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Goldman Sach’s Astounding Projections for Healthcare Virtual Reality

“Virtual reality (VR) and augmented reality (AR) have the potential to become the next big computing platform, and as we saw with the PC and smartphone, we expect new markets to be created and existing markets to be disrupted.” – reads the first full sentence in Goldman Sach’s research report on Virtual and Augmented Reality which was released on January 13th. Clearly they are bullish on VR.

Given that Virtual Reality is in a very early stage of development, Goldman outlines 3 scenarios over the next decade. Even in their base case, they estimate $580bn in revenue by 2025. Here’s the chart:

Goldman_Sachs_VR_Report_Scenarios

Of more interest to me personally, were the meaningful use cases they see which will drive VR markets. Looking beyond videogames, they predict real estate, retail, and healthcare will be among the first markets that VR/AR disrupts. In particular they signal out healthcare as being $5.1bn by 2025, a huge number, and an 11% slice of the pie.

Goldman_Sachs_VR_Report_Uses

Goldman forecast three primary uses for VR/AR technology in healthcare: 1) as a tool to aid doctors in medical procedures and day-to-day tasks, 2) for physical therapy and to treat phobias like fear of heights, and 3) to increase access to doctors through virtual visits.

One of the most successful uses of Google Glass was in Healthcare. Glass was used to overlay vital info for EMTs and surgeons and to provide hands-free assistance. You could easily see a hybrid of a VR headset and Google Glass being used in a similar manner, with the ability to provide more information and interactivity. I worked on a project for Sudler and Hennessey which used Google Glass in an augmented fashion to enhance a conference experience, adding a layer of imagery and information over what was in the booth. So, I could see Prediction #1 bring on target.

As far as Prediction #2 goes; virtual reality is a visceral experience and if you’re afraid of public speaking and could practice in a VR headset, I believe you could make some progress. This is entirely new territory but the options appear viable.

Increasing access to doctors through virtual visits, Prediction #3, seems a stretch. Doctors have been slow to adopt telemedicine due to reimbursement issues, and the physical need to interact makes the use challenging. Possible, but way out in the future.

VR has been in the news a lot this first month of the year. CES was full of VR gear and hype, and the headsets people having been waiting for, like the Oculus Rift, are only months away from launch. The Sundance Film Festival featured virtual reality for the second year. Under a program called New Frontier, the festival is promoting eleven independently produced VR films on a smartphone app. One of the notable shorts, Defrost, is a sci-fi drama that follows a woman who suffered a massive stroke and was cryogenically frozen. The woman’s waking up 30 years later as the film begins. The viewer experiences the story from the perspective of the woman, Mrs. Garrison, who’s wheeled around the hospital after awakening and is reunited with her very family – which has aged 30 years into the future. In a way it’s healthcare VR, so perhaps Goldman Sach’s will be right.

Sundance VR Film Defrost

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Will 2016 be a Big Year for Virtual Reality in Pharma?

Excedrin Oculus RiftOne of the more amazing technological innovations of 2015 was the consumerization of virtual reality. Google Cardboard, which started out almost as a joke, came into its own this November when the New York Times distributed over 1 million Cardboard units to their subscribers, featuring a  film, “The Displaced,” which follows the lives of three refugee children. Also in November, the consumer launch of the Samsung Gear VR created a sensation – bringing to market an inexpensive and already refined product that uses an ordinary smartphone to drive an immersive VR experience. The Gear sprang into being with a rich content library and a very polished user experience. If you own the right flagship Samsung phone the Gear was likely on your holiday shopping list.

Virtual reality offers many possibilities for pharma. In the short-term, the sheer novelty of the technology guarantees a certain share of attention. This is likely only a 12 month opportunity. Next year many virtual reality units are scheduled to be rolled out, so it is probable that there will be a flood of pharma efforts by mid-year.

If you’ve had a chance to try it out, virtual reality offers a riveting experience and intense moments of simulation. What better technology could there be to teach HCPs to relate emotionally to the suffering of patients of various disease states?

Excedrin MigraineLast Summer Excedrin created a stunt with Oculus Rift, the most sophisticated but expensive and unwieldy VR apparatus out there, and simulated the effects of a migraine. Excedrin clearly reached  way out of their box in terms of their indication, but they got their point across and plenty of attention.

Recently, in Australia, there was an effort to convey the experience of Multiple Sclerosis using a bicycle – built to malfunction. “Its gears are unpredictable, its frame off-balanced, and its brakes numb to press,” the ad’s narrator continues. “This bike has multiple sclerosis.” You can imagine doing something similar with VR. Many disease states where symptoms are visual, auditory, or balance related can be simulated with VR – migraine being a leading example.

The high-tech geewhiz effect of VR offers a tremendous method to visualize the structure and chemistry of some of the high-science drug compounds now launching. It delivers a Fantastic-Voyage-type experience of zooming through chemical structures and pathways in order to understand the science behind the therapies. VR serves up great gaming possibilities for learning – which could be an interactive competition at a conference or online. And the fact that the Samsung Gear VR is only $100 makes it well within  possibility to equip sales forces with the unit to deliver unique and interesting experiences to doctors.

The two options above offer standalone experiences built specifically for VR. It’s always takes a big push to get someone to download an individual app or sign up for one of your experiences. Maybe that’s too much to ask. Another option is to piggyback on other developed VR content – whether it’s a movie, story, or game – and interject a brand message of some sort, almost like an advertisement, to put it crudely. Ideally this would be content complementing the subject matter so branded content wouldn’t seem out of place and would offer value to the viewer.

Next year, Oculus will launch its full-scale Rift headset in the first quarter of 2016, while HTC is expected to begin selling its much-anticipated Vive not much later. Sony is also said to be readying to launch its PlayStation VR headset in the first half of next year. 2016 will be a big year for virtual reality in general and VR could be an area where pharma can actually be in the forefront of innovation rather than its typical laggard position. Let’s hope so.

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Fixing the Apple Watch App Layout: Internet to the Rescue

As much as I dig using my Apple Watch I am not a fan of the app layout you’re presented with on the Watch’s face. The default layout is a honeycomb of app icons. You can shrink or zoom an app somewhat to a max of about a quarter of an inch – zooming more that that opens that app. The problem is that, even zoomed up, they’re tiny, leading to accidental taps (annoying and time-consuming to exit).

Apple Watch Face with X LayoutIn the six months or so since the Watch has been on the market, there’s been a minor explosion of Watch applications that I personally use. This has lead to a cluttered and unorganized layout on my Watch. Well, it’s holiday time, leading to tinkering with a second screen (a Watch in my case) while watching movies or sports. So, I have cleaned up my Watch to make it a better experience.

The first thing to do is get rid of all the apps you don’t use or that don’t serve a purpose. In the Watch iPhone app it’s pretty easy to review all the apps with Watch extensions and turn them on or off. Some icons are cryptic: even if you’re familiar with the iPhone app, recognizing the Watch app may be a guessing game. In this way you clean up your screen and realize what’s what.

Apple Watch App Layout X iPhoneNext, you try to group the apps into related groups – most used, travel, weather, etc. This is like walking on ice while drunk. The best way to edit the layout is on the app on your iPhone, but the little buggers are slippery and naturally snap towards the center of the honeycomb. In my view,  different grid types should be offered as an option here, or you should be able to add spacers and cluster your apps – maybe apart from the central nucleus. It’s very challenging to arrange the apps anywhere near to a layout you want. I eventually managed to work my layout into an X with logical groupings of apps, but it’s a work in progress. The Watch app itself is an anchor in the center and I realized late in the game you can’t actually move it.

The Internet has come to the rescue for help with this task, specifically the Apple Watch subreddit. In the subreddit users have crafted complex layouts that must require a ton of dexterity and even more patience. The key post that started it all has a very functional format (no idea how he did it), and there are some remarkable designs posted. I’m sure we’ll see some Christmas tree layouts in the next four weeks.

Apple Watch Layouts

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Can the Apple Watch Plus HealthKit Tie All Your Health Tracking Needs Together?

Now that Apple Watch OS 2 is out and the product has been in the market several months, what’s the verdict on the watch as a health tracker? Note the emphasis on health, not fitness.

In a rare PR move for Apple, there was an interview with Jay Blahnik, Apple’s director of fitness for health technologies, in Outdoor magazine in August. The interview was revealing as to Apple’s intentions in the area of health and their overall approach. Jay laid out the strategy behind the creation of the Activity and Workout apps and said it all boiled down to – sit less, move more, and get some exercise.

So, how does the Apple Watch succeed against these goals? What’s missing?

Workout on WatchThere have been many reviews of the watch as a fitness device, most saying it’s solid for recreational athletes but perhaps lacking for fitness fanatics. If you haven’t seen it in action, tracking exercise on the watch uses the Workout app. When you work out, you can either set a calorie goal, a time goal, or an open ended goal. A heart rate monitor is built into the Watch and runs while you exercise. I’ve tested it against my Polar chest-strap based monitor and it was quite accurate – so now I’ve replaced the chest strap with the watch for my workouts. Since a decent heart rate monitor could easily run you $100, that can be factored against the price of the watch. At first I was pampering my Watch and wouldn’t have done worn it during a workout, but now the honeymoon’s over. The sport watch band is well suited for workouts and changing bands is so easy you can swap them for a daily workout in less than a minute. The Watch doesn’t track time in heart rate zones, but it does what I need and it’s probably sufficient for most people – if they are willing to measure workouts the Apple way. However, If you’re a dedicated runner or cyclist, you may want an exercise-specific app instead of the Workout app, or specialty device like a running watch.

Activity on WatchThe Activity app is Apple’s gamification dashboard for overall health. As described in the Outside article, Apple wants you to make healthy choices. It’s not enough to exercise – being sedentary is evil. By most accounts the hourly watch prompts to stand and hit your move goal are motivating. So, most would agree the Apple Watch does a solid job against those goals of: sit less, move more, and get some exercise.

However, overall health is a broader concern than simply exercise and movement. Nutrition (weight too) and sleep are missing from Apple’s tracking.

Watch HealthKit CroppedApple has wisely left nutrition tracking to several already existing and excellent apps. Let’s use MyFitnessPal as an example. It’s a highly polished app that lets you either enter your meals or zap the UPC codes of items you eat to track your calorie intake. If you plan to lose some weight, you identify your goal and the app will track you to a daily calorie limit. MFP on WatchIf you set alerts to enter your meals in MyFitnessPal, you’ll get a reminder to do them on your Apple Watch, which is motivating. Calories show up in the Apple Watch companion app.

When you look at the integration of MyFitnessPal nutrition data with Apple’s exercise and activity tracking it gets interesting. Apple has an underlying health data interchange platform called HealthKit. HealthKit exchanges selected data between apps, including data from devices such as the Apple Watch, wifi scales, etc. and integrates it all in one place. It can also connect to Electronic Health Record systems such as Epic, meaning you can share what you want with your doctor.

HealthKit is Apple’s operating system for health information but it’s a work in progress.

Pulling all this data together isn’t as simple as the advertisement shows. I used to enter workouts into the MyFitnessPal app where they would then show a calorie offset against the day, e.g. 220 calories from exercise on an elliptical meant 220 more calories I could eat that day. I setup MyFitnessPal as a source in the Health app (which is the dashboard app for HealthKit). Calories transferred seamlessly, but not workouts. This is where you start banging your head on the table. When you set up MyFitnessPal as a source in HealthKit, you’ll see that it MyFitnessPal can read workout data from Health but not write to it.

That’s OK, you can enter a workout directly into the Health app. So, I entered a bike ride into the Health app as a data point. The workout showed up in Health, but would not transfer into MyFitnessPal (even though Health is set up as a source). It also did not show up in the Activity app against the 30 minute exercise goal. Crap.

So Health/HealthKit is something of an island at this point and you have to be a good data analyst and willing to tinker with the apps you use to get everything working for you. I wrote about HealthKit a year ago and many of the same issues are still there.

MFP Exercise from Watch 50perHowever, if you go all-in on the Apple way and use the Workout app, things will work smoothly. The time you spend on the treadmill will count against the exercise circle goal in Activity. The workout will also show up in the Health dashboard, and the calories burned transfer from Workout -> Health -> MyFitnessPal. It’s pretty damn smooth.

The Workout app is simplistic and inflexible – it lists only a certain set of exercises and a few ways of tracking. Apple, we need some options here! People are waiting for this. If you’re doing martial arts or swimming you’re not going to want to wear your Apple Watch or any watch for that matter. If you want to track that exercise you should be able to enter it into Health or another app. The data should then transfer smoothly throughout this data ecosystem just like it does with Workout.

That’s not happening today. Activity does not appear to talk to any of the leading running or biking apps out there. Some specialty apps, like Runkeeper, will serve as a source for Health(Kit) and exchange data. But if you want to use Activity to stay healthy and do it the Apple way, your 1 hour run entered into Runkeeper isn’t going to make it back to Activity – you’ll still have your 30 minutes to go. Strava and Runtastic appear to be in the same boat and neither runs natively on the Watch, meaning you have to drag your iPhone around with you, which is a no-go with me. This lack of integration of Activity with third-party apps is a huge gap in Apple’s health tracking.

The Watch is a mass-market health and fitness tracker. It’s likely that Apple would prefer to satisfy running and other exercise enthusiasts by allowing great third-party apps to fill that gap (like they are). In the Outside article integrating Activity with leading apps was mentioned as part of the OS 2 update, so hopefully it’ll happen soon.

The Health app itself, though charmless, has gotten interesting.

It’s a solid example of the integration at work. Take a look at these calorie charts (which are better in MyFitnessPal), and also charts for active and resting calories. There’s even a heart rate chart (by the way, when did I give Apple permission to monitor me all the time?) Weight also gets picked up from MyFitnessPal.

Health-Calories-Heart

Sleep tracking is another area frequently identified as key for health. The Jawbone Ups were notable in this category as having excellent information display in the app and being pretty unintrusive on your wrist while you slept. I had two of them.

Sorry Jawbone, but now for free you can use Sleep++ on your Apple Watch. You simply wear your Watch when you sleep; you start the app when you go to bed and switch it off when you wake up. It shows the depth of your sleeping and sends the data over to Health. Overnight it uses about 10% of the charge on your watch and, critically, it’s a native watch app that runs independent of the phone – you can put your watch in airplane mode to save juice. Personally, I don’t want to wear the Watch when I sleep, but in my experience this app works smoothly.

The Apple Watch with the help of excellent partner apps and HealthKit covers all the bases and does a solid job of tying all your health tracking needs together. But, what’s next?

Health Data SourcesActivity, exercise, nutrition, and sleep are external drivers of health. How about blood pressure, cholesterol, and everything that goes on inside your body? This is where HealthKit is a slumbering giant. If you go into the Health app under “Health Data,” you’ll see all the current biometrics that HealthKit currently covers, and more are constantly being added. This image shows the categories available. HealthKit can be a living dashboard of your total health and help you tackle medical issues, going well beyond simple tracking.

I recently worked on an app that helps patients collect and manage crucial streams of health information for their anemia due to kidney disease or chemotherapy. The app integrates with HealthKit, using patient entered data as well as data captured from the phone. The combined data can be easily shared with your doctor. The app, Procrit’s Health View App, provides help beyond the prescribed drug to aid these patients – beyond the pill, as it’s known in the biz. It recently won the app category for PM360’s Trailblazer Awards (an industry trade magazine).

HealthKit eventually will be able to integrate app data, data from devices like a blood pressure cuffs, patient reported outcomes, and also environmental factors. Then you’ll be able to share this data with your doctor either via a patient portal, an electronic health record system, plain old email, or simply printing it out. At that point, you can work with your doctor to take a stronger role in your health, far beyond fitness. That’s the promise.

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Unstick the Greyed Out Apps on Your iPhone 6S

iPhone Grey Home I was very excited to get my Apple iPhone 6S. But, I knew it could take me a while to get it going. Even though Apple is excellent at the out-of-box experience sometimes things can get dicey. A month or so ago I had an issue upgrading my 64GB iPad and when I had to restore it it took hours to get all the data across. So, I knew I needed to give myself some time.

I’ve had more problems than I thought. The first time I restored from my 5S iTunes backup half of my Apple icons were greyed out. After doing a little research, I found the grey ones were slowly downloading from the App Store cloud. Apple no longer stores the apps on your computer but rather in the cloud. This is a good thing for conserving space on your computer but apparently it’s not working as smoothly as it could. I left the phone connected on wifi overnight but when I got up the next morning the situation was exactly the same. I had a bit of time the next morning before going to work, so with my cup of coffee I restored the phone again from the backup. Unfortunately, once again half of the apps if not more were greyed out. But, I had a working phone so I went to work.

iPhone Grey PhotographyMy new phone kept showing some activity when it was on wifi as if it was doing something with the apps but nothing seem to be happening – a day later the phone was essentially in the same place. I started doing research online and found a fair number of people with similar problems, but I didn’t see a big uproar on Twitter or on support sites, so I seem to be singled out for special punishment. I’m writing about it now in the hope that maybe it will help somebody else out, or someone will give me some better fixes.

I have the feeling I could restore 5 times, with the same result, so I’ve resigned myself to slowly fixing my phone. Also, each time I do the restore I have to unpair and then restore my Apple Watch, so it’s like I’m doing two restores. These are some of the recommendations I’ve found:

  • If an app is grayed out or stuck loading for a long time, make sure you’re connected to a wifi network. Then, tap the app to pause the process, and tap it again to continue. If this doesn’t solve the issue, try deleting and re-downloading the app. (Tip: you don’t have to delete.)
  • If your third-party app icons are visible, just darkened, try tapping the app icon in question to jump it to the top of your download queue. This doesn’t work every time—when your apps are outright missing, for instance, this is useless—but can often be all the troubleshoot you need in this situation.
  • Your device may be stuck on an iCloud path that’s clogged up or otherwise immovable. You can try to reboot the process by force rebooting your iPhone—just hold down the Power and Home buttons until the screen flashes and you see the Apple logo.

None of these fixes work for me.

I have at least a hundred greyed-out apps. What I have been forced to do is: as a need an app that’s greyed out, I pull down from the top screen to get search on my iPhone, search for the app and add the word ‘app’ or ‘app store’ – that usually pulls up a direct link to the App Store. Then I hit then I hit the cloud icon and this will kick-start the download process and restore the app to my phone. I’m doing a bit of housecleaning and getting rid of the ones that I truly don’t need because this is a pain in the ass (I do it during meetings). I’ve found I don’t need to delete the app, just re-download to unstick it.

iPhone Grey App StoreAnother spot where you can restore your apps in larger numbers is by going to App Store on the phone and then to Purchased -> My Purchases.  There I see a huge list of apps not downloaded that should be on the phone. The good news is that downloading there starts a download right away to the phone. That’s the quickest and best solution I’ve found so far. I’m hoping that perhaps the app store will suddenly speed up and resume downloading on its own.

I’m going to post on the Apple forums and see if other people have any more elegant solutions. Please leave any tips below.

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International Voice over IP

A long time ago, when I was in high school, I did a summer language program in Valencia, Spain. Back in those days, when you wanted to make a phone call to the United States it was a big ordeal. You had to go down to the Central Telephone Office, slap your ten Pesetas on the counter, and then sit on a bench until a line was opened to the United States.

world-phoneNow, you can be connected all the time anywhere – if you can afford it. You can text, Facebook, tweet, and look up travel information to your heart’s content. Unlimited texting now pretty much comes with an international monthly plan, and data has gotten affordable enough so you can use it frequently on a trip. Talk time, however, is still at a premium. I just took a trip to Spain and even with my hefty data plan, calls to the U.S. were still $2 a minute.

Of course, once you’re on wifi the rules completely change. And free wifi is now pretty ubiquitous in hotels. With good wifi you can do anything that demands data for free, including of course, video chat like Facetime or Skype.

So, can you use that accessible wifi to make voice calls as well? Yes you can, and pretty easily. I recently found myself in Spain again, and thanks to the usual crisis that comes along with flying United Airlines (almost every time), I was in need of inexpensive telephone calls to the United States to straighten out my air travel.

I use Skype for video chat in the states and it’s just terrific for voice calls abroad when you want to avoid paying for expensive international minutes. Skype has evolved some very interesting and flexible telephone calling features. If you buy Skype credit it’s easy to make high-quality outbound calls. For example, my 65 minute call to United Airlines was 65*$0.02 = $1.30 and would have been 65*$2.00= $130 on AT&T (and unreimbursed by the nincompoops at United Airlines). Skype will also give you your own dedicated phone number for $18 for every three months, which is useful for inbound calls.

Old Fashioned Phone Handset iPhoneI  became a big fan of Talkatone on this trip. Talkatone’s rates are very slightly lower than Skype’s, and they give you a free dedicated number, so it can be a complete phone replacement. This means anytime that you’re on wifi you have almost no barriers to making or receiving phone calls. In fact, it makes you wonder if you really need such a big calling plan in the US – you could substitute Talkatone instead. Now that I’m back, I’ve used Talkatone to turn an Android tablet into an ersatz phone by just using my home wifi.

Of course, Skype, Viber, and Facetime are all free and convenient if your friends are using the same app. However, Skype and Talkatone do an amazing job of bridging the gap to phones. Next time I travel, I wonder if I’ll need much of a data plan at all.

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