{"id":27689,"date":"2013-07-11T13:22:10","date_gmt":"2013-07-11T12:22:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=27689"},"modified":"2013-07-12T09:23:54","modified_gmt":"2013-07-12T08:23:54","slug":"pritpal-s-tamber-health-2-0-and-academia-reconciling-experimentation-and-protectionism","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/07\/11\/pritpal-s-tamber-health-2-0-and-academia-reconciling-experimentation-and-protectionism\/","title":{"rendered":"Pritpal S Tamber: Health 2.0 and academia\u2014reconciling experimentation and protectionism"},"content":{"rendered":"

\"\"<\/a>This week I attended a Health 2.0 London<\/a> event on mobile sensors<\/a>. The title of the event asked if they were key to remote patient monitoring. I think the answer is an obvious yes; without them it\u2019s not going to be possible. But I\u2019m not sure the event was asking the right question. For me, the question is how we derive actionable knowledge from all the data that we might amass.<\/p>\n

There were two accelerometer-based devices on display, Fitbug<\/a> and Withings<\/a>; one service that lets you pool all your accelerometer-based activity onto one website, Tictrac<\/a>; and one mobile heart monitor, AliveCor<\/a>. <\/p>\n

AliveCor immediately impressed me. It provides an accurate ECG trace just by holding a special iPhone case (see here). In the UK it costs \u00a3169 and is apparently as accurate as hospital based machines that cost thousands of dollars. It was easy to see not only how they might be used in clinics but also how patients could be \u201cprescribed\u201d them so that they can record what\u2019s happening in their hearts when they have those \u201cfunny turns.\u201d I loved it.<\/p>\n

The accelerometer based devices convince me less. I actually use three accelerometer based devices every day: Nike\u2019s Fuelband<\/a>, Fitbit\u2019s One<\/a>, and the Moves app<\/a>. I have developed a strange relationship with them whereby on a daily basis I wonder why I am bothering because they don\u2019t seem to be telling me anything interesting and yet at the same time I\u2019m unwilling to stop using them when I see all the fancy charts<\/a> they\u2019ve drawn of my movements. I seem to be convincing myself that they\u2019ll mean something at some point somehow.<\/p>\n

Quite how, I am not sure. It seems to me that the quantified self movement<\/a>, as it\u2019s called, is busy having nerdgasms about measuring stuff but hasn\u2019t started talking about how it might analyse it to derive something meaningful and compelling enough to change people\u2019s behaviour.<\/p>\n

Sooner or later we\u2019re going to have to throw a little academic discipline at how we measure, record, and analyse all the observational data collected through mobile sensors. The challenge for academia is that it\u2019s going to have to deal with dirty data\u2014or, more accurately, real world data<\/a>. What I fear is that academia will revert to type and try to clean the environment. Although I appreciate the need to remove glaring confounders, I think that rather than make the data fit for academic study, academic study needs to become fit for the real world of health related behaviour.<\/p>\n

Later in the week I was at the second NHS Entrepreneurs Day at which we heard about the forthcoming Academic Health Science Networks (AHSNs). There are going to be 15 of them across England and their role seems to be to aid the adoption of new services locally, while helping frontline staff to share their ideas. One of the people who presented at the Entrepreneurs Day was Maneesh Juneja<\/a>, the leader of Health 2.0 London. While he told the audience about the community he leads I couldn\u2019t help feeling that there is a significant disconnect\u2014if not an overt fissure\u2014between his world and the forthcoming AHSNs.<\/p>\n

The Health 2.0 community is experimenting with what\u2019s possible; they\u2019re playing with innovations, usually new technologies, and seeing what value they can create. The community appears to be eclectic, with representation from academia, pharma, the NHS, start-ups, designers, doctors, nurses, and students. The only thing they seem to have in common is their willingness to experiment\u2014or learn about experiments that others are doing.<\/p>\n

By contrast the AHSNs came across as gatekeepers. \u201cWe\u2019re your access to the NHS,\u201d they seemed to be saying, \u201cit\u2019s through us that you\u2019ll be able to trial your products.\u201d Although their tone was welcoming it felt protectionist.<\/p>\n

Obviously we cannot do wild experiments on patients. A degree of protection is needed. But at the same time we have to find ways for new ideas and approaches to see the real world in which we can evaluate their effectiveness. The tension between experimentation and protection needs to be understood and slowly resolved.<\/p>\n

The one thing that binds these two groups, though, is the need for reliable forms of analysis. The Health 2.0 community is going to have to embrace the analytic methodologies needed to derive reliable, actionable knowledge from all the data they\u2019re collecting. The AHSNs also need these methodologies to assess which products to try on patients.<\/p>\n

These days we take for granted that randomised controlled trials should be conducted and assessed in line with the CONSORT statement<\/a>. But this statement was first drafted 20 years ago and has been constantly revised ever since. CONSORT was started by 30 experts meeting, discussing, and agreeing what was needed to assess a trial, a seminal moment in defining how we might trust their findings. Something similar needs to happen with observational data.<\/p>\n

Will this happen? Perhaps. In the US, the Robert Wood Johnson Foundation is supporting the Health Data Exploration Project<\/a>, which is \u201cexploring how to bring individuals and companies who collect data together with health researchers to uncover insights into personal and population health.\u201d Also, the United Nations has launched Global Pulse<\/a>, which is \u201cexploring how new, digital data sources and real-time analytics technologies can help policymakers understand human well being and emerging vulnerabilities in real-time.\u201d In England, I understand the clinical practice research database<\/a> is considering how it might incorporate data from fitness trackers.<\/p>\n

I find all this hugely encouraging. I only hope that the experimentalists and protectionists realise they have the same goal and create something that serves both communities.<\/p>\n

Competing interests:<\/strong> I am a member of the Health 2.0 London community and have met Maneesh Juneja but have no commercial ties with him. I paid for my Nike Fuelband but got the Fitbit for free while at TEDMED 2013. I downloaded the Moves app from app store and recall that it was free.<\/em><\/p>\n

Pritpal S Tamber<\/strong> is the Director of Optimising Clinical Knowledge Ltd, a consultancy that helps organisations in and around health care design clinically credible strategies that have a measurable impact on care. Follow him on Twitter, @pstamber<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

This week I attended a Health 2.0 London event on mobile sensors. The title of the event asked if they were key to remote patient monitoring. I think the answer […]<\/p>\n

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