The Journal of mHealth Vol 1 issue 2 - 2014

WHAT’S INSIDE

NEWS, REVIEWS, CLINICAL DATA, mHEALTH APPLICATIONS

The

Journal of mHealth The Global Voice of mHealth April 2014 | Volume 1 Issue 2

mHealth...

What Does it Really Mean?

ARTICLES

REVIEWS WS

INTERVIEW

‘Bionic Eye’ Treatment Paving the Way for Artificial Sight

Google Glass: Gl Transformative Technology for Healthcare?

With Peter Ohnemus at dacadoo

Interview with Peter Ohnemus at dacadoo

Interview with Peter Ohnemus at dacadoo This issue sees the first in a series of interviews with leading figures from the world of mHealth. As Digital Healthcare evolves we ask leading CEOs, Clinicians, Industry Innovators, and Developers to share their insight and opinions of the mHealth industry. We ask what it takes to develop, deploy, and integrate successful digital health solutions that have the potential to revolutionise the way in which healthcare is delivered.

As part of our investigation into the ‘Definitions of mHealth’, in this edition, we talk to Peter Ohnemus founder and CEO at dacadoo, a company pioneering the delivery of digital-prevention and lifestyle-navigation platforms.

We ask him to share his experience of developing and bringing to market a leading mobile digital health solution and to provide his thoughts on how the dacadoo model could potentially alter the way in which we all perceive health.

into business process re-engineering, and satellite communications… the last company I built, was Asset4 where we developed a very significant algorithm that was used to rate and benchmark companies based on their water usage, energy usage, legal claims, etc., so really looking for ‘quality’ data on the World’s 4,000 largest public quoted companies.

This taught me a lot about real time information and how to value and rate real time information.”

A serial entrepreneur and leading figure in the field of data-analytics, Peter Ohnemus, founder and CEO at Swissbased dacadoo has made a career developing innovative solutions that collate and analyse large datasets in real time, in order to extract meaningful insight and realise tangible outcomes. Speaking to The Journal of mHealth from the dacadoo headquarters in Zurich Switzerland, Peter shares some of the insights and philosophy that has led to the creation of his latest company.

After selling Asset4 to Thompson Reuters in 2009, Peter chose to apply his considerable knowledge and expertise of real-time data analytics to the growing sector of mhealth and related lifestyle management, the result of which has been dacadoo.

“I have been in high-tech all my life having been involved with four [different] companies that went public, and always dealing with big data.” Peter tells us. “I originally sold IBM mainframes, before moving to build Sybase, a database company, in Europe. I then went

“After I sold Asset4 to Thompson Reuters I started thinking about what I would like to do next? I have five daughters myself and I was concerned about people not moving. When I mean moving, [I mean] keeping an overall active lifestyle and so I began to wonder that if there could be a way where you can show people their health in an easy, understandable, way then you would have something that people can navigate within their life. If you then combine that with what we call “SoLoMo”

(Social, Local, and Mobile), then you have something very powerful, because you can follow people’s lives in real time on a smartphone.” “… We have more people dying now of sitting than of smoking. Obesity in America is clearly defined as a disease by the American Medical Association (AMA) and in an article published by The New England Journal of Medicine it has been suggested that one of the most important parts of ‘Obamacare’ is the provision under paragraph 2705 of the Patient Protection and Affordable Care Act (ACA) where companies can reserve 30% of their overall healthcare spending for digital prevention and lifestyle navigation… Being an entrepreneur all my life I believe instead of just watching and complaining, that you do something about it!”

Staying true to those original convictions, in a relatively short period of time Peter has managed, along with the team at dacadoo, to develop, and deploy an extremely innovative platform that has already proven itself to have the potential to significantly alter the way in which we perceive and manage our individual health. The result of this Continued on page 38

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Interview with Peter Ohnemus at dacadoo Continued from page 37

innovation is an easy-to-use, wireless, secure and fun way to manage personal health and fitness from a lifestyle and wellness perspective called the ‘dacadoo Health Score Platform’. The platform calculates an individual’s personal dacadoo Health Score, a number from 1 (poor) to 1,000 (excellent), and this becomes a directional relative indicator of your current health and fitness sta-

tus in real time. By integrating gaming and social networking principles, dacadoo motivates users to be active in an easy way by automatically tracking and comparing their personal health, fitness and lifestyle. The platform is available across a whole range of devices, allowing it to be fully integrated into an individual’s daily life.

Peter describes the foundation for the Health Score, “For 500 years medicine has been based on what we call Da Vinci’s lifestyle model, which consists of who you are, how you feel, and how you live, and that is how we have created the Health Score” This concept has been directly incorporated into the system so that an individual can input hard data such as age, gender, weight, height, body dimensions, blood values and blood pressure.

They can then also record emotions, using a quality of life questionnaire, and finally, they can capture activity data such as physical activity, nutrition/ food, stress, sleep and daily steps. The company have collated over 80 million people years of clinical data that has been used to define and construct the Health Score Platform, and upon which the complex algorithm

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for calculating the score is based. This has been done with numerous strategic partners from around the world, such as Nuffield Health in England, and AOK in Germany.

Peter tells us, “We have created something called ‘Instant Health Scoring’, where instead of [users] completing a lot of complicated questionnaires and filling out who knows what, if you provide your gender, your height,

some fresh air!”

“The whole idea is of course that we want to keep you fit and happy and we have invented something we are proud of that we think is a good terminology which we call the ‘REF factor’. This stands for ‘Relevant’ to your life, ‘Easy’ to understand, and ‘Fun’. The more REF factor, the more successful the overall m-health platform!”

All of these factors help to keep users engaged and interested in investing time to work with their individual score. Users can share their outcomes via social media channels, or compete against friends and family, who can in turn make suggestions to help them meet specific goals.

your weight, and your age, we can provide an instant Health Score using the underlying 80 million people years of clinical data. We can give you a Health Score “on the fly” and then you can invite your friends [to share your health activity], or you can compete with your work colleagues based upon your Health Score. Basically, your Health Score becomes a real time proxy of your effective health and wellbeing.”

“We have normalised the Health Score for age and gender, so that everyone can relate to it and compare the same way, which basically means that my 12-yearold daughter can actually benchmark herself against my 78-year-old father.”

Peter describes how these features have been incorporated into the system and the plans for the future, “Our core business is the Health Score and then the second part of our business is based upon lifestyle navigation. We have built what we call the “Feedback Loop”, which is our own avatar called ‘Q’, which of course comes from James Bond. Let’s say that you normally walk 5,000 to 10,000 steps a day and then there are 3 days when you have not walked, then suddenly your smartphone will talk to you and say “hello, haven’t you been out walking? I need

The corporate health and wellness market offers significant opportunities for the dacadoo platform, and the company is rapidly gaining recognition and acceptance within this sector.

The unique nature of the Health Score allows companies to track employee activity and encourage competition between different groups within an organisation. This enables corporate users to easily monitor the overall health of their staff, and identify any areas for concern.

Peter describes how this works in practise, “We sell mostly into corporations, so let’s say that you have a big British pharmaceutical company, they could have different groups [set up] so that the marketing department would be competing against the sales department or the manufacturing [department] against the R&D department. We have over 115 different activity styles supported by the system, and we measure in real time the amount of energy you burn in METs, the metabolic equivalent of a task. Afterwards we then work that into calories by adding your weight information.”

By providing an ecosystem for monitoring health within an organisation and across departments, not only can

Interview with Peter Ohnemus at dacadoo employers monitor the overall general health and wellbeing of the employees, using a quantifiable method of analysis, they can also begin to extract meaningful insights from the data. By incorporating a social aspect then it becomes engaging for those involved and helps encourage positive lifestyle management.

Peter describes how this is a phenomena that is becoming widely accepted across the medical arena. “…If you look at the healthcare sector generally there is something called the Hawthorne Effect. Hawthorne was a town in America where they put 1,500 people on diets and asked them to share their daily activity and their daily nutrition consumption. They then took 1,500 people and told them to do exactly the same but that they didn’t have to share with anyone. To keep a long story short, the ones that had to share what they were doing, about what they were eating, where they were walking, etc. lost the weight three times faster than the people that were doing the exercise with no social interaction.”

“You can punish people, you can put pictures of dead people on tobacco packages and they will still smoke. If somebody wants to smoke they will smoke! If somebody wants to be an alcoholic then they will be an alcoholic!

I personally believe that you need to work with happiness and relevance like the REF factor and then of course also give people economic incentives.”

This concept of personal motivation is definitely something that underlies the dacadoo philosophy. Without an individual wanting to undertake physical activity or take steps to lead a healthier lifestyle then there is little chance of them actually achieving any significant progress. By integrating health into everyday life, making it something that can be fun, rewarding achievement and encouraging engagement via social interaction and financial incentive, then it becomes more likely that an individual will take greater personal respon-

sibility for their own health and wellbeing.

In order to make the platform integrate easily with people’s lifestyles the company has gone to great lengths to ensure that the system can be used with a wide variety of monitoring devices.

“We have integrated over 35 different vendors of bio-sensors, e.g. Jawbone, Fitbit, etc.” tells Peter. “But, at the end of the day it is not about the device, it is really about building in a fun factor. That you create challenges, that you provide prizes that people can win, or that you give them achievements, and personal recognition… we have levels, you have personal activity achievements, or you have ‘Q’ serving in on personal lifestyle issues.”

Peter and his team are themselves proof of the benefits that the system can deliver. “I use the Health Score every day! I have stopped smoking!

Our CTO has lost 80 pounds using the platform.”

The simplicity of the execution that is the Health Score is testament to the power of the concept that the dacadoo team have created. Beneath the customer facing ‘outcome’ is an extremely complex set of data driven algorithms and an integrated data analysis engine, the potential for which is far reaching.

By monitoring and analysing health data in real time dacadoo has managed to create a quantifiable method of benchmarking health. The Health Score changes in real time depending upon a variety of factors from levels of activity to your dietary intake, providing the user with actionable data on their immediate relative health.

Peter states that, “What we have built mathematically is definitely state of the art.”

As the company takes on more users, who generate data, then this is anonymised and used to feedback into the system, thus over time making it more intuitive.

“We are going to have millions of users.

Users give us feedback so at the end of the day the social graph and the distribution of the system just make the system more and more powerful.”

The Health Score has potential far beyond the individual consumer, and the company is rapidly building a range of business models that all rely upon a benchmarked outcome.

Peter explains how this works, “We have done something that we call ‘Health Score Indexing’ where we can actually create a zip code based Health Score. There is a huge difference between health in different regions across a country or across the EU. We are currently in talks with government organisations, talking about how we could improve the overall average health across regions such as Europe and how we could have an outcome that is benchmark-able.”

“If you think about it, if you cannot measure something, then how can you manage it? So we give it an outcome!

Let’s say that the Health Score in Leeds (England) was 521 but that the Health Score in central London was 610 then you have a very clear evidence of the Continued on page 40

The Journal of mHealth

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Interview with Peter Ohnemus at dacadoo Continued from page 39

fact that there are worse health outcomes in Leeds than in London.”

“We can also create Health Scores on the fly. We can receive complete medical histories and anonymously create a Health Score for 10,000, or 100,000, or millions of users… this becomes very powerful because you can create a departmental Health Score, or a zip code Health Score which does not only give you the score but it actually also tells you where are the related issues without mentioning any employees [or individuals], because everything is done anonymously.” dacadoo has seen significant global growth in the short time the Health Score product has been available. The company has a number of high-value, high-growth markets that they are looking to target with the Health Score, not least the possibilities for revolutionising the way in which we value health in association with insurance.

“I think that people really see that the Health Score [as something that]: First, gives you a hardware, software, and content agnostic profiling and real time scoring system; Second, mixes this with the fun factor of gamification: and, Third, which is very significant, we are working with some of the world’s leading insurance companies as they start integrating the Health Score into their overall pricing, so if your Health Score improves over time you will actually have a lower health insurance premium”.

This proposition has very significant possibilities for the future ways in which insurance policies are valued.

We have already seen ‘driver behaviour models’ incorporated into motoring insurance policies, whereby the insurance provider can analyse the manner in which you drive, and then make adjustments to your policy based upon the results. To apply a similar model to health insurance poli-

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April 2014

cies, using the dacadoo Health Score as the benchmark for analysing health and well-being is fairly ground-breaking.

Peter believes that this will be the way we can expect to value health insurance in the not so distant future, “In the future I believe if someone is living healthy and moving around then they will actually get a better price for their insurance.”

Discussing the company’s wider business model, it becomes apparent that the Health Score has the potential to be disruptive across a significant number of large markets. Peter describes how in a relatively short period of time dacadoo has already made a substantial impression on many of these target industries.

“We see very strong interest from large employers. That is definitely our core market. All large companies must check the health of their employees once a year, maybe they buy them a fitness program or something similar, but with dacadoo you actually see the health of the employees in real time. Of course

all the data is anonymised so that the employer cannot see that Mr. Smith has a Health Score of 200 or 800, but you can see the average Health Score of all marketing employees, or the average Health Score of all the people in the factory, etc.”

“Our key strategy is to work with what I would call the industry highways for our distribution... Around our industry you have an ecosystem of 3-4 key industries and we are pushing those and supporting those very dynamically with the Health Score.”

This business model seems to be working extremely effectively, with the company seeing rapid market penetration despite being at a relatively early stage of its evolution. This is reflected in the significant number of subscribers that the company has amassed from around the world.

“In England we work very closely with Nuffield Health who have a large number of corporate clients, they also have hundreds of thousands of fitness club members. In Germany we work with

Interview with Peter Ohnemus at dacadoo AOK. America is the biggest market for us. We work with a very large health organisation, which has not been announced yet, but is a very significant organisation with over 80 million clients. We work with partners in Russia, we just signed a deal with a health provider in Brazil, and we are also in Australia. Last year we finished the year with about 100,000 paying users which make us ones of the largest mhealth operators in the world, and I would say that within the next 24 months we will have over a million paying users alone in the corporate world.”

The infrastructure behind dacadoo is state-of-the-art, with the company aiming to protect personal health data with the strongest possible security and encryption techniques. To this end they have built their security protocols from the ground up. Where many digital health providers have relatively weak security infrastructure, Peter believes that health data should be protected in a similar manner to financial and banking data.

“You can hack any health app within half an hour, trust me and get all the data that you want and that is not the business we want to be in. We did not build security as an accident or afterwards said, ‘Oh we also need this’ we really designed dacadoo from the ground up using our 25 years of deep data experience. Hiring four of the world’s leading professors we have a very strong academic advisory board challenging the Health Score every quarter. It has cost us a fortune to do everything but we have done it, in the most professional way.”

“We have a huge data centre run on HP blade servers so that we can calculate everything in real time. That is based in Switzerland, in a nuclear-safe data centre, in the middle of the Alps. We encrypt all data, we segregate all data, meaning that the physical blood pressure of Mr. Smith is data segregated so that if someone were to run into our data centre and steal an HP server they

would come home with a server where it would say 80-120, 90-130, but you wouldn’t have a name from any individual because the affected blood pressure would be segregated from the person’s identity”.

“Your health data is one of the highest value assets that you have and I am a big believer in privacy and providing people with a level of privacy. If you are sick or healthy I think your private data is your private data. [Which is why] we don’t do any advertising on the platform, we don’t license any data to anyone, it is solely used in anonymous ways to improve the overall algorithm.”

For Peter the wider topic of mHealth is one that is close to his heart and he is regularly asked to provide commentary on the state of the industry: “For me, the definition of mHealth is: That firstly, your health doesn’t become static, and secondly that you can benchmark and track your health wherever you are.”

“In today’s world, which is still the analog world for most people, the first place [for healthcare] is the doctor, the second place is the hospital, and the third place is your private home or where you happen to be. And in today’s world, if you go to the doctor you create expenses anywhere from $200 to $500, or Euros, or if you go to the hospital you create expenses per day, which can be from $2,000 to $3,000, or Euros, or more, per day in the hospital.

Now if we can provide a way to have your healthcare follow you, where you happen to be (meaning the third place) and at the same time take out 50% of the expense, then I think that we will have a very successful industry.”

“There are two examples I can give: Number one is for ECG. If you buy a 2/4/8-channel ECG in a hospital, that equipment could very easily cost anywhere from $5,000 to $10,000 dollars.

Today you can buy a 2-channel ECG that you can attach to the cover of your

smartphone for just $100. Now [if you can] take that down to less than $25 by having a Wi-Fi enabled patch that you put next to your heart to get complete 24/7 observation of your heart, then that for me is an incredible breakthrough.”

“Another example would be in skin cancer areas, where I can take a picture with my iPhone and upload it to the doctor instead of going to the hospital where they would need to take photos and have specialist consultations. There are now platforms, who have trained dermatologists that will evaluate the picture of your skin, and they will charge something like 30 Euros instead of the 300-400 Euros that you would normally pay to visit the doctor.”

“These are just two concrete examples where with very little pain you can gain up to 90% savings. Going forward this is just the beginning; being an entrepreneur I personally believe we have seen nothing in mobile health! I think mobile health means that it is with me 24 hours a day, wherever I want to be and that it is convenient.”

The unique nature of the dacadoo Health Score has meant that the company has won or been nominated for a considerable number of industry awards. In the UK the company have produced the Nuffield Health Score as a white label platform and this has now been nominated for Health Innovation of the Year 2014. The company have also won the German Health Media Award in 2013, the Swiss ICT Award, and have recently been announced as one of the winners of the Red Herring Top 100 Europe Awards 2014 as well. These successes are likely to continue as the dacadoo platform grows in global popularity and application.

May we take this opportunity to thank Peter Ohnemus for his time and for sharing his thoughts and opinions with The Journal of mHealth. For more information about the dacadoo platform, please visit: www.dacadoo.com. 

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INDUSTRY NEWS News and Information for Digital Health Professionals

dacadoo Health Score Application Now Available for New Samsung Gear 2 ‘dacadoo’ have announced that their innovative and award winning Health Score Platform is now available for the new Samsung Gear 2. Launched at the Mobile World Congress in Barcelona, the next generation Samsung Gear 2 will come pre-installed with the dacadoo Health Score application.

The dacadoo application is optimised for the Samsung Gear 2 as a mini version of its comprehensive dacadoo health and wellbeing platform. With the dacadoo app, users will be able to see their personalised Health Score, an overall measure of health and well-being, based on their body metrics, lifestyle and activity.

Peter Ohnemus, President and CEO of dacadoo AG, shared: “dacadoo is very proud to announce this major partnership with Samsung Electronics, the leading worldwide producer of mobile wireless devices.

Bringing the dacadoo mini-application onto the new Samsung Gear 2, we expect to increase the visibility of the dacadoo Health Score concept worldwide”.

The dacadoo Health Score web platform and the dacadoo mobile applications enable people to track, document and benchmark their health and wellbeing in real-time in an easy and fun way. dacadoo gives users a personal Health Score from 1 (low) to 1,000 (high), which moves up or down depending on how the body, emotional wellbeing, and activ-

8 April 2014

ities (exercise, nutrition, stress and sleep) change.

The Health Score is based on “big data” with several tens of millions of personyears of clinical data and incorporates many of the well-known cardio cerebrovascular risk studies and quality of life assessment tools. dacadoo systematically applies techniques from the gaming industry, group dynamics from social networks and provides relevant lifestyle feedback to users to engage and motivate them to use the Health Score Platform regularly and thereby adopt a healthier lifestyle.

More information can be found at: www.dacadoo.com 