My 2012 Prediction: Action Not Theory

I predict that 2012 will be a year of actions and not just theory in mobile health. This is primarily due to a realignment of payment incentives (or lack of payment) by the Affordable Care Act which will go into action in October. Starting in October, hospitals will be financially penalized for readmitting Medicare patients whose relapses were preventable. Low-cost technology tools such as mobile health programs or remote monitoring devices will pay for themselves — and then some — if they prevent even a single $10,000 hospital readmission.  It is just simple math.


Therefore, I predict that hospital systems and payors will be turning more and more to evidence-based mobile health purchases and implementations that affect health outcomes. My partner Duet Health and the EndoGoddess app are now speaking with several different collaborating partners and will fill you in with details when things become official so stay tuned! Watch for exciting developments for patient-centered, outcome-centered mobile intervention ACTION in 2012!

Holidays and Technology

As a doctor at family gatherings, I am often asked numerous medical questions by family members each year which started during my first year of medical school. But now, as a technology entrepreneur, I get asked technology questions too. Over the holidays, one of the kid's iTouches met the toilet, and appeared to stop working. Tears quickly ensued in the 8 year old little girl's eyes until the 'technology family members' came to the rescue with the special instructions (which they searched for with their smartphones) to bring it back to life: low-grade heat and rice. The first Christmas miracle of the night pictured here.

The second Christmas miracle of the night came in the form of new interest in mobile technology from an older relative who still finds email intimidating. However, she's finding herself  now open to the idea of smartphones for their ease in sending pictures to her grandchildren. Mobile technology just feels more approachable to her than PCs, and now she may soon be purchasing an iPhone!

Smartphones and tablets dominated my family's and friend's wish lists this year so it wasn't a surprise to me that a lot of app shopping seemed to be occuring on Christmas day. I'm super excited to report that the EndoGoddess app picked up a batch of new customers thanks to all of those 'technology family members' in living rooms across the country on Christmas day!

A New Year and A New App?

The end of the year is approaching and we are all likely planning how we are going to convert our new years resolutions into actions. For organizations such as hospital systems or for individual physicians practices, perhaps mobile health is on that list. A great first step to putting that resolution into action is reaching out to a mobile partner. My partner (and disclaimer, happily my employer too) is Duet Health by eProximiti. Duet Health is building great white-label apps (including the EndoGoddess App) from the ground up. Here is a demo:

Will we be building your app be next?? :)

How A Diabetes Pilot Study Led To App Development

The EndoGoddess App developed from the seeds of a diabetes SMS texting pilot study that I created and executed in 2010. The pilot study showed how weekly standardized texting conversations between the physician and teen patients could improve health outcomes. This piece was filmed August 2010 at Nationwide Children's Hospital in Columbus, Ohio by NBC:

My mHealth Summit Summary

I just returned home from mHealth Summit Meeting in DC which, in my opinion, is still one of the biggest and best mobile health conferences of the year. On the first day of the conference, I discussed the EndoGoddess App as a use case example of mobile health from the practicioner point of view.

There were many great networking opportunities but my favorite was at the Rock Health's Disruptive Women Party where I had the pleasure of meeting other ambitious women who were also technology entrepreneurs.  Pictured with me above on the far right is Deborah Fergusson, of Ayogo Games, who created the awesome facebook game HealthSeeker along with Diabetes Hands Foundation. I have always admired the idea of games and social media to influence health behaviors so it was a THRILL to meet Deborah, a nurse by training. The game is discussed below:

Sadly, the numbers of physicians in the mobile health entrepreneural space at mHealth Summit were still few and essentially unchanged from last year by my counts. Although I realize that many actively practicing physicians cannot attend all technology meetings, I would consider mHealth Summit to be that one meeting a year that an ambitious physician mobile health entrepreneur would take the time to attend. Therefore, I am assuming that this correlates with a low number of physician entrepreneurs in the marketplace. Although large numbers of physicians are certainly using smartphones, there is still a notable lag in the incorporation of mobile health within the traditional medical practice. For example, case examples of physicians recommending health apps to their patients and then measuring changes in medication adherence or health outcomes are not common. Additionally, mobile phone sensors as a dominant outpatient diagnostic tool is also uncommon although cardiologist Dr. Eric Topol mentioned that his mobile phone vscan ultrasonic sensor has now replaced his stethoscope in his outpatient clinic. Exchanges on twitter such as the one listed below may mirror the fact that perhaps physicians aren't taking mobile health seriously:

I hope more of my fellow physicians take the opportunity to use their voices (as new entrepreneurs) to shape the future of medicine into the one that they would like to see. Physician voices are important and a critical part of making mobile health and other technologies successful in improving patients' lives. Hope to see and hear more physician voices next year at mHealth Summit! :)

EndoGoddess, Mobile Apps, and Congress

Yep, I recently had the opportunity to spend a day in the US Congress at the first congressional hackathon on December 7th in DC. The event brought together technology entrepreneurs and social media enthusiasts to brainstorm how to modernize congress and to make it more social.



Interestingly, the issues and challenges discussed were very similar to those faced in the modernization of medicine:

• a zero margin of error
• critical data transfers and data entry in real-time
• rethinking data so as to make it more useful and engaging to patients/constituents 

Perhaps it is as simple as saying that modern democracy and modern medicine is best when it is transparent and social. It is VERY exciting to be a part of this modern renaissance that claims its success when we are ALL actively participating in our government and our healthcare. Engagement is most certainly my #1 goal in mobile health and measure of success. Here is a great video summary of the event and of what we came up with:

EndoGoddess App To Go To Paris!

I am soooooo excited to be asked to speak in Paris in May 2012 at Doctors 2.0 on how social media, web 2.0, and mobile applications are impacting healthcare. New communities, new services, new tools, mobile apps are extending the reach of professionals and patients, raising both opportunities and challenges which will be discussed....from the doctor and patient point of view.



These 10 questions and more will be covered at Doctors 2.0 in 2012:
What do we know about e-patient experiences and Doctors 2.0?
Which healthcare social media campaigns by pharma, government, and hospitals work?
Where are we with regulatory and legal?
What do new patient communities look like? What is new with PatientsLikeMe? How are their European counterparts developing?
What is the Quantified Self movement and how does it impact chronic disease?
What is new in online consultation?
Which mobile applications are popular with professionals and also patients?
How do online communities engage physicians in Emerging Markets, North America, Europe?
How is Med Ed changing as a result of Mobile Apps, Social Media and online communities?
Should you be considering 3D video or Serious Games?



You can also see my video promo here too:

NBC Features EndoGoddess App!

Taking Risks: Entrepreneurship

While attending BlogWorld Expo in LA this week, I have been busy speaking but mainly listening. As is typical at conferences, I find most of my inspirations from the patient voices. Speaking to diabetes blogger Kerri Sparling of Six Until Me was a huge pleasure:

My brain is cluttered right now with inspiration and questions, but I would like to share one thought on what I was asked about the most: leaving academic medicine and becoming an entrepreneur. Many reasons played into my decision:



1. Timing. The combination of the rising epatient movement, the increase of social media allowing new voices in the collective whole to be heard, the passing of patient-centered Affordable Care Act legislation and the consequential restructuring of payment incentives toward quality rather than quantity of services, the approachability of technology and development, the enthusiasm behind investments in related healthcare startups despite otherwise dismal economic growth in other sectors, the upcoming expected necessicity for pharma to embrace new business models upon patent expirations, financial incentives rewarding embracement of electronic health records with a consequential more positive change in adoption culture, and the baseline independent popularity of mobile phones among doctors and patients...it is the perfect storm for consumer-based mobile health solutions to be embraced and paid for and effective.

2. Passion. I really began all of my social media and mobile health app developing endeavors as a hobby. I often found myself up late into the wee hours of the night before a clinic working on various aspects of my early mobile health work without realizing how late it was. I truly love working on mobile health, and still often lose track of time!

3. Business Planning. After speaking to MANY people in the mobile health space, I became convinced that I was not the only one that had enthusiasm for the power of mobile health to improve health outcomes and that indeed, making a living was possible. And so, I began the journey of planning.

4. Courage. My patients gave me the courage to pursue this journey by continually asking me when they could download the EndoGoddess app. However, it was also the courage that my patients showed me everyday in their will to live their lives well despite diabetes that also inspired me. Their enthusiasm and grace gave me the courage to leave academic medicine and work on finishing the app full time so that they could indeed download it.

In conclusion, now 6 months into this journey, I am happy, challenged, thrilled, and fulfilled everyday. This is a life that certainly has risks but as Amber Naslund, social media strategy expert and author of the awesome book The Now Revolution, said in her Blogworld keynote after answering the same question: 'don't be afraid to take risks people, it's called living.' I am truly living. :)

A New Project: My Diabetes Digital Magazine

Sitting in a hospital waiting room recently while helping a friend navigate through the healthcare system, I became acutely aware of the fact that there are very few magazine options for young people with diabetes. Furthermore, publishing is changing rapidly and becoming more digital and mobile focused.

I would love to see a young (18-40yo) diabetes magazine on the iPhone's newsstand so that I can read this in the waiting room (or when I'm at the hair salon, grocery store, airport, etc). Thus, I have teamed up with comprehensive creative media company Mills James to begin creating content for such a magazine. Here is a sneak peak of the platform we call 'folio' showing how ads within the magazine can be interactive:

I am hoping that you will be able to see the first issue Spring 2012. We will be making both a female-focused issue and a male-focused issue so that lifestyle topics affected by diabetes such as fashion, hobbies, relationships are covered from each perspective accordingly. Stay tuned for more information over the next few months. The magazine is a subscription rather than a prescription for living GREAT with diabetes!!

A Personal Story

Stories are the first way we learn as children. So, I am going to share my personal story in the hopes that a lesson is learned from reading this post. I lost my sweet English Springer Spaniel, Sadie, 2 weeks ago. I was lucky enough to have her with me for almost 15 years. We were inseparable and as connected as two souls can be.

Despite speaking frequently about the power of online communities to help with healing and being able to recite related behavioral theories, it was hard for me to write a message on the English Springer Spaniel Lovers Facebook Page. I don't like being vulnerable, and asking for support feels vulnerable: what if it makes my pain worse? What if I'm really crazy to miss my dog as much as I do?


However, using my mobile phone gave me the courage to write on the English Springer Spaniel Lovers Facebook Page. It felt intimate and safe to use my mobile phone to do so...perhaps because I associate my phone so closely with texting my lovely friends and family. And, just like the theories and studies I often recite in my speeches about healthcare and the power of online communities, I felt the overwhelming power of support from a community of peers who assured me I wasn't crazy to feel like I did. The support didn't make my pain disappear, but it replaced my pain with a feeling of connectedness to other dog lovers who honored my sweet Sadie through their support.


The Moral of the Story: I am thankful that my mobile phone gave me the courage to join an online support group and to begin to heal. This experience inspires me to continue further community development within the EndoGoddess app to allow users with diabetes to more easily gain that courage to heal their pain too. And yes, you guessed it: I wrote this piece using my mobile phone! :)

Waiting Room: No Cell Phones Sign

While I was in the waiting room of a local hospital today helping a very dear friend navigate through the healthcare system, I needed some good reading material. I was really hoping to find some great up-to-date information about the condition that my friend faces while I was waiting. Sadly, I only found one magazine rack and NO health materials around.

This is a sign that I found just above the magazine rack. It demonstrates the large ocean between the excitement on the mhealth frontier and implementation within medical practices and hospitals. There is alot of work yet to be done.


However, I am not discouraged. Just because something is hard does not mean that it is wrong. Reducing the ocean that divides mhealth excitement and implementation is certainly possible. A marathon rather than a sprint is what it will take, and I am certainly a runner in this exciting race.

Diabetes Awareness: Blue Fridays

The blue O in the EndoGoddess logo represents the diabetes awareness symbol. Diabetes awareness and education is one of my central goals. I am honored to have been asked to participate in this sweet video announcement made by the diabetes online community (#dsma). This video highlights the 'Blue Fridays' diabetes awareness movement which occurs every November. I hope to see you wearing blue in November, too!

EndoGoddess Goes To Mayo Clinic

Am packing for a fun-filled, educational few days at the Mayo Clinic Social Media Summit. I am honored to have the chance to discuss how the EndoGoddess app incorporates online communities and social media principles in an effort to improve diabetes health outcomes.

If you would like to see the rest of the agenda, you can click here. You can follow the conference in real-time via twitter using #mayoragan.

Tech Bubble

I think I might have been living in a tech bubble over the past several months. However, yesterday it popped.

Yesterday, I heard a great presentation given by a passionate middle-aged primary care physician who donates her time weekly to practicing medicine in a free clinic for the homeless within a homeless shelter in Columbus, Ohio. Amazing right? Even more amazing...this was her FIRST time to give a powerpoint presentation and she was nervous about using the technology!


The irony of having recently attended Stanford's Medicine 2.0 in Silicon Valley where conference badges had QR codes to attending a conference by The Ohio Association of Free Clinics in Columbus Ohio yesterday where powerpoint is a novelty really demonstrates some of the real life barriers that healthcare technology visionaries such as myself must not lose perspective on.


Physicians such as this wonderful one are doing truly fearless humanitarian work right here in the US on the frontlines of medicine caring for the underserved population. Yet, notable fear by some healthcare providers is present with regards to technology. Interestingly enough, this physician DOES have a smartphone and DOES feel comfortable using it. She uses her smartphone mostly outside of the clinic in her personal life but also uses apps inside of the clinic. She often looks up drug interactions using Epocrates mobile app while in the clinic which is consistent with national trends reporting that 80% of physicians use smartphones in their daily medical practice. I'm happy to see concretely that mobile health via smartphones offers a solution to technology fear by healthcare providers given data showing growing numbers of provider users both inside and outside of the clinic. This is different than powerpoint or EMRs given that healthcare providers are rarely using these technologies outside of the professional environment.


I will try hard to maintain a healthy appreciation of the fear that some healthcare providers have about technology. However, I have confidence in my pursuit of a mobile health future knowing that a fearful powerpoint novice is not afraid of her smartphone. Thus, a mobile health future is tangible, and even welcomed.

Medical Device Discussion

Future directions for the EndoGoddess app: integration with medical devices?

Check out my #MedDevice chat interview with medical device marketing consultancy @MedicalMarcom:

http://www.medicalmarcom.com/blog/?utm_source=Endo

The App's Purpose

A few readers have asked me to clarify the purpose of the EndoGoddess App. The main purpose of the EndoGoddess App: a glucose journal that you get rewards from. Here is an example of the old-fashioned glucose journal that all diabetes patients are very familiar with:

The EndoGoddess App serves as a more modern form of journal for your glucoses (also with corresponding carb intake and insulin dosing).

However, the journal also has a rewards (and points) feature. In the next month or so, you will be able to download an iTunes song weekly if your points are high enough. You can keep track of your points on the home page currently.

Diabetes Apps: The Competition

A wonderful academic review paper assessing qualities of available diabetes apps for self-monitoring was recently published (link here). Different elements of app function were assessed among 49 apps that were identified as quality self-monitoring apps (features % prevalence among the 49 quality apps):

I am excited that the EndoGoddess app not only offers insulin and carbohydrate journaling but also a social media component, an education component, and alerts/reminders. Later in the year, the EndoGoddess app will also offer a PHR web portal to more easily manage diabetes glucose and carbohydrate data.

Glucose Logging

I am dedicating this blog post to Auntly H, a diabetes patient blogger in Minnesota (@auntlyh on twitter). Auntly asked me to discuss what the glucose log looks like. The log can be easily shared from the EndoGoddess app to an email address.

Right now, the email log does not include time stamps beyond the date but we are changing that this week so that both date AND time stamps go with the email.

Easily shared glucose data is very important for good health as diabetes patients are often dealing with multiple medical offices for their medical care. Sharing data easily is something that the EndoGoddess app is very proud of as this is a unique yet important feature.

App Icon or App Avatar?

It is interesting to me that this symbol doesn't really have a formal name other than app store icon. At first I thought is was called an app avatar but apparently that is not true. What do you think it should be called?


Anyhow, the EndoGoddess app icon or avatar widget will be available soon with a direct link to the App Store on this page.

Ready For Download!!

Yay!!

Go to the Apple App Store and search EndoGoddess where you'll find the app.

Start collecting points when you enter your daily blood glucoses and you will be able to eventually cash those points in within the iTunes store for a song download (this transaction isn't quite finished in the programming but will be soon).

In a few days, there will also be a place for you to enter your comments and YOUR ideas for inspiring quotes which help YOU get through a hard day with diabetes.

New features will automatically be updated through the App Store but check back here for the latest.

Android version will be here soon... :)

Columbus Ohio vs. Silicon Valley

I just returned from an inspiring trip to Silicon Valley to discuss advances in mobile health at Stanford Medicine 2.0 . It was wonderful to be surrounded by the positive Valley vibe which radiates that anything is possible.

However, upon return to the 'real world' here in Columbus Ohio, I feel that being surrounded by the challenge of implementation of these tools is actually an advantage and more likely to produce a product that works for most people. A post that I read recently summarizes it best:

• People Still Don’t Know What Craigslist Is – While people in the Valley are talking about how Yelp.com is already passe, keep in mind that most people still don’t even realize what Craigslist is.  I ask people all the time how often they use Craigslist and 9 out of 10 respond “What’s Craigslist?  Is it like Angie’s List?”
• People Don’t “Need” Venture Capital – Because the costs of operations are a fraction of the costs in the Valley and frankly because there is so little of it outside the Valley.  What happens when capital is so scarce is that companies are forced to figure it out without capital – and they do.  Companies are run for customers/patients/users and profits, not for VC’s.
• No One Throws Launch Parties - We’re all too busy in Columbus actually building companies to take the time to wallow in our own manufactured successes.  We’re also likely spending our own money, which no one would waste away on launch parties.
• Most Users Live in Columbus, Ohio – Sure, people in the Valley think a new Web app is sweet.  But getting a bunch of other nerds to use an app only buys a small initial audience.  Critical mass comes when you get the everyman to use your app, and the everyman lives in Columbus, Ohio.
• Our Businesses Need to Earn a Profit – Maybe people in the Valley can afford to squander $20 million on a product that has no revenue model in hopes it’ll get bought.  The rest of the world has to build real companies that make real money to sustain themselves.

I am in agreement with these points. Your thoughts?

APPROVED...(but a few graphic problems, ready on Friday)

So excited to report that the EndoGoddess app has been approved!! It was temporarily available for download today but we took it down because of a few graphic problems. But, no worries because it will be ready for sure for download on Friday September 23rd. YAY!!! :)

Waiting Game

Waiting, waiting, waiting on the Apple App Store after submitting the EndoGoddess app on Saturday. Luckily, work on the android version will be finished this week, too. The wait for the android store is only 24hrs. Feels like watching paint dry for an impatient person like myself. But, 7-10 days and 24hrs will be here soon enough so I am learning to try to live in the 'now' moment. :)

Style and Mobile Health

New York Fashion Week started several days ago where innovations in style are celebrated within the fashion world.

Style has an important function in the mobile health world, too. App design and style translate to the user experience. Without a good user experience, there are no users and thus there are no influences on health outcomes. On the EndoGoddess app, I have worked closely with Eproximiti's resident artist to develop an inviting and of course fashionable style to the app so that the user experience is one that is inviting and beautiful.

Another great example of style in mobile health is AgaMatrix' nugget which is a glucometer that works with the iPhone as well as independently and is pending FDA approval soon. The sleek design did not happen by accident. In fact, the chairman and co-founder, Sonny Vu (who is also a friend of mine from Oklahoma), started out college as an art major!

So, what is the future stylish direction for the EndoGoddess app? Integration with a sleek mobile phone glucometer would be ideal so as to eliminate self-entry of glucoses within the app and to make life even easier for those living with diabetes. Just a dream right now.

EndoGoddess App Version 1: Apple App Store Submission!

I am excited to report that version 1 of the EndoGoddess app is ready for submission to the Apple app store! After submission, you should be able to download the app in 7-10 days so watch for it in late September.


The rewards points are alot like foursquare. However, cashing in points for iTunes download rewards is not yet available on this first version. The ability to submit feedback within the app is also not yet available. But, updates will be frequent and often with the feedback function being ready next week.


Feedback will be an important feature. Many future versions of the app will be in response to your feedback because listening is a priority with the EndoGoddess app.

The Diabetes Online Community (DOC)

The Diabetes Online Community (DOC) has a large presence on the internet - one of the largest chronic disease communities online. This community provides a place for people with diabetes to communicate with others that understand the mental, physical and emotional side of diabetes and how to embrace it and spread diabetes awareness.

Every Wednesday evening at 9pm EST, there is a moderated hour-long Twitter chat (Diabetes Social Media Advocacy or #DSMA) dedicated to diabetes themed discussions. Varied members of the diabetes online community come together to share their thoughts and opinions on issues important to them. Topics have included: juggling diabetes at work or school, online privacy, regulatory agencies, advocating for diabetes, and many more. The conversation is taken a step further on Thursdays via a live interview known as DSMA Live. Each week, Cherise Shockley along with co-hosts George Simmons and Scott Johnson, speak about the current week’s topic with a different guest every week.  People participate by calling in or chatting on the message board. You can continue the conversation from twitter by joining Cherise, George and Scott every Thursday, 9 PM EST on DSMA Live (blog talk radio).

I am honored to be part of the conversation this week on #dsma and #dsamlive discussing the meshing of the awesome diabetes online community (DOC) and mobile health with the EndoGoddess app. Tune in and be a part of the conversation too! You can link directly here: http://dsmalive.com/2011/09/06/dsma-live-with-dr-jen-dyer-md-mph-on-982011/ 

Evidence-Based App Design

The EndoGoddess app has a scientific evidence-based design derived from BJ Fogg's Health Behavior Model (http://www.behaviormodel.org/). The model confirms that three elements must converge at the same moment for a health behavior or outcome to occur: Motivation, Education, and Trigger. When a behavior does not occur, at least one of those three elements is missing.

The EndoGoddess app supplies all three elements for targeting the behavior of checking glucoses 4 times per day:

• Motivation comes from iTunes rewards on a weekly basis so that the user can download a song
• Education comes from the multimedia content within the app related to diabetes
• Triggers come from the app's daily inspiring messages taken from the diabetes online community as well as medication reminders or alarms that each user designates

We all know diabetes is hard work so it's about time that someone rewarded us for it!! The EndoGoddess app rewards, educates, and triggers or inspires people with diabetes to check their glucoses 4 times per day.

Picking My Partner: Eproximiti Duet Health

When I began programming a simple app to automate the SMS texting protocol that I designed and used in a small pilot study with my patients, I did not intend on making it commercially available. In fact, I intended the app to be used only by myself for research. My original app is pictured on the left.

However, several mobile health startup companies approached me over the past year with ideas to expand the app. I ended up partnering with Eproximiti after they introduced themselves to me. Their software platform is called Duet Health as it involves both the patient and the doctor in development. When we met earlier this year, I was instantly impressed with their patient-centered mission, their local location in Columbus Ohio, and their swift ability to produce beautiful and functional app products. Together, we designed the EndoGoddess app with many more features than the app that I originally programmed on my own. I highly recommend collaborating with Eproximiti to any physicians out there who have a mobile health app idea that they would like to see come to life.

In The Beginning...

I am starting a new blog. I have decided to chronicle the adventures that I am having upon the release of my new EndoGoddess app. Health app development feels a little bit like writing a book that 'does something'. So, I thought I'd actually write about what it feels like to share my app, aka my baby, with you and let it do what it was born to do...help motivate and celebrate the hard work it takes to live well with diabetes!