Man In The Mirror

Since health 2.0 is at least partially about shifting responsibility from the doctor to the consumer, I figured I’d start my journey into healthcare technology with, as Michael Jackson put it, the “Man In The Mirror”. (This photo is my reflection in “The Bean”, a stainless steel sculpture in Chicago’s Millennium Park).

Getting started with a PHR and self-tracking.

I see a doctor every couple of years, he tells me my blood pressure is fine, my blood glucose is fine and my cholesterol is a bit high but nothing to worry about. “Keep doing what you’re doing, we’ll see you next year.” He has to focus on people with problems that need to get healthy and doesn’t really have the energy or resources or billable insurance codes to help me stay healthy.

A month ago if you had asked me what my blood pressure was I would have answered: “a hundred somethin over somethin less than that”. How has it been trending in the past 5 years? Yea, right. Of course I know that high blood pressure is the “silent killer”, but I’ve always just left it up to the doctor’s office to measure it and tell me if it was high or low… well that doesn’t sound very health 2.0 now does it?

I want to track my blood pressure and learn how it reacts to exercise, meditation, diet and weight – all factors I can control. I want to understand how it trends during a good week and a bad week and over the next decade. After doing some research, I’ve learned that my BP could ideally be lower than it is and that lifestyle changes can help me get there. My cholesterol is a bit high too and it turns out that lifestyle changes to help lower my blood pressure, something I can measure every day, can also help lower my cholesterol. I’m all in. Would I be doing this if I weren’t a technology guy interested in how technology can help… not sure, my doctors certainly never encouraged it.

My current doctor, for 4 years now, is at the Palo Alto Medical Foundation (PAMF). They use Epic for their electronic medical record system (EHR) which has a portal that allows me to log in and see my medical data. This is known as a PHR, or personal health record, because I, the patient, can access it. But there is no data there from more than 4 years ago (my previous doctor was in Los Angeles) and there is no way for me to add my 3-times-a-day blood pressure and pulse readings or my current weight. I’d have to go to the doctor’s office 3 times a day to make that happen, which is just ridiculous. And what happens when I move in a few years and leave PAMF behind? Bye, bye electronic medical record.

So while the PHR provided by PAMF is good, it isn’t good enough.

  • I want my own health record that contains data from my healthcare providers and data that I add on my own.
  • I want it to be mine forever.
  • I want data to flow into that record automatically from my healthcare providers and from my personal devices such as a blood pressure monitor and scale.
  • I want to be able to expose my health data to healthcare providers, various tools, applications and other people as I see fit and of course keep it private from everyone else.

And oh yea, I want some help with this blood pressure thing: What does all of this data actually mean? What lifestyle changes will help me bring it down and ensure that it stays down?

I, I, I … it’s all about me isn’t it? Yup, I’m in control now, not my doctor. I’m going to start managing my health – my doctor is one of my resources, but 20 minutes with my doctor every other year isn’t likely to keep me healthy.

Microsoft HealthVault or Google Health

There are arguably only 2 PHR options right now that come close to my requirements: Microsoft HealthVault and Google Health. Neither meets all of my requirements because my doctors at PAMF have no way to export my data to either HealthVault or Google Health. (Note to self, find a new doctor that can work with MY data.).

Being able to automatically upload readings from a blood pressure monitor, scale and glucometer is critical for me because there is no way I’ll keep doing this if I have to manually enter data multiple times per day, every day. Microsoft has a list of medical device partners that integrate with HealthVault; Google has fewer. I wasn’t able to find a blood pressure monitor or glucometer that could export directly to Google Health.

The choice between these 2 platforms has many, many dimensions – a blog post for another day. I need to track my blood pressure and that is enough of a reason for me to start with HealthVault.

HealthVault is a bit odd in that it isn’t a PHR per se. It is really just a data service. Their site lists 69 different PHR apps and partners that interface with HealthVault and 18 devices that can export their data directly to HealthVault. I can’t find a list but there are many healthcare providers that can import and export to HealthVault (hopefully PAMF and Epic will join the party). The HealthVault ecosystem is big and growing; that’s good and it’s a bit of a problem because it’s up to me to parse through those 69 different applications and 18 devices and find the right ones for me. But I think that this is one of those good problems to have and it’s much easier to make a decision knowing I can unplug my data and take it to the next guy whenever I want to.  Additionally, I don’t have to choose a single application but can mix and match, because they are all looking at the same data.

Blood Pressure Monitor and Scale

From what I have figured out so far, I need to track my blood pressure, weight, blood glucose and cholesterol. I decided to ease into this and start with blood pressure and weight so I needed to buy devices that can export their data to HealthVault; here are the rest of my requirements:

  • Accurate readings
  • Easy to use and compact/mobile
  • Capable of tracking readings for at least 2 users
  • Integrated with HealthVault, ideally wirelessly. I hate wires.
  • Reasonably priced but I’ll pay a premium for gadgets that are more easy and fun to use because this will keep me engaged.

Choosing a blood pressure monitor was surprisingly hard. The HealthVault site’s list of integrated devices didn’t always match the manufacturer’s description on their site – so there was some confusion as to whether or not some of the models did link with HealthVault. Some BPMs required you to purchase an extra cable to connect, some didn’t. None of them were wireless, unfortunately, because that would have made the choice simple for me. After talking to customer service at a couple of the manufacturers, I ended up buying the Microlife 3AX1-4U Premium Wrist Blood Pressure Monitor. It’s accurate, simple to use, compact, supports 2 users, and the USB cable was included. I’m happy with my choice. The main reason I chose this one over others on the list was its averaging mode: it takes your blood pressure 3 times in a row and averages the results – so it seemed to me that it would be more accurate. Reviews on Amazon also suggested it was a very accurate device. It was easy for me to get it set up and talking to HealthVault, but I’m a technical guy. The overall setup experience has a long way to go, including fixing the Windows only requirement.

Interesting to note at this point that I am doing all of this research and learning on my own using the Internet – no insurance company billing codes are involved. I wonder how my doctor feels about that.

The Microlife wrist BPM is a great little device, it works and I’m using it regularly because it is convenient and easy to use. But the Withings Body Scale is just simply freaking cool. Never thought I’d hear myself describe a scale as cool, but there you go. It looks cool, and that’s important since it is an addition to the décor in our home. If I don’t leave it out and easily accessible I won’t use it. But that is the least of why this scale is so cool. It’s wireless… nuf said. It doesn’t require any software installed on a computer in my house, but instead jumps on my wireless network at home and every time I step on the scale it sends the reading up to my account on the Withings web site and then on to HealthVault. I don’t have to pick the scale up and walk it over to my computer and plug in a wire to download the data. This was actually one of those “aha” technology moments for me – this scale is an endpoint on the Internet. It was super easy to get set up and configure, including hooking up my HealthVault account. Now, when I step off the scale and walk over to my computer and check my HealthVault account, my last “weigh in” is already there. Seamless, and very freaking cool. It deals with multiple users automatically; I don’t have to first select the user because it knows me by my weight! I mean, this is “user experience” done right, a critical piece of engaging consumers so they can become healthier. Beware that this scale uses some funky electrical signal to try to determine body fat percentage and can’t be used by folks with a pacemaker. I’ve read that the accuracy of this calculation is suspect but I don’t care about body fat percentage right now, so I don’t have an opinion on how accurate it is or not.

At $145 on Amazon, it’s not cheap, but also not outrageous in comparison to other scales that do body fat calculations. I haven’t spent too much time on the Withings site yet, they have a useful application to help you track and manage your weight and an iPhone app to go along with it… did I mention how cool this thing is? I wanted my weight logged in HealthVault automatically and I got it.

Hopefully Withings is planning on building a glucometer and blood pressure monitor. I’ll wait in line for them if they do.

PHR and Blood Pressure Maintenance Application

Not a lot to talk about on this front today. I have only started researching various PHR’s that connect with HealthVault – no decisions yet. But here’s an important point: I don’t need to make this decision before starting to track my data in HealthVault; the critical thing is to get going on creating a data trail and I’m doing that. For blood pressure management, I’ve decided to start with the American Heart Association’s Heart360 Cardiovascular Wellness Center. I chose this application simply because of name recognition and because I knew that instead of importing and exporting data from HealthVault, they use HealthVault directly as their patient database – so I don’t have to worry about how secure the data is. There was another fundamental “aha” moment for me when I went to their site and created an account: after authorizing it to use my HealthVault data, the next screen I saw was a home page with dashboard-like visuals displaying information about my blood pressure, weight, current medications and making it immediately clear that it was missing data on blood glucose, cholesterol and exercise. It was like going to see a new doctor who somehow magically already knew me – exactly what I wanted to achieve.

Will it Catch On?

I’m not the only one in the mirror, as a society we all need to learn to live healthier. An odd thing about this experience for me so far has been the reaction from some of my friends and family. They think I’m nuts, and that I’ve just gone off the deep end again. “You are thin and healthy, why would you want to bother monitoring and logging your blood pressure and weight?” I even got push back from a nurse at Stanford’s blood donation center when I asked her for advice on the type of blood pressure monitor I should buy: “Don’t waste your money on a blood pressure monitor, unless of course your doctor has told you that you have a problem.”

Is it that odd to take 30 seconds out of the day to track my blood pressure and weight? Is it that odd to want to see a trend over months and years and understand how my blood pressure reacts to changes in my lifestyle? Isn’t hypertension the “silent killer”? Quick, what’s your blood pressure? Could it be a hundred and somethin over somethin less than that – like mine was?

About Mark Feinholz

Software developer, architect, technical product manager. Inspired by technology to help us live happier and healthier lives.
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