The document discusses opportunities for health technology focused on helping individuals and families (99% of the population) manage their own health outside of interactions with healthcare professionals. It presents a framework showing the many factors that influence health and self-management, and suggests areas where technology could help, such as providing personalized health information and analytics, sensors for self-monitoring, communication tools, and productivity apps to support daily health-related tasks. While some solutions exist, the document argues there is still a lack of consumer-oriented tools designed specifically for personal health management.
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Health technology for the other 99%
1. Health Technology
for the other 99%
Health Hack Day, Stockholm, 17 May 2013
Rajiv Mehta
Hello ...
Weâre here this weekend to shape the future, to spark the innovations that will shape the
future. The innovations that we create this weekend will depend heavily on the problems we
seek to address. Put another way, the answers we ïŹnd will depend on what questions we ask,
and how we frame those questions. In my talk, Iâd like to suggest a frame different than the
one weâre used to thinking about â I want to talk about health technology for the other 99%.
2. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Not talking about ...
2
Just to be clear, Iâm not talking about the Occupy movement.
3. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Traditional perspective:
Doctors & Patients
3
Person
Healthcare
Professional
Traditionally for health technology we see healthcare professionals and people (also known
as patients)
4. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Doctors & Patients & Technology
4
Person
Healthcare
Professional
MOST
Health technology efforts
SOME
Patient Engagement
Telemonitoring
Patient Education
PHRs
?
The vast majority of technology for health is oriented towards the needs of health
professionals. Patients are not users of such tools; theyâre not in the picture.
Some technology is geared towards doctor-patient interactions. Categories include âpatient
engagementâ, tele-monitoring, patient education, and personal health records.
Relatively little is geared towards peopleâs own use; when doctors are not in the picture.
5. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
For most of our lives (>99%) we take
care of ourselves
5
Person
This is surprising because for the vast majority of our lives, health professionals are NOT in
the picture. For most of your life, you are being taken care of by yourself and your family.
6. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
For most of our lives (>99%) we take
care of ourselves
6
US Veterans Health Administration
âą âThe gold dot represents the average number of minutes
(100) a patient spends with a provider per year and the white
represents 525,600 minutes in a yearâ
This point was made in a diagram created by the US Veterans Health Administration. They
note that the average patient spent only 100 minutes a year being cared for by a professional
â thatâs the gold dot. The white space is the rest of the year, the other 99.98% of the year.
It turns out that this diagram is not accurate â the gold dot is too big.
7. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
For most of our lives (>99%) we take
care of ourselves
7
This diagram, by Sara Riggare, shows the same thing â she only spent 1 hour with a health
professional in 2012.
But, this diagram is accurate. Can you ïŹnd the gold dot?
8. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
For most of our lives (>99%) we take
care of ourselves
8
Health Technology
for the other 99%
So, this is what Iâm talking about.
What technology can help us take care of ourselves?
What technology will address the other 99%?
Iâd like to suggest a framework to help us think about this.
9. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
A diagram of health self-management
9
Person
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)
affect
Goals
& Plans
affect
Observations made by
New observations ... ... suggest new Actions ...
Here is a diagram of a person taking care of himself.
The person has some desired health goals and some health-related activities that he plans to
do to achieve these goals. On a day-to-day basis he carries out these actions, and they have
some impact on his health. His health is also impacted by his environment. Noting his actual
health compared to his goals, he may make some changes.
10. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
HCPs may have a strong inïŹuence on
the personâs activities
10
Person
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)
affect
Goals
& Plans
Observations made by
New observations ... ... suggest new Actions ...
HCP
inform
affect
What the person chooses to do and what he considers proper goals are inïŹuenced by his
doctors and other health professionals.
This is a nice, simple model.
11. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Itâs complicated ...
11
There are inner loops of execution, with many
opportunities for failure (e.g. ânon-adherenceâ)
Person
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Tasks
affect
New observations ... ... suggest new Actions ...
affect
HCP
inform
Unfortunately, real life is more complicated.
First of all, the person may not carry out his actions exactly as planned. This is often referred
to as ânon-adherenceâ.
12. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Endless torrent of mundane tasks
12
Day-to-day (even hr-to-hr)
tasks for health, wellness,
... life in general
Mundane but varied
Appointments, Bathing, Biometrics, Chores,
Cleaning, Companionship, Cooking, Dressing,
Eating, Errands, Exercise, Grooming, Listening,
Medications, Moving around, Observations,
Planning, Shopping, Socializing, Symptoms,
Therapies, Toileting, Transportation, ...
Never ending
Overwhelming!
This failure of execution is not surprising. While each little health-related activity seems
simple in isolation, together they can be overwhelming. Itâs not just taking one pill on time ...
a wide variety of activities may be important for health, and they happen multiple times each
day, for all of your life.
13. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Endless torrent of mundane tasks
13
MEDICATIONS
6a 9a noon 3p 6p 9p midnight
Insulin Novolin
Insulin Novolog
Metformin
ACE Inhibitor
Multi-vitamin
Ibuprofen
Blood glucose
Blood pressure & pulse
Weight
EXERCISE
Walk/Swim
Yoga
DIET/FOOD
Food Journal
Carbs
OBSERVATIONS
Sleep
Excessive thirst
Excessive sweating
Mood
BIOMETRICS
Herbal supplements
THERAPIES
Foot massage
Breathing exercise
6a 9a noon 3p 6p 9p midnight
MEDICATIONS
Morning supplements (6)
Albuterol (nebulizer)
Hypertonic saline (nebulizer)
Pulmozyme (nebulizer)
Tobi antibiotic (nebulizer)
Pancreatic enzymes
Advair
Noon supplements (4)
Evening supplements (4)
Bedtime supplements (4)
Caloric shake
THERAPIES
Vest
Acapella
BIOMETRICS
Weight
OBSERVATIONS
Sleep
Mood
Coughing episode
OTHER
Clean / Sterilize nebulizers
Here are some examples of the daily health regimens of some people I have worked with. The
x-axis covers about 18 hours of the day. The y-axis lists their activities.
14. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Itâs more complicated ...
14
And outer loops â health is a means to higher-
level life goals
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
HCP
inform
Life itself adds it own complexity. Health is not the only priority in your life, and often other
aspects of life â work, family and social responsibilities, and your personal happiness â take
higher priority.
15. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Most people arenât hermits
15
They belong to family groups whose actions are
intertwined and have strong interactions
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
HCP
inform
In addition, most of us are social, and our lives are interwoven with others â family, close
friends, and colleagues.
Focusing only on the individual works only for hermits.
16. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Networks of care
16
We take care of others, and in turn they take care of us. We strongly inïŹuence each other. Our
own health activities are often not fully under our own control.
17. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Real-world care networks
17
These diagrams are from research I did last summer, they show the care networks for two
people that were interviewed.
18. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Often many external inïŹuencers
18
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Also, external inïŹuencers include much more than healthcare professionals. There are many
alternative health providers, the formal and informal media, neighbors, etc. who have some
impact.
19. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Framework for seeing health
technology opportunities
19
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
This diagram provides a framework for thinking about health technology opportunities, a way
to see how we might help the person, the family take care of themselves.
20. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Formal & informal health information
20
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
1.
One obvious opportunity is for smarter and more personalized information.
21. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Very active space ... much room for
improvement
21
Searchable, ïŹltered, real-time ... just for me
There is already a lot happening here. Some efforts to provide better, more tailored
information have been in place for over a decade. There are many efforts to make existing
data more available to individuals. And of course social media makes it possible to ïŹnd
people who speak to your particular issues.
And yet ... anyone who has tried to ïŹnd information knows that it is still very hard to ïŹnd
what you want to know.
22. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Sensors & diagnostics
22
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
Measure
inform
inform
inform
2.
Another hot space is new ways to measure ourselves.
23. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Lots happening here as well
23
Physical, psychological and environmental
factors, wellness activities â as well as task
execution and other aspects of life
This includes devices to track physiological and environmental factors, as well as interactive
apps to track activities, emotions and cognition.
These new gadgets and apps are what sparked the QuantiïŹed Self movement.
Many feel that weâve barely scratched the surface yet ... thereâs enormous room for
innovation here.
24. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Analysis & visualization and
personalized recommendations
24
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
Measure
inform
inform
Analyze
inform
3.
However, all this new data exposes a new problem.
25. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Dearth of consumer solutions ...
25
For combining multiple and disparate sources of
data, and making sense of it all.
BodyTrack / Fluxtream
Which is that we donât have tools to learn from the data. Itâs not enough to see a chart of just
your weight, or just your sleep, or just your calories. Health is a multi-factorial issue, and we
desperately need tools to see and learn from this data.
Unfortunately today you have to be a whiz at using spreadsheets or statistical programming
languages such as R. A step in the right direction is a project at Carnegie Mellon University in
Pittsburgh called BodyTrack/Fluxtream, but it is not yet consumer-friendly.
So, this space is wide open for innovation.
26. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Communication & coordination,
within family and with inïŹuencers
26
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
Measure
inform
inform
Analyze
Converse
support
inform
support
4.
Another area that is surprisingly difficult is supporting conversations about health, both
within the family and with external partners.
27. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
So many choices ... and still itâs hard
27
Convenience + Richness + Privacy + Control
Phone, email, txt, facebook, twitter, skype,
instagram, pinterest, foursquare, ...
There are seemingly an inïŹnite variety of communication tools, and yet we know from our
own lives that somehow the right tool often doesnât seem to exist.
28. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Making it easier to do the doing
â âproductivityâ tools
28
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
Measure
inform
inform
Analyze
Converse
support
utilize
support
Enable
inform
support
5.
The ïŹnal opportunity Iâd like to bring to your attention is to help people âdo the doingâ. You
can think of it as productivity tools for personal health.
29. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Dearth of consumer solutions ...
29
Repurposed tools Designed for the
Consumer
If these productivity challenges occurred in any profession, that industry would be screaming
loudly for help. But, being just regular people, our screams are not being heard.
We make do by repurposing tools made for other reasons. Tools designed especially for the
consumer, for the unique needs of our personal, family lives are rare. There is much room for
improvement here!
One good example is Cozi, an app for managing family calendars. Another is my own effort,
Unfrazzle.
30. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Unfrazzle
Family caregiverâs assistant
30
Enable: Remember and keep track of any / all of
your care responsibilities
Converse: Stay in-sync with co-caregivers
Unfrazzle is an app, available now for iPhone and soon for Android, that helps users
remember and keep track of all their care activities, whether for themselves, their mother,
their son, or their pet cat. And it helps the family coordinate these activities.
31. Health Hack Day, Stockholm, 17 May 2013 Rajiv Mehta
Remember the 99%!
31
Person/Family
Health / Wellbeing
Disturbances / Environment
take(s) Actions (Daily Living)Observations made by
affect
to accomplish
Goals
& Plans
Life
affects
Tasks
affect
New observations ... ... suggest new Actions ...
affect affect
InïŹuencers
(HCPs, âalternativeâ practitioners,
media, extended family & friends)
inform
Inform
inform
create
Measure
inform
inform
Analyze
Converse
support
utilize
support
Enable
inform
support
So, in closing, for the rest of the weekend, I would like to urge you to remember that for over
99% of our lives, we are taking care of ourselves. In the future this could be much, much
easier. This is a fertile ïŹeld in which to plant your creativity.