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Wearable Devices:
BRAVE IN A WORLD OF RISK
Barry Dixon, Vice President Underwriting
Canadian Reinsurance Conference - April 14, 2015
Overview
• History and Evolution of “Wearables”
• Medical Innovation/Better Rx Compliance
• Possibilities and Opportunities
• Confidentiality & Privacy Issues
• New Product Ideas?
• Conclusions
3
WEARABLE DEVICE HISTORY
WEARABLE DEVICE HISTORY
2001 2007
5 MAJOR DIGITAL ADVANCES
1973 Cell Phone
1977 Personal Computer
1994 Internet
2001 Digital Devices
2003 Human Genome Sequencing
6
Smartphone
WEARABLES: WHAT DEVICES COME TO MIND?
7
Inspector Gadget
WEARABLES: WHAT DEVICES COME TO MIND?
8
THE SONIC SCREWDRIVER
IN THE PAST – WEARABLE DEVICE DILEMMA
9
1) Fuji DL-80 Compact Camera
2) Heart-rate Monitor
3) Creative Zen MP3 Player
4) GameBoy Pocket
5) Pedometer
6) Video Camcorder
7) Flip phone
8) Portable radio
9) Polaroid camera
10) Mini Disc Player
11) Sat/Nav System
Source: http://www.phones4u.co.uk/community/wearable-tech-unwearable-to-wearable/#sthash.QbFkSmEi.dpuf
IS THIS THE WELL-CONNECTION PERSON OF THE FUTURE?
10
Glasses
Cardiac Monitoring
Health Monitor
Smart Watch
Wearable Fitness Sensors
Patient Monitor
Outside Hospital
WHAT IS WEARABLE TECHNOLOGY?
11
“Wearable Devices” or “body-borne computers” that can be worn by user
– Intended to interact with the wearer without punching keys or other
manipulation
- Always on, always working
- Perform calculations and process Information
SUM OF TWO (2) PARTS
12
The Wearable technology consists of Two parts
----------------------------------------------------------------------------
{ 1. Sensors, glasses, watches { 2. Information aggregator
Yes - even foot wear & analyzer
U.S. HEALTH CARE – WEARABLE OPPORTUNITY?
13
Image Credit - West Health Institute
Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control
AAMC and NEHI
U.S. HEALTH CARE AS A SHARE OF GROSS DOMESTIC PRODUCT (GDP)
14
Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease
Control AAMC and NEHI
Source: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and
reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
2001
14.5%
2010
17.9%
U.S. health care spending grew 3.7% in 2012, reaching $2.8 trillion or $8,915 per person.
As a share of the nation's Gross Domestic Product, health spending accounted for 17.2 percent.
U.S. HEALTH CARE AS A SHARE OF GROSS DOMESTIC PRODUCT GDP)
15
Data from California Healthcare Foundation, Congressional Budget Office,
U.S. Centers for Disease Control AAMC and NEHI
2001
14.5%
2010
17.9%
2021
19.6%
2035
26%
2012 Per Capita Spending
$2.7 TRILLION or $8,952/person
U.S. HEALTH CARE – AGING POPULATION PEOPLE 65+
16
Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control
AAMC and NEHI
13%
40.3 MM
2010
U.S. HEALTH CARE – AGING POPULATION PEOPLE 65+
17
Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control
AAMC and NEHI
13%
40.3 MM
2010
19.6%
71 MM
2030
HOSPITAL READMISSIONS – THE COST PROBLEM
1 in 5
readmitted
within 30
days
Health cost
burden
$25
Billion/year
18
HOSPITAL READMISSIONS – THE COST PROBLEM
19
ALS (Lou Gehrig's Disease)
Alzheimer's Disease and other Dementias
Arthritis
Asthma
Cancer
Chronic Obstructive Pulmonary Disease (COPD)
Cystic Fibrosis
Diabetes
Eating Disorders
Heart Disease
Obesity
Oral Health
Osteoporosis
Tobacco Use and Related Conditions
CHRONIC DISEASES AND CONDITIONS
HOSPITAL READMISSIONS – THE COST PROBLEM
$3 out of
$4 in
health care
spending
$1.875
Trillion
spent
annually
20
WORSENING PHYSICIAN SHORTAGE (U.S.)
21
Source: AAMC Center for Workforce Studies, June Analysis, 2011
Physician Demand
Physician Supply
680,000
730,000
780,000
830,000
880,000
930,000
NECADE:
Will be SHORT - 45,000 Primary care physicians - AND - 46,000 Surgeons & Medical Specialists
2010
2015
2020
2025
130,600
91,500
62,900
13,700
723,400
798,500
851,300
916,000
709,700
735,600
759,800
785,400
DEMOGRAPHICS AND SOCIAL TRENDS
Higher Life Expectancy
Higher Ratio of Seniors
Increased Prevalence of
Chronic Disease
Cost - $2 TRILLION
22
DEMOGRAPHICS AND SOCLIAL TRENDS
Higher Life Expectancy
Higher Ratio of Seniors
Increased Prevalence of
Chronic Disease
Cost - $2 Trillion
23
DEMOGRAPHICS AND SOCIAL TRENDS
Higher Life
Expectancy
Higher Ratio of
Seniors
• Increased
Prevalence of
Chronic Disease
• Cost - $2 Trillion
More Patients in
Need of Long Term
Care
Decrease
Length Hospital Stays
24
ADD IN SILVER TSUNAMI….
Aging In Place – Silver Tsunami
78 Million Boomers
Turned 65 in 2011
9 of 10 Seniors want to stay in
the home they retired in
25
ADD IN SILVER TSUNAMI….
Care at Home – Remote Monitoring Programs
1) Well Aware
2) Genesis Tele Monitor
3) Phillips Lifeline
(and others)
Aging In Place – Silver Tsunami
78 Million Boomers
Turned 65 in 2011
9 of 10 Seniors want to stay in
the home they retired in
26
MONITORING DEVICES AVAILABLE NOW
• WellAware measures key wellness indicators, such as sleep quality,
activity levels, bathroom visits, & other physiological information through
an array of wireless sensors and analytical software.
• When subtle changes become trends, the caregiver is alerted so they
may address potential, emergent health conditions more quickly.
Well Aware
27
MONITORING DEVICES AVAILABLE NOW
• WellAware measures key wellness indicators, such as sleep quality, activity
levels, bathroom visits, & other physiological information via an array of
wireless sensors and analytical software.
• When subtle changes become trends, the caregiver is alerted so they may
address potential, emergent health conditions more quickly.
Well Aware
• Asks subjective disease-related questions to provide a more complete
picture of the individual’s health
• Automatically prompts in-home users when time to take vital signs
through voice or text communication
• Can accommodate multiple medical peripherals such as a glucose meter
Genesis Tele Monitor
28
MONITORING DEVICES AVAILABLE NOW
• WellAware measures key wellness indicators, such as sleep quality,
activity levels, bathroom visits, & other physiological information through
an array of wireless sensors and analytical software.
• When subtle changes become trends, the caregiver is alerted so they
may address potential, emergent health conditions more quickly.
Well Aware
• Measures heart rate, blood pressure, weight
• Asks subjective disease-related questions to provide a more complete
picture of the individual’s health
• Automatically prompts in-home users when time to take vital signs
through voice or text communication
• Can accommodate multiple medical peripherals such as a glucose meter
Genesis Tele Monitor
• Every year, approximately one in every three adults age 65 and older will
fall
• Nearly 50% are unable to get up after the fall
• Lifeline can automatically place a call for help if it detects a fall &
individual unable to push the button for help
Phillips Lifeline
29
HEALTH CARE COSTS MUST CHANGE/IMPROVE
30
Health Economics dictate a shift in spending1
HEALTH CARE COSTS MUST CHANGE/IMPROVE
31
Health Economics dictate a shift in spending
TO:
Health Care that is customized to:
MONITOR, DIAGNOSE, EDUCATE, &
INTERVENE
Regardless of location or time
1
2
PERFECT STORM FOR WEARABLES TO HELP HEALTH CARE REFORM
• Increased pressure on insurers and government services
(Medicare) to control costs
• 10 years ago began building a $4 Billion electronic
health - record system (research based clinical advice, & added
analytics tools and data from more sources – including information
from a patient’s medical device)
• Payoff – mining “Big Data” may provide insights into the best
treatment options for the lowest cost & find associations not
predicted, or anticipated (Good or Bad)
Source: MIT Technology Review Vol. 117 No.5
32
BENEFITS OF WEARABLE TECHNOLOGY
Educate and empower patients to take control of their health
Help physicians & patients monitor & diagnose disease
Assist in medical procedures
Allow patients to control & manage their pain
Make personal fitness more fun
33
HEALTH CARE
• "What's going to accelerate health as much as anything is
consumer devices having medical features on them so that we're
continuously collecting this data over a large population of patients"
Source: Dr. Leslie Saxon, cardiologist at the University of Southern California Keck School of Medicine & Executive Director and founder of the USC Center for Body Computing.
34
Promise of making consumers healthier
35
Attaining a critical mass of data to detect patterns, supports
expectations for making new discoveries
Promise of making consumers healthier
Provide a basis for lowering Health care costs
36
Attaining a critical mass of data to detect patterns, supports expectations for
making new discoveries
Promise of making consumers healthier
Provide a basis for lowering Health care costs
Opportunity for IT & deployment of technology – Particularly
data analytics applied to Health care
37
Attaining a critical mass of data to detect patterns, supports expectations for
making new discoveries
CAN TECHNOLOGY & BIG DATA IMPROVE MEDICAL CARE?
Medicine in the Data Age with Mobile Technology
38
Possible to capture information about individuals & their environment
Analytic
Software
Sensors
Genome
Sequencing
WHO WOULD BENEFIT IMMEDIATELY?
People who might benefit most from body-tracking wearable devices
may be those least expected:
Elderly
The Infirm
Chronic Illness Sufferers
Source: http://pando.com/2013/11/27/study-finds-that-the-people-most-likely-to-benefit-from-fitness-wearables-arent-using-them/
Pew Center found that 84% of people with chronic conditions use a pen and paper or rely on their memory to track their physical condition
ONLY 4% used applications or other tools on their smart phones
39
WHO WOULD BENEFIT IMMEDIATELY?
• People with chronic diseases don’t suddenly decide that they’re over it
& the novelty has worn off
• Tracking and self-measuring helps keep them out of the hospital
Apple’s ResearchKit software allows researchers to design apps
that use built-in sensors on the iPhone + data from other
wearable devices to gather health data on volunteers and help
individuals follow through with important health behaviours
Researchers will be able to enroll participants remotely to create sample
groups “that are order of magnitude” greater that in the past and at a
fraction of the cost
40
Source: Dr. Eric Schadt, genomics professor at the Icahn School of Medicine at New York’s Mount Sinai Hospital
EXIT – LEGACY MEDICAL DEVICES
EEG equipment for recording and monitoring brain waves for epileptic
activities
Same for ECG monitor, sphygmomanometer, oximeter, & many other devices
used to perform medical procedures
If they capture any data - the data remains with the device
42
BLUETOOTH ENABLED DEVICES
Put a sensor with Bluetooth technology into/or onto anything
- you have a smart object!
Monitoring outside the medical facility is becoming a reality, and increasingly preferred.
Will be able to coordinate the capture of comprehensive physiological, electrical, chemical data about the body, in sickness and in health,
intermittently ,or continuously
New era medical devices are magnitudes better than their legacy
counterparts because :
• Software - add/extend functions & features
• No need to turn the device on or off
• Not necessary to stop what you are doing to use the device
Data more meaningful to consumers & users
43
Medical devices, as endpoints, can provide openings into networks, allowing criminals to gain access and perform more
far-reaching attacks and exploits on manufacturers
Risk of attacks on the general public via these devices is low, and the cost of device security must be factored into the overall
value of the risks being managed
GLOBAL WEARABLE DEVICES MARKET – 3 SEGMENTS
Pain Management
• Glucose/Insulin Monitoring
• Respiratory Therapy Devices
Vital Signs Monitor
• Fetal and Obstetric Devices
• Neuromonitoring Devices
Sports and Fitness
• Remote Patient Monitoring
• Home Healthcare
Source: http://www.wearabledevices.com/2013/12/10/wearable-medical-devices-market-is-expected-to-reach-usd-5-8-billion
DR. ERIC TOPOL’S 10 TARGETS FOR WIRELESS MEDICINE
45
Disease No. Affected Wireless Solutions
Alzheimer’s 5 Million Track Vital Signs, Location, Activity & Balance
Asthma 23 Million Track Respiratory Rate & Peak Flows –
so Patients Can Use Inhaler Before an Attack
Breast Cancer 3 Million Ultrasound Self-Exam & Send Scan to their Doctor –
Reduce need for mammography
COPD 10 Million Monitor FEV1, Air Quality, & Oximetry
Depression 21 Million Track Med Compliance, Activity, & Communication
Source: http://mobihealthnews.com/1220/topols-top-ten-targets-for-wireless-medicine/
Dr. Topol is Director of the Scripps Translational Science Institute, established to apply genetic discoveries to personalized medicine
DR. TOPOL’S 10 TARGETS FOR WIRELESS MEDICINE
46
Disease No. Affected Wireless Solutions
Alzheimer’s 5 Million Track Vital Signs, Location, Activity &,Balance
Asthma 23 Million Track respiratory rate & peak flows –
so patients can use inhaler before an attack
Breast Cancer 3 Million Ultrasound Self-exam & send scan to their Doctor –
reduce need for mammography
COPD 10 Million Monitor FEV1, Air quality, & Oximetry
Depression 21 Million Track Med Compliance, Activity, & Communication
Diabetes 24 Million Monitor Blood Glucose, Hemoglobin A1C
Heart Failure 5 Million Monitor Cardiac Pressures, Weight, & BP
Hypertension 74 Million Continuously Monitor BP, Medication Compliance
Obesity 80 Million Track Weight, Glucose, Caloric Intake, & Activity
Sleep Disorders 40 Million Monitor Sleep Phases, Quality of Rest, Apnea, & Vital
Signs
Source: http://mobihealthnews.com/1220/topols-top-ten-targets-for-wireless-medicine/
Dr. Topol is Director of the Scripps Translational Science Institute, established to apply genetic discoveries to personalized medicine
ACCURACY?
47
In case you were wondering……..
Minuscule pendulum in a little box, which moves around when the sensor is moved, and approximates values that change
on each of the x, y and z axes while compensating for gravity
Each person has a different range of motion
Until software can detect & adapt to a person’s specific range of motions
there will be a significant error rate
IMAGINE THE UNINMAGINABLE!
• Ingestible cameras capable of real time transmission of the images
to image processing module
1)1) 2) 2) 3)
Future: 24 hour vital sign & ECG monitoring coupled with physical activity profile
Simultaneous monitoring of airway resistance, & medication delivery
48
PRESENT AND NEAR FUTURE
49
Zio XT Patch – FDA Approved
Prescribed by Physician who sets monitoring
period
Continuously records patient’s heartbeats.
After up to 14 days device sent to manufacturer for
Device is non-invasive, water-resistant & no wires
Google introduced it’s smart lens project
device (thinner than a strand of hair) to monitor
Glucose levels for people with DIABETES through
their tears, once per second
Currently in talks with FDA
(needed to bring product to market)
Soft contact Lens
Encapsulates electronics
Sensor
Detects glucose in tears
Chip & antenna
Received power, sends info
SAPERE AUDE – DARE TO KNOW
50
Source: https://www.scanadu.com
Scanadu Scout designed to be medical grade Tricorder
linked via Bluetooth to a smartphone & emulate an ER in your hand
(Pending FDA approval!)
Heart Rate & ECG
Blood Pressure
Temperature
Respiratory Rate
Oximetry
1) Visible & near-IR LED & sensor (for the oximetry test)
2) ECG sensor, a far-IR sensor (for temperature)
3) Microphone (to gauge heart and breathing sounds)
Star Trek Tricorder
Scanadu Scout
MEDICAL DEVICE DEFINITION
51
Definition
• Instrument, apparatus, implement, machine, contrivance,
implant, in vitro reagent, or other similar or related article,
including a component part, or accessory
MEDICAL DEVICE DEFINITION
52
Definition
• Instrument, apparatus, implement, machine, contrivance,
implant, in vitro reagent, or other similar or related article,
including a component part, or accessory
Intended to affect the structure of any function of the body of
man, or other animals
Source: http://www.fda.gov/medicaldevices/deviceregulationandguidance/overview/classifyyourdevice/ucm051512.htm
COMMUNICATION – NEW GENERATION MEDICAL DEVICES
Devices will communicate information
(to: Physician, Case manager, Benefit manager, etc.)
A
53
Multi-functional, Adaptable, Portable, Self-documenting,
Self-managing & Intelligent
Multi-function, Adaptable, Portable, Self-documenting
Anyone
Anywhere
OBVIOUS DILEMMA
54
Information
Privacy
OBVIOUS DILEMMA
55
Information
Privacy
DEFINED BY UNITED STATES JUSTICES:
S. WARREN & L. BRANDEIS (1890)
• “Right To Be Left Alone”
and to keep information
about themselves from
being disclosed to others
Information shared in a clinical relationship is considered confidential
& MUST BE protected
• E.g. Identification data, diagnoses, treatment, progress notes & lab results
56
“I never said I want to be alone.
I said I want to be left alone.
There is a world
of
difference”
Greta
Garbo
CONSEQUENCES
Advances in technology, including computerized medical databases have
opened the door to potential breaches of private/confidential information
57
2014 MOST COMMON & WORST PASSWORDS
58
Source: http://splashdata.com/index.htm
Rank # Password Rank # Password
1 123456 11 1234567
2 password 12 monkey
3 12345 13 letmein
4 12345678 14 abc123
5 qwerty 15 111111
6 123456789 16 mustang
7 1234 17 access
8 baseball 18 shadow
9 dragon 19 master
10 football 20 michael
These "Worst Passwords" that will expose anyone to being hacked or having their identities stolen
makes password management applications
AREAS OF SECURITY CONCERN
Wearable Device Itself
59
AREAS OF SECURITY CONCERN
Wearable Device Itself Transfer of Data To
Companion Device &
Transfer to Cloud
60
AREAS OF SECURITY CONCERN
Wearable Device Itself
Transfer of Data To
Companion Device &
Transfer to Cloud
Data Storage in the
Cloud
61
AREAS OF SECURITY CONCERN
Wearable Device Itself Transfer of Data To
Companion Device
Transfer to Cloud
Storage Of Data In
The Cloud
Data Storage Is
Hacker’s Target!
62
CONCERN OVER SECURITY OF HEALTH DATA
Security concerns arise from the increased use of
Electronic Health Records (EHRs)
1) Increased Use of Mobile Devices,
2) Medical Identify Theft
3) Anticipated Exchange of Data
Between Clinicians, Federal Agencies
& Patients
Near future there will be one national network that contains every citizen’s
health record – SUCCESSFULLY addressing privacy issues would mean -
individual health record could be easily accessed by an insurance company
- Speeding Up Decision Making -
63
3
2
1
LEVELS OF THEAT TO INFORMATION SECURITY
Insiders abusing record
access privileges
64
Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure,
levels of threats to privacy fall into the above categories
Insiders abusing record
access privileges
Vengeful
Employee &
outsiders
65
Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure,
levels of threats to privacy fall into the above categories
LEVELS OF THREAT TO INFORMATION SECURITY
Insiders who access
information for spite or
profit
LEVELS OF THREAT TO INFORMATION SECURITY
Insiders abusing record
access privileges
Insiders who access
information for spite or
profit
Vengeful
Employee &
outsiders
66
Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure,
levels of threats to privacy fall into the above categories
LEVELS OF THREAT TO INFORMATION SECURITY
Insiders abusing record
access privileges
Insiders who access
information for spite or
profit
Unauthorized physical
intruder
Vengeful Employee
or outsider(s)
Intent to damage
systems or disrupt
operations
67
Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure,
levels of threats to privacy fall into the above categories
WEARABLE DEVICES - VULNERABILITIES
68
Flood device with information
so normal communications do
not reach it
WEARABLE DEVICES - VULNERABILITIES
69
Unauthorized device
reprogramming & data
extraction
Flood device with information so
normal communications do not
reach it
WEARABLE DEVICES - VULNERABILITIES
70
Unauthorized device
reprogramming & data extraction
Flood device with information so
normal communications do not
reach it
Tactics to prematurely drain battery
by repeatedly awakening it from a
sleep state
WHAT IS CONSIDERED CONFIDENTIAL?
71
Age √
Religion √
Health √
Conditions &
Problems
WHAT IS CONSIDERED CONFIDENTIAL?
72
Age √
Religion √
Health √
Conditions &
Problems
Gender √
Marital Status √
Insurance
information √
WHAT IS CONSIDERED CONFIDENTIAL?
73
Age √
Religion √
Health √
Conditions &
Problems
Gender √
Marital Status √
Insurance
information √
Race √
Health information
√
(includes lab tests, x-rays,
blood work, MRI & CT scans
plus any diagnostic patient
procedure/physician contact)
DATA ENCRYPTION
Apply Data Encryption
Disguise all data inside medical files through cryptography
8% of the data breaches listed on Health & Human Services’
“Wall of Shame” are due to hacking
92% of breaches come in the form of simple yet costly human errors:
Losing a laptop
Taking a break & not locking down a keyboard, etc.
74
Involved persons who received treatment from a physician's office tied to a network-owned hospital in the past
5 years "No matter how good you make the technology, "we'll never get the risk down to zero."
75
COMMUNITY HEALTH SYSTEMS (206 hospitals /29 States)
8/ 2014 – Hackers gained access to names, Social Security #’s, Physical addresses, birthdays & telephone #’s
2014 HEALTH RECORD BREACHES REPORTED
(Breaches affecting 500 or more people)
Name of
Covered Entity State
Individuals
Affected
Breach
Date
Type of Breach Location of Breached
Information
Baylor Medical
Center
Texas 2,308 Jan. 23rd Hacking/IT Incident E-mail
Health Texas
Provider Network
Texas 2,742 Jan. 23rd Hacking/IT Incident E-mail
Salina Family
Healthcare Center
Kansas 9,640 April 8th Unauthorized
Access/Disclosure
E-mail
Group Health Care
Plan
Michigan 2,289 May 13th Unauthorized
Access/Disclosure
E-mail
Nirad Medical
Associates
New York 97,000 April 24th Unauthorized
Access/Disclosure,
Hacking/IT Incident
Desktop Computer, other
portable Electronic
Device
Rady Children’s
Hospital
California 14,121 June 6th Unauthorized
Access/Disclosure
E-mail
76
Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html
Since 2009, federal law has required health care providers to report to the
Department of Health and Human Services and the news media all data
breaches affecting 500 patients or more
LARGEST DATE BREACHES SINCE 2009
(Breaches affecting 500 or more people)
Health Care Provider State # Affected Type of Breach Date
Tricare Virginia 4,901,432 Loss of Backup tapes Sept. 13, 2011
Health Net, Inc. California 1,900,000 Unknown Jan. 21, 2011
North Bronx Healthcare
Network
New York 1,700,000 Electronic medical records
theft
Dec. 23, 2010
AvMed, Inc. Florida 1,250,000 Laptop theft Dec. 10, 2009
Nemours Foundation Florida 1,055,489 Loss of Backup tapes Aug. 10, 2011
Blue Cross Tennessee 1,023,209 Hard Drive theft Oct. 2, 2011
Sutter Medical Foundation California 943,434 Desktop computer theft Oct. 5, 2011
South Shore Hospital Massachusetts 800,000 Loss of portable electronic
device
Feb. 26, 2011
Utah Dept. of Health Utah 780.000 Hacking March 10, 2012
Eisenhower Medical Center California 514,330 Computer theft Marcy 11, 2011
77
Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html
AT THE PEARLY GATES….
78
Sorry - I had no idea you died -
We don’t have access to your medical records”
GROWING SUPPORT FOR WEARABLES
January, 2014 (CES)
Consumer Electronics Show
Intel’s CEO Brian Krzanich announced the company’s goal
of penetrating the wearable computing market led by an SD-
sized computer with built-in wireless-ness, the “Edison”
“Full Pentium-class PC in the form of an Secure Digital card”
79
Source: http://www.business-standard.com/article/companies/intel-exploring-women-focused-wearables-114091101198_1.html
HOW INTEL SEES THE FUTURE OF WEARABLES
“Edison” can be redesigned to work with most devices - not
limited to computers, phones, or tablets & can house multiple applications”
Well positioned to support innovation & product development
80
Source: www.intel.com/edison
ANNOUNCEMENT - August 13, 2014
Intel announced a partnership with
Intel's devices will help research on & treatment of neurodegenerative brain
disease
Intel hopes to mine data to improve research, & better understand the
behaviors/progression of the disease
81
INTEL HELP BATTLE PARKINSON’S
82
Device like the popular FitBit (a wristband activity monitor)
300 data points will be recorded per second
- equivalent to one GB of data per patient/per day
- Information uploaded to Intel's system by a smartphone
Objective :
Create algorithms to automatically measure body movement symptoms
& sleep patterns
APPLE ANNOUNCEMENT (9/2014)
83
“There are several things called
smartwatches that are shipping….
But certainly there have been none
that have changed the way people
live their lives.
That’s our objective”
-- Tim Cook CEO 2/ 2015
Built in infrared & LED sensors accurately record pulse rate
TIKKER: HAPPINESS WATCH OR DEATH WATCH?
84
TIKKER: HAPPINESS WATCH OR DEATH WATCH?
85
Source: http://mytikker.com/products/tikker
Cost -$79.00
HOW DOES TIKKER PREDICT
DEATH?
To set up Tikker
the wearer fills out
a questionnaire by
entering
information about
their medical
history, including
allergies or
Illnesses
They are asked
whether they drink
or smoke and if
there are any
instances of cancer,
diabetes and other diseases
in their family
Wearers are additionally asked about
how much exercise they do, as well as
how much they weigh before receiving
a score
Their age is deducted from the results
to predict a death date and the Tikker
begins the countdown
Tikker: Kickstarter
INSURANCE OPPORTUNITIES
“Mobile devices and social media have "fundamentally changed
consumer expectations," and by harnessing mobile technology,
Insurers can reach & service "markets that increasingly demand
Convenience & a flexible interface.“
“Traditional insurance products and distribution channels aren't
well suited for Generations X and Y”
Source: Ernst & Young's 2014 Global Insurance Outlook
86
INSURANCE OPPORTUNITIES
87
1. Developing direct-to-consumer
relationship (apply data analytics &
more efficient underwriting)
– Can evolve into an online sales system
2. Developing a multi-channel approach
(self-service options along with an
enhanced customer experience)
Consider:
LIFE INSURANCE
Can we develop Well-Being Benefit Products or at a minimum?
88
Identify Best
Risks
Prioritize Cases
Increase Placement
Ratio
Underwriting Speed
& Consistency
DIRECTLY MARKETED TO PROPOSED INSUREDS
• Direct to consumer marketing to bring down distribution costs
• Integrate data with electronic applications, data analytics, use of
underwriting systems
• Younger risks, professionals & the wealthy likely to be more
& willing to purchase insurance via direct
online/call centers & provide wearable device proof of insurability
• U.S. Data - “Only 46% of middle-market consumers have individual life
insurance….however, employees under Age 45 say they find it more comfortable to
purchase online “
Source: 2014 Employee Benefit News and SourceMedia, Inc.
89
WELL-BEING BENEFITS MAY APPEAL TO:
Younger customers, who tend to focus on staying fit & healthy
Aging segments (pre-retirees & retirees)
Choosing to lead a healthy lifestyle & actively
attempting to delay onset of chronic diseases
An opportunity to expand the life insurance market
90
Source: http://www.lifehealthpro.com/2014/02/12/resuscitating-the-life-insurance-business-model
ELIZABETH HOLMES FOUNDER & CEO - THERANOS
Blood is drawn with a finger stick - rather than a needle in the arm
Theranos - One drop. A world of answers
“Our laboratory can precisely analyze tiny samples.
A few drop are all we need to perform most tests.
So now, you can have your labs – from blood, urine,
fluids and more – done quickly, easily, and accurately”
• One drop of blood is enough for dozens of different tests and the procedure can be conducted at a pharmacy, with results arriving within 4 hours.
List of tests available at https://www.theranos.com/#!/test-menu?ref=our_solution
Imagine a “snapshot”- style discount being available to life insurance
shoppers for submitting periodic test results that prove their blood pressure,
diabetes or cholesterol is under control
Sources: https://www.theranos.com/#!/our-solution
http://singularityhub.com/2013/11/18/small-fast-and-cheap-theranos-is-the-poster-child-of-med-tech-and-its-in-walgreens/
91
1.29 cm
TRUE WELL BEING DISCOUNTS?
• To encourage sharing of personal health information
insurers could provide policyholders both:
FINANCIAL INCENTIVES
(e.g., decrease in premiums)
NON-FINANCIAL INCENTIVES
(e.g., physical health and psychological) benefits
92
DO WEARABLES HAVE VALUE?
A lot needs to be done to convince people that Wearables
have value:
93
DO WEARABLES HAVE VALUE?
Including - The people that make up the technology companies
AND
PPeople that create the technology companies
94
DO WEARABLES HAVE VALUE?
AND
Users they are targeting
95
Users they are targeting
INTEL FUTURIST STEVE BROWN
2014 Keynote address:
“Up to now, the industry has concentrated on doing what
is possible rather than what people want”
96
Source to see samples of new devices http://www.theguardian.com/technology/gallery/2014/mar/20/london-wearable-tech-show-2014-pictures
FUTURIST & AUTHOR PATRICK TUCKER
“ We are going to see the normalization of
wearable tech as we did with the Internet,” ….
“Even people who don’t look forward to the
prospect of buying a wearable device will still benefit
from the data that is collected about topics including fitness
and health.”
Source: Patrick Tucker, a futurist & author of the book “The Naked Future: What Happens In A World That Anticipates Your Every Move?”
97
PRIVACY POLICY SHOULD INCLUDE INFORMATION SUCH AS:
• Who is collecting the data?
• What is being collected?
• When is data collected?
• What will the data be used for?
• How long will the data be kept?
• How can the user access and control the data?
• Will the data be shared with third parties?
98
Tom Cruise – The Minority Report
DESPITE PRIVACY CONCERNS…
• Positive potential for businesses, health care & insurers
IS:
Consumer electronics corporations must develop smart, connected,
& secure devices that simplify a user’s life - without compromising security
Need wisdom to ignore technology
- when it leads us in the wrong direction!
99
WEARABLE TECHNOLOGY NEEDS TO BE
Power Efficient
Small
Footprint
100
WEARABLE TECHNOLOGY NEEDS TO BE
Small
Footprint
101
WEARABLE TECHNOLOGY NEEDS TO BE
Power
Efficient
Accurate Cost
Effective
Small Footprint Connected
Long Battery
Life
102
THERE IS ALSO THE FUNDAMENTAL QUESTION …..
Will people ever be comfortable having their health data monitored
this extensively????
103
THERE IS ALSO THE FUNDAMENTAL QUESTION….
Will people ever be comfortable having their health data monitored
this extensively????
104
IN CONCLUSION
• In a way…..
Future of Wearables is to become
“Unaware-ables”
“To serve consumers best when they call as little attention as possible to
their own exquisite cleverness”
105
It’s not what you wear…
It’s how are you connected!
Questions?
106
Thank You!
Q & A
Barry's 2015 CRC presentation with new CRC ppt template

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Barry's 2015 CRC presentation with new CRC ppt template

  • 1.
  • 2. Wearable Devices: BRAVE IN A WORLD OF RISK Barry Dixon, Vice President Underwriting Canadian Reinsurance Conference - April 14, 2015
  • 3. Overview • History and Evolution of “Wearables” • Medical Innovation/Better Rx Compliance • Possibilities and Opportunities • Confidentiality & Privacy Issues • New Product Ideas? • Conclusions 3
  • 6. 5 MAJOR DIGITAL ADVANCES 1973 Cell Phone 1977 Personal Computer 1994 Internet 2001 Digital Devices 2003 Human Genome Sequencing 6 Smartphone
  • 7. WEARABLES: WHAT DEVICES COME TO MIND? 7 Inspector Gadget
  • 8. WEARABLES: WHAT DEVICES COME TO MIND? 8 THE SONIC SCREWDRIVER
  • 9. IN THE PAST – WEARABLE DEVICE DILEMMA 9 1) Fuji DL-80 Compact Camera 2) Heart-rate Monitor 3) Creative Zen MP3 Player 4) GameBoy Pocket 5) Pedometer 6) Video Camcorder 7) Flip phone 8) Portable radio 9) Polaroid camera 10) Mini Disc Player 11) Sat/Nav System Source: http://www.phones4u.co.uk/community/wearable-tech-unwearable-to-wearable/#sthash.QbFkSmEi.dpuf
  • 10. IS THIS THE WELL-CONNECTION PERSON OF THE FUTURE? 10 Glasses Cardiac Monitoring Health Monitor Smart Watch Wearable Fitness Sensors Patient Monitor Outside Hospital
  • 11. WHAT IS WEARABLE TECHNOLOGY? 11 “Wearable Devices” or “body-borne computers” that can be worn by user – Intended to interact with the wearer without punching keys or other manipulation - Always on, always working - Perform calculations and process Information
  • 12. SUM OF TWO (2) PARTS 12 The Wearable technology consists of Two parts ---------------------------------------------------------------------------- { 1. Sensors, glasses, watches { 2. Information aggregator Yes - even foot wear & analyzer
  • 13. U.S. HEALTH CARE – WEARABLE OPPORTUNITY? 13 Image Credit - West Health Institute Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control AAMC and NEHI
  • 14. U.S. HEALTH CARE AS A SHARE OF GROSS DOMESTIC PRODUCT (GDP) 14 Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control AAMC and NEHI Source: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html 2001 14.5% 2010 17.9% U.S. health care spending grew 3.7% in 2012, reaching $2.8 trillion or $8,915 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.2 percent.
  • 15. U.S. HEALTH CARE AS A SHARE OF GROSS DOMESTIC PRODUCT GDP) 15 Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control AAMC and NEHI 2001 14.5% 2010 17.9% 2021 19.6% 2035 26% 2012 Per Capita Spending $2.7 TRILLION or $8,952/person
  • 16. U.S. HEALTH CARE – AGING POPULATION PEOPLE 65+ 16 Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control AAMC and NEHI 13% 40.3 MM 2010
  • 17. U.S. HEALTH CARE – AGING POPULATION PEOPLE 65+ 17 Data from California Healthcare Foundation, Congressional Budget Office, U.S. Centers for Disease Control AAMC and NEHI 13% 40.3 MM 2010 19.6% 71 MM 2030
  • 18. HOSPITAL READMISSIONS – THE COST PROBLEM 1 in 5 readmitted within 30 days Health cost burden $25 Billion/year 18
  • 19. HOSPITAL READMISSIONS – THE COST PROBLEM 19 ALS (Lou Gehrig's Disease) Alzheimer's Disease and other Dementias Arthritis Asthma Cancer Chronic Obstructive Pulmonary Disease (COPD) Cystic Fibrosis Diabetes Eating Disorders Heart Disease Obesity Oral Health Osteoporosis Tobacco Use and Related Conditions CHRONIC DISEASES AND CONDITIONS
  • 20. HOSPITAL READMISSIONS – THE COST PROBLEM $3 out of $4 in health care spending $1.875 Trillion spent annually 20
  • 21. WORSENING PHYSICIAN SHORTAGE (U.S.) 21 Source: AAMC Center for Workforce Studies, June Analysis, 2011 Physician Demand Physician Supply 680,000 730,000 780,000 830,000 880,000 930,000 NECADE: Will be SHORT - 45,000 Primary care physicians - AND - 46,000 Surgeons & Medical Specialists 2010 2015 2020 2025 130,600 91,500 62,900 13,700 723,400 798,500 851,300 916,000 709,700 735,600 759,800 785,400
  • 22. DEMOGRAPHICS AND SOCIAL TRENDS Higher Life Expectancy Higher Ratio of Seniors Increased Prevalence of Chronic Disease Cost - $2 TRILLION 22
  • 23. DEMOGRAPHICS AND SOCLIAL TRENDS Higher Life Expectancy Higher Ratio of Seniors Increased Prevalence of Chronic Disease Cost - $2 Trillion 23
  • 24. DEMOGRAPHICS AND SOCIAL TRENDS Higher Life Expectancy Higher Ratio of Seniors • Increased Prevalence of Chronic Disease • Cost - $2 Trillion More Patients in Need of Long Term Care Decrease Length Hospital Stays 24
  • 25. ADD IN SILVER TSUNAMI…. Aging In Place – Silver Tsunami 78 Million Boomers Turned 65 in 2011 9 of 10 Seniors want to stay in the home they retired in 25
  • 26. ADD IN SILVER TSUNAMI…. Care at Home – Remote Monitoring Programs 1) Well Aware 2) Genesis Tele Monitor 3) Phillips Lifeline (and others) Aging In Place – Silver Tsunami 78 Million Boomers Turned 65 in 2011 9 of 10 Seniors want to stay in the home they retired in 26
  • 27. MONITORING DEVICES AVAILABLE NOW • WellAware measures key wellness indicators, such as sleep quality, activity levels, bathroom visits, & other physiological information through an array of wireless sensors and analytical software. • When subtle changes become trends, the caregiver is alerted so they may address potential, emergent health conditions more quickly. Well Aware 27
  • 28. MONITORING DEVICES AVAILABLE NOW • WellAware measures key wellness indicators, such as sleep quality, activity levels, bathroom visits, & other physiological information via an array of wireless sensors and analytical software. • When subtle changes become trends, the caregiver is alerted so they may address potential, emergent health conditions more quickly. Well Aware • Asks subjective disease-related questions to provide a more complete picture of the individual’s health • Automatically prompts in-home users when time to take vital signs through voice or text communication • Can accommodate multiple medical peripherals such as a glucose meter Genesis Tele Monitor 28
  • 29. MONITORING DEVICES AVAILABLE NOW • WellAware measures key wellness indicators, such as sleep quality, activity levels, bathroom visits, & other physiological information through an array of wireless sensors and analytical software. • When subtle changes become trends, the caregiver is alerted so they may address potential, emergent health conditions more quickly. Well Aware • Measures heart rate, blood pressure, weight • Asks subjective disease-related questions to provide a more complete picture of the individual’s health • Automatically prompts in-home users when time to take vital signs through voice or text communication • Can accommodate multiple medical peripherals such as a glucose meter Genesis Tele Monitor • Every year, approximately one in every three adults age 65 and older will fall • Nearly 50% are unable to get up after the fall • Lifeline can automatically place a call for help if it detects a fall & individual unable to push the button for help Phillips Lifeline 29
  • 30. HEALTH CARE COSTS MUST CHANGE/IMPROVE 30 Health Economics dictate a shift in spending1
  • 31. HEALTH CARE COSTS MUST CHANGE/IMPROVE 31 Health Economics dictate a shift in spending TO: Health Care that is customized to: MONITOR, DIAGNOSE, EDUCATE, & INTERVENE Regardless of location or time 1 2
  • 32. PERFECT STORM FOR WEARABLES TO HELP HEALTH CARE REFORM • Increased pressure on insurers and government services (Medicare) to control costs • 10 years ago began building a $4 Billion electronic health - record system (research based clinical advice, & added analytics tools and data from more sources – including information from a patient’s medical device) • Payoff – mining “Big Data” may provide insights into the best treatment options for the lowest cost & find associations not predicted, or anticipated (Good or Bad) Source: MIT Technology Review Vol. 117 No.5 32
  • 33. BENEFITS OF WEARABLE TECHNOLOGY Educate and empower patients to take control of their health Help physicians & patients monitor & diagnose disease Assist in medical procedures Allow patients to control & manage their pain Make personal fitness more fun 33
  • 34. HEALTH CARE • "What's going to accelerate health as much as anything is consumer devices having medical features on them so that we're continuously collecting this data over a large population of patients" Source: Dr. Leslie Saxon, cardiologist at the University of Southern California Keck School of Medicine & Executive Director and founder of the USC Center for Body Computing. 34
  • 35. Promise of making consumers healthier 35 Attaining a critical mass of data to detect patterns, supports expectations for making new discoveries
  • 36. Promise of making consumers healthier Provide a basis for lowering Health care costs 36 Attaining a critical mass of data to detect patterns, supports expectations for making new discoveries
  • 37. Promise of making consumers healthier Provide a basis for lowering Health care costs Opportunity for IT & deployment of technology – Particularly data analytics applied to Health care 37 Attaining a critical mass of data to detect patterns, supports expectations for making new discoveries
  • 38. CAN TECHNOLOGY & BIG DATA IMPROVE MEDICAL CARE? Medicine in the Data Age with Mobile Technology 38 Possible to capture information about individuals & their environment Analytic Software Sensors Genome Sequencing
  • 39. WHO WOULD BENEFIT IMMEDIATELY? People who might benefit most from body-tracking wearable devices may be those least expected: Elderly The Infirm Chronic Illness Sufferers Source: http://pando.com/2013/11/27/study-finds-that-the-people-most-likely-to-benefit-from-fitness-wearables-arent-using-them/ Pew Center found that 84% of people with chronic conditions use a pen and paper or rely on their memory to track their physical condition ONLY 4% used applications or other tools on their smart phones 39
  • 40. WHO WOULD BENEFIT IMMEDIATELY? • People with chronic diseases don’t suddenly decide that they’re over it & the novelty has worn off • Tracking and self-measuring helps keep them out of the hospital Apple’s ResearchKit software allows researchers to design apps that use built-in sensors on the iPhone + data from other wearable devices to gather health data on volunteers and help individuals follow through with important health behaviours Researchers will be able to enroll participants remotely to create sample groups “that are order of magnitude” greater that in the past and at a fraction of the cost 40 Source: Dr. Eric Schadt, genomics professor at the Icahn School of Medicine at New York’s Mount Sinai Hospital
  • 41. EXIT – LEGACY MEDICAL DEVICES EEG equipment for recording and monitoring brain waves for epileptic activities Same for ECG monitor, sphygmomanometer, oximeter, & many other devices used to perform medical procedures If they capture any data - the data remains with the device 42
  • 42. BLUETOOTH ENABLED DEVICES Put a sensor with Bluetooth technology into/or onto anything - you have a smart object! Monitoring outside the medical facility is becoming a reality, and increasingly preferred. Will be able to coordinate the capture of comprehensive physiological, electrical, chemical data about the body, in sickness and in health, intermittently ,or continuously New era medical devices are magnitudes better than their legacy counterparts because : • Software - add/extend functions & features • No need to turn the device on or off • Not necessary to stop what you are doing to use the device Data more meaningful to consumers & users 43 Medical devices, as endpoints, can provide openings into networks, allowing criminals to gain access and perform more far-reaching attacks and exploits on manufacturers Risk of attacks on the general public via these devices is low, and the cost of device security must be factored into the overall value of the risks being managed
  • 43. GLOBAL WEARABLE DEVICES MARKET – 3 SEGMENTS Pain Management • Glucose/Insulin Monitoring • Respiratory Therapy Devices Vital Signs Monitor • Fetal and Obstetric Devices • Neuromonitoring Devices Sports and Fitness • Remote Patient Monitoring • Home Healthcare Source: http://www.wearabledevices.com/2013/12/10/wearable-medical-devices-market-is-expected-to-reach-usd-5-8-billion
  • 44. DR. ERIC TOPOL’S 10 TARGETS FOR WIRELESS MEDICINE 45 Disease No. Affected Wireless Solutions Alzheimer’s 5 Million Track Vital Signs, Location, Activity & Balance Asthma 23 Million Track Respiratory Rate & Peak Flows – so Patients Can Use Inhaler Before an Attack Breast Cancer 3 Million Ultrasound Self-Exam & Send Scan to their Doctor – Reduce need for mammography COPD 10 Million Monitor FEV1, Air Quality, & Oximetry Depression 21 Million Track Med Compliance, Activity, & Communication Source: http://mobihealthnews.com/1220/topols-top-ten-targets-for-wireless-medicine/ Dr. Topol is Director of the Scripps Translational Science Institute, established to apply genetic discoveries to personalized medicine
  • 45. DR. TOPOL’S 10 TARGETS FOR WIRELESS MEDICINE 46 Disease No. Affected Wireless Solutions Alzheimer’s 5 Million Track Vital Signs, Location, Activity &,Balance Asthma 23 Million Track respiratory rate & peak flows – so patients can use inhaler before an attack Breast Cancer 3 Million Ultrasound Self-exam & send scan to their Doctor – reduce need for mammography COPD 10 Million Monitor FEV1, Air quality, & Oximetry Depression 21 Million Track Med Compliance, Activity, & Communication Diabetes 24 Million Monitor Blood Glucose, Hemoglobin A1C Heart Failure 5 Million Monitor Cardiac Pressures, Weight, & BP Hypertension 74 Million Continuously Monitor BP, Medication Compliance Obesity 80 Million Track Weight, Glucose, Caloric Intake, & Activity Sleep Disorders 40 Million Monitor Sleep Phases, Quality of Rest, Apnea, & Vital Signs Source: http://mobihealthnews.com/1220/topols-top-ten-targets-for-wireless-medicine/ Dr. Topol is Director of the Scripps Translational Science Institute, established to apply genetic discoveries to personalized medicine
  • 46. ACCURACY? 47 In case you were wondering…….. Minuscule pendulum in a little box, which moves around when the sensor is moved, and approximates values that change on each of the x, y and z axes while compensating for gravity Each person has a different range of motion Until software can detect & adapt to a person’s specific range of motions there will be a significant error rate
  • 47. IMAGINE THE UNINMAGINABLE! • Ingestible cameras capable of real time transmission of the images to image processing module 1)1) 2) 2) 3) Future: 24 hour vital sign & ECG monitoring coupled with physical activity profile Simultaneous monitoring of airway resistance, & medication delivery 48
  • 48. PRESENT AND NEAR FUTURE 49 Zio XT Patch – FDA Approved Prescribed by Physician who sets monitoring period Continuously records patient’s heartbeats. After up to 14 days device sent to manufacturer for Device is non-invasive, water-resistant & no wires Google introduced it’s smart lens project device (thinner than a strand of hair) to monitor Glucose levels for people with DIABETES through their tears, once per second Currently in talks with FDA (needed to bring product to market) Soft contact Lens Encapsulates electronics Sensor Detects glucose in tears Chip & antenna Received power, sends info
  • 49. SAPERE AUDE – DARE TO KNOW 50 Source: https://www.scanadu.com Scanadu Scout designed to be medical grade Tricorder linked via Bluetooth to a smartphone & emulate an ER in your hand (Pending FDA approval!) Heart Rate & ECG Blood Pressure Temperature Respiratory Rate Oximetry 1) Visible & near-IR LED & sensor (for the oximetry test) 2) ECG sensor, a far-IR sensor (for temperature) 3) Microphone (to gauge heart and breathing sounds) Star Trek Tricorder Scanadu Scout
  • 50. MEDICAL DEVICE DEFINITION 51 Definition • Instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory
  • 51. MEDICAL DEVICE DEFINITION 52 Definition • Instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory Intended to affect the structure of any function of the body of man, or other animals Source: http://www.fda.gov/medicaldevices/deviceregulationandguidance/overview/classifyyourdevice/ucm051512.htm
  • 52. COMMUNICATION – NEW GENERATION MEDICAL DEVICES Devices will communicate information (to: Physician, Case manager, Benefit manager, etc.) A 53 Multi-functional, Adaptable, Portable, Self-documenting, Self-managing & Intelligent Multi-function, Adaptable, Portable, Self-documenting Anyone Anywhere
  • 55. DEFINED BY UNITED STATES JUSTICES: S. WARREN & L. BRANDEIS (1890) • “Right To Be Left Alone” and to keep information about themselves from being disclosed to others Information shared in a clinical relationship is considered confidential & MUST BE protected • E.g. Identification data, diagnoses, treatment, progress notes & lab results 56 “I never said I want to be alone. I said I want to be left alone. There is a world of difference” Greta Garbo
  • 56. CONSEQUENCES Advances in technology, including computerized medical databases have opened the door to potential breaches of private/confidential information 57
  • 57. 2014 MOST COMMON & WORST PASSWORDS 58 Source: http://splashdata.com/index.htm Rank # Password Rank # Password 1 123456 11 1234567 2 password 12 monkey 3 12345 13 letmein 4 12345678 14 abc123 5 qwerty 15 111111 6 123456789 16 mustang 7 1234 17 access 8 baseball 18 shadow 9 dragon 19 master 10 football 20 michael These "Worst Passwords" that will expose anyone to being hacked or having their identities stolen makes password management applications
  • 58. AREAS OF SECURITY CONCERN Wearable Device Itself 59
  • 59. AREAS OF SECURITY CONCERN Wearable Device Itself Transfer of Data To Companion Device & Transfer to Cloud 60
  • 60. AREAS OF SECURITY CONCERN Wearable Device Itself Transfer of Data To Companion Device & Transfer to Cloud Data Storage in the Cloud 61
  • 61. AREAS OF SECURITY CONCERN Wearable Device Itself Transfer of Data To Companion Device Transfer to Cloud Storage Of Data In The Cloud Data Storage Is Hacker’s Target! 62
  • 62. CONCERN OVER SECURITY OF HEALTH DATA Security concerns arise from the increased use of Electronic Health Records (EHRs) 1) Increased Use of Mobile Devices, 2) Medical Identify Theft 3) Anticipated Exchange of Data Between Clinicians, Federal Agencies & Patients Near future there will be one national network that contains every citizen’s health record – SUCCESSFULLY addressing privacy issues would mean - individual health record could be easily accessed by an insurance company - Speeding Up Decision Making - 63 3 2 1
  • 63. LEVELS OF THEAT TO INFORMATION SECURITY Insiders abusing record access privileges 64 Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, levels of threats to privacy fall into the above categories
  • 64. Insiders abusing record access privileges Vengeful Employee & outsiders 65 Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, levels of threats to privacy fall into the above categories LEVELS OF THREAT TO INFORMATION SECURITY Insiders who access information for spite or profit
  • 65. LEVELS OF THREAT TO INFORMATION SECURITY Insiders abusing record access privileges Insiders who access information for spite or profit Vengeful Employee & outsiders 66 Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, levels of threats to privacy fall into the above categories
  • 66. LEVELS OF THREAT TO INFORMATION SECURITY Insiders abusing record access privileges Insiders who access information for spite or profit Unauthorized physical intruder Vengeful Employee or outsider(s) Intent to damage systems or disrupt operations 67 Source: According to the Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, levels of threats to privacy fall into the above categories
  • 67. WEARABLE DEVICES - VULNERABILITIES 68 Flood device with information so normal communications do not reach it
  • 68. WEARABLE DEVICES - VULNERABILITIES 69 Unauthorized device reprogramming & data extraction Flood device with information so normal communications do not reach it
  • 69. WEARABLE DEVICES - VULNERABILITIES 70 Unauthorized device reprogramming & data extraction Flood device with information so normal communications do not reach it Tactics to prematurely drain battery by repeatedly awakening it from a sleep state
  • 70. WHAT IS CONSIDERED CONFIDENTIAL? 71 Age √ Religion √ Health √ Conditions & Problems
  • 71. WHAT IS CONSIDERED CONFIDENTIAL? 72 Age √ Religion √ Health √ Conditions & Problems Gender √ Marital Status √ Insurance information √
  • 72. WHAT IS CONSIDERED CONFIDENTIAL? 73 Age √ Religion √ Health √ Conditions & Problems Gender √ Marital Status √ Insurance information √ Race √ Health information √ (includes lab tests, x-rays, blood work, MRI & CT scans plus any diagnostic patient procedure/physician contact)
  • 73. DATA ENCRYPTION Apply Data Encryption Disguise all data inside medical files through cryptography 8% of the data breaches listed on Health & Human Services’ “Wall of Shame” are due to hacking 92% of breaches come in the form of simple yet costly human errors: Losing a laptop Taking a break & not locking down a keyboard, etc. 74
  • 74. Involved persons who received treatment from a physician's office tied to a network-owned hospital in the past 5 years "No matter how good you make the technology, "we'll never get the risk down to zero." 75 COMMUNITY HEALTH SYSTEMS (206 hospitals /29 States) 8/ 2014 – Hackers gained access to names, Social Security #’s, Physical addresses, birthdays & telephone #’s
  • 75. 2014 HEALTH RECORD BREACHES REPORTED (Breaches affecting 500 or more people) Name of Covered Entity State Individuals Affected Breach Date Type of Breach Location of Breached Information Baylor Medical Center Texas 2,308 Jan. 23rd Hacking/IT Incident E-mail Health Texas Provider Network Texas 2,742 Jan. 23rd Hacking/IT Incident E-mail Salina Family Healthcare Center Kansas 9,640 April 8th Unauthorized Access/Disclosure E-mail Group Health Care Plan Michigan 2,289 May 13th Unauthorized Access/Disclosure E-mail Nirad Medical Associates New York 97,000 April 24th Unauthorized Access/Disclosure, Hacking/IT Incident Desktop Computer, other portable Electronic Device Rady Children’s Hospital California 14,121 June 6th Unauthorized Access/Disclosure E-mail 76 Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html Since 2009, federal law has required health care providers to report to the Department of Health and Human Services and the news media all data breaches affecting 500 patients or more
  • 76. LARGEST DATE BREACHES SINCE 2009 (Breaches affecting 500 or more people) Health Care Provider State # Affected Type of Breach Date Tricare Virginia 4,901,432 Loss of Backup tapes Sept. 13, 2011 Health Net, Inc. California 1,900,000 Unknown Jan. 21, 2011 North Bronx Healthcare Network New York 1,700,000 Electronic medical records theft Dec. 23, 2010 AvMed, Inc. Florida 1,250,000 Laptop theft Dec. 10, 2009 Nemours Foundation Florida 1,055,489 Loss of Backup tapes Aug. 10, 2011 Blue Cross Tennessee 1,023,209 Hard Drive theft Oct. 2, 2011 Sutter Medical Foundation California 943,434 Desktop computer theft Oct. 5, 2011 South Shore Hospital Massachusetts 800,000 Loss of portable electronic device Feb. 26, 2011 Utah Dept. of Health Utah 780.000 Hacking March 10, 2012 Eisenhower Medical Center California 514,330 Computer theft Marcy 11, 2011 77 Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html
  • 77. AT THE PEARLY GATES…. 78 Sorry - I had no idea you died - We don’t have access to your medical records”
  • 78. GROWING SUPPORT FOR WEARABLES January, 2014 (CES) Consumer Electronics Show Intel’s CEO Brian Krzanich announced the company’s goal of penetrating the wearable computing market led by an SD- sized computer with built-in wireless-ness, the “Edison” “Full Pentium-class PC in the form of an Secure Digital card” 79 Source: http://www.business-standard.com/article/companies/intel-exploring-women-focused-wearables-114091101198_1.html
  • 79. HOW INTEL SEES THE FUTURE OF WEARABLES “Edison” can be redesigned to work with most devices - not limited to computers, phones, or tablets & can house multiple applications” Well positioned to support innovation & product development 80 Source: www.intel.com/edison
  • 80. ANNOUNCEMENT - August 13, 2014 Intel announced a partnership with Intel's devices will help research on & treatment of neurodegenerative brain disease Intel hopes to mine data to improve research, & better understand the behaviors/progression of the disease 81
  • 81. INTEL HELP BATTLE PARKINSON’S 82 Device like the popular FitBit (a wristband activity monitor) 300 data points will be recorded per second - equivalent to one GB of data per patient/per day - Information uploaded to Intel's system by a smartphone Objective : Create algorithms to automatically measure body movement symptoms & sleep patterns
  • 82. APPLE ANNOUNCEMENT (9/2014) 83 “There are several things called smartwatches that are shipping…. But certainly there have been none that have changed the way people live their lives. That’s our objective” -- Tim Cook CEO 2/ 2015 Built in infrared & LED sensors accurately record pulse rate
  • 83. TIKKER: HAPPINESS WATCH OR DEATH WATCH? 84
  • 84. TIKKER: HAPPINESS WATCH OR DEATH WATCH? 85 Source: http://mytikker.com/products/tikker Cost -$79.00 HOW DOES TIKKER PREDICT DEATH? To set up Tikker the wearer fills out a questionnaire by entering information about their medical history, including allergies or Illnesses They are asked whether they drink or smoke and if there are any instances of cancer, diabetes and other diseases in their family Wearers are additionally asked about how much exercise they do, as well as how much they weigh before receiving a score Their age is deducted from the results to predict a death date and the Tikker begins the countdown Tikker: Kickstarter
  • 85. INSURANCE OPPORTUNITIES “Mobile devices and social media have "fundamentally changed consumer expectations," and by harnessing mobile technology, Insurers can reach & service "markets that increasingly demand Convenience & a flexible interface.“ “Traditional insurance products and distribution channels aren't well suited for Generations X and Y” Source: Ernst & Young's 2014 Global Insurance Outlook 86
  • 86. INSURANCE OPPORTUNITIES 87 1. Developing direct-to-consumer relationship (apply data analytics & more efficient underwriting) – Can evolve into an online sales system 2. Developing a multi-channel approach (self-service options along with an enhanced customer experience) Consider:
  • 87. LIFE INSURANCE Can we develop Well-Being Benefit Products or at a minimum? 88 Identify Best Risks Prioritize Cases Increase Placement Ratio Underwriting Speed & Consistency
  • 88. DIRECTLY MARKETED TO PROPOSED INSUREDS • Direct to consumer marketing to bring down distribution costs • Integrate data with electronic applications, data analytics, use of underwriting systems • Younger risks, professionals & the wealthy likely to be more & willing to purchase insurance via direct online/call centers & provide wearable device proof of insurability • U.S. Data - “Only 46% of middle-market consumers have individual life insurance….however, employees under Age 45 say they find it more comfortable to purchase online “ Source: 2014 Employee Benefit News and SourceMedia, Inc. 89
  • 89. WELL-BEING BENEFITS MAY APPEAL TO: Younger customers, who tend to focus on staying fit & healthy Aging segments (pre-retirees & retirees) Choosing to lead a healthy lifestyle & actively attempting to delay onset of chronic diseases An opportunity to expand the life insurance market 90 Source: http://www.lifehealthpro.com/2014/02/12/resuscitating-the-life-insurance-business-model
  • 90. ELIZABETH HOLMES FOUNDER & CEO - THERANOS Blood is drawn with a finger stick - rather than a needle in the arm Theranos - One drop. A world of answers “Our laboratory can precisely analyze tiny samples. A few drop are all we need to perform most tests. So now, you can have your labs – from blood, urine, fluids and more – done quickly, easily, and accurately” • One drop of blood is enough for dozens of different tests and the procedure can be conducted at a pharmacy, with results arriving within 4 hours. List of tests available at https://www.theranos.com/#!/test-menu?ref=our_solution Imagine a “snapshot”- style discount being available to life insurance shoppers for submitting periodic test results that prove their blood pressure, diabetes or cholesterol is under control Sources: https://www.theranos.com/#!/our-solution http://singularityhub.com/2013/11/18/small-fast-and-cheap-theranos-is-the-poster-child-of-med-tech-and-its-in-walgreens/ 91 1.29 cm
  • 91. TRUE WELL BEING DISCOUNTS? • To encourage sharing of personal health information insurers could provide policyholders both: FINANCIAL INCENTIVES (e.g., decrease in premiums) NON-FINANCIAL INCENTIVES (e.g., physical health and psychological) benefits 92
  • 92. DO WEARABLES HAVE VALUE? A lot needs to be done to convince people that Wearables have value: 93
  • 93. DO WEARABLES HAVE VALUE? Including - The people that make up the technology companies AND PPeople that create the technology companies 94
  • 94. DO WEARABLES HAVE VALUE? AND Users they are targeting 95 Users they are targeting
  • 95. INTEL FUTURIST STEVE BROWN 2014 Keynote address: “Up to now, the industry has concentrated on doing what is possible rather than what people want” 96 Source to see samples of new devices http://www.theguardian.com/technology/gallery/2014/mar/20/london-wearable-tech-show-2014-pictures
  • 96. FUTURIST & AUTHOR PATRICK TUCKER “ We are going to see the normalization of wearable tech as we did with the Internet,” …. “Even people who don’t look forward to the prospect of buying a wearable device will still benefit from the data that is collected about topics including fitness and health.” Source: Patrick Tucker, a futurist & author of the book “The Naked Future: What Happens In A World That Anticipates Your Every Move?” 97
  • 97. PRIVACY POLICY SHOULD INCLUDE INFORMATION SUCH AS: • Who is collecting the data? • What is being collected? • When is data collected? • What will the data be used for? • How long will the data be kept? • How can the user access and control the data? • Will the data be shared with third parties? 98 Tom Cruise – The Minority Report
  • 98. DESPITE PRIVACY CONCERNS… • Positive potential for businesses, health care & insurers IS: Consumer electronics corporations must develop smart, connected, & secure devices that simplify a user’s life - without compromising security Need wisdom to ignore technology - when it leads us in the wrong direction! 99
  • 99. WEARABLE TECHNOLOGY NEEDS TO BE Power Efficient Small Footprint 100
  • 100. WEARABLE TECHNOLOGY NEEDS TO BE Small Footprint 101
  • 101. WEARABLE TECHNOLOGY NEEDS TO BE Power Efficient Accurate Cost Effective Small Footprint Connected Long Battery Life 102
  • 102. THERE IS ALSO THE FUNDAMENTAL QUESTION ….. Will people ever be comfortable having their health data monitored this extensively???? 103
  • 103. THERE IS ALSO THE FUNDAMENTAL QUESTION…. Will people ever be comfortable having their health data monitored this extensively???? 104
  • 104. IN CONCLUSION • In a way….. Future of Wearables is to become “Unaware-ables” “To serve consumers best when they call as little attention as possible to their own exquisite cleverness” 105 It’s not what you wear… It’s how are you connected!