“Mobile Health What Really Works”

Organised by the Persuasive Technology Lab at Stanford, Mobile Health 2011 “What Really Works” definitely proved “What Really Makes Money” (delegate tickets sold out at $2,099 each prices ranging from $379 to $2,099 each) but I found my thoughts about the event were somewhat clouded by too much unneccessary hype:

We are the conference that highlights real solutions for real people — practical, proven solutions. Each speaker will share with you “what really works” — right now. In fact, “What really works” is our official theme. This is not a conference about speculation or sexy ideas that live only in slides. That’s not helpful. Our conference is about what really works to improve the health behavior of everyday people. For two action-packed days, you’ll hear from the winners, and you’ll learn from their successes. But that’s not all. This year we show you what really works in many facets of mobile health, from prototyping to testing, from distribution to monetization. Our event moves quickly: You’ll hear from 25 speakers each day, and we stick strictly to the schedule. No one rambles on and on. By design, we give you long breaks so you can meet the speakers and network with others

Thankfully a post event summary of the conference written by R Craig Lefebvre (who worked as a member of the events content team) brings us back to ground:

Despite the best efforts of our content team, of which I was a member, to solicit the evidence, the answer seems to be: we have some clues, but research beyond pilots and feasibility tests is sorely needed

I hope this will be a reminder of the need to be careful to avoid strategic misrepresentation in this industry. It’s unlikely to be missed (patients have some of the strongest vested interests), increasingly likely to be reported on (thanks to the rise of social media and the rights of patients) and will never come anywhere near to creating the value of clinical evidence or real customers who are happy to freely advocate for the efforts of service providers.

In this instance it was particularly sad to find it as although there are plenty of the competitive events there really was no need for the team at Stanford to hype what they had planned. The inaugural 2010 event had been sold out, they had a great line up of speakers/sponsors and the whole event was focused on the enormous opportunities that are developing as a result of the convergence of two trillion dollar industries.

Trying to ignore the expectations that the statement “What really works” creates for me here are my key take aways after following the tweets from the event and reviewing the slide decks (that have all been generously shared here):

As a $10,000 Diamond sponsor my expectations of Kaiser Permanente ran high but even ignoring that I fail to see the point of sponsoring a mHealth event to tell us you’re “Sifting through the hype”. It fails me to think of a reason why KP wasn’t more generous in sharing their knowledge and expertise as we’ve previously read about the enthusiasm and support Michael Cross has from his CMIO.

What would I have liked to learn about?

> X% of our patients use their mobiles when they stay with us
> X% of patients have chosen to register their mobile number
> X% of our staff use BlackBerry’s, X% Apple iPhones
> X% have replaced pagers with smartphones
> Website stats: X% PC/Laptop, X% iPad, X% Mobile

Obviously I have to be careful with what I say here (I don’t want Jody discouraging any more of my readers from paying attention!) but can anyone see anything in this thats more than just an introduction to the work of the mHealth Alliance?

I’m sure it would have been fascinating to know what works from the perspectives of a multimillion dollar mHealth NGO.

In this slide deck Jafar Shenasa, Senior Manager, Regulatory Affairs and Aaron Filner, Associate Director Health Application Platform, at Proteus Biomedical tried to help the audience “Understanding FDA Regulation of Mobile Health”. Don’t miss Slide 6 where they suggest:

“mHealth = Acquiring and delivering health data outside of a clinical facility”.

So pre-18th century everything was mHealth right? 😉

I was thinking it a shame that someone didn’t represent the FDA’s point of view on this until I viewed the slide deck of Sanjay Koyani, Senior Communications Advisor FDA Center for Tobacco Products:

I’m amazed to think that anyone could think it would discourage smoking to be sending “Everyone” a SMS asking “What happened to Light, Low and Mild?”

Nor can I think of anything that would be MORE effective at educating impressionable young people about how “cool” and “anti-authority” it might be to start smoking young than the FDA Tobacco Control’s educational team sending the “General Public” a SMS stating:

FDA: Are you under 27? If so, you may be carded when buying tobacco products. The new laws are to protect youth. http://www.fda.gov/ProtectYouth

It’s rather depressing for me to see this type of US Government backed communication as I’d be genuinely surprised if cigerette advertising companies could actually think of something that would be more effective at getting youth people to consider smoking.

This report by Abby King on “Employing “Virtual Advisors” to promote physical activity in underserved communities” by a team from the Stanford Univerisity School of Medicine, was way off topic (there was no use of mobile technology/devices at all) and its always disappointing to see medical research using such out dated technologies.

To give you the general idea of what I was expecting here is a screen shot of a Japanese mobile running an inbuilt pedometer monitor (it was a basic mobile available in stores across Japan in 2006):

Unlike the successful mobile phone based pedometer solutions that millions of patients already use this study involved a “downloadable Omron pedometer”. From a look at the evidence showing improvements over time in 20 patients I really cannot see it reliably concluding anything more than:

“Visiting a computer in an elderly care centre may remind patients to carry/use an expensive pedometer device”

Thankfully Tim Roberts, VP Interactive at Fit Bit, presented how you can make a successful commercial product from activity monitoring with his “Flower Power” challenge presentation.

I’m looking forward to see the result of FitBit’s collaboration with mobile device makers as this represents a huge opportunity to leverage the motion sensors that now feature in a wide range of mobiles and could prove a great way of building and maintaining brand loyalty: if you could easily see how your Samsung/Nokia/Apple/BlackBerry helped you reach fitness goals and lose lbs I’m sure it would be a hard act to follow.

Larry Swiader of The National Campaign to Prevent Teen and Unplanned Pregnancy was wide of the mark and from his slide deck I fail to see any “mHealth what really works”. In fact it looks like a concerted effort to design a system that would avoid the use of mobile tools:

And please don’t tell me that the Bedsider iCondom iPhone App qualifies as I cannot begin to even imagine how well received those Facebook updates would be:

Rather than even looking at the potential for mobile to make a difference the slides also ignored the abundance of evidence that suggests most women have already figured how to set reminders with the calendar/alarm functionality on even basic mobiles:

Then again maybe some of the mobile networks who are struggling to support customers taking advantage of unlimited data plans might work with TheNC to try and discourage people from stressing the mobile networks? 😉

In this presentation Bojan Bernard Bostjancic, Azumio, offered the type of smartphone app data that I would have expected an event at Stanford Medical School to have moved on from:

I really think there is an urgent need for us to move on from saying “8 million heart rate apps have been downloaded, 50k per day and growing” to a stage where we’re either talking about the money (eg. how many of these are paid for, how many click throughs these created for advertisers etc) or we’re talking about how many of these patients are continuing to use the apps on a day to day basis.

In the world of mobile content you might want to talk about millions of transactions but I think in Healthcare it’s more important to get things right first as most healthcare providers would actually be more impressed by 500 patients achieving better clinical outcomes than a billion free downloads.

Steven Dean’s “10 Mobile Health Hacks” neatly described 10 pointers that I feel would provide an useful exercise for developers looking to develop and add value to mHealth services:

1. Remind me 2. Assist me 3. Motivate me 4. Interrupt me 5. Tell me 6. Capture me 7. Record and report me 8. Motivate me 9. Track me 10. Reward me

I wonder if more of the presenters would have given such helpful presentations had there been less pressure (inferred from the event title) to show “what really works”?

Eric opened strong by sharing some useful data (eg. over a 4 month period 214,530 messages were received at the KNOWIT short code, and the hours of 3-4 am proved the most popular hours for participation) but it would have been useful to know much more about the numbers:

What % of SMS’s/ZIP codes were correctly submitted?
How many customers sent more than 1 request?
What % dropped out of the service after 1/2/3/4/5 messages?
What factors underlined the high early morning engagement levels (was this linked to late night TV commercials running etc)?

He also showcased the “Old Spice SMS Stinky Alerts” campaign as an example of how we can involve “Friends/Social” to drive behaviour change:

I found this a concerning development and am surprised none of the audience tweets picked up on this as I see it as little more than yet another digital means of bullying.

Sadly I wouldn’t be completely surprised to see the Healthy food alert services next:

“Diet Fizzy Drink SMS Fatso Alerts: How do you tell someone they really really need to lose some weight without embarrassing them in public?”

It’s useful to see this all the same as mHealth developers should be aware of the potential for these issues when considering how to add patient community/peer pressure features to their services.

Dr Roni Zeiger MD, Chief Health Strategist, Google was a Diamond sponsor for the event but used his presentation to merely explain how a medical professional could share Google Body images with patients using a tablet device and screen share (via TV Out) from this to a fixed TV screen in the clinic.

This was disappointing for me as Google have an enormous opportunity to lead the mHealth market and make up for some of the previous criticism they’ve faced with regard to making money through unethical/irresponsible business practices in healthcare. What would I have loved to hear Roni talk about?

> Differences between health searches on mobile and PC
> What Google Health visitors are trying to do?
> What problems do patients face?
> What’s next for Google Health, will they be an enabler or provider?
> If Larry Page could grant me 1 wish I would…
> Tools we’re building into Android that Healthcare providers will love!

It’s a shame Google have stopped wowing the crowds and been so content to hand over this important job to Apple. If Apple had a technology as powerful as Google Body do you think for a minute Steve Jobs would miss out on the opportunity to show how it could be used in conjunction with FaceTime to enable remote consulting healthcare providers to more effectively consult with their patients?

“I can’t touch it but take a look here on the screen and you’ll see exactly where your thyroid is and it would be really helpful if you could touch the screen exactly where you’re feeling the pain on your body”

Let me know what you made of it all… did I miss any nuggets?

About David Doherty

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5 Responses to “Mobile Health What Really Works”

  1. BJ Fogg says:

    Thanks for writing about Mobile Health.

    Your first statement, though, is not entirely accurate. You imply we sold all the tickets for over $2000. That’s not true. While we priced “Late Bird” tickets at $2099, almost everyone bought tickets earlier at a much lower price, including “Early Bird” tickets at $379.

    Putting that issue aside, let’s talk about the event content . . .

    Yes, my team would agree that the theme of “what really works” was ambitious. We knew that from the start, but we wanted to put the challenge out there. For months we worked to bring in speakers that could deliver on this theme. Some did; some didn’t.

    As the promotional tone — yep, agreed. We’ll try to do better in the future.

    Oh, another thing to clarify: The person from Kaiser who spoke was not part of the Kaiser team who sponsored the event. (Background: Sponsoring our event does not give you a slot the program.)


    –BJ Fogg, Executive Director, Mobile Health at Stanford

  2. Hi BJ,

    Thanks for your comment and for the important work you and Stanford University are doing in this area.

    > Thanks for writing about Mobile Health

    No problem at all, I’ve been blogging on the topic for nearly 4 years and I really value the contribution you continue to make. Especially grateful that you’ve openly shared the slide decks. If only you posted the videos of the presentations… okay now I know I’m dreaming!

    > Your first statement, though, is not entirely accurate. You imply we sold all the tickets for over $2000. That’s not true. While we priced “Late Bird” tickets at $2099, almost everyone bought tickets earlier at a much lower price, including “Early Bird” tickets at $379.

    I didn’t intend to imply this but there was no other information to go on when I checked the website. I’ve edited the article where it states: “delegate tickets sold out at $2,099 each” so it now reads: “delegate tickets sold out at prices ranging from $379 to $2,099 each”

    In case it’s not clear: I have no issues at all with the ticket prices or you making money for using your initiative and convening such an important event.

    > Yes, my team would agree that the theme of “what really works” was ambitious. We knew that from the start, but we wanted to put the challenge out there. For months we worked to bring in speakers that could deliver on this theme. Some did; some didn’t.

    At any stage did you think it might be wise to rename the event?

    FYI I’d be happy to make recommendations for your next events as I’m aware of some really great mHealth firms there in the USA that definitely exceed your challenge already eg. WellDoc

    > Oh, another thing to clarify: The person from Kaiser who spoke was not part of the Kaiser team who sponsored the event. (Background: Sponsoring our event does not give you a slot the program.)

    Personally I find that even more surprising than if they had paid for the opportunity to present. I can only see a “sifting through the hype” slide that refers to mHealth. Surely it’s a stretch to suggest that this represented “real solutions for real people — practical, proven solutions”?

  3. Pingback: Mobile Health 2011: A Look Back at What Really Worked « Unnatural Language Processing

  4. Pingback: Zero to One Million in One Month! Is KP’s mHealth initiative the fastest ever adoption of digital health services in history? « mHealth Insight: the blog of 3G Doctor

  5. Pingback: Evolution of Mobile Health at Stanford: 2011 = “What Really Works”, 2012 = “the power of “baby steps” « mHealth Insight: the blog of 3G Doctor

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