What is Quantified Self?The Beginner’s Guide to Quantified Self for Smart Health

ICT has recently made it possible to measure individual activity and certain physical constants, and to keep its history on smartphones and on the net. Even if these “quantified self” systems still deserve to be improved (the reliability of the devices is often questioned), they open today the way to a quantified self-knowledge, followed in time and, consequently, to the management of part of your state of health.So what is Quantified Self? How Quantified Self improve your health by smart health self management?

Collecting autonomous data

Newly informed patients can now be equipped with connected data collection tools. These miniaturized tools collect a wide spectrum of data, ranging from the simple number of steps in a day to biological data, including electrocardiograms.

This interest in self-awareness through self-traceability shared by users and tool makers appeared in 2007 in Silicon Valley. Translated by the concept of “self-measurement”, this phenomenon brings together the means allowing the collection, monitoring (healthtracking) and sharing of personal data to get to know each other better (in a medical approach, to compare oneself with others, as tools social support, etc.). The novelty is the use of ICT applied to self-measurement, because the phenomenon is not new in itself. What is new is the type of data collected, the simplicity of collection, continuous and permanent collection, the possibility of easily sharing it with other people (including his doctor), and the analyzes and responses provided by the applications. or systems.

Connected wristbands are activity sensors that transmit the information detected on a smartphone via an application. They can capture a lot of information such as the number of steps taken, the distances traveled, the sleep times. Some, more developed, capture the pulse and the temperature. Other features may be considered in the near future.

The Frenchman Withings is developing an ecosystem of connected objects allowing everyone to build a health dashboard. This device allows users to have a better visibility on their health and to think of it in a positive way (thanks to a development of the positive effects of physical activities and a controlled diet). The user no longer waits to be sick to take an interest in his health, he is “empowered” (according to Withings advertising) and can build an accurate database (connected scale, blood pressure monitor, activity sensors and others ) on the evolution of his state of health. Apple and Samsung have also embarked on the commercial adventure of the connected watch with the release of the i-watch and Gear Fit respectively. The watches are presented as a sort of discreet but omnipresent individual sports coaches.

As an example, here are the business arguments for the i-watch: “The Apple Watch gives you a particularly comprehensive view of your daily physical activity. The three rings in the Activity app show you the progress you make each day and keep you sitting down, exercising more, and exercising. The Apple Watch is also a great sports watch, which provides a variety of statistics in real time. Over time, it gets to know you and determines your level of activity and fitness. It then uses this information to refine its measurements and suggest a suitable activity goal every day. They even send you personalized reminders to encourage you to keep on track. ”

Likewise, many telephone applications are being developed to allow better compliance with treatment as well as to avoid dosing errors.10 To cite a few applications as an example, in the United States we find Mango Health, CyberDoctor, AiCure, MediMinder, MediSafe.

Finally, these tools can be used for another purpose. Individuals are now able to share their data with their doctor and loved ones, but also with anyone in the network who has the same application. This functionality leads, through the comparison offered, to competitions between individuals to find out who will be the best performer. If this practice can be considered positive, accompanying a greater interest of individuals for their health, it can also lead them in spirals of counterproductive, even dangerous performances.

The “quantified-self” is proving to be an emerging trend of great magnitude. Between the first and second half of 2013, the market for connected bracelets and watches increased by 500%, estimates the firm Canalys. Citizens today face a market of nearly 100,000 mobile health apps available on multiple platforms such as iTunes, Google play, Windows Marketplace and Backberry World. The 20 most popular apps (sports, fitness and health combined) already account for 231 million downloads worldwide. By 2017, 3.4 billion people worldwide will have a smartphone, and half of them are predicted to use mobile health apps. In 2017, if its potential is fully exploited, mobile health could save € 99 billion in healthcare costs in the European Union.

New practices integrated into everyday uses

People are nowadays more and more equipped with new technologies and in particular with smartphones (there are more on earth than toothbrushes). The collection of health data (likely to enrich medical data) now goes through these “intelligent” mobile tools.

Several systems exist today to capture physiological data and transmit it to the doctor. The following section gives some examples from various sources, academic and professional. They are sorted by type of pathology and give an overview of the possibilities of retrieving information from the individual.

Blood glucose and Diabetes

We know the constraint, and sometimes the difficulty, for diabetics to take their measurements on a daily basis. Today, there are several systems that make it easier to measure this rate:
CGM (Continuous glucose monitoring) is a mini sensor embedded in the skin but its cost still seems too high to be marketed on a large scale.

Walt Mossberg, a famous American journalist specializing in new technologies, demonstrated in an TED Talk in 2010 an iPhone application capable of measuring blood sugar levels (using a glucometer connected with a USB key).

There are also new technologies being tested: contact lenses that change color or tattoos that become fluorescent when the blood sugar level changes.

Finally, there is Theranos, a company founded in 2003 by Elizabeth Holmes (a young chemistry student then aged 19) with the aim of rationalizing and standardizing blood tests by creating a pocket sampling device. Indeed, since 1960, the blood sampling protocol had hardly changed. You have to go to the laboratory, have your arm stung in a prominent vein, and fill several tubes with blood. Today, thanks to technology developed by Elisabeth Holmes herself, a drop of blood is enough.

The sample can thus be taken by the individual and sent by post, freeing them from the classic space-time constraints (and incidentally from fear of the needle).

The EKG and heart rate monitoring

Cardiology is a specialty with multiple monitoring needs. In 1949, Norman Holter invented the first monitoring. These measuring instruments have long been cumbersome machines with which baths and exercises were prohibited. In 1999, a new, more portable technology was developed by the company Cardio net. However, it was only popularized in 2008. Today, miniaturization continues with i-rhythm adhesive patches, which send information on the heart condition by email. There is also an application that has become popular on smartphones, Alive Cor.

The start-up Acacia France has just released its latest innovation (November 2014), called MyRythme, which is a light telemedicine solution making it possible to perform ECGs remotely and without training. This system aims to respond to very specific problems in order to prevent heart accidents.

High blood pressure

High blood pressure may not have any symptoms for several years. However, poorly managed, hypertension is one of the main risk factors for cardiovascular disease. Measuring blood pressure, if taken well, is the most effective way of knowing your condition in the face of this disease. Doctor Nicolas Postel-Vinay has set up a site allowing the patient to report the voltage measurement data and other types of data on a form to be given to his doctor or to follow daily on the site www.automesure. com the evolution of his tension.

In the logic of portability and permanent activity control, data capture technologies are now tending towards maximum miniaturization, and measurement instruments equipped with nano-sensors are now developed.

Myocardial infarction

Today there are nanosensors (the size of a grain of sand) capable of detecting myocardial infarction in time (sometimes confused with indigestion) and sending the information over the phone to the patient or doctor.

Cancer

Likewise, nanosensors spot cancer cells in the blood, and send the information to the smartphone and by email directly to the doctor.

Fever

e-Celsius® is an unmanageable capsule which, by telemetry, continuously communicates the precise measurement of the central temperature. They are also developing a dermal patch that communicates the heart rate.

And in the near future, other examples of the use of nano-sensors could appear in various fields.

Rejection of transplant

Methods for detecting rejection of a transplant have been very invasive to date. A less invasive way would be to look for donor DNA in the recipient’s blood (a high rate indicating rejection) via the nanosensor user.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease that begins years before the disease is declared with the production of “beta-islet” pancreatic cells. It would be interesting to succeed in detecting the presence of these cells from the start of their production, for example using nanosensors in certain patient profiles.

Among the “quantified-self” tools, there are also today textile innovations leading some to consider that connected clothing is the new carrier of tomorrow’s data sensors. Researchers at the University of Laval in Quebec are currently working on the manufacture of clothing capable, thanks to sensors integrated into textile fibers, of preventing a cardiovascular accident and alerting emergency services in real time.

Several uses could be declined on these new connected garments, for medical purposes in particular, even if one can also imagine other applications such as the location of children in real time, etc. By transmitting information via the Internet, clothing will become a communication platform and an information relay like other existing connected objects. Clothes could capture different types of information like glucose levels, brain activity, or analyze movement and spatial coordinates.

However, these connected garments remain proposals for the future and it is still difficult to know the date of their possible marketing. Indeed, the questions of connecting the textile to a wireless network or the power supply, remain unanswered as other more practical points such as resistance to washing.

The affirmation of individual autonomy in the management of one’s health

In the healthcare sector, “Quantified-Self” is an additional opportunity for the patient to become a player in their health by giving them more autonomy.

Cue, for example, allows you to “connect to your health at the molecular level”. Indeed, this small personal device makes it possible to analyze at home and monitor five biological elements related to health. The 5 elements are measured in different types of fluids (blood, saliva, nasal secretions) sampled using single-use “cartridges”. Advice on food to be consumed or activity to be performed is given in response to the analyzes carried out. Cue carries a vision of “monitored life” where each decision would be rationalized using biological arguments. This device, not yet validated by the FDA, is under evaluation. (https://cue.me/)

Cue represents well the shift of biomedical expertise towards the patient, testifying to the patient’s empowerment in the medical world.

These applications, if they multiply, however, continue to pose a problem for experts, both because of their pervasive and diffusive characteristics. Four questions are notably put forward:
• The security of mobile health applications,
• Concerns related to the use of the data they use,
• Lack of interoperability between existing solutions,
• The ignorance by stakeholders of the legal obligations applicable to mobile applications relating to lifestyle and well-being, such as compliance with data protection rules and the need to obtain the CE marking for applications that can be considered medical devices.

Finally, the reference questions and algorithms used for the analysis of each person’s data are questioned. Indeed, for example, the WHO recommendation of 10,000 steps per day, taken up by all sellers of activity trackers, is empirical data from Japanese walking clubs. It is medically risky to give such a target of daily activity to certain fragile people, when others could on the contrary have higher objectives.

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