mHealth

flying cadeuciiThat’s right…it really happened.

At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”

In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.

My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins.  A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents.  The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.

Continue reading “My Doctor Just Gave Me His Cell Phone Number …”

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”

After years of speculation about a possible name change, Health 2.0 has become mHealth & Associates. My partner Co-Chairman and CEO Indu Subaiya and I didn’t take this move lightly. We were though concerned that the tired “2.0″ moniker is now thoroughly discredited by the emergence of the fully interoperable semantic Web, particularly as it’s been demonstrated in the healthcare sector in the US in recent years. In addition leading luminaries such as Chris Schroeder have finally realized the importance of the brand new smart phone devices that we’ve been ignoring for most of the last decade. And after some prompting, we were convinced by the intellectual rigor of the wider mHealth movement with its clear definition of mobile health, including the incorporation of highly portable technologies such as televisions bolted to the walls of hospital rooms.

Admittedly, while mHealth Intelligence and the mHealth Challenge roll off the tongue, we were a little stuck by what to call our main Fall conference–our organization’s best known event. But while mHealth Summit, mHealth Conference and most other variants are already use, we think that clear market visibility will surround out new name. So instead of the 8th Annual Health 2.0 Fall Conference, this September we’ll welcome you to the First mHealth Confabulation.

Finally we wanted to acknowledge the role of  our wider movement, our team and our 75 chapters across the globe, so we have added the “*& Associates” moniker to the name. In recognition of their contributions all mHealth colleagues will now be known as Mobile Health Associates or in its shortened version, as an “mHealth Ass.” Indu has suggested that I adopt the title of “Biggest mHealth Ass.”

It’s time for those of us working in health tech to power up—and use our health tech muscle to make a real and lasting difference in young people’s lives.

In video games, power ups restore game characters’ health, increase their strength, shield them from damage, give them special abilities, and help them beat the odds. In health tech, power ups can help us find winning solutions for improving young people’s health and wellness.

Power Ups for Youth Health Tech:

  • Data-Driven (+1 Power Up) – Data can inform new research and spark insights, and well-visualized data can transform perceptions and change behavior. Young people prefer when information is shown, rather than stated. Use data visualizations to help young people understand how they fit into the big picture.
  • Connected (+1) – Health tech cannot be tied down by time, place, or even platform. A safe, connected, networked, multi-platform mindset should be our default.
  • Agile (+5) – We need to learn quickly what works, keep what does, and discard what doesn’t. You only get one chance with young people, so you’d better make it good.
  • Innovative (+10) – At its best, health tech will be creative and even disruptive. Let’s focus on radically accelerating and scaling our best solutions.
  • Authentic (+25) – Trust is the most indispensable currency for dealing with youth. Period.
  • Continue reading “Power Up: What’s Next in Technology for Youth and Wellness”

Join Health 2.0 for an afternoon at the mHealthSummit – Dec 9th near Washington DC, at the Gaylord Convention Center!

 

First, we reveal the first ever Health 2.0 Annual Report – an insider’s guide to the 7th Annual Fall Conference, our biggest event yet. With company profiles that detail products, services, and why each presenter was selected for our stage, the Report captures all the trends and analysis you may have missed. Pre-order your copy of the report by emailing Kim Krueger. Available December 10th.

While the government is scrambling to get their exchange up and running smoothly, other tools are popping up everywhere for consumers to make smarter decisions about their insurance coverage. Jane Sarasohn-Kahn and Matthew Holt take the stage in The New Marketplace to review companies making waves in health care insurance.

Don’t miss Future of Self-Tracking and Personalized Medicine and Clinical and Population Data for Transforming Care which will cover the latest consumer quantifying tools, and how health care professionals are aggregating millions of these patient data points to streamline and provide better care.

Unmentionables is back!  Leigh Calabrese-Eck of Eliza moderates this session about life’s buffers and magnifiers.

We’ll wrap the afternoon by revealing the new Health 2.0 Database, a go-to aggregated source for all players in the industry today.

LIVE demos from:  GetInsuredWebMDConnectedHealthIntuitOk Copay - Pokitdok – Azumio – BetterFit TechnologyWithingsAetna CarePassHumetrixAlereElation EMRathenahealthManTherapyMeQuillibriumUT MD Anderson - Sexual Health Innovations – and more!

You can register for this session as a stand-alone or in addition to the whole event.

I first posed the question, “Could Mobile Health Become Addictive?” on August 20th.  Since then I’ve done more thinking and I’m warming to the concept.

To start with, addiction is a word laden with negative meaning.  When we hear the word, we think of opiates, street drugs, cigarettes, or possibly gambling.  In fact, Wikipedia defines addiction as, “the continued repetition of a behavior despite adverse consequences.”  So, with that definition as backdrop, is there any way health can really be addictive?  Probably not.

What I’m really talking about is the juxtaposition of motivational health messaging with some other addictive behavior, specifically checking your smartphone.

New evidence shows that people are in love with these devices, checking them more than 100 times per day!  I’ve heard people are tapping in 110, even 150 times a day. Of course this varies, but let’s face it, we check our smartphones a lot and it’s hard to stop.  A somewhat disturbing video makes the case well.  It’s easy to build a case that smartphones are addictive.

Recent research shows that checking your phone results in a small release of the neurochemical dopamine.  Dopamine release has long been associated with ingestion of addictive substances such as heroin and tobacco.  In fact, once the pattern of ingestion and dopamine release is established, even thinking about the ingestion triggers the dopamine release, the biochemical explanation for cravings.

For this post and a series to follow, I choose not to question whether this compulsive relationship with smartphones is good or bad, but simply to acknowledge that it is common, almost universal among smartphone users and to ask if we can exploit it as tool to improve your health.

Continue reading “Making Health Addictive”


Hello.  I am Mike Painter, and I track. I don’t necessarily have a compelling reason to track health parameters such as exercise patterns, heart rate, weight, diet and the occasional blood pressure. Yet I do.  I do most of my tracking with several small devices, simple sensors and software applications. My tracking is also pretty social—meaning I share much of my data widely and daily. You’re welcome to see it—most of it is on Strava. Admittedly, I still keep some data daily on a paper calendar, and I do monitor diet and sleep in my head—i.e., nobody needs to remind me about my food splurge days. The local bakery is intimately aware of that data point as the employees witness me charge in, wild-eyed and drooling for a giant cinnamon roll every Thursday morning—almost without fail.

It all feels pretty normal to me.

Here’s the rest of the story: I track to enhance athletic performance rather than monitor my health, per se, or even really my wellness. I am an avid cyclist and have tracked miles, location, accumulated elevation, heart rate and power readings and other data for years. I share that information with both cyclist colleagues I know and don’t know on Strava. That site eagerly ingests my data—and among other things, plops it into riding (and running) segment leader boards, riding heat maps—and, most importantly, in training, trend graphs like the attached. All that data is incredibly helpful to me—it empowers me by making me face the numbers—it makes my training data- and reality-based. I don’t have to guess to maximize my fitness and minimize my fatigue level in anticipation of a big event. I follow the numbers.

Is all that bad? To me, my obsession with tracking my athletic performance seems like an extension of observing data for health and wellness.

Continue reading “Confessions of a Self-Tracker”

Having been supported by several small business grants from the National Cancer Institute to create online interventions for cancer patients, I have been learning gradually about commercialization models to get our work out to the public. I am dismayed about the major disconnect between eHealth entrepreneurs and eHealth intervention researchers (my personal reference group).

Last year I attended Stanford Medicine X and last week I did a demo of one of our web sites at Health 2.0 in Santa Clara. Both times, I was struck by the assumption in the IT developer and consumer community that giving people realtime feedback about their health will automatically result in major positive changes in behavior, not to mention cost savings for insurers.

The Connected Patient movement seems particularly naïve to me. Psychologists have been using self-monitoring, i.e. recording behaviors such as smoking, eating, and exercise, for at least 30 years to promote behavior change. First we used paper-and-pencil diaries, but researchers like Saul Schiffman quickly adapted the first handheld computers to prompt people to record their behaviors in realtime, greatly increasing the accuracy and power of self-monitoring.

As technology has advanced, so have our means of self-monitoring. Overall, however, the technology matters far less than the procedure itself. For most people, tracking their smoking, calories, mood, or steps does change unhealthy behaviors somewhat, for a limited period of time. A small group of highly educated, motivated people is more successful in using self-monitoring to make larger, more lasting changes.

I was reminded of this last year in a seminar on tracking at Stanford Medicine X, when a concierge physician from San Francisco and several of his patients talked about being empowered to change their health by using feedback from various types of sensors. One had paid out of pocket for a continuous blood glucose monitor since his insurance would not cover the costs to use it for his Type II diabetes.

Another doggedly demanded access to the data from his cardiac defibrillator. They believed their experiences heralded a sea change in health care in the United States. I am all for empowering patients with knowledge, tracking tools, and social support.

However, if knowledge and feedback was all it took to change unhealthy behaviors, psychologists would be superfluous in the world.

Continue reading “Healthcare’s Tech Disconnect: Why Aren’t We Building the Products Patients Really Need?”

The developers of  the app Pain Care, the winner of the Robert Wood Johnson Foundation’s Project Health Design challenge two years ago,  have this to say about THCB contributing writer Dr. Leslie Kernisan’s recent post wondering why the winning entries of development challenges have a habit of  disappearing and never being heard from again:

We are the app developer. We are also disappointed with the outcome of the app. But I think we also learned valuable lessons here.

One of the challenges small business facing is the need to rapid prototype and test the market, and then move on to another idea when the previous idea fails to gain traction. That is especially true with grant funded projects — they need to “make money” after the grant ends in order to justify continued development effort.

Pain Care was developed in the early days of mHealth, and it was indeed very physician focused — the reason is that we believe we must engage physicians to look at the data. We still hold that belief. It is a learning process for us. We put in our own money to develop the app, and fortunately, won the developer challenge.

We made the app public after the challenge to “test the market” — so to speak. But, as you know, essentially *none* of the pure app-based “patient journal” has turned out to be a success (let alone a financial success). Our app is no exception. It is enormously costly keep the app updated for all those iPhone, iPad, iOS released every year, as well as thousands of Android devices released since then.

So, the app becomes one of those “outdated” apps in the app store, and I think it is quite obvious to users as well. However, I think the app did contribute significantly to the “science” of mHealth. We now understand much more what works and what not in “patient engagement”. Many other “pain management” apps have since emerged, and many have done a better job than ours. I think that was what RWJF wanted when they challenged developers back then. :)

Today, we do things a lot differently. We no longer release research grant-funded apps to the public. Instead, we run clinical studies to test them in much smaller / controlled groups. We do not attempt to tackle vague “big problems” like general pain management any more — instead, we are much more focused on managing specific diseases that include pain. We are also moving beyond “pure software” and “simple reminders” to engage people in multiple modalities.

All of these would not be possible without the generous award RWJF gave us in picking Pain Care as the winner of one of the first developer challenges.

Health care providers and consumers are increasingly using mobile technology to exchange information. Many health IT providers readily acknowledge that some level of oversight is required to ensure patient safety and privacy protections, but many providers question whether the FDA is the right agency for the job and want to see the FDASIA recommendations.

Can the FDA, with its already limited resources and lengthy review cycles, regulate the fast-moving health IT industry? Should it? Health IT is fundamentally different from a medical device in many ways. For oversight purposes, the key differentiator between the two is the opportunity for clinical intervention in the use of health IT. Many medical devices interact directly with the patient (such as an infusion pump or pacemaker). Most health IT, on the other hand, merely provides information to clinicians, who ultimately make independent, experienced care decisions. Physicians are informed, but not controlled, by the information. This leads to a vast difference in the patient risk proposition and rigid regulatory oversight is not appropriate.

Advocates of a broad health IT oversight framework – which encompasses mobile health IT – are urging the FDA to delay release of its final guidance, particularly in light of a July 2012 Congressional mandate for the creation of a comprehensive oversight framework that avoids regulatory duplication.

But some mobile medical application developers are pressing the FDA to move forward immediately, believing its guidance will reduce the regulatory uncertainty that they believe is stifling innovation and investment in some aspects of mHealth.

Continue reading “Regulating Health IT: When, Who, and How?”

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