2015 is poised to be a big year in health care.

Health care tech-reform is really beginning to happen - both internally, in hospitals and through the FDA, and externally, as startups etc. target ailments of people and the healthcare industry alike.

Ultimately, digital health tracking will have profound implications on the way we practice medicine, how we personalize medicine, how patients interact with their doctor, the role of the doctor, etc.

Wearables Today

The metrics we can currently track (via FitBit, FuelBand, etc., but also including those a smart watch can track) are pretty useless, medically. They collect limited, simple, focused measurements. They do not scale, and they don’t play nice with others.

These consumer-focused trackers allow purchasers to get excited about their health (for a little while), but they usually lose interest. FitBit has been witnessing this fact firsthand: the first few times it buzzes letting you know you’ve walked your 10,000 steps, it feels great! After a few months, the fireworks often lead people to leave it in their dresser drawer.

Wearables have not found their killer app. The hype has died down, and while we know it’s coming, we’re not sure what it is yet.

Driving engagement on a long-term (life-time) platform is not easy. Especially when everyone safegaurds their data, and so deriving deeper benefits from it is not possible.

Changing Directions

We are beginning to shed away some in vogue, (in my mind) annoying trends (gamification comes to mind), and become more comfortable with pervasive technology in our life. We expect microsecond interactions, minimal latency, and have fallen in love with data.

Recent trends in these health-tracking wearables have unfortunately seemed to focus less on engagement per se, and more on getting consumers to keep wearing them by positioning them as fashion accessories. Customizability is a manifestation of trying to make these devices personal. Yes, people do need to consistently wear them for wearables to be useful. I think it’s just noise, until we get to a domain of ‘invisibles.’

I’m hoping health-focused wearables instead make good on their intention to track and aggregate data, and actually make it useful.

Wearables Next Year

The most interesting thing about the release of the  Watch was that it was with so lacking of Jobs-esque fanfare - not because it was Tim Cook, but because (I believe) it was intentional. The  Watch is a wearable, data-aggregation platform. As we move toward a real internet of things, tech giants are making their claims at being at the center of it all. And so, the  Watch is a little thick, because it could not skimp on sensors, wireless, connectivity, etc. Apple’s investment hopefully will make tracking health via wearables a socially-acceptable mainstream activity.

With Google Fit and Apple Health, we now two have contenders for meaningful health data dissemination. Google ventures has quadrupled its investment in health care. Political, privacy, and social reservations aside, hopefully they will lead to real sharing of health data. Realistically, I don’t know that that will happen pro bono, but here’s to hoping it doesn’t lead to massive commodification of health data.

Healthcare Corporatization

We’ve already seen the corporatization of hospitals. Few specializations (e.g. Dentistry, Plastics) exist autonomously outside of a hospital system.

Insurance companies have followed a similar trajectory. The marraige of these insurance + hospital conglomerates comes with all the disadvantages of monopolization in any other industry. Like our cable situation, we’re stuck with often subpar insurance - insurance which you must buy, because healthcare costs too much without it. Consumers increasingly purchase plans with high deductibles, so hospitals make their first dollar off consumers. When consumers don’t pay, the hospital (which is likely financed by debt) sees diminished credit worthiness, so incentive to collect only rises.

It is unlikely that these trends will reverse on their own. All the big companies are trying to get into healthcare. Startups are beginning to sell into big pharma. Amazon and Google Shopping will likely make a foray into high-margin healthcare markets.

There are some individuals and coalitions working to democratize healthcare, and especially return patient data to patients. They are wrestling with issues like patient privacy, who owns patient data, etc. These issues will only be magnified when that data can be commodified, and when that data can be used to inform health decisions, and as patients start collecting more data, and more useful data, that goes beyond how many steps they walked.

Deep changes are needed to fight the incentive challenges in health care. Fee-for-service billing and third-party payments lead to the health behemoths we have now. We must fix not only provider incentives, but also patient incentives, which hopefully will happen naturally as variations in pricing become less opaque. Consumer-driven health plans, combining high deductibles with health savings accounts may be one road toward that goal.

In the meantime, I’m just trying to find some big health data sets to play with. There’s genomes available (e.g. ExAC) but we don’t know enough about genomes to do much translational with them, especially beyond SNPs. The few health APIs I’ve come across (e.g. HumanAPI and RunKeeper’s Health Graph) understandably don’t do mass-sharing, and instead allow access to an individual’s health (but don’t really do much beyond Apple and Google’s offerings).

I’m still waiting for cross-patient analytics to connect patients, design treatments, and drive research. And make some graphs :)