Health and Wellness Data in a Decentralized World

Big changes are sweeping through the health and wellness space. As we move to a more decentralized world, tectonic shifts in how we think of fitness, health, and wellness data are inevitable. Health and wellness companies that embrace new technologies will survive in the new health economy and create integrated patient outcomes that improve human life.

Fitness Data as a Vital Sign

The emergence of fitness-related data as a vital sign in the medical space is a welcome trend for human health and wellness. There is a vanishing distinction between fitness data and health data, and rightfully so - these two types of data have a combined utility that is key to a comprehensive wellness approach.

The current state of medical treatment is dysfunctional due to its reactive nature; we have sick care, not health care. The American Heart Association (AHA) made its position clear in Q4 2016:

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.

A system built on treating a problem after it has already occurred is inefficient. Health and fitness data will make inefficiencies identifiable, quantifiable and categorizable - and therefore easy targets for correction. Kaiser physician Robert Sallis, a leading advocate for fitness as a vital sign and co-author for this new AHA position, will be considered an early adopter for what will have become the new standard.

There is reason to think that the health care insurance industry will follow suit. Health care plans that are able to identify, quantify and categorize the definable health effects of fitness routines on their clients will outperform health care plans that pay hefty premiums to providers for overpriced procedures, prescriptions, and medicines. Incentivizing behavioral health counseling and regular fitness routines can usher in a renaissance in the health and wellness space.

Health & Fitness Data: Opportunities and Shortfalls

What will drive this change? Health and fitness data itself provides the economic incentive for innovation. Data has a quantifiable value, and that value adds up quickly. The five most valuable listed companies in the world are all data companies, and as technology continues to proliferate and advance, data will continue to dominate. As societies increasingly focus on health, fitness and general wellbeing, the 500 million (and growing) users of mobile health and fitness applications will continue to generate high-quality data automatically when they use their favorite apps and devices.

But this data cannot remain siloed. Siloed data is never truly aggregated, and that is crushing the revolutionary potential of big data in the health and wellness space. The age of big data and artificial intelligence is the age of integrated systems and uniform orchestration - healthcare interoperability is the key to producing superior patient outcomes.

Why? Because data-driven solutions require aggregation at scale. To make real use of data in the health and wellness space, massive cross-spectrum data aggregation is necessary. Something like the following 7 conditions could set the standard:

• Data is accessible to and usable by the owner
• Data is owned by and can be monetized by the owner
• Data is tied to owner via unique identifier
• Data is accessible to fitness professionals and health professionals at each Point of Care (POC) echelon at owner’s discretion
• Data is collaborative and verifiable in nature
• Data is secure and encrypted at point of origin and destination
• Identity default is anonymous

The World Economic Forum determined in 2011 that data should be considered an asset class, and the laws of individual nations are evolving in accordance with this declaration. In most places, health related data is one of the most valued data asset classes. Ownership of this data is a tricky subject; health data presents unique and serious challenges to technology companies because a patient’s data is subject to strict and ever evolving privacy and security laws and regulations. These laws and regulations are threatening a proven tech industry revenue stream, which creates a fascinating study of economics - how do you incentivize companies to share their most valuable resource?

It can be done. Powerful economic and human health incentives, combined with profound technological innovation, are slowly moving the health and wellness space towards collaborative healthcare interoperability. Innovative companies that think outside of the box can still profit in this system - while empowering their customers by relinquishing ownership of user-created data.

HL7 FHIR & The Argonaut Project

This is not just pie-in-the-sky stuff here. Serious initiatives already exist to make this future a reality. HL7 FHIR compliant APIs can participate in a growing digital international health community. FHIR allows secure information exchange and can interoperate with mobile health & fitness applications, social media applications, payment systems, data enrichment services, health analytics innovations, and blockchain-based marketplaces. There is no financial barrier to entry, as access to the HL7 FHIR framework is free.

HL7 spawned the Argonaut Project, an implementation community advancing the cause of modern, open interoperability standards across the healthcare industry. The goal of this HL7-led private sector initiative is a world in which a patient is able to aggregate all of their records on their device, and use it as a secure vehicle for sharing. Notable participants in this project include some of the industry’s top vendors and providers: Accenture, Cerner, Epic, McKesson, Meditech, Surescripts, The Advisory Board Company, Beth Israel Deaconess Medical Center, Partners HealthCare, and most recently, Apple. The sheer weight of the addition of such a heavy hitter as Apple to this list is a game changer, and may be the catalyst to opening up health information sharing at scale. Apple’s participation will allow for the iPhone to become a powerful tool of healthcare interoperability, and there is little reason to think that Apple’s competitors will not follow suit.

Security & Micro-Identifies

As these initiatives and others continue to pop up across most market categories, the new economy unfolds before us in real time. Singular ownership, siloed information and resources, and isolated systems are being replaced by a sharing economy, redistribution markets, and collaborative systems. Blockchain technology has particularly exciting use-cases for health & fitness big data in a decentralized p2p world.

Future generations of blockchain solutions might provide conditional access to medical records and other health information, especially if they are integrated with data-gathering social networks. Data-driven social-mapping can allow users to find and connect with individuals with similar health and fitness conditions, leveraging the combined power of health & fitness big data analytics. This find and connect feature can also be managed by personal trainers, doctors, and eventually artificial intelligence. By bringing communities together and learning from their interactions, better health & fitness outcomes become predictable and prescribable.

Blockchain technology paired with a social network also makes provider-to-provider data transfers within a trustless ecosystem possible. The current HL7 FHIR server system has gaps that blockchain solutions can solve, such as obtaining entity trust, accurately identifying individuals in a trustless environment, and requesting user information at the next point of care (POC). The TeamMate platform requires users to have unique User IDs tied to unique blockchain wallets with their own encryption keys for each transaction, thus ensuring acquisition of the correct data in a secure manner. This system allows for not only identity verification, but also the sharing of fitness and health event transactions between entities. This multi-layered verification apparatus achieves trust while preserving anonymity, and leverages a robust suite of soft multi-factor authentication tools.

Well-executed blockchain solutions are complex systems in which truth and integrity are measurable and verifiable. The same cannot be said for traditional health and fitness data solutions.

The Identity Theft Resources Center reported 572 data breaches, exposing 13,491,597 records as of August 2, 2016. Across banking, education, government and healthcare, healthcare was attributed to 206 of the breaches or 36.8 percent of all breaches in the first half of 2016. These healthcare breaches resulted in the loss of 4,962,136 health-related records. With almost 50 billion new devices scheduled for connectivity to the internet by 2020, this problem will amplify. Virtually every health system is at risk for being compromised.

Blockchain solutions allow for both the owner as well as the health and fitness professional to prove that their client’s data has not been compromised. This new level of system integrity is possible thanks to the blockchain’s ability to establish data authenticity, and due to the chain of custody ledger built into the blockchain.

Empowered Users

In terms of monetary value and opportunity, data is the new oil. But there is an important difference; unlike oil, data comes from people. The companies that are collecting this data are using and monetizing it as they see fit; there is no comprehensive mechanism in place for users of that technology to take ownership of their data, and use it in such a way as to maximize its economic and health benefit to them. Users are generating data - but they do not own it. The Cambridge Analytica Facebook scandal has recently brought this unsettling reality into public view.

So if it’s clear that decentralization and interoperability are optimal, and that they imply a transfer from the centralized system to the individual, how do we get there?

The health and wellness industry leaders of tomorrow will find ways to create value for businesses while empowering users by giving them the keys to the meta-data that they themselves create. Innovative newcomers like TeamMate can lead the way. TeamMate gamifies athletic evolution via social capital and social diversification, using fitness communities as both a motivator for exercise and as a reward system. Athletes own their data, are rewarded for providing it, and gain influence in their fitness communities through sharing it. By putting the economics of this system onto a decentralized ledger, the rules of this game become clear. Athletes at any level can work their way up to becoming the CEOs of their fitness lives, using each other to get to the next level.

TeamMate turns self-care into a game; data flow acts as both the lifeblood of this game and as a tool for the user to pursue athletic improvement. Companies that want to tap into this platform to advertise their relevant goods and services can do so - at a price - which allows for TeamMate to continue to operate and empower its users. Combined with the fitness data as a vital sign movement, TeamMate’s approach is an example of the kinds of innovative approaches that will soon dominate the health and wellness space.