The quantified self and accuracy

Fitness tracking and accuracy

There has been a lot of discussion recently around the usefulness of activity trackers in enabling people to be more health. Some of these are less favourable incluing https://www.independent.co.uk/news/health/nhs-apple-watch-fitbits-ai-waiting-times-gp-misdiagnosis-a8749876.html.

I thought it is time for me to share my own personal views of using activity trackers for some time. My first activity trackers were cheap things bought from Amazon which gave a sort of measurement of steps which was useful but the dashboard was not really useful for me so I upgraded to a Fitbit Charge 2. I still wear this all the time and love the data it provides me. The key thing is the data is understandable and in a form I can digest, although there are parts of it I do not record as I am not interested in them.

Overall, throughout my time using a Fitbit, I have become fitter and more aware of my own levels of health. I like the sleep tracker and although I am aware of my sleep patterns it is great to be able to see how my sleep patterns change when I am under stress or doing a lot of exercise.

What I have learned is that data is useful to support what I already know. I don't think the data from the Fitbit has enabled me to find out anything new that I did not already have a good idea about, apart from the heart rate function.

The Heart Rate Monitor (HRM)

What I like about the Fitbit Charge 2 is the ability to see my heart rate at any time at a touch of a button and a screen touch.  I am really happy I am considered to be in excellent fitness with a cardio score of over 45. I have also found that my resting heart rate is around 60BPM. Again this is very encouraging as it means I am not necessarily the decaying person I sometimes feel I am.

Being a nerd, I have regularly counted my pulse at the same time as using the Fitbit and I have always found it really accurate. Accurate at low rates, but at higher rates it is a little less reliable.

I cycle, when I can,  on a push bike.  I also belong to a local cycle group which means that every week there are people going out for group rides.  These rides started at around 20 miles and have increased for me last year to 70 miles and hopefully in June I will ride my first 100 mile sportive since becoming an adult.

The Fitbit's accuracy on rides is very patchy.  I noticed more than a year ago that when I ride to the top of a hill, which I find very hard indeed as I hate hills, my pulse skyrockets. I recall counting my pulse for a short time when we stopped once and it was going at about 170bpm but the Fitbit was showing 85bpm.  Quite a disparity, wouldn't you agree?

In order to test this out in a more scientific setting I did a small test at home on my turbo Trainer, doing hill reps. The session was only 30 mins or so but it did show a huge difference in readouts between the two devices. I should point out that I use a Wahoo Heart Rate Monitor chest strap when I cycle.

Here are the readouts:

Firstly the Fitbit readout for the morning including the ride:

As you can see my pulse went up to 90bpm according to the Fitbit during this rather strenuous session.  This is not bourne out by my own observations of my pulse which I recorded as @176 at one point during the session using my watch and fingers.

Interestingly the Wahoo HRM gave a slightly different picture and one which seems to bare my own experiences out:

The Wahoo HRM puts my pulse/heart rate at averaging 166bpm for the session, which is almost twice what it recorded my peak rate on the Fitbit.  Moreover, the Wahoo has me doing upwards of 184bmp at a few points in the session.  Which explains the reasons why when I finished I was exhausted and felt like I had undertaken a good workout.

Is accuracy important?

The big question is whether accuracy is important?

My personal response is yes and no!

No it is not totally important to be totally accurate. I know when I wake up and look at my Fitbit and it says I have walked 160 steps this is not accurate.  For me the progress I make is more important.  By this I do not mean that I have to keep beating what I did before, rather that I am acknowledging to myself and affirming through Fitbit that I have not been a couch potato all day.

To me everything is a relational scale which I use to make judgements on how well I am doing.  in 2016 I had a year where I was really unwell for much of the time and if I had had this data then I might have gained some solace that I was improving, at times.  Even today when I have bouts where my condition resurfaces, I can use the data from the Fitbit to affirm I am still alive and continuing to move.

There is an issue though; How can a Fitbit be so wildly inaccurate during an exercise session.  I recall looking at the Fitbit on many occasions during the Turbo session and each time it recorded my pulse as below 90 where as the display from the Wahoo had me at at least 170 at the times I was looking. This could be a problem if I was not able to think for my self and relied totally on the output from the Fitbit.

If for example I had a heart condition, which hopefully I do not, then it is really important to keep you heart rate within clear parameters. As it is, I try to do this in any case which is why I purchased the Wahoo for cycling as when you are out and about, it is more difficult to tap a watch from the position of riding a bike.

Should data be God?

Poor heading, I know, but I could not think of anything better to explain the question. Data, via the quantified self, in which we are constantly measuring ourselves to determine who health we are, is the new fad.  It saves time at the doctors by allowing us as people to take control over our own health... or so the great plan in the sky suggests. But is is really possible to be accurate with health data. We constantly use short hand phrases which have no scientific backing as messages from on high. for example, 10,000 Steps,  five a day, or my BMI is too high. Although these well known quantifications are used readily and without doubt have been useful to allow people to change their behaviours, there is little scientific substance to either.

Using fitness tracking devices does mean that we are allowing ourselves to accept poor data. But this is not a problem unless the data is being used by people who do not understand it is poor or take the data as some form of Gospel truth.

Any data is flawed. The bigger the dataset the more accurate the results, does not always ring true.  I realise I am diverging into a mathematical discourse but what I hope any reader can take from this is that instead of letting the machine determine your health, you can determine it and use the machine to support you in your quest.

Personally I don't care whether I walked 3000 steps of 10000 steps or  two million steps, I am only interested in the fact that I am active every day as much as I can be.  Technology can support this but it does not control it.  I do as I hope you control your own.

Finally, No I have no intentions of ditching my Fitbit just yet and have not found any more accurate wrist health monitors around.  I am sticking with Fitbit and Wahoo.

Telecare - the interoperability issue revisited

 
At a recent Athene meeting I discussed the idea of interoperability and in so doing thought it might be wise to share these thoughts more formally.

When telecare was conceived, it appears to have been considered as a reactive, rather than proactive technology that generates alerts after something bad has happened. It does not stop falls, or stop anything, but can generate rather vague alerts which can go through to a call centre or a family member. That said it can also produce false positives which can and often are very annoying for family members.

It, therefore, seemed appropriate that one of the key concerns of telecare is that it should be interoperable, by which I mean I can take any piece of telecare and it will connect to any other piece of telecare irrelevant of who made it, in a sort of plug and play way.  This is also a legacy of the smart home/home automation KNX association which provided the world’s only open standard an interoperability standard for smart buildings which are compliant to EN 50090, EN 13321-1, and ISO/IEC 14543. Interconnectivity would do away with the need for connecting boxes, extra wire and potentially making less dependable systems.

Continua Health Alliance  and many other organisations and groups (see http://projecthydra.info/wp-content/uploads/2012/07/Standards_Project_Hydra.pdf) have been set up to explore the relative merits or interoperability, but as companies might say how much they are in agreement with this idea, it is not is their business interest to allow their own devices to connect to someone else’s. If they did allow this then certain monopolies would potentially come crashing down. Instead, we are left with a faint nod to interoperability whilst ensuring that the top players in telecare and telehealth retain their throne through not allowing other devices to connect easily.

If we look to the emerging mobile market, there are currently three main players, Apple, Google and Microsoft, with their iOS, Android and Windows mobile operating systems. These systems allow companies to make apps for these devices, and apps which are written in C++ and HTML5 are often easier to cross platform. What is interesting about this is that one app, can be cross-platformed to a range of mobile devices and even have standard computer based versions as well. A good example of this is the game ‘Angry Birds’ which can be played in the browser (Chrome) as well as through Facebook, as well as on most mobile devices.

If we consider what we actually want from telecare in the future, it might not be the reactive containment model that currently exists, instead we might want a more flexible proactive technology that can predict and prevent falls, or unexpected difficulties etc. This, I am sure will come through the mobile platforms, in the near future, with people having mobile devices which have sensors monitoring actions and activities in the home as well as outside the home. We will hopefully dispense with anything we need to wear, such as the pendant, and have unobtrusive sensors built into everyday artefacts and clothing. We will hopefully develop systems in which the data is more usable to the person with health conditions so they can sensibly make their own rationale decision on their health state, as well as alert the correct people if someone is in crisis without direct intervention.

I also see the rise in robots as interesting, but wonder if this is the actual way we want things or whether the building of robots is actually a step in making technologies more intelligent and more honed to our future needs and wishes. 

There are always utopia's and dystopia's, and the reality will possibly somewhere in the middle, but I can see that mobile platforms provide a valuable reference to build and new telecare world in which the person is not a passive recipient of care. This change in the way of seeing telecare does require a large change in the way we see telecare and consider its merits, but I think that it is evident that we need to take things to a new level.

So what is the next step? 

I hope that someone from one of the big companies, be that Microsoft, Apple, Google, IBM, Philips, Bosch, Samsung, Nokia, HTC, Backberry etc read this and like some of the vision and start to run with it.  I, of course, would be happy to add some assistance fin this venture. 

So we need to move away from interoperability thinking and instead consider cross platform mobile devices which are proactive and reactive.  We need to have devices that are what people want and will use that produce real information that helps the person as well as the health professional.  We need a cultural shift in the thinking of telecare and telehealth to embrace this new thinking, and we need the big IT/mobile companies to take up the health and social care challenge today so we can start to experience it before it is too late.

What do you think?

The world's most digital health service - the NHS?

There has been a recent spate of articles alluding to the NHS becoming the most digital health service (see http://www.telecareaware.com/index.php/the-nhs-to-become-the-worlds-most-digital-health-service-uk.html).  For over ten years I have been listening to people telling me that the NHS is to become paperless.  To some degree I think it will and it has, but I am always alarmed by the notion of a paperless office or paperless business.

I do as much as I can on line, this is not because I do not keep paper records, because I do, rather it is because there is insurance from storing things online and completing things digitally, which is the digital footprint.  When I pay a bill online, I leave a digital footprint behind, and I receive online confirmation as well as, in most cases, an email confirmation that the bill is paid.  For me, this is a double insurance policy that I have two forms of proof of payment. This is traceability.

The addition of cloud services have allowed me to use online storage space to keep track of important data which I might require wherever I am. This storage means I can access my data wherever I am located as long as I have an internet connection.

This same principle is used in the new NHS. People can stay at home whilst their medical information is in virtual space.  This allows health practitioners to undertake virtual consultations, and telehealth some products to function appropriately. 

I fully embrace the digital health record and the ability for my health data to be shared between practitioners at a touch of a button.  All this is brilliant.

What I am concerned about is what happens when electronic data is corrupted or lost - when there is a critical failure.  The necessity for paper backup data is even more important if we are to use paperless working practices.

When I worked for a local authority, as well as when I worked for universities, and even now when I work from home as a writer and consultant, I require data to be available 24/7 and in a range of forms. In the event of a power failure, I have back up power from the batteries in the devices, this is limited but does allow me to continue working. I have things stored offline as well as online so I can refer to the most important data whether power is on or not. Similarly as the Internet is prone to being hacked or ISPs crashing off line printed data is critical to maintaining my working practices.

There are so many difficulties with relying solely on the use of online data and online data storage that it does not require me to even start to describe them, but it is important to realise that although online data is preferable in many cases the limitations within the health arena are many.  A good illustration of this is the use of Xrays or MRIs which provide images to the Dr’s desktop within minutes.  This allows the Dr to make a speedy diagnosis.  If this were changed to pictures of moles looking for cancerous indications, this will depend on the quality of the camera image and the screen image to make diagnosis a possibility.

As we increasingly rely on health technology, such as telecare, telehealth and mHealth systems to be used to support and ameliorate care in the community it is critical that the powers that be understand the areas where critical failures are likely to occur and take steps to prevent this causing a system that could work well from crashing.

So digital future is good as long as the paper is available to keep it from failing.

Taking Telecare to a new level

With the beginning of a new year, after considerable thought I have decided to take telecare activities to the next level. Having spent three years as a Telecare Coordinator for a London Borough and obtained excellent CQC reports for the service whilst in charge, and having worked as an academic for over ten years working in the field of telecare, assistive technology, smart homes, telehealth, ambient technologies, ubiquitous technologies, eHealth, mHealth, mobile technologies in addittion to my other interests in architecture and building design, health in general and of course people with long term conditions and disabled people, I now feel that the time is right for something new.

The Whole Systems Demonstrators (WSD) by the UK’s Dpeartment of Health (DH) has recently reported on its headline findings which clearly indicate a positive use of technology can save lives and save resources. There is little doubt that these findings will be scrutinised fully once the full reports are available, and at this point the headlines might not reveal the whole picture, but they are very encouraging.

We can now be confident that technology can save lives and resources, but we also need to ensure that the technology meets the needs and expectations of the people requiring it. It is important that as a result of using technology the person is not expected to become a machine, operating in unreasonable and predictive manners.

If you have a long term condition, your life is punctuated by regular events, such as taking medication, medical appointments, all the way through to the more chronic who might require assistance in all activities of daily living. What I consider unacceptable, is that technology designed to assist becomes the problem. This could be through making assumptions about people’s lifestyles and expecting unreasonable interactions such as checking-in every hour, or pressing a button regularly to stop an alert. This could also be through false alerts or just the technology not meeting operational expectations.

We are in a era which is really exciting. Technology is evolving faster than ever before and we should be able to harness this technology to enhance people’s live by removing barriers of distance, by producing virtual communities, and bringing virtual services through the cloud to people anywhere in the world.

My current concern is that although some electronic devices benefit from the advances in modern technologies, (eg mobile phones, tablets etc) other more mundane technologies, such as pendant alarm based systems or wandering sensors are failing to think beyond the standard.

We are entering a new year, 2012, and we have the chance to begin to create the world we want. A world where distance is not an issue, where access to products and services is far easier through modern technology. My hope for this new year is that we can get together and design products that will last, which have relevance and meaning to those we design for. This year could and should be the year of personalisation and innovation.

We need to stop waiting for tomorrow to create what is needed to today. We need to act now!

We need to change the way we think about products.

We need to change the way we think about services and service provision.

We need to change the way we think about technology and we need to change the way we think about people.

We need to step away from the tick box solution.

Let’s make Person-Centred Design truly person-centred!

It is with these messages in mind that I have started a new business called gdewsbury which is a Freelance Specialist Technology Writing Service and Consultancy (gdewsbury.com) with which I wish to work with the cutting edge businesses to assist in the build and design or truly exeptional products and help small or new businesses become great through expert input.

This is the year to take telecare to a new level.

Choosing a telecare mobile phone

The telephone is a simple device that has been with us for many years in various forms. In recent years it has undergone some considerable revolutions allowing hands-free communication, number identification and a range of other features to enhance the experience. For older people, big button phones appeared which were ideal for the visually impaired and phones with loop settings aided the hearing impaired.

The mobile phone is a new development for many. Although most people have a mobile phone, their potential is often not realised. Just as Microsoft Office can do amazing things most people use it for typing things and generally use only a fraction of what it can do.

It seemed to be a good idea to think about phones. Phones make and an ideal gift for parents who are less than tech savvy. The mobile phone has changed so much and continues to evolve with new models three to four times a year. As Steve Jobs understood, the traditional computer is less likely to be developed as handheld mobile devices are likely to proliferate the market. This could happen if the experience of the person using the mobile is equal to their expectations.

I have a confession, I love mobile phones and am passionate about the variety available and which is the best. When it came to my upgrade, I spent months working through exactly the specifications that I needed from my new phone before making the decision.

The mobile market is interesting as it currently has four main operating systems: Windows mobile, Apple IOS, Android (from Google) and Blackberry which are available on the mass market.There are other operating systems out there but these are the big four.

Each operating system has its own usability issues and positive and negative features. The phone manufacturer can also add the the features as can your phone operator by limiting some functions and expanding others, so already you can see that the choice of phone is very difficult.

The mobile phone makes a potentially excellent telecare device. The difficulty is matching the phone to the person. There are a range of simple display phones available. There are also phones with clear well defined keys to enable dialling. There are large displays phones which enable people with visual difficulties to see what they are dialling or writing and loop phones for the hearing impaired, but are these telecare phones? There are a number of mobiles that provide dedicated digits or an extra button which can be dedicated to sending a call through to a pre-specified recipient. These can be useful as long as the person using the phone has the capacity to operate it when required and will operate it.

Mobile phones have a range of other things that might be worth considering. Applications, or apps that can be downloaded from the operating system provider and can be very useful for making a phone into a medical device or reminder system, ideal for people with medical conditions or memory problems. Each operating system has its own apps and it is worth considering the apps available before buying a phone, similarly the ease of downloading them and the reliability are key things to think about. Viruses and malware are problems with smart phones where you can download apps to and the operating systems way that they deal with malware and viruses is also something to consider prior to purchase.

Location, location, location... Many phones have simple location devices built in and most smart phones have a range of locating software built in to the phone which can be used to locate a lost older person and provide a map home (if maps are built in and preprogrammed). Having maps and location properties on a mobile is only the beginning as the actual software that comes with the maps might be too difficult for the user to use so actually playing with the location software is very important in the decision process.

Gyroscopes and accelerometers can be built into phones which can be set to alert a friend or family when someone falls. These are a great idea and well worth exploring but always test the functionality of them before purchase. Do they trigger false alerts? Do they not work when someone actually falls? These conditions can easily be replicated in a shop. It is also important to consider the alert call that could be produced and who is to respond. There is no point in living a long way away and being the first call number, ideally a neighbour or a call centre would be be better, as speed of getting to the person who has fallen is most important, but read the blog entry on fall detectors before considering purchasing this on a phone.

The downside to location services and fall detection is the additional battery usage. As phones have become smarter, more applications run undetected, in the background, constantly working things out, such as where the phone is and at what angle is. All this background data analysis consumes battery life and timely changing of a mobile phone is a critical feature for modern smartphones. Although the battery life that the manufacturers provides are accurate, they are before any applications are downloaded and location and other services are activated. If you want a phone with ‘bells and whistles’ you pay with battery life, so expect to charge the phone daily. This can be a difficulty for some people so the capacity to do this is essential.

Sound quality, network coverage and ability to use the phone are actually the most important aspects to consider in a phone when purchasing it for someone else. A good phone should enable a the person to make calls easily, be able to hear the person they call and have a call go through from where they live without needing to go outside.

Finally, don't forget about the cost of calls and network coverage, the smarter the phone and the more things it does the more likely it will use more bandwidth even if no calls are made as there will be a lot of things sending and receiving data on the phone so ensure the package is one that enables the person to use the phone as they would like.

In sum, a mobile phone is potentially a very good telecare device providing the ability to alert others when a difficulty arises, but just because a phone sounds good does not mean it will be the correct phone for the person. Hopefully, issues already addressed in this blog will help in the decision process and this entry has highlighted the main things to think about.

The increase in telecare

With the release of the UK government’s “Equity and excellence: Liberating the NHS” document the emphasis for health promotion falls on GPs as they will be getting the vast amount of money from the dissolution of the PCTs (Primary Care Trusts). This really interests me. When I worked for social services in North London, I found that GPs were by and large a very difficult group of people to interest in telecare. Actually finding access to their forum was hard and harder still to get any enthusiasm for the potentials of this new technology.

It seems that with the release of this document and the fact that the commissioning of services will be undertaken predominantly by GPs in the future that they are going to need a crash course in telecare, telehealth, mHealth and eHealth.

So how is this going to happen?

Who is going to do this?

The only way that this can be done is for telecare to be included in the documentation that the government produce but it is nowhere to be seen.

If we are to follow the preventative agenda, then surely telecare must be the spearhead of changing the way we consider health and care. Ideally as a result of the proposed changes and the distinct lack of money in the UK it behoves all GPs to get tele-trained pretty quickly.

I can see that this should also not be something that comes from the manufacturers as this could bread suspicion in GPs rather I can see a role in this for the TSA (Telecare Services Association) as well as the government to bring this information to the desktops of the General Practitioner of tomorrow. But before this can happen, how are can the profile of telecare be raised to such an extent that GPs will actually begin to take a message on board that they have resisted for the last five years?

Any answers gratefully received!