The Healthy App Challenge launched by Surgeon General Regina Benjamin, MD, at the December 2011 mHealth Summit in Washington DC, and sponsored by the Office of the National Coordinator for Health Information Technology, has awarded awards to the following 4 smartphone applications to promote her vision for a healthy and fit nation:
Fitness/physical activity category
“Lose It! helps individuals achieve their nutrition and physical activity goals by setting daily calorie budgets that require users to record their food intake and physical activity. It also has a feature that allows users to invite their friends to view their logs on Facebook”
Nutrition/healthy eating category
“GoodGuide makes it easy for individuals to get the information they need about their food, personal care, and household products to help make healthy choices. It has a bar code scanner that allows users to scan products while they shop to get this information”
“Fooducate helps you make healthy food choices. When shopping you can scan the product bar code for a quick read on the nutritional values and additional information such as nutrients and additives; the app can offer healthier alternatives and compare two products side-by-side”
Integrative health category
“Healthy Habits recognizes that good health is not just about staying active and eating well, but is also reliant on other factors, such as sleeping well and mental health. This application addresses health issues such as smoking, wearing sunscreen, and reducing stress by tracking the user’s success and goals”
Other apps that received a strong recommendation included:
Whilst there is no doubt the winners represent some very interesting smartphone mHealth application innovations but I’m quite surprised at the focus of all this from the Surgeon General’s office. According to the website the apps “were assessed against a range of criteria including innovativeness, usability, the ability to generate and download personal data, and whether they made the health-promoting activity fun. They also had to be available for free”.
Here’s why I think this focus was a poor choice:
1) Why is it limited to Apps?
Okay so I’m obviosuly quite critical of public health approaches where smartphone apps are heralded as a simple fix all but I also appreciate the importance of recognising the efforts of innovators. Whilst these innovators deserve recognition I personally think a lot more could have been achieved if the focus of the competition was different and aimed to recognise more joined up services.
2) Limitations of “FREE”
I think this is not only a pointless precondition for this competition but it’s also limiting the selection pool for potential applicants and could be seen by some as calling into question how the US government thinks and values mHealth – and the service providers who might want to provide it. Obesity is costing the US government billions of dollars annually and childhood obesity is undermining all future plans so what’s so wrong with an app provider charging for something that makes money while helping to address this intractable challenge?
It’s also a bit odd when you look at this from a mobile commerce perspective as the company that is providing most of these “free” apps (Apple) is making huge profits selling ads all over them and retailing the devices that they are run on. The reality is even on mobile nothing is really free and for digital experiences the conventional “free” normally just means advertiser funded.
The screenshot from the MapMyFitness website (above) highlights the consumer experience with these. The lack of regulation of the advertisers, what they sell, how they capture patient data (eg. web bugs, cookies, etc) and the very uncertain third parties that they share personal health data with is something that the US Surgeon General should pay close attention to.
There is another rather obvious advantage of paid for apps over free apps that’s linked to the sense of value they can generate in their prospective customers. Why shouldn’t a healthcare provider be encouraged to engage on mobile and expect a ROI or at least some payment for their efforts?
If we evangelize only the “freemium” digital business models I wonder if this might be further alienating existing healthcare brands – a group that should be looked to as one of the biggest potential advocates for mHealth.
Unfortunately several of the apps were available for the iPhone only which gives the impression (to me at least) that from the viewpoint of the organisers of this competition usability = having a iPhone. It is a big shame that this competition has ignored the biggest opportunity mobile offers us to take control of healthcare expenditure – connecting senior citizens.
4) “the ability to generate and download personal data”
It doesn’t surprise me that there is no mention of the creation of “actionable information” or the “ability to put personal data to effective use”. Too many people are focused on this personal data generation process but it’s not what makes people change their behaviour. Weighing scales are in most US homes creating data but it’s not in itself dramatically changing anything as there is already too much data and too little interpretation and comprehension being made of that data. Once again the advertising (paying for these ‘free’ apps) is conflicting with this data too.
5) Focus on children
I think it would have been better if the focus had been more on apps for parents rather than for the kids. There’s a whole world out there beyond the mobile and parents shouldn’t be actively encouraged to provide their kids with more smartphone apps to use.
I’d very surprised if much research was done into the health impact of what appears to be an unsupervised child yoga app. I also think the “plate filling guide” app targeted at children (Max’s Plate) seems to be a little misconceived in as much as it’s probably not best practice for children to be responsible for choosing what’s being put on their plates.
Focusing on iPhone apps for kids is also side stepping the major issues schools are facing as children bring these expensive devices with them outside of the home. Perhaps governments should be sensitive to the pressures there are on parents to be buying expensive iPhones for their children rather than giving the children another excuse to ask for one.
If I was to pick a smartphone app on the criteria provided I would have loved to give it to an app that taught parents more about preparing and eating healthy meals with their children. I’m not overly familiar with US celebrity chefs but I know there’s a wide range of good quality apps available eg. Jamie Olivers 20 min healthy meal app:
How could the organisers of this competition improve it?
I think it would be a tragedy if the mHealth community didn’t work to try and maintain the momentum that has been started by this “on high” recognition of it’s work, but perhaps it could be better focused?
If it was up to me I’d scrap the headline grabbing name, instead of “Healthy App Challenge” I’d rename it the “Mobile Health Service Challenge” or “The Surgeon General’s mHealth Challenge” so that it can be more inclusive of a wider variety of opportunities – especially services that use the native features of mobiles (eg. SMS, Voice, Mobile Web etc).
If it were up to me I’d focus on recognising and supporting community efforts that:
> use far more basic processes of mobile engagement. I would have loved to have seen something that used SMS recognised for it’s ability to reach new audiences with important and timely healthcare messages eg. a Bone Marrow Donor recruitment drive such as HelpSameer.org.
If you’re not familiar with SMS abilities and think it’s only smartphone apps that have the power to make change please read this article by mobile industry guru Tomi Ahonen that shows how effective SMS has been for Obama – who started campaigning with SMS in 2007.
> promote opportunities that can actually take people away from digital experiences (especially children) like the TV, iPhone games, Facebook, to help them see the opportunities to switch off and make regular physical exercise a social activity.
It’s also important that we appreciate that whilst the award process rewarded features “that allows users to invite their friends to view their logs on Facebook” this referral is going to a place where the content is largely uncontrolled eg. Facebook shows a range of inappropriate advertising to children who have incorrectly registered their age.
This could also be having a negative health impact on other audiences eg. the young friends and parents who will be spending even more time glued to their laptops watching how their friends are doing rather than getting any exercise for themselves.
> Promote opportunities that mHealth enables care providers to save resources so they can better apply their limited funds and free up time so that they can then use it to improve the patient experience. SMS appointment reminders are a good example as they are a key innovation that all care providers should be introducing as there is plenty of evidence of the multitude of benefits for both provider and patients.
> Promote opportunities that help care providers to effectively interact with patients who are using their initiative and accessing online healthcare resources. Fortunately US clinicians (at the Mayo Clinic) are leading the world developing these – see this video of Dr John Bachman MD for more information.
> Promote services that lead to greater adoption of mobiles by seniors as this is the immediate opportunity the USA has to control future healthcare costs.
Even if you were stuck with just iPhone apps – there are more 50+ adults in the US with an iPhone than there are children aged under 18 but America has fallen far behind other markets in it’s focus on mobile amongst senior audiences despite launching a MVNO for seniors in 2006 (the Jitterbug by GreatCall Inc) as markets like Japan have moved on so quickly (eg. all seniors there have 3G mobiles, most run pedometer style apps and the vast majority use mobile data, etc).
What would have got my vote today in the USA?
Kaiser Permanente – a care provider that is taking the initiative with mHealth by enabling 9 million patients to access their records via mobile free of charge.
I think it’s quite obvious that until this type of integrated step change is made by healthcare providers a lot of the work of mHealth developers will be limited and may in many cases (by increasing fragmentation) be adding to the challenges that both care providers and patients face.
The US Surgeon General’s recognition of KP’s work would have sent a strong message highlighting best practice and reminding other healthcare providers of their role in helping increase appropriate access to the data that already exists.
AT&T, LG and Microsoft for taking the initiative to warn the texting generation on getting a new mobile to be careful using the device when driving. Research shows there have been more than 10,000 deaths and countless more injuries on US roads from drivers being distracted by mobile phones.
In 2012 I really hope we see the networks and device makers across the world working on even more innovative ways to help address this massive problem that mobility has introduced and is capable of solving eg. preinstalling safety video messages on mobiles, enabling phones so that they can automatically select a “driving” profile that diverts calls to SMS etc, etc.