Health technology for the other 99%

1. Health Technologyfor the other 99%Health Hack Day, Stockholm, 17 May 2013Rajiv MehtaHello ...We’re here this weekend to shape the future, to spark the innovations that will shape thefuture. The innovations that we create this weekend will depend heavily on the problems weseek to address. Put another way, the answers we ﬁnd will depend on what questions we ask,and how we frame those questions. In my talk, I’d like to suggest a frame different than theone we’re used to thinking about — I want to talk about health technology for the other 99%.

2. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaNot talking about ...2Just to be clear, I’m not talking about the Occupy movement.

3. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaTraditional perspective:Doctors & Patients3PersonHealthcareProfessionalTraditionally for health technology we see healthcare professionals and people (also knownas patients)

4. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaDoctors & Patients & Technology4PersonHealthcareProfessionalMOSTHealth technology effortsSOMEPatient EngagementTelemonitoringPatient EducationPHRs?The vast majority of technology for health is oriented towards the needs of healthprofessionals. Patients are not users of such tools; they’re not in the picture.Some technology is geared towards doctor-patient interactions. Categories include “patientengagement”, tele-monitoring, patient education, and personal health records.Relatively little is geared towards people’s own use; when doctors are not in the picture.

5. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFor most of our lives (>99%) we takecare of ourselves5PersonThis is surprising because for the vast majority of our lives, health professionals are NOT inthe picture. For most of your life, you are being taken care of by yourself and your family.

6. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFor most of our lives (>99%) we takecare of ourselves6US Veterans Health Administration• “The gold dot represents the average number of minutes(100) a patient spends with a provider per year and the whiterepresents 525,600 minutes in a year”This point was made in a diagram created by the US Veterans Health Administration. Theynote that the average patient spent only 100 minutes a year being cared for by a professional— that’s the gold dot. The white space is the rest of the year, the other 99.98% of the year.It turns out that this diagram is not accurate — the gold dot is too big.

7. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFor most of our lives (>99%) we takecare of ourselves7This diagram, by Sara Riggare, shows the same thing — she only spent 1 hour with a healthprofessional in 2012.But, this diagram is accurate. Can you ﬁnd the gold dot?

8. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFor most of our lives (>99%) we takecare of ourselves8Health Technologyfor the other 99%So, this is what I’m talking about.What technology can help us take care of ourselves?What technology will address the other 99%?I’d like to suggest a framework to help us think about this.

9. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaA diagram of health self-management9PersonHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)affectGoals& PlansaffectObservations made byNew observations ... ... suggest new Actions ...Here is a diagram of a person taking care of himself.The person has some desired health goals and some health-related activities that he plans todo to achieve these goals. On a day-to-day basis he carries out these actions, and they havesome impact on his health. His health is also impacted by his environment. Noting his actualhealth compared to his goals, he may make some changes.

10. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaHCPs may have a strong inﬂuence onthe person’s activities10PersonHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)affectGoals& PlansObservations made byNew observations ... ... suggest new Actions ...HCPinformaffectWhat the person chooses to do and what he considers proper goals are inﬂuenced by hisdoctors and other health professionals.This is a nice, simple model.

11. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaIt’s complicated ...11There are inner loops of execution, with manyopportunities for failure (e.g. “non-adherence”)PersonHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansTasksaffectNew observations ... ... suggest new Actions ...affectHCPinformUnfortunately, real life is more complicated.First of all, the person may not carry out his actions exactly as planned. This is often referredto as “non-adherence”.

12. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaEndless torrent of mundane tasks12Day-to-day (even hr-to-hr)tasks for health, wellness,... life in generalMundane but variedAppointments, Bathing, Biometrics, Chores,Cleaning, Companionship, Cooking, Dressing,Eating, Errands, Exercise, Grooming, Listening,Medications, Moving around, Observations,Planning, Shopping, Socializing, Symptoms,Therapies, Toileting, Transportation, ...Never endingOverwhelming!This failure of execution is not surprising. While each little health-related activity seemssimple in isolation, together they can be overwhelming. It’s not just taking one pill on time ...a wide variety of activities may be important for health, and they happen multiple times eachday, for all of your life.

13. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaEndless torrent of mundane tasks13MEDICATIONS6a 9a noon 3p 6p 9p midnightInsulin NovolinInsulin NovologMetforminACE InhibitorMulti-vitaminIbuprofenBlood glucoseBlood pressure & pulseWeightEXERCISEWalk/SwimYogaDIET/FOODFood JournalCarbsOBSERVATIONSSleepExcessive thirstExcessive sweatingMoodBIOMETRICSHerbal supplementsTHERAPIESFoot massageBreathing exercise6a 9a noon 3p 6p 9p midnightMEDICATIONSMorning supplements (6)Albuterol (nebulizer)Hypertonic saline (nebulizer)Pulmozyme (nebulizer)Tobi antibiotic (nebulizer)Pancreatic enzymesAdvairNoon supplements (4)Evening supplements (4)Bedtime supplements (4)Caloric shakeTHERAPIESVestAcapellaBIOMETRICSWeightOBSERVATIONSSleepMoodCoughing episodeOTHERClean / Sterilize nebulizersHere are some examples of the daily health regimens of some people I have worked with. Thex-axis covers about 18 hours of the day. The y-axis lists their activities.

14. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaIt’s more complicated ...14And outer loops — health is a means to higher-level life goalsPerson/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectHCPinformLife itself adds it own complexity. Health is not the only priority in your life, and often otheraspects of life — work, family and social responsibilities, and your personal happiness — takehigher priority.

15. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaMost people aren’t hermits15They belong to family groups whose actions areintertwined and have strong interactionsPerson/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectHCPinformIn addition, most of us are social, and our lives are interwoven with others — family, closefriends, and colleagues.Focusing only on the individual works only for hermits.

16. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaNetworks of care16We take care of others, and in turn they take care of us. We strongly inﬂuence each other. Ourown health activities are often not fully under our own control.

17. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaReal-world care networks17These diagrams are from research I did last summer, they show the care networks for twopeople that were interviewed.

18. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaOften many external influencers18Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInfluencers(HCPs, “alternative” practitioners,media, extended family & friends)informAlso, external influencers include much more than healthcare professionals. There are manyalternative health providers, the formal and informal media, neighbors, etc. who have someimpact.

19. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFramework for seeing healthtechnology opportunities19Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informThis diagram provides a framework for thinking about health technology opportunities, a wayto see how we might help the person, the family take care of themselves.

20. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaFormal & informal health information20Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreate1.One obvious opportunity is for smarter and more personalized information.

21. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaVery active space ... much room forimprovement21Searchable, filtered, real-time ... just for meThere is already a lot happening here. Some efforts to provide better, more tailoredinformation have been in place for over a decade. There are many efforts to make existingdata more available to individuals. And of course social media makes it possible to findpeople who speak to your particular issues.And yet ... anyone who has tried to find information knows that it is still very hard to findwhat you want to know.

22. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaSensors & diagnostics22Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreateMeasureinforminforminform2.Another hot space is new ways to measure ourselves.

23. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaLots happening here as well23Physical, psychological and environmentalfactors, wellness activities — as well as taskexecution and other aspects of lifeThis includes devices to track physiological and environmental factors, as well as interactiveapps to track activities, emotions and cognition.These new gadgets and apps are what sparked the Quantiﬁed Self movement.Many feel that we’ve barely scratched the surface yet ... there’s enormous room forinnovation here.

24. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaAnalysis & visualization andpersonalized recommendations24Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreateMeasureinforminformAnalyzeinform3.However, all this new data exposes a new problem.

25. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaDearth of consumer solutions ...25For combining multiple and disparate sources ofdata, and making sense of it all.BodyTrack / FluxtreamWhich is that we don’t have tools to learn from the data. It’s not enough to see a chart of justyour weight, or just your sleep, or just your calories. Health is a multi-factorial issue, and wedesperately need tools to see and learn from this data.Unfortunately today you have to be a whiz at using spreadsheets or statistical programminglanguages such as R. A step in the right direction is a project at Carnegie Mellon University inPittsburgh called BodyTrack/Fluxtream, but it is not yet consumer-friendly.So, this space is wide open for innovation.

26. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaCommunication & coordination,within family and with inﬂuencers26Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreateMeasureinforminformAnalyzeConversesupportinformsupport4.Another area that is surprisingly difficult is supporting conversations about health, bothwithin the family and with external partners.

27. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaSo many choices ... and still it’s hard27Convenience + Richness + Privacy + ControlPhone, email, txt, facebook, twitter, skype,instagram, pinterest, foursquare, ...There are seemingly an inﬁnite variety of communication tools, and yet we know from ourown lives that somehow the right tool often doesn’t seem to exist.

28. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaMaking it easier to do the doing— “productivity” tools28Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreateMeasureinforminformAnalyzeConversesupportutilizesupportEnableinformsupport5.The ﬁnal opportunity I’d like to bring to your attention is to help people “do the doing”. Youcan think of it as productivity tools for personal health.

29. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaDearth of consumer solutions ...29Repurposed tools Designed for theConsumerIf these productivity challenges occurred in any profession, that industry would be screamingloudly for help. But, being just regular people, our screams are not being heard.We make do by repurposing tools made for other reasons. Tools designed especially for theconsumer, for the unique needs of our personal, family lives are rare. There is much room forimprovement here!One good example is Cozi, an app for managing family calendars. Another is my own effort,Unfrazzle.

30. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaUnfrazzleFamily caregiver’s assistant30Enable: Remember and keep track of any / all ofyour care responsibilitiesConverse: Stay in-sync with co-caregiversUnfrazzle is an app, available now for iPhone and soon for Android, that helps usersremember and keep track of all their care activities, whether for themselves, their mother,their son, or their pet cat. And it helps the family coordinate these activities.

31. Health Hack Day, Stockholm, 17 May 2013 Rajiv MehtaRemember the 99%!31Person/FamilyHealth / WellbeingDisturbances / Environmenttake(s) Actions (Daily Living)Observations made byaffectto accomplishGoals& PlansLifeaffectsTasksaffectNew observations ... ... suggest new Actions ...affect affectInﬂuencers(HCPs, “alternative” practitioners,media, extended family & friends)informInforminformcreateMeasureinforminformAnalyzeConversesupportutilizesupportEnableinformsupportSo, in closing, for the rest of the weekend, I would like to urge you to remember that for over99% of our lives, we are taking care of ourselves. In the future this could be much, mucheasier. This is a fertile ﬁeld in which to plant your creativity.

32. Rajiv Mehtarajiv@bhageera.com+1 650 823-3274www.bhageera.comHealth Hack Day, Stockholm, 17 May 2013Rajiv MehtaRemember the 99%!Thank you.