1

Metronome Overview June 1, 2015

Metronome will be a smartphone platform that allows people to collect data from their daily lives, securely store it, and share it with their insurers and healthcare providers in exchange for authenticated identity and better/cheaper/faster care and/or incentives that help them live healthier, at lower cost, with higher quality of life. Using mobile technology, wearable sensors, secure archiving and a trusted exchange, it will synchronize the interests of healthcare consumers, stakeholders, and technology developers with the resulting citizen-centered health data ecosystem.

Our Vision: What Metronome Will Do and How It Will Help Each patient/consumer will have their own instance of Metronome, collecting their data regardless of current provider or payer. Metronome will provide three types of benefits for all health stakeholders:

The Metronome User Experience 24/7/365, a user’s activity (measured via smartphone accelerometers, location, and other sensors TBD) is logged to an instance of Metronome hosted in a private and secure cloud. Periodic polls on mood, nausea, appetite, pain or other states capture self-reported data in real time. Check-ins for where users go (clinics, labs, gym, stores, restaurants, workplaces, etc.) are also collected and stored securely. A user’s calendars, contacts, and other data (social network activity, etc.) are also logged, indexed or otherwise linked to this timeline of their activities. Meanwhile, machine learning and a blockchain-inspired smart contracting interface allow privacy-guarding and intelligent interaction with other systems.

Authenticated, Secure, Universal and

Non-Proprietary Connections:

Data, devices, software, systems

Facilitate Wise Health Decisions: Triggers, actions and more that help drive better care, wellness,

healthy behaviors and caregiving

Patient-Benefitting

Visibility into Their Lives:

Understand what’s happening with the patient outside the

hospital/clinic that is influencing their health

and outcomes (adherence,

readmissions, etc.)

2

Open Development:

For Metronome to be trusted equally by patients, providers and payers, it will be developed in an open, secure, trusted manner. Each phase builds on the preceding one, iteratively building trusted data stores and market-based innovations to use them.

Initial/MVP Phase Activities Goal: a few dozen 5-10 person user groups

• Build a blockchain-inspired open source instance of Metronome Personal & Private Date Store (Metronome PPDS) for a single OS and limited peripheral set

• Create a fair data licensing framework and interface; deploy dummy data set as a developer sandbox

• Create initial developer tools, community, and ecosystem • Build Query Engine(s) (QE’s) for peer and population interaction • Small Beta test of the above (pregnancy and QSXX use cases) • Establish Governance/Advisory board for PPDS • Funding Plan – sponsorship, in-kind-contributions, crowdfunding

Phase 1.0 Activities Goal: a few population health management users with 100-500 patients in a population

• Updates to Metronome PPDS and QE’s to include self-funded benefit plan tools and high-ROI use cases

• Add hack events in targeted markets for internal and entrepreneurial innovators • Prize based pre-seed funding to spark interest amongst potential developers • Funding Plan – event and development sponsorships, in-kind contributions and a “New

PHI Data Paradigms” workshop

Phase 2.0 Activities Goal: a first EHR/CDS integration for a provider system with thousands of users

• Continued development and first integration of PPDS and QE with an EHR/CDS/PHM system

• Metronome splits into two entities – a non-profit PPDS foundation and a for-profit QE organization

• Funding Plan: o Non-Profit PPDS – continued from previous phases plus data-interaction royalties o For-Profit QE – subscription to premium services, private investment

Phase 3.0 Activities Goal: scale and grow to hundreds of thousands of users

• Continued separate and complementary development of PPDS and QE • Outreach to targeted early adopter communities (i.e. diabetes, asthma, etc.) • Funding Plan:

o Non-Profit PPDS – continued as above o For-Profit QE – subscription to premium services, IPO or additional capital raise

3

Metronome Modes Metronome provides value in three settings – in the background, with physicians and caregivers and their staffs, and in active interaction.

In the background, Metronome is continuously: • Authenticating and otherwise normalizing data collected from onboard and other sensors • Running general algorithms (“SyncScripts”) on the data being collected and comparing it to past

history, comparative patients, and a demographically similar population and presenting it as a simple and actionable dashboard

• Scheduling poll questions, contextual educational messages based on user activities • Tracking engagement, response and activity/behavior outcomes for messages, interaction etc.

for machine learning and continuous Metronome improvement

During a visit with a caregiver and their staff, the patient can: • Authenticate the patient’s identity and synch them to past actions and events • Share data collected over time in a format that aids in discussion with the caregiver • Jointly query their data (“Let’s see what happened to your activity level and weight since your

last treatment,” or, “Let’s see how your pain management plan is working since you’ve started the new regimen,” for example)

• Record their conversations for listening to later (or they can be transcribed with jargon marked-up and defined)

• Capture provider instructions, information about their condition and other information for teach-back and assessment of understanding

• AI scheduling of future appointments, labs, imaging, etc. based on their location history, preferences and calendar

• Capture data from the visit to add to their record

Anytime the patient likes, they can actively interact with Metronome: • Browse educational content with teach-back related to relevant diagnoses or treatments • View their health appointments, schedule them, build location- and condition-aware to-do lists

and prepare for them (appointments come pre-loaded with FAQ, preparatory questions, etc.) • Browse how their data has changed over time and look for correlations which they can notate

and share (“I notice my pain most often when I engage in XX activity,” for example)

4

Possible Future Features and Capabilit ies Over time, Metronome can be updated with additional features, use cases and integrate with more Healthcare IT (HIT) systems. This acts to accelerate the positive network effects for all health stakeholders. For example:

Going through their day, the user could: • If they opt in, join a community of patient peers for interaction TBD • Add more data points (images, weight, food intake notes, medication adherence, BP, BGL,

environmental sensor values, etc.) to their record • Browse and accept incentives (“If frequent nausea is bothering you, your insurer can offer you a

solution. Click here to have Metronome anonymously check if you qualify.”) • View and compose notes between caregivers, themselves and/or payers related to their

condition • Delegate any or all functionality to a caregiver or family member • Browse coverage and cost of care, explore options, and plan • Ask a friend to help with any care activity scheduled (drive them to an appointment, help with

home care, support them at the gym, etc.)

Meanwhile, at any point a caregiver that already has relationships with users could: • Query their patient population to optimize their resources and their outcomes – impacting

population health

Meanwhile, at any point a payer that a user already has a relationship with could: • Offer incentives to lower their risk while maintaining the privacy of their customers

Meanwhile, at any point a researcher could: • Query millions of patients to see what actions have the greatest impact while respecting Users’

privacy

Meanwhile, at any point, a verified Metronome Developer could: • Use proven tools like A/B testing and analytics to rapidly improve the results they get – while

respecting the privacy of individuals and their data • Develop and sell user interfaces, incentives with measurable outcomes, sensors, and services

faster, cheaper and more predictably than ever before

5

Pregnancy: a first use for Metronome We’re in the process of understanding a first use case for Metronome in collecting and presenting data to coordinate care for expectant mothers. The data Metronome could collect and how it is presented could be extremely useful to patients, physicians, their staffs, risk-bearing entities and others in this context. We’re also exploring other use cases (cancer care and rare chronic diseases requiring complex coordination of care for example) with large potential for improving outcomes and reducing risk and costs by improving the actionability of data from patients, caregivers, providers, payors and employers.

A Day in the Life of a Metronome User

6

Summary of Metronome Feature/Functionality Development MVP 1.0 2.0

Use Case Newly pregnant women with diabetes or other physical/social complications

Women conceiving, pregnant, or in the post-partum period

Either gender managing diabetes, hypertension or other condition similar to MVP and 1.0

General Description

Users collect data 24/7 in their blockchain and cloud, allowing others to synch to it in-person or in limited remote ways to improve outcomes and reduce costs and risk

Same Same

Continuous or Periodic

Automated Data Collection

5-6 most relevant metrics from: • Temperature • Weight • Blood pressure • Blood glucose level (via peripheral

devices) • Activity (steps) • Location/check-ins • Audio and/or video of any event • Over the counter or point of care

medication, activities, etc

5-6 more relevant metrics from previous set, plus: • Rx adherence • Additional movement

(gait, range of motion, etc.)

5-6 more relevant metrics from previous sets

Scheduled Collection of

Self-Reported Data

5-6 most relevant metrics from: • Nausea • Appetite • Food journal • Mood • Energy level • Fetal movement • Bleeding • Questions for caregiver

5-6 more relevant metrics from previous sets

5-6 more relevant metrics from previous sets

Interaction Modes

• Continuous data collection • Patient authentication for caregiver/payer • Patient browsing independently • Outcomes data export to CSV

Add: • Shared browsing with

caregiver, trusted friend, or other

• Secure video chat with caregiver

Add: • Payer interaction

functions

Other Systems to Connect

With

• Practice Management Systems (for scheduling)

• Incentive and payment gateway • User and friends’ SMS, email, calendars • Social media

Add: • One EHR • Population Health

systems

Add: • Multiple EHR’s • Clinical Trial

Management Systems

Content

Wellness content sets (from others TBD) pre-scheduled or triggered by user actions/data (w/ A/B testing and tracking to determine effectiveness)

Choice of third party persona-driven content sets relevant to pregnancy

Choice of 3+ third party persona-driven content sets

Triggers and Incentives

Motivational gifts paid for by others - like digital downloads - for hitting usage and/or activity goals (w/ A/B testing and tracking)

Expanded from MVP Further expanded

Coordination of Care

Functionality

Schedule appointments, assign errands to friends/family, user diary for teach-back, alerts when caregivers request them

Additional functions TBD Additional functions TBD

Target Users 100+ users for 12-15 months each 500-1000 users for 15+ months each

1000-5000 users for 24+ months each

7

Metronome Features and Assumptions

For those more focused on the details, our initial plan for Metronome includes:

Proposed Metronome Features: • Authentication of users for stakeholder transactions • Reduced risk of provider/payer data breach • Artificial intelligence, automation and data mining for common medical/health tasks • Gathering and presenting outside the clinic/hospital data (personal behaviors and other

data) that's clinically relevant that drives decision-making • Analyzing activities to determine those that drive behaviors and result in positive ROI

(health, economic, etc.) • Provide method or platform for predicting risk (events, poor outcomes, etc.) and driving

smart interventions • Easy-to-use physician, patient and payer-targeted mobile interface designed to enable

data to be used in a variety of clinical, wellness and population health contexts • A clear incentive and data presentation/use scheme that encourages use of the

Metronome framework (the behaviors you want people to engage in) • A simple user-centric “Creative Commons-type license” for health data

Metronome Assumptions: • Security/privacy are priorities • Data will be presented in an attractive and meaningfully useful format • Is aligned with and developed following the open data/open source philosophy • Alignment with existing standards/efforts like HIMSS Continuity of Care Maturity Model,

the Personal Connected Health Alliance, The Global Alliance for Genomics and Health, TidePool, etc.

• Patients, providers and payers want access to actionable data that compliments and is different from what can be obtained via existing sources

• Outcomes will be measured/captured in a way useful for Population Health Management • Metronome will make it easier for existing and future stakeholders to interact with each

other; it will enable instead of interfere with the growth of a trusted, transparent and fair ecosystem for health data and incentives

8

Metronome’s Architecture Each user has their own “instance” of Metronome that they own. These instances each have two parts – a mobile app that collects and authenticates data and provides a user interface, and a cloud-based database and processing system that allows other stakeholders to query that data to provide better, faster, cheaper and much more personalized healthcare.

A Metronome Instance

9

Metronome Details:

Governance: We will recruit and engage a fully independent user/stakeholder-oriented board with full visibility into process, transactions, etc. Initially, we’ll also look to our board members to connect us to early stage funding and strategic partnerships.

To give users and other stakeholders confidence in Metronome’s trustworthiness, we need this board to help us know:

• If Metronome is on a viable track and has a realistic plan and suitably ambitious vision • How to optimize trust, transparency and inclusiveness for all stakeholders in the

Metronome product and process • What will make Metronome a platform for others’ success, not just compete with what’s

already there • Who might support our effort with money, collaboration, resources, etc. • Oversee the transition of Metronome’s intellectual property from Openly Disruptive LLC

to a suitable non-profit form supported by earned revenue

Advisory Board Member Candidates: TBD

10

Metronome Details (cont’d): Business Model:

• Open, transparent, non-profit organization producing a non-proprietary, open-source package for all stakeholders to create their own instances of Metronome personal health data exchanges

• A subsidiary consulting/integration firm for Metronome deployments

Revenue: • See Development Timeline for early phase details • Later phases – micro-payments per query or data transaction

Development Expenses: • Staff • Product development (secure code base and open SDK) • Outcomes assessment at each phase • Developer and ecosystem development (delivered through QS, health accelerator and

other established channels) including possible small grants/prizes to incentivize consideration/adoption during early phases

Distribution: • 80+healthcare accelerator programs, incubators and innovation events • HIMSS, etc. • Other channels like Quantified Self TBD

Product Development Relationships: Much of Metronome’s functionality has been addressed by others. Their work will be aggregated into Metronome’s technology stack as appropriate to speed development. Some of these include:

• Personal Connected Health Alliance • Global Alliance for Genomics and Health • TidePool • Apple’s ResearchKit • ClearHealthCosts • Sage Bionetworks • OpenMHealth • OpenNotes • Apervita • Open Epic • Blockchain