietary guidelines concerning food with cholesterol have just been changed. How do you keep up with this shift in nutrition? The information on the internet may be outdated, correct but not validated, or wrong, but articulated by someone in the position of authority.

In another example, a person might find that the constant migraine is related to nutrition. So what is the most important thing to track? It is defined by our clinical needs. New windows into the self will be opened and we will come to the startling revelation that what we think we should do may not be true. Will we see Digital Health solutions integrated in all areas of life?

About John Nosta John is a thinker entrenched in the world of science, medicine and innovation. He is also the founder of NOSTALAB - an amorphous, selforganizing neural network dedicated to the advancement of Digital Health. www.nostalab.com

www.XLHEALTH.de/en

Yes! The question is not if, but when. The emergence of sensors and passive data acquisition will become the standard. Take cars as an example. Modern cars have 70-100 sensors, which we do not notice and do not worry about. We have no sense of awareness until that check engine light is on. Digital Health can function as the check light for our body. Yet, I do not believe, that future data will be acquired through wearables or other portable sensors. Instead, passive collectors like your bathroom mirror, will track for temperature and an EKG, your toothbrush will scan for cavities, and toilets will be used for chemical analyses. And even carpets will be used to analyse gait, giving a signal to an emergency contact, when an elderly person suddenly changes her

What influence will the added health facts have on Google search?

We all have a condition called information overload At the moment, we experience a tradeoff between expertise and innovation. In a way, we know about trending topics, for example via twitter, but at the same time we do not know the depth of data and its value. I think it is

1/2015

DIGITAL HEALTH DIGITAL HEALTH

INSIGHTS INSIGHTS Measuring Health: Interview with Peter Ohnemus, Founder of dacadoo

important to look for ways to source and sort the data. It is an absolute imperative to curate clinical data, so Google’s partnership with the Mayo Clinic is essential.

What inspired you to found dacadoo?

What is your outlook on Digital Health? Digital Health is Digital Fitness, Digital Wellness, and Digital Medicine. Right now, the tracker lives on the wrist of somebody who probably does not need it. For example a 60-year old man with metabolic syndrome will not get a wearable. But this is not the promise of Digital Health. The promise rather is to find more data to move from fitness to clinical imperative. This will not happen via fitness devices, but by the development of nano technology to track cancer, for example. It becomes something you carry with you like your life depends on it and not a wearable that lies on the nightstand with low battery.

Digital Health will move from fitness to clinical imperative Another fundamental change will be the age of Digital Health users. Those young people and students who will soon be working in the medical field are the first generation of digital natives in health. Technology in medicine has caused a lot of problems to those, who did not grow up with technology and older doctors may think technology is a burden, but from my experience, medical students are finding a new normal, invigorating their interest in their profession.

About Peter Ohnemus Peter Ohnemus is the founder, Chairman, President and CEO of dacadoo ag and dacadoo americas, inc. Peter has been involved in high-tech and bio-tech investments over the last 25 years and this had led to four IPO’s and multiple trade sells. His Health Score is 701 and could be, so he says himself, higher if he got more sleep and ate healthier. At the moment, Peter is challenging his brother to a healthier lifestyle and higher Health Score.

Peter Ohnemus has a Health Score of 701

The common theme in my work as an entrepreneur has always been about big data. After having sold my last company, I realised the many similarities between the acquisition of data in economy and health. Health business generates massive amounts of data that, in comparison to stock market data, will never be analysed. The loss of knowledge through the lack of analysis inspired the concept of a Health Score, a measurement that assesses an individual‘s health in realtime. For over three years we worked on an algorithm, which, today, is based on more than 80 million person-years of clinical data. At the end of 2012, dacadoo went online in England, Nuffield Health. In 2013, we started a cooperation with AOK in Germany and since 2014, we are known globally through cooperations with Samsung and Swiss Re. We believe that in the near future, health and life insurance companies will use the Health Score to assess costs. Similar to what we see in the automobile sector, when drivers are equipped with a black box.

The Health Score: a measurement in real-time Is the self-quantification trend restricted to people with defined fitness goals? No. Quantification gives answers to health related questions for all people; it is not solely a fitness tool. Our users benefit from the social motivation within the dacadoo network and the

www.XLHEALTH.de/en

connection to social media. They can easily organise small challenges among their friends and family, connect to and participate in groups, and aim for personal goals. Do you see a connection between self-quantification and chronic conditions? In the long run, continuous tracking of several indicators can improve the early diagnosis of chronic conditions. Already now, our Health Score engine could theoretically assist in diagnosing heart problems or diabetes for example, but we are not a medical diagnosis platform. The more data we acquire with dacadoo, the more accurate the Health Score will be. At the moment, the Health Score comprises 100 different data points, collected from approximately 100.000 users. In order to assess an individual‘s risk of developing a chronic condition, we would need to have at least one million users.

Quantification improves early diagnosis What is the role of wearables and smartphones in self-quantification? Currently, more than two billion smartphones are being used worldwide. By the end of 2020, this number is supposed to double. We expect a greater development for wearables and it can be assumed that the number will more than quadruple in an even shorter period of time. By 2018, the number of wearables will have soared from 100 million, to 475 million worldwide.

www.XLHEALTH.de/en

A huge market is evolving around individual health and fitness, opening up for fast and easy self-quantification without complications. However, there is one great disadvantage no wearable or smartphone has solved so far. Users often have to enter their data and interpret the results for themselves. dacadoo tries to create a “navigation system for a healthy life”, by simplifying the process of data analysis and putting the results into perspective. The Health Score offers a real-time indicator for a user‘s health and wellness. It changes immediately when data is added and includes indicators for the physical and emotional well-being, as well as activity, nutrition, stress and sleep.

2018, app. 475 million wearables will be in use Comparing continuous tracking and regular measurements, where do you see the bigger health benefits? If health indicators are being measured regularly, no matter how diligent the tracker is, she or he will not achieve the same level of information, as somebody who uses a tracking device continuously. If a runner measures his indicators at the beginning and the end of a run, he will never have a valid statement on his performance during the run. He will not know about his running behaviour on different surfaces, while running over a hill or how much faster he subconsciously runs, once close to home. Similar to the diagnosis of chronic conditions, a rich data background can help identify and diagnose other illnesses. Take Google as an example,

whose researchers are working on nanoparticles that can be transferred into the blood circulation and there, can work as an early warning system for cancer. The behaviour of these nanoparticles can be influenced and analysed with an app.

Inconsistent measuring can only provide health snapshots

About dacadoo dacadoo offers a comprehensive health engagement solution that enables individuals to track, manage and benchmark their health and well-being in an easy and fun way. Applying the principle of “what you can measure, you can manage”, dacadoo visualizes the current health and well-being of an individual with a personal Health Score, a scientifically calculated number from 1 (low) to 1,000 (high). The score works as an indicator and moves up or down in real-time, depending on the change of body values, emotional wellbeing, and activities (exercise, nutrition and sleep). dacadoo applies motivation techniques from behavioural science and gaming, and uses social dynamics from groups and social networks. www.dacadoo.com

1/2015

DIGITAL HEALTH DIGITAL HEALTH

INSIGHTS INSIGHTS A high-maintenance monster called diabetes

About mySugr mySugr is an Austrian startup founded in 2012 and located in Vienna. Founded by people with diabetes, mySugr creates digital health solutions for diabetes management and education. Their products are characterized by the intelligent combination of design, technology, and medical expertise focused on diabetes. Particularly well-known is mySugr Logbook with more than 200.000 registered users across US and Europe. The company holds an ISO13485 certificate. In Europe and the USA, mySugr Companion is a registered medical device. In March 2015, mySugr secured an investment round of 4.2 million Euro from Roche Ventures (Basel), iSeed Ventures (San Francisco, Beijing) and XLHEALTH (Berlin). This is to date the largest Digital Health investment in the German speaking countries. www.mysugr.com

Diabetes currently affects 387 million people around the world, and the rate of diagnoses is rising. The prevalence and realization of impending fiscal fallout is why we are hearing more about it in mainstream media. What we don’t hear is that there are a few different kinds of diabetes. The two most common types are type 1 and type 2. Type 2 diabetes is a metabolic disorder where the body can’t properly use insulin, and type 1 diabetes is an autoimmune disorder where the body can’t make insulin. The causes are diverse and, to some extent, the treatments are equally diverse, but the goal is the same: the blood sugar has to be monitored and treated constantly. Insulin regulates the amount of sugar in the blood, which has to stay within a minute scope for our body to function. Prior to 1921, when insulin was discovered, type 1 diabetes was a death sentence. Since then, the powerful hormone has allowed diabetics to survive but it requires careful monitoring, since it is influenced by numerous factors.

at times, especially early in diagnosis or when things don’t feel like they are going well. It is easy to experience a sense of failure and it is common to go through periods of burnout which cause dangerous and damaging periods of poor health management. mySugr was created by people who live with diabetes for people with diabetes. We are changing not only how people live with, but also, how they feel about their diabetes and therapy day to day. We believe that our daily needs can be met while providing style, elegance, innovation, beauty, and even fun. We leverage non-traditional approaches to connect devices that are mostly already in use, making life with diabetes about living, less about using things. mySugr has extremely high quality standards in product design, data security, and regulatory compliance (meeting medical decive class IIwb requirements); creating a company that is very unique in the medical device industry. By adding these elements and influencing behavior through game-like usability, mySugr works hard to optimize diabetes therapy and make people with diabetes happier and healthier.

Blood sugar levels have to stay within a tight scope for our body to function

HE ALTH 5

Diabetes is managed almost entirely by the patient. Rather than following the common pattern of doctor‘s visits and treatments, people with diabetes make decisions concerning their medicine, diet, and activity many times a day. It is simultaneously scary and empowering to be in control. The responsibility can be overwhelming

Scott K. Johnson, Communications Lead, USA T1 diabetes since ‘80 mySugr

www.XLHEALTH.de/en

Jennifer Smith from Wisconsin, USA, is a Certified Diabetes Educator who has lived with diabetes since childhood. She is a clinician with Integrated Diabetes Services, the practice owned and operated by Gary Scheiner, author of Think Like a Pancreas and AADE’s 2014 Educator of the Year. “My clients love using the mySugr Logbook because it offers a unique motivational feature: challenges. These motivate them to be more active, test before and after a meal, and to aim for “no hitter” days. It makes a real difference. Even aiming to tame your “diabetes monster” is a challenge and keeps you logging! He cheers for you when you‘ve met a challenge or tells you to eat a snack when you‘ve logged a low BG, etc. It is great to have interaction with a program that helps you keep track of your disease management and makes it fun in the process.”

www.XLHEALTH.de/en

Matthew Deets, from Oregon, USA, was diagnosed with diabetes in 2007.

Ashley Ng, from Victoria, Australia, is a registered dietician who has lived with diabetes since 2009.

“Diabetes logging is important for me, because there are so many details I have to keep track of on a daily basis. mySugr Analysis allows me to see patterns through all of the details so I can make adjustments in my diabetes management. The daily points system and challenges keep me motivated and are fun. I always like to log enough each day to keep my diabetes monster tamed and happy.”

“I really disliked carrying a bloodstained paper logbook around. Then I heard about mySugr Logbook and I love how much fun it is. It is easy to see patterns because of the clear colour coding and the weekly reports. The best thing about mySugr is that it was founded and developed by people with diabetes, so they really understand what people want from diabetes products.” (On her graduation day, Ashley decided to wear her insulin pump using an elastic band, much like a garter belt.)

1/2015

DIGITAL HEALTH DIGITAL HEALTH

INSIGHTS INSIGHTS

Who measures what? An overview of US trackers

About us

69% of adults track their health indicators; roughly half do so regularly

46% of US adults using self-quantification change their overall approach to health

for 40%, tracking leads to new questions at the doctor‘s office

34% of trackers are affected in their decisions about how to best treat their condition

people with two or more chronic conditions track more often (62%) than those without any chronic condition (19%)

This is an overview of self-quantification in the US, the most active country in health related tracking. Source: http://pewinternet.org/reports/2013/ tracking-for-health.aspx; Source icons: ICU monitor, man clinic, tasks, drugs containers, medical doctor, by Freepik is licenced under CC3.0

XLHEALTH is Germany‘s first investor exclusively for Digital Health startups. We provide network access, capital, office space, mentorship and operational support to high-potential entrepreneurs working on outstanding solutions in Digital Health. Following our mission statement: “Digital Health – Made in Germany”, we envision a Digital Health ecosystem in which young companies make a sustainable impact to preserve and improve human health with smart IT solutions. Startups, who share our vision, benefit from our strategic partners and exclusive mentors, including entrepreneurs and professionals in the healthcare system. Moreover, they

grow by the inspiring exchange in our co-working space in Berlin.

Ulli Jendrik Koop, Vorstand / CEO

Guido Hegener, Partner

Min-Sung Kim, Partner

Laura Beyer, Public Relations

XL Health AG Oberwallstraße 10 10117 Berlin Germany T: +49 (0)30-2260 5270 E-Mail: info@xlhealth.de Registered office: Berlin Registration court: Berlin-Charlottenburg HRB 153749 B

We are looking for solution-oriented, clever, product-centric ideas that address consumers in order to improve health and/or solve real problems in healthcare. Products can be in the form of web or mobile apps, services, and may have a hardware or sensor component. We welcome international teams!

Outlook

Digital Health Insights 2/2015 In the upcoming issue of Digital Health Insights (2/2015), we will feature the Polish startup HARIMATA. Pawel Jarmolkowicz, founder of HARIMATA, will give us insights on his vision for childrens’ health care and the technology behind the software. Tackling late diagnosis, HARIMATA turns all mobile devices into health monitors, giving easy access to health, tracking and treatment. The mobile devices detect behavioral

patterns that are signatures for particular disorders or conditions, which thus can be diagnosed earlier. And, because this is a quantification issue, here are some numbers on HARIMATA: • 140 indicators measured • 90% method accuracy

“Within the next years, we will see a transformation in healthcare unlike anything we experienced over the last decades. The digitisation of medical, wellness, fitness and general health issues will lead to a increased self-responsibility in individual and global healthcare. We are looking for entrepreneurs who will work towards this vision together with us.”

• 15 minutes for the results