Most health and fitness monitors are worn on the wrist. The OURA Ring is different: it is (as its name implies) worn on a finger. The company claims the ring tracks sleep and activity with “unparalleled precision.” It senses arteries in the finger, taking 250 samples per second.

The unit can be worn while swimming. It automatically turns off Bluetooth while the user is sleeping. However, the battery can only operate two to three days before it needs recharging.

For sleep monitoring, the firm claims the OURA Ring measures total sleep time, deep sleep time, REM sleep, sleep efficiency, sleep latency (how long it takes you to fall asleep), restless sleep, and sleep timing (midpoint of sleep). However, the website descriptions are ambiguous. For instance, deep sleep is defined as “when your blood pressure drops and your heart and breathing rates become regular.” Does the OURA Ring measure heart rate, respiration rate, and blood pressure? Like an oximeter, it should be able to measure heart rate. And the firm states explicitly that it measures skin temperature. The “full technical specifications” say nothing about what sensors are used, what they measure, and how accurate they are.

The website's front page says the OURA Ring “Detects blood volume pulse, body temperature and activity level with advanced sensors.” My guess is that everything is based on these three measures. There is no way to know how useful the company’s proprietary “readiness score” (insights about your well being) is without trying it out.

The OURA Ring is pricey at $299 for artic white and mirror black models, and $499 for stealth black. The unit comes with a charger. The associated iOS and Android apps are compatible with phones from Apple, Huawei. LG, Motorola, Nexus, Samsung, and Sony.

Think about telemedicine and a personal health monitoring ecosystem built around smartphones and wearables:

In-Depth: What Texas's landmark telemedicine legislation means for the industry and the nation

By Jonah Comstock
May 26, 2017

In the State of Texas, a major piece of telemedicine legislation is sitting on Governor Greg Abbott’s desk. Known as Senate Bill 1107 and House Bill 2697, the bill abolishes the requirement that patient-physician relationships be established with an in-person visit before telemedicine can be used.

Texas is the final state of 50 to abolish this requirement, so the bill's passage will allow national direct-to-consumer telemedicine companies like Teladoc, American Well, Doctor on Demand, and MD Live to extend their video-based operations nationwide. Technically, there are still limitations in Arkansas and Idaho, as those states still have restrictions on phone call-only telemedicine.

As well as opening up this market and bringing telemedicine services to a large, geographically distributed population that could greatly benefit from them, this bill also signals the end of a more than two-year legal battle between Teladoc and the Texas Medical Board that culminated in what might have been a landmark antitrust case.

Read the rest here.

An article in the Wall Street Journal discusses how uncertainty surrounding the future of the ACA is creating challenges for health tech startups. One of the companies we profiled recently, Pillsy, is said to be focusing more on selling its products directly to consumers -- online and through pharmacies -- rather than through healthcare providers.

Other startups are finding it harder to attract funding. Perhaps that's because too many healthcare tech startups and healthcare tech investors are focused on opportunities they believe are created by healthcare laws and regulations. If your business plan is designed to exploit laws and/or regulations, then you risk disruption by new policies and legislation. Plus, you tend to compete by lobbying government officials and agencies. The opportunities created by laws and regulations could be called artificial markets as they are man-made and imposed by government rather than naturally occurring.

In contrast, companies that design their business plans around customer needs and direct marketing are less dependent on government decisions over which they may have little influence. They compete by developing products that are responsive to customers' needs and expectations. These natural markets can be served in many different ways. It's up to the creativity and perseverance of the health tech startups to transform raw customer needs into ongoing, profitable businesses.

So which is preferable?

There is an interesting article at The Medical Futurist about companies applying virtual reality to fields including behavioral psychology, pain management, medical training, rehabilitation, and meditation.

The specific examples include treating anxieties, depression, and phobias; pain management; surgical training, planning, and assistance; education (learning human anatomy); exercise and rehabilitation; assisting people with physical disabilities; and meditation.

Virtual reality is in its infancy. This is going to get much more interesting as processing, storage, and communication capabilities continue to advance.

Betsy McCaughey writes at Real Clear Politics about health insurance for people with pre-existing conditions. Obamacare was designed to pressure anyone not in a group plan to buy a plan on the individual market and pay pre-existing condition prices. It makes more sense, and is fairer, to cover people with pre-existing conditions separately. Before the ACA was passed, about two-thirds of the states had high-risk health insurance pools that used a combination of government and insurance company subsidies to ensure affordable rates.

Obamacare essentially penalizes healthy people who are self-employed, work for small businesses, or work less than full-time.

Excerpt:

The new House bill sets up a fairer way: a $130 billion pot of money, federally funded, to pay for people with pre-existing conditions. The entire nation chips in, not just people stuck in the individual market.

Under Obamacare, the healthy and the chronically ill paid the same premiums. It's called community pricing. Healthy people would never meet their sky-high deductibles. Instead the premiums extorted from them would be used to cover huge medical bills for the chronically ill, who consume 10 times as much medical care.

In fact, Aetna CEO Mark Bertolini reports that less than 5 percent of Obamacare enrollees consume over half of the health care.

Most healthy people saw that being charged the same as these sick people was fundamentally unfair and refused to sign up.

Read the entire article here.

Pillsy has introduced a medication adherence solution that uses a "smart pill bottle" to ensure that the patient takes their medicine as directed. The bottle senses when it is opened and closed, and communicates via Bluetooth with a mobile app running on an Android or iOS device. The system reminds the patient when they forget to take a dose, warns them when they try to take a double dose, and permits sharing the information with family or friends.

Pillsy addresses a serious problem. Many patients (particularly the elderly) fail to take medications as directed. Reportedly, 125,000 people die each year because they did not take their medications as prescribed.

However, there is no perfect solution to this problem. Pillsy can detect when the pill bottle is opened and closed, but it can't ensure that the patient ingested the medication. (An elderly patient might open a bottle, get distracted, and forget whether they took the pill.) Plus, many patients take multiple prescriptions, so they need to work with multiple bottles -- Pillsy does not sell a smart weekly or monthly pill keeper.

Pillsy will probably work well for some patients, but not for others. Younger patients may just need a daily reminder. Older patients with short-term memory problems may need to be prompted to perform each step: Get the container, open it, take out today's dose, swallow the pill(s), confirm the dose was taken, and close the container.

There are dozens of pill reminder apps on the market. According to Mobile Health News, Pillsy's competitors include Medisafe, AdhereTech, PillDrill, AiCure, and Catalia Health.



Medisafe is an Israeli company that has developed an adherence platform consisting of a wireless pill bottle, smartphone app, and cloud-based infrastructure. The firm claims to have 3.5 million patients and caregivers on its platform. Medisafe recently raised $14.5 million in series B funding.



AdhereTech is another company using wireless smart pill bottles. The bottle can light up and/or generate an automated phone call as reminder. The battery can run for over six months before it needs to be recharged.





PillDrill offers a smart pill organizer that reminds the patient to take their meds, records that a dose has been taken, and enables the patient to indicate how they are feeling -- all by scanning the pill containers and a Mood Cube using the PillDrill hub. The hub sells for $199. The pill keeper contains removable pods for two or four weeks' worth of meds. The hub communicates with family members via Wi-Fi. The patient does not need to have a smartphone, but Android and iOS apps are available. The firm also offers scannable tags that can be used with original pill bottles.


AiCure has developed an artificial intelligence platform that visually confirms medication ingestion using a smartphone. The firm touts its solution as helping to reduce clinical trial failures (AiCure says 30% of clinical trials fail).



Catalia Health sells the Mabu personal healthcare companion. The unit features a touchscreen, accepts voice input, asks the patient how they feel, and can send reminders to their phone for when they are away from home.

A short but sweet commentary by Heritage Foundation policy analyst Aylene Senger gives eight reasons why Obamacare should be repealed. I can think of more -- though the first reason Senger offers is more than sufficient:

1. Costs
2. Choice and Competition
3. Exchange Enrollment
4. Exchange Websites
5. If You Like Your Plan, but the Government Doesn’t, You Can’t Keep It
6. Collapsed Co-Op Program
7. Dumping Millions Into Medicaid
8. Restricted Access to Providers

I’ve carried an Omron HJ-720IT pedometer around with me every day for several years. It’s a nice little activity monitor. It counts ordinary and aerobic steps, and calculates distance, calories used, and fat burned.

The pedometer’s battery needs to be replaced every several months. If I don’t have a spare coin cell battery on hand, it may be a day or two before I get around to buying another two-pack. There have been occasional short gaps in my activity monitoring.

The last time my pedometer’s battery died I decided to try the Samsung Health smartphone app. A smartphone contains -- among other things -- motion sensors and a GPS receiver. A smartphone can monitor physical activity and much more.

The smartphone and standalone pedometer each has its pros and cons. The advantage of the pedometer is that I can slip it into a pocket and carry it with me all day. It’s smaller and lighter than a smartphone. However, it’s battery needs to be replaced from time-to-time, and I have to connect it to a PC to upload and archive the data. (The HJ-720IT has a USB port, but does not support Bluetooth.)



Screenshot from Samsung Health running on a Galaxy S7

The advantage of the smartphone is that it can handle many other health and wellness tasks such as measuring heart rate and blood oxygen, and it runs the apps that collect, present, and analyze the data. The only real disadvantage is that I don’t carry it with me at all times when I’m indoors.

The two devices operate differently and I suspect one is somewhat more accurate. With the pedometer, you are instructed to measure and enter your stride length and your weight. With the smartphone app, you enter your height and weight, but there is no need to enter your stride, because the phone can measure how far you’ve traveled directly. The app can also distinguish between walking and running.

In fact, Samsung Health is really a fitness and wellness ecosystem. The Samsung Health website lists more than 125 partner companies. No doubt, you can import data from other devices such as Bluetooth-equipped blood pressure monitors. You can also manually record food and water intake, other activities (such as archery!), and sleep time.

A smartphone can’t perform all fitness and wellness tasks by itself, but it can work with other devices, and it can collect and analyze the data and present it in a useful form. Samsung even offers a telemedicine service -- you can consult with a doctor online without an appointment and for a modest fee.

I don’t think smartphones will eliminate other wearables and personal health devices. However, they will replace if not eliminate desktop fitness and wellness apps. Smartphones and smartphone apps are more capable and more personal. Their overall functionality is enhanced by specialized external devices. You might let your smartphone double as a pedometer, but you still need a waterproof, Bluetooth-enabled bracelet if you want to track your swimming activity.

Ira Brodsky

I cringe when I hear policy wonks complain about the excessive use of advanced technology in health care. Sure, advanced technology is often very expensive, but it’s usually worth every penny. Medical technology greatly enhances our ability to diagnose and treat health problems.

Wearable robots, also known as “exoskeletons,” are a great example. Someday we may learn how to cure paraplegia, but in the meantime wearable robots can dramatically improve the quality of life for many wheelchair-bound patients. If there is a way to get this technology to patients who are likely to benefit from it, then who is to say that it is too expensive?

Robotics is advancing rapidly largely thanks to the development of complex control algorithms. Also contributing are inexpensive sensors and field programmable gate arrays (FPGAs) that speed development and ensure robust performance.

I recently spoke with National Instruments, a company providing Hyundai with tools for developing wearable robotics. Hyundai is focusing on patients with knee or hip injuries, patients in rehabilitation, elderly patients, and paraplegics.

Based in Austin, Texas, National Instruments specializes in products to help scientists and engineers solve difficult problems. In this case, Hyundai needed to acquire data from multiple sensors, perform real-time analysis, and refine robot control algorithms.

At one time, it seemed like giving patients the ability to control motorized limbs required interfacing directly with nerves. Fortunately, it’s now possible to use multiple non-invasive sensors to determine the patient’s intent. With a bit of patient training and the right control algorithms, a paraplegic outfitted with a robotic exoskeleton can stand up, walk over flat ground, and sit down.

Work at The Central Advanced Research and Engineering Institute at Hyundai Motor Company is facilitated by National Instrument’s LabVIEW RIO platform. As the number of sensors and actuators increases, control algorithm complexity grows exponentially. The LabVIEW RIO platform not only eases development of complex algorithms, it employs field-programmable gate arrays (FPGAs) to essentially hardwire the algorithms so they can be executed much faster -- fast enough to exert control down to the microsecond level.

Hyundai is using wireless technology (ZigBee) to collect data about the patient’s gait -- data that can be analyzed and used to better control the wearable robot.

The Israeli company ReWalk is already selling exoskeletons in the US for roughly $50,000 each. However, it’s clear that there is a much larger market waiting to be served, so there is probably room for several competing makers of walking assistance wearable robots.

Beginning June 20, 2016, the Food Safety and Inspection Service (FSIS) under the U.S. Department of Agriculture will require establishments that grind raw beef to keep records (for at least one year) including "supplier lot numbers and production dates"; "the date and time each lot of raw ground beef product is produced": and "the date and time when grinding equipment and other related food-contact surfaces are cleaned and sanitized." The stated purpose is to more quickly stop foodborne illness outbreaks. FSIS investigators will check retail establishments to ensure they are in compliance. It seems a safe bet that the price of ground beef will increase as a result of the new rule.

SaniTrace, LLC, a startup based in Creve Coeur, Missouri, has developed a logging and labeling solution to ease compliance and provide notifications to consumers.

Consumers can be automatically notified if the meat they purchased is recalled -- provided that they scan the QR code with their smartphone's camera or text the identifier number from the label to a local phone number.

The final rule can be found here. The record-keeping rule applies to about 70,000 establishments -- most of them small businesses.

Few companies have experienced such a sudden reversal of fortune as the health care technology startup Theranos. The once-celebrated brainchild of Stanford University student Elizabeth Holmes is now the target of a criminal investigation.

We should be skeptical of claims made by businesses about new products or services. But we should also be skeptical about accusations made by former employees, potential competitors, and government regulators.

I still believe there is a bright future for Theranos’s vision of making blood tests more convenient, inexpensive, and proactive. Some of the charges against the firm seem petty. Unfortunately, it’s hard to ignore the government report that says Theranos’s finger stick system failed quality control tests at an alarming rate, and in some cases the QC failures were ignored.