Fred Trotter, co-author of O’Reilly’s Meaningful Use and Beyond, is diving in head first into the quantified self movement, and for good reason: Quantified self and Meaningful Use are becoming meaningfully connected.
On the surface, the areas of Meaningful Use and quantified self may seem far apart: one’s a government-run incentive program to enable health IT and the other has the appearance of a self-improvement program for data hungry geeks, but they are part of a broad spectrum related to relevant data, architectures and patient engagement that will be needed to fulfill the triple aim. This was clear during two very different, but equally compelling, conferences during the week of July 16 that built on this theme, OSCON and Healthcare Unbound.
If you’re not familiar with the term quantified self, it means measuring and providing feedback on things you can measure about yourself. Wikipedia states, quantified self is “a movement to incorporate technology into data acquisition on aspects of a person’s daily life in terms of inputs (e.g., food consumed, quality of surrounding air), states (mood, arousal, blood oxygen levels), and performance (mental and physical).”
Quantified self “technologies” could be a notebook or spreadsheet where you track your weight or glucose levels over time, or it could be an app that logs your location and speed with a smart phone or GPS. Like much consumer-driven technology, it’s quickly becoming transparent, automated and connected through mobile phones or connected devices such as WiFi scales and blood pressure monitors like Withings. On mobile phones, apps like RunKeeper, and devices like FitBit measure where you go, how long it takes you and allows you to share that info with friends or competitors.
Name a sensor that can measure something about someone and it will likely be attached to the larger system through the Internet of Things. Soon, just about anything that can be quantified about us will be, and it will be connected.
Why are things headed in this direction? A full spectrum of health data.
I had a chance at OSCON to meet with Fred, hear an interview and sit in on his talk on Hacking Yourself: Hard Core Behavior Change. After OSCON, I was able to attend Healhthcare Unbound and see a talk (among several others phenomenal talks) by National Coordinator for Health Information, Dr. Farzad Mostashari, and see where Meaningful Use may be headed.
It was clear from Fred, Farzad and several other luminary speakers at both conferences that we’re entering an era, through payment reform and Meaningful Use, where truly fundamental shifts are taking place around how data is collected, how systems are architected and how patients are engaged as each of these elements relate to the triple aim of health care.
We’re in the process of building a full spectrum of data, with Meaningful Use as a foundation, from genomics to EHRs to quantified self apps that will seek what health truly means, and how we can improve it, all centered around patients/consumers. Bottom line: Health data will be like a computer without an internet connection. If it’s not connected, it’s not very valuable by any order of magnitude.
Quantified Self Meets Meaningful Use
It was central to most, if not all of the speakers that quantified self and its close cousin, behavior change, are where we have to take health data to achieve the triple aim. Farzad alluded to this when he said “Meaningful Use is foundational”, that providers, under payment reform (another key tool to achieve the triple aim) would quickly become responsible and care about all patients. “For the first time, providers are becoming concerned with those that haven’t yet come through the door,” he said.
We need to keep them healthy so they don’t come through the door, and quantified, connected information about patients that is engaged with the larger system is where quantified self meets Meaningful Use.
Recall that quantified self means “data acquisition on aspects of a person’s daily life.” It’s in people’s daily lives that we must measure and use these measures to improve care and help people make better decisions through feedback, incentives, and the lessons from behavioral economics. But they are quickly merging into a spectrum of health data collection focused on individuals and consumers, and that will likely mean more consumer-focused architectures. We’re moving from Meaningful Use as one part of the foundation for quantified us.
The more data you can connect, the more interesting questions we can ask it. To maximize value, we’ll need a complete spectrum of data from genomics to health records to quantified self data. Ideally, it will be all a part of the same, connected data set.
An overarching theme from both conferences is that the fee-for-service healthcare model is dead, or at least broadly unsustainable, and healthcare is shifting rapidly to pay for quality. The themes of patient engagement, usability and user experience, self-tracking, and exchanging health information are all part of the changes that will be required to complete this picture. There was evidence on display at Healthcare Unbound that the companies who understand the aspects of engagement, such as user experience, have a critical advantage in the marketplace. This mindset, a cornerstone of Silicon Valley thinking for a couple of years in relation to consumer-facing technologies, will become ever more important as health care moves towards a consumer-centered marketplace. This point was reiterated in several panels at Healthcare Unbound, including senior leaders from HealthTap, Massive Health, Practice Fusion, Kaiser Permanente, Intel-GE, Humana and many, many others.
Data, Quantification, Behavior and Risk
Quantification in general, and quantified self in particular, are not just developing data for a baseline for improvement or learning, but measurement as a part of driving incentives for behavior change. It remains unclear how much behavior change can actually be influenced, but it’s very early.
Progressive offers chips that can go in your car that will provide you with discounts based on your driving habits.
I haven’t yet seen a health insurance company offer a FitBit to provide discounts for our movement habits (and insurers at Healthcare Unbound seemed cool on the idea), but I’m guessing the day when that happens is not far away.
We know that games and measures work in a variety of realms for behavior change, and although often dismissed, money does motivate. Our economy is built on this simple concept.
Think of quantified self as enabling a wide range of games and enabling gamification because now we we can “keep score” on just about everything, through sensors and ever-present engagement with technology. Gamification is not a new concept, As Fred Trotter said during OSCON: “tennis and soccer are the gamification of running.”
Quantifying and gamifying must, ultimately, find a way to enable behavior change. That’s where some very interesting things will be happening. Insurers, providers and all the thought leaders who spoke and attended Healthcare Unbound seemed to understand this simple idea: If data can’t help individuals take responsibility for their own long term health and behavior change through changing motivation, it won’t work.
Population health still starts with the individual health. As one example, Fred Trotter introduced a new app he’s been working on called “Run or Else.” It’s not unlike the behavioral-economics inspired app, Stikk, but with more of a focus on running. It has integration with RunKeeper, and a more positive spin on incentives through charitable donations.
Fred mentioned during OSCON that we’ve recently shown that running is healthy. That may sound like we’ve recently discovered that water is wet, but it’s significant in that we haven’t always been able to associate activities with health outcomes. And that’s significant because, in our emerging health care system, quantified self measures, health data, genomics and the like will ultimately be quantified as having real quantifiable value if they can be related to risk reduction. Risk reduction in the new health system will be the quantification of the value of better health as it relates to the triple aim in terms of satisfaction, outcomes and cost.
Brent Vaughan, COO and Co-founder of WellnessFX, alluded to this at Healthcare Unbound, when he mentioned that a patient’s level of engagement might soon become akin to a type of risk measure, a health credit score. It says you are engaged in achieving the triple aim for yourself. While they are still in the data collection phase, patient engagement might well be a proxy for healthier outcomes, experiences and costs, and that means a better bottom line for accountable care organizations in terms of the ultimate incentive quantified measure, money.
One final note: As part of this whole new movement, I ran in the “Couch to Quantified 5K” (#c2q5k) at OSCON. You can see my (very slow) run data here. I did, just barely, pull even with the draw bridge opening delay, achieve my goal of 8 min/km, and that’s a good incentive for long-term behavior change to keep it going.