Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship                    May 2012    Jennifer Shine Dyer M.D., ...
•   Pediatric    Endocrinologist•   Health Behavioralist    (MPH)•   Problem-solving    technology    entrepreneur•   Soci...
2007: Health Literacy, Online          Content
2009: Twitter
Used an app for the first timewhen I bought my iPhone, 2009
Bolus Reminder App, 2010          • When: Fall 2010 (never            released in App Store)          • Who: Dyer teen pat...
EndoGoddess App, 2011         • When: September 2011,           Apple App Store         • Who: any patients with          ...
Intensive Basal Bolus Therapy                 Prandial BolusesInsulin                   Basal InsulinBG mg/dl           0h...
Meal Bolus
Pump download, missed meal boluses
Barriers to Bolus Adherence:• No insurance              • Depression• Low socioeconomic         • Adjustment disorder  sta...
Hypothesis• Weekly personalized and interactive  engagement via texting with the physician  will improve meal bolus mindfu...
MethodsWeekly Texting Protocol (Thursdays at 5pm)• Initial greeting message• Customized question unique to each patient’s ...
Results
External Internet Services: Facilitate initial programming, Facilitate operations of                        SMS texting de...
NickJonasMusicAlso lovesFrappuccinos.
Hey Nick! I’ve added you  to my address book!         Cool. Thanks! Keep          rockin’ Dr. Dyer.
Dr. Dyer here. Hope the work on the new albumis going well.
Nick. Hope the carb counting is going well. Iknow u love Frappuccinos! :)
Keep on rocking the boluses, Nick! See you in afew weeks. March 3rd
What Isn’t Working?... • Bolus adherence and glucose   checks decreased over time  • Needed reminders          • Needed mo...
e p roxim iti.com   d u e th e alth .com                                           35
EndoGoddess App           Hypothesis:• Target engagement behavior: glucose  checks• Motivating, educating, triggering this...
BJ Fogg’s Health Behavior         Model
Literacy (ability)Make the mobile phone give information  at the right time:• Online content without searching• Frequently...
TriggerMake the mobile phone DO SOMETHING at the right time:•   Send push notifications•   Add calendar events with alarms...
MotivateMake the patient WANT to take their  medication:• Utilize Game Mechanics• Competition• Social
Coding at Duet Health Eproximiti
Download from App Store     (iOS,Android)
Platforms: iOS vs Android
EndoGoddess App: Journal
EndoGoddess App: Motivation              • iTunes rewards points              • Friends/family                sponsorship ...
Social Business Model:Peer & FamilyReinforcement/Motivation Motivation from Support •iTunes account deposits              ...
EndoGoddess App: Trigger
EndoGoddess App: Literacy
How many diabetes apps arethere?    «diabetes» OR «glucose» search on               iTunes Norwegian Market               ...
Results                         Feature Prevalence (%)   19/49 Apps Free   Mean Price = $4.00   Modal Price = $3.00       ...
EndoGoddess App Future?          • EndoGoddess app RCT          • EndoGoddess Kids App          • ?Partnership with medica...
Patient Activation Measure          (PAM)
Device Data Integration          EndoGoddess App           Integration         • Agamatrix Sanofi Aventis           iPhon...
Affordable Care Act
DC Code-a-thons
DC Code-a-thons@PhilBaumann   @EndoGoddess   @2healthguru
DC Code-a-thons
DC Code-a-thons
Winner: MAYA Food Oasis• http://vimeo.com/20034533• @MAYAFoodOasis
Accelerators/VCs
Crowdfunding
The Future:Insurers To Pay For Quality/Prevention
“The most exciting breakthroughs of the 21st century will not occur because of technology but because of an expanding conc...
endogoddess.blogspot.com/
Thank You!jennifer.dyer@duethealth.com
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer
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
  • http://www.maya.com/the-feed/maya-design-wins-health-20-dc-code-a-thon 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! 
  • Keynote - Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship - Dr Jennifer Shine Dyer

    1. 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. 2. • Pediatric Endocrinologist• Health Behavioralist (MPH)• Problem-solving technology entrepreneur• Social media enthusiast (@EndoGoddess)
    3. 3. 2007: Health Literacy, Online Content
    4. 4. 2009: Twitter
    5. 5. Used an app for the first timewhen I bought my iPhone, 2009
    6. 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. 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. 8. Intensive Basal Bolus Therapy Prandial BolusesInsulin Basal InsulinBG mg/dl 0hr 24hr
    9. 9. Meal Bolus
    10. 10. Pump download, missed meal boluses
    11. 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. 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. 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. 14. Results
    15. 15. External Internet Services: Facilitate initial programming, Facilitate operations of SMS texting delivery and storage
    16. 16. NickJonasMusicAlso lovesFrappuccinos.
    17. 17. Hey Nick! I’ve added you to my address book! Cool. Thanks! Keep rockin’ Dr. Dyer.
    18. 18. Dr. Dyer here. Hope the work on the new albumis going well.
    19. 19. Nick. Hope the carb counting is going well. Iknow u love Frappuccinos! :)
    20. 20. Keep on rocking the boluses, Nick! See you in afew weeks. March 3rd
    21. 21. What Isn’t Working?... • Bolus adherence and glucose checks decreased over time • Needed reminders • Needed motivation • Needed more support
    22. 22. e p roxim iti.com d u e th e alth .com 35
    23. 23. EndoGoddess App Hypothesis:• Target engagement behavior: glucose checks• Motivating, educating, triggering this target behavior will lead to improved medication adherence
    24. 24. BJ Fogg’s Health Behavior Model
    25. 25. Literacy (ability)Make the mobile phone give information at the right time:• Online content without searching• Frequently used links• How-to videos
    26. 26. TriggerMake the mobile phone DO SOMETHING at the right time:• Send push notifications• Add calendar events with alarms• SMS• CALL• (Email)
    27. 27. MotivateMake the patient WANT to take their medication:• Utilize Game Mechanics• Competition• Social
    28. 28. Coding at Duet Health Eproximiti
    29. 29. Download from App Store (iOS,Android)
    30. 30. Platforms: iOS vs Android
    31. 31. EndoGoddess App: Journal
    32. 32. EndoGoddess App: Motivation • iTunes rewards points • Friends/family sponsorship • Social: daily motivational quotes submission
    33. 33. Social Business Model:Peer & FamilyReinforcement/Motivation Motivation from Support •iTunes account deposits Positive reinforcement •Social Network support from friends & family: Motivation + rewards
    34. 34. EndoGoddess App: Trigger
    35. 35. EndoGoddess App: Literacy
    36. 36. How many diabetes apps arethere? «diabetes» OR «glucose» search on iTunes Norwegian Market T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/
    37. 37. 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/
    38. 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. 39. Patient Activation Measure (PAM)
    40. 40. Device Data Integration  EndoGoddess App Integration • Agamatrix Sanofi Aventis iPhone/iPod-linked blood glucose meter iBGStar • FDA approval in US (December 2011)
    41. 41. Affordable Care Act
    42. 42. DC Code-a-thons
    43. 43. DC Code-a-thons@PhilBaumann @EndoGoddess @2healthguru
    44. 44. DC Code-a-thons
    45. 45. DC Code-a-thons
    46. 46. Winner: MAYA Food Oasis• http://vimeo.com/20034533• @MAYAFoodOasis
    47. 47. Accelerators/VCs
    48. 48. Crowdfunding
    49. 49. The Future:Insurers To Pay For Quality/Prevention
    50. 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. 51. endogoddess.blogspot.com/
    52. 52. Thank You!jennifer.dyer@duethealth.com

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