Health technology for the other 99%

1. Health Technology for the other 99% Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Hello ... We’re here this weekend to shape the future, to spark the innovations that will shape the future. The innovations that we create this weekend will depend heavily on the problems we seek 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 the one 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 Mehta Not talking about ... 2 Just to be clear, I’m not talking about the Occupy movement.

3. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Traditional perspective: Doctors & Patients 3 Person Healthcare Professional Traditionally for health technology we see healthcare professionals and people (also known as patients)

4. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Doctors & Patients & Technology 4 Person Healthcare Professional MOST Health technology efforts SOME Patient Engagement Telemonitoring Patient Education PHRs ? The vast majority of technology for health is oriented towards the needs of health professionals. Patients are not users of such tools; they’re not in the picture. Some technology is geared towards doctor-patient interactions. Categories include “patient engagement”, 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 Mehta For most of our lives (>99%) we take care of ourselves 5 Person This is surprising because for the vast majority of our lives, health professionals are NOT in the 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 Mehta For most of our lives (>99%) we take care of ourselves 6 US Veterans Health Administration • “The gold dot represents the average number of minutes (100) a patient spends with a provider per year and the white represents 525,600 minutes in a year” This point was made in a diagram created by the US Veterans Health Administration. They note 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 Mehta For most of our lives (>99%) we take care of ourselves 7 This diagram, by Sara Riggare, shows the same thing — she only spent 1 hour with a health professional in 2012. But, this diagram is accurate. Can you ﬁnd the gold dot?

8. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta For most of our lives (>99%) we take care of ourselves 8 Health Technology for 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 Mehta A diagram of health self-management 9 Person Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living) affect Goals & Plans affect Observations made by New 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 to do to achieve these goals. On a day-to-day basis he carries out these actions, and they have some impact on his health. His health is also impacted by his environment. Noting his actual health compared to his goals, he may make some changes.

10. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta HCPs may have a strong inﬂuence on the person’s activities 10 Person Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living) affect Goals & Plans Observations made by New observations ... ... suggest new Actions ... HCP inform affect What the person chooses to do and what he considers proper goals are inﬂuenced by his doctors and other health professionals. This is a nice, simple model.

11. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta It’s complicated ... 11 There are inner loops of execution, with many opportunities for failure (e.g. “non-adherence”) Person Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Tasks affect New observations ... ... suggest new Actions ... affect HCP inform Unfortunately, real life is more complicated. First of all, the person may not carry out his actions exactly as planned. This is often referred to as “non-adherence”.

12. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Endless torrent of mundane tasks 12 Day-to-day (even hr-to-hr) tasks for health, wellness, ... life in general Mundane but varied Appointments, Bathing, Biometrics, Chores, Cleaning, Companionship, Cooking, Dressing, Eating, Errands, Exercise, Grooming, Listening, Medications, Moving around, Observations, Planning, Shopping, Socializing, Symptoms, Therapies, Toileting, Transportation, ... Never ending Overwhelming! This failure of execution is not surprising. While each little health-related activity seems simple 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 each day, for all of your life.

13. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Endless torrent of mundane tasks 13 MEDICATIONS 6a 9a noon 3p 6p 9p midnight Insulin Novolin Insulin Novolog Metformin ACE Inhibitor Multi-vitamin Ibuprofen Blood glucose Blood pressure & pulse Weight EXERCISE Walk/Swim Yoga DIET/FOOD Food Journal Carbs OBSERVATIONS Sleep Excessive thirst Excessive sweating Mood BIOMETRICS Herbal supplements THERAPIES Foot massage Breathing exercise 6a 9a noon 3p 6p 9p midnight MEDICATIONS Morning supplements (6) Albuterol (nebulizer) Hypertonic saline (nebulizer) Pulmozyme (nebulizer) Tobi antibiotic (nebulizer) Pancreatic enzymes Advair Noon supplements (4) Evening supplements (4) Bedtime supplements (4) Caloric shake THERAPIES Vest Acapella BIOMETRICS Weight OBSERVATIONS Sleep Mood Coughing episode OTHER Clean / Sterilize nebulizers Here are some examples of the daily health regimens of some people I have worked with. The x-axis covers about 18 hours of the day. The y-axis lists their activities.

14. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta It’s more complicated ... 14 And outer loops — health is a means to higher- level life goals Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect HCP inform Life itself adds it own complexity. Health is not the only priority in your life, and often other aspects of life — work, family and social responsibilities, and your personal happiness — take higher priority.

15. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Most people aren’t hermits 15 They belong to family groups whose actions are intertwined and have strong interactions Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect HCP inform In addition, most of us are social, and our lives are interwoven with others — family, close friends, and colleagues. Focusing only on the individual works only for hermits.

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

17. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Real-world care networks 17 These diagrams are from research I did last summer, they show the care networks for two people that were interviewed.

18. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Often many external influencers 18 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Influencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Also, external influencers include much more than healthcare professionals. There are many alternative health providers, the formal and informal media, neighbors, etc. who have some impact.

19. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Framework for seeing health technology opportunities 19 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform This diagram provides a framework for thinking about health technology opportunities, a way to see how we might help the person, the family take care of themselves.

20. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Formal & informal health information 20 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create 1. One obvious opportunity is for smarter and more personalized information.

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

22. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Sensors & diagnostics 22 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create Measure inform inform inform 2. Another hot space is new ways to measure ourselves.

23. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Lots happening here as well 23 Physical, psychological and environmental factors, wellness activities — as well as task execution and other aspects of life This includes devices to track physiological and environmental factors, as well as interactive apps 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 for innovation here.

24. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Analysis & visualization and personalized recommendations 24 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create Measure inform inform Analyze inform 3. However, all this new data exposes a new problem.

25. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Dearth of consumer solutions ... 25 For combining multiple and disparate sources of data, and making sense of it all. BodyTrack / Fluxtream Which is that we don’t have tools to learn from the data. It’s not enough to see a chart of just your weight, or just your sleep, or just your calories. Health is a multi-factorial issue, and we desperately need tools to see and learn from this data. Unfortunately today you have to be a whiz at using spreadsheets or statistical programming languages such as R. A step in the right direction is a project at Carnegie Mellon University in Pittsburgh 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 Mehta Communication & coordination, within family and with inﬂuencers 26 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create Measure inform inform Analyze Converse support inform support 4. Another area that is surprisingly difficult is supporting conversations about health, both within the family and with external partners.

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

28. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Making it easier to do the doing — “productivity” tools 28 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create Measure inform inform Analyze Converse support utilize support Enable inform support 5. The ﬁnal opportunity I’d like to bring to your attention is to help people “do the doing”. You can think of it as productivity tools for personal health.

29. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Dearth of consumer solutions ... 29 Repurposed tools Designed for the Consumer If these productivity challenges occurred in any profession, that industry would be screaming loudly 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 the consumer, for the unique needs of our personal, family lives are rare. There is much room for improvement 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 Mehta Unfrazzle Family caregiver’s assistant 30 Enable: Remember and keep track of any / all of your care responsibilities Converse: Stay in-sync with co-caregivers Unfrazzle is an app, available now for iPhone and soon for Android, that helps users remember 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 Mehta Remember the 99%! 31 Person/Family Health / Wellbeing Disturbances / Environment take(s) Actions (Daily Living)Observations made by affect to accomplish Goals & Plans Life affects Tasks affect New observations ... ... suggest new Actions ... affect affect Inﬂuencers (HCPs, “alternative” practitioners, media, extended family & friends) inform Inform inform create Measure inform inform Analyze Converse support utilize support Enable inform support So, in closing, for the rest of the weekend, I would like to urge you to remember that for over 99% of our lives, we are taking care of ourselves. In the future this could be much, much easier. This is a fertile ﬁeld in which to plant your creativity.

32. Rajiv Mehta rajiv@bhageera.com +1 650 823-3274 www.bhageera.com Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta Remember the 99%! Thank you.

Health technology for the other 99%

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