The Coming Age of Contextual Health

August 14, 2012

Shel Israel recently suggested that there have been several great steps in human communication over the past century.  The Age of Broadcast lasted 80 years until blogging and social media created the Age of Conversation.  Coming next is the Age of Context.  It’s the subject of a book he is writing with Robert Scoble.


What is contextual computing?  It centers on hardware and software that understands you and offers the information you need based on what you’ve done, where you’ve been and where you are.  It’s predictive.  Google does this by giving you what you may want based on your search history.  Facebook figures what you may like based on who you Like.

Contextual sensing happens now through applications like Highlight, which tells you something about who’s immediately around you.  Alohar’s PlaceMe records where you’ve been and how long you’ve been there.  The idea is that information like this will help us understand where we may want to go or what we may want or need to do.

This idea of context may have been nudged along by Qualcomm’s recent release of Gimbal, a new mobile system that takes the burden of ambient sensing off of the software and puts it into the hardware.  This cuts the burden on the battery and may represent a critical flexion point in how all of this advances.

Contextual health

There’s nothing more contextual than health.  I can’t help but think that The Age of Contextual Health is upon us.  This will emerge as quantified self, biosensors, mobile technology and smart software come of age together.  It used to be that health information found us through our social networks.  Now it will intuitively find us based on where we are, what we’re doing and what we’re eating.

Geofencing will allow the delivery of specific information in certain areas of hospitals.  Information from accelerometers and skin impedance sensors may help the patient with cardiac disease recognize when they’re going too far.  Targeted educational materials on crohn’s disease may be available to a young mother waiting for an appointment in a pediatric gastroenterology clinic.

Understand where people eat and you can begin to understand what kills them.  My phone knows what restaurant I’m in, who I’m with, where I’ve come from and where I’m going.  It also knows how many calories I’ve burned along the way.  The epidemiologic impact of this kind of data is staggering.  I, for one, would kill to see how my geography and relationships relate to my health.  This is the stuff that Nicholas Christakis can only dream of.

Creepiness vs. opportunity

Sure there’s a creepy element to all of this and there’s lots to think about.  But we spend too much time worrying about how technology can violate our rights and too little time thinking how it can be used to keep us alive and well.  In Shel’s words, “You may not like everything that’s about to happen, but as sure as the night follows the day, the Age of Context is coming and you might as well start thinking about it and perhaps adjust course.”


eri August 14, 2012 at 8:27 pm

Bryan, Thank you for the article. We (Scanadu) share your vision of contextual health. Whether it will emerge as a value add to participants depends on who pushes and how the infrastructure evolves. I would argue that we need corporate ventures, who deeply know the consumer, to lay the groundwork for connected, contextual health. To add to my positioning, I’m working on it as we speak! :-)

Dr. Wes August 15, 2012 at 6:53 am

Contextual health: HIPAA? What’s HIPAA? The locator and unique identifier aspects of a person’s cell phone number and serial number flies in the face of restrictions required by our governmenal overlords for de-identification of personal health info, does it not? But most of us realize the law has few teeth directed toward the clever.

Still, “creepiness” is too pleasant an adjective. The idea that my personal info is being used for a centralize Progressive feel-good initiative to change my personal habits would steer me far from utilizing such an app or product. Sure, some will, but they are likely the compliant anyway.

Further, the idea of social engineering of health based on context gets comical, too. Just imagine an individual (soon-to-be patient) who wants a pack of cigarettes at Joe’s local bar, a favorite social hangout of his. Can we look forward to instant messages that say “Bad boy! Don’t you know cigarettes kill!” Or maybe a Marlboro t-shirt that can identify when it’s near a pack of cigarettes that flashes an LED alert. Seriously, it could happen. But will it sell?

While people’s location and social situations might be determined by context, the idea that contextual health will be capable of changing poverty, broken families, and the host of other societal challenges ahead of us that affect health complicance (the expensive stuff) is a pleasant Progressive vision of computerized Utopia. You and I know that, even when we see a person face-to-face in our office, actually shifting behavior is far harder in reality.

My enthusiasm is probably old-school, but I think contextual health will have a market with the compliant because of it’s “gee whiz” factor, but be much less acceptable for the non-compliant, socially stressed individual. The idea of sculpting realistic plan for affecting an individual’s health will still rest on the doctor-patient relationship in my view, despite what Wall Street wants us to believe.

DrV August 15, 2012 at 8:19 am

Wes – Thanks for your thoughtful comment. Your insight is a critical counter to my technoutopian view of the world.

Regarding HIPAA, agreed. This is a huge issue. I’ll go out on a limb and suggest that the law as it currently stands is incompatible with the advances in technology that patients will personally elect to use. I suspect that this will change within our careers (Actually….when are you retiring?)

I think that we don’t necessarily need to take this to the extent of social engineering although it’s easy to see this as a possible outcome. I think that this could have real impact with respect to the simplest things such as helping seniors to remember to take medicines based on contextual cues.

Agreed, behavioral change is crazy hard but I can personally attest to the fact that the ambient recording of PlaceMe has shown me things that I wasn’t quite aware of. I think self quantification can be very powerful.

While I don’t expect the eradication of poverty I think that there will be some interesting impact with respect to the way we view health and disease.

Of course, we’re in the drivers seat. As docs especially, we can choose to see this from the perspective of risk or opportunity.

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