Since the 2nd century AD, humans have been fascinated by one thing: ourselves.
Roman Emperor Marcus Aurelius’s To Myself (Τὰ εἰς ἑαυτόν), written around 180 AD, is one of the first existing diaries ever written. Today, most of us have smartphones for life-logging and many even have technology that keeps track of our lives for us. (I have been wearing a FitBit for the past few weeks. This device records the number of steps I take, calories I burn throughout the day, and other data.)
The digital age has made the process of recording everything we do even easier, and the Quantified Self movement, as it has come to be known, is gaining in popularity. We may bemoan our friends instagramming their every bite and tweeting their every trip to the gas station. However, there are some useful applications of these activities for the management of chronic diseases.
In conditions like diabetes it is known as self-monitoring: paying attention to changes in symptoms and other data like blood glucose levels or the effects of medications. Patients and their providers can use information gathered through self-monitoring to make treatment decisions and reinforce positive behaviors. For example, if a patient with diabetes feels more energetic and sees their blood glucose levels drop when they stick to a healthy diet, they may be more likely to make that lifestyle change a habit.
So whatever your opinion on life logging, it isn’t going away anytime soon. Let’s just hope we use our obsession with ourselves for good.(Read full post)
This little device takes stress control to the next level. PIP is a biosensor from Galvanic Ltd. that detects your stress level in real time. Just hold it between your fingertips and it communicates your stress level to an iOS or Android smartphone. This is not just another tracker, but a gamified system that provides a suite of gaming and entertainment apps that allow you to visualize and master your stress in a fun and engaging way.
For example, one game called Relax and Race pits you in a race where your stress level determines your speed – the more you relax, the faster you go. Another game called The Loom turns winter into summer as you relax and your stress melts away. The Lie Detective game is a more socially-oriented and entertainment game that allows you to see your stress response to probing questions from your friends.
This kind of interaction allows people to see how their breathing, concentration or changes to their environment can affect their stress.
The PIP has recently reached its funding target on Kickstarter last month.
Watch this video from Gary McDarby, Director of Galvanic Ltd., to learn more:(Read full post)
June 26-28th, 2013 marked the 9th annual Games for Health Conference held in Boston, MA. This three-day event brings together experts in game development and health with the common goal of advancing gaming technologies to improve our health care experiences and outcomes. This year the topics ranged from creating Zombies, Run, an iphone app. designed to encourage exercise through placing the user in a virtual zombie apocalypse, to GeckoCap, a gamified app. meant to encourage asthma treatment adherence in children.
It is clear that there is a rapidly growing industry in improving our health through gaming. Whether it is via phone app., video game, computer program or even board game, Americans are interested in staying healthy or getting healthier, but we want it to be fun. We live in a world where it is quickly becoming not enough to simply run for the sake of running or take prescriptions because we’re supposed to, we’d like it better as a game and we want rewards. I wonder, though, what does this mean for future generations? Will they expect a game to be attached to all health-related activities? Maybe that’s taking it a bit too far, but I do wonder where the gamification of health will take us. As a public health student I am certainly a fan of better chronic disease management and overall health, I only hope we can find ways to use gaming to improve habits that do not necessarily create reliance on such rewards. I think the question all developers need to ask themselves is, are the games we’re building meant to be used indefinitely or only for a period of time in order to create long-lasting, intrinsic motivation? Staying healthy takes daily effort and I hope we can find success through a combination of badges, stars and points but also because it just feels good to do so.(Read full post)
Do you get enough sleep each night? No? I’m not surprised. For several months now I’ve been preaching the gospel of the Sleep Cycle iPhone app. and converting all my friends to users and believers. I’ve even joked that its developers owe me some commission. Placed under your fitted sheet while you sleep, the app. claims to track your movements throughout the night and wakes you within a pre-set timeframe at a period of lightest sleep. Ideally you’ll wake up feeling rested and ready for the day instead of wanting to throw your phone across the room.
It’s hard not to love this app. It makes sweet, peaceful noises to gently rouse me in the morning, uses an “intelligent” snooze timer based on my pre-set wakeup time and creates an easily understood graph of each night’s sleep. The morning output is even complete with a “sleep quality” percentage for us number people out there. Wake up to a 45%? Maybe I shouldn’t have had that last beer. Open my eyes to a 94%? I’m definitely starting the day on the right foot. I compare sleep quality percentages with friends in cheerful competition and sometimes make a point of going to bed early, hoping it will help my percentage climb higher. The app has brought my sometimes-unhealthy sleep habits to my attention and offers just enough feedback to motivate me to make sleep a higher priority. Honestly, the movement-sensitive alarm is worth the $.99 even without the collected sleep data.
The question, though, is –am I really sleeping and waking up any better than I would be with a regular ol’ alarm clock? One doctor certified in sleep medicine claimed that the answer is no. Dr. Rose explains that there can be movement in all stages of sleep so it is impossible for an app to gauge sleep cycles based on its accelerometer alone. Whether Dr. Rose is onto something or not, waking up with Sleep Cycle is so easy and peaceful that it almost doesn’t matter to me how accurate its data really is. And if it encourages myself and other dedicated users to sleep more hours each night then does a professional’s approval or disapproval really matter?(Read full post)
The Peanut Butter and Chocolate (PBC) metaphor is used quite a bit, even in mobile app development. I ran across two concepts that go together like a package of peanut butter cups.
One is the PBC Approach. At its core the PBC Approach is HTML-5 formatted content as peanut butter, surrounded by a delicious native app chocolate shell. Some say this is a good thing; others disagree.
The main reasons people use HTML5 and other open Web technologies instead of coding specifically for the native operating system (iOS, Android or any other platform, for that matter) is convenience. HTML5-based apps can presumably be run anywhere. This enables device agnostic development that helps developers write multi-platform apps.
“Write once, run everywhere” is a main promise of open Web technologies, and, for some purposes, these technologies will work; however, for other purposes they may not. The following decision matrix can be helpful in determining which development method is best in terms of the app’s needed capabilities and the number of platforms it has to run on:
The other PBC concept is the notion of tiny little apps with large back-ends. In other words, this is the combination of mobile apps (tiny little apps) and cloud computing (large backend). In general, this architecture permits the app that is running on the mobile device to be smaller because it can tap into the cloud for data and back-end services. This concept can also be extended toward building the next generation of applications for the reimagined desktop. The small app with a large back-end is similar to the single-page Web application in that a great deal of work is accomplished on the server side.
Microsoft is a proponent of this concept as it considers the combination of Windows 8 and Windows Azure as a powerful architecture. There are other mobile backend-as-a-service platforms such as Stackmob, Parse, Appcelerator, Kinvey, and Kii that are similar to Azure in that they provide the foundation and infrastructure for an app’s large backend. You can listen to this recording of Chris Koenig speaking on the subject for more details on Microsoft’s approach.
So like anything in the development world, each of these PBC concepts must be well understood in terms of both pros and cons so that it can be applied to the right circumstances for the greatest benefit.(Read full post)
Dr. Charlene Quinn, from the NIH’s Office of Behavioral and Social Sciences Research, put it this way in her recent spotlight video (you can watch below) concerning mHealth in diabetes management: “There are thousands of applications calling themselves mobile health, but very few of those applications actually have science behind them…”, which includes the clinical data, the evidence, they actually work. She concludes by saying: “We really need to think through not only data and numbers, but what behaviors, using mobile health or mobile technologies, most encourages people to change their behavior, improve their health, and ideally improve the health of a population.”
That got me to thinking about what fundamental characteristics that an mHealth intervention needs to have to be successful in changing a patient’s behavior. Many of these characteristics are simply good design principles: understanding the patient, knowing the socio-ecological system and sub-systems, iterative design and implementation. In general, simple messages delivered at the right time in the right place that are tailored, non-disruptive and repetitive and consistent is a sound way to think of how to build an mHealth intervention. The nature of portable computing with mHealth gives us the right place (where the patient is). Characteristics for a behaviorally-based mHealth intervention also require the ability to detect points of decision, behavior, and consequence and mobile devices require attention to interface design.
One important thing to consider is that sensors sometimes lose contact or run out of power or the wireless network is interrupted. Additionally, patients may willfully disable senor devices or not log the data or be as truthful as they should. What then? Statistics can play a big role with imputation techniques (procedures are designed to fill in the missing data gaps), but there can be legal, privacy and medical issues and is a topic for another day.
So as we think about both the advantages of mHealth (ability to observe multiple and repeated levels of behavior as it happens in naturalistic settings) we must also consider some of the issues (missing data, good user experiences, privacy, etc.) as well.(Read full post)
Take Two Apps and Call Me in the Morning
It may not be too long in our future when part of a prescription from our physicians may include and app (or two). This is the exciting idea of medically prescribed apps. Some futurists predict that doctors will prescribe FDA-approved apps to treat patients. So far, the FDA has maintained that it will only vet apps that perform device-like functions, such as making diagnostic determinations or treating ailments. The FDA has yet to release its full guidance on the regulation of mobile apps and will not go after the many available downloads that make untested medicinal claims until its rules are in place.
WellDoc is one of the pioneers in the prescription-app field. Its DiabetesManager system collects biometrics about a patient’s diet, blood sugar levels and medication regimen through manual input or from wireless devices. It then gives advice to a patient and sends clinical recommendations to the doctor. The Food and Drug Administration gave the system 510(k) clearance to operate as a medical device in 2010.
Happtique (health app boutique) is a company that operates a mobile app prescribing solution for healthcare called mRx. Happtique has recently launched a pilot that will test whether the company’s solution will encourage doctors to prescribe mobile software for patient use. mRx consists of Apple and Android smartphone and tablet compatible apps that focus on cardiology, rheumatology, endocrinology, orthopaedics, physical therapy and fitness training. The mRX system gives patients more structured guidance when it comes to selecting and using health apps and empowers them with tools to help them take a more active role in their care. And similar to traditional prescription, mRx will track how many times an app is prescribed as well as how many times patients click the “fill” button once the prescription is sent.
If the mRx trial is successful, it will help demonstrate that mHealth technology will be viewed as legitimate, powerful healthcare tools, not just fun programs to install on a phone or tablet.
From a behavioral point of view, the WellDoc and mRx systems can help encourage a dialogue between physicians and patients about available healthcare technology tools. These conversations will not only give patients additional resources, but will also encourage them to consider incorporating apps and other healthcare technology into their health management. In addition to increased health care provider connectedness, these systems also help achieve behavioral change and continued adherence through sustained influence over the patient’s multiple chronic states and enhanced patient self-determination.
When you think about it, these apps are no different from physicians prescribing a diet, a support group or any other resource. In fact, these apps will enable physicians to be more creative with the ways they engage their patients and provide the best care to them.(Read full post)
Gamification is the infusion of game design techniques, game mechanics, and/or game style into anything, and it has proven popular in the medical world as well. While gamification can help liven up health-related tasks and make them more enjoyable, it can also provide health benefits – take the Pain Squad for young people with cancer, T-Haler for asthma sufferers, the depression-tackling SPARX game and Limbs Alive for hemiplegia patients as good examples.
From my perspective, these solutions are best as part of a well-considered behavior change program for patients.
The Pain Squad app was developed by the Canada-based Hospital for Sick Children, also known as SickKids. Pain Squad gamifies the process of tracking the physical and emotional wellbeing of young people with cancer. Pain Squad uses the narrative of a police force hunting down pain. Patients are inducted as recruits in Pain Squad – a special police force dedicated to hunting down pain. Their pain reporting mission is to fill out a daily survey – which asks questions relating to whether they felt pain that day, how intense it was and its location. Patients move up through the ranks of the force when they keep their records updated. Stars from Rookie Blue and Flashpoint appear in videos that are unlocked when patients do well and progress the narrative. By gamifying the process, the app gives patients an incentive to keep a daily journal of their pain. The app is still in the testing phase, but SickKids hopes to release it later this year. Watch the following video to see how the app works:
T-Haler, developed by Cambridge Consultants, uses wireless technology to gamify inhaler use and help those with asthma get the optimum dose of medication. Interactive software, linked to a wireless training inhaler, monitors how a patient uses their device and provides real-time feedback via an interactive video ‘game’. T-Haler provides visual feedback to the user on their performance and the areas that need improvement. Feedback is highly visual which allows asthma sufferers to see what is wrong with their technique and monitor their progress as they improve. The interface offers visual instructions on how to correctly use the inhaler, such as shaking the device before use. Check out the video and see how it works:
SPARX, which stands for Smart, Positive, Active, Realistic, X-factor thoughts, is a 3D fantasy roleplaying game that teaches young people with mental health issues the skills they need to boost their confidence. SPARX was developed by a team of specialists in treating adolescent depression from the University of Auckand. SPARX leads players through seven realms (each about 30 minutes long) that teach mental behavioral skills for battling depression. For example, in one level, gamers battle their way through a swamp where they’re attacked by black, smoldering balls called GNATS (Gloomy Negative Automatic Thoughts). SPARX doesn’t require supervision and could help fill treatment gaps, especially in underserved areas. It’s also a private way for kids to get help when they may not want to talk to an adult. The SPARX trial results are in the British Medical Journal (20/04/2012). Watch the SPARX trailer:
Limbs Alive is a therapy service for hemiplegia patients that uses games to improve motor skills in a fun way. Using Limbs Alive’s first game, “Circus Challenge,” patients can do much of their physical therapy at home – in conjunction with consultations from experts. This is the first action video game designed specifically to be played at home that provide an expert therapy program. Using wireless controllers, players participate in activities such as lion taming, juggling, plate spinning, high diving, and flying the trapeze. The games are meant to encourage patients to work their way through increasingly difficult levels of movement designed to gradually build up the strength and skills of the patient. Limbs Alive plans to create a whole library of games that help make therapy fun and effective for patients suffering from other conditions such as Cerebral Palsy, Chronic Lung Disease, Type 2 Diabetes and Dementia. Take a look at this video for more background:(Read full post)
According to trendwatching.com “brands that behave more humanly…will be awesome”, which is an interesting idea in and of itself. The people at Trendwatching talk about “human brands” – not an entirely new thing. Tag lines like “random acts of kindness” are similar in concept. They say that there are four forces at work here:
- People are disillusioned at corporate behavior
- People look for personality in brands
- Online culture is becoming the culture
- People have a hard time connecting (really trusting) others who are not human (i.e., too perfect)
The idea about being more human made me wonder if healthcare could be more human and what the human face of healthcare might look like.
I found an interesting answer to my question from a Ted Talks video by Lucien Engelen called “Crowdsource your health.” His talk is in essence about people helping people with their healthcare. This is not diagnosing, this is all about support and encouragement in the eHealth space.
He gives a great example of his weight loss journey where he uses a digital scale that uploads his weight into the cloud. Then his twitter followers help him with eating tips –pretty cool as it uses technology to connect him and his goals with the world. The great thing about this concept is that it can be extended across most health-related issues like smoking cessation, etc.
The most powerful segment of his talk is a video clip of a person who died (presumably from a heart attack). It goes backward in time showing us that the person trying to help had no other option but to wait for the ambulance. To alleviate this kind of scenario, Mr. Engelen created an application that shows locations of automated external defibrillators (AEDs). With the public’s input (we submit AED locations), nearby AEDs can be found to help save lives. Visit the site, aed4.us, and add an AED near you (you can also download the app).
This is truly technology helping create a world of people working together.(Read full post)