NFC Has Role to Play in Health and Fitness Applications

NFC could have a growing role in health and fitness applications, especially helping to collect and transmit data, though it’s not suited for all uses.

That’s according to panel discussion this week organized by the MIT Enterprise Forum’s NFC Cluster in Boson, titled “How NFC Will Keep Us Fit.”

Panel members weighed potential uses for NFC in health and fitness for 25- to 45-year-olds. That includes wellness applications ranging from tracking fitness and activity for healthy adults to ensuring the correct administration of medication in hospital. Panelists discussed situations they believe are good fits for NFC and those that are not.

“Our view on a lot of technologies is that all too often they’re a hammer in search of a nail,” said Michael Davies, founder and chairman of strategy consulting company Endeavor Partners. “There are a set of optimal use cases for NFC, but also a bunch of things you just shouldn’t try and do with it.”

For example, Davies classified “macro-location” check-in, which involves using a mobile device to log a user’s presence at a gym, restaurant, park, or other location, as a “suboptimal” use of NFC technology. “That should be done passively and should happen automatically,” he said.

Instead, NFC is better suited to “micro-location” check-in, that is, checking in at much more narrowly focused locations, such as a piece of gym equipment. “It’s not just that I’m at the gym,” he said during the panel discussion. “It’s that I’m at the third weight machine along…which is location to meter- or centimeter-level accuracy.”

These precision check-ins, according to Davies, could help users track their gym activity. For most fitness tracking applications currently on the market, identifying a piece of gym equipment to add it to a workout log can be a hassle for some users. In one proposed use case for NFC in fitness, users of workout tracking applications could tap an NFC tag on a piece of gym equipment to add it to their workout.

According to Dr. Kamal Jethwani, leader of the research and program evaluation initiatives at Partners Health’s Center for Connected Health, these equipment-level tags could also help track the use of fitness equipment in nursing homes and assisted living facilities. “These places are known to have a lot of facilities for people but no way of tracking who’s using what,” he said. “NFC can solve that problem.”

NFC Versus Bluetooth Low Energy
A significant portion of the discussion about NFC in health and fitness has focused on transferring data from tracking devices or monitors to smartphones, where it could be transmitted to physicians or uploaded to online wellness profiles. Davies, however, said that although one-time pairing of devices is a good use of NFC, asking users to continually repeat the pairing or information exchange between devices is not optimal. “There are better solutions,” said Davies, “probably Bluetooth low energy in that case in particular.”

For instance, Jethwani discussed NFC as a means of uploading data about users’ fitness activity from a tracking device, such as one made by U.S.-based Fitbit. “A criticism of NFC is that it introduces a step for a person to do,” said Jethwani, such as tapping a Fitbit tracker to a smartphone after a walk to upload the distance walked to the user’s profile.

“Compare that to what I have today; my Fitbit wirelessly just communicates with my phone via Bluetooth and it just tells me what I'm supposed to do; it measures my steps, it takes it at 15 minute intervals, and I don't have to do anything, and that's definitely a big win for Bluetooth," said Jethwani.

“My suspicion, even though I haven’t done it with activity, is that that extra step is actually going to lead to about 30% to 40% less engagement.”

Jethwani based this expectation on a two-year-old study in which the Connected Health Center compared adoption time and engagement for wellness tracking devices with different methods of sending data. One group received modem-based devices, which required them to press a button to upload data to physicians; the other group received wireless devices, which uploaded the data automatically with no action from the patient.

“The wireless people took almost half the time to just open it up and start using it compared to the people who used the wired devices,” Jethwani said. “The same thing with days to first measurement, which means that you're measuring yourself faster just because you have an easier-to-use device than having a wired device.” Patients with the wireless devices also took and uploaded more measurements each day than those with the other devices, which Jethwani attributed to the faster feedback the wireless group was able to receive from doctors. “That encouraged them to get more data to me," he said.

As a physician, Jethwani’s goal is to use patients’ own health and fitness data, such as changes in weight, to persuade them to adopt healthier habits and change unhealthy behaviors. Often, just getting patients to take the measurements is a challenge, and the easier it is for them to get the data to him, the more likely they are to do so.

“I want to use a technology that is passive, which means it sits on the person's body or it sits somewhere where the patient doesn't even realize it and is sending me data. That's the best kind of data, because I'm not dependent on their willingness to do it,” said Jethwani during the panel.

Despite the extra step, however, he believes that NFC does have a potential role to play in gathering wellness data from patients. He cited portability, flexibility, configurability and secure transmission as assets of NFC technology.

Combining Fitness and Loyalty
“If you already are using existing infrastructure for payments or other things, you can tag on a health care use to that, and that might make it useful and easy,” Jethwani said.

Ryan Norris, vice president of technology at software and services company Medullan, plans to do exactly that. At the November 2012 NFC Forum Hackathon, his team designed an NFC application called Gratify, which aims to steer consumers toward healthier habits by offering rewards for healthy behavior.

He cited the psychological model of habits as the product of cues, reinforced by rewards until the behavior becomes routine; Gratify is intended to provide different cues and rewards, leading users to develop healthier routines.

“Typically the model with applications of health and wellness devices is that there's this desire to be healthier, and because of that I'm going to engage in healthier activities, and the reward is that I'm going to be healthier,” he said. “It's not necessarily that simple.” Instead, Gratify will offer users a more immediate reward.

When Gratify users tap their smartphones to an NFC tag at a coffee shop, bakery, or convenience store, they will be prompted to complete a specified amount of physical activity within a specified time period; if they complete the activity and return to the store in time, they receive a reward. For instance, said Norris, “if I run four miles within two days and come back, I get a free coffee.”

The reward for retailers in this scenario would be increased consumer loyalty, along with the ability to market themselves as healthier options for consumers, said Norris. Retailers could incorporate Gratify into their existing loyalty programs, and the NFC check in could be part of contactless payment at the point of sale.

Norris and his team prototyped the application during the hackathon, and he said, “we're still experimenting with it as a business concept.” He did not say whether or when Gratify might launch, but he noted that the application took second place in the hackathon.

Evaluating Inpatient Applications
According to medical studies cited by Dr. Adam Landman, emergency physician, director of clinical informatics and instructor at Harvard Medical School, one million medication errors occur in U.S. hospitals each year, and 7,000 of them kill the patients involved. Landman recently tested NFC as a way to help reduce those numbers.

Most hospitals currently use the Electronic Medication Administration and Reconciliation, or EMAR, system to avoid errors in dispensing medication to patients. Nurses scan bar codes on medication containers and patient ID bracelets. Via Bluetooth, the bar-code scanner transmits the medication and patient information to a laptop on a rolling cart, which nurses push around the hospital on their rounds. The computer checks the medication against the physician’s orders for that patient and logs the administration of each dose.

EMAR improves the accuracy and safety of the medication process by around 50%, but, in Landman’s words, “bar codes can be a pain in the neck to scan,” and the rolling workstations are unwieldy in crowded hospital corridors. In short, Landman describes EMAR as “not ideal technology for the bedside.”

Instead, he hopes to replace the bar codes with NFC tags and the rolling workstations with NFC-capable tablets. He recently conducted a study in a simulation center, a mockup hospital using mannequins instead of real patients, and found that nurses completed the medication scenario in roughly the same amount of time using Galaxy Nexus 7 tablets and NFC tags as they did using the EMAR system, with which they had much more experience. Landman said during the panel that the nurses were enthusiastic about bringing the technology to hospitals, but there is no indication of a rollout in the near future.

Predicting NFC Adoption
“I applaud you guys for working on this,” Davies told the other members of the panel. “I'm delighted to see that somebody is investing their heart and life and soul, but boy, do you have a hard road to climb in terms of getting this to permeate and widely adopt in the US health care system.”

Among those challenges, Davies listed “hospital administrators and their fear of technology and all its possible side benefits,” as well as challenges from regulation and compatibility issues. To overcome those barriers to adoption, he said, “we think adoption will be driven primarily (from the) bottom up…by consumers, where NFC is an optimal solution,” rather than from the top down by institutions.

Davies said that factors working in favor of consumer adoption include increased consumer interest in health and fitness, increased market penetration of NFC-enabled smartphones, recent technological improvements in NFC tags compared with earlier generations, and “better security options, things like working with trusted execution environments rather than having to work with trusted service providers.”

The trusted execution environment is a secure area on smartphone processors that could add security to applications and software that don’t require an actual secure element.