Tuesday, July 17, 2012

Health Apps Rising

Today, Tuesday, July 17, 2012 iHealthBeat is reporting that although the number of mobile health applications has grown dramatically over the past few years, there has not been a corresponding rise in the number of people downloading health apps. Brian Dolan, editor and co-founder of MobiHealthNews, said data show the number of consumer health apps in the Apple Store has increased from 2,993 in February 2010 to 13,619 in April 2012. He noted, "But a persistent trend is that the majority of these apps are focused on tracking fitness or diet ... and far fewer are focused on what most people would consider true health problems, like chronic conditions or chronic condition management." Recent data from the Pew Internet and American Life Project indicate that about 88% of U.S. residents have a mobile phone and about 50% of those are smartphones. However, only about 10% of smartphone users have downloaded health-related apps, a figure that has remained steady since 2010. Susannah Fox, lead health researcher for the project, said, "We are in a situation where we have the technology and we certainly have the need -- just look at all of the statistics on the rise of obesity and other unhealthy trends." She added, "But what we have not yet seen is an uptick in the percentage of people who are adopting and using these health apps." Lee Ritterband -- director of the behavioral health and technology program at the University of Virginia -- noted that "We know very clearly that one size doesn’t fit all when it comes to the range of health issues: People need different things and need to be helped along and prompted given their particular needs" (Butler, Washington Post, 7/16). Current national demographic trends highlight the problems of a one-size-fits-all approach to health and healthcare. First, the aging of the US population is one of the most important demographic trends that will affect the future healthcare system. The currently aging health workforce also raises concerns that many health professionals will retire about the same time that demand for their services is increasing and when the healthcare system has little ability to respond quickly through traditional provider training programs Secondly, the changing racial and ethnic distribution of the population also has substantial implications for the future healthcare system. Disparities in access to care account for part of this difference, in addition to other language, cultural and socio-environmental factors. This has significant implication for providers. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients is projected to rise from approximately 31 percent to 40 percent. So what’s the solution? Firstly you should always get health insurance. Given consumer health IT’s increasing role in clinical care and patients’ self-care and self-management, one potential solution lies in designing health IT that is socioculturally-informed. To Health IT designers though, creating culturally informed consumer health IT can seem daunting. Recently a Culturally-Informed Design Framework has been proposed as a guide to socioculturally conceptualize and personalize four key dimensions of health IT including 1) the technology device/platform, 2) application functionality, 3) technology content/messaging, 4) the user interface. Informing design choices by a deep understanding of the user’s clinical needs and sociocultural factors may be the only way for emerging health IT tools to help the US healthcare system overcome the health challenges that lay before us.
Read more: http://www.springerlink.com/content/2190-7188 
Read more:http://www.ihealthbeat.org/articles/2012/7/17/number-of-health-apps-rising-but-download-rates-remain-low.aspx#ixzz20vPaCz9D

Wednesday, June 13, 2012

Uncomfortable with being Comfortable

Fitness maven Jeanette Jenkins recently tweeted that “to see big results you have to get comfortable with being uncomfortable.” In other words, making change happen, inevitably leads to emotional or physical discomfort. If you are serious about change you must be willing to endure a lot of discomfort. While this is no doubt true, I would take things one or maybe two steps further and say “Disruptive change will only happen when you become uncomfortable with being comfortable”! Yes, change is almost always hard. But not all change is sufficient, significant nor even good! There is probably no better example of this than in healthcare. Over the past decade there has been a significant amount of work done to understand healthcare disparities. This work has led to a lot of change (practice, interventions, policy, pharmacology) in many areas (Social Determinants of Health, Cultural Competency, Community Partnerships, Community Based Participatory Research, Environmental Health, Populomics, Big Data Science etc…) that took a lot of effort, on the part of many people to achieve, and the progress continues. Yet, as we look across our nation, as the latest volume of the National Health Care Disparities Report indicates, there has been no significant, sustained improvement in any disparity in almost a decade! Similarly, a huge amount of effort at many levels is occurring around the notion of bringing our healthcare system into the digital age through notions of Personalized Medicine, Genomics and more recently Health Information technology (clinical decision support tools, Consumer Health Informatics tools, Health Information Exchange). As with the previous example, much effort along these lines, has resulted in much change in many areas, however the hypothesized and potential impact of drastically improved healthcare processes and outcomes, particularly at the population level, have not been realized. While it can be credibly argued that we are just at the beginning of innovation curve in both these areas (as such it would be impossible to see significant change yet), I believe this is not the primary reason keeping disruptive improvements from happening. I believe this because when you study change, the type of large, life altering change that is so significant, the results could not have been predicted at the outset – so called disruptive change (iPhone, PC, Internet) – it rarely occurs as the end product of incremental improvements over time. Rather, the innovators, inventors, physicians, entrepreneurs or visionaries simply refused to be satisfied with the then current norms or absolutely relentlessly sought solutions to challenges that most others considered impossible. In other words they became uncomfortable with accepting the status quo or reaping the comforts that the status quo afforded, even though others may not be able to receive the same benefits. They became driven by the pursuit of one thing, not just change, not only improvements, not financial gain, but rather large scale solutions and wide spread problem elimination! They pursued these goals often in the face of constant criticism, in spite of the “conventional wisdom” and even against the realities of their own past experience! They remained focused on the notion that societal solutions or personal triumph over failure was achievable…period! Whether the goal is personal weight loss, professional achievement, disparities elimination, patient access to personal health data, societal health improvement, or global peace, resist the logical, evidence based tendency to be satisfied with “change”, and release yourself to achieve what others think impossible by first becoming uncomfortable with being comfortable!

Wednesday, March 21, 2012

Health by Southwest?

Although most health and HIT technophiles probably have never heard of it, The Austin Interactive Technology festival, (or South by Southwest [SXSW] as it is otherwise affectionately known) may soon become a “must attend” event for those serious about staying ahead of the health technology innovation curve. Last year almost 20,000 people attended. This year before it is all done there'll be more than 1,000 panels and presentations spread across 15 Austin Texas campuses.

Recently at SXSW, Ray Kurzweil made a presentation about his vision of a technology enhanced future. Kurzweil has been called a “genius" by the Wall Street Journal, and "the ultimate thinking machine" by Forbes. He was the principal developer of the first CCD flat-bed scanner, the first omni-font optical character recognition, the first print-to-speech reading machine for the blind, the first text-to-speech synthesizer, the first music synthesizer capable of recreating the grand piano and other orchestral instruments, and the first commercially marketed large-vocabulary speech recognition.

Mr Kurzweil believes that humans and technology are blurring and will eventually merge. (most of us have already grown smart phones and other digital devices at the ends of our fingers.) "We live in a human-machine civilization where everybody has been enhanced with computer technology," he told a capacity crowd of more than 3,000. "They're really part of who we are.” Kurzweil believes technology is advancing so fast that previously unimaginable inventions will be a reality within decades. He cited nanotechnology -- microscopic computers -- that will be 1,000 times more powerful than human blood cells and injected in people's bloodstreams to give them superhuman endurance. He also believes computer technology is democratizing society by empowering people."You can start world-changing revolution with the power of your ideas and the tools that everyone has," he said. "A kid in Africa has access to more information than the president of the United States did 15 years ago." He also predicted that "Siri will get better.", Moore's Law, will become outdated and useless in the next 8 years and in the future search engines aren't going to wait to be asked. They'll be listening [to humans] in the background. And [the search results] will just pop up."

Speculation, fantasy you say? Perhaps. What’s clear is that while everything has not come to pass, in 1960, the things we thought we would have and do in the year 2012 are in many cases, well beyond our 1960’s imaginations! So if things continue as they have, Healthcare in 2052 will likely look very different than what it looks like today, and technology will have a large role to play in what it does looks like. Healthcare leaders should embrace and help lead this inevitable change or else they will be forced to get out of the way and simply follow the innovation of others.

FMI - http://www.cnn.com/2012/03/12/tech/innovation/ray-kurzweil-sxsw/index.html

Monday, March 19, 2012

Participatory Medicine 2.0

Original post can be found at Project Health Design

In “Participatory 8000 Medicine: Must You Be Rich to Participate?” in the Journal of Participatory Medicine, Graedon and Graedon pose a question: “Is the participatory movement leaving [the non-affluent] behind?” Their article suggests that only the affluent members of our society can afford care that is participatory. Their premise appears to be built on two assumptions that should be regarded as faulty.

Redefining patient engagement

The first is that the only engagement relevant to the participatory community is the engagement between a patient and a clinical provider. The primary causes of morbidity and mortality in contemporary society are chronic diseases. By definition, individuals have these ailments for up to 30 or 40 years. Antecedents of atherosclerosis (fatty streaks) have been documented in 10-year-old children (5), yet most individuals only become aware of the existence of a problem after the age of 50. As such, the actions, behaviors and exposures that impact health begin early in life and are often the result of engagement with a vast array of individuals (relatively few of which are medical providers). In addition, most patients are actually in clinical settings for a relatively short period of time over the course of their lives. In other words, most of the interactions, or participation, that govern the important behaviors that impact health occur outside of the clinical setting and between patients and non-clinicians.

This reality is in no way an attempt to downplay the importance of either clinical encounters or clinical providers, but rather an attempt to illustrate the fact that when we fail to understand the full context of participatory medicine, we may similarly fail to understand the true barriers, drivers and opportunities for participatory medicine to make a difference. More importantly, we may also be unable to fully understand why patients have such difficulty achieving clinical goals or why well-intentioned and elegantly designed interventions yield only marginal results. In fact, emerging data suggest that patients are participating in their health care in a big way, just not as much with their health care providers.

Patients turn to the Internet for health information and support

For the first time ever, more Americans are turning to the Internet for health and medical information than are turning to health care providers.(1) In addition, emerging evidence suggests that the Internet has considerably more influence over consumer health decisions and actions than traditional channels like print, TV and radio.(3) The numbers of online health seekers have swelled to more than 175 million people to date.(6) Increasingly, they report having become informed and empowered. They have generally been able to find what they are looking for and report that the Internet is increasingly helping them to connect to emotional support and practical help for dealing with their health issues.(2) In fact, racial and ethnic minorities and the poor appear to be using some forms of technology more than their non-minority counterparts.(4)

We can argue and speculate as to why these things are happening or the long-term impact of these shifts, but the reality is that these shifts are, in fact, happening. These changes may represent an important opportunity to reach and engage many patients, including those who historically have been left behind. The most important questions then become:

Do our evolving notions of what health care and participatory medicine need to become include the realities in which patients live?
Will current and future health care providers embrace these realities and lead the inevitable change?
If not, we may be destined to well-intentioned but largely unrealistic notions that ultimately leave the health care system far behind where many patients are already going.


1) Cybercitizen Health v8.0. 2008. New York, NY, Manhattan Research.
2) E-Health Solutions for Healthcare Disparities. New York: Springer Pubs; 2008
3) Cybercitizen Health v9.0. 2010. New York, NY, Manhattan Research.
4) Korzenny F, Vann L. Tapping into thier connections: The multicultural world of social media marketing. 2009. Talahassee, FL, Florida State University Center for Hispanic Marketing Communication.
5) Tanganelli P, Bianciardi G, Simoes C, et al. Distribution of lipid and raised lesions in aortas of young people of different geographic origins (WHO-ISFC PBDAY Study). World Health Organization-International Society and Federation of Cardiology. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb 1993; 13(11): 1700-10
6) Taylor H. Cyberchondriacs on the rise? [electronic article]. 2010.