XPRIZE Health at Home

Many people fear going to the doctor or worry about expensive medical bills or long waiting times. Hospital systems are burdened by congestion and scarcity of resources. Aging populations put an additional stress on nursing homes. Innovation in home care is concentrated on wealthy users in Western countries.

There is an urgent need to:

  • Test, diagnose, and provide care at home;
  • Enable people to continue living at home, safely, when they age and/or suffer chronic conditions;
  • Reduce pressure on hospitals and nursing homes; and
  • Bring down overall health costs.

We are thinking of a prize that would challenge teams to either integrate scattered diagnostic and tele-medicine tools or develop best practices for a healthy home in which people can age in place.

Would such a prize competition be audacious enough in light of existing innovations? What exactly should we challenge teams to accomplish? How would we judge their solutions?

Please share your feedback here!

@DGlass, @abartke, @addy_kulkarni, @ArthurDR, you may be interested in this idea for an XPRIZE competition. Please let us know if you think this strikes the right balance between audacious and achievable in light of emerging innovations and needs.

CC @KenDychtwald

@henry_bro, @Elena_Milova, @Lizzy_2020, @pepsicola28, @sstrasser, @user587274, I wouldd like to ask your advise on this potential XPRIZE, given your expertise in the fields of aging and nursing.

We are thinking of challenging competing teams to design a “living home” by integrating technologies that embed smart, adaptive support for health and wellness into the home environment. The most impactful solution will comprehensively optimize health and quality of life at home for the major life stages of the occupant(s) that includes safely aging in place without structural modifications being required for the home. The solution’s monitoring and diagnostic capabilities must track and demonstrate improved health outcomes from a baseline assessment.

Additional points will be considered for the integration of advanced robotics in the home design that can replace tasks performed by human caregivers.

We have a lot of potential judging and testing criteria. Would appreciate any and all feedback you can give us:

  1. Assist in multiple activities of daily living (ADLs):
  • Basic: Ambulating, feeding, dressing, personal hygiene, continence, toileting.
  • Instrumental: Transportation and shopping, managing finances, meal preparation, house cleaning/maintenance, managing communication with others, managing medications.

Should we require at least the basic and then score teams on how many instrumental ADLs they can support?

  1. Provide early detection and diagnosis of X.

Should we define the conditions the system needs to be able to detect and diagnose? Or set a minimum number? Or leave it up to the judges to score?

  1. Prevention and home optimization:
  • Detergents and cleaners (are they aligned with the user’s health?).
  • Electro-magnetism.
  • Fall-proofing (improving ergonomic conditions, such as loose wires, throw rugs, slippery bathtubs).
  • Food and beverage selection, storage, and preparation.
  • Furniture (which support healthy living and which are literally crippling).
  • Light (optimizing the vision, skin, and brain dynamics of lighting, natural as well as artificial).
  • Smells (affects thinking, sleeping, digestion).
  • Sound (of equipment, devices, etc. can impact the brain and sleep).
  • Temperature.
  • Water (optimizing the healthiness of drinking and bathing water).

Above could be scoring card for judges: the more points the solution provides recommendations for, the more likely the team is to win?

  1. Ease of use.

Hard to define. Please make recommendations, but we can also leave it up to the subjective determination of the judges.

  1. Response time to falls and other accidents.

  2. Low-cost:

  • Affordable.
  • Significantly cheaper than a human caregiver.

What does affordable mean? Should we set an absolute dollar amount; a share of the average pension/income; “affordable to X percent of the elderly population”?

  1. Flexible. Must be adaptable to multiple (home) environments.

Should we set a number on this? For example, you need to test your solution in at least an apartment and a stand-alone house in 2 different regions, so 4 demonstrations in total?

  1. Measure the impact of the home environment on health and well-being.

We have several options for this:

A. Components of the Aging Society Index:

  • Productivity and engagement
  • Well-being
  • Equity
  • Cohesion
  • Security

B. Flanagan Quality of Life Scale:

  • Material and physical well-being
  • Relations with other people
  • Social, community and civic activities
  • Personal development and fulfillment
  • Recreation.

C. Quality of Adjusted Life Years

D. Improvement of existing health conditions (for example, NIH top health challenges)

The advice we’ve received from our founder and chairman, Peter Diamandis, is that this would be too broad of a prize. His recommendation is to focus is on at-home testing.

Specifically for: blood tests, dermatology, and mammograms.

I’ve done a little research into portable mammograms. There is a device called iBreastExam, but it costs ~$10,000.

I’m not sure there’s a market failure in at-home blood testing. LetsGetChecked offers a wide range of home diagnosis kits by mail, ranging from $50 to $400. There is Circle HealthPod, which tests for COVID-19, flu, and STDs from nasal swabs, and it only costs €109. Maybe a non-evasive blood test that instantly diagnoses X?

I’ve yet to look into dermatology.

@nastyahaut, @jewhitson, @solangemassa, what are your thoughts on this idea for a prize competition? What would be the most impactful at-home test? Can we combine various things into one device, or should this be a multitrack competition where teams can sign up to built one of X options?

I saw a new breast exam tech company is currently raising money on Republic.co: Invest in Koning — Republic

Maybe the founders have some insights here.

I would not specify yet what type of test that should be. An early diagnostic test including something that could use a cell phone app would be Very helpful. The big game changer here is Bility to use the phone and communicate back-and-forth and perhaps get digital healthcare. Especially when combined with other biomarkers From other digital devices.

Granted that all I’m saying is Healthcare at home but would also be equally true that it could be Healthcare on the move.

To me the question is what advancement has revolutionized this area. To me it’s the number of connected and communicating sensors. Cellphone, Smart watches, etc.

However what I’m proposing is perhaps a little different from what your stated the scope is.

If I had to pick categories here it would be in:

  1. New devices
  2. New healthcare intervention of disease
  3. Novel communication

Key metrics would be;
Cost, Performance, Ease-of-use, Potential impact on society

There’s some brilliant ideas here that would result in very useful solutions. Healthcare (or “social care”) at home is in great demand. It’s likely to be unfeasible to address all of these points in just one XPRIZE challenge. These ideas are worthy of multiple dedicated challenges that focus on specific subsets.

For example:

  • providing physical support to people (helping the disabled get out of bed, go to the toilet, move around the house; and washing and bathing)

  • health diagnostics

  • interactivity to facilitate well-being and happiness

  • etc.

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Thank you for the feedback, @akb, @Derek, and @lancemcneill!

I found that Google is also working on a clinical research study with Northwestern Medicine to explore if and how AI can assist in diagnosing breast cancer, and there’s a company called Natera that uses blood and saliva samples to test up to 53 genes associated with risk for common hereditary cancers. So I don’t think at-home mammography is in need of an XPRIZE.

At-home dermatology also seems a crowded space:

  • DermTech sells a sticker that lifts skin cells off a mole to test for melanoma ($760).
  • First Derm lets users take a picture of their skin with a smartphone and gives them advice from a dermatologist within 24 hours.
  • Haut.AI is a tool for skincare brands to run AI-powered analysis of their customers’ skin.
  • TeleSkin uses breakthrough imaging techniques to diagnose melanoma and other skin conditions.
  • Skin Analytics and Triage uses AI to diagnose skin conditions based on physician- or user-submitted photos. Google is developing a similar AI tool to diagnose 288 conditions.
  • T.R.U.E. TEST is a patch that medical professionals can place on a patient’s skin to test for allergic contact dermatitis ($685).

So I’m leaning in the direction of at-home blood testing. What do you think could be a breakthrough there?

@akb, specifically to a couple of your suggestions:

  • We considered a prize around supporting aging-in-place and people living with disabilities. The argument against it was that it would require multiple innovations, which would make it hard to run a “democratic” competition in which lots of teams could participate, or essentially a nursing robot which could do many things, but that again might be too much to ask of teams competing in a prize.
  • When it comes to well-being and happiness, check out the Measuring Mental Health prize sketch we’re working on.
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Hi Nick.
I agree the robot would have to achieve many challenging tasks. It might (still) be too ambitious, but then again look at what robots can do these days (e.g. Boston Dynamics’ Atlas and Spot). Perhaps this is the sort of focus / challenge an advanced robot company needs to make such healthcare possible.

There is a company in my hometown of Austin called Everlywell that is doing a lot of at-home testing kits. Check them out: Everlywell - Innovative at-home Health Testing

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My initial thought when reading this XPrize offering was an AI system – not necessarily a robotic one, however. I think there is great wisdom in NOT replacing humans (as caregivers) completely. Rather, to introduce an AI as a whole system (home-hospital staff-lab-care providers, etc.) monitor/communicator acting as home-care ‘liaison’ between the patient and his/her/their family, medical providers, and household caregivers.

My apologies for joining the discussion so late. As an example of what I am referring to / describing, I’ve linked (below) to a short story (written in response to an InnoCentive.com challenge back in 2012 on ‘The Future of Healthcare’); it is 10,000 word PDF (sorry, it’s about the length of a typical New Yorker essay/article) and incorporates a good amount of tech (speculative, theoretical and feasible) but the main point of the piece is the INTEGRAL and FUNCTIONAL ROLE of the AI in the daily activities and life of the main character (Louis). It also offers a scenario in which humans and technology collaborate to effect the optimal healthcare for the client. It may offer some new direction or ‘ideational guidance’ for the refinement of this challenge (the story includes the describing of various ‘diagnostic’ and daily monitoring tests – from the mundane to the most critical – conducted by the AI [known as ‘ALICE 3000’], as Peter D. recommended). Here’s the (dropbox) story link:

Enjoy!

Thank you all for your feedback here! I think the final direction we’re going in is closer to what you suggested, @marz62. We would challenge competing teams to design the best home healthcare system that:

  • Optimizes health outcomes
    • Allows users to age in place
    • Improves quality of life
    • Actively helps manage any chronic health conditions/comorbidities of the user(s)
  • Detects (likelihood of) conditions and incidents
    • Top 5 preventable diseases of the country
    • Fall
    • Stroke
  • Responds to emergencies in the shortest time

The objectives are deliberately broad in order to enable different technologies to compete.

Teams would have to demonstrate their solutions in a sample environment.

The judging criteria would be:

  • Ease of use: The solution must be intuitive.
  • Efficacy: The demonstration allows for a complete evaluation of the solution’s efficacy in a real-world context.
  • Flexible: Must be adaptable to multiple (home) environments.
  • Functionality: Must work out-of-the-box.
  • Health Impact: Measured according to:
    • Activities of daily living
    • Quality of life self-assessment (SF12 or SF36)
    • Diagnosis of local top 5 preventable diseases
    • Detection of fall and stroke
  • Privacy: Must respect user privacy.
  • Response time: Will be measured relative to other entries.

Bonus points would be awarded to solutions that benefit historically marginalized and/or underserved populations.

Would you add, change, or remove anything from the above? I’d be particularly interested in suggestions for the point about privacy, which right now is vague.

@NickOttens - What you have out-lined seems like a good/solid starting point.

A couple of thoughts: What role (if any) would the AI play in the actual ‘care’ component of ‘healthcare’? (i.e., would it be strictly detection, diagnosis, and communication…leaving the care up to humans?). For example, could the AI assist with physical therapy? Or, assist with preparation of dietary needs (special foods, nutritional supplements)…or anything beyond reminders to take medications…? Obviously, the whole point of an AI (acting as a ‘home health assistant’) is to perform duties that a human might/could do if s/he were available (but is not actually present). So, what is the full scope (realistically) of thee ‘duties’?

As for privacy, I see no reason why an AI cannot be ‘trained’ to adhere to HIPAA rules for reporting/sharing personal health information the same as any human professional…perhaps the AI could help expedite/facilitate HIPAA-protected health information sharing by facilitating and verifying verbal/written approval from the patient (e.g., to provide med history to a new doctor/specialist) or for medical research purposes.

Lastly, ‘health impact’ (and its measurement) may be a sticking point…apart from determining which healthcare activities (e.g., monitoring, treatment/care of an actual illnesses/conditions) are within the AI’s purview, there will need to be a priori determinations (by medical professionals) as to which analysis/assessment (statistical) methods/tools will be used and which outcome parameter(s) are key/critical for that specific ailment, disease, or condition, etc. (thus also, the numerical values/cut-offs determining ‘success’ or ‘failure’)

Thanks, @marz62!

To your first question, about what the system would actively do, other than respond to emergencies we’re leaving that open-ended and then judges can evaluate which entries are the most impactful.

To your last point, the judges may need to decide beforehand, in the competition’s guidelines, what they’ll evaluate to make sure the competition is fair. But I’ll kick that can down the road. It requires more in-depth discussion and evaluation, and we don’t need to decide that right now.

Thanks for suggesting adhering to HIPAA! I’ll add that.

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I like the scope of this description and especially laud the inclusion of chronic conditions (most seniors suffer from chronic, not acute conditions at this time albeit with acute flareups).

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@NickOttens - in regards tot he concern over (personal data) privacy, here is a link to an article discussing the FAHME data analytics system (which utilizes ‘multi-party homomorphic encryption’)…enabling both (scaled-up) collaborative research AND maintenance of patient privacy (security if bio-medical data sets). This could be the standard against which, or through which, future solutions in this arena are gauged.

https://scitechdaily.com/healthcare-of-the-future-a-cryptography-game-changer-for-biomedical-research-at-scale/

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@NickOttens
Adding HIPPA but also including but not limited to; (i) Data Protection Laws (as defined in the Data Processing Addendum); (ii) the Declaration of Helsinki; (iii) the current ICH E6 Good Clinical Practice Guidelines, the EU and US GxP regulations (as published in EudraLex and US Code of Federal Regulations), GDPR and the US FDA rules and guidelines applicable to the conduct of clinical trials; and (iv) relevant industry or professional standards

will substantiate and protect the sensitive data generated.

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Thank you all! These are also helpful recommendations for the Digital Twin and Measuring Mental Health prizes, which have similar data privacy and -security concerns.

We’re considering focusing this prize specifically on a robotic nurse while incorporating many of the elements we’ve discussed so far.

The reason is that few people want to live in nursing homes, and nursing homes everywhere are understaffed. Tools exist that monitor vital signs, remind users to take their medication, and respond to emergencies, but there is no single, adaptive homecare technology that combines these functions, let alone one that also supports users in their activities of daily living.

Demand for robots in the home is fairly low. Wealthier potential users can afford (relatively low-paid) human caregivers while those who can’t afford a human nurse or health aid can’t afford a robot either. Manufacturers are focused on designing robots for clinics and hospitals.

The prize would challenge teams to build a robotic nurse that:

  • Supports users in their activities of daily living;
  • Actively helps manage chronic health conditions;
  • Detects fall, stroke, and the onset of disease;
  • Responds to emergencies in the shortest time;

and can be sold for less than $10,000.

(We picked $10,000 because it’s half the average cost of a home health aide in the USA, and we want retail insurance to cover the technology, so users don’t require a speciality plan.)

The testing and judging criteria would largely be the same.

What do you think?

Here is the almost-final version of the prize sketch, which will be pitched to XPRIZE benefactors on the weekend of Nov 12-14. If you have any final feedback, please share it with us this week!

The global challenge

Healthcare systems are not prepared for an aging population. Life expectancy at birth has increased by almost 20 years in the last half century. 2 billion people, or 22% of the population, will be over 60 by 2050. Currently 62% of people over 60 live in low- and middle-income countries. This share will rise to 80%.

As we age, we require more care. In the richest countries, one in eight older adults live with three or more chronic conditions. One in four are categorized as “high need”, meaning they have multiple chronic conditions or trouble performing activities of daily living, such as cooking and shopping. The US tops the list with 43% of elderly adults being considered high-need.

There is an urgent need to…

Few people want to live in nursing homes, and nursing homes everywhere are understaffed. But people struggle to age in place, financially and health-wise.

Financially: 80% of older adults in developing countries have no regular income. Only one in four retirees across low- and middle-income countries receive a pension. Among wealthier nations, American seniors stand out for their financial precarity. 23% avoid healthcare because of costs.

Health-wise: A third of Americans over 65 who live at home fall each year. Falls account for 70% of accidental deaths in over-75s and cost the American healthcare system $50B per year. Stroke is the world’s second cause of death, after heart disease, and the fourth leading cause of death in America. 75% of strokes occur in people over the age of 65. Worldwide, the share of people living with dementia is projected to double in two decades. 71% of people with dementia will live in low- and middle-income countries by 2050, when the economic cost is projected to be $2.8T.

We urgently need to make strides in homecare technology or healthcare systems will be overwhelmed.

Imagine a world in which…

Aging in place is affordable and safe.

Core problems
(i.e. the market and systemic failures blocking a solution)

  • Tools exist that monitor vital signs, remind users to take their medication, and respond to emergencies, but there is no single, adaptive homecare technology that combines these functions, let alone one that also supports users in their activities of daily living.

  • Demand for robots in the home is low. Wealthier potential users can afford (relatively low-paid) human caregivers while those who can’t afford a human nurse or health aid can’t afford a robot either. Manufacturers are focused on designing robots for clinics and hospitals.

The winning team will…

Build a technology that:

  • Supports users in their activities of daily living;
  • Actively helps manage chronic health conditions;
  • Detects fall, stroke, and the onset of disease;
  • Responds to emergencies in the shortest time;

and can be sold for less than $10,000.

Prize purse

20M

Timeline

3 years:

  • 6 months for proposal.
  • 2½ years for prototyping.
  • 1-month demonstration in simulated home environments.

Testing and judging

  • Cost to user: Sale price must be $10,000.
  • Ease of use: The solution must be intuitive.
  • Efficacy: The demonstration allows for a complete evaluation of the solution’s efficacy in a real-world context.
  • Flexible: Must be adaptable to different age groups, people with different chronic conditions, and multiple (home) environments.
  • Functionality: Works out-of-the-box.
  • Health impact: Measured according to:
    • Supporting activities of daily living (ambulating, dressing, hygiene, feeding) and medication management.
    • Detection of fall, stroke, and other diseases.
    • Quality of life self-assessment (SF12 or SF36).
  • Response time: Will be measured relative to other entries.

Extra points for solutions that benefit populations underserved by healthcare systems.