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Jennifer Shine Dyer M.D., M.P.HJennifer Shine Dyer M.D., M.P.H..Mobile Health EntrepreneurMobile Health Entrepreneur
Duet HealthDuet HealthColumbus, OhioColumbus, Ohio
May 2012May 2012
Social-ized Medicine: Apps, Patient Engagement, Entrepreneurship
• Pediatric Endocrinologist
• Health Behavioralist (MPH)
• Problem-solving technology entrepreneur
• Social media enthusiast (@EndoGoddess)
2007: Health Literacy, Online 2007: Health Literacy, Online ContentContent
2009: Twitter2009: Twitter
Used an app for the first time when I bought my iPhone, 2009
Bolus Reminder App, 2010Bolus Reminder App, 2010• When: Fall 2010 (never
released in App Store)
• Who: Dyer teen patients with diabetes on insulin
• Why: Automate personalized weekly SMS texting protocol
• How: Master phone has app, patient phones SMS texting only
EndoGoddess App, 2011EndoGoddess App, 2011• When: September 2011, Apple
App Store
• Who: any patients with diabetes on insulin (teens, young adults)
• Why: motivate, educate, trigger behavior of checking glucoses 4X /day
• How: self-entry glucose journal, iTunes rewards, diabetes online community motivating quotes
BasalBasal InsulinInsulin
Prandial Boluses
Insu
lin
0hr 24hr
BG
mg
/dl
Intensive Basal Bolus TherapyIntensive Basal Bolus Therapy
Meal BolusMeal Bolus
Pump download, missed meal bolusesPump download, missed meal boluses
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
HypothesisHypothesis
• Weekly personalized and interactive engagement via texting with the physician will improve meal bolus mindfulness and reduce hgba1c % within 3 months (at next clinic visit) in teens with type 1 diabetes.
MethodsMethodsWeekly Texting Protocol (Thursdays at 5pm)Weekly Texting Protocol (Thursdays at 5pm)• Initial greeting message• Customized question unique to each patient’s
interests (how is your lacrosse team playing?, how did your finals go?, how is marching band?, did you have fun 4-wheeling last week?)
• Questions specific to diabetes adherence: glucose testing, meal boluses, frequency of high glucoses, frequency of low glucoses
• Conclusion message stating continuation of text messaging at regularly scheduled time
ResultsResults
External Internet Services: Facilitate initial programming, Facilitate operations ofExternal Internet Services: Facilitate initial programming, Facilitate operations ofSMS texting delivery and storageSMS texting delivery and storage
Nick
Jonas
Music
Also loves Frappuccinos.
Hey Nick! I’ve added you to my address book!
Cool. Thanks! Keep rockin’ Dr. Dyer.
Dr. Dyer here. Hope the work on the new album is going well.
Nick. Hope the carb counting is going well. I know u love Frappuccinos! :)
Keep on rocking the boluses, Nick! See you in a few weeks. March 3rd
What IsnWhat Isn’’t Working?...t Working?...
• Bolus adherence and glucose checks decreased over time
• Needed motivation
• Needed reminders
• Needed more support
eproximiti.com duethealth.com
35
EndoGoddess App EndoGoddess App Hypothesis:Hypothesis:
• Target engagement behavior: glucose checks
• Motivating, educating, triggering this target behavior will lead to improved medication adherence
BJ Fogg’s Health Behavior BJ Fogg’s Health Behavior ModelModel
Literacy (ability)Literacy (ability)
Make the mobile phone give information at the right time:
• Online content without searching
• Frequently used links
• How-to videos
TriggerTrigger
Make the mobile phone DO SOMETHING at the right time:
• Send push notifications
• Add calendar events with alarms
• SMS
• CALL
• (Email)
MotivateMotivate
Make the patient WANT to take their medication:
• Utilize Game Mechanics
• Competition
• Social
Coding at Duet Health EproximitiCoding at Duet Health Eproximiti
Download from App Store Download from App Store (iOS,Android)(iOS,Android)
Platforms: iOS vs Android
EndoGoddess App: JournalEndoGoddess App: Journal
EndoGoddess App: Motivation EndoGoddess App: Motivation
• iTunes rewards points
• Friends/family sponsorship
• Social: daily motivational quotes submission
Motivation from Support•iTunes account deposits
•Social Network supportPositive reinforcement from friends & family: Motivation + rewards
Social Business Model: Social Business Model: Peer & Family Reinforcement/MotivationPeer & Family Reinforcement/Motivation
EndoGoddess App: TriggerEndoGoddess App: Trigger
EndoGoddess App: LiteracyEndoGoddess App: Literacy
How many diabetes apps are there?
«diabetes» OR «glucose» search oniTunes Norwegian Market
T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/
ResultsFeature Prevalence (%)
19/49 Apps Free
Mean Price = $4.00
Modal Price = $3.00
T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/
EndoGoddess App Future?EndoGoddess App Future?• EndoGoddess app RCT
• EndoGoddess Kids App
• ?Partnership with medical device (glucometer)
• ?Partnership with pharma for test strips
• ?EMR partnership and integration
• ?Advertisements
Patient Activation Measure Patient Activation Measure (PAM)(PAM)
Device Data IntegrationDevice Data Integration
EndoGoddess App Integration
• Agamatrix Sanofi Aventis iPhone/iPod-linked blood glucose meter iBGStar
• FDA approval in US (December 2011)
Affordable Care ActAffordable Care Act
DC Code-a-thonsDC Code-a-thons
DC Code-a-thonsDC Code-a-thons
@PhilBaumann @2healthguru@EndoGoddess
DC Code-a-thonsDC Code-a-thons
DC Code-a-thonsDC Code-a-thons
Accelerators/VCsAccelerators/VCs
CrowdfundingCrowdfunding
The Future:The Future:Insurers To Pay For Quality/PreventionInsurers To Pay For Quality/Prevention
“The most exciting breakthroughs of the 21st century will not occur because of technology but because of an expanding concept of what it means to be human.”
~John Naisbitt
endogoddess.blogspot.com/endogoddess.blogspot.com/
