Engineering Biosensors for Engagement: A conversation with Nag Murty

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Naganand (Nag) Murty

Naganand (Nag) Murty, Innovator in Residence at both the West Health Institute and the U.S. Department of Health and Human Services, is both a realist and an optimist. Perhaps that is what an engineer in the life science and healthcare innovation space has to be.

“The bigger problems in healthcare today are not so much technological as they are systemic and people-related,” Nag notes. “They are rooted in things like failures in care coordination, inadequate reimbursement, or inappropriate utilization.

He posits that currently emerging technology in health will eventually prevail over legacy systems, even if it seems like a stumbling block at the moment. Eventually policymakers and everyone else will come around to it, he says. It just takes time for systems and people to figure out what to do with it. That’s true in any field, not just healthcare.

Addressing Project HoneyBee’s emphasis on wearable biosensors, Nag says that such technology comprises a small but potentially very significant part of the technology solution. But the hold-up lies with a lack of focus on people and a lack of understanding of the right problems to solve. “I think the challenge that we have with wearables specifically is a proliferation of devices and technologies, but in most cases none of the engineering truly starts with the users and their needs.

The number of different activity trackers on the market and under development is astonishing, and increasing. What’s more, Nag noted, is they all tend to do essentially the same or similar things. “They’ll collect stats and display a pretty graph to you.” The real question, he continued, is around engagement. “Are these biosensors really helping people change their behavior? Are they really doing what they are supposed to be doing? Are they helping put the user’s own health in the context of the lives that they lead?”

These are the exact questions Project HoneyBee is asking. And according to Nag, the answer to all is a resounding no. Until we can directly incorporate the right clinical questions and connect them to positive behavior change in the foundation of biosensor design, “We can build all the technology we want, but it’s not really going to change anything for those who are not already healthy or inclined to proactively strive to translate their biometrics into positive behavior change.”

The potential value of biosensors is huge, and Nag is optimistic that we will eventually figure out how to engineer the technology to be truly useful, particularly in clinical settings.

With the rapid pace of population aging, we can’t afford not to.

nag_featured2West Health is finding that the key to meaningful use in many cases is to develop technology that enables providers and caregivers to take better care of patients, not so much about designing technology for patients themselves. “From an engineering perspective,” Nag reflected, “the challenge is for the hardware to be relatively invisible and totally non-invasive for patients, and yet the technology must provide powerful insights back to the providers and the caregivers.”

When it comes to aging, the other aspect of technology, specifically for biosensors, is capturing the biometric and biological information, as well as all the other contextual information that can quantify and describe the patient’s social, emotional, and physical environments.” Such contextual information can often provide a more reliable read of health and well-being, as well as a more accurate source of health challenges, than biometric data alone. How to incorporate it into each device remains a compelling question.

But first, what does this information look like? For Nag, it means understanding how active an elder is within their community, how strong their social connections are. Are they in decline? Are they healthy? All those things become a lot more important than just figuring out their heartrate. Nag reflects: “It almost calls for a total refresh of how we think about designing these sensors and what we choose to measure really when it comes to aging.”

The devices in this context become enablers to a process of care, and what’s more interesting than their hardware is the relationships that have been formed around them. “I think the question becomes,” he continues, “how do we preserve the human connections that these people have had, while at the same time, making their care more efficient?” Nag admits that that’s a really difficult question to answer.

We hear a lot about aging in place, or aging in community, but Nag notes that these concepts go against efficiencies in providing service because they focus on isolated individuals. Rather than looking primarily at individuals, Nag keeps coming back to feedback rather than data—actionable feedback for providers, caregivers, coaches, and whoever else is using these devices.

While answers are elusive today, Nag continues his quest for them.

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