How Apple and Google plan to reinvent healthcare

How Apple and Google plan to reinvent healthcare:

For many years the digital health industry has been driven by wearable devices like the Fitbit, Nike’s Fuelband, and Jawbone’s Up. But if the titans of the smartphone industry succeed in creating a dominant platform for health and fitness data, this business could be in trouble. “A lot of the basic functions we have seen in fitness wearables — tracking your steps, taking your heart rate — those functions will become basic features on a smartphone or smartwatch,” says Wang.

As someone who’s worn one of these trackers for years now [1] and who is obsessive about carrying my smartphone, I cannot disagree more. My phone does rough calculation of how much I move every month and it’s routinely off by absolutely enormous magnitudes. [2] To some extent, that’s because the phone isn’t calibrated to precisely monitor how far I walk. To a greater extent, however, it’s because while I’m obsessive about keeping my phone around me it’s actually not on my person for about 30% of my movements each day. I don’t carry my phone at night when walking the dog, or necessarily when I’m wander around the building I work in.

For people who want just casual or ambient information about movement a smartphone might be fine. But anyone who is even moderately interested in tracking their activity for health reasons isn’t going to be willing to ‘guesstimate’ 1/3 of their day’s activity. The real power of smartphones is delivering information-rich notifications or aggregating data from a variety of sensors; it’s the software that they bring, first and foremost, that is their value add. And I think that for the fitness device companies to be successful they’ll need to develop powerful data mobilization schemes – you’ll need to be able to integrate data from the fitness hardware to any smartphone OS – to really capture significant portions of the market over the longer-term. I don’t buy the idea that people will keep buying sub-par products because the data is bound within a specific operating system or mobile phone ecosystem. Though, perhaps that’s just me as someone who hops between smartphone and smartphone OSes every 12–14 months.

  1. I’ve lost a pair of Fitbits, returned another, and currently use a Jawbone UP 24. I bought my first Fitbit in April 2012.  ↩
  2. As an example, My Jawbone tracked me walking somewhere between 135–150 miles last month whereas Google suggested I walked just 30–40 miles.  ↩

Google’s ‘Friendly Tracking’: Fitfully Creepy?

Kashmir Hill wrote an article last week about how Google Now is informing some Nexus owners of how active they have been over the past week. She rightfully notes that this is really just making transparent the tracking that smartphones do all the time, though putting it to (arguably) good and helpful use. This said, Google’s actions raise a series of interesting issues and questions.

To begin, Google’s actions are putting a ‘friendly face’ on locational tracking. Their presentation of this data also reveals some of the ways that Google can – and apparently is – using locational data: for calculating not just distance but, based on the rate of movement between locations, the means by which users are getting from point A to B. This isn’t surprising,given that Google has had to develop algorithms to determine if subscribers’ phones are moving in cars (in fast or slow traffic) for some of their traffic alerts systems. Determining whether you’re walking/biking instead of driving is presumably just a happy outcome of that algorithmic determination. That said: is this mode of analyzing movement and location necessarily something that users want Google to be processing? Can they have been genuinely expected to consent to this surveillance – barring in jargon-ridden Terms of Service and Privacy Policies – and, moreover, can Now users get both raw data and the categories into which their locational data has been ‘sorted’ by Google? Can they have both sets of data fully, and permanently, expunged from Google databases?

Friendliness – or not, if you see this mode of tracking and notification as problematic – aside, I think that Google’s alerts speak to the important role that ambient technology can play in encouraging public fitness. In the interests of disclosure, I’ve used a non-GPS-based system to track the relative levels of my activity for the past six or seven months. It’s been the single best $100 that I’ve spent in the past five years and led to very important, and positive, changes in my personal health. I specifically chose a non-GPS system because I worry about the implications of linking health/fitness information with where individuals physically move: I see such data as a potential gold mine for health insurers and employers. This is where I see the primary (from my perspective) concerns: how can individuals be assured that GPS-related fitness information won’t be made available to health insurers who are setting Android users’ health premiums? How can they prevent the information from leaking to employers, or anyone else that might have an interest in this data?

Past this issue of data flow control I actually think that making basic fitness information very, very clear to people is a good idea. A comfortable one? No, not necessarily. No one really wants to see how little they may have been active. But I’m not certain that this mode of fitness analysis is necessarily creepy; it can definitely be unpleasant, however.

Of course individuals need to be able to opt-out of this kind of tracking if they’d like. Really, it should be opt-in (from a privacy perspective) though from a public health perspective I can’t help but wonder if it shouldn’t be opt-out. This is an area where there are competing public goods, and unlike a debate around security and privacy (which tends to feature pretty drawn out, well entrenched, battle lines) I’m not sure we’ve had a good discussion about the nature of locational tracking as it relates to basic facets of public fitness and, by extension, public health.

In the end, this is actually a tracking technology that I’m largely on the fence about, and my core reason for having problems with it are (a) I don’t think people had any real idea that they had opted-in to the fitness analysis; (b) I don’t trust third-parties not to get access to this data for purposes at odds with the data subject’s own interests. If both (a) and (b) could be resolved, however, I think I’d have a much harder time disagreeing with such ‘fitness alerts’ being integrated with smartphones given the significant problems of obesity amongst Western citizens.

What are your thoughts on this topic?