Nahum Kovalski

Born Free (Data)

It seems that every other day, a new medical device and/or application hits the market. The focus of these various items tends to be the way in which they collect information (entered by the user, recorded by a sensor) and what specific information they collect (various health and activity parameters). But once the information is collected, the next key issue is where to store the information and how to save it and share it with medical providers.

Most mobile health applications have a phone-based interface such that you can review the collected information on your own, post it to a site such as Facebook and share it with a physician (eg., via email). While this may be sufficient for tracking an individual vital sign like blood pressure, multiple different types of information collected from multiple devices tend not to be storable in a single common location, such as an online electronic medical record. As the number of sensors grow, and more medically related information is retrieved from various sources, a physician may find him or herself jumping between multiple websites and/or emails to get a full picture of the health of a patient.

An obvious and simple solution would be for all devices and medical information sites to use a standard format for all of their information [like HL7, as I discussed in the previous blog post]. At least for now, many developers are primarily focused on getting the information and sharing it, but not on saving it in a standard format to a common medical store.

As such, I would say that there are two key factors that need to be dealt with in order for mobile health to take the next major step forward. The first would be a willingness on the part of patients to share their information via centralized web based data stores. Of course, these data stores would be secured, but as is evident from so many news articles, there really is no such thing as absolute security. Therefore patients would need to be willing to take a certain risk that their personal information could be exposed.

The second factor does relate to finding a common format for all types of information. At some point, mobile health developers will adopt a standard format for all data, for the very simple reason that it will increase the value of their products and thus increase their potential revenues. There is another movement within the technology world that is addressing the issue of sharing all types of information amongst many devices and data stores. This new technology trend is referred to as the “Internet of things” and will have a major role to play in medicine as well.

I will discuss the Internet of Things (IoT) in more detail in the future. For now, it is enough to say that this trend refers to the assignment of unique identifiers to every “thing” around us [such as a toaster, a blood pressure cuff, a TV, a heart monitor and so on] and to the sharing of information by these things with each other and other data stores. The success of IoT will, almost by definition, depend on a common format for moving information around. So it is already clear that the IoT would be an appropriate approach for handling disparate medical devices and information sites.

There really is no technological barrier to achieving this type of universal handholding system which allows for information to flow freely around us. But in order for IoT to be fully implemented, the business model will have to be clear. For example, while it may be technologically possible to equip a refrigerator with the “smarts” to share its information about items contained within it, the question is who will ultimately pay extra for this option. If you connect such a refrigerator to an online shopping site such that milk and eggs are always ordered automatically when needed, then you are speaking of added value that will appeal to many people. In terms of the medical world, IoT includes technologies that would allow for the individual labeling of every single pill or tablet that we take for various medical conditions. Linking our medication usage information to a centralized list of our regular medications and allergies, would allow computers to verify the safety of any ingested new medication. Of course, an additional benefit would be that there would be automatic requests for refills of medications that are running low.

I find it fascinating that none of IoT is intuitively difficult to understand. That is one of the reasons that it is now being so widely embraced. When the IoT approach is used to create a whole medical ecosystem, such that our entire health profile is generated by vast numbers of sensors, we will truly begin to see the benefits of mobile health. It will not be long before IoT becomes second nature to most of us. When it does, we will see the next major wave of innovation in healthcare. It will be the equivalent of building a new, huge highway that reaches every important geographical location. Once this infrastructure exists, the traffic that flows will benefit all of us economically. And when this digital highway is used for medical information, all of our health will benefit equivalently.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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