Today, Philips becomes the next big consumer tech giant to get in the diabetes game in a big way with the announcement that they're creating a sophisticated logging app for diabetes, backed by a cloud-based system for diabetes data sharing. They claim it will be capable of integrating data from nearly any device, and will offer direct connectivity to healthcare providers and EHR (electronic health records) data. Pretty ambitious!
The announcement is being made by none other than Kim Tas, a 20-something who was diagnosed with type 1 diabetes as a pre-teen and happens to be the daughter of Philips Healthcare CEO Jeroen Tas (!) Kim is making the announcement and showing a demo on-stage today at the software innovation conference Dreamforce 2015 taking place in San Francisco this week.
While Kim certainly knows her stuff when it comes to dealing with diabetes, we were a bit surprised about the sweeping claims Philips is making regarding their new prototype platform, developed in conjunction with Radboud university medical center in the Netherlands.
The press release touts that the new app and data platform:
- Offer a next-generation virtual community that connects consumers to healthcare providers and allows them to share both consumers' personal health data and healthcare organization’s clinical data
- Let patients track blood glucose levels, insulin use, nutrition, physical activity, mood and stress and get data-driven feedback and coaching guidance*, at home and on the go
- Are based on Philips' cloud-based HealthSuite digital platform and the new Salesforce App Cloud that will enable broad medical device and data interoperability
(The * asterisk notes that the data-driven feedback coaching will not be available in the U.S. Grrrr)
Watch this APP DEMO to get a sense of what they're creating.
And watch this video of Kim and Jeroen Tas sharing the story behind Philips' diabetes push:
Note that we requested but were unable to get a list of exactly which glucometers and other devices connect to their new cloud solution at this time, but Philips is extremely confident that a wide array of diabetes devices will "seamlessly integrate" with their platform very soon.
Note also that Philips just recently announed their own next-gen wearable device, the Philips Health Watch, that's expected to go on sale in April 2016.
What a wave of big consumer / electronics companies getting into diabetes! What with all the recent news about Google, Apple, Microsoft, Samsung, and Panasonic even acquiring Bayer Diabetes. It's quite the trend. And they all seem to be claiming open-source based on their lead in consumer markets. It's exciting, yet how much they will really impact core diabetes care remains to be seen.
We spoke at length with CK Andrade, Philips Director of Product Management of HealthSuite Digital Platform, to get the skinny on this new diabetes system they're creating.
DM) Of course there are multiple diabetes data apps out there. How is Philips hoping to change the game?
CKA) What makes this different is that we have been able to connect the data from healthcare organizations' EMRs (electronic health records) -- whether it's a pharma or hospital EMR -- with data from connected devices and also bring in the individual with diabetes' personal data, whether it's data from a PHR, an app, or a diary about stress or physical activity. So it's this combination of being able to view and share data across board with the right permissions and access controls in place that takes the app to the next level.
The big sticking point is of course a lack of standards for diabetes and other health data interoperability. How will Philips allow data from all of these diverse sources to be populated in a single platform?
There have actually been two stumbling blocks to being able to do this. One is interoperability, and the other is a lack of identifiers to be able to reconcile the patients' records. So in our HealthSuite Digital platform we are using the HL7 standard (FHIR APIs and resources) to be able to provide that baseline to enable communication with clinical data.
We have integration engines, adapters so to speak, that allow us to pull in different types of data. We have our Intellibridge Connect cloud that allows us to bring in the EMR data, and we also have our Device Cloud that allows us to bring in consumer and medical device data as well.
So what devices are now uploadable in your system?
One of the nice things about our Device Cloud is that it has the flexibility to be able to pull in data from different devices based on different protocols. In this case we're using a standard glucose meter. But we have different propositions on the platform that allow for connectivity to everything from thermometers to activity step counters to heart rate monitors (as offered on the Philips smartwatch) all the way through to medical equipment and consumer-grade devices -- because Philips has been in the business of connected devices for a long time now.
In the diabetes world, what people care about is whether they can use their Accu-Chek meter, OmniPod pump, Dexcom CGM, etc., and will all the data be sucked in automatically and be compatible?
That's our goal. With this prototype, we began using a standard glucose meter because a larger group is using those than an insulin pump. Currently an adapter is required to connect the glucose meter -- it's a software and hardware (cable) solution. But what we're moving toward is to be able to get past that middle step of needing adapters to make data connection a lot simpler -- where you won't need an adapter, but can do it seamlessly through the data cloud.
And we do have the technical capability to pull data from an insulin pump, a continuous glucose monitor (CGM) or a range of different devices.
That cable-free cloud solution is of course the big goal! But given that all the devices are proprietary, don't you have to get agreements in place with each vendor individually, as for example Tidepool and Glooko have done?
Yes, there are two parts to this: the license agreement piece, and the 'Can the technology make these devices talk to each other?'
With our cloud technology, the talking to each other is the simple part of the equation -- we have the capability to do that. But going through the hoops to get the agreements in place is the harder part.
Are you aiming more at type 1 or type 2 diabetes here?
The first group of people we worked with on the design were people with type 1 diabetes. So when you look at the app, you'll see there is a large focus on the insulin management piece.
But you'll also see on the dashboard that we have the Tracker and My Goals sections, allowing you to track things like weight, and set goals around diet and exercise -- things that are more applicable to type 2 diabetes.
We recognize that the needs of type 1 diabetics and type 2's using insulin are very different from those with (non-insulin-using) type 2 diabetes. But we think it is possible to offer a common interface that's useful for both -- letting people choose the components they'd like displayed on their own dashboard, i.e. the pieces that are relevant to them. That was the feedback we got from the many patients we worked with in the Netherlands. We will continue to work on expanding the functionality.
So you took a patient-centered design approach to building this?
Yes. The typical approach is, 'We know the technology -- we will design the app that will change your life.' But we decided we didn't want to take that approach.
We worked hand in hand with patients at Radboud, initially with two dozen type 1s and now with two larger groups of 50-100 people with type 2 on a small prototyping project. The question was, 'If we wanted to empower someone to self-manage, what would the tool be?' They designed it for us, piece by piece. We asked if it needs to be two separate apps (for T1 and T2), and they said no, there's enough commonality, as long as people can customize their dashboard.
Can you tell us about the influence that the Philips Healthcare CEO’s daughter Kim has had on this?
Kim was diagnosed at age 12 in the Netherlands, and later went off to study in the United States. She’s just recently graduated.
A lot of this has come out of … things that (her father) Joeren says they wish they had as a family when she was diagnosed. A big part of that is the psychological pressure of having to keep making decisions and worry about this all the time.
The message we got loud and clear from her and other patients was: ‘Can you put us at the center of the conversation? Can we be in control? We’re a little tired of being told by healthcare providers what we should do, because we are the experts on what’s happening in with our bodies and lives. That was the perspective we tried to take this project.
But you worked with a very limited number of patients…
Yes, for us it was about having a small group of people we could get to know really well and a story, rather than surveying hundreds and just having a superficial relationship with them. We were trying to make this collaborative.
Kim makes a point in the video that her health data is ‘out there somewhere in somebody’s files’ and she can’t see it. So it’s about leveling the playing field, sharing that data, and empowering patients to be informed and drive the conversation a bit better.
Still, the demo you created contains some things that don't seem like they were vetted by actual patients, like a whopping 6.5 unit insulin dose recommendation for stress...?
What the patients designed is the functionality -- being able to get alerts and recommendations -- but picking that exact number was random. The set of dummy data plugged into this demo was not designed by patients (but rather) by folks in a team sitting in a room trying to put in some values to run the demo.
You'll have to forgive us for having a few values that are not quite accurate, but our focus is on the value of the functionality.
OK, and can you elaborate on the specific functionality that patients requested here?
The notion of being able to define for yourself that factors that are relevant to you and eliminate those that aren't, on the Dashboard. So yes, glucose and carbs are central, but there may be days when stress, mood, or other factors play in.
We actually did a number of sessions with patients that are still ongoing, where they asked us, 'Can you help us visualize all this?' For example, for the month of July they want to see the hotspots -- today I had stress, yesterday I played tennis, Friday was a heat wave, I forgot lunch Monday, etc. They wanted to be able to combine all these readings and their comments. We worked with them to design graphs and visual displays of all this data.
This isn't the first app or system that promised a doctor or healthcare provide will be 'waiting on the other end' to analyze our data and interact, but doctors in the U.S. not reimbursed for that, so how will Philips make it happen?
The challenge connecting with healthcare providers has been twofold: first, having consoles and apps that are so complicated to use that they don't want to take the time, and second is the issue of reimbursement. We can't fix the financial incentives but can make it easy for a healthcare organization to make a little tweak in their workflow to be able to support this sort of model.
We know it's not enough to just parachute an app and console into a hospital and say, 'Here you go, it’s perfect.' So we've been working with Radboud in the Netherlands on understanding clinical workflow... (regarding) how this will realistically fit into a clinical model -- also for the U.S. and anywhere else.
One of the things we've done is streamline how we structure permissions and data access so you can set up functionality that allows group responses, for example. Or you can set up the system to say, 'You can expect a response in X period of time.' Part of getting folks on board is to help them recognize there are models that fit into the day-to-day workflow if there's not a lot of overhead with the app. In other words, it can fit into their clinical routine so it doesn't take up so much time that reimbursement becomes a problem -- while folks are still doing the work on lobbying to make sure there are codes to be able to bill this.
With all this data sharing, of course we have to ask about HIPAA...
Of course we address it. One of the key issues for us is access control -- privacy and security. Because when you have a data-sharing situation like this one, you don't want the power of sharing data to become utterly devalued by allowing people to see info they shouldn't or didn't want to share.
A big piece of what our HealthSuite platform brings is Identity Management -- the ability to set a complex set of roles. So for example, I as individual might want to let someone see my endocrinology info but not my mental health info. Or a provider might say. 'We haven't discussed these lab values yet, so I don't want to make this visible yet.' You can set that level of access control. Those are really the cornerstones for us as a foundation of the platform.
The app also has an “integrated community” -- what about privacy there?
In the community, we do not provide a dashboard of data for that reason. We've gotten some interesting feedback around community, for example some people said they want to be anonymous in the community. So from your app you can pick a value and share it and you choose the privacy settings in your circle of friends as to who sees it, or you can put the value into a private message to send directly to someone.
Your press release notes that the data-driven feedback and coaching guidance features will not be available in the U.S. Is that just initially?
That disclaimer is there because the evaluation was done in Netherlands. Basically the general disclaimer we're obligated to add with any system like this is that it's not a substitute for medical advice. The other part of it is, correct -- these features are not for use in America right now in Q4 because we're still in the process of testing our claims for intended use for FDA regulations. We're still in the prototyping stage, so haven't submitted for FDA review yet.
But you still plan to launch the basic system in the U.S. soon, correct? Will that be coordinated through clinics and health plans, or will it be more of a consumer app?
We will roll out in the new year. The typical route is that a healthcare organization would sign up to use it, and their patients would be invited. But we're looking at ways to structure it so an individual can invite their healthcare provider as well, i.e. I could invite my endo and they can sign up to join the community.
We're trying to design the tech part seamlessly so that people can adapt it -- payers can adapt how they might want it to be available or a hospital can drive it. Or patients can sign up individually.
Of course, depending on which country, there are lots of limitations. We've worked with an international group of developers in Canada, the Netherlands and the U.S. -- crossing at least three healthcare systems to understand how they could use it in their system.
The business model seems like nearly as big a challenge as achieving such sweeping data and device interoperability...
We wish we could have more control over what happens clinically, but we don't...
The most we can do is what we have to offer here: breaking down the data silos, being able to connect data so that as an organization or healthcare system is ready for it, what this will allow them to do is very seamlessly integrate information for both the provider and patient. So at a glance, you can combine info on lab values with data from your diary on your stress or activity levels or diet, and pull in the info from your other apps and put it all together. That is what we're trying to bring to the table.
Howard Look, CEO of the nonprofit Tidepool, who's been honored as a champion of working to create an open, cloud-based platform for diabetes data, says this: "The more companies like Google, Apple, Microsoft, Samsung and now Philips getting into this, the better! If they’re building an ecosystem for diabetes data management and sharing, that's great -- that's what we want." But when I tell him that Philips' CK Andrade says connecting the devices and data is "the easy part," he chuckles.
"Every insulin pump has a different protocol, a different data model – there's definitely work to be done to read from multiple vendors' devices in a uniform way. Hopefully they are on top of that and if we can be helpful in any way we'd love to. Our mission is to help the industry move forward."
After all, Tidepool and Glooko and DiaSend have been working on this for a long time. So what is Look's "word to the wise" if he were to give Philips some advice, I ask?
"The way startup think and big companies think is very different... I would say, 'Get your solutions into people's hands and iterate as quickly as you can. Let feedback from patients, parents and providers guide what you do."
EDITOR'S NOTE: We are delighted to be welcoming CK Andrade for a demo of Philips' new solution at the upcoming fall DiabetesMine D-Data ExChange event!