The document discusses the potential of personal health systems and mobile health (mHealth) technologies to support behavior change and chronic disease management. It makes three key points: 1) Chronic disease prevention and management is a major challenge that requires behavioral changes supported by tools like personal health systems. 2) Citizens are key co-producers of their own health, and their behaviors strongly influence health outcomes. Technologies can help promote healthier behaviors. 3) Personal health systems using mobile technologies, connected devices, self-monitoring, and persuasive feedback techniques can help catalyze behavioral changes needed to improve health and reduce healthcare costs.

1. mHealth perspectives towards 2015
and
Professor Ilkka Korhonen
Department of Biomedical Engineering
Tampere University of Technology, Tampere, Finland
September 1st, 2011
EMBC 2011

2. 2
Key messages
1. Chronic disease prevention and management
is our biggest challenge
 To efficiently prevent and manage them a
behavioral change is needed
2. Co-creation of health – citizen to be
understood as a key co-producer of health
3. 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

3. 3
CHRONIC DISEASE
CHALLENGE
3.8.2011

4. 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

5. 5
CITIZEN AS A CO-PRODUCER
OF HEALTH
3.8.2011

6. 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

7. 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 an
improved understanding of hygiene and public health than to any
other single cause.
The 20th Century was the Century of Medicine. Vaccines,
antibiotics, transfusions, and chemotherapy all helped to contribute
to longer, healthier lives. In 1900, the life expectancy of an American
was 49 years. In 2000, it was 77 years.
The 21st century will be the Century of Behavior Change. Medicine
is still making fundamental discoveries that can extend lives, but
changing daily, long-term behavior is the key to adding years and
quality to our lives. This will involve reducing risky behavior and
making changes in exercise and nutrition.”
Brian Wansink, Cornell University

8. 8
Catalysing behavioral change with
PERSONAL HEALTH SYSTEMS
3.8.2011

9. Personal Health Systems =
Health and Wellness Technologies
Designed for the Consumer
Monitoring + Connectivity + Analysis + Feedback

10. 10
Engineering building blocks:
mHealth, personal monitoring, wearable
monitoring, signal processing and interpretation

11. 1
1
Services and technologies designed in parallel
Services create needs for
new technology products
Services Technologies
Technologies enable
new services
Environment:
Organisational structures, laws,
regulations, guidelines, advocacy
groups, media
© Niilo Saranummi, VTT

12. 1
2
PHS Keys
1. Self-monitoring
2. Personal and personalised
feedback
3. Persuation
3.8.2011

13. 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)

14. 1
From monitoring to personal 4
feedback via intelligent analysis
HIC 2011 3.8.2011

15. 1
From information sharing to 5
persuation - 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!

16. 1
6
Framing effects matter
Source: Dan Ariely,
Predictably Irrational
(2008)

17. 1
Example: Choice architecture – framing impact
7
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18. 1
Choice architecture – nudging impact 8
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19. 1
Choice architecture – 9
predictably irrational
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Predictably Irrational
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20. 2
0
Setup:
• Normal weight and overweight consumers
• Ads shown before lunch
Arranging and framing insurance adds (control)
• Car information
helps 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

21. 2
1
Smart phone as a key platform for PHS
MHEALTH TRENDS
3.8.2011

22. 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 2.0
frame 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 models
Inflection
points
1970s- 1981- 1996- 2010
(c) Matti Mäkelin, Nexec Oy, Finland

23. 2
3
Smart 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 consumer
targeted eHealth services
3.8.2011

24. 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.

25. 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.

26. mHealth application categories
(Source: Research4guidance 2010)

27. Traditional vs. new mHealth market model
(c) Research4guidance 2010

28. mHealth
is
democratic

29. mHealth reduces provider revenues
Source: Healthhcare unwired, New business models delivering care anywhere,
Health Research Institute, PricewaterhouseCoopers, September 2010

30. 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?

31. (c) Frog design 2010

32. Thank you!
Ilkka Korhonen
Professor
Dept Biomedical Engineering
Tampere University of Finland
ilkka.korhonen@tut.fi