What iPhone-Based Health Care Could Look Like In 10 Years

Chronicle, a new concept from the design consultancy Artefact, is like a doctor in your pocket.

Mark Wilson 03.09.16

 Heart disease, cancer, diabetes, obesity, arthritis—chronic conditions such as these account for 84% of health care spending. Yet many are preventable. An estimated 40% of all premature deaths can be attributed to lifestyle, such as smoking and inactivity. How can the health care system shift focus (and dollars) from acute to preventative care?

The Seattle-based design firm Artefact has created a compelling new concept called Chronicle. It would be the first app to monitor someone’s health across various chronic diseases, as it compares to others with similar conditions, in real time.
"It’s about all this time you’re not actually focused on your condition, sitting in your home doing research about it," says Matthew Jordan, insights and strategy director at Artefact. "Real life is where the biggest risks are, which is why we wanted to think of something like Chronicle."

Chronicle is a hypothetical mobile health care app. You enter your condition(s), and it monitors you throughout the day via whatever sensors you might have on your body—that might include your phone’s GPS and accelerometer, but also, something like a wrist-worn heart-rate monitor or over-the-shoulder personal oxygen system. You opt in to share this data into a pool of patients with similar conditions (much like PatientsLikeMe). On the back end, the system crunches hidden trends to warn you on a moment’s notice.
Sure, it’s the same big data promise we’ve heard before, but Artefact demonstrates how it might be useful in immediate, day-to-day interventions. They give the example of a hypothetical woman named Olivia who suffers from a chronic lung disease and is outside for a morning stroll to get coffee. One coffee shop is at the top of a tall hill. The other is just down the street. She’s at a crossroads. Which one is right?

"Let’s say, two years ago, someone with the same lung capacity and blood oxygen levels had walked up the same hill and had to call an ambulance," Jordan says. "Can we translate, record, and give those insights back to Olivia?"
Maybe. Imagine Chronicle could see her path, air intake, oxygen levels, heart rate, and the temperature and humidity around her. From this data, Chronicle could push an easily readable "layered insight" to her, right as she stands at this fork in the road for her health.

Up top, it’s a fact she can learn from: "People similar to you in cooler environments have been able to walk longer." Below that, the factoid is translated to no-nonsense advice, "Consider walking at a time of day when the air temperature is lower." And then, below that, there’s a small data visualization, projecting Olivia’s position in the broader trend, should Olivia want to peruse them and weigh the risk for herself. If she still can’t decide, there’s also a button that can take her deeper into her personal history, should she want to see how she usually performs in these situations.
"Good decisions are about having some insight on the past, the ability to see into the future, and to make better decisions now," Jordan says. In this sense, Chronicle walks a fine line between providing simple, actionable advice and enough data for someone to make his or her own decision. It also layers these strata of insight specifically to teach Olivia about the triggers behind her own disease, so that she'll just know for the future without even consulting the app.

So what if Olivia still wants to climb that hill, knowing that she is statistically at risk? For this undertaking, she can engage a "turbo tracking" function. Turbo tracking forces her sensors to feed more updates into the cloud—draining a bit more battery and using more data, sure—but also monitoring her biometrics during the climb. With this data, Chronicle can send more urgent notifications ("stop" or "sit down for a bit") if she reaches emergency territory, and it can add her performance data to its grander library, so the app gets smarter the more she and others use it.

Chronicle would evolve through design by democracy.

As Jordan explains it, Chronicle would evolve through "design by democracy." The users, self-reporting anything from medications to potential epileptic triggers, would inform the system’s evolution. If self-reporting unearths trends, such as that some supplement is causing nausea, then those trends could shape Chronicle itself—such as by prompting the timely question, "Are you on X supplement?" when someone reports nausea. And of course, all of this data could be fed back to health care providers themselves, to hopefully offer better, more informed care during hospital visits. Theoretically, this data could do something to curb chronic health care spending—a doctor portal could allow caregivers to skim patient data quickly, and its findings could serve as a form of medical research, too, rather than taking up limited funds. But that's not Artefact's primary goal with the platform. The goal is to make sure the most at-risk patients are getting proper medical guidance when they're away from hospitals.
Technically speaking, everything Artefact presented is possible. But it would require some health care tools to be more interoperable, just by allowing open data standards and Bluetooth syncing with one’s phone, and for the public to be willing to disclose very private health data.

That latter point may be an especially tough pill to swallow. Artefact claims that a vast majority of the population is actually okay with sharing such private information, but with 23andMe data coming under fire for blocking someone's ability to get life insurance, and the mega-hacks going on in secure databases every day, it does seem like there would have to be considerable measures to protect patient anonymity, even within a broader shared data pool.
Artefact developed Chronicle for its own internal exploration, but the firm is open to the partners who might want to take the concept to market.