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
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
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
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>
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>
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>
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>
Hey Nick! I’ve added you to my address book! Cool. Thanks! Keep rockin’ Dr. Dyer.
Nick. Hope the carb counting is going well. I know u love Frappuccinos! :) February 24th
Keep on rocking the boluses, Nick! See you in a few weeks. March 3rd
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>
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>
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>
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>
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
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/
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/
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>