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Every Patient Has a Story

I have just returned from my first Beryl Institute Patient Experience Conference 2016 (PX2016), and I’m inspired. At Wellpepper, we are focused on empowering the patient to feel ownership and accountability to participate in their healthcare journey. The Beryl Institute and their members are doing the same and it was great to connect with so many like-minded people. The PX2016 conference is just one way they bring together this community.

PX2016 is 6 years young and attended by mostly caregivers, nurses, doctors, regular people who were touched by a personal health experience and now are in the field, and patients. With only 1000 attendees, it’s possible to form relationships. There was lots of hugging, sharing, pictures and overall excitement to be in Dallas. I met several newbies and like me, they were inspired too.

The conference opened up with a real life patient story. Les, a heart attack survivor, told his story of how he was participating in a sculling exercise and went into cardiac arrest in the middle of the water. The following chain of events happened that allowed him to be standing in front of us to tell his story. A retired nurse was on board and jumped into action to do CPR (she was filling in for her friend who couldn’t make it), the bowman had his cell phone to call 911 (typically he doesn’t bring it on the boat), another rower in his own boat happened to be near the dock gate and had a key to unlock the gate (usually locked because it was 5:30AM) which allowed the paramedics to get to Les. If there was one break in that chain, Les would not be with us. He went on to share his experience about his care at UCLA Medical Center and how every touch point from the people on the boat, to paramedics, to the care team made a difference in his recovery. By this time, there was not a dry eye in the place. It was all about why we in this profession of healthcare really do want to make a difference in the patient experience.

This lead to the theme that every patient has a story. From the other keynotes to the sessions I attended, this theme was pervasive. The focus of PX 2016 is to share stories, best practices and ideas on how to bring together interactions, culture and perceptions across the continuum of care.

In the session, Removing Complexity from the Post-Acute Care Patient (one of our passions at Wellpepper), it became clear that the long term care model needs to be reinvented for simplicity. True simplicity comes from matching the patient’s experience with the patient’s expectations. As an example, The New Jewish Home is renaming its post-acute rehabilitation to The Rapid Recovering Center which supports setting a different tone for the patient and ultimately in their experience. When a patient is sent to a post-acute rehabilitation center it can suggest a long and difficult recovery. But, naming it the Rapid Recovery Center aligns with the patient’s expectation of wanting to get better as soon as possible.

Another session that hit close to Wellpepper’s core values was how University of Chicago puts family and patients first in their patient experience strategy. Enhancing Patient Experience and Engagement through Technology Innovation by Sue Murphy, RN, Executive Director- Patient Experience and Engagement Program and Dr. Alison Tothy, Associate CMO – Patient Experience and Engagement Program at University of Chicago suggest the ability to capture real-time opportunities for engaging patients in their care and in their service expectations with innovative technology and techniques can lead to overall happier patients. Such technologies like rounding, discharge call centers and interactive patient care have led to substantial outcome improvements. However, just implementing technology did not solve the patient experience challenge. A culture shift in the staff was required which inspired them focus on individualized care for each patient. Combining a culture shift with innovative technology has allowed the University of Chicago to increase patient satisfaction scores, reduce readmission rates and improve outcomes. Furthermore, leadership is engaged and excited about the power of technology to improve the patient experience.

To bring it to a close, we were inspired by another personal patient story from Kelly Corrigan. She is a New York Times best-selling author who shares her most personal stories, including her health challenges. She has had more than her share of health encounters between herself and her family. She read an excerpt from her book, The Middle Place, where her and her Dad where both diagnosed with cancer in the same year. It was a compassionate and funny rendition of when she just starting her chemotherapy sessions and her Dad came across country for support. She talked about how in the middle of crisis, magnificent can happen. She was amazed to witness how all the people around her, including herself, able to conform into the new reality – cancer. Although a happy ending for her, not so much for her father. He passed away last year. She emphasized how at the end of her father’s journey, she made a point to thank all the caregivers for they really did make a difference in a very difficult time. Then looking out at all of us in the audience at that moment, almost with a tone of authority, she challenged us to hold on to the feelings of why we went into healthcare.

For some of us, it was a personal experience. For others, it was the opportunity to make a difference. Regardless, as Kelly so eloquently put it, people want to feel as if they have been felt and be a good listener because every patient has a story.

Posted in: Behavior Change, chronic disease, Healthcare transformation, Managing Chronic Disease, patient engagement, Patient Satisfaction

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Did HIMSS deliver on its Charter? Transforming Health through IT

HIMSS Annual Conference
February 29-March 4, 2016

Another HIMSS has come and gone for me. I will not brag about how many times I have attended this conference, but I will brag about it being the first time with Wellpepper. Overall, the level of activity exceeded our expectations and validated the need for innovative patient engagement technologies like ours.

Being with a new company gave me a whole new perspective on the HIMSS annual event. Reflecting back, years of HIMSS events can blur together and it can seem like the same old same old. This year was different: the healthcare ecosystem is going through a profound change and the providers and payers know this. Health systems are beginning to understand that the model is moving away from a passive engagement with the patient, to a model where the patient is taking more initiative to include their own wants/needs to participate in their care delivery.

With that, comes a whole new set of demands from the patient consumer and that I believe is where HIMSS is trying to make the transformation.  For the second year, HIMSS has partnered with HX360’s Innovation Pavilion to showcase pioneering health IT solutions that are addressing these challenges. As a start-up company, we can often get lost in the maze of vendors at a large conference such as HIMSS (estimates suggest more than 1200 exhibitors). The HX360 Innovation Pavilion provides an opportunity for entrepreneurial health IT companies to shine… and that we did.

Along with this venue, HX360 sponsors an Executive Program that runs concurrent with HIMSS. These educational sessions attract leaders such as Chief Innovation Officers, Nursing Informatics Officers and Vice Presidents of Digital Health who are looking for innovative solutions from companies like Wellpepper. Because of this venue and opportunity, we were able to have meaningful conversations with IT and executives that are looking to get a head of the curve and provide innovative solutions for their patients and systems.

Upon my travels home, I felt optimistic this shift to value-based healthcare will really drive innovation and allow companies like Wellpepper to part of the conversation and solution. The future appears to be bright and full of opportunity.  It is an exciting time for both the healthcare community and the consumer.

So, did HIMSS hit their mark? In part, yes. HIMSS is making great strides to keep up with the changing landscape of healthcare. No longer is it just about the EMR, servers, networks and storage in the IT back room. It’s about patient facing solutions that provide ownership and accountability for the patient while securing that brand loyalty for the provider.

The transformation of healthcare is now. Healthcare does not take to change lightly. But, companies like Wellpepper will continue to pave the way to innovation and the industry will take notice.

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Telemedicine

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Falls Prevention Awareness Day September 23rd

Last year my 80 year old grandmother fell walking back from my cousins wedding reception, luckily she grabbed onto my sister and broke her fall. Nevertheless as we studied the sidewalk for several minutes only to discover its perfectly flat surface and our tremendous worry… my dear grandmother could think of nothing other than her embarrassment. We later learned from my grandfather that she has fallen several times over the last few months; she shook it off with laughing commentary in the background saying he was exaggerating. Whereas I appreciate her humor, it is no laughing matter. 2.5 million elderly adults are treated in the ER for fall injuries, with one out of five falls result in broken bones. With those statistics I continue to worry about the next time she falls and my sister isn’t there.

Pick up your cars, grandma is coming over!

With that said, today being Falls Prevention Awareness day I cannot help but think of everyone in my life that is prone to falling… which I am sure you are now pondering yourself. So we should all take a minute (or longer depending on how caught up you are on house chores!) and look around our environment for fall hazards and think about prevention. I have a two year old son that contributes a lot to fall hazards with his hotwheels toys strewn all over the house, which makes my house a high risk zone no doubt! I have to ask what’s on my grandmothers floor?! We need to encourage our elderly loved ones to remove fall risk factors in their homes too; broken steps, faulty handrails, uneven pavement, clutter, throw rugs, poor lighting… grandchildren toys! However most of all we need to make sure they are still getting out of the house and do NOT let the fear of falling limit their mobility. Lower mobility is a major fall risk factor due to deteriorating body strength, which in return also influences balance. It is argued strengthening your balance is the single most important factor in avoiding falls. Senior centers across the country teach classes to elderly adults called “Matter of Balance” (I have taught a few in the past!), they are a great way to teach folks about balance strengthening through exercise and awareness of ‘fall-ty’ habits.

Working for Wellpepper and learning more each day about how it is helping patients, I cannot help but think about how mHealth technology could also help with fall prevention. There are several balance strengthening exercises that we do in our ‘Matter of Balance’ classes at the senior center that could be very easily translated onto the mHealth platform. Honestly now that I think about it the whole class could be taught this way, and might even have better results since a lot of elderly adults express interest in the class, but don’t show up because they are too embarrassed about admitting to of fallen, just like my poor grandmother.

Such thoughts of mine have been expressed officially (to say the least!) by Harvard researchers, because today it was announced on Falls Prevention Awareness Day no less, in a press release, that they are utilizing Wellpepper as an patient engagement solution to lower the costs of care and to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. I cannot wait to see how this study plays out, because it could mean a whole world of good for our lovely elderly family members. I cannot help but visualize how cute my grandmother would be practicing her muscle strengthening exercises on an iPad and the great peace of mind my family would have.

Congratulations team Wellpepper for your involvement in making this Falls Prevention Awareness Day a big notch in your ongoing achievement index!

Posted in: Aging, Behavior Change, Healthcare Research, M-health

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Session Picks for 2015 American Telemedicine Meeting

We can’t promise to get to all these sessions and blog about them for you, but here are a few that caught our attention at the American Telemedicine Association Annual meeting coming up in Los Angeles next week.

Monday May 4th

Establishing a Program to Reduce Readmissions and Costs in the Ambulatory Setting: A California Success Story

Telehealth is proven to decrease costs without sacrificing quality for many scenarios.

Learning Opportunities from Large Scale Telemedicine Initiatives

An interesting mix of private and public sector initiatives across disciplines including pediatrics and psychiatry.

Improving Commitment, Quality, and Outcomes

We love outcomes, and this session also feature’s Seattle’s own Carena.

It’s a Small World After All: Approaches in Neonatal ICU Care

Cute title, serious results with examples across pediatric care.

A New Model for Remote Diabetes Care Best Practices

One of the biggest issues facing our healthcare system so new models welcome!

Expanding Telehealth to Improve Hospital-wide Readmission Rates

Readmissions and care transitions, so important.

Mainstream Medicine Moves into Direct to Consumer Health

Mercy, a Catholic Health System from St. Louis, is a quiet leader in telehealth. Find out why they dedicated an entire new building to for their telehealth practice. Plus a case study from Cleveland Clinic. Whew, that’s a lot of great content.

Tuesday May 5th

Utilizing Interactive Voice Response (IVR) and Telemonitoring to Reduce Hospital Admissions and Readmissions for Heart Failure Patients

Heart failure is a patient group where readmissions can be prevented with better communications, which telemedicine and remote monitoring can provide.

A Large Provider Focuses on Consumers: The Experience at Kaiser Permanente

With large deductibles, patients are increasingly making decisions as consumers.

Implementing Successful Clinical Specialty Programs: Burns, Infectious Diseases, and Genetics

Telemedicine helps scale specialists, especially from centers of excellence and to rural areas.

Using Community Health Models to Enhance Patient Performance and Outcomes

Another great benefit of telemedicine is to empower community health workers through remote support from specialists.

Posted in: Behavior Change, Health Regulations, Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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Wellpepper’s Top Healthcare Blog Posts of 2014

We had quite an amazing year at Wellpepper and are really looking forward to great things in 2015. We’re looking forward to more changes and disruption in mobile health and telehealth, as well as new business models, billing codes, and proof of the efficacy and effectiveness of mobile health.

As we look forward, we thought we’d spend a few minutes to recap our most popular blog posts of 2014. In order of popularity they are:

Misfit Shine

Jewelry? Hmm.

A Tale of Two Sensors: Misfit Shine vs FitBit Zip

Not surprisingly given the hype around sensors in 2014, our post comparing how the two stacked up was our most popular blog post.

The Future of Mobile Health is Like a Warm Marshmallow

We read somewhere that your favorite tweet is not destined to be your most popular. This blog post has a warm space in our heart as it was a surprise to see mobile health as mainstream as a heartwarming Disney film.

Forging Ahead With Telehealth: A Roadmap for Physical Therapists

Our conference recaps are always popular, and this one was especially popular as all healthcare professionals are champing at the bit for billing codes that reflect the innovative new ways they want to practice.

Healthcare Is Part Of Our Supply Chain: The Boeing Company

Boeing is really pushing the payers and providers to deliver cost-effective outcome-driven care, so we are chuffed to see this one at the top of the list. Which other employers are going to take the mantle for 2015?

Post or Perish: Disseminating Scientific Research and the Kardashian Index

This recap of a talk on social media and popularity as important to scientific research made our top 5, and while the advice was great, and the debate on popularity vs credibility is important, we suspect it may have something to do with the mention of the “K” word.

Posted in: Behavior Change, Healthcare transformation, Lean Healthcare, M-health, Rehabilitation Business, Telemedicine

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Choosing the Right M-Health Tools for the Job

“People will share about their diarrhea on Twitter but they won’t use an app called ‘Diarrhea Near Me” said John Brownstein, Director of the Computational Epidemiology Group at Children’s Hospital Boston and founder of HealthMap, on why patient reported outcomes alone won’t solve our data problems in healthcare.

The third day of the M-Health conference coincided with the first day of the Global MHealth Forum, and the keynote presented the most aspirational view of the three conference keynotes.

HealthMap, which was recently acquired by Booz Allen, focuses on mining public data to predict epidemics and to chart the course of infectious diseases. We’ve seen this before with Google Flu Trends, but HealthMap goes beyond what people are searching for crawls over 200,000 websites globally including social media networks, news, government sites. HealthMap uses natural language processing to take it a step further by comparing this data to satellite images to see whether quarantine is working. While HealthMap considers itself a public data set for health, Brownstein is clear that partnerships with private sector are the only way to scale health programs, and that these programs must have a business model. Texting for health scenarios that partner with carriers are a good match. The carriers are looking for new customers, and SMS programs have proven to be very effective in developing countries. In a twist on that model, Orange partnered on a program in Liberia where health workers got free data access to any government health information sites and then used their own data for Facebook and Twitter, capitalizing on human nature that while we might buy our devices for work we spend a lot of time goofing around on them.

Validating Clinical Data To Reinvent Medicine

The second half of the keynote was a panel discussion focused more on how to deal with all of the medical data coming in, and reflected some of the concern and disappointment with sensors and quantified self movement. Even though the hype and funding for these activity tracker and sensor companies does not seem to have cooled off, there are a few issues that the healthcare industry has identified:

  • Too much data that we can’t make sense of. We haven’t previously been capable of tracking people’s vital signs 24/7 during daily life so it’s impossible to know what a “normal” data set looks like.
  • The novelty of trackers wears off after you calibrate. We’ve written about this before. Once you know how many steps something is or how many calories you’re burning, you don’t need to keep wearing the tracker.

Of course, there is also the often-cited issue of doctors not having the time, interest, or financial incentives to look at all this data.

The solution was to look at tracking in context of a care path or a specific issue, and to figure out how to provide insight along with the data both for the consumer and for the healthcare provider. Panelist Bryan Sivak, CTO of the US Department of Health and Human Services said he didn’t just want to know that he slept poorly but why he slept poorly. Sivak also outlined what he saw as the barriers to MHealth really taking off:

  • Questions of data ownership
  • Privacy and data protection issues
  • Standards of care
  • Incentives for providers
  • Design for clinician workflow

None of these are particularly new or daunting, which again points to the need for solid implementation and adoption evidence from m-health vendors.

James Levine, Professor of Medicine at the Mayo Clinic, wanted more thought put into what data we use and why, and provide the example that many over the counter blood pressure readings are not valid. Levine would like mobile health applications evaluated by the following criteria.

  • What is the medical benefit?
  • Is it cost-effective? What is the return on investment?
  • Is data interoperable? Is data protected?
  • Can you analyze the data the application collects?
  • Can you take action if you need to address something based on patient entered data?
  • How is it reimbursed?
  • Is it constantly improving based on patient input?

Teri Pipe, Dean of ASU College of Nursing, and as the moderator pointed out the only nurse on a panel at the conference, said that the promise of m-health is being able to know when to bring a patient into a clinic for treatment, and allowing them to stay at home when they want it. We would add to that, how do you help them manage when they are at home. She also felt that mobile health held great promise in the hands of nurses who can prevent ER visits from the field while being connected to the healthcare system via mobile. Teri used the example of fire departments having nurses on staff to treat minor trauma and injury onsite rather than sending people to the ER.

This was our first MHealth Summit, although it was the 6th annual, so we can’t compare to previous years. It seems like the overall tone was of cautious optimism. Attendees, panelists, and presenters all firmly believed in the promise of mHealth but there was not enough demostratable evidence, and certainly not enough examples of health systems, payers, and m-health companies overcoming the barriers we have in the market. Hopefully, as the first day keynote asked, 2015 will be the breakout year for MHealth, and we’ll see more success stories, ROI, and clinical validation at the summit next year.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, M-health

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The Connected Patient Is Here

After either a realistic or pessimistic Day 1 keynote, depending on whether you’re a glass half full or half empty kind of person, Day 2 at the MHealth Summit started with a difficult topic but a much more inspiring message and continued with presentations stressing that patients are already connected and engaged. A bonus for those of you who are counting (XX in Health, Halle Tecco), is that ¾ keynote speakers on this day were women.

Confronting Mental Illness Online

First up was Jen Hyatt (@jennyhyatt) CEO and co-founder of Big White Wall, and online community for mental health. Big White Wall provides an online community for people who are mentally distressed and sometimes suicidal. Jen relayed a heart-breaking story of a possibly preventable suicide, if the person had just had an anonymous place to share what he was feeling. Big White Wall provides a community of people who are trying to self-manage their mental distress with support from clinical process and staff. It does so confidentially and anonymously. Anonymity is a key part of how Big White Wall works. People are more comfortable sharing when they know they won’t be judged and sometimes talking to a machine rather than a person can provide that, to illustrate, Hyatt shared the story of the young autistic boy who made friends with Siri. Hyatt has compared the accuracy of the data behind Big White Wall to predict depression and suicide risk to that of standardized tests, and says that interactions on Big White Wall provide enough information to be as accurate as the tests. Considering the difficulty of getting people to take these tests, and especially those who might not be seeking help for mental illness, this holds great promise for the power of patient (or people) generated data.

Serving the New Connected Patient

Source: MHealth Summit

The connected patient is already here, and she’s a millennial says Janet Schijns, Vice President of Global Verticals and Channel Marketing at Verizon. Schijns used a recent ER visit by her daughter, a college student to elaborate how patients are outpacing hospitals when it comes to digital care. Schijns daughter sprained her ankle badly, while waiting for a nurse to return with discharge instructions, she had already found and watched a video on how to navigate the world on crutches, ordered groceries online so she wouldn’t have go out, and researched how she would be able to get around campus. Schijns posits that healthcare organizations are spending dollars in the wrong areas online because they don’t really understand what patients are looking for. She talked about how patients are creating their own content through community sites like Patients Like Me and filling in gaps in the information the healthcare system is providing.

 Email Is Our Killer Application

Christine Paige, Senior Vice President of Marketing and Internet Services from Kaiser Permanente helped all m-health entrepreneurs in the audience breathe a sigh of relief when she said that Kaiser was not going to get into the m-health app business and instead focus on working with companies that help them improve the patient provider relationship. Paige called email Kaiser’s killer app for two reasons, one is that patients are not able to absorb key information when they’re in the clinic, especially if they’ve had a difficult or surprising diagnosis and second because they want convenience and a connection to their physicians. Kaiser’s patients who engage online are healthier, and only 1/4 emails results in a doctor’s office visit.

While personalized medicine is a hot topic these days, Paige warned against personalization trumping patient privacy and the risk of personalized recommendations being wrong. That is, patients using technology trust their physician with the information, but not necessarily if an application starts intervening and providing recommendations based on that data.

While the day 2 keynote was optimistic about the promise of m-health, it was definitely cautiously optimistic. Patients and providers are still feeling their way through the role of technology in communication and automating care.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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Seattle Health Meetup: Focus on Consumer Health and Wellness Technology Sector

Less than a year ago, I was at an event sponsored by the Washington Biotechnology and Biomedical Association, where a room full of health IT and consumer health startup CEOs bemoaned the lack of a healthtech community in Seattle. We have all the elements here: talent, world-class healthcare facilities, and b2b or enterprise IT pedigree. Events like Seattle’s Health Innovators Forum Meetup and Health 2.0 are trying to change that by bringing together startups, investors, and general health enthusiasts for learning and sharing. This month’s Health Meetup, organized by Edmund Butler, was focused on Consumer Health and Wellness, and featured local startups in this space. Speakers were:

54824v1-max-250x250Marcelo Calbucci (@calbucci) is Co-Founder and CTO of Everymove, a company that automatically integrates data from various fitness trackers and provides consumer rewards from its partners.

 

 

 

Julie Kientz (@juliekientz) is the director of the Computing for Healthy Living and Learning Lab (CHiLL), a group of UW researchers interested in designing, developing, and evaluating apps that aim to promote healthy lifestyles and education.

 

 

Rebecca Norlander (@rebatwork) is the Co-Founder and CEO of Health123,  a consumer health company that helps people make decisions and track the small changes in their lives that can make a big difference in their health.

The three speakers shared a passion for designing person friendly applications for consumers to manage and improve their health. The three talks provided different perspectives on the topics of how to engage users and overcome their barriers or burdens to both application use and improving their health.

Marcelo kicked it off with his “8 Pet Peeves of Health Apps.” (I’m sensing an Everymove love of numbers as I also attended another talk by CEO Russell Benaroya called 25 Reasons You Suck At Sales. They also like to have provocative titles. 😉 )

Here they are in order:

    1. Calling people patients. Marcello pointed out that for all other applications they are users. He prefers people or member. (Later Rebecca noted that some industry conventions need to stay in order to communicate with your target customer. Patients is a tough one. People don’t like to be called patients, but the entire healthcare industry refers to them this way.)
    2. Trying to be all things to all people. This was a criticism of apps that try to track too many things. Figure out what behavior you’re trying to affect and do a great job of that.
    3. Putting the organization rather than the person at the center. This would be designing for the healthcare organization rather than the patient or worse yet for the insurance company rather than the patient.
    4. Misaligned or misguided incentives. Marcelo used the example of paying people to track something for example finding out their BMI rather than trying to incent them to change something, like become more active (and then lose weight). Historically there has been an idea in the health and wellness area that if you have information you will change. Information is really only one component (as Julie elaborated on in her session).
    5. Health Risk Assessments. Marcelo thought that these were particularly dangerous as people tend to associate these types of assessments with tests and then inflate their answers and then assume they are healthier than they thought.
    6. Bad UX and bad visual design. Marcelo showed an EMR screenshot saying “the 90s called, they want their interface back”.
EMR Screenshot

Source, Microwize.com.

  1. Treating a person as a condition. The person’s condition is not who they are and is only one component of the information a healthcare provider or application needs to understand to care for or help support that person.
  2. Making you change to fit the application or service. Wearables still fall into this category. You need to remember them, you need to wear them, and in the case of the new FitBit force, you need to get medical attention after wearing them.

Julie Kientz was up next, and her human-centered design approach provided practical advice to solve many of the pet peeves that Marcelo mentioned. The goal of Julie’s research is to understand and reduce the burdens in healthcare design. She described 8 key burdens that can impact adoption of healthcare technology.

Physical: Is the technology comfortable to use or to wear? Does it fit in with my surroundings or what I am doing? With wearables, physical is obvious, but physical could also be how you access the application, for example which tasks are better for a mobile device versus a PC?

Privacy: Where does the data go? Who is able to see it? For applications that have social sharing, are others able to track you? (Did you call in sick and then go for a 15K run?)

Mental: How do you feel about the technology? Julie said she feels sad when she forgets to put her FitBit on, and often goes back home to get it. As well, she is on her 6th FitBit in 3.5 years due to losing them, so is also feeling some guilt about the loss.

Access: Is the technology designed for diversity? For example, many nutrition trackers do not include foods that are popular with different ethnic groups.

Time: How much effort is required to enter or review data? Julie personally doesn’t look at her FitBit data online, just at the step count on the display. The online reporting is too much effort for her.

Emotional: What is the emotional impact of not meeting the goals the technology is tracking? Do you feel like a failure?

Financial: How much does it cost? Does it require expensive equipment like a smartphone? Are there added costs like a data plan?

Social: Does others use of tracking make you feel better or worse? Do you feel guilty when someone posts their runs online?

Because these burdens compete with each other it’s impossible to design to eliminate all of them at once, and so you have to understand which are the most important or provide the biggest barriers for the audience you’re designing for. Julie and her lab published a paper on this if you want to know more “Understanding the emotional burden of health technologies”. She also provided some practical examples of how her team has developed technologies and studies to accommodate these burdens.

ShutEye

One example is the ShutEye sleep tracker that’s designed for people who have some trouble sleeping but are not motivated enough to seek professional help. ShutEye is an Android app that displays on the homescreen with recommendations based on the time of day. For example, it will tell you whether it is too late to have caffeine if you want to get a good night’s sleep.

Another application, BabySteps deals with the emotional component of child development, by displaying development stages as trees in different stages of growth. This removes the stigma of clinical terms like delayed. BabySteps is designed to be used over the first 5 years of a child’s life so the team is also experimenting with different interactions to keep parents engaged for example, a Twitter feed that asks questions about child development. You can find links to all of Julie’s research here.

Julie then summarized with these words of advice:

  • Embed actions in activities people are already doing
  • Provide multiple options for tracking/achieving goals
  • Balance between manual and automated tracking
  • Priortize which burdens you will resolve based on your user’s desire and what your application is intended to accomplish
  • Match the burden to the motivation level of your user

Rebecca took the stage next and tied the two previous talks together with examples from how they built Health 1-2-3 to overcome barriers to engagement in health. While 85% of people say they want to feel better, a number of factors prevent them from reaching that goal. The absence of the following can be barriers to wellness:

Awareness: Not knowing what the actual situation is. (See Marcelo’s Pet Peeve # 5 on Health Risk Assessments.)

Knowledge: Once you have awareness, what can you actually do? Health information is often not delivered in a way that is actionable.

Self-efficacy: People cannot make big changes all at once. How do you make small and incremental changes towards health?

Personalized Solutions: Generic solutions don’t speak to the person or help them take personal responsibility for their health. Personalized solutions are customized based on information about that patient and provide options appropriate for that person’s health.

Time: Solutions need to integrate with people’s lives. Behavior change cannot take so much time as to be prohibitive. What small steps can be integrated?

Support: What types of social support does a person need to make a change? For example, there are many great fitness and health communities, like Strava for cyclists, where people support each other’s goals. On the other hand, social support needs to be in the control of the person. Applications shouldn’t be posting updates on the person’s behalf.

Rebecca walked through all of the above in the context of a Health 123 demo that showed how they simply address the issues. For example, awareness takes the form of a series of simple health questions. Knowledge is tailored health information based on the questions the patients answered. Self-efficacy is addressed by making health challenges reasonable to fit into a person’s day and week.

If you’re interested in or working in health technology in Seattle, I highly recommend these meetups. The content and discussions are packed with inspiration and information, and the burgeoning Seattle Health IT community needs your support.

You can find out about the next meetup here.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, M-health

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