CR Where do you see the biggest opportunities for innovation in healthcare, when it comes to wearable technology?
Yves Béhar I think we’re moving from a time when consumers have gotten curious about their data, their lifestyle, their heart rate and blood pressure – from consumer lifestyle to consumer health…. The technologies that are small-scale, wearable, that people can live with on a 24-hour basis are, I think, the technologies that healthcare should be moving into, ones that can be integrated into our everyday life.
CR Are there are any other areas of healthcare where you think wearable technology could prove particularly useful? For example, helping patients adhere to medical or physical regimes?
YB Once you start tracking blood pressure or heart rate, once you add more sensors, and once you’re able to apply those sensors to chronic diseases like heart disease, you’re really able to monitor patients on a daily basis, whether they’re healthy or sick.
Doctors have a really hard time checking in with their patients over long periods of time and the way we keep people in a regime, both physical and medical, or the way we keep track of them is the way we can reinforce behaviour – for example, these apps and devices combined with doctors’ advice can reinforce good behaviour and treatment over time with encouragement and motivation … [and] the ability for other people in the social circle or family circle and other patients to support each other in those treatments all reinforce mechanisms that can change adherence. We see that significantly in the way that people stay on [a healthy regime] for lifestyle reasons, and I believe the same would apply for medical and treatment reasons.
CR In the UK, there’s been a lot of talk about connected systems where GPs and hospital staff would be able to monitor patients’ healthcare and progress remotely – is this something you see becoming widespread through the use of wearable technology?
YB I don’t think disease or healthcare is a once-every-six-months type of subject. It’s an ongoing dialogue and it goes both ways: doctors being able to monitor and check on a patient and vice versa, for patients to be able to check back in with their doctor. It’s the kind of interaction and preventative medicine that I think would be very beneficial to everyone.
There are doctors that are starting to encourage their patients to be on some of the more consumer-like devices that are currently in use [for example, consumer fitness trackers] and do ongoing follow-ups with them, asking questions not just about how they’re feeling, but for example: ‘I can see you have been sleeping better, or you’re not sleeping very well, and why is that – is it stress?’ and the recommendations that come from that can be very beneficial.
CR Is this social aspect – being able to encourage others and receive encouragement to behave more healthily – something that you think is key to helping people stick to healthy regimes and change their behaviours? Has it proved particularly successful with Jawbone?
YB For me and my family, we live on different continents. I live [in the US], my brothers live in Switzerland and I can see how they’re doing, I can see what they’re doing, I can see my brother applying himself more to running or doing daily sports and I can be supportive of that. I think the supportive nature, when people have friends that are healthy or encourage them to be healthy is really important…. Many studies have shown the importance of social circles for encouraging and reinforcing healthy lifestyles.
CR While fitness trackers have become increasingly popular, they still seem limited to early adopters and people who have an interest in health and fitness already. Do you think they will ever become truly mainstream?
YB I agree with you that, in many ways, fitness trackers and wearables have gone to people who are generally healthy. But I’ve also seen and heard from many of our users how they’ve been able to make significant progress in their health and how combining better eating habits with more fitness etc has allowed them to lose weight, and feel more energised and motivated.
I think moving from this population, which certainly can afford to be focused on their health, to people who may have chronic diseases etc requires that health professionals start integrating [these technologies] into their practice. I’ve seen doctors on the West Coast [of the US] start to do this, but I think there’s still a large gap between these types of methodologies being adopted at a mainstream scale. There are tens of millions of people using tracking devices today, which is certainly more adoption than you have seen in any health and lifestyle product probably ever, but at the same time, there is a vast amount of people who would really benefit from the product more on the medical and patient scale that still need to be reached.
CR What needs to be done to reach these people, for example, those with chronic health conditions, those that can’t afford consumer devices or those who don’t feel comfortable using apps and wearable technology?
YB Currently, devices are more general purpose, but I think we will see the emergence of more specialised devices that are focused on certain categories of patient, certain groups of patients.
The other side is if insurance companies and others are promoting and reimbursing people for some of these devices, then we will definitely see more of them out there, so I think it’s a combination of things. As the technology advances, devices will become cheaper, and more specialised technology will also lead to lower cost.
CR Do fitness trackers like Jawbone really have a tangible impact on people’s health?
YB We have tens of thousands of people who’ve used it and who’ve made lifestyle changes, and had health improvements through the insights that the device affords you. I’ve had letters, notes and testimonials from all around the world.
CR What are the key things you have to keep in mind when designing wearable technology? What were your key concerns when designing Jawbone, for example?
YB I think it’s very important when a product is worn on the body that it disappears in a sense, that people forget it’s there. Discretion is key, whether that’s [in terms of] size, how it fits on the body, how comfortable it is.
For me, the other thing is that a technology product needs to be universal, in the sense that it’s not about giving people a singular look and feel, it’s about the range of people’s personal styles and preferences, and how [devices] can fit within that. From the very beginning, we pioneered the approach that there are many different finishes, you can really customise the look on your wrist and we don’t want to take over your entire wrist – I want people to still be able to wear their favourite jewellery or their favourite watch. Making devices that take over someone’s entire wrist is a mistake, I think, because then people have to choose between what they like to wear, and wearing a tracker, and if they have to choose between the two, I think you’re failing.
CR What about the interface design and user experience?
YB To me, the interface should reinforce good behaviour and give you encouragement. The other day, for example, I was up in the mountains and I didn’t sleep well. The insight the next day was that maybe I didn’t drink enough water, because lack of sleep often comes from dehydration, and I thought ‘that’s true, I didn’t drink enough in the afternoon or evening prior’. So there’s definitely some things that are friendly and insightful. It should also be engaging to look at. I think it’s very important that the interface, the software platform that you build around isn’t just about providing people with data but very personal, catered insights. It’s not about checking up on people, more checking in on them – giving them the benefit of the doubt, but nudging and informing them.
CR How has the design of Jawbone’s trackers evolved over the years?
YB We’ve always had the strategy or the belief that we had to create a product that integrated really well into people’s everyday lives.…There’s certain dimensionalities we analyse and understand to identify a better approach, and these have been kind of built upon and progressed, but the core philosophy was really there from the start. It has evolved because we’re simply doing better, the sensors are better and the technology is getting better.
A lot of it is also to do with the notion of comfort, making designs that match people’s lifestyle, and using materials like aluminium and steel to keep the product in the space of personal accessories and jewellery, rather than big plastic pieces. With the UP2 [pictured], it was about the ability to make it look lighter. It has two circular ropes that go around the wrist, rather than a strap, which makes it breathable so there’s less contact with the skin.
CR You’ve also spoken about the need to move away from devices with screens. Why do you think this is important?
YB For me, it’s always been important that technology isn’t the be all and end all. People really engage with the [Jawbone] app … and having advice and engagement isn’t something you get from having a number on display. The mistake technologists sometimes make is to cram more features in, and add more elements such as screens, for example, which tend to make the product larger and give it a shorter battery life. It might be something nice at first glance but in the end, all those elements – being larger, heavier, more cumbersome – will make people use the product less, and they will have less adherence. So I think there is definitely a balance to strike in that the design and features should be angled more towards discretion rather than becoming potentially burdensome.
CR What kind of work have you done with healthcare professionals when designing Jawbone? And what kind of user testing do you do, to monitor what works well and what doesn’t?
YB It’s hard to describe without revealing confidential information, but … a lot of the knowledge around adherence and the problems that result from lack of adherence for example, a lot of this has come through research we have done in the field. I have worked with health professionals and pharma companies as well. And now that products are connected, you get real time information about which features are most used, which ones people appreciate the most, which ones create or have the most adherence…
CR And how accurate are these devices, in general?
YB I think accuracy is a keystone of how these products are built and what they deliver [but] there are a lot of new entrants in the space and not everybody has the same amount of experience and background in terms of accuracy…. The sensors and software that analyses data, all of those are quite accurate at this stage, but as you add new functionality, it’s critical for everyone in the industry, particularly with new types of sensors and data, to allow plenty of time for testing.
CR As these devices become more accurate, do you think there is a danger they could be used to penalise rather than motivate people – for example, if insurance companies use them to ‘check up’ on customers?
YB Every time there is a new technology, there is obviously a privacy danger, and I think companies have to absolutely prioritise privacy. Data, in my mind, always has to be owned by the wearer of the device, and I think that sharing that data should be a choice. You should be able to decide who you share stats with. There are always some questions and well-founded worries about that, and I think that the key [for companies working in this space] is to partner with your customers, to make sure that the level of privacy is, essentially, a decision that they make.