Henrik Wieland discusses how technology such as connected devices and shared care services can help motivate behavioral changes that improve health. Connected devices can track health metrics and activity levels, while shared care services provide a 360-degree view of the patient to better coordinate care across providers and empower patients. The goal is using technology to facilitate lifestyle changes and manage chronic conditions long-term.

1. Henrik Wieland, Associate Partner, Healthcare Industry Leader, IBM Global Business Services
Belief, Motivation and Access
- Changing Lifestyle with Technology
NOCOGO, Billund, 22 October 2012
© 2012 IBM Corporation

2. A New Set of Digital Transformation Drivers is Emerging
Mobile Revolution
 Speed /
Immediacy
 Always On
 Location Aware
Hyper Digitization Social Media Explosion
 Streaming video  Shared
knowledge
 Sensor networks  Connectedness
The Power of Analytics
 Intelligence
 Optimal
response
2 © 2012 IBM Corporation

3. Determinants of poor health (60% of disease burden)*
 Hypertension
 Tobacco use
 Harmful use of alcohol
 High serum cholesterol
 Overweight
 Unhealthy diet
 Insufficient physical activity
Can technology help improve health through
behavioural change?
* WHO European Health Report 2009
3 © 2012 IBM Corporation

4. Motivation for Behaviour Change – Transtheoretical Model*
The individual needs to decide that the goal is important to them,
and there are 5 different stages of motivation:
.
Pre-contemplation—no intention to change in the foreseeable future
Contemplation—seriously considering changing, but has not committed to taking
action
Preparation—intends to take action in the next month and has unsuccessfully
taken action in the past year
Action—has performed the desired behavior consistently for less than six months
Maintenance—has consistently performed the desired behavior for six or more
months
Technologies can be used selectively to support these
different stages of health and wellness improvement
Prochaska, J.O., DiClemente, C.C., Norcross, J.C. “In search of how people change: Applications to addictive behaviors,”
Amer Psych, 47(9), (Sep 1992), 1102-14. © 2012 IBM Corporation

5. Motivation for Behaviour Change – Transtheoretical Model*
Stage of Behaviour Change Characteristics Type of Support Needed
Pre-contemplation No intention to change in the Education
foreseeable future
Contemplation Seriously considering changing, Overcoming barriers, rewards for
but has not committed to taking performing behaviours
action
Preparation Intends to take action in the next Rewarding behaviours, increasing
month and has unsuccessfully awareness of patterns of
taken action in the past year behaviour
Action Has performed the desired Keeping track of progress, and
behavior consistently for less than social influence (peer group)
six months
Maintenance Has consistently performed the Coping strategies, showing clear
desired behavior for six or more progress towards the intended
months goal
Prochaska, J.O., DiClemente, C.C., Norcross, J.C. “In search of how people change: Applications to addictive behaviors,”
Amer Psych, 47(9), (Sep 1992), 1102-14. © 2012 IBM Corporation

6. The Role of Technology in Changing Lifestyles
A look at two promising areas:
1. Using Connected Devices to monitor health status and
measure activity levels
2. Shared Care services to empower the patient and enable
improved health management
© 2012 IBM Corporation

7. The current state of health devices
Today the health device industry reflects a proprietary, device-
centric strategy
Examples of healthcare devices
Cholesterol
Weight
Monitor
Scale
Today’s health device is an instrument, Blood-
Home
sensing &
apparatus, appliance and/or software pressure control
which can: Glucose
Meter
- Sense, monitor, or measure a Bed / Chair
Sensors
person’s vital signs Thermometer
- Targeted at wellness, diagnostic or Pulse
Implant
Monitors
Oximeter
therapeutic purposes
- Used alone or in combination with Spirometer
Baby
other devices Monitors
- Single or multi-function Medication
Tracking
- High level of innovation
PERS
Pedometer
Consumer
Electronics
Fitness
equipment
Sources: WHO definitions; IBM Institute for Business Value Analysis © 2012 IBM Corporation

8. Connected Devices
We see users in the health device market split between three main
segments:
- Motivated Healthy: Fitness focused, highly health conscious
- Information seekers: Aware of the benefits from monitoring activity,
lifestyle, and conditions that are not life threatening
- Chronically Monitored: Terminally or chronically ill patients that
require constant condition monitoring
Current product offerings have focused on the needs of the Motivated
Healthy and Chronically Monitored segments
© 2012 IBM Corporation

9. The current state of health devices
For health devices to be more widely successful, they must
address the needs of consumers outside their typical focus
Motivated Information Chronically
Healthy seekers Monitored
One family’s story…
Ramon is 35… Andrew is 48 … Maggie is 52… Kevin is 10… Ann is 75…
he’s physically active his intensive activity is she’s very active during he was diagnosed with she’s had a stroke
and very health largely centered the day, but finds ADHD during his and surgery for
conscious. He around a stressful that her mood can first year of school. cancer. She’s
has two small work schedule. He swing wildly as she’s His parents and not debilitated
children. He’s needs to lose about dealing with doctors have and continues to
very aware of his 8kg and has been menopause. She’s struggled finding the live with her
family history, is taking hypertension tried a few different right medication and husband in their
taking care of medication for a few medications, but dosage to manage home. She visits
himself, wants to years. He’s can’t get a his condition or for the doctor
teach his children struggled to find consistent read on him to describe how monthly
to do the same time to exercise whether they’re he feels
helping her
Sources: IBM Institute for Business Value Analysis © 2012 IBM Corporation

10. Information seekers – The Quantified Self
© 2012 IBM Corporation

11. Increasing sophistication of connected devices for health and
wellness – improved design and integration with personal goals
Motivated Healthy and Information
Seekers
Apple and Nike Fitbit Nike+ FuelBand
Combines running and music for the Monitors activity with motion and 3-Axis sports-tested
fitness market. Smartphone provides online data storage and accelerometer, monitors activity
applications collect data from analytical tools. Does not provide as steps, calories and Nike Fuel,
sensors in fitness equipment, ability share data outside of its which can be uploaded with
enabling users to monitor their walled garden Nike+ Connect to set goals,
performance collect rewards
© 2012 IBM Corporation

12. Consumer interest in health care devices is shifting towards
preventive care and remote monitoring
Primary function of the current / future device
Measure and manage
51%
Current While half of current
a known health 20% less devices in use
problem Future 41% today are for known
health problems…
13%
Encourage physical
activity 30% more
17% …interest in using
devices for
Inform others of 5% preventive health
someone’s changing 100% more is expected to rise
health condition in the next two
10% years
Consumers are eager to shift to prevention and remote monitoring, but may
not be familiar with available solutions
Source: IBM Institute for Business Value, 2009 Connected Health Devices Survey (Current Devices: N = 1256, Total mentions = 1507; Future Devices: N=604, Total mentions = 503)
© 2012 IBM Corporation

13. Obtaining feedback from health care professionals is nearly as
important as results from the device
Importance of the ability to get feedback on health data from sources
Device feedback is critical
Feedback from Feedback is expected in real-time, easy to
device 86% read and understand
Feedback from Provider feedback is as well
healthcare Feedback could be in “near-time”, online
professionals 77%
or used in a subsequent visit.
Feedback from the device does not replace
personalized feedback from healthcare
professionals—whether it is done online or
in-person at a later time.
In addition, consumers want health professionals to accept and incorporate the data
from health devices into their care
Source: IBM Institute for Business Value, 2009 Connected Health Devices Survey (N = 678, Total Mentions = 697), % rating ‘Important’ and ‘Very Important’
© 2012 IBM Corporation

14. The potential capabilities of home-based gaming and fitness
devices are also evolving and converging, thanks to advances in
sensor technologies
XBox Kinect
Sensor array and processing software that directs game play by recognizing and
evaluating gestures, faces, and voices
Withings Internet Connected Body Scale
Wifi-enabled scale marketed as an interactive weight loss tool. Data can be
analyzed using pc and Smart phone applications, stored in electronic health record
repositories, and shared with via email and social networking websites
Potential Opportunities
 Human-machine interfaces are evolving to a state where accurate measurements of movement are possible
 Technology that makes current gaming possible could be used to develop healthcare monitoring capabilities
 Providing an accurate health condition assessment may soon be possible remotely and automatically
© 2012 IBM Corporation

15. Optimal coordination can provide great benefits for all parties
 Effective coordination between patients, relatives and health professionals will lead to:
– Early detection and early active effort
– Coherent carepaths across the healthcare sector
– Empowerment and motivation of the patient in relation to their own treatment and care
– More qualified decision based on a holistic view.
General
practitioners
Shared Care
Municipality coordination Hospital
(Care)
Telemedicine
Patient
© 2012 IBM Corporation

16. 360 degree view of the patient/citizen
Treatment
goals and
Activity list status in
relation to
patient
Patient’s
Relevant links
schedule
Patient’s Notes about
clinical values the patient
The Patient’s
Medication diary
Health
professional Instructions
contacts
© 2012 IBM Corporation16

17. Follow up and support to the carepath
An activity for a patient may be to Data is available for the patient and for
An activity for a patient may be to Data is available for the patient and for
complete a questionnaire as healthcare professionals across the
complete a questionnaire as healthcare professionals across the
preparation to the visitation healthcare sector
preparation to the visitation healthcare sector
conversation. This can be completed
conversation. This can be completed
online by the patient in the Activity list
online by the patient in the Activity list
in Shared Care.
in Shared Care.
The healthcare professional
The healthcare professional For example, questions
will get support to remember
will get support to remember about:
questions/task to a current
questions/task to a current
activity – for example in the - Diet
activity – for example in the
visitation conversation.
visitation conversation. - Smoking
- Alcohol
- Exercise
- Blood pressure
During the visitation
During the visitation - Cholesterol
conversation the
conversation the
doctor/nurse will be able to - BMI
doctor/nurse will be able to
search for the actual
search for the actual
patient and get the
patient and get the Individual treatment goals
patient’s Activity list Individual treatment goals
patient’s Activity list can now be added based
can now be added based
on the questionnaire and
on the questionnaire and
the conversation. The
the conversation. The
goals will be used for
goals will be used for
further monitoring of the
further monitoring of the
patient across the
patient across the
healthcare sector, in
healthcare sector, in
relation to relatives and the
relation to relatives and the
patient. Data from home
patient. Data from home
monitoring included.
monitoring included.
© 2012 IBM Corporation

18. Summary
Sustained behavioural change is needed in order to reduce
health risks, and manage long-term conditions well
Technology in the form of Connected Devices can be used to
provide motivation and support
For those living with long-term conditions, well designed Shared
Care services can increase motivation and self-management
© 2012 IBM Corporation