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Smart devices and the advent of the Internet of Things (IoT), cloud computing, data analytics, and artificial intelligence (AI) are leading to disruption in all sectors of the economy, including healthcare.

When such tools are used to measure the activities, lifestyle, health, and even mood of an individual, the information they produce can enable a slew of software-enabled healthcare products and services.

Together, such offerings have come to be known as digital health, and the era they are defining has been called that of the “quantified self.”

This will redefine the relationship between individuals and healthcare providers, say experts and medical professionals who spoke to The ACCJ Journal.

International hardware accelerator HAX has increased the number of healthcare startups in its portfolio.

STARTUP NATION
For Israel-based tech entrepreneur Doron Libshtein, finding lasting solutions for managing stress levels seemed the perfect entry point to digital health.

Libshtein is co-creator of the WellBe, a digital bracelet that supports a user’s wellbeing. Combining a heart-rate monitor and a mobile app, the device can detect a person’s stress level based on the time of day, location, and events. It can also track your daily contacts and correlate that with how stressed you felt.

Having identified stress triggers, the device guides you to stress management strategies, including bio-feedback exercises such as mindfulness and meditation. The WellBe not only induces relaxation, it also helps users tackle ailments such as headaches, fatigue, poor sleep, and high blood pressure.

“Our Stress Management Solution service allows users not only to measure their level of stress, but also to manage it,” said Libshtein, who is also the founder of Mentors Channel, a company that manages a platform where mentors can provide meditation strategies.

“With the WellBe, I wanted to reach those people who were aware of meditation, but thought it was not relevant to them or whether it would work for them.”

WELLNESS INSIDE
Daniel Maggs has also found a niche in the quantified-self market as chief executive officer and co-founder of digital healthcare company Bisu.

“Bisu is a healthcare IoT startup whose aim is to help people take better care of themselves, eat the right food, and avoid chronic diseases like diabetes,” Maggs said.

The health monitoring technology developed by Bisu is used to prevent diseases through early intervention, such as improved dietary choices suggested by the device.

“The real issue in things like diabetes or kidney disease is that the doctor is at

some point going to say, ‘You need to do something to take care of yourself.’ You may feel okay and plan to try, but actually fail to do anything about it. Five to 10 years later, you may end up with a very serious condition.”

To avoid such outcomes, Bisu is working on both a bathroom-installed and portable device to analyze biomarkers that relate to a user’s diet and metabolic condition. It then syncs that information to an app on a smart device. Based on the readings, the app provides customized lifestyle and dietary recommendations.

Tokyo-based IoT startup BISU is developing healthcare technology to prevent disease through early detection.

WEALTH IN HEALTH
Libshtein and Maggs may be onto something. According to a 2017 report by global consultancy firm Deloitte—Connected Health: How Digital Technology Is Transforming Healthcare and Social Care—“digital technology is advancing exponentially and its cost is plummeting. At the same time, the demand for and cost of healthcare is rising, which is challenging most health economies across the world.”

The report notes that the number of health apps for smart devices has grown to more

than 100,000 in the past two-and-a-half years. And while global revenue for mobile health was $2.4 billion in 2013, forecasts suggest the figure will climb to $21.5 billion by 2018—an annual growth of 54.9 percent.

William Bishop, vice-chair of the American Chamber of Commerce in Japan (ACCJ) Healthcare Committee and chair of the Medical Devices and Diagnostics Subcommittee, agrees with the prediction. “Considering the increasingly urgent need for home-based and remote health monitoring in rural regions of developed countries with rapidly aging populations, and the rising need in the developing world for mobile solutions, mobile health is an area in which we can expect significant growth.”

That said, he adds: “Japan is playing catch-up in the field of medical device and technology innovation, [even though the] government has attempted to stimulate these industries in recent years.”

SELF TRACKING
Medical health professionals in Japan are beginning to jump onto the digital-health bandwagon. Kohta Satake, co-founder of CureApp, Inc., is one such individual.

A physician by training but with advanced qualifications in business, Satake first became interested in digital health when he was a researcher in the field of health informatics at Johns Hopkins University. His studies at the time included research into software development for clinical use in hospitals.

“At that time, I read many articles on apps, and their introduction and use in hospitals, including how to use them to manage diseases. Some of the apps also provided guidance to patients with limited involvement by a physician.”

That was 2014. When he returned to Japan a year later, Satake created CureApp, a smartphone-based app that provides personalized real-time clinical guidance to patients, including those in therapy programs for nicotine addiction.

The company is developing a second app to treat lifestyle diseases, in this case for people suffering from nonalcoholic steatohepatitis (NASH), a condition in which fat accumulates and inflames the liver. While there is no treatment for NASH, its symptoms can be managed by changes in lifestyle—changes that can be tracked and used for guidance by the app.

Physician Masahiko Sakamoto and his colleagues created a healthcare app to plug the gaps in medical information that parents and guardians of children face.

COMMUNITY EFFORT
For physician Masahiko Sakamoto, the rise of nuclear families coupled with the attenuation of links within communities—and the challenge of receiving timely and convenient healthcare advice—created the conditions necessary for him to seek mobile healthcare solutions for the families under his care.

Sakamoto and his colleagues at the Saku Central Hospital and Saku Doctors Association in Saku City, Nagano Prefecture, established the Oshiete Doctor Project.

Launched in 2015, the project has three main pillars. The first is to create a booklet that explains childhood diseases, home management strategies, and hospital visitation planning. The second is to provide outreach lectures by pediatricians who visit daycare centers. And the third is to create a mobile app with digital content from the booklet.

“The purpose of this project is to reduce anxiety about raising children—especially for guardians of kids under three years old. We also aim to reduce the burden placed on emergency services by unnecessary hospital visitations,” Sakamoto said.

For example, the app conveys information “about child sickness, how to care for a sick child, and how to manage hospital visitations. There is also an immunization scheduler on board.”

The Oshiete Doctor app has other functions, including guidance for self-diagnosis of symptoms, a guide to local health services, and information regarding local daycare facilities.

Ken-Compass, an app created by Dr. Toshio Miyata in collaboration with pharmacists, can be used for guidance in self-diagnosis and medication.

OVER THE COUNTER
Satake and Sakamoto are not the only doctors in Japan who are taking advantage of the digital health revolution. An engineer, physician, and surgeon by training, Toshio Miyata founded Ken-Compass Inc. in 2016.

Via the company’s mobile app, individuals are empowered to manage their health in four main ways: self-medication, medical intervention, prevention and screening, and healthy living.

“Self-care is what people do for themselves to establish and maintain health and prevent and deal with illness. Self-medication is the selection and use of medicines by individuals to treat self-recognized illness or symptoms,” Miyata explained.

The Ken-Compass app was created through a collaboration between doctors and pharmacists to support self-care and selection of the appropriate over-the-counter (OTC) drugs. The app also provides guidelines for minor ailments and suggestions for local healthcare services.

When a user inputs a symptom, it provides answers and guides them to the appropriate OTC and other healthcare products. If a serious illness is diagnosed, it recommends the appropriate hospital or medical service.

“Health is the property of each person, and people are getting more concerned about their own health,” Miyata said.

LIFE REFLECTS ART
While digital health is all the rage today, its history can perhaps be traced back to the 1960s. The first vision of a handheld device for scanning, recording, and analyzing data to examine living things was perhaps the tricorder, a medical diagnostic tool imagined by screenwriter Gene Roddenberry for his television series Star Trek.

“A lot of science fiction fans are really excited to see technologies that were first seen in sci-fi programs 50 years ago finally come to light,” Grant Campany told The ACCJ Journal. “What was once science fiction is now becoming a reality.”

Campany, an entrepreneur in the medical devices space, is senior director of the Qualcomm Tricorder XPRIZE, a $10 million award inspired by Star Trek that incentivizes entrepreneurs to develop a mobile device that can diagnose diseases—and perform better than physicians in doing so.

When the Qualcomm Tricorder XPRIZE competition ended in April 2017, two teams from a field of 300 received prizes and have now taken their ideas into clinical trials.

The highest-performing team, Final Frontier Medical Devices, from the United States, received $2.6 million. In second place, Taiwan’s Dynamical Biomarkers Group was awarded $1 million. Both nearly met the prize’s full challenge to create a device that can diagnose 13 disease states.

PERSONAL PROPERTY
While excitement over digital health remains high, most contributors acknowledged that many challenges remain, not least of which is ensuring personal data security.

“Hospitals have become networks of connected objects, with everything from MRI scanners and X-ray machines to doctors’ smart devices and patients’ wearables all online,” explained John Kirch, regional director for North Asia at Darktrace—a leading machine learning company in the cyber security space—and vice-chair of the ACCJ Information, Communications, and Technology Committee.

“This is mostly good for patient care, but the same devices are often particularly vulnerable to cyber-attack, thereby putting critical patient data at risk.”

How can these challenges be tackled? “By leveraging machine learning and AI algorithms to understand the ‘pattern of life’ of every user and device—including staff IoT devices and hospital visitors connecting to Wi-Fi—healthcare organizations have a much better chance of mitigating threats early,” Kirch told The ACCJ Journal.

DIGITAL FUTURE
Despite the challenges, players in the digital health sector remain bullish. “The number of digital health founders has exploded in the past few years. Experts, engineers, and even medical doctors now feel they have an opportunity that did not exist a few years ago,” said Benjamin Joffe, a partner at the international hardware accelerator called HAX, which counts Tokyo-based Bisu among its portfolio of digital healthcare start-ups.

Why is this? CPUs and sensors are cheaper than ever, as are prototyping tools and the number of iterations they provide, Joffe explained. This means entrepreneurs can go to market more quickly and for less money.

“And instead of trying to dump everything into a device, you can offload much of it to the cloud via smart devices,” he added. “The ecosystem has come together to make digital health possible.”

John Amari is a writer and editor from the UK who specializes in articles on startups, entrepreneurs, science, tech, and business.