Dyer mHealth Summit Presentation 2011


Published on

Use case examples of mobile health in diabetes medical care to change health behaviors and affect health outcomes given at mHealth Summit December 5, 2011.

Published in: Health & Medicine, Business
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • 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)
  • A lot of visits (good doc patient relationship) but they weren’t helping as noted by skipped bolues. I’m an academic and have removed some details of methods.
  • Good patients record/engage, and bad patients don’t record/engage. Not checking glucoses.
  • Motivation, Ability, Trigger….engagement theory
  • Email – too passive
  • Email – too passive
  • Startup lifestyle
  • Startup lifestyle
  • So
  • Published in the September edition of the Archives of Internal Medicine , William H. Shrank , MD, from the division of pharmacoepidemiology and pharmacoeconomics, department of medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues conducted a survey of online social networking sites to explore characteristics of social media communities and to better inform physicians and patients about the choices available to them. The researchers evaluated and abstracted data from 15 online social networking website focused on diabetes . Membership ranged from 3,074 to more than 300,000 patients; three sites had more than 150,000 members, eight had more than 10,000 members, while two were confidential and one was unavailable, the authors found. “Eighty percent of the sites directly linked to Facebook and 67 percent linked to Twitter . All but two of the sites had an explicit membership process, a requirement to post a comment.” According to the authors, the level and type of health professional participation varied across the sites. Site administrators reviewed the content of posts in 67 percent of the sites. And in 47 percent of the sites, administrators responded directly to questions from the members. “Physicians were available to answer questions in 33 percent of the sites but systematically scanned postings and offered feedback in only 7 percent of postings. More than half of the sites used diabetes educators to answer member questions and in 13 percent they scanned member discussions. “Online social networks may play an increasing role in health promotion, as primary care physicians are asked to see increasing numbers of patients, limiting time for telephone consultations to answer questions related to chronic disease management , and as a web-savvy population ages and develops more chronic diseases,” the authors remarked. “Existing sites differ in their approach toward communication structure, authenticity and quality oversight, expert participation, and advertising or sources of funding. These metrics may be important to patients when selecting a community and may be of interest to healthcare providers who ultimately may advise patients about their particular needs.” Shrank and colleagues concluded with a call for further research regarding these metrics to explore patient and healthcare provider perceptions to build an evidence-based database to encourage social network development that will promote patient health.
  • After showing that there are a lot of downloads,
  • 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! 
  • Dyer mHealth Summit Presentation 2011

    1. 1. Jennifer Shine Dyer M.D., M.P.H . Chief Medical Advisor DuetHealth.com by eProximiti Columbus, Ohio December 2011 Doctor-Patient Use Cases: Mobile Health and Diabetes
    2. 2. <ul><li>Pediatric Endocrinologist </li></ul><ul><li>Health Behavioralist (MPH) </li></ul><ul><li>Problem-solving technology entrepreneur </li></ul><ul><li>Social media enthusiast (@EndoGoddess) </li></ul>
    3. 3. Bolus Reminder App, 2010 <ul><li>When: Fall 2010 (never released in App Store) </li></ul><ul><li>Who: Dyer teen patients with diabetes on insulin </li></ul><ul><li>Why: Automate personalized weekly SMS texting protocol </li></ul><ul><li>How: Master phone has app, patient phones SMS texting only </li></ul>
    4. 4. EndoGoddess App, 2011 <ul><li>When: September 2011, Apple App Store </li></ul><ul><li>Who: any patients with diabetes on insulin (teens, young adults) </li></ul><ul><li>Why: motivate, educate, trigger behavior of checking glucoses 4X /day </li></ul><ul><li>How: self-entry glucose journal, iTunes rewards, diabetes online community motivating quotes </li></ul>
    5. 5. Meal Bolus
    6. 6. Pump download, missed meal boluses
    7. 7. Hypothesis <ul><li>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. </li></ul>
    8. 8. Methods <ul><li>Weekly Texting Protocol (Thursdays at 5pm) </li></ul><ul><li>Initial greeting message </li></ul><ul><li>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?) </li></ul><ul><li>Questions specific to diabetes adherence: glucose testing, meal boluses, frequency of high glucoses, frequency of low glucoses </li></ul><ul><li>Conclusion message stating continuation of text messaging at regularly scheduled time </li></ul>
    9. 9. Subjects
    10. 10. Results
    11. 12. External Internet Services: Facilitate initial programming, Facilitate operations of SMS texting delivery and storage
    12. 14. Nick Jonas Music Also loves Frappuccinos.
    13. 16. Hey Nick! I’ve added you to my address book! Cool. Thanks! Keep rockin’ Dr. Dyer.
    14. 19. Nick. Hope the carb counting is going well. I know u love Frappuccinos! :) February 24th
    15. 20. Keep on rocking the boluses, Nick! See you in a few weeks. March 3rd
    16. 21. What Isn ’ t Working?... <ul><li>Bolus adherence and glucose checks decreased over time </li></ul><ul><li>Needed motivation </li></ul><ul><li>Needed reminders </li></ul><ul><li>Needed more support </li></ul>
    17. 22. What Isn’t Working: Engagement
    18. 23. eproximiti.com duethealth.com
    19. 24. EndoGoddess App Hypothesis: <ul><li>Target engagement behavior: glucose checks </li></ul><ul><li>Motivating, educating, triggering this target behavior will lead to improved medication adherence </li></ul>
    20. 25. BJ Fogg’s Health Behavior Model
    21. 26. Literacy (ability) <ul><li>Make the mobile phone give information at the right time: </li></ul><ul><li>Online content without searching </li></ul><ul><li>Frequently used links </li></ul><ul><li>How-to videos </li></ul>
    22. 27. Trigger <ul><li>Make the mobile phone DO SOMETHING at the right time: </li></ul><ul><li>Send push notifications </li></ul><ul><li>Add calendar events with alarms </li></ul><ul><li>SMS </li></ul><ul><li>CALL </li></ul><ul><li>(Email) </li></ul>
    23. 28. Motivate <ul><li>Make the patient WANT to take their medication: </li></ul><ul><li>Utilize Game Mechanics </li></ul><ul><li>Competition </li></ul><ul><li>Social </li></ul>
    24. 29. SXSW Interactive
    25. 30. Coding at Eproximiti
    26. 31. Download from App Store
    27. 32. EndoGoddess App: Journal
    28. 33. EndoGoddess App: Motivation <ul><li>iTunes rewards points </li></ul><ul><li>Friends/family sponsorship </li></ul><ul><li>Social: daily motivational quotes submission </li></ul>
    29. 34. Motivation from Support <ul><li>iTunes account deposits </li></ul><ul><li>Social Network support </li></ul>Positive reinforcement from friends & family: Motivation + rewards Social Business Model: Using Peer & Family Reinforcement
    30. 35. EndoGoddess App: Trigger
    31. 36. EndoGoddess App: Literacy
    32. 37. Online Communities: DSMA
    33. 38. Social Networks: Diabetes
    34. 39. EndoGoddess App: Droid version in process…
    35. 40. How many diabetes apps are there? «diabetes» OR «glucose» search on iTunes Norwegian Market T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/
    36. 41. Results Feature Prevalence (%) 19/49 Apps Free Mean Price = $4.00 Modal Price = $3.00 T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/
    37. 42. EndoGoddess App Future? <ul><li>EndoGoddess app RCT </li></ul><ul><li>EndoGoddess Kids App with dog/cat motivation </li></ul><ul><li>?Partnership with medical device (glucometer) </li></ul><ul><li>?Partnership with pharma for test strips </li></ul><ul><li>?EMR partnership and integration </li></ul><ul><li>?Advertisements </li></ul>
    38. 43. endogoddess.blogspot.com/
    39. 44. [email_address]