The Power of One

You took 5,322 steps yesterday, burned 686 calories exercising, and made 12 phone calls. You were stressed at work, so you sent 20 texts in 10 minutes to vent to a friend, while a gadget on your wrist marked your skyrocketing heart rate. Your smartphone calendar reminded you to book a follow-up with the podiatrist – again – and you ignored it – again.

If all of those gadgets could talk to each other in one easy-to-use platform, they might be able to give you – and your doctor – a vivid snapshot of your overall health picture, along with suggestions on how to improve it. (See the podiatrist.)

Deborah Estrin presented the benefits of converting our “digital breadcrumbs” to a vast overall health picture at TEDMED 2013. She has been making this vision reality since 2011, when she founded Open mHealth, a non-profit that develops open source code to normalize and provide information frameworks and interfaces for health data, improving analytics among apps, platforms, developers and users.

“If you just take the words blood glucose – well, there are 300 different types of blood glucose. There’s no alignment on how data is being represented,” says David Haddad, Open mHealth Director. (For more about open mHealth architecture, read his blog post.)

Haddad says the group’s work was initially a “conceptual challenge” for many potential partners, but that the past year has seen a big bump in interest levels. The group has ramped up projects with Kaiser Permanente, with Qualcomm Life, which has a wireless platform that captures medical device data, and has received funding from WebMD.

One Patient, Eons of Data

If one is given the tools to be able to self-monitor, visualize and report health information, the discoveries can be eye-opening for both patient and provider. To that end, Open mHealth has assembled teams for case studies on various chronic illnesses.

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Alex Freeman, a pediatric nurse with type 1 diabetes, had problems keeping her blood sugar levels stable, even though she exercised regularly. Open mHealth worked with a number of partners, including My Comparisons – a mobile, patient-facing data comparison tool, and GreenDot ‘blip’ – a web-based, clinician-facing diabetes data application – to gather input on her insulin levels and diet. In the end, Alex’s doctor was able to see that she actually overcompensated with insulin before eating high-carb foods, like pizza.

Another pilot measured the day-in, day-out stressors of a man with PTSD (Post-Traumatic Stress Disorder).

“He was texting us in between clinical visits, and his mood went down and his PTSD symptoms got worse. It turns out this was a result of his wife having gestational diabetes.  The clinical term [for what he was suffering] is separation anxiety, and it could be dangerous for somebody who has been diagnosed with PTSD,” Haddad says.

Next up, the Open hHealth platform will be used for a University of California at Davis trial involving an app that tests pain intervention, called Trialist. The app allows patients to conduct their own “N for 1” study, a variant on the randomized controlled trial in which a single patient is the entire research cohort, and which can be especially helpful in determining causality and how individual variables influence outcome. Trialist will measure the effectiveness of various medical and lifestyle pain treatments, from drug treatments to meditation, with the ultimate goal of determining the lowest effective dose of medication.

A Once-a-Day Dose for Diabetics

The power of one is also a theme for Sensulin. The startup is developing a once-a-day insulin therapy that responds to glucose levels, a potentially revolutionary therapy for diabetics who struggle with pumps, injections and laborious carb counting to stay healthy – and alive.

Mike Moradi is working on the breakthrough with Ananth Annapragada, Ph.D, Director of Basic Research in the Edward B. Singleton Department of Pediatric Radiology at Texas Children’s Hospital. Annapragada theorized in the course of his work that as blood sugar stimulates the release of insulin, a drug might be developed that is also released to that stimulus.

Sensulin's proprietary Agglomerated Vesicle Technology (AVT).
Sensulin’s proprietary Agglomerated Vesicle Technology (AVT).

“The technology could eliminate the need for separate basal-prandial insulin injections. We know that it works. Right now, we’re optimizing our system so that it releases over a 24-hour-period and withstands the Western diet,” Moradi says.

Sensulin has been awarded a $225,000 STTR (Small Business Technology Transfer Program) grant from the National Science Foundation, and successfully held a $500,000 1st closing on its Series A round. It’s also received a Notice of Allowance from the United States Patent and Trademark Office on its key patent.

The company hopes to have a final formulation some time early next year and will then prepare for a human clinical trial – the “blocking and tackling” of pharmaceutical development, as Moradi puts it.

A biochemist early on, Moradi was on his way to dental school when he heard the call to become an entrepreneur in nanotechnology.

“Around that same time a number of people in my family were being diagnosed with type 2 prediabetes and diabetes, and I thought I could use my talents for something more personally rewarding. When I saw this opportunity, it was so compelling I felt it was some strange force. It’s exciting to wake up every morning and feel you’re on the cusp of something awesome,” he says.

One of his biggest boosts comes from the patient community, Moradi says.

“Diabetes patients are some of the best patient advocates out there. They’re very vocal about helping get things through the FDA,” he says.

Catalyst is a regular series about innovation in health and medicine, with a focus on companies from TEDMED 2013 Hive. Click here to read previous posts.


Can we paint a personal health picture from our daily digital traces?

We leave a long trail of digital breadcrumbs every day as we go about even the most mundane tasks: Answering e-mail; making phone calls; using GPS to find a post office; shopping for dinner; tracking our sleep and steps with a Fitbit.

Data collected from search engines, social networks, and mobile carriers, combined with smart apps, can turn these tracks into a continuous, real-time picture of our personal health, said Deborah Estrin, co-founder of the non-profit open software builder Open mHealth and a professor of Computer Science at Cornell Tech, speaking at TEDMED 2013 in April.

“I’m not taking about doing detailed medical diagnosis…replacing the communication  between you and your doctor and with your loved ones or even your own self-awareness. I’m talking about enhancing each of these with personalized, data-driven insights…such as early warning signs of a problem or gradual improvement in response to a treatment,” she said.

She continued, “I like to think of it as a digital social pulse, because it’s a single measure that I can look at over time that represents my well being, and social because it’s something I can selectively share with a small number of friends and family. Once we as patients can get access to our small traces — our small data — we’ll be able to fuel a new market of apps and services,” she said.

Though our daily behaviors are already monitored and analyzed extensively, the results are unavailable to users and there’s no vehicle to make them accessible, Estrin said in an interview today.

“There’s nothing lost by letting an individual have their data back, and having them do things that are useful with it,” she said. “It simply plays into having people manage their lives and their health and welfare. Imagine the utility that I will get out of an app that helps me figure out whether I’m taking supplements in an effective dose or not, or helps me monitor a my kid whose going away to college who has a complicated health issue.”

Though Estrin co-founded Open mHealth in 2011, the group is already working on a number of initiatives, including a web app called ClinVis that trends subjective units of depression (SUD) scores. Estrin is already building a coalition of service providers and app developers for this venture. She’ll meet with a few major phone and network service providers in a few weeks to start a smaller-level “virtual testbed” in New York City. Wikilife, a collaborative that seeks to anonymously collect and share health data to measure the health impact of lifestyle choices and nutritional habits, among other measures, is also considering implementing Open mHealth’s API, she said.

Some carriers are apprehensive about appearing to violate privacy regulations, Estrin acknowledges, but adds, “There is a lot of interest in making sure this is done securely, and receptiveness to the notion of personal data vaults within the cloud. I think that the minute we can prototype an initial viable product and a couple of feeds and let people come together and run some apps, we’ll see a lot of uptake,” she says.

The apps will be built on an open-source development platform, which dovetails with the project’s goal of shared knowledge.

“Part of the story of small data is having it happen in an open architecture content because you can then build upon each other’s skills. You’re not counting on any one vendor to build the system, and you get a very exciting Internet economy,” Estrin says.

Watch her talk at TEDMED 2013, and click here if you’re interested in a compilation of your own small data.