Quantified Self: Helping Physicians Empower Their Patients Best Practices And Technologies For Doctors And Patients Monitoring Chronic Diseases

1. Brought to you by
Quantified Self: Helping Physicians
Empower Their Patients
Best Practices And Technologies For Doctors And
Patients Monitoring Chronic Diseases

2. About the Moderator
Brian McGowan, Ph.D., Moderator, @BrianSMcGowan
Brian S. McGowan, PhD is your host for this series. Dr
McGowan is the Co-Founder and Chief Learning Officer at
ArcheMedX a healthcare informatics and e-learning
technology company. He is the author of '#socialQI: Simple
Solutions for Improving Your Healthcare'. He has lectured
both nationally and internationally on the need to drive
innovation in healthcare. He is currently consulting with
start-up companies, medical societies, patient advocacy
groups, and academic medical centers committed to
accelerate quality improvement through innovative
technology and frictionless information flow.

3. About The Panel
Sarah Krug, CEO, Cancer 101, @SarahKrug1
Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of the
Society for Participatory Medicine, a patient/provider member driven organization whose
mission is to enable collaborative partnerships between patients and healthcare professionals.
Kathleen Starr, Ph.D., SVP, Behavioral Insights & Strategy, Inventiv Health,
@DrHealthPsych
Kathleen holds a doctorate in Clinical Health Psychology from the University of Miami and
completed a post-doctorate fellowship at Duke University Medical Center. She has over 15
years of experience in the life science industry translating behavioral insight into commercial
strategy.
Robert Stern, CEO, Projects in Knowledge, @RSStern
Robert Stern is the founder, president and chief executive officer of Projects In Knowledge, an
ACCME-accredited developer of continuing medical education programs for physicians and
other healthcare professionals. Stern is also the founder and past president and chief executive
officer of MedPage Today, an award-winning medical news website.
Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddess
Dr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, an
accomplished behavioral researcher with a MPH in health behavior studies. She created the
award-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automate
her successful weekly SMS texting protocol that she used with her teen diabetic patients to
improve their insulin adherence.

4. How to Participate
• Submit your questions in the GoToWebinar presentation
window
• Follow along and share your thoughts on Twitter at
#HWClive
• This webinar will be recorded and available for
download a few days after the webinar

5. The Psychology of
Self-Monitoring Technology
Kathleen Starr, Ph.D.

6. 6
• Observing and Recording
› Target thoughts, feelings, and behaviors
› Real time
• Natural Environment Assessment & Therapeutic Tool
› Track patterns
› Assess progress
› Reinforcement or punishment
What is Self-Monitoring?

7. 7
Self-monitoring is a powerful change agent
Essential ingredient of self-regulation
Internal feedback loops that
regulate behavior
CognitiveAffective
Physiological
Current Situation Desired State (Goal)
digitalart at www.freedigitalphotos.net

8. 8
Is self-monitoring technology key to motivating people
towards healthier behavior?
tungphoto on www.freedigitalphotos.net

9. 9
No perfect linkage between motivation and behavior
Adoption
I’m going to give this a try.
•Behavioral consistency
•Goal setting
•Self-evaluation reaction
•Expectations for goal-related
performance
•Privacy expectations
Sustained engagement
I’m going to keep it up!
•Memory & attention
› Information overload
•Effortful self-awareness
•Information accuracy
› What am I learning?
• Causation versus correlation
•False sense of responsibility
Is lack of motivation the only problem?

10. 10
• Feedback Loops
• Reinforcement
• Social encouragement
• Cues
• Goal planning
• Incentives
How to super charge behavior change
Breaking habits
Starting new behavior
Maintaining behavior

11. 11
How to identify mechanisms underlying behavior
change in robust yet scalable ways
Future Directions
How technology itself impacts/changes models
of health behavior change
How to leverage technology to promote behavioral
maintenance

12. The Patient & Self-Tracking
Sarah Krüg
CEO, CANCER101
President, Society for Participatory Medicine
sarahkrug@cancer101.org

13. The FACTS
Pew Research Center/CHCF Health Survey, September 2012

14. The FACTS
What are patients using to track health indicators?
34% of individuals who track use non-technological methods such as notebooks or journals.
21% of individuals who track use at least one form of technology such as apps or devices.
Who are patients sharing their data with?
34% of trackers share their data or notes with someone else
52% share with a health professional
22% share with a spouse/partner
What is impact of self tracking and how are patients using their data?
46% of trackers say that this activity has changed their overall approach to maintaining their health or the
health of someone for whom they provide care.
40% of trackers say it has led them to ask a doctor new questions or to get a second opinion from
another doctor.
34% of trackers say it has affected a decision about how to treat an illness or condition.

15. Integrating Data into Daily & Clinical Care
Self-tracking experimentation: Patients needs to be able to figure out if their self-monitoring is
working (e.g. Diabetics who use glucose monitor to track blood sugar levels in correlation to food intake)
Clinical Care: Clinicians want to know how their patients are doing on a new treatment without having
to wait months or may want to provide encouragement or modify dosages (e.g. Tracking symptoms &
Medications)
Research: Data can act as research evidence to generate knowledge about what works, in which
context and for which patients

16. Technology & the Elderly
90% of the elderly have at least one chronic disease and 77% have two or more chronic conditions
In a recent study of patients between the ages of 65-100:
• 41% owned a PC, 61% owned a cell phone but adoption of other technologies lagging with 3% who
owned a smart phone, 3% a tablet, and 8% a laptop
• Of those in study none were currently using health monitoring devices that transmit health data to
their clinicians
• 40% who are thinking about using a self tracking device said they would prefer a clinician teach
them how to use the technology
Issues
• Clinician Coaching: #1 person elderly people want to train them on technology is the doctor—the
least likely person to train them
• Literacy: Screen sizes, fonts, menus, audio volume
• Costs: 71% had an annual income of $25K or less and unwilling to pay for technology

17. Krug, Sarah. “Bridging the HCP-Patient Gap.” Pharmaceutical
Executive. April 2011.
Patient EmpowermentPatient Profile

18. Participatory Medicine
Participatory Medicine aligns the HCP and patient on a common pathway
SHARED DECISIONSSHARED DECISIONS
“Participatory Medicine is a model of cooperative healthcare that seeks to achieve active
involvement by patients, professionals, caregivers, and others across the continuum of care on all
issues related to an individual's health. Participatory medicine is an ethical approach to care that
also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and
improve the cost of care.”—Society for Participatory Medicine
ALIGNED GOALSALIGNED GOALS
http://participatorymedicine.org/

19. CANCER101
Overview
CANCER101 Today
Navigator Distribution
 Cancer101’s Navigator guides patients through the cancer journey by:
‒ Providing information to understand treatment options
‒ Deploying tools to track and manage symptoms and medications
‒ Arming patients with a platform to keep it all organized
‒ Facilitating coordinated cancer management between patients, caregivers
and the medical community
‒ Enabling patients to document experiences in a way that complements
objective healthcare data gathered during the care process
 Thousands of cancer centers and community practices pre-order navigators and
provide them to patients at the point of care. Patients and caregivers can also
order directly through our website.
Navigator Sections
•Tumor Specific Information (22 different Cancer Types)
•myMedical History
•Questions to Ask Doctor
•Symptom Tracker
•Medication Tracker
•Medical Bills & Insurance Tracker
•10 Year Calendar & Appointment Tracker
•What is a Clinical Trial?
•Caregiver Support
•Medical Dictionary
•National Resources
We distribute approximately 100,000 requests per year and
receive over 300,000 requests for navigators.
We partner with over 1200 cancer centers and community
oncology practices to disseminate our materials in all 50
states & Canada. We have also received requests from over
40 countries.
Our Reach
http://cancer101.org/

20. Patient communities are emerging as key influencers and disrupting the healthcare landscape. They
are impacting strategies, policies, and setting the stage for new patient-centric innovations. Patients
are now sought after thought leaders influencing the way healthcare systems think about and interact
with patients and prodding them to improve the patient experience.
The Patient Shark Tank™: If you build it, they will come?
The Patient
Goal: To incorporate the voice of patient into the
design, development or enhancement of
technology being developed by the healthcare
community and move away from the notion: "If
you build it they will come".

21. Jennifer Shine Dyer, M.D., M.P.H.
Physician, Mobile Health Entrepreneur
Duet Health, LLC
EndoGoddess, LLC
Columbus, Ohio
June 19th, 2013
Quantified Self: Pediatric
Diabetes Case Study

22. Problem: Adherence

23. Endocrinologist

24. 1. Support glucose
checking
Patient Engagement: Physician Role

25. 2. Support glucose logging
Patient Engagement: Physician Role

26. 3. Support meal (bolus) insulin dosing
Patient Engagement: Physician Role

27. BasalBasal InsulinInsulin
Prandial Boluses
Insulin
0hr 24hr
BGmg/dlIntensive Basal Bolus TherapyIntensive Basal Bolus Therapy

28. Meal BolusMeal Bolus

29. Pump download, missed meal bolusesPump download, missed meal boluses

30. Barriers to Bolus Adherence:Barriers to Bolus Adherence:
• No insurance
• Low socioeconomic
status
• Reduced health
literacy
• Lack of frequent office
contact
• Over/under
involvement of family
• Family conflict
• Depression
• Adjustment disorder
with chronic disease
• Eating disorder
(diabulimia)
• Forgetfulness
• Fear of low blood
glucose reaction
• Peer pressure

32. This is Paige.

34. Paige has insulin-dependent diabetes.

35. …and loves her smart phone.
A SMS texting pilot study that Paige was
a part of helped her to remember to
check her blood sugars and to take her
insulin.

36. However, texting stopped helping Paige after
3 months…

46. Weekly Prepaid Visa Card

49. BRIDGING THE GAP
@ehrandhit : Some day someone is
going to ask me for the data (an ACO
or someone else). Are you ready for
others to see your metrics?
-John Lynn, Founder EHRandHIT
@ Point of Care360TM

50. BRIDGING THE GAP
@ Point of Care360TM
Real Time Clinician
Knowledge
Real Time Patient
Data

51. BRIDGING THE GAP: FULL 360°
@ Point of Care360TM
Clinicians Self reported real-time dataHIPAA compliant messaging
PatientsClinician knowledge support Health care organizations
CLINICIAN PERFORMANCE IMPROVEMENT
MEASURING PATIENT OUTCOMES

52. BRIDGING THE GAP: FULL 360°
@POINT OF CARE360™ WITH MY360™ PATIENT COMPANION APP
@ Point of Care360TM
@Point
of
Care360
™
My360
™
PatientsClinicians Data

53. SYNCING CLINICIAN WITH PATIENT DATA
@ Point of Care360TM
ENGAGING CLINICIANS
• Patient driven learning
• Integrate patient reported data
in context with @Point of Care360™ clinician
platform
• Allows clinicians to track patients between visits
• Reports Level 7 patient-centered outcomes
• HIPAA-compliant

54. ENGAGEMENT DRIVES ADHERENCE
@ Point of Care360TM
•ACCOUNTABILITY FOR CLINICIANS
•ACCOUNTABILITY FOR PATIENTS
•ACCESS TO RELEVANT INFORMATION

55. SYNCING CLINICIAN WITH PATIENT DATA
@ Point of Care360TM
PATIENT GRAPHS: SHARED DATA
Shared Graph Component
MY360™ Patient App @Point of Care360™ Clinician App
On demand Sync
Component
On demand Sync
Component

56. BRIDGING THE GAP: FULL 360°
@ Point of Care360TM
Maximizing reimbursement
through data
@Point
of
Care360
™
My360
™
PatientsClinicians
Analytical
Health360™
Healthcare
Organization
Core relationship
Empowering clinician &
patient engagement
Championing MU 2 & 3 in
the industry
Outcomes

57. How to Participate
• Submit your questions in the GoToWebinar presentation
window
• Follow along and share your thoughts on Twitter at #HWClive
• This webinar will be recorded and available for download a
few days after the webinar

58. About The Panel
Sarah Krug, CEO, Cancer 101, @SarahKrug1
Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of the
Society for Participatory Medicine, a patient/provider member driven organization whose
mission is to enable collaborative partnerships between patients and healthcare professionals.
Kathleen Starr, Ph.D., SVP, Behavioral Insights & Strategy, Inventiv Health,
@DrHealthPsych
Kathleen holds a doctorate in Clinical Health Psychology from the University of Miami and
completed a post-doctorate fellowship at Duke University Medical Center. She has over 15
years of experience in the life science industry translating behavioral insight into commercial
strategy.
Robert Stern, CEO, Projects in Knowledge, @RSStern
Robert Stern is the founder, president and chief executive officer of Projects In Knowledge, an
ACCME-accredited developer of continuing medical education programs for physicians and
other healthcare professionals. Stern is also the founder and past president and chief executive
officer of MedPage Today, an award-winning medical news website.
Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddess
Dr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, an
accomplished behavioral researcher with a MPH in health behavior studies. She created the
award-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automate
her successful weekly SMS texting protocol that she used with her teen diabetic patients to
improve their insulin adherence.

59. Thanks for Joining Us
• This webinar will be available on-demand at
www.HealthWorksCollective.com.
• Stop by to learn more and share your comments.