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Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
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Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer


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  • This is PJ, a fantastic kid who I diagnosed with type 1 diabetes at 15mo and was lucky enough to get to see him every 3 months for his checkups as his endocrinology doctor. Who am I? 30-something physician first, behavioralist 2 nd , and mobile health entrepreneur. As a 30-something I did not grow up with texting or apps but I have seen how technology is integrated deeply within our lives…and things have changed fast in my lifetime
  • Initially focused on medication adherence by friendly personalized nagging (aka, personal question then standardized nagging once a week as their doctor asking about taking their meds)
  • Frequent contact (intensive) as evidenced by DCCT trial and more physiologic basal bolus therapy.
  • Despite fact that bolus can be easily given by pressing pump button or by insulin pen thanks to improvements in devices, similar nonadherence trends in type 1 diabetes.
  • … texting is preferred method of communication.
  • Motivation, Ability, Trigger….engagement theory
  • Email – too passive
  • Email – too passive
  • Startup lifestyle
  • So
  • After showing that there are a lot of downloads,
  • Validated measure of patient engagement, I hypothesize correlates strongly with mobile health for diabetes effectiveness to influence health outcomes.
  • The government is motivated to change this
  • Todd Park discusses federal government which I first heard at South By Southwest
  • Meaningful use is just an appetizer
  • The real change comes from the ACA and the change of incentives. We should know about this and as citizens encourage the development of technologies that we (patients and HCP and hospitals) can use to improve quality, access, and to reduce costs which is the goal. Government wants to partner with us, conference coming up.
  • Innovation! Public private partnerships next.
  • Health 2.0 Developer Challenges. Can be sponsored by anyone, just go to website. This one was sponsored by Kaiser Permanente.
  • Gregg Masters (ex insurance agency executive) and Phil Baumann (nurse) all technology enthusiasts
  • MAYA is design team out of Pittsburgh. Used food desert data from USDA along with SMS texting feedback loops with education to help lead to behavior changes. Working with local organizations for pilot study.
  • Double disruption: new funding mechanism and funding for disruptive innovation itself
  • Because of the affordable care act, insurers will begin to pay for quality and prevention (penalties otherwise). Mobile provides both quality and prevention at a low cost so creates a valuable commodity that the market pays for.
  • Technologies that engage are really the key to changing health behavior which is the real benefit of mHealth.
  • Being a 30 something technology entrepreneur, I never went to school specifically for app making but find myself here solving human problems with human methods just by watching how technology integrates into mine and my patients lives…and you can and should do it too! 
  • Transcript

    • 1. Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship May 2012 Jennifer Shine Dyer M.D., M.P.H. Mobile Health Entrepreneur Duet Health Columbus, Ohio 1
    • 2. • Pediatric Endocrinologist• Health Behavioralist (MPH)• Problem-solving technology entrepreneur• Social media enthusiast (@EndoGoddess)
    • 3. 2007: Health Literacy, Online Content
    • 4. 2009: Twitter
    • 5. Used an app for the first timewhen I bought my iPhone, 2009
    • 6. Bolus Reminder App, 2010 • When: Fall 2010 (never released in App Store) • Who: Dyer teen patients with diabetes on insulin • Why: Automate personalized weekly SMS texting protocol • How: Master phone has app, patient phones SMS texting only
    • 7. EndoGoddess App, 2011 • When: September 2011, Apple App Store • Who: any patients with diabetes on insulin (teens, young adults) • Why: motivate, educate, trigger behavior of checking glucoses 4X /day • How: self-entry glucose journal, iTunes rewards, diabetes online community motivating quotes
    • 8. Intensive Basal Bolus Therapy Prandial BolusesInsulin Basal InsulinBG mg/dl 0hr 24hr
    • 9. Meal Bolus
    • 10. Pump download, missed meal boluses
    • 11. Barriers to Bolus Adherence:• No insurance • Depression• Low socioeconomic • Adjustment disorder status with chronic disease• Reduced health • Eating disorder literacy (diabulimia)• Lack of frequent office contact • Forgetfulness• Over/under • Fear of low blood involvement of family glucose reaction• Family conflict • Peer pressure
    • 12. Hypothesis• Weekly personalized and interactive engagement via texting with the physician will improve meal bolus mindfulness and reduce hgba1c % within 3 months (at next clinic visit) in teens with type 1 diabetes.
    • 13. MethodsWeekly Texting Protocol (Thursdays at 5pm)• Initial greeting message• Customized question unique to each patient’s interests (how is your lacrosse team playing?, how did your finals go?, how is marching band?, did you have fun 4-wheeling last week?)• Questions specific to diabetes adherence: glucose testing, meal boluses, frequency of high glucoses, frequency of low glucoses• Conclusion message stating continuation of text messaging at regularly scheduled time
    • 14. Results
    • 15. External Internet Services: Facilitate initial programming, Facilitate operations of SMS texting delivery and storage
    • 16. NickJonasMusicAlso lovesFrappuccinos.
    • 17. Hey Nick! I’ve added you to my address book! Cool. Thanks! Keep rockin’ Dr. Dyer.
    • 18. Dr. Dyer here. Hope the work on the new albumis going well.
    • 19. Nick. Hope the carb counting is going well. Iknow u love Frappuccinos! :)
    • 20. Keep on rocking the boluses, Nick! See you in afew weeks. March 3rd
    • 21. What Isn’t Working?... • Bolus adherence and glucose checks decreased over time • Needed reminders • Needed motivation • Needed more support
    • 22. e p roxim d u e th e alth .com 35
    • 23. EndoGoddess App Hypothesis:• Target engagement behavior: glucose checks• Motivating, educating, triggering this target behavior will lead to improved medication adherence
    • 24. BJ Fogg’s Health Behavior Model
    • 25. Literacy (ability)Make the mobile phone give information at the right time:• Online content without searching• Frequently used links• How-to videos
    • 26. TriggerMake the mobile phone DO SOMETHING at the right time:• Send push notifications• Add calendar events with alarms• SMS• CALL• (Email)
    • 27. MotivateMake the patient WANT to take their medication:• Utilize Game Mechanics• Competition• Social
    • 28. Coding at Duet Health Eproximiti
    • 29. Download from App Store (iOS,Android)
    • 30. Platforms: iOS vs Android
    • 31. EndoGoddess App: Journal
    • 32. EndoGoddess App: Motivation • iTunes rewards points • Friends/family sponsorship • Social: daily motivational quotes submission
    • 33. Social Business Model:Peer & FamilyReinforcement/Motivation Motivation from Support •iTunes account deposits Positive reinforcement •Social Network support from friends & family: Motivation + rewards
    • 34. EndoGoddess App: Trigger
    • 35. EndoGoddess App: Literacy
    • 36. How many diabetes apps arethere? «diabetes» OR «glucose» search on iTunes Norwegian Market T Chomutare, et al. JMIR, 2011.
    • 37. Results Feature Prevalence (%) 19/49 Apps Free Mean Price = $4.00 Modal Price = $3.00 T Chomutare, et al. JMIR, 2011.
    • 38. EndoGoddess App Future? • EndoGoddess app RCT • EndoGoddess Kids App • ?Partnership with medical device (glucometer) • ?Partnership with pharma for test strips • ?EMR partnership and integration • ?Advertisements
    • 39. Patient Activation Measure (PAM)
    • 40. Device Data Integration  EndoGoddess App Integration • Agamatrix Sanofi Aventis iPhone/iPod-linked blood glucose meter iBGStar • FDA approval in US (December 2011)
    • 41. Affordable Care Act
    • 42. DC Code-a-thons
    • 43. DC Code-a-thons@PhilBaumann @EndoGoddess @2healthguru
    • 44. DC Code-a-thons
    • 45. DC Code-a-thons
    • 46. Winner: MAYA Food Oasis•• @MAYAFoodOasis
    • 47. Accelerators/VCs
    • 48. Crowdfunding
    • 49. The Future:Insurers To Pay For Quality/Prevention
    • 50. “The most exciting breakthroughs of the 21st century will not occur because of technology but because of an expanding concept of what it means to be human.” ~John Naisbitt
    • 51.
    • 52. Thank You!