LifeChart's AirWatch Monitor

Managing Asthma
The AirWatch Monitor measures the lung capacity of people with asthma. Patients breathe into the device which measures their airflow and then stores the results in its memory. Patients receive immediate feedback in the form of a green, yellow or red light letting them know which medication to take according to their doctor's instructions. Wilby serves as a guide by smiling when a measurement is good and frowning to indicate concern. By plugging the AirWatch Monitor into a phone line, patients can use it as a modem to send data to LifeChart.com and post health readings to a secure web site accessible to patients and their doctors. People with asthma and their doctors can then easily track their health, identify triggers and potentially dangerous situations, and chronicle progress and change.

1. For what class of users and uses is this technology is likely to be most appropriate and effective?
The AirWatch Monitor is designed to help the approximately 14 million adults and children (over 5 years old) with moderate to severe asthma. The information gathered by this monitor is critical to tracking and maintaining good health. Asthma is completely manageable if people modify their behavior and use appropriate medication but it requires daily monitoring, particularly in serious cases. This device is marketed towards individuals who must measure their lung capacity daily, record results and make choices about medication and behavior based on the measurements.

The web site and written materials about this device also show the target audience is quite wide. The instructions are written in an easy-to-understand comic strip format and rely on the cartoon figure, Wilby as a guide to provide tips and reminders. The web site contains a Flash presentation that is easy to use but does require the plugin indicating there is an expectation users will be somewhat computer savvy. The monitor itself strives to make it easy and appealing for both adults and children to participate in the daily monitoring of their health.

Since AirWatch is more expensive than other devices, cost may make it prohibitive for some given the initial price, the monthly payment to maintain and record information on a web site and the cost of a computer or fax machine to receive the results. It is also possible to measure peak flow with a cheaper device and record information in a written log. In treating asthma, patient participation is critical and AirWatch will only be successful if people want to use it and find the information it provides helpful.

2. What new or improved affordances are offered by this technology?
The AirWatch Monitor offers several important affordances. It is designed to:

• facilitate monitoring and tracking of asthma by both doctor and patient
• relate to medication suggestions from the patient's doctor
• provide immediate, clear feedback about airflow
• indicate incorrect usage
• produce monthly reports analyzing records over time
• display the highest reading during a ten minute period

The key features of the device include:

• portability
• ability to take medical measurements
• ability to communicate health levels through appropriate feedback
• ability to store information
• ability to transmit data to LifeChart who makes it available to both patient and doctor
• Wilby the guide
• ability to recognize a measurement has been taken incorrectly by comparing previous results
• ease of use

3. What new interaction styles and metaphors seem especially well suited to this technology?

In many ways, this measurement device calls on familiar interaction styles. People with asthma have used similar, non-electronic devices to measure their peak flow. For children, the AirWatch Monitor may be reminiscent of a handheld game in that it has a small cartoon character, Wilby, who serves as a guide and gives immediate feedback. The color coding with red representing a potentially dangerous result will also be familiar. For an adult, a more familiar analogy may be a Palm Pilot in that this device is easily portable, stores important information and can transmit data to a larger computer.

AirWatch promotes a new kind of interaction between asthma sufferers, medical information and doctors. Each month patients are automatically sent results by email or fax in an understandable format and thus are engaged in their own health care in a different way. Not only do patients literally have control over this device, they also receive and can interpret the results. While a young child may need adult help, this medical information is designed to be accessible rather than requiring a doctor's translation.

Doctors can use AirWatch to easily and frequently track a patient's health. Reports are available 24 hours a day allowing doctors to monitor patients closely by simply checking the results of their daily measurements. LifeChart claims this has reduced the number of office and emergency room visits for people with asthma.

Patient compliance and adherence are serious issues in asthma treatment. While this device does not address all aspects of a healthy lifestyle, it does seem to increase the ease of peak flow measurement.

This technology has implications for other chronic conditions requiring regular monitoring such as diabetes. Diabetes can be expensive to treat and fatal if mistreated or monitored incorrectly. By making it easy for patients to participate in their own health care, they can see and immediately understand their current medical condition and the results of their choices about medication and behavior. Doctors can receive daily information about their patients and hopefully avert some major health emergencies.

4. What is the current commercial availability and success of this technology?
On LifeChart's website, the product is currently available for $99 with a $9.95 monthly fee to maintain service. After a quick web search of four pharmacies, one listed the AirWatch monitor. As of last January, more than 100,000 had been sold for clinical trials and LifeChart has received FDA approval for AirWatch.

In August of 1999, LifeChart entered into corporate partnerships with Johnson & Johnson, Nokia and MedicaLogic. Nokia showcased the AirWatch Monitor at CTIA Wireless IT earlier this fall.

LifeChart seems to have the potential to tap into a large audience. If this device can fit into patients' daily routines and if doctors support its use, the AirWatch Monitor can facilitate self-care and close monitoring of health conditions.

LifeChart has also received positive coverage in the medical and technology press. There seems to be a great deal of interest not only for asthma management but in terms of other possible medical applications.

5. What key technical constraints currently limit development and deployment of this technology?
As the wireless technology grows more stable and widespread, the possibilities for this kind of device expand. Nokia's involvement indicates to me this is clearly a direction LifeChart would like to pursue. Potentially, the AirWatch could transmit critical information wirelessly and directly to doctors. In an emergency, it could call an ambulance, set off a beeper or send a prescription to a pharmacy.

AirWatch is not stand-alone technology. Some doctors and patients do not have access to computers so LifeChart has incorporated the use of faxes. Currently, the market for this device is limited to patients and doctors with computers or fax machines. Asthma rates are rising particularly in low income urban areas where people have less access to the minimum requirements for AirWatch to work effectively such as proper medical treatment, money to spend on health care and access to phone lines, computers, fax machines and email.

Because a key characteristic of this monitor is its size and portability, its functionality is limited. The screen is quite small so patients must refer to a paper copy of their asthma plan or their computer in order to determine appropriate actions. Patients also cannot receive and store monthly reports on the actual device.

6. What broader social and economic implications are likely to create either benefits or problems from the new technology?
Changes in monitoring health can shift doctor-patient relationships. If patients can understand and interpret results in conjunction with doctors, they may take more active responsibility for their health. Instead of arriving at doctors' offices to be tested, AirWatch allows patients to arrive having seen test results and some analysis. This shift in control over information makes it possible for patients to participate actively in conversations and decisions about their health.

Patients may have legitimate concerns about privacy as their personal information is stored and transmitted by a third party. If LifeChart can establish itself as trustworthy and if medical companies in general adhere to high ethical standards around the use of information technology, the benefits of using this device may well outweigh privacy concerns.

As mentioned earlier, AirWatch is more costly than standard peak flow monitors and has other economic implications. Its benefits are important to all people. Given that asthma effects the poor at alarming rates, it is important to ensure access for all. If insurance companies and federal medical aid programs see benefits for this type of device, they may cover the cost. If AirWatch is successful at increasing patient compliance and doctors use it to monitor patients at risk, it could reduce the need for expensive emergency medical treatment.

Aspects of AirWatch have obvious applications for chronic health conditions such as diabetes and hypertension and other measurable medical conditions requiring close monitoring.

The potential for social and economic change is great though it remains to be seen how widely this product will be adopted by patients, doctors, insurance companies and the medical establishment.