Health technology for the other 99%

Health Technologyfor the other 99%Health Hack Day, Stockholm, 17 May 2013Rajiv 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%.

Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta

Not talking about ...

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Just to be clear, I’m not talking about the Occupy movement.


Traditional perspective:Doctors & Patients

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Person

HealthcareProfessional

Traditionally for health technology we see healthcare professionals and people (also known as patients)


Doctors & Patients & Technology

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Person

HealthcareProfessional

MOSTHealth technology efforts

SOMEPatient Engagement

TelemonitoringPatient 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.


For most of our lives (>99%) we take care of ourselves

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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.



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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.



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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?



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Health 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.


A diagram of health self-management

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Person

Health / Wellbeing

Disturbances / Environment

take(s) Actions (Daily Living)

affe

ct

Goals& Plans

affect

Observations 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 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.


HCPs may have a strong influence on the person’s activities

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Person

Health / Wellbeing


take(s) Actions (Daily Living)

affe

ct

Goals& Plans

Observations made byNew observations ... ... suggest new Actions ...

HCP

info

rm

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.


It’s complicated ...

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There are inner loops of execution, with many opportunities for failure (e.g. “non-adherence”)

Person

Health / Wellbeing


take(s) Actions (Daily Living)Observations made by

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to accomplish

Goals& Plans

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New observations ... ... suggest new Actions ...

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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”.


Endless torrent of mundane tasks

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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.


Endless torrent of mundane tasks

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MEDICATIONS6a 9a noon 3p 6p 9p midnight

Insulin NovolinInsulin Novolog

MetforminACE InhibitorMulti-vitamin

Ibuprofen

Blood glucoseBlood pressure & pulse

Weight

EXERCISEWalk/Swim

YogaDIET/FOOD

Food JournalCarbs

OBSERVATIONSSleep

Excessive thirstExcessive sweating

Mood

BIOMETRICS

Herbal supplements

THERAPIESFoot massage

Breathing exercise

6a 9a noon 3p 6p 9p midnightMEDICATIONS

Morning supplements (6)Albuterol (nebulizer)

Hypertonic saline (nebulizer)Pulmozyme (nebulizer)

Tobi antibiotic (nebulizer)Pancreatic enzymes

AdvairNoon supplements (4)

Evening supplements (4)Bedtime supplements (4)

Caloric shakeTHERAPIES

VestAcapella

BIOMETRICSWeight

OBSERVATIONSSleepMood

Coughing episodeOTHER

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.


It’s more complicated ...

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And outer loops — health is a means to higher-level life goals

Person/Family

Health / Wellbeing



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Life affects

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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.


Most people aren’t hermits

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They belong to family groups whose actions are intertwined and have strong interactions

Person/Family

Health / Wellbeing



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Life affects

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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.


Networks of care

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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.


Real-world care networks

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These diagrams are from research I did last summer, they show the care networks for two people that were interviewed.


Often many external influencers

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Person/Family

Health / Wellbeing



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to accomplish

Goals& Plans

Life affects

Tasksaffect


affect affect

Influencers(HCPs, “alternative” practitioners,media, extended family & friends)

info

rm

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.


Framework for seeing health technology opportunities

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Person/Family

Health / Wellbeing



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Goals& Plans

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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.


Formal & informal health information

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Person/Family

Health / Wellbeing



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Inform

inform

create

1.

One obvious opportunity is for smarter and more personalized information.


Very active space ... much room for improvement

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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.


Sensors & diagnostics

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Person/Family

Health / Wellbeing



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Inform

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2.

Another hot space is new ways to measure ourselves.


Lots happening here as well

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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.


Analysis & visualization and personalized recommendations

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Person/Family

Health / Wellbeing



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to accomplish

Goals& Plans

Life affects

Tasksaffect


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Inform

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3.

However, all this new data exposes a new problem.


Dearth of consumer solutions ...

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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.


Communication & coordination, within family and with influencers

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Person/Family

Health / Wellbeing



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Goals& Plans

Life affects

Tasksaffect


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Inform

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Conversesupport

inform

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4.

Another area that is surprisingly difficult is supporting conversations about health, both within the family and with external partners.


So many choices ... and still it’s hard

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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.


Making it easier to do the doing — “productivity” tools

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Person/Family

Health / Wellbeing



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to accomplish

Goals& Plans

Life affects

Tasksaffect


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Inform

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Measure

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Analyze

Conversesupport

utilize

support

Enable

inform

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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.


Dearth of consumer solutions ...

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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.


UnfrazzleFamily caregiver’s assistant

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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.


Remember the 99%!

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Person/Family

Health / Wellbeing



affe

ct

to accomplish

Goals& Plans

Life affects

Tasksaffect


affect affect


info

rm

Inform

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create

Measure

inform

inform

Analyze

Conversesupport

utilize

support

Enable

inform

supp

ort

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.

Rajiv [email protected]+1 650 823-3274www.bhageera.com

Health Hack Day, Stockholm, 17 May 2013Rajiv Mehta

Remember the 99%!

Thank you.

Health technology for the other 99%

Health & Medicine

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