Paris Bound!

Am off to Paris to speak 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. Follow me on twitter for updates over the week! :)

'Sky Is The Limit': IPhone Meters, Apps, Skymall

I am so excited to see that the awesome iPhone iBGStar glucometer is now available for purchase in the Apple Store: http://store.apple.com/us/product/H8974?WT.mc_id=BGWB002

Glucose strips are also now available for purchase at Walgreens: http://www.walgreens.com/store/c/bgstar-blood-glucose-test-strips-for-ibgstar---50-count/ID=prod6108726-product

As noted in a prior blog post about my trip to South By Southwest , last month we at Duet Health started to build data connectivity between the EndoGoddess App API and all of Agamatrix glucometer APIs including the iBGStar. However, progress is halted.

Ideally, it would be great for everybody (patients, doctors, pharmaceutical companies) if there was a 'skymall' of choices for apps with devices so that each person could have their favorite app (each with its unique features) with data connectivity to their favorite device. Although the iBGStar glucometer device itself is FDA approved, anytime an app creates data connectivity with the approved glucometer, the app must undergo a separate FDA approval as it becomes a medical device 'accessory'. Financially, undertaking the investment in the quality assurance certification required by the FDA (estimated time 1 year, an estimated price of $100,000) is not feasible. This is sadly even further true given that we would eventually like to connect the EndoGoddess App to multiple glucometers (each with a $20,000 price for each separate application submission to the FDA).

Perhaps the answer is in the 'sky', or more specifically in the cloud. Rather than every app being evaluated separately for data connectivity with awesome devices like the iBGStar glucometer, I suggest letting the 'sky be the limit'. In other words, the integrity of the cloud's ability to predictably transfer data from the cloud could be the standard for FDA attention and regulation to assure quality of the original device data. Given the recent growth of federal cloud computing implementation related to the noted large cost savings for the US Government, standardized cloud regulation for data integrity with data transfers seems to just make sense. Cloud regulation rather than app regulation could lead to abundant innovation for apps with only 'the sky as the limit'. Without this clarity, however, progress for data connectivity with the EndoGoddess App will sadly remain grounded.

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! :)