Health Wearables and the Yeshwant Table

By Benjamin Robbins

Hundreds of people gathered in an event space in Google’s Cambridge, MA, office last month to demo the latest in health wearables and watch the final round of a health tech competition co-sponsored by Google, Anthem, MedTech Boston, and Medstro.com. The event suggests  that we may be seeing a striking evolution of fitness-oriented health wearables to devices with the potential to improve patient care.

I’ll admit that I had relatively low expectations – imagining walking into a room full of devices designed to keep already-healthy people marginally more healthy. However, when I arrived I was struck by the number of knowledgeable medical experts who had built devices that seemed like they could truly help alleviate or prevent suffering caused by disease.

Over the past two years, my friend, mentor, and boss, Krishna Yeshwant, MD, has shaped my perspective of health wearables and other forms of patient-generated data. I work with Krishna at Google Ventures, where we’ve reviewed dozens of wearable health devices. Krishna is a practicing primary care physician, and our discussions are often related to his clinical experiences. During one of those conversations, Krishna recognized that I was confused about how to evaluate the true value of wearable devices. He drew a simple yet profound chart on a whiteboard that I now refer to as the Yeshwant Table. He wanted to help me understand how he, as a doctor, thinks about wearables. He drew one line on the board and wrote “medical complexity.”

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He said (I’ll paraphrase), “This is a y-axis that represents the medical complexity in a patient population. At the origin, there are people with no history of significant illnesses, and undergoing no treatment currently. At the top, there are people who have multiple serious medical conditions.”

 

Robbins 2Then he drew an x-axis, wrote “social complexity,” and drew a dotted grid. “This is an x-axis that represents the social complexity in a patient population. At the origin there are people with good housing, good insurance, supportive family and friends, no substance abuse issues. To the right there are people who have none of these benefits, often exacerbating their medical conditions.

“This is a simplification of my patient population,” he said.  “Each quadrant represents a different subset of patients.”

He explained that the chart’s lower-left quadrant is largely made up of relatively healthy, engaged people, usually with access to lots of resources. This group disproportionately has mobile phones, email addresses, and may wear  fitness trackers on their wrists.  While they are engaged, they only represent a small fraction of Krishna’s patients, and are the least difficult to treat.

The other three quadrants represent the ones that keep doctors like Krishna awake at night, and have been least served by wearables:

  • The lower right could be someone living in extreme poverty, perhaps homeless, and addicted to drugs, but who is otherwise miraculously healthy.
  • The upper right could be this same person, who has developed hypertension and diabetes, but can’t afford the medications to treat these conditions and doesn’t have access to transportation to see a doctor.
  • The upper left could be a person who is more fortunate in their social condition, but is diagnosed with cancer.

In some ways, the health care industry is optimized for patients in the upper left quadrant. However, the groups physicians need the most help with are in the upper-right and lower-right quadrants.

Health wearables in the recent past have offered few tools to patients outside the lower left of the Table. This isn’t too surprising when considering that entrepreneurs tend to skew a bit younger and healthier. Like everyone starting a business, they are well-equipped to build products for people with needs similar to theirs. Patients in the lower-left quadrant also usually have more disposable income. A lot of successful wearables have been built for them. However, there’s a significant disconnect between these products, and the needs of patients outside of the lower-left quadrant, as well as their physicians.

 

Robbins 3At the recent Cambridge event, however, I clearly saw how the wearables world is shifting. A surgeon, for example, showed a device that allowed hands-free translation in an operating room that allowed him to train non-English-speaking trainees. A smart wearable app improved the social skills of autistic children through a variety of approaches. Although there remains too little effort to improve the care of patients with the greatest social complexity, the increasing focus on helping patients with more medically complex issues is encouraging.

At the end of the night, a panel of four judges decided on a winner.  Their pick, surprisingly, was not a beautiful wearable designed to help improve the health of already healthy people. It was a device designed to improve the long-standing, difficult problem of compliance with physical rehabilitation regimens.

As applause broke out at the announcement of the winner, I felt inspired.  It was exciting to see the hundreds of people in attendance celebrate a team of entrepreneurs who built an invention oriented towards solving an intractable source of suffering for a large number of people.

ben-robbinsBen Robbins is a venture partner in life sciences at Google Ventures. He is a dual degree student at Harvard Medical School and Harvard Business School. He co-founded a company to monitor drug adherence at a community health center in Boston and a non-profit to operate a school for AIDS orphans in Tanzania.

Ben received his Bachelor of Arts with honors from Dartmouth College and has been recognized multiple times for his social impact work including the Harvard Medical School Dean’s community service award, Harvard Medical School Agents of Change seed grant, Harvard Medical School Master Scholar scholarship, and Harvard Business School Social Enterprise fellowship.

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