The words most often used to denote the retooling of health care—“Health 2.0,” “Digital Health,” and “eHealth”—say next to nothing. Apparently that’s how some people want it to be.

I call it Personal Health Tech because empowering individual consumers (and caregivers, too) is a huge opportunity. It’s desperately needed because health care in the US is becoming increasingly bureaucratic and expensive. The good news is that Personal Health Tech is enabled by stuff that’s within reach of virtually everyone: smartphones, apps, and cloud services. Hopefully, what’s currently happening in US health care will prove analogous to the rise of the personal computer.

Unfortunately, many health care pundits downplay the personal empowerment angle. They apparently feel that most people are uninterested in or incapable of personal empowerment. They believe that it is enough for patients to participate in their own care. They scoff at solutions touted by sophisticated early adopters. But that’s generally how successful technologies get their start.

My article about disposable wireless health sensors at Newsfactor Network:

A combination of disposable wireless sensors and smartphones is about to make health care more personal, immediate, and affordable. New solutions are emerging that harvest real-time health data and respond with on-the-spot warnings or suggestions. This technology will not only produce better outcomes, it will help extend the benefits of modern health care to people in developing countries and keep consumers everywhere better informed about the latest health products and practices.

The disposable wireless sensors being developed and commercialized by Gentag, Inc. are a good example. The sensors are intended for use by consumers and come packaged as either skin patches or specimen dipsticks. Gentag believes there is a huge global market for sensors that can be mass-produced, are easy to use, and work with popular smartphones and tablet computers.

Unlike telemedicine, which was conceived to conquer distance, Gentag’s technology is mainly about immediacy. Consumers can use skin patches and dipsticks at their convenience in their homes and workplaces. Smartphone apps provide instant feedback and can automatically forward results to caregivers. Problems can be spotted in their earliest, most treatable stages and therapy can begin at once.

Disposable sensors offer significant savings over traditional solutions. Most of the sensor designs lend themselves to high-volume mass production. They work with smartphones that consumers already have or are expected to have in the near future. And disposable wireless sensors avoid the costs associated with traveling to and using outpatient labs.

Gentag’s skin patch sensors typically consist of printable chemical strips and near field communications (NFC) chips. The chemical strips can test and measure parameters such as body temperature, skin moisture, and (with the aid of microneedles) blood glucose. NFC makes collecting the results as simple as a waving a mobile phone over the skin patch. (NFC sensors don’t require batteries because the phone provides the power.) Using NFC to read a sensor also helps avoid human error. Dipstick sensors can test specimens such as urine for pregnancy, prostate cancer, and other conditions.

The disposable wireless sensor-smartphone combination can be used to manage serious medical conditions. A smartphone app for managing diabetes can collect blood glucose readings from a skin patch containing microneedles and send commands to an implanted insulin pump. The app can determine when insulin is needed and whether a delivered dose was sufficient. The app can also take into account time of day, food consumed, and the patient’s past responses. Gentag hopes that skin patches with microneedles will free children with Type 1 diabetes from having to stick themselves several times per day.

Gentag’s dipstick sensor technology can detect very specific medical conditions. Monoclonal antibodies are used to produce biomarkers for particular pathogens, allergens, cancers, and drug toxicity. There are potentially thousands of biomarkers that can be detected. The urine test for prostate cancer mentioned above uses biomarkers.

Disposable wireless sensors offer additional benefits to makers of consumer health products. Manufacturers can deliver increased value by bundling disposable wireless sensors that help customers use their products more effectively and efficiently. When customers download the free apps that are required to use the disposable sensors, they identify themselves and establish direct communications with the manufacturers.

This is a big deal, because until now non-prescription consumer health products were nearly always purchased anonymously. Free smartphone apps can be used to gather demographic data, to gauge customer satisfaction, and to learn more about how customers use specific products. The apps can also be used to deliver electronic coupons, new product announcements, and health tips. Most manufacturers are likely to conclude that it’s worth the cost of giving away disposable sensors and smartphone apps to learn about and communicate directly with their end users.

There is another intriguing potential benefit of disposable wireless sensors. Modern medicine is highly information-driven, but most physiological data is collected when patients visit a doctor or emergency room. With Gentag’s technology, data can be gathered from people as they go about their daily activities. Large scale tracking of physiological data could help health care providers detect epidemics earlier and more accurately identify the warning signs for specific medical problems. Disposable wireless sensors and smartphones should also make clinical trials easier for both participants and researchers.

Technology is often blamed for the high cost of health care. However, technology has proved essential to driving down costs in industry after industry. By diagnosing health problems earlier and enabling patients to manage medical conditions at home, disposable wireless sensors and smartphones will help produce better outcomes at lower cost. It’s a bit like having a doctor in your pocket.

Many people believe that extending the Internet to things is a major opportunity. A “thing” could be a window, an automobile tire, or (for our purposes) a person’s arm. However, it does not make sense to literally connect a person’s arm to the Internet. We are really talking about connecting a sensor or controller of some sort to the Internet.

The Internet of things calls for a networking technology that is flexible, easy to deploy, and easy to use. It should be able to relay sensor data and controller commands in a timely, reliable, and (when necessary) secure fashion. And it should enable devices that are small, inexpensive, and consume minimal power. Ideally, it should be wireless, support ad hoc and mesh networking, and enable devices that can run for years off a small battery. ZigBee, a solution ten years in the making, meets these requirements.

There are two major potential health applications for ZigBee. One is connecting personal health devices to PCs and smartphones. Another is providing coverage throughout a home or care facility for patients who need continuous monitoring and emergency signaling.

While ZigBee would be an excellent solution for personal health and fitness devices that require long battery life, it faces stiff competition from Bluetooth low energy (BLE). Bluetooth is already widely used by mobile phones, tablets, and PC peripherals. And BLE-equipped personal health devices are starting to hit the market. However, markets often evolve in unexpected ways, and ZigBee may yet find its way into consumer health and fitness devices. As Cees Links, Founder and CEO of GreenPeak Technologies points out, ZigBee can do things that Bluetooth can’t.

A case in point: using ZigBee to continuously monitor elderly and chronically ill patients in their homes or assisted-living facilities. In these situations both low power consumption and building-wide coverage are essential. ZigBee enables building-wide coverage using its mesh networking capability. For example, a patient in an assisted-living facility could be continuously monitored in both their apartment and common areas.

Keep in mind that home monitoring can help patients avoid expensive hospital stays (through early detection) and reduce the length of stays (through early release). Honeywell HomMed has been able to sell more than 70,000 home health monitors with intermittent monitoring (wired and Bluetooth). Imagine how much more effective these devices would be if they provided continuous monitoring via a wireless technology such as ZigBee.

Several health and fitness gadgets debuted at the 2013 Consumer Electronics Show:

The FitBit Flex is a wristband that tracks daily activity including steps taken, calories burned, hours of sleep, and sleep quality. Data can be uploaded via the included USB cable and real-time statistics displayed on select iPhone and Android smartphones as well as desktop PCs. The unit apparently has an embedded NFC tag that lets owners of select Android phones "tap your device to launch your Fitbit stats."

The Misfit Shine is a competing device. It is a small round metal unit that its developer claims can be can be worn anywhere and that tracks steps as well as distances covered cycling or swimming. The unit is called "Shine" because its internal indicator lights shine through roughly 3,000 tiny holes drilled in its aluminum case. The device syncs with an iPhone by being placed on the iPhone's screen (it apparently uses the iPhone's touchscreen technology to upload current activity stats -- see the 2:42 video on the firm's website).

Other new activity trackers include the ibitz PowerKey (for children) and ibitz Unity (for parents). The ibitz PowerKey provides incentives (involving virtual pets and games) for children to meet their physical activity goals. The devices use Bluetooth low energy (BLE) to sync with smartphones, tablets, and iPods.

BodyMedia's Core 2 is the firm's newest armband activity monitor. The unit features four standard sensors (skin temperature, heat flux, galvanic skin response, and 3-axis accelerometer) plus an optional heart rate monitor. Reportedly, the unit will support Bluetooth low energy for syncing.

The iSpO2 from Masimo measures heart rate and blood oxygenation. Designed to work with the iPhone (as well as iPad and iPod Touch) via a connecting cable, the unit takes individual readings with the use of a finger sensor. The product is targeted at hikers, climbers, airplane pilots, and airplane passengers. However, the maker warns that the unit is not intended for "medical use."

Perhaps the most unique new product is the HAPifork from HapiLabs. It is a special fork that monitors how fast the user eats and warns the user when they should slow down. The firm says that "eating too fast, and not chewing long enough leads to poor digestion and poor weight control."

AliveCor announced today that its Heart Monitor iPhone ECG for the iPhone 4 and iPhone 4S has received FDA clearance for sale and is ready for preorder. The add-on device sells for $199, is "for use by licensed U.S. medical professionals," and will begin shipping in early January 2013.

The FDA approval process raises a few issues. Could "licensed U.S. medical professionals" prescribe the device for use by patients? Presumably, one advantage of the device is that it would enable patients to be trained to capture and transmit single-channel electrocardiograms to their physicians. Given how rapidly new smartphone models are introduced, is there an accelerated approval path for other versions of the device? And while it makes sense for the FDA to certify that the device does what it claims, it's not clear that that justifies delaying its introduction and restricting sales. Who is to say that a PhD in Biology is not qualified to use this device?

Regulatory issues aside, there is tremendous interest in this device and it represents just the tip of the iceberg for new and powerful mobile health technology.

Near field communications (NFC) – featured in recent Samsung television commercials – is the technology that lets users exchange playlists and videos by simply tapping their phones together.

Still, you might wonder whether there is a role for NFC in personal health. There is. NFC is a versatile technology and, as the Samsung commercials demonstrate, its “tap and go” operation can simplify many tasks.

As I explained in my article for NewsFactor Network, “NFC is as close to a cable connection as you can get with wireless.” Though NFC operates at radio frequencies it actually uses magnetic induction. In fact, the NFC antenna is designed to suppress radio waves – not launch them into space. That’s why NFC’s range is only 4 – 20 centimeters. And it’s also why NFC is nearly invulnerable to security attacks from more than a few feet away.

So what are some of the personal health applications for NFC?

NFC is a candidate for connecting consumer devices used to track fitness, monitor vital signs, and perform specialized tests to PCs and smartphones. Today, these devices typically communicate via a USB cable or Bluetooth. However, NFC may prove to be the better solution because it is easy to use and works with passive wireless sensors (such as the disposable wireless diagnostic skin patches made by Gentag).

NFC is already being used to automate home health care. Visiting caregivers can check in and check out merely by tapping an NFC card worn by the patient or installed in a convenient location in the patient’s home. Caregivers can also use the NFC card to verify the patient’s identity and access the patient’s records.

There is even an NFC solution designed to enable surgical patients to return home sooner. Disposable diagnostic skin patches can be used to monitor variations in pressure and temperature for signs of swelling. The patient uses an NFC phone to collect data from the patches and uploads it to their physician.

NFC-readable biometric sensors could, in fact, revolutionize health care. Sensors can be placed on the body to measure things such as blood pressure, heart rate, body temperature, blood oxygen, blood glucose, cholesterol, and prothrombin time. Self-test kits for pregnancy, AIDS, and even certain types of cancer can provide NFC-readable results.

NFC can be used to assist visually impaired and physically disabled shoppers. Product displays are equipped with NFC tags that provide product details such as pricing and ingredients. An NFC phone or tablet reads the information aloud using synthesized voice. Visually impaired patients can also use NFC to identify food and other packaged goods at home. NFC can even be used to create “talking medicine packages.” The patient taps the package with an NFC phone for spoken information and directions.

NFC is being applied to monitoring potential sleep disorders. A small card is attached to the patient’s arm and is used to monitor the patient’s physical activity overnight. The card can be read by an NFC phone in the morning and the data can be sent to a physician or therapist.

At least one company (Poken) is using NFC as a substitute for business cards and brochures, and health care is one of their primary target markets. Consumers attending health workshops at local hospitals can collect information with two-way tags (called “Pokens”) and continue interacting after the event via an online hub.

NFC tags can also be used by patients or caregivers to call emergency services. The user taps the phone on a passive tag and the call is automatically placed. The patient’s name and address may also be uploaded.

NFC has a couple of weaknesses. Though NFC is not a good solution for exchanging large quantities of data, it can be used to set up a secure Bluetooth connection. And though NFC’s physical link is extraordinarily secure, NFC phones are vulnerable to rogue tags placed in public locations by mischief makers.

If NFC becomes relatively ubiquitous – as it seems poised to do – then people will surely invent many other personal health, fitness, and safety applications.

This is the first in a series of posts about the wireless options for personal health technology.
Newcomers are often confounded by the number and variety of wireless choices. There’s no single technology that is best for all applications. Wireless is evolving so rapidly that products following the latest standards are usually backward-compatible with older standards. To further complicate things, there are different standards and frequency allocations in different parts of the world.

Even for a well-defined application, the choice is often not simple. Consider the female patient with a life-threatening heart condition who needs to be monitored continuously. The most important factor in this application is coverage, so she needs a device that uses the cellular standards that blanket the area in which she lives, works, and commutes. Coverage may be spotty indoors, so the device should also support Wi-Fi. And it should employ one or more radio-locating techniques to ensure that paramedics will know where to find her in an emergency.

Here’s a brief overview of wireless technologies for personal health applications. I’ll delve deeper into specific technologies in future posts.

Cellular: Operators are currently deploying fourth generation (4G) technology for Web browsing and multimedia, but the more ubiquitous 3G technology is fine for most health apps. Given that operators are moving away from unlimited data plans, it’s best to use free Wi-Fi where available (homes, offices, and many Wi-Fi hotspots). If you travel internationally, a GSM model may be your best choice. Smartphones are preferred over basic mobile phones as they can run health and fitness apps. There are even smartphones optimized for health needs.

Wi-Fi: Wi-Fi was developed to replace indoor cabling, but it’s also used to create indoor hotspots and outdoor hot zones, and support for device-to-device transactions has been added. Withings, a French company, offers weight scales that can communicate via either Wi-Fi or Bluetooth; Wi-Fi makes most sense when the scale is permanently stationed in a bathroom because it offers longer range than Bluetooth.

Bluetooth: Bluetooth was developed for personal area networks—it’s best known for wireless headsets and hands-free operation in cars—but it’s also a good choice for connecting personal health gadgets to PCs and other devices. A relatively new Bluetooth mode, Bluetooth low energy (BLE), enables devices with long battery life. A heart rate monitor with BLE can periodically upload data to a smartphone for a year or longer using the same coin cell battery.

ZigBee: ZigBee is designed for low-cost, low-power sensor and control networks. ZigBee can be used to monitor the elderly and chronically ill in their homes or care facilities. It’s also a good fit for a range of personal health and fitness applications. Philips Hue, a ZigBee-controlled LED lighting system, offers light therapy for the winter blues (otherwise known as seasonal affective disorder, SAD). The lights’ brightness and color can be controlled with an Android or iOS device communicating via Wi-Fi to a controller that, in turn, communicates with the LED lights via ZigBee.

Near field communications (NFC): Thanks to its very short range (4 – 20 centimeters), NFC is most often discussed as a secure connectivity solution for mobile payments. However, NFC can also be used in health care facilities to track patients, drugs, and any other items with programmable tags. NFC can also be used by individuals to collect data from wearable sensors and to track prescription drug use.

Satellite: Satellite communications may not be practical for most health and fitness apps, but it is uniquely qualified for search and rescue operations. There are messaging devices for adventurers that can be used to signal for help. Some will even call for help automatically under specific circumstances. Satellites are also used along with cellular to guide emergency services to the site of a major automobile accident.

Radio-locating: Bystanders can use locating technology to find the nearest emergency room or public external defibrillator. There are two global satellite navigation systems, one operated by the US (the global positioning system, GPS) and one by Russia (GLONASS). Unfortunately, satellites have trouble covering indoor locations, urban canyons (areas between tall buildings), and tree-lined streets in the summer. Users can also be located based on their distance from cell towers or proximity to Wi-Fi networks.

Next I’ll take a closer look at NFC and ZigBee, two relatively new technologies with unique advantages.

An article about machine-to-machine devices and big data analytics at InformationWeek touches briefly on health monitoring--but makes the point. By monitoring patients at home and in daily life, we will learn to recognize early warning signs:

Healthcare is another area where M2M has the potential to transform an industry. Machine-to-machine devices, including blood pressure monitors, glucose meters, and electronic weight scales, have integrated sensors that check patients' conditions in the home, thereby saving a trip to the doctor's office or hospital.

An M2M monitor can also alert a physician when it detects a potential health problem. "Rather than waiting for a person to end up in the emergency room or hospital, which gets very expensive, the physician can be notified when the patient is in a negative state, and proactively schedule a visit," said Lottero.

This idea seems to be catching on in auto insurance. Companies such as Progressive Insurance believe they can better assess risk through routine monitoring.

An article in the Wall Street Journal, What Your Breath Reveals, suggests that a practical, near-term Star Trek tricorder-like device should focus on the patient's breath. The list of medical conditions that influence the composition of your breath include asthma, stomach ulcers, lung cancer, diabetes, kidney disease, liver disease, irritable bowel syndrome, lactose malabsorption, and heart transplant rejection.

Every individual has a unique breath signature—like a fingerprint—that contains not only oxygen, nitrogen and carbon dioxide but also volatile organic compounds. Those are chemicals from inside and outside the body that evaporate at room temperature and are the source of most breath odors. Exhaled breath also contains nonvolatile compounds—microscopic droplets of proteins, antibodies, peptides and DNA that contain a wealth of additional health information.

If that's so, then it could make sense for most people to get a baseline measurement every few years. Changes in the composition of your breath could be used to detect disorders in their early stages.

An article at Israel21c highlights 64 innovative Israeli products. Not surprisingly, many are health care related, and some of those involve personal health technology.

Included are the ReWalk robotic exoskeleton; the WatchPat for diagnosing sleep problems at home; the Babysense for preventing crib death; Deep Breeze for remote monitoring of chronic obstructive pulmonary disease (COPD) patients; and a number of devices and systems for use in hospitals and clinics such as the PillCam for diagnosing gastrointestinal problems.

The most common criticism of my Op-ed last week, Obamacare and the vanishing medical miracle, was that government meddling in citizens' personal health care decisions under ObamaCare is a right-wing myth.

That would be reassuring--if only it were true. The first question that needs to be asked is: Why would the President of the United States offer his opinion about a personal health care decision ("Maybe you are better off not having the surgery, but taking the painkiller") if he didn't believe that it is an appropriate topic of public policy?

The lead editorial in today's Wall Street Journal provides further evidence. Cheesecake Factory Medicine fingers several of ObamaCare's intellectual gurus and demonstrates that they really do believe that government is most capable of reducing waste, that decisions about what gets paid for and what doesn't should be made by an Independent [sic] Payment Advisory Board, and that medical treatments should be standardized. So just forget all of that talk about personalized health care.

One of the gurus is former White House budget director Peter Orszag:

So get a load of Mr. Orszag's Tinker Bell alternative, which he called the "most important institutional change" after ObamaCare passed in 2010: the Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care.

Who are these Orszag 15? Well, nobody knows. The board was supposed to be up and running by the end of September, but the White House is avoiding naming names for Senate confirmation until after the election. No one knows, either, what this group of geniuses will propose, but that too is part of the grand Orszag plan.

Another is Atul Gawande:

...the surgeon and influential New Yorker magazine writer Atul Gawande, has further instructions for the medical masses, this time from—believe it or not—the Cheesecake Factory, the chain restaurant.

Dr. Gawande's point is that medicine would function better if care were delivered by huge health systems that can achieve economies of scale, like commercial kitchens. Care ought to be standardized like preparing a side of beef, with a "single default way" to perform each treatment supposedly based on evidence, with little room for personalization.

The editorial notes that in preparation for these changes the US health care industry is undergoing major consolidation. Hospitals and health insurance companies are merging to better grapple with anticipated new layers of bureaucracy and regulations.

Here is precisely the kind of thing that we should worry about:

The immediate danger of the Orszag-Gawande-Obama vision is that layer on layer of new regulation will lock in less-than-best practices. This makes the status quo worse, because too-big-to-fail oligopolists have less incentive to innovate to reduce costs and improve quality.

The longer-run danger is that Mr. Orszag's cost board starts to decide what types of care "work" for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan's market proposal is rejected, then government a la Orszag will do it by brute political force.

A murderer's row of liberal health-care gurus—Zeke Emanuel, Neera Tanden, Don Berwick, David Cutler, Uwe Reinhardt, Steve Shortell, Mr. Orszag, many others—recently acknowledged as much in the New England Journal of Medicine. They conceded that "health costs remain a major challenge" despite ObamaCare. That would have been nice to know in, oh, 2009 or 2010.

Anyhow, their big idea is the very old idea of price controls that are "binding on all payers and providers," much as post-RomneyCare Massachusetts is already doing. When that strategy fails as it always has, and the public denies further tax increases, the Orszag payment board will then start to ration or prohibit access to medical resources that it decides aren't worth the expense.

My opinion piece at the Daily Caller:

Obamacare is an imminent threat to people with life-threatening medical conditions.

People with serious medical conditions often achieve miraculous results in the U.S. thanks to a private health care system that gives them the freedom to track down and go to doctors with the right knowledge and experience. These people, who have the greatest and most urgent health care needs, will be stymied by Obamacare’s new layers of bureaucracy. Instead of swiftly obtaining the right diagnosis and treatment, they will lose precious time submitting forms and filing appeals.

As every physician knows, it’s important to arrive at a correct diagnosis as soon as possible because medical conditions are most treatable in their early stages.

A recent article in The Wall Street Journal illustrates the point. “Facing Lifesaving Heart Surgery, Twice” bemoans the plight of people who had heart surgery as children only to experience further heart problems as adults. Doctors were often baffled because their hearts had been reconfigured during childhood. In some cases, the best course of action proved to be going back to the pediatric hospitals and surgeons who performed the original operations. This is possible in a private health care system because patients are correctly viewed as customers. Under Obamacare — a system that perceives people with serious medical conditions as financial burdens to a government already deeply in hock — these patients are more likely to find themselves boxed in by rules designed to contain costs.

Read the rest here.