8. Digital is transforming the world
“Re-imagination of nearly
everything powered by
New Devices +
Connectivity + UI +
Beauty.”
Mary Meeker of KPCB
Confidential
Page
8
9. Digital and mobile disruption
Finance
Education
Telecom
The medical sector is a
prime example of this.
Traditional industry verticals are
often inward-looking.
The disruption starts from a
broader consumer-led domain.
Retail
Medical
Mary Meeker estimates
the ‘re-invention’ market
impacted to have a
turnover of over $35tn.
Confidential
Page
9
10. An aging population
Percentage of people 65
years or older in the EU
As the workforce
decreases, there is
18%
less income
By 2060 the share will be
30%
for society while
healthcare costs
increase
Confidential
Page 10
11. Bad lifestyles
& chronic disease
1
Billion
300
Million
50%
increase
of the world’s
population is
overweight
of these 1 billion are
clinically obese
in diabetes in the UK
in the last 5 years
Confidential
Page 11
12. Age impacts what we care about
25
50
75
Look better
Live healthier
Prevent disease
Treat disease
Confidential
Page 12
13. Quantification for everyone
The world of logging apps and sensor-enabled
devices is looking to the mainstream, and the
pursuit of well-being for everyone.
Confidential
Page 13
15. The wrist is the next frontier
Funding for smartwatches is surging. MetaWatch
and TouchWatch are funded, and Pebble raised a
record $10M on Kickstarter. However, there is still a
quest for the killer app. The Fuelband is liked, but
many complain about inaccuracy.
Confidential
Page 15
16. Open wellness platforms emerge
Data siloes are a problem for people and
healthcare professionals alike.
Open activity collection platforms are
seeing the daylight. Fluxtream and Health
Graph allow users to both read and write.
Withings has a new wellness coach that
aggregates a range of services and
sensors from Zeo to Bodymedia.
Qualcomm Life is also moving towards
aggregation.
Confidential
Page 16
22. The living services wave
CHARACTERISTICS
ENABLERS
Shaped around the individual
• A fast-growing range of
devices and sensors
•
Each person's service
experience is unique
•
Deep customization,
at scale
• Faster and cheaper data
transfer through networks
• Cloud ubiquity
• Context-sensing
Constantly evolving
• Natural interfaces
•
Self-learning and adaptive
•
Data used intelligently
and in real time
• Sophisticated identity &
privacy solutions
Confidential
Page 22
25. Key to success:
Elegant simplicity
Everything can be re-thought,
simplified, and improved. Even
things we’ve taken for granted all
our lives.
The X-Beam™ offers a new
definitive design for wrenches – it’s
simply better.
Simply by rotating the two ends
90˚ the grip is improved, offering
500% increase in surface contact
area and applying 25% more force.
The X-Beam™ is always easy to pick
up from a flat surface.
Confidential
Page 25
34. The chart fatigue challenge
For people who start monitoring themselves, initially the
raw data is interesting. But the novelty wears off. When
you need to move from achieving a goal to maintaining a
level, chart fatigue easily kicks in.
Confidential
Page 34
36. The risk of a doctor–patient gap
DOCTOR
PATIENT
Most healthcare
professionals have not
adopted new digital
tools at work. At the
same time people’s
expectations are
changing.
Confidential
Page 36
38. Raw data is not sufficient
WISDOM
Context
KNOWLEDGE
Understanding
principles
INFORMATION
Understanding
patterns
DATA
Understanding
relations
Understanding
Confidential
Page 38
41. Challenges with wearables
Body sensors are easy to lose
Apps and devices
require constant power
Malfunctioning hardware
Proprietary software and data
Confidential
Page 41
42. Sensors get
lost and washed
One drawback of wearable sensors that
are clipped onto our clothes is that we
tend to forget them, lose them, or destroy
them in the laundry machine.
Sensors that are worn on your skin or are
embedded in the smartphone are less
likely to be lost or forgotten.
Confidential
Page 42
43. Good data
visualization is critical
The age of Big Data is upon us,
particularly for health and wellness.
The challenge is in making the data
meaningful and actionable.
Confidential
Page 43
44. Some needs are universal
“In the 19th century health was
transformed by clean and clear water.
In the 21st century health will be
transformed by clean, clear knowledge.”
Sir Muir Gray
Confidential
Page 44
An aging population is putting a massive strain on Western societies. It’s a huge structural issue. A huge group of pensioners with long-term illnesses is a growing problem.
In future elderly people will account for an increasing share of the population
People aged 65 years or over will account for almost 30.0 % of the EU’s population by 2060 (in 2010 17,4 %)
Long term health conditions (LCTs) such as diabetes, heart disease and COPD (chronic obstructive pulmonary disease) will rise in Europe from currently 53 billion to 64 billion in 2025.
The workforce declines, while the healthcare system – and the costs – is growing
Poor lifestyle choices that lead to various chronic problems and diseases is also a huge structural problem for society.
More than 1 billion people in the world are overweight, and at least 300 million of those are clinically obese
More than 8 % of the U.S. population have diabetes
(estimated 79 million U.S. adults have pre-diabetes)
In 2010 almost 2 million new cases of diabetes were diagnosed in people aged 20 years or older
(In UK has been a 50 % increase in diabetes in the past 5 years, costing the National Health Service almost a tenth of its total budget in treatment)
Medical expenses for a person with diagnosed diabetes are more than twice as much as the expenses of a person without diabetes
People try to take a better care of themselves but still the obesity keeps rising in numbers (Knowledge makes us think, but not act)
As you grow up / grow old, you add new health- and wellness-related priorities. Naturally this graph is not universally applicable – for example there are many kids with serious illnesses – but it’s important for us as designers to recognise the fact that the primary drivers change and evolve over time.
Young people don’t typically worry about the future so much, and about potential future illnesses. Many of them don’t really care about healthy living either. Their focus is on looking good and getting laid. But over time, as people go through different life stages, they start to pay attention to new dimensions, and start to spend time and effort in addressing them.
It’s increasingly easy and affordable for individuals to detect and get info about various different aspects of themselves. This ‘quantified self’ trend is gathering momentum, and it’s evident across various consumer categories. For example:
Sports: Nike+ in shes, in the FuelBand, with Adidas MiCoach, with Endomondo, SportsTracker, RunKeeper, Suunto, Polar, FitBit, etc.
Well-being: Withings scales, Jawbone UP (monitors sleep patterns too), etc.
In people’s smartphones there are also a lot of sensors, and there are numerous apps that can give you stats based on the movement of your smartphone and you.
The mass-market habit of quantifying oneself is starting to build in the West.
Increasingly, consumer devices and services are also starting to play a role within the more specialist core of H&W.
Powerful, reliable new sensor technologies are increasingly available to consumers and are being adopted through devices like smart phones or wearables.
One example is the ECG (electro cardio gram) technology. Now one can buy an iPhone ‘sleeve’ with heart rate sensors.
When the price of specialist technology like ECG goes down, and as the ECG availability moves from the hospital to everyone, it has the potential to change a lot.
Using one of these ECG iPhone readers, the Doctor and mHealth guru Eric Topol saved a person’s life on board a passenger plane when he used one of these devices to correctly diagnose a massive heart attack. The patient still lives.
The iPhone and other smartphones have shrunk and moved the computer to the pocket.
The next frontier in miniaturization will be to move the computer to the wrist.
Just like the smartphone used to have a strong umbilical cord that connected it to the old digital hub – the laptop – it will be important for smart watches to connect well with the new digital hub – the smartphone. The smartphone will have better text input, more screen space, better data connectivity, etc. The smartphone and the wrist-worn devices will be in symbiosis, at least in the beginning of this revolution.
Currently people-related data is typically captured and kept in silos of individual services or the siloes of the healthcare system.
One of the biggest data needs in H&W is to enable the data captured to be cross-pollinated and used in many places.
Open platforms will become key, and the trend is moving in that direction.
There are numerous regulatory and privacy matters to overcome, but until H&W data can be set free, its effects on society will remain limited.
In digital services, we can see a few waves of transformation. The first one was about the desktop web. It was the first digital service wave that really disrupted and challenged traditional businesses. The wave started growing in the early 90s, and hit the commercial mainstream in the second half of the decade. Internet services – which were conceived in this wave – are still powering the digital economy.
In digital services, we can see a few waves of transformation. The first one was about the desktop web. It was the first digital service wave that really disrupted and challenged traditional businesses. The wave started growing in the early 90s, and hit the commercial mainstream in the second half of the decade. Internet services – which were conceived in this wave – are still powering the digital economy.
In digital services, we can see a few waves of transformation. The first one was about the desktop web. It was the first digital service wave that really disrupted and challenged traditional businesses. The wave started growing in the early 90s, and hit the commercial mainstream in the second half of the decade. Internet services – which were conceived in this wave – are still powering the digital economy.
In digital services, we can see a few waves of transformation. The first one was about the desktop web. It was the first digital service wave that really disrupted and challenged traditional businesses. The wave started growing in the early 90s, and hit the commercial mainstream in the second half of the decade. Internet services – which were conceived in this wave – are still powering the digital economy.
The next big wave – living services – is enabled by an ever-growing range of digital devices that are connected to each other and/or the Internet. These devices also have various sensors, and this will allow the capturing and analysis of huge amounts of data – often in real time.
This digital platform allows us to imagine and design services that are living.
The services themselves can be constantly alive, flexing, adopting, and changing. So we will not design dead artifacts – we will design highly fluid entities.
The services can be created around individuals to a greater degree than ever before. They can be uniquely tailor made for each person, and can change based on time of day, place, user needs, etc.
The services can start to make use of more natural interfaces. Instead of being limited to a mouse or a finger tap, the services can work with voice, with gestures in thin air, and can react and change based on wearable body sensors or other inputs. This is a great design challenge – to shape the next language for the digital world.
This next stage of digitization represents the gradual merger of the digital and real world.
As digital is meeting H&W, as a species, we’re evolving. From the humans we know today…
…to Homo Cumulus, a technically enhanced physical and mental ecosystem.
Our bodies and our gadgets (some of which are worn) will contain more and more sensors, and we can capture every aspect of our body and mind with ever more accuracy.
This data is connected to the cloud (Cumulus) where it is analysed, compared, and utilised in clever ways. Smart algorithms will make predicitions, risk analysis, suggest optimisation, etc. The data collected will also be shared in appropriate ways with other services and environments that are related to the body ecosystem: our car, our home, our fridge, the world…
To make improvements in H&W, people need to break bad habits, and need to start new better habits. Behavioural change sounds easy, but is one of the hardest things to accomplish. Just ask anyone who has ever made a New Year’s resolution :-)
An important aspect of prevention through behavioural change is establishing rituals or habits. The medical domain enjoying most success in this are is probably dentistry. Kids are taught from an early age about the importance of regular brushing, and the combination of this activity with getting up and going to bed routines has ingrained it into our daily lives.
Rituals come in different flavours. While there are daily rituals like tooth brushing, there are less frequent health related rituals like having your blood picture done once a year. The lower the frequency, the harder it is to remember and keep doing it. Again, dentistry is a good example since in many cases patients are actively reminded of such less frequent check-ups through postcards or reminder emails.
Introducing new rituals is very complex, however. In the case of tooth brushing, it involves components like understanding of consequences (for example in the form of pictures and stories about what might happen to one’s teeth, or fear of going to the dentist and therefore doing anything to prevent that) and enforcement (like parents making their children brush their teeth)
Fjord has identified a shortcoming with the current services: one that we call ‘Chart Fatigue’.
While some of the current products are effectively motivating users to be more active and help them achieving a goal, the excitement and interest generated by self-measurement quickly wears off.
This is a design challenge. These services need to move from a focus on helping to achieve to a focus on helping to maintain.
As ePatient David deBronkart puts it, “the patient is the most underused resource in medicine today.” The healthcare industry treats symptoms, and is highly specialised, which leads to information not flowing well between the industry silos. The dialogue with the patient is often fragmented or no-existent. It’s a massive lost opportunity.
While self quantification and digital information are very positive development for users, Fjord’s research indicates that this is today still largely ignored or even discouraged by the professional medical space.
Doctors need to embrace this development. There is a major opportunity for services that can bridge the gap between the professionals and the people; between doctor and patient.
This should lead to services that fulfil the requirements and current shortcomings seen by the professional space, while still offering the advantages of social networking and knowledge exchange.
Turning raw data into something meaningful is one of the primary challenges. Most of the current wearable wristband devices and other tracking products and services are little more than aids for data collection and visualisation.
As the information hierarchy suggests, from data comes information, leading to knowledge and then finally wisdom. At the moment, it is down to the user to take even that first step.
Fjord believes this shortcoming can be overcome with service design. A perfect example of an improvement is the way Wired magazine redesigned the blood test results sheet. By visually putting the results in context of health averages, something the doctor would normally do in a verbal consultation, the user is able to gain a better understanding from the raw data.
Fjord believes this shortcoming can be overcome with service design. A perfect example of an improvement is the way Wired magazine redesigned the blood test results sheet. By visually putting the results in context of health averages, something the doctor would normally do in a verbal consultation, the user is able to gain a better understanding from the raw data.
We seems to wash and loose a lot of sensors in the early days of quantified self, this is a common problem with the FitBit.
Sensors that are embedded in clothing are still lab stuff, or alternatively used in high performance sports only.
Data visualisation will be key to make data understandable, and also glanceable. The visualisation should not be merely pretty, but also understandable and actionable. As data and info constantly increases but our bandwidth remains the same, better ways to quickly glance and understand dynamics, patterns, and information, will be key.
The visual on the left is a dynamic visualisation of the various purported health benefits of the health supplements on offer, their popularity and their effectiveness at actually helping. See it here: http://www.informationisbeautiful.net/play/snake-oil-supplements/
The data visualisation in the middle is from Withings, and it uses simple visuals to help better communicate some simple statistics.
The visuals on the right are from Nike’s Fuel-band service. Nike has worked hard on data visualisation – both on the hardware itself with LED text & numbers, and with coloured light strips, and in the digital user interfaces, like on the iPhone screen shown here, which shows the ‘fuel’ burned compared to the daily target of the user.
Everyone can benefit from better knowledge and more information about themselves, their bodies, and their minds. Not everyone chooses to ACT on the information, but having access to it can be transformative.
Increasingly, as we’ll see later on in the presentation, technology is making information and knowledge available.