mHealth perspectives towards 2015 and Professor Ilkka Korhonen Department of Biomedical Engineering Tampere University of Technology, Tampere, Finland September 1st, 2011 EMBC 2011
2Key messages1. Chronic disease prevention and management is our biggest challenge To efficiently prevent and manage them a behavioral change is needed2. Co-creation of health – citizen to be understood as a key co-producer of health3. Personal health systems and mHealth are key tools to support co-production of health a) Smart phone as a platform b) Connected devices c) Persuasive technologies d) Challenge: from data to decision support HIC2011 3.8.2011
4 Chronic conditions• According to the WHO, 77% of the disease burden in Europe are accounted for disorders related to lifestyles. Direct healthcare costs in Finland: Cardiovascular 17%• Prevalence of chronic conditions is Mental health 13% rapidly increasing Respiratory 11% Lost production in Finland: Mental health 22% Musculo-sceletal 22%• Chronic or long-term conditions make >70% of all health care costs • Costs due complications caused (partially) by sub-optimal management • Investment on better management return of investment through decreased # of complications
Citizen behavior and health outcomes are closely linked Determinants of• Behavioral changes would significantly reduce health status life style diseases and improve wellbeing • 70–90% of cardiovascular disease, type II diabetes and stroke would be avoided (Willet, 2002) Social (15%) Environmental• Individuals with healthy lifestyles: Behavioral (5%) (40%) • 50% reduction in health care costs (Pronk et al., 1999) Health Care • 14 longer expected life time (Khaw, 2009) (10%)• Behavioral change requires interventions to lifestyles Genetic • Life style changes cannot be prescribed – they have to be (30%) marketed and promoted • Life style is very personal and impacted by complex motivational and value-based factors • Personal health systems facilitate behavioral change McGinnis et al., Health Affairs 21(2), 2002 Actual health outcomes are largely produced by the citizen behaviors – not by health care procedures (alone) • Also other stakeholders in the society
Century of behavior change“The 19th Century has been called the Century of Hygiene. That is,in the 19th Century more lives were saved or extended due to animproved understanding of hygiene and public health than to anyother single cause.The 20th Century was the Century of Medicine. Vaccines,antibiotics, transfusions, and chemotherapy all helped to contributeto longer, healthier lives. In 1900, the life expectancy of an Americanwas 49 years. In 2000, it was 77 years.The 21st century will be the Century of Behavior Change. Medicineis still making fundamental discoveries that can extend lives, butchanging daily, long-term behavior is the key to adding years andquality to our lives. This will involve reducing risky behavior andmaking changes in exercise and nutrition.”Brian Wansink, Cornell University
8Catalysing behavioral change withPERSONAL HEALTH SYSTEMS 3.8.2011
Personal Health Systems = Health and Wellness Technologies Designed for the ConsumerMonitoring + Connectivity + Analysis + Feedback
10Engineering building blocks:mHealth, personal monitoring, wearablemonitoring, signal processing and interpretation
1 2PHS Keys1. Self-monitoring2. Personal and personalised feedback3. Persuation 3.8.2011
Benefits of self-monitoring• Daily weight monitoring helps in weigh loss and weight maintenance (Kayman et al., 1990; Linde et al., 2004; Wing et al., 2006)• Regular diet and energy consumption monitoring supports weight loss and may decrease food intake (Baker & Kirschenbaum, 1993; Perri et al., 1989; Foreyt, 2005)• Step monitoring increases exercising and improved body composition and blood pressure (Bravata et al., 2007; Clemes 2009)• Self-monitoring is the most effieicnt Wing et al., 2006 method for getting rid of bad habits (Quinn, 2010)
1From monitoring to personal 4feedback via intelligent analysis HIC 2011 3.8.2011
1From information sharing to 5persuation - nudging• Knowledge-behavior gap: most citizen have sufficient information about healthy lifestyles but this information does not transform into behaviors • It is unlikely that more information alone would significantly improve the situation• Reasons? Human being is not a rational actor • Most of our daily behaviors are automatic – not deliberate – decisions Organise environment and information to help to make better automatic decisions!
1Example: Choice architecture – framing impact 7 SUBSCRIPTIONS Welcome to The Economist Subscription Centre Pick the type of subscription you want to buy or renew. Economist.com subscription - US $59.00 One-year subscription to Economist.com. 68% Includes online access to all articles from The Economist since 1997. Print & Web subscription - US $125.00 One-year subscription to the print edition of 32% The Economist and online access to all articles from The Economist since 1997. Source: Dan Ariely, Predictably Irrational (2008)
1Choice architecture – nudging impact 8 SUBSCRIPTIONS Welcome to The Economist Subscription Centre Pick the type of subscription you want to buy or renew. Economist.com subscription - US $59.00 One-year subscription to Economist.com. Includes online access to all articles from The Economist since 1997. Print subscription - US $125.00 One-year subscription to the print edition of The Economist. Print & Web subscription - US $125.00 Source: Dan Ariely, Predictably Irrational One-year subscription to the print edition of (2008) The Economist and online access to all articles from The Economist since 1997.
1Choice architecture – 9predictably irrational SUBSCRIPTIONS SUBSCRIPTIONS Welcome to Welcome to The Economist Subscription Centre The Economist Subscription Centre Pick the type of subscription you want to buy or Pick the type of subscription you want to buy or renew. renew. Economist.com subscription - US $59.00 Economist.com subscription - US $59.00 One-year subscription to Economist.com. One-year subscription to Economist.com. Includes online access to all articles from Includes online access to all articles from The Economist since 1997. The Economist since 1997. 68 16 Print & Web subscription - US $125.00 Print subscription - US $125.00 One-year subscription to the print edition of The One-year subscription to the print edition of The Economist and online access to all articles from Economist. 0 The Economist since 1997. 32 Print & Web subscription - US $125.00 One-year subscription to the print edition of The Economist and online access to all articles from The Economist since 1997. 84 Source: Dan Ariely, Predictably Irrational (2008)
2 0 Setup: • Normal weight and overweight consumers • Ads shown before lunch Arranging and framing insurance adds (control) • Car informationhelps people to make better adds • Exercise choices • Eaten calories measured Choice architectures matter • Consumers unaware of use them deliberately in design! actual purpose of the study (“ad rating study”) HIC 2011 3.8.2011
2 1Smart phone as a key platform for PHSMHEALTH TRENDS 3.8.2011
Phases of ICT development PCs PCs connected to Internet MOBILE INTERNET Slow or no connections Fixed broadband Mobile took the lead with Business-driven Consumer- and business-driven “History suggests the mobile Internet has potential tophones, tablets, One architecture: Client-Server Megatrend (OECD -centric) smart create more wealth than prior computing cycles based SIMs / destroyOne architecture: Web Office automation and process embedded on Location-awareness and development 10x userNew business models multiplier effect. gadget integration Regarding pace of change, more users will likely broadband with Mobile connect to the Internet via mobile devices than desktop capacity and quality issues Connected PCs within 5 years”. life Cloud Consumer- and utility-driven Morgan Stanley (The Mobile Internet Report, 2009)Main- Internet Connecting Size bigger than in cycle #4 Mini PC 2.0frame In fact, the sales of smart phones exceeded Gigatrend (global) world to the the sales of Intenet Three or four architectures: PCs inInternet February 2011. Emb, web, app, broadcast Connecting cache people “The dominant design is the Internet and the future of mobility is New ecosystem-centric the future of Internet” (Matti Mäkelin, Nexec Oy) business modelsInflectionpoints 1970s- 1981- 1996- 2010 (c) Matti Mäkelin, Nexec Oy, Finland
2 3Smart phones• Inherently personal• ”Always” at hand• Contextual• Perceived as trusted store for personal information• Good for consuming content• Excellent for short notes and measurements• Excellent as hubs for connected sensors• Designed for connectivity and communication• Rich UI Smart phones are the media for large scale consumertargeted eHealth services 3.8.2011
mHealth application market today• Share of mHealth apps is 3% of the total, i.e. ~17000 apps• Usually the business model is the pay-per-download• Ratio of paid/total mHealth application is 70-90%, which is 10-20% higher than the average for all applications.
mHealth market is taking off seriously (Mobile Health Market Report 2010-2015, research2guidance, Nov 2010)• 1.4B smartphone users in 2015• 500 million users have downloaded at least one mHealth application by 2015• mHealth market revenue will grow to US$ 6 billion by the end of 2015• New smartphone based mHealth market model gives a push for the traditional mHealth market to advance from the trial stage• Total number of downloaded mHealth applications will grow from 275 million (2010) to almost 1.4 billion (2015), from which 15% are paid.
mHealth reduces provider revenues Source: Healthhcare unwired, New business models delivering care anywhere, Health Research Institute, PricewaterhouseCoopers, September 2010
Take home messages• Century of behavior change• Chronic disease prevention and management will not succeed without the citizen as an active participant – co- producer of health• Consumer health – design eHealth solutions for the citizen • Behavioral psychology and economics, marketing, design• We must focus on improving health (instead of improving just healthcare)• mHealth = eHealth – convergence • Smart phone is the future way of accessing Internet • Game will change within next 5 years • Great challenge: automation of data processing and feedback• mHealth will destroy old business – and create new • In which category do you want to be?