Apps

flying cadeuciiWhile your correspondent is tantalized by the prospect of healthcare consumers using mHealth apps to lower costs, increase quality and improve care, he wanted to better understand their real-world value propositions.

Are app-empowered patients less likely to use the emergency room?

Do they have a higher survival rate?

Do they have higher levels of satisfaction?

In other words, where’s the beef?

That’s when this paper caught my search engine eye. It’s a report on using an app to monitor post-operative patients at home. Continue reading “Using a Mobile App for Monitoring Post-Operative Quality of Recovery”

flying cadeuciiWhile your humble correspondent continues to delight in the emerging science of “mHealth” as a newly minted start-up Chief Medical Officer, he ran across this interesting article on risk and patient safety.

Authors Thomas Lewis and Jeremy Wyatt worry that “apps” can lead to patient harm.

They posit that the likelihood of harm is mainly a function of 1) the nature of the mistake itself (miscalculating a body mass index is far less problematic than miscalculating a drug dose) and 2) its severity (overdosing on a cupcake versus a narcotic).  When you include other “inherent and external variables,” including the display, the user interface, network issues, information storage, informational complexity and the number of patients using it, the risks can grow from a simple case of developer embarrassment to catastrophic patient loss of life.

In response, they propose that app developers think about  this “two dimensional app space” that relies on a risk assessment coupled to a staggered regulation model.  That regulation can range from simple clinical self assessment to a more complex and formal approval process.

Continue reading “Could mHealth Apps Be a Reprise of the EHR? The Need For Clinician Input”

flying cadeuciiYour correspondent is avidly learning about health apps for patients.

As described here, half of U.S adults now own a smartphone, half of them use them to obtain health information and approximately a fifth have at least one health app loaded on their device.

Regular  readers are well aware of the potential for health apps, including lay-person education, the promotion of consumer behavior change, increased consumer-provider connectivity with greater access to care, better medication compliance as well as medication reconciliation, increased self-care, greater quality and lower costs.

But as this author’s e-health experience grows, he has encountered two under-recognized features of apps that – in his opinion –  are sure to also drive their adoption:

1. The Provider App Arms Race:  As  competition for loyal patients grows, health systems, care organizations, insurers, buyers and provider networks are going to expect their apps to create greater consumer “stickiness.”  For example, offering a tablet with a pre-configured app may enable hospitals to not only reduce readmissions, but enhance their brand recognition.

2. The App Is the Outcome: It will take years for science to prove that apps cause better outcomes. While lingering skepticism will prove to be another bonanza for outfits like this, the luster of smart-device gadgetry will be too much to resist. As a result, it’s only a matter of time until Boards and their CEOs pressure their management teams to launch their own app.  While the electronic record and big data are important advances, let’s face it: they’re in the background. There’s nothing like a patient-facing app to remind customers, families and providers of the organization’s health tech chops.

Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where an earlier version of this post first appeared.

Screen Shot 2014-11-24 at 9.33.22 AMYou may have seen some news regarding a study MyFitnessPal recently did with UCLA.

I wanted to take a minute to address this study, since we participated in it directly. We are excited that we got to work with some very smart people to answer a question we also wanted to know the answer to. We jumped at the opportunity to find out—is having your physician introduce you to the app and help you sign up enough to kickstart a health journey?

What we learned is that just introducing people to MyFitnessPal wasn’t enough. People have to be ready and willing to do the hard work.

The app itself does work—if you use it. Our own data and the data from the study show that the more you log on, the more you use the app, the more success you will see. Users that logged in the most lost the most weight. In fact, we already know that 88% of users who log for 7 days lose weight.

We make tools designed to make it as clear and simple as possible for you to see the path to achieving your fitness goals. We are not, however, making a magic bullet—because there is no magic bullet. Ultimately, you’re the one who has to do the work.

Continue reading “MyFitnessPal Works If You Use It”

Screen Shot 2014-11-13 at 9.52.57 AM

65 million people lost weight with MyFitnessPal. Really?

Now, let’s see, according to Gallup, 18% of American adults are at their ideal weight, so we’ll assume they don’t want to lose weight.

That means 82% of American adults or about 198 million people might want lose weight. Thus, based on My Fitness Pal’s headline boast, their market penetration is nearly a third of the adults who need to lose weight, which is just boffo if you are a potential advertiser.

Or, is it? Observe, my dear Watson, as we play 20 questions with My Fitness Pal:

  1. How many of these people were repeat customers?

  2. How often did they come back?

  3. At what time intervals?

  4. When they came back, how much weight had they (re) gained?

  5. How much weight did the average user lose? Continue reading “65 Million People Lost Weight With MyFitnessPal?”

Screen Shot 2014-09-08 at 7.27.05 AM
People are becoming more conscious about their health. It’s why fitness apps are booming and both Apple and Google are looking to get into the health game. But apps that try to go beyond simple calorie counting and movement tracking often struggle to gain traction with users.

Although people are open to sharing how many steps they’ve taken or how much they weigh, they’re more hesitant to share their personal medical details.

Here are some data-related fears consumers often have with healthcare apps:

  • Personal medical information could get leaked. Revealing users’ medical information could be embarrassing and life shattering.
  • Companies could use the data for marketing purposes. Imagine your spam getting smarter about your personal health details. Companies are already pinpointing viewers’ interests, and revealing this information could expose you to targeted email spam and calls tailored to your health issues. Members of Congress have already discussed legislation that would forbid medical apps from selling personal data without the user’s consent.
  • Unqualified employees could access their information. Patients feel comfortable divulging medical information to a doctor, but they probably wouldn’t want the IT guy who supports the app to see and read their information.

There are many reasons people might hesitate to use your app. But by identifying potential concerns and considering them as you develop and market your app, you can quell their fears and ensure the long-term success of your medical app. Continue reading “Why Nobody Is Using Your Health App (And How to Fix It)”

Apple Senior Vice President of Software Engineering Craig Federighi

I am writing this from the Apple Worldwide Developer Conference (WWDC) here in San Francisco, where I got to substitute for John Halamka at the Keynote (now I keep having urges to raise Alpacas); John missed the most amazing seats [front row center!].

There were many, many, many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for healthcare.

If you remember the state of digital music, prior to the introduction of the iPod and iTunes music store, that is where I feel the current state of the healthcare app industry is at; there is no common infrastructure between any of the offerings, and consumers have been somewhat ambivalent towards them as everything is a data island; switching apps causes data loss and is not a pleasant experience for patients.

Amazingly there are 40,000+ apps on the App store at Apple alone, showing huge demand from users, but probably a handful can talk to each other in a meaningful way; this is both on the consumer and professional side of healthcare.

Individual vendors such as Withings have made impressive strides towards data consolidation on the platform, but these are not baked into the OS, so will always have a lower adoption rate. If we take the music industry example further, Apple entering a market with a full push of an ecosystem at their scale, legitimizes the technology in ways that other vendors simply can’t match.

Continue reading “Apple Enters the Healthcare Software Ecosystem”

Manpo-Meter Take 2
When it comes to discussing exercise with friends, family and patients, it seems that many of us are at a loss for words. What kind of exercise should we recommend? How much exercise is enough? How much is too much? How do I know that my patient is actually exercising? How do I prescribe exercise?

According to the U.S. Department of Health and Human Services, U.S. adults should engage in moderately intense physical activity for a minimum of 150 minutes each week; this is equivalent to 30 minutes a day, 5 days per week [1]. While it is relatively easy to keep track of the duration and frequency of exercise, it is much more difficult to quantify the intensity of an activity, let alone ensure that the activity is “moderate” for the entire 30 minutes.

In fact, in a 2008 study of women’s understanding of “moderate-intensity” of physical activity as presented in the popular media, the authors found it is not enough to simply hear and read a description of physical activity, but that it requires practice [2].

So, what are we to do? Should we have our patients log their daily activities? Should we have our patients show us sign-in sheets from the local gym?

It turns out that the dilemma of how to quantify physical activity has been a hot topic for more than 50 years. In 1965, a Japanese inventor developed the first pedometer to give people the opportunity to meet measurable goals and, thus, increase their physical activity. The device was called the Manpo-Kei (meaning “10,000 steps meter”) and it was based on research by Dr. Yoshiro Hatano that demonstrated that 10,000 steps per day allowed for a proper balance between the traditional Japanese caloric intake and the activity-based caloric expenditure of walking approximately five miles per day (the average person’s stride length is approximately 2.5 feet long, therefore 2,000 steps/mile) [3].

Continue reading “Download Two of These And Call Me In the Morning”

Screen Shot 2014-05-04 at 5.43.36 PMLast week’s news that Doximity has raised another $54 million got me thinking ..

On one hand, I’m glad to see these guys continue to raise money and continue their development.

On the other hand, I’m disappointed that we don’t have a better physician-centric social network. While they have been successful at signing up doctors, it seems (at least anecdotally) few are engaging with the network.  I have connected with many of my classmates and some physicians I know on the network. I have never interacted with any of them through Doximity.

The article quotes LinkedIn co-founder and Doximity board member , Konstantin Guericke:

I think a lot of doctors will have a LinkedIn profile and Doximity profile. But the key is which part is really going to get ingrained in their lives.

The key question is—what value does Doximity provide over other, non-physician centric social networks? More plainly, what is going to make me open up Doximity on my iPhone instead of my favorite Twitter client?

The current answer to that question is: nothing.

In their smartphone app, the news feed features medical journal articles from the likes of NEJM, JAMA, Lancet, etc. It is unclear exactly how these are selected, but quite clear they are not tailored to my interests.  Twitter, on the other hand, provides a constant stream of thoughts and articles related to my interests because of the people I’ve chosen to follow.

Continue reading “Doximity Raises $54 Million. But What Value Will They Add?”

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At the first White House public workshop on Big Data, Latanya Sweeney, a leading privacy researcher at Carnegie Mellon and Harvard who is now the chief technologist for the Federal Trade Commission, was quoted as asking about privacy and big data, “computer science got us into this mess; can computer science get us out of it?”

There is a lot computer science and other technology can do to help consumers in this area. Some examples:

•    The same predictive analytics and machine learning used to understand and manage preferences for products or content and improve user experience can be applied to privacy preferences. This would take some of the burden off individuals to manage their privacy preferences actively and enable providers to adjust disclosures and consent for differing contexts that raise different privacy sensitivities.

Computer science has done a lot to improve user interfaces and user experience by making them context-sensitive, and the same can be done to improve users’ privacy experience.

•    Tagging and tracking privacy metadata would strengthen accountability by making it easier to ensure that use, retention, and sharing of data is consistent with expectations when the data was first provided.

•    Developing features and platforms that enable consumers to see what data is collected about them, employ visualizations to increase interpretability of data, and make data about consumers more available to them in ways that will allow consumers to get more of the benefit of data that they themselves generate would provide much more dynamic and meaningful transparency than static privacy policies that few consumers read and only experts can interpret usefully.

In a recent speech to MIT’s industrial partners, I presented examples of research on privacy-protecting technologies.

Continue reading “Using Technology to Better Inform Consumers about Privacy Decisions”

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