EndoGoddess App Goes To DC!

I am honored to be invited to discuss the EndoGoddess app use for diabetes in the Hispanic community at the National Hispanic Medical Association 16th Annual Conference in DC later this week. There will be a White House briefing appearance as well! Watch for updates later this week on my adventures in diabetes technology advocacy in DC. :)

EndoGoddess App Update

The EndoGoddess App launched in September 2011 as a work in progress. As of today, the unique points reward feature is present but the ability for users to cash those points in for iTunes downloads has not yet been updated in the app store.

The EndoGoddess App is one of several entrepreneural products that have been produced by mobile software startup Duet Health (formerly named Eproximiti). Otherwise, we at Duet Health have been making proprietary products for healthcare companies and hospitals. Happily, those clients have been growing. However, that means that time for coding and updates is diverted to making products for clients until the entrepreneural products, like the EndoGoddess App, receive more investment funding to pay for the time that it will take to finish the necessary software updates as well as finishing the building of the exciting app accessory features which are currently only partially built (meter connectivity, CGMS connectivity, EMR connectivity, prescription renewal, patient portal).

Since the launch of the EndoGoddess app, the growth of new users has slowed down some. I believe that the lack of noted iTunes software update has likely slowed growth. Interested investors have said that there need to be more users before they will invest. However, time is money and thus time spent for EndoGoddess App updates takes away from Duet Health's proprietary revenue. Thus, as in the diagram above, the EndoGoddess App is stalled right before the 'release of improvement'.

Determination and hard work are two things that I know well from medical school and medical training. So, the pursuit of more EndoGoddess App funding is my new target. I know 100% that the EndoGoddess App is a GREAT product for patients and an engaging tool that endocrinologists can happily recommend to their patients to motivate their glucose checking behaviors and to improve their health outcomes, especially for teens. Thus, you can bet that I will be chasing after as many opportunites and reward challenges and accelerators that exist. Stay tuned! :)

Diabetes Technology History

This is a great picture that has been circulating amongst the diabetes online community:

This is a picture of the very first insulin pump from the 1960s by Dr. Arnold Kadish. It was worn on the back and was roughly the size of a Marine backpack. It was not commercially available due to its size. The diabetes online community has reminded me that sometimes, looking back in history makes it easier to imagine greatness in the future. The realization of how far we've come makes the idea of apps and insulin pumps and CMGS devices and glucose meter interconnectivity seem undeniably plausible despite the challenges. Thanks again to the diabetes online community for all of your great lessons and for teaching me perspective, especially on days like today when I am feeling a little overwhelmed with comprehending and managing all of the regulations for mobile health! :)


PS: For anyone that is interested in the history of insulin pumps, a great summary on medscape is here: http://www.medscape.org/viewarticle/460365_2

Apps and CGMS?

A CGMS (continuous glucose monitoring system), such as the DexCom pictured below,  is an FDA-approved device that records blood sugar levels throughout the day and night. There are several approved devices -- Medtronic's MiniMed device, DexCom, and the Navigator, for example -- that can provide up to 288 blood sugar measurements every 24 hours.

The continuous glucose monitor is not a replacement for standard blood sugar monitoring. It is only intended for use to discover trends in blood sugar levels. This helps the health care team make the most appropriate decisions regarding the best treatment plan.

Several clinical studies have validated improvements in diabetes outcomes related to the usage of CGMS (such as steadier glucoses noted above). However, insurance companies still do not always pay for it as sometimes patients obtain the device then never use it.

A solution: perhaps adding apps that focus on patient engagement, like the EndoGoddess app, to CGMS could increase CGMS engagement. This increase in engagement could really increase the value of CGMS to insurance companies and thereby improve diabetes outcomes, save lives, and decrease healthcare costs overall. Sometimes 1+1=3 so I am definitely interested in exploring this idea further!

My Healthcare Social Media Science

Yesterday, facebook bought social picture-sharing mobile app instagram for $1 billion. Why? Because social media is valuable. Period.

Social media is really a social science and thus equally applicable to medicine which involves people AND science. For docs an important unique rule applies: don't talk about patients in any way that could be identified. Beyond that, however, social science such as Dale Carnegie's 'How To Win Friends And Influence People' applies. This was one of my favorite books that I first read when I was in 3rd grade to overcome my shyness. Here are a few of the 'rules' of social science that I follow to bring value to my social media efforts:

Don't just say anything, have a reason or a strategy. For example: getting blog page views or increasing your peer-review journal paper's google scholar references. You can then use social media analytics to measure your progress accordingly.

Censoring: if you're not sure if you should say it, count to 16.  If you're still not sure, then don't say it.

Like 'Love Story' where love means never having to say you're sorry...good social media censoring means never having to say you're sorry. But, if you make a mistake, own it and say you're sorry.

Use a cocktail party conversation strategy. Being personal in all situations (work, home) is my cocktail party style so I don't need to worry about differentiating. However, if you are totally different people at home and at work, pick your work self and your work self style for your cocktail party social media strategy. You can eventually combine both if you feel comfortable.

You'll never have regrets if you speak from your heart about putting patients first and if you are always nice about what you say. But, also be honest about what you say. Don't be two-faced or lie...you'll get caught and then you'll have regrets.

Remember your audience and what they think is interesting or useful.

Don't be the tin man from oz without a heart just broadcasting messages. In social media, broadcasting AND interacting from your heart works better.

Retweet and listen, don't hog all of the attention.

Learn from others and ask them questions. If you're feeling alone then you're not getting the benefit from the 'social' opportunity to ask and learn more by interacting with the information.

Like the Goonies, have a fun adventure with a higher purpose.

Like most of the great things in life (love, friendship, community, art, Ohio State sports), you get more than you give just by being in the game! :)

Basic Economics Wednesdays

As a physician, I have been extensively trained to use science to lead my patients to better health. As a health behavioralist, I have been educated on the models of behavior and influence that help to predict better health. As a journalism undergraduate major, I am well trained in the art of communication and sentence structure. As a mobile health app developer, I am well aware of what is required for the actual development of a product. As a mobile health entrepreneur, I am well educated on business models and actually using a variety of business models to create revenue (and to make a living). However, I have never taken an economics class.

Last night, while watching my favorite 80s movie The Secret of My Success with Michael J. Fox (pictured above), I realized that in a plot central to the movie, I did not fully understand the economic principles behind the corporate response of expansion vs. retraction in the face of economic change. The principles of economics were actually present throughout the entire movie, affecting all of the characters' behaviors.

Starting today, I am aiming to change my economics knowledge so that I can better predict not only the movie character's behaviors but also mobile health users behaviors given that economics has a role that is often overlooked. No matter how busy, I am dedicating Wednesday afternoons to reading the principles of economics. I have chosen Thomas Sowell's Basic Economics as the text. I will be reflecting on the lessons that I am learning each week here on this blog as they relate to health behaviors and mobile health. Perhaps the 'E' in EndoGoddess will also stand for Economics?! :)

Data Connectivity

A weakness of the EndoGoddess App (and others like it) is the fact that glucose journal entries must be typed into the data fields by the user rather than automatically filled in by the glucometer which actually stores all of the glucose readings. Currently, the FDA requires a separate regulation process for apps that connect to medical devices (full policy here). However, when an app requires a user to enter data themselves and does not instruct any management advice or algorithms, the app does not require FDA regulation for release.

Glucometers are without question medical devices that should have FDA regulation as they are devices upon which people with diabetes owe their glucose control and lives to everyday. Every aspect of the glucometer development and quality process as well as functioning is carefully assessed by the FDA.

However, transfer of data (or connectivity) with the meter to an app does not carry the same weight in my opinion. Glucometer technology transfers have minimal to no errors as has been shown by many device companies in their FDA approval process. Perhaps device makers that have their data stored in the cloud (rather than the device) can assure the FDA that their data precision methods and software are consistent as part of the FDA device approval. This would allow a free marketplace for app developers to use the quality-assured, FDA-regulated data without redundant work by the app developers who seek only to display this data. I am researching this possibility for the EndoGoddess App given the importance of connectivity in taking the EndoGoddess App to the next level.