audiology, Biometrics, hearables, Smart assistants, VoiceFirst

Capping Off Year One with my AudiologyOnline Webinar

FuturEar Combo

A Year’s Work Condensed into One Hour

Last week, I presented a webinar through the continuing education website, AudiologyOnline, for a number of audiologists around the country. The same week the year prior, I launched this blog. So, for me, the webinar was basically a culmination of the past year’s blog posts, tweets and videos that I’ve generated, distilled into a one-hour presentation. By having to consolidate so many things I have learned into a single hour, it helped me to choose the things that I thought were most pertinent to the hearing healthcare professional.

If you’re interested, feel free to view the webinar using this link (you’ll need to register, though you can register for free and there’s no type of commitment): https://www.audiologyonline.com/audiology-ceus/course/connectivity-and-future-hearing-aid-31891  

Some of My Takeaways

Why This Time is Different

The most rewarding and fulfilling part of this process has been to see the way things have unfolded and the technological progress that has been made both with the hardware and software of the in-the-ear devices and also the rate at which the emerging use cases for said devices are maturing. During the first portion of my presentation, I laid out why I feel this time is different from any previous era where disruption might feel as if it’s on the doorstep, yet doesn’t come to pass, and that’s largely due to the fact that the underlying technology has matured so much of late.

I would argue that the single biggest reason why this time is different is due to the smartphone supply chain, or as I stated in my talk – The Peace Dividends of the Smartphone War (props to Chris Anderson for describing this phenomenon so eloquently). Through the massive, unending proliferation of smartphones around the world, the components that comprise the smartphone (which also comprise pretty much all consumer technology) have gotten incredibly cheap and accessible.

Due to these economies of scale, there is a ton of innovation occurring with each component (sensors, processors, batteries, computer chips, microphones, etc). This means more companies than ever, from various segments, are competing to set themselves apart in any way they can in their respective industries, and therefore are providing innovative breakthroughs for the rest of the industry to benefit from. So, hearing aids and hearables are benefiting from breakthroughs occurring in smart speakers and drones because much of the innovation can be reaped and applied across the whole consumer technology space, rather than just limited to one particular industry.

Learning from Apple

Another point that I really tried to hammer home is the fact that our “connected” in-the-ear devices are now considered “exotropic” meaning that they appreciate in value over time. Connectivity enables the ability for the device to enhance itself, through software/firmware updates and app integration, even after the point-of-sale; much like a smartphone. So, in a similar fashion to our hearing aids and hearables reaping the innovation from other consumer technology innovation occurring elsewhere, connectivity does a similar thing – it enables network effects.

If you study Apple and examine why the iPhone was so successful, you’ll see that its success was largely predicated on the iOS app store, which served as a marketplace that connected developers with users. The more customers (users) there were, the more incentive there was to come and sell your goods as a merchant (developers) in the marketplace (app store). Therefore the marketplace grew and grew as the two sides constantly incentivized one another to grow, which compounded the growth.

That phenomenon I just described is called two-sided network effects and we’re beginning to see the same type of network effects take hold with our body-worn computers. That’s why a decent portion of my talk was spent around the Apple Watch. Wearables, hearables or smart hearing aids – they’re all effectively the same thing: a body-worn computer. Much of the innovation and use cases beginning to surface from the Apple Watch can be applied to our ear-worn computers too. Therefore, Apple Watch users and hearable users comprise the same user-base to an extent (they’re all body computers), which means that developers creating new functionality and utility for the Apple Watch might indirectly (or directly) be developing applications for our in-the-ear devices too. The utility and value of our smart hearing aids and hearables will just continue to rise, long after the patient has purchased their device, making for a much stronger value proposition.

Smart Assistant Usage will be Big

One of the most exciting use cases that I think is on the cusp of breaking through in a big way in this industry is smart assistant integration into the hearing aids (already happening in hearables). I’ve attended multiple conferences dedicated to this technology and have posted a number of blogs on smart assistants and the Voice user interface so, I don’t want to rehash every reason why I think this is going to be monumental for the product offering of this industry, but the main takeaway is this: the group that is adopting this new user interface the fastest is the same cohort that makes up the largest contingent of hearing aid wearers – the older adults. The reason for this fast adoption, I believe, is because there are few limitations to speaking and issuing commands/controlling your technology with your voice. This is why Voice is so unique; It’s conducive to the full age spectrum from kids to older adults, while something like the mobile interface isn’t particularly conducive to older adults who might have poor eyesight, dexterity or mobility.

This user interface and the smart assistants that mediate the commands are incredibly primitive today relative to what they’ll mature to become. Jeff Bezos famously quipped in 2016 in regard to this technology that, “It’s the first inning. It might even be the first guy’s up at bat.” Even in the technology’s infancy, the adoption of smart speakers among the older cohort is surprising and leads one to believe that they’re beginning to grow a dependency on smart assistant mediated voice commands, rather than tap, touch and swiping on their phones. Once this becomes integrated into hearing aids, patients will be able to conduct many of the same functions that you or I do with our phones, simply by asking their smart assistant to do that for them. One’s hearing aid serving the role (to an extent) of their smartphone further strengthens the value proposition of the device.

Biometric Sensors

If there’s one set of use cases that I think can rival the overall utility of Voice, it would be the implementation of biometric sensors into ear-worn devices. To be perfectly honest, I am startled how quickly this is already beginning to happen, with Starkey making the first move with the introduction of a gyroscope and accelerometer into its Livio AI hearing aid allowing for motion tracking. These sensors support the use cases of fall detection and fitness tracking. If “big data” was the buzz of the past decade, then “small data”, or personal data, will be the buzz of the next 10 years. Life insurance companies like John Hancock are introducing policies built around fitness data, converting this feature from a “nice to have” to a “need to have” for those that need to be wearing an-all day data recorder. That’s exactly the role the hearing aid is shaping up to serve – a data collector.

The type of data being recorded is really only limited to the type of sensors that are embedded into the device, and we’ll soon see the introduction of PPG sensors, as Valencell and Sonion plan to release a commercially available sensor small enough to fit into a RIC hearing available in 2019 for OEMs to implement into their offerings. These light-based sensors are currently built into the Apple Watch and provide the ability to track your hear rate. There have been a multitude of folks who have cited their Apple Watch for saving their life, as they were alerted to abnormal spikes in their resting heart rates, which were discovered to be life-threatening abnormalities in their cardiac activity. So, we’re talking about hearing aids acting as data collectors and preventative health tools that might alert the hearing aid wearer to a life-threatening condition.

As these type of sensors continue to shrink in size and become more capable, we’re likely to see more types of data that can be harvested, such as blood pressure and other cardiac data from the likes of an EKG sensor. We could potentially even see a sensor that’s capable of gathering glucose levels in a non-invasive way, which would be a game-changer for the 100 million people with diabetes or pre-diabetes. We’re truly at the tip of iceberg with this aspect of the devices, and this would mean that the hearing healthcare professional is a necessary component (fitting the “data collector”) for the cardiologist or physician that needs their patient’s health data monitored.

More to Come

This is just some of what’s happened across the past year. One year! I could write another 1500 words on interesting developments that have occurred this year, but these are my favorites. There is seemingly so much more to come with this technology and as these devices continue their computerized transformation into looking like something more akin to the iPhone, there’s no telling what other use cases might emerge. As the movie Field of Dreams so famously put it, “If you build it, they will come.” Well, the user base of all our body-worn computers continues to grow and further enticing the developers to come make their next big pay day. I can’t wait to see what’s to come in year two and I fully plan on ramping up my coverage of all the trends converging around the ear. So stay tuned and thank you to everyone who has supported me and read this blog over this first year (seriously, every bit of support means a lot to me).

-Thanks for Reading-

Dave

audiology, Biometrics, hearables, Live-Language Translation, News Updates, Smart assistants, VoiceFirst

Hearing Aid Use Cases are Beginning to Grow

 

The Next Frontier

In my first post back in 2017, I wrote that the inspiration for creating this blog was to provide an ongoing account of what happens after we connect our ears to the internet (via our smartphones). What new applications and functionality might emerge when an audio device serves as an extension of one’s smartphone? What new hardware possibilities can be implemented in light of the fact that the audio device is now “connected?” This week, Starkey moved the ball forward with changing the narrative and design around what a hearing aid can be with the debut of its new Livio AI hearing aid.

Livio AI embodies the transition to a multi-purpose device, akin to our hearables, with new hardware in the form of embedded sensors not seen in hearing aids to date, and companion apps to allow for more user control and increased functionality. Much like Resound firing the first shot in the race to create connected hearing aids with the first “Made for iPhone” hearing aid, Starkey has fired the first shot in what I believe will be the next frontier, which is the race to create the most compelling multi-purpose hearing aid.

With the OTC changes fast approaching, I’m of the mind that one way hearing healthcare professionals will be able to differentiate in this new environment is by offering exceptional service and guidance around unlocking all the value possible from these multi-purpose hearing aids. This spans the whole patient experience, from the way the device is programmed and fit, to educating the patient around how to use the new features. Let’s take a look what one of the first forays into this arena looks like by breaking down the Livio AI hearing aid.

Livio AI’s Thrive App

Thrive is a companion app that can be downloaded to use with Livio AI, and I think it’s interesting for a number of reasons. For starters, what I find useful about this app is that it’s Starkey’s attempt to combat the potential link of cognitive decline and hearing loss in our aging population. It does this by “gamifying” two sets of metrics that roll into your 200 point “Thrive” score that’s meant to be achieved regularly.

Thrive Score.JPG

The first set of metrics is geared toward measuring your body activity, comprised around data collected through sensors to gauge your daily movement. By embedding a gyroscope and accelerometer into the hearing aid, Livio AI is able to track your movement, so that it can monitor some of the same type of metrics as an Apple Watch or Fitbit. Each day, your goal is to reach 100 “Body” points by moving, exercising and standing up throughout the day.Body

The next bucket of metrics being collected is entirely unique to this hearing aid and is based around the way in which you wear your hearing aids. This “brain” category measures the daily duration the user wears the hearing aid, the amount of time spent “engaging” other people (which is important for maintaining a healthy mind), and the various acoustic environments that the user experiences each day.

Brain Image.JPG

So, through gamification, the hearing aid wearer is encouraged to live a healthy lifestyle and use their hearing aids throughout the day in various acoustic settings, engaging in stimulating conversation. To me, this will serve as a really good tool for the audiologist to ensure that the patient is wearing the hearing aid to its fullest. Additionally, for those who are caring for an elderly loved one, this can be a very effective way to track how active your loved one’s lifestyle is and whether they’re actually wearing their hearing aids. That’s the real sweet spot here, as you can quickly pull up their Thrive score history to get a sense of what your aging loved one is doing.

Healthkit SDK Integration

 

Another very subtle thing about the Thrive app that has some serious future applications is that fact that Starkey has integrated Thrive’s data into Apple’s Healthkit SDK. This is one of the only third-party device integrations that I know of to be integrated into this SDK at this point. The image above is a side-by-side comparison of what Apple’s Health app looks like with and without Apple Watch integration. As you can see, the image on the right displays the biometric data that was recorded from my Watch and sent to my Health app. Livio AI’s data will be displayed in the same fashion.

So, what? Well, as I wrote about previously, the underlying reason this is a big deal, is that Apple has designed its Health app with future applications in mind. In essence, Apple appears to be aiming to make the data easily transferable, in an encrypted manner (HIPAA-friendly), across Apple-certified devices. So, it’s completely conceivable that you’d be able to share the biometric data being ported into your Health app (i.e. Livio AI data) and share it with a medical professional.

For an audiologist, this would mean that you’d be able to remotely view the data, which might help to understand why a patient is having a poor experience with their hearing aids (they’re not even wearing them). Down the line, if hearing aids like Livio were to have more sophisticated sensors embedded, such as a PPG sensor to monitor blood pressure, or a sensor that can monitor your body temperature (as the tympanic membrane radiates body heat), you’d be able to transfer a whole host of biometric data to your physician to help them assess what might be wrong with you if you’re feeling ill. As a hearing healthcare professional, there’s a possibility that in the near future, you will be dispensing a device that is not only invaluable to your patient but to their physician as well.

Increased Intelligence

Beyond the fitness and brain activity tracking, there are some other cool use cases that come packed with this hearing aid. There’s a language translation feature that includes 27 languages, which is done in real-time through the Thrive app and is powered through the cloud (so you’ll need to have internet access to use). This seems to draw from the Starkey-Bragi partnership which was formed a few years ago, which was a good indication that Starkey was looking to venture down the path of making a feature-rich hearing aid with multiple uses.

Another aspect of the smartphone that Livio AI leverages is the smartphone’s GPS. This allows the user to use their smartphone to locate their hearing aids if they have gone missing. Additionally, the user can set “memories” to adjust their hearing aid settings based on the acoustic environment they’re in. If there’s a local coffee shop or venue that the user frequents, where they’ll want their hearing aids to have a boost or turned down in some fashion, “memories” will automatically adjust the settings based on the pre-determined GPS location.

If you “pop the hood” of the device and take a look inside, you’ll see that the components comprising the hearing aid have been significantly upgraded too. Livio AI boasts triple the computing power and double the local memory capacity as the previous line of Starkey hearing aids. This should come as no surprise, as the most impressive innovation happening with ear-worn devices is what’s happening with the components inside the devices, due to the economies of scale and massive proliferation of smartphones. This increase in computing power and memory capacity is yet another example of the, “peace dividends of the smartphone war.” This type of computing power allows for a level of machine learning (similar to Widex’s Evoke) to adjust to different sound environments based on all the acoustic data that Starkey’s cloud is processing.

The Race is On

As I mentioned at the beginning of this post, Starkey has initiated a new phase of hearing aid technology and my hope is that it spurs the other four manufacturers to follow suit, in the same way that everyone followed Resound’s lead with bringing to market “connected” hearing aids. Starkey CTO, Achin Bohwmik, believes that traditional sensors and AI will do to the hearing aid what Apple did to the phone, and I don’t disagree.

As I pointed out in a previous post, the last ten years of computing was centered around porting the web to the apps in our smartphone. The next wave of computing appears to be a process of offloading and unbundling the “jobs” that our smartphone apps represent, to a combination of wearables and voice computing. I believe the ear will play a central role in this next wave of computing, largely due to the fact that it serves as a perfect position for an ear-worn computer with biometric sensors equipped that doubles as a home to our smart assistant(s) which will mediate our voice commands. This is the dawn of a brand new day and I can’t help but feel very optimistic about the future of this industry and hearing healthcare professionals who embrace these new offerings. In the end however, it’s the patient who will benefit the most and that’s a good thing when so many people could and should be treating their hearing loss.

-Thanks for Reading-

Dave