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Apple is partnering with the Singapore government to improve citizens’ health, opening a new chapter in the relationship between public health and digital health innovations.

Joining forces Singapore is believed to have one of the most effective health care systems in the world, even though its expenditure on health does not exceed 5% of GDP. Average life expectancy at birth is a recordbreaking 84.8 years. Society is aging quickly, and according to forecasts by 2030 one in four Singaporeans will be over 65 years old. It is a rich country, in which the gross domestic product per capita is higher than in the USA. The 5.6 million residents of Singapore will now have a chance to participate in a pioneering health prevention program, LumiHealth. It is being introduced by the government and Apple as part of the Smart Nation initiative. The big tech company has exactly what health care needs, namely technology in the form of smartphones and smartwatches which can be used to get people into health programs. “This partnership between Singapore and Apple will enable Singaporeans to lead healthier lives but, equally important, it will contribute valuable insights to improving the health of people all over the world,” said Heng Swee Keat, Singapore’s Deputy Prime Minister. Jeff Williams, Apple’s chief operating officer, sees this partnership as an opportunity for a “holistic approach to well-being”. It is not the first partnership between private and public entities, but it is pioneering in terms of its scale and approach, which involves the use of Apple Watches. This solution is not cheap (prices start at about 200 euros), but in a country like Singapore, with prosperity based on a culture of innovation, the authors of the project are not accused of exacerbating the health inequalities. In less wealthy countries, this step would be risky.

To motivate and encourage What kind of things cannot be done with the traditional tools used by health ministries or public health organizations, but which become possible through technology? The answer is the personalization of preventive healthcare, play-based involvement and direct tracking of results. Moreover, the program is fully digital and designed as a free mobile application.

So how does it work? Users travel to different worlds with a friendly intergalactic explorer, who guides them through challenges adapted to their age, sex and weight. They include weekly physical activity goals, which can be achieved by walking, swimming, practicing yoga or some other type of exercise preferred by the user. LumiHealth reminds users about routine checkups and vaccinations. It encourages them to develop healthy eating and sleeping habits. When the challenges are completed, they help the intergalactic explorers to return home. By playing the game, the users can also win prizes worth up to 380 US dollars during the 2-year program. For the program to be successful, it is necessary to win social trust, so the application processes only the data required to personalize the challenges. Participation is voluntary, and the incentive is the play-based concept and financial benefits.

Will preventive health care gain in importance? The opportunities offered by today’s digital technologies can be used by contemporary medicine and healthcare in different ways. For example, the above Apple Watch can measure many parameters other than physical activity, and thus become a tool for managing the health of people from different risk groups. The continuous monitoring of heart rhythm along with electrocardiography can help detect atrial fibrillation and arrhythmia, which are a cause of strokes. It can also be used to design and implement programs aimed at improving the quality of sleep. The latest version of Apple Watch, Series 6, measures blood oxygen saturation levels, which makes it possible to diagnose sleep apnea. As smart devices gain more sensors and effectively become pocket laboratories, they will also include more applications in the field of health and wellbeing. However, their effectiveness will not depend solely on the capabilities of technology but also on appropriate incentives, for example those related to health insurance contributions, precisely targeting different groups of patients, e.g. youths, seniors, the chronically ill, etc.

The well-being of technology users Nevertheless, before such programs are introduced by government institutions, using public money, we need to be sure that everyone from the target group can

LumiHealth app encourages healthy lifestyle changes through technology. The twoyear program will be offered from late October 2020.

use them. This means that wearable technology may have to be adapted on a large scale or an alternative offered. After all, health cannot become a luxury, it must be available to everyone who wants to become more involved in the care of it. It should be expected that technological companies increase the number of medical applications for their innovations, trying to reach new target groups and boost sales. It is a matter of time before Apple announces that a new version of Apple Watch can, for example, measure blood sugar levels without pricking one’s finger. Over 420 million patients around the world are waiting for such an innovation. Of course, no public health care system can cover the cost of buying such devices for all patients, which will lead to the emergence of a twospeed health care system. When public health institutions make use of mobile applications or other new technologies in their health programs, they can improve health results of the participants, but what they need to keep in mind is the level of adaptation to digital innovations. Partnerships between public health institutions or health ministries and innovative companies should be more frequent, whenever patients could benefit from them and when the interdisciplinary cooperation of science, politics and business can improve health results. After all, those times when health was the exclusive domain of health ministries are long gone. 

Advosense is working on improving incontinence care products by developing a brief (adult diaper) with sensor technology that monitors patients for episodes of incontinence. Once a patient becomes wet, the system provides a real-time notification via a web application to the caregiver that the patient needs to be changed.

It all started in November 2018, where the co-founders Martina and Erin attended a ‘Hacking Female Health’ event. When participants pitched their ideas about improving female health, they were disappointed that no solutions were focused on improving the health of geriatric women. With Erin’s prompting, Martina pitched an idea focusing on an area of geriatric nursing care that needed much attention. They became a team of six over that weekend and came up with the idea that ended up winning the hackathon.

How did you build the team?

Advosense is a team of three women, with Erin and Martina as the founding members. Martina and Erin have over 15 years of practical experience in the field of nursing and healthcare management.

We met at Maastricht University in 2016, where we both completed our master’s in Healthcare Policy, Innovation, and Management. Since March, we’ve been joined by Grace-Anne Marius. She has worked with startups and scaleups, bringing expertise in developing go-to-market strategies, product launches, and global strategy.

Do you think that patients will accept innovation? Geriatric care is challenging – patients require an empathetic approach; they can have mixed emotions and feelings about technology. Some patients, for example, are ashamed to communicate their problems regarding incontinence.

We are very mindful of creating an empathetic technology that is not invasive and supports the patient’s dignity and privacy. That is why we are developing a technology that is invisible to the patient, their families, and visitors. Only the caregiver receives a personal notification, so our solution keeps patient privacy in mind. No alarms, no yelling out, no family members coming to visit only to find their mother sitting a soaked brief. Regardless of technology or not, caregivers need to know if their patients are wet or they will end up with complications such as dermatitis or urinary infections. So, rather than requiring a caregiver to physically take off the patients’ briefs to check every time, or a patient remaining in wet briefs with an unpleasant odor because their caregiver may be unaware, our solution allows the caregiver to respond to this problem in a more empathetic way. Our innovation lessens this burden and gives the voice to patients with limitations who cannot communicate that they have become incontinent.

The solution will also influence the way nurses work. Will they accept modified workflow?

Patients everywhere today are using adult disposable incontinence briefs without sensors. When using our disposable brief with a sensor, changing the actual brief will not require any additional steps. If anything, Advosense can eliminate unnecessary steps, such as finding a patient wet and having to go gather all materials or additional staff to help by preparing the caregiver with the information they need to provide the best care.

Things like checking patients for incontinence and waking them up, only to find them dry, or alternatively finding a patient soaked, requiring extra clean up or bed sheet change that could have been avoided if the brief was changed in time. Our solution will have a positive impact on the efficiency of the task at hand. Yes, nurses may have to change briefs more often as they will now know that it needs to be changed. This does not mean the nurse should drop everything they are doing and run to clean the patient. Instead, it means they can prioritize their care more effectively and therefore save time in the end. Packing, cleaning, and dressing a pressure ulcer wound caused by improper management of incontinence is much more work than changing an extra brief and a substantially different quality of patient care.

What added value does the solution offer?

Not only does our solution provide value to the patient through increasing the quality of care they receive, but it is also directly linked to critical patient and quality indicators of healthcare organizations. These include patient and staff satisfaction, the prevalence and cost of hospital-acquired complications, and the process for materials management. The Advosense solution also adds value to direct clinician care through efficient workflows and time management.

What is the stage of innovation development?

We’re currently building our MVP (minimum viable product). We are working with a great group of external partners who have expertise in hardware, Internet of Things, and software development to get our product tested and ready for the market. Moreover, we have lots of activities that are keeping us busy! This includes testing our product, preparing for medical device regulation, reaching out to potential customers, and securing funding. Though we have a great founding team, we are not yet complete and are excited to expand and further diversify the Advosense team. This is just the beginning for us.

What’s your motivation to launch the solution?

We exist to transform the way we feel about aging and nursing care for our elderly. That is the ultimate driver for us. We want to give caregivers the tools they need to provide the quality of care our patients and grandparents deserve.

What are the biggest challenges you expect on your way?

Many. We know that healthcare is not an easy industry to disrupt, since the system is so complex, and each market entry path has its own challenges. The technical readiness of clinicians and organizations is a significant barrier; however, through COVID-19, the industry faces a change, and acceptance of technology from care providers is increasing. 