back to article If you know what's good for you, your health data belongs in the cloud

An average-looking chap in a suit in hotel lobby takes out his phone and makes a call. “Hi. You ok?" he asks. “ I got a notification that you’re at 60." Something that might sound vague or bizarre to many - what does "at 60" mean? - had a profound and immediate meaning to me. Many of my relatives are diabetic - it seems to be …

  1. David Roberts Silver badge
    WTF?

    What?

    So this T1 is wired up to the eyeballs and the cloud, but doesn't have a low blood sugar alarm as part of his kit?

    So he gets a phone call from Pop, which he answers, but he completely ignores the same phone which is playing the "sugar time" warning at full blast?

    Be shit out of luck if Pop's phone was turned off.

    Something very not right about this scenario.

    1. Anonymous Coward
      Anonymous Coward

      Re: What?

      I think you've missed the point. Putting this data in the cloud now means we get used to allowing our health details to be seen by all and sundry four "our safety". So, please don't look at the details and come back with logical arguments.

      I also quite liked the bit about alerts on irregular heart beats... the NHS can't cope with the patients its already got who've actually had heart attacks let alone one's who may or may not be about to have something wrong with them.

      Still, I saw the word "cloud" so it must be good.

    2. hypernovasoftware

      Re: What?

      Hypoglycemia can affect people such that they aren't thinking rationally and thus his son might not have realized what was going on.

      1. Bill B

        Re: What?

        Hyper is right. My mother sometimes wouldn't detect an insulin reaction and there were occasions when I'd returned home to find her slumped on the floor. If you have a problem with the 'cloud' word then let's just go with "neighbours and friends can be alerted in the event of an attack".

  2. Voland's right hand Silver badge

    What an utter load of tripe

    So, how exactly does this connect to the cloud when I am in any of:

    1. London Underground or other sub-way with nearly non-existent mobile coverage.

    2. Out in the sticks with no coverage (>10% of Europe is not covered - covering mountains to 100% is nearly impossible).

    3. Standing in the middle of a crowd on a London station concourse when the trains are suspended and everyone is yapping on their phone bringing the Liverpool Stret/King's Cross/Insrt Your Name Here net to 100% capacity. Ditto for traffic jams. Ever tried to get data on a motorway in the middle of a 10 mile tailback?

    The idea of "IoT device reported to the cloud and cloud produced an alarm" in a health context is a rank raving lunacy. Real world is not the Silly valley. YOU MAY NOT HAVE A DATA CONNECTION (I am saying that as someone who used to architect cellular equipment for 7 years).

    Now long term trends, correlation, prediction, etc - that is a different story. It is indeed in the big data/map reduce/machine learning domains - stuff cloud does best. But definitely not "your blood sugar dropped, you got an alarm". That is idiotic to the extreme. A system trying to do that in real life will kill half of its diabetics under observation even before the first lawyer says the words class action suit.

    1. Anonymous Coward
      Anonymous Coward

      Re: What an utter load of tripe

      First of all, I'm totally with you on the lack of data connectivity being a critical factor, but there's another reason I would want this sort of event localised: I am NOT keen on sharing medical data with anyone. Period.

      1. Voland's right hand Silver badge

        Re: What an utter load of tripe

        I am NOT keen on sharing

        "Share" in google-talk where the dictionary definition is: "Bend over for inspection and we shall extract whatever we would like out of you to monetize". Definitely. 100% with you.

        Feed of medical data into a long term running profile to which _ONLY_ my GP has access on a daily basis - different story. Providing that to a medical professional with whom I have made an appointment based on a referral from my GP conditional on the appointment being setup - different story again. Emergency services getting access in a medical emergency - different story again. I will _PAY_ for that. Directly, indirectly (as a tax or as a part of medical insurance fees). Without thinking for a second.

        There is however _ONE_ condition - that CLOUDY marketeers, admen and other slimy scumbags never ever get their hands on it.

    2. FelixReg

      Re: What an utter load of tripe

      So, without 100%, 24/7 connectivity, a notification system has the value of tripe?

      Interesting.

      1. Voland's right hand Silver badge

        Re: What an utter load of tripe

        So, without 100%, 24/7 connectivity, a notification system has the value of tripe?

        You missed one important adjective. REALTIME. So that should be: So, without 100%, 24/7 connectivity, a REALTIME notification system has the value of tripe?. Actually, not even that - tripe makes for a fine soup (works well on hangovers).

        Example - I am severely allergic to half of the plants out there including "peanut level" intolerance to wheat, barley, rye and even rice. When I need to whack that epipen needle into my thigh and call an ambulance I on average have less than 5 minutes to do so. If that notification is not there within a minute or two, it arrives to an unconscious body which cannot whack the eipipen. If it arrives past the 5 minutes mark it would arrive to a phone attached onto a dead body.

        Thankfully, I do not rely on notifications from the cloud for stuff like that. If I was, my SWMBO would have cached my life insurance already.

  3. John Hawkins

    Guess you need to be there yourself to understand

    I worried a lot about my brother until he got a new pacemaker installed, so I get this.

    I have the same heart defect myself (though not as serious as my brother; his heart stops, mine just slows until I faint) and I now use a Fitbit HR so that I can log my pulse. I'd have no problem sharing that information with concerned family members. Or at to least alert them when I'm having problems again.

    1. Adam 52 Silver badge

      Re: Guess you need to be there yourself to understand

      You're not though you're sharing it with, to quote, "the health community about trends; for marketing and promotional use; or for sale to interested audiences".

    2. Anonymous Coward
      Anonymous Coward

      Re: Guess you need to be there yourself to understand

      @" I'd have no problem sharing that information with concerned family members."

      Does it fix a real problem, does it even fix their *concern*? Because feeding your family an intermittent feed is not a way to alleviate concerns! What are they supposed to do, listen to your pulse 24/7?? Yet if they don't, what if you died when they weren't looking at it? What if the data is feed is down, do they panic?

      And it doesn't fix the real problem, since that needs to be fixed locally. In this case the man needed to take a starburst, but instead of telling him to take a starburst it had to send the data to someone to read, to call him back to tell him to take the starburst!

      It's like someone wants to sell cloud services to medical providers, and dreams up a nonsense argument as to why this makes sense.

    3. John Hawkins

      Re: Guess you need to be there yourself to understand

      Reading the replies I might add that the prospect of imminent death to yourself or someone in your family focuses you. Many things that people get excited about become nothing more than white noise.

  4. Anonymous Coward
    Anonymous Coward

    I really am not getting the cloud part of this. What benefit does "Cloud" give to this situation?

    I can understand historical analysis of information but again that could be done locally on a smart phone. If the sensors are there you would prefer to have an actual simple device with an alarm and monitor that is less likely to fail than a smart phone.

    1. VinceH Silver badge

      "I really am not getting the cloud part of this. What benefit does "Cloud" give to this situation?"

      None whatsoever.

      As someone pointed out further up the comments on this article, the device the son had (er... should I have used a spoiler warning if you didn't read to the end for that amazing revelation?) could have notified the son directly, rather than going through to his dad.

      Even the dad being notified didn't really need the cloud. The monitoring device could have either cellular connectivity of its own or be paired to the son's mobile phone, and send an alert message directly to the dad (and other configured numbers).

      (None of which would work if the boy was somewhere with no connectivity).

      The cloud is completely irrelevant. The whole story was just a MacGuffin to sell us all on the supposed benefits of its use - and like most MacGuffins it doesn't stand up terribly well to scrutiny.

      1. John 110

        Pillock

        "could have notified the son directly, rather than going through to his dad."

        Have you ever dealt with someone having a hypo? At best they need talked through the procedure to fix it (go get some sugar or drink some lucozade), at worst they need third party intervention. It's not clear from the article whether the message to dad was first or second line response (you know, inform the diabetic, if nothing changes, then inform somebody else)

        1. VinceH Silver badge

          Re: Pillock

          Before getting all ranty about it and calling people names, consider the way the story is told. Just isolate the one-sided conversation from the rest of it.

          “Hi. You ok? I got a notification that you’re at 60."

          ...

          “Yeah, I got notified your blood sugar is dropping - yeah I know you’re in Florida, but that device sent me a message. It’s great."

          ...

          “So you didn’t even know? You didn’t feel anything? Well, you would have."

          ...

          “No, it’s ok. Just go have a Starburst or three."

          So the son's having a hypo that is so bad, the dad can take the time to hold a short conversation with the son (including being complimentary about the service that notified him) before suggesting that the son has a Starburst or three.

          And the son apparently didn't even know. So if 60 mg/dL is so dangerously low in his particular case that it needs third party intervention, why the monitoring device not set to warn the son himself before it gets that low?

          It should have levels set that are appropriate for the person it is monitoring.

          1. Bill B

            Re: Pillock

            Don't need to get rants about this, but the context is that of a diabetic hypo. For those of you who don't know what this is, it's a lack of blood sugar caused by an excess of insulin, usually because the diabetic in question hasn't had a dose of sugar (read 'meal') at the appropriate point after an injection, or has engaged in an activity that has used more blood sugar than the insulin was supposed to have balanced.

            The commentators may not know that the early symptoms of a hypo is similar to that of a drunk (probably due to the same reason ... brain functions shutting down). This means that the sufferer's judgement is impaired. If the person is in a 'zone' (for example .. In the middle of a job) they may judge that there is enough time to finish the job and then get some sugar ... and that judgement may be wrong.

            As someone who had a diabetic in the family that phone conversation was very familiar. The '60' in this conversation is less than 60mg/dL of blood sugar and yeah, at this point the person is still rational but really really needs to get some sugar. Myfamily would often detect that my mother was going hypo well before she knew herself. She would respond to 'mum, take some sugar' (or if she was particularly advanced, "mum, take some sugar NOW") even though she herself didn't feel the need, and I suspect the son in the article hadn't realised the need himself.

            I would agree that this remote alarm to family etc shouldn't be the first line of support. However, I can see it being a useful tool to help diabetics manage their condition. As I've pointed out above, families, friends and neighbours can be a great help, but the problem arises when they are not there. I've come back home to find my mother in a coma because she hadn't realised she was going hypo and there was no-one around to help.

            So to all those who call this lunacy, shouldn't be implemented etc ... you're entitled to your opinion but as someone who had to deal with a family member with type 1 diabetes ... I think it's a great idea.

            1. John 110

              Re: Pillock

              @vinceh

              Sorry for the rant (I had a colleague who was diabetic and a diabetic grandson)

              @Bill B

              That's what I meant to say...

  5. frank ly Silver badge

    Welcome to the future

    "... giving each Estonian a public/private key pair ..."

    I wish somebody in the government would give me a public/private key pair. Then I could encrypt my data in the secure knowledge that only I and people who I authorise could access it.

    1. Vic

      Re: Welcome to the future

      I wish somebody in the government would give me a public/private key pair. Then I could encrypt my data in the secure knowledge that only I and people who I authorise could access it.

      Well, not really.

      If you encrypt with a private key, anyone can decrypt it with a public key. And that's public.

      But if you encrypt with your public key, the recipient needs your private key to decrypt it. And then it's not private any more.

      What you actually need is to know the recipient's public key, and the encrypt with that. And then we're straight into the usual problems of key verification and making sure that the holder of your data actually follows procedure and encrypts with the right key, rather than just sending it all in plaintext.

      TL;DR: the author of this piece made up the bit about sharing health information[1] without really thinking through how it will work. 2/10 must try harder.

      Vic.

      [1] And the rest of the article, really...

  6. robbie hughes 1

    Health is really about behaviour change

    The point about this, and the reason the author is getting so excited, is that the behaviour change aspect of health now has another way of being managed.

    Using peer groups/pressure to help patients/people/customers to change their ways is a very very effective way to help people get better.

    Whilst this is a little bit of buzzword bingo, the real breakthrough here is a diabetes management methodology based on getting the best out of 'buddies' as well as data.

    Just as AA has a buddy, so using the same thing for other chronic conditions will make a massive difference to how these things are managed.

    It's a really lovely use of tech.

    In terms of privacy, I assume this is selectively shared data with selective individuals, so it's the patient's choice.

  7. This post has been deleted by its author

  8. Anonymous Coward
    Anonymous Coward

    And of course all this information will be available to insurance companies like Kaiser Permanenté when the Health Secretary finalises moving the NHS to an insurance based model.

    https://www.youtube.com/watch?v=0HyL-riKqqc

    I know it's a video, but it's worth a watch, it's only 9 minutes, Jeremy Hunt explicitly states talking about moving either back to or forward to financial arrangements like Kaiser Permanenté for paying for NHS treatment.

    Kaiser Permanenté is a US based HMO

    The HMO model was cooked up by President Nixon & Edgar Kaise, the founder of Kaiser Permanentér, and it's aim is to maximise profit by denying treatment on grounds of cost.

    This is the system Jeremy Hunt wants the NHS to adopt, or at least he did on the 9th of May 2016

  9. Anonymous Coward
    Anonymous Coward

    I would have loved (and hated) this as a kid

    If their blood sugar was 60 mg/dl (3.3 mmol/L) then there's a chance that they could have been a bit disorientated and that some light assistance (a phone call from dad) is what's needed.

    The device should have given an alert, but they could have missed it - a replaceable sensor unit is adhered to the skin and is paired with a larger more power-hungry "base unit" which is carried elsewhere (e.g. in a pocket, but maybe they had it in a bag, and so missed the alert). And they might not have missed the alert, just not acted on it quickly enough, or they might have been a bit disorientated. There could even just be embarrassment at having dad calling to make sure they're okay.

    The point is that the device gave them a backup - someone to help when they were in trouble - and that's an incredible thing to have.

    I've been diabetic for >30 years now (since the age of 11), and the simple fact is that diabetes is an absolute b*gger - it's complex, difficult, and highly personal. Dealing with a condition that is with you 24/7, and which requires very careful management and modification of treatment regime and medication every day is a huge challenge. Add to that the dietary constraints which it introduces and it's a big thing to deal with.

    These kinds of devices which are able to export data over cellular networks and to trigger alerts to third parties are absolutely fantastic. I'm sure that my parents would have loved this when I was a kid. I'm sure that I could have hated it as well with it telling them when I was getting things wrong, but the benefits (not just the alerts - glucose readings every few minutes 24/7, giving incredibly rich datasets to assist in management of the condition) would have been huge. Effectively having somebody with me 24/7 to help when I was in trouble would have been the (sugar-free) icing on the cake.

    As much as we may get stressed about the possibility of data getting to unwanted parties, it is impossible to ignore the health benefits and I suspect that for the vast majority of parents, users and medics those benefits will far outweigh security concerns. That's not to say that security shouldn't be a concern - it absolutely should - but other clear benefits will easily push it down the list of priorities.

    1. Vic

      Re: I would have loved (and hated) this as a kid

      As much as we may get stressed about the possibility of data getting to unwanted parties, it is impossible to ignore the health benefit

      Yes, but the benefits arise from having sensors with the ability to send notifications; putting the data in the cloud for processing is a net detriment, since it requires connectivity and availability to be of any use whatsoever.

      This is a puff-piece about Cloud. Cloud is the last thing you want in this sort of situation.

      Vic.

      1. x 7

        Re: I would have loved (and hated) this as a kid

        " putting the data in the cloud for processing is a net detriment, since it requires connectivity and availability to be of any use whatsoever"

        but the point of using "the cloud" is that the data becomes available through existing connectivity: it does not require a new bespoke network. Agreed, internet access can be patchy in places, but in reality this kind of data needs little more than a 2G text message so should be reasonably reliable. Certainly using "the cloud" is better than the alternative: no connectivity at all.

        1. Vic

          Re: I would have loved (and hated) this as a kid

          but the point of using "the cloud" is that the data becomes available through existing connectivity: it does not require a new bespoke network.

          Putting your data in the cloud does cock all good.

          Using existing connectivity to pass messages is a good thing.

          The latter does not imply the former - indeed, the former is actively harmful to any real-time reporting, whereas the former is a good thing - and has existed for far longer than anyone has been spouting crap about "cloud".

          The Internet is not "cloud". The ability to pass messages cross the world is not "cloud". Sending emails, as we have done for some decades now, is not "cloud".

          Vic.

  10. Doctor Syntax Silver badge

    Standards

    I don't know how many sets of units are in use in blood sugar testing. In this scenario 60 was dangerously low. My wife's recent test by the health centre was 50 and they were pleased, but not over-pleased that she'd got down to this figure so I doubt the result is in the same units as in the scenario. The readings on her home monitor are of an order of magnitude different to the lab results so they must be in a third set of units. Unless there's a standardisation on units this sort of system could be very dangerous.

    1. Anonymous Coward
      Anonymous Coward

      Re: Standards

      That recent test result for your wife was an HbA1c result - it's a measurement indicative of blood glucose levels over the previous 30/60 days, and is a totally different measurement/standard to the glucose reading given in the article.

      More details on HbA1c here: http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

      :)

  11. Loyal Commenter Silver badge

    Two very different things:

    1) Connected medical device such as a blood glucose monitor with a single, or small number, of secured users

    2) All your medical data 'in the cloud', under the control of whoever the government of the day decides to contract it out to. No control over access - you're unlikely to even know who has access, let alone be able to control it. Security is a single-point-of-failure for everyone's data, so a large, juicy target for anyone who wants to harvest that data for nefarious means.

    Number 1 is fine, number 2 most definitely is not. Trying to equate the two things is, at best, highly deceptive.

  12. yet_another_wumpus

    And just how are you going to tell the difference between real medical analysis and an effort to sell you more viagra, oxycodin, or whatever drug has the highest markup? Americans unfortunate enough to be near a television will be getting inundated by drug pushers. Inboxes are either programmed to filter out such "help" or are useless due to the spam.

    It should also be noted that in America, there is zero legal difference between someone other than your doctor recommending a real medical treatment and recommending a treatment entirely based on the profit returned to the company making the recomendation (this has additional ethical issues where the drug makers lobby the doctors directly).

    Lets just say that in America (home of the world's most profitable health system) we won't notice a difference.

  13. MondoMan
    Boffin

    There are different types of diabetes

    It's probably worth clarifying that the story author was writing about the autoimmune disease type I diabetes (often called "juvenile onset"), which is quite rare but getting less so. In it, blood sugar levels are not well controlled, and can get either too high or too low (the latter being the condition requiring prompt action alluded to in the story).

    The vast majority of diabetes in the modern world is now type II diabetes (caused not by autoimmunity but rather by obesity and lack of exercise), where the problem is too-high blood sugar levels (not too low), which causes chronic problems, but does not demand a prompt response.

  14. x 7

    something you lot don't realise.

    In the UK, virtually all GP medical records are already "in the cloud". The three major providers of GP clinical systems: Emis (Web), TPP (SytsmOne), INPS (Vision) run hosted data centres in which your medical data is stored. Emis and TPP have their centres in Leeds, I don't know where INPS keep theirs.

    Between them they have something like 90% of GP primary care records.

    That data is restricted to the "owning" GP surgery, but in emergencies it is accessible to third parties e.g. by "out of hours" GP services, or by A&E departments

  15. ecofeco Silver badge

    Oh hell NO!

    Nothing, NOTHING belongs in the cloud except data you really don't care about. Personal health information? Go fuck yourself.

    1. x 7

      Re: Oh hell NO!

      "Nothing, NOTHING belongs in the cloud except data you really don't care about. Personal health information? Go fuck yourself."

      if you're wheeled into hospital A&E 300 miles from home over a weekend you could be very very grateful that your GP's records are available online. It could mean the difference between diagnosis and death

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