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Dyer mHealth Summit Presentation 2011


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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.

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Dyer mHealth Summit Presentation 2011

  1. 1. Jennifer Shine Dyer M.D., M.P.H . Chief Medical Advisor 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.
  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.
  36. 41. Results Feature Prevalence (%) 19/49 Apps Free Mean Price = $4.00 Modal Price = $3.00 T Chomutare, et al. JMIR, 2011.
  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.
  39. 44. [email_address]