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Kevin A. Clauson, PharmD @kevinclauson
Next Gen Pharmacy
mHealth, Wearables & Invisibles
I have more
optimism about
the future of
pharmacy than some
people feel is
merited
Objectives
1. Describe the mobile health (mHealth) arena
and its relevance to pharmacy practice.
2. Contrast the paternalistic and participatory
medicine models as they relate to mHealth.
3. Discuss the use of mHealth applications (apps)
and wearables to enhance patient self-care.
4. Summarize hurdles associated with mHealth
in pharmacy.
mHealth Arena
Am J Health Syst Pharm 2013;70(15):1348-52.
mHealth is the use of mobile devices
and global networks to deliver health
services and information
Kairos
Fogg BJ. Persuasive Technology: Using Computers
to Change What We Think and Do, 2002.
Καιρος: Greek god of the favorable moment
Leveraging
mobile
technology to
facilitate
behavior change
Dimension Factor mHealth tool(s)
Social and economic Limited English language
proficiency
Medical encounter app (MediBabble); Mobile
medical translator (Jibbigo)
Health care system Lack of positive
reinforcement
HealthPrize; Mango Health; Memotext
Condition-related Depression Mobilyze
Therapy-related Complexity of medication
regimen
AdhereTech; eMedonline; eTect; Helius;
Pillboxie
Patient-related Alcohol or substance abuse Alcohol–Comprehensive Health
Enhancement Support System (A-CHESS
Mobile Platform)
mHealth tools to address factors in
medication non-adherence by dimension
Chapter 33. mHealth and Pharmacy in Healthcare.
mHealth Multidisciplinary Verticals, 2014.
Wearables are an accessory that
enable personalized mobile
information processing
Conf Proc IEEE Eng Med Biol Soc 2014;2014:4155-8.
2005 2007 2009 2011 2013 2015
www.bionicly.com/digital-health-hype-cycle
PharmacyPractice2015;1(1):23,25.
Longwoods White Paper, October 2014.
Participatory
Medicine
Paternalistic approach to healthcare*
*Legacy model Health Aff 2014;33(9):1627-34.
Participatory Medicine
“Movement in which networked patients
shift from being mere passengers to
responsible drivers of their health, and in
which providers encourage and value them
as full partners.”
www.participatorymedicine.org
Source: The Accenture Connected Health Pulse Survey, 2012 (n=1,100).
Prescriptions
Appointments
Patients want to refill Rxs via digital channels:
Patients want to manage via digital channels:
73%
72%
72%
68%
Mobile
Mobile
Website
Website
90% of patients want online
access to health information
and education
Consumers want to use health apps
Source: Consumer Health Information Corporation, April 2011 (n=395)
Percent
mHealth & Wearables
‘Bridge’ Technology
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
pillboxie.tumblr.com
adheretech.com
etectbio.com
Wearable Categories
• Fitness trackers
• Smart watch/hybrids
• Health-focused wearables
• Productivity wearables
• Wearables with health applications
www.fitbit.com
www.fitbit.com
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
Misfit Shine
www.misfit.com
Misfit Flash
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
www.hioscar.com
The $12 Fitness Tracker
www.pivotalliving.com
Kids’ activity can be
converted into:
– coins
– ibitz game points
– Device unlock time
App compliant with Children’s Online Privacy and Protection Act
(child’s activity information cannot be shared with anyone besides the parent)
www.getwuf.com
www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf
1Nike+ Fuelband, 2Fitbit Ultra,
3Jawbone UP, 4BodyMedia FitCore,
5Adidas MiCoach
1 2
3
4 5
10 men and 10 women
ages 18-44 wore all
devices to measure steps
and energy expenditure
Comparison of steps taken measured using hand counting
compared to steps taken from the activity devices
Devices Treadmill
Walking
Treadmill
Running
Elliptical Agility
Actual 2425+/-177.9 3182+/-173.9 2631+/-371.5 805+/-51.9
Jawbone UP 2403+/-176.6 3186+/-171.5 2627+/-359.0 783+/-110.1
Nike
Fuelband
2273+/-154.8* 3169+/-171.2 2580+/-458.7 533+/-70.4*
Fit Ultra 2425+/-177.2 2990+/-313.0* 2630+/-370.6 645+/-90.0*
NL-2000i 2425+/-178.0 2869+/-247.1* 2477+/-471.1* 671+/-106.9*
www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf
Values represent means +/- standard deviation
*Significantly different than actual steps (p<0.05)
Device Observations
Galaxy S4 Moves App 28
iPhone 5s Moves App 28
iPhone 5s Health Mate 27
iPhone 5s Fitbit App 27
Nike Fuelband 28
Jawbone UP24 28
Fitbit Flex 28
Fitbit One 26
Fitbit Zip 27
Digi-Walker SW-200 28
JAMA 2015;313(6):625-626.
500 1000 1500 2000
App
Mean number of steps
Device outcomes for 1500 step trials
Fitbit activity tracker
Microsoft Band + Health app
www.microsoft.com/microsoft-band/en-us
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
www.apple.com/watch
“…what I, as a CIO, need to do is gather the
data on your… devices in your home, and
understand what I can do to keep you well.”
“You will, through the device that you have,
your mobile phone, be able to use
middleware integration to the various
kinds of telemetry in your home, and
therefore [have] a single point of
interaction between your phone and the
EHR.”
– John Halamka, M.D.
Chief Information Officer of Beth Israel
Deaconess Medical Center
mobihealthnews.com
Middleware
in action
Apple HealthKit Institutional Partners
Apple HealthKit App Partners
EVERYONE
except
( )
Ok, not really but it can seem that way
https://itunes.apple.com/us/app/mychart/id382952264?mt=8
Smartphone share by platform in U.S.
Source: comScore MobiLens Mobile Metrix September 2014
Mimo Baby Smart Monitor
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
Stress, autism, epilepsy, PTSD, depression, and anxiety
www.mota.com
Boogio
Game
controller
Gait
analysis
Fall risk
www.boogio.com
Next Gen Pharmacy: mHealth, Wearables, and Invisibles
www.xoeye.com
lumoid.com/wear
Wearables InvisiblesEvolution of body computing
By 2017, 30 percent of
wearables will be invisible*
*invisible = unobtrusive to the eye
Predicts 2015: New Business Opportunities and Complexity on the Rise in Consumer Devices Market
Smart contact lenses for diabetes
Hurdles with mHealth
and Wearables
83%
!
83% of consumers
have difficulty using
their intelligent
devices
22% said their wearables
didn’t set up properly
24% said the devices were
too complicated to use
21% said the devices
didn’t work as advertised
Accenture. Engaging the Digital Consumer in the New Connected World, 2014.
One million Fitbit Forces
recalled in 2014
(but this was likely due to
hygiene, not product defect)
Are we isolating future generations with devices?
(maybe things haven’t changed as
much as we think)
Privacy
Security Interoperability
Regulatory
Financial
Could the holy
grail become
the pois ned
chalice?
EHR
Wearable data
Summary points
1. mHealth and wearables offer pharmacy the
potential to engage patients and enhance
positive health behaviors
2. Data from wearables can help fill in the
blanks for the (majority of) health that
happens outside the health care system
3. It is early days for wearables and invisibles
and there is a paucity of effectiveness data
Images
• http://a.tgcdn.net/images/products/zoom/eabe_half_full_optimi
st_glass.jpg
• http://reasonradionetwork.com/images/2012/04/opportunity.jpg
• http://www.google.com/trends/explore#q=wearable%20technolo
gy&cmpt=q&tz=
• http://www.myvirtualpaper.com/doc/pharmacy-
practice/pp_february_2014/2014043001/23.html#22
• http://www.longwoods.com/articles/images/TELUS%20Sante_v2
.pdf
• http://www.walgreens.com/store/c/walgreens-activity-
tracker/ID=prod6256835-product
• http://www.walgreens.com/topic/balancerewards/balance-
program-details.jsp
• http://geopalz.com/
• https://geopalz.com/wordpress/wp-
content/uploads/2013/09/POWERKEY-PRODUCT.jpg
• http://sr63parrot.caregroup.org/cmi/headshots/jhalamka_1744.j
pg
• http://www.pcmag.com/article2/0,2817,2470591,00.asp
• http://upload.wikimedia.org/wikipedia/en/d/d4/Fitbit_logo.jpg
• http://www.gizmag.com/mimo-baby-monitor-
ces/30277/pictures#3
• https://static-content1.empatica.com/XvPNd/img/carousel-
iphone.jpg
• http://www.google.com/glass/start/
• http://www.forbes.com/sites/leoking/2014/07/15/google-smart-
contact-lens-focuses-on-healthcare-billions/?slide=13
• http://d0.awsstatic.com/logos/customers/Novartis-logo.jpg
• https://qzprod.files.wordpress.com/2014/01/baghi49cyaaz2ps.jpg?w=1024&h=714
•
http://imageserver.moviepilot.com/the-usual-suspects-the-usual-suspects-cast-
20-years-after-keyser-soze-fooled-us-all.jpeg?width=1920&height=1080
Questions?
Kevin A. Clauson, PharmD @kevinclauson

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Next Gen Pharmacy: mHealth, Wearables, and Invisibles

  • 1. Kevin A. Clauson, PharmD @kevinclauson Next Gen Pharmacy mHealth, Wearables & Invisibles
  • 2. I have more optimism about the future of pharmacy than some people feel is merited
  • 3. Objectives 1. Describe the mobile health (mHealth) arena and its relevance to pharmacy practice. 2. Contrast the paternalistic and participatory medicine models as they relate to mHealth. 3. Discuss the use of mHealth applications (apps) and wearables to enhance patient self-care. 4. Summarize hurdles associated with mHealth in pharmacy.
  • 5. Am J Health Syst Pharm 2013;70(15):1348-52. mHealth is the use of mobile devices and global networks to deliver health services and information
  • 6. Kairos Fogg BJ. Persuasive Technology: Using Computers to Change What We Think and Do, 2002. Καιρος: Greek god of the favorable moment Leveraging mobile technology to facilitate behavior change
  • 7. Dimension Factor mHealth tool(s) Social and economic Limited English language proficiency Medical encounter app (MediBabble); Mobile medical translator (Jibbigo) Health care system Lack of positive reinforcement HealthPrize; Mango Health; Memotext Condition-related Depression Mobilyze Therapy-related Complexity of medication regimen AdhereTech; eMedonline; eTect; Helius; Pillboxie Patient-related Alcohol or substance abuse Alcohol–Comprehensive Health Enhancement Support System (A-CHESS Mobile Platform) mHealth tools to address factors in medication non-adherence by dimension Chapter 33. mHealth and Pharmacy in Healthcare. mHealth Multidisciplinary Verticals, 2014.
  • 8. Wearables are an accessory that enable personalized mobile information processing Conf Proc IEEE Eng Med Biol Soc 2014;2014:4155-8.
  • 9. 2005 2007 2009 2011 2013 2015
  • 12. Longwoods White Paper, October 2014.
  • 14. Paternalistic approach to healthcare* *Legacy model Health Aff 2014;33(9):1627-34.
  • 15. Participatory Medicine “Movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.” www.participatorymedicine.org
  • 16. Source: The Accenture Connected Health Pulse Survey, 2012 (n=1,100). Prescriptions Appointments Patients want to refill Rxs via digital channels: Patients want to manage via digital channels: 73% 72% 72% 68% Mobile Mobile Website Website 90% of patients want online access to health information and education
  • 17. Consumers want to use health apps Source: Consumer Health Information Corporation, April 2011 (n=395) Percent
  • 24. Wearable Categories • Fitness trackers • Smart watch/hybrids • Health-focused wearables • Productivity wearables • Wearables with health applications
  • 31. The $12 Fitness Tracker www.pivotalliving.com
  • 32. Kids’ activity can be converted into: – coins – ibitz game points – Device unlock time App compliant with Children’s Online Privacy and Protection Act (child’s activity information cannot be shared with anyone besides the parent)
  • 34. www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf 1Nike+ Fuelband, 2Fitbit Ultra, 3Jawbone UP, 4BodyMedia FitCore, 5Adidas MiCoach 1 2 3 4 5 10 men and 10 women ages 18-44 wore all devices to measure steps and energy expenditure
  • 35. Comparison of steps taken measured using hand counting compared to steps taken from the activity devices Devices Treadmill Walking Treadmill Running Elliptical Agility Actual 2425+/-177.9 3182+/-173.9 2631+/-371.5 805+/-51.9 Jawbone UP 2403+/-176.6 3186+/-171.5 2627+/-359.0 783+/-110.1 Nike Fuelband 2273+/-154.8* 3169+/-171.2 2580+/-458.7 533+/-70.4* Fit Ultra 2425+/-177.2 2990+/-313.0* 2630+/-370.6 645+/-90.0* NL-2000i 2425+/-178.0 2869+/-247.1* 2477+/-471.1* 671+/-106.9* www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf Values represent means +/- standard deviation *Significantly different than actual steps (p<0.05)
  • 36. Device Observations Galaxy S4 Moves App 28 iPhone 5s Moves App 28 iPhone 5s Health Mate 27 iPhone 5s Fitbit App 27 Nike Fuelband 28 Jawbone UP24 28 Fitbit Flex 28 Fitbit One 26 Fitbit Zip 27 Digi-Walker SW-200 28 JAMA 2015;313(6):625-626. 500 1000 1500 2000 App Mean number of steps Device outcomes for 1500 step trials
  • 38. Microsoft Band + Health app www.microsoft.com/microsoft-band/en-us
  • 41. “…what I, as a CIO, need to do is gather the data on your… devices in your home, and understand what I can do to keep you well.” “You will, through the device that you have, your mobile phone, be able to use middleware integration to the various kinds of telemetry in your home, and therefore [have] a single point of interaction between your phone and the EHR.” – John Halamka, M.D. Chief Information Officer of Beth Israel Deaconess Medical Center mobihealthnews.com
  • 44. Apple HealthKit App Partners EVERYONE except ( ) Ok, not really but it can seem that way
  • 46. Smartphone share by platform in U.S. Source: comScore MobiLens Mobile Metrix September 2014
  • 47. Mimo Baby Smart Monitor
  • 49. Stress, autism, epilepsy, PTSD, depression, and anxiety
  • 56. By 2017, 30 percent of wearables will be invisible* *invisible = unobtrusive to the eye Predicts 2015: New Business Opportunities and Complexity on the Rise in Consumer Devices Market
  • 57. Smart contact lenses for diabetes
  • 59. 83% ! 83% of consumers have difficulty using their intelligent devices 22% said their wearables didn’t set up properly 24% said the devices were too complicated to use 21% said the devices didn’t work as advertised Accenture. Engaging the Digital Consumer in the New Connected World, 2014.
  • 60. One million Fitbit Forces recalled in 2014
  • 61. (but this was likely due to hygiene, not product defect)
  • 62. Are we isolating future generations with devices?
  • 63. (maybe things haven’t changed as much as we think)
  • 65. Could the holy grail become the pois ned chalice? EHR Wearable data
  • 66. Summary points 1. mHealth and wearables offer pharmacy the potential to engage patients and enhance positive health behaviors 2. Data from wearables can help fill in the blanks for the (majority of) health that happens outside the health care system 3. It is early days for wearables and invisibles and there is a paucity of effectiveness data
  • 67. Images • http://a.tgcdn.net/images/products/zoom/eabe_half_full_optimi st_glass.jpg • http://reasonradionetwork.com/images/2012/04/opportunity.jpg • http://www.google.com/trends/explore#q=wearable%20technolo gy&cmpt=q&tz= • http://www.myvirtualpaper.com/doc/pharmacy- practice/pp_february_2014/2014043001/23.html#22 • http://www.longwoods.com/articles/images/TELUS%20Sante_v2 .pdf • http://www.walgreens.com/store/c/walgreens-activity- tracker/ID=prod6256835-product • http://www.walgreens.com/topic/balancerewards/balance- program-details.jsp • http://geopalz.com/ • https://geopalz.com/wordpress/wp- content/uploads/2013/09/POWERKEY-PRODUCT.jpg • http://sr63parrot.caregroup.org/cmi/headshots/jhalamka_1744.j pg • http://www.pcmag.com/article2/0,2817,2470591,00.asp • http://upload.wikimedia.org/wikipedia/en/d/d4/Fitbit_logo.jpg • http://www.gizmag.com/mimo-baby-monitor- ces/30277/pictures#3 • https://static-content1.empatica.com/XvPNd/img/carousel- iphone.jpg • http://www.google.com/glass/start/ • http://www.forbes.com/sites/leoking/2014/07/15/google-smart- contact-lens-focuses-on-healthcare-billions/?slide=13 • http://d0.awsstatic.com/logos/customers/Novartis-logo.jpg • https://qzprod.files.wordpress.com/2014/01/baghi49cyaaz2ps.jpg?w=1024&h=714 • http://imageserver.moviepilot.com/the-usual-suspects-the-usual-suspects-cast- 20-years-after-keyser-soze-fooled-us-all.jpeg?width=1920&height=1080
  • 68. Questions? Kevin A. Clauson, PharmD @kevinclauson

Editor's Notes

  1. http://a.tgcdn.net/images/products/zoom/eabe_half_full_optimist_glass.jpg
  2. http://reasonradionetwork.com/images/2012/04/opportunity.jpg
  3. http://www.google.com/trends/explore#q=wearable%20technology&amp;cmpt=q&amp;tz=
  4. http://www.myvirtualpaper.com/doc/pharmacy-practice/pp_february_2014/2014043001/23.html#22
  5. http://www.longwoods.com/articles/images/TELUS%20Sante_v2.pdf
  6. http://www.walgreens.com/store/c/walgreens-activity-tracker/ID=prod6256835-product http://www.walgreens.com/topic/balancerewards/balance-program-details.jsp
  7. https://www.hioscar.com/
  8. http://geopalz.com/ https://geopalz.com/wordpress/wp-content/uploads/2013/09/POWERKEY-PRODUCT.jpg
  9. http://www.getwuf.com/
  10. http://www.uwlax.edu/
  11. http://www.microsoft.com/microsoft-band/en-us
  12. https://www.apple.com/watch/health-and-fitness/
  13. http://sr63parrot.caregroup.org/cmi/headshots/jhalamka_1744.jpg
  14. http://www.pcmag.com/article2/0,2817,2470591,00.asp
  15. http://www.athenahealth.com/ http://www.cerner.com/include/img/logo-cerner.gif http://www.uhc.com/ https://www.humana.com/ https://upload.wikimedia.org/wikipedia/en/7/76/Mayo-clinic-logo.png http://upload.wikimedia.org/wikipedia/commons/thumb/2/26/Epic.png/200px-Epic.png https://d1ewxbznfa539k.cloudfront.net/s/_logo/abee27e0ff0df2dace561a742960a657.png https://upload.wikimedia.org/wikipedia/en/0/06/Stanford_University_Medical_Center_logo.png http://upload.wikimedia.org/wikipedia/en/thumb/6/6f/PennMedVerticalLogoSVG.svg/235px-PennMedVerticalLogoSVG.svg.png http://upload.wikimedia.org/wikipedia/en/f/f1/DukeMedicine_Logo.svg http://upload.wikimedia.org/wikipedia/en/4/42/Johns_Hopkins_University_Logo.png http://upload.wikimedia.org/wikipedia/en/5/57/Cleveland_Clinic_logo.png
  16. http://upload.wikimedia.org/wikipedia/en/d/d4/Fitbit_logo.jpg
  17. http://cowbgonaca.blogspot.com/2011/06/wallpaper-for-android-mobile.html http://img1.wikia.nocookie.net/__cb20130826153355/logopedia/images/c/c7/Windows_logo_-_2012.pnghttp://www.mac-wallpapers.com/Apple-Wallpapers/white-apple-logo-wallpaper/ http://www.laptopsteria.com/wp-content/uploads/2011/06/blackberry-logo.jpg http://www.comscore.com/Insights/Market-Rankings/comScore-Reports-September-2014-US-Smartphone-Subscriber-Market-Share
  18. http://www.gizmag.com/mimo-baby-monitor-ces/30277/pictures#3
  19. http://www.amazon.com/Smart-Monitor-Starter-Natural-Months/dp/B00JU99G8Y
  20. https://static-content1.empatica.com/XvPNd/img/carousel-iphone.jpg http://www.media.mit.edu/ http://www.nasa.gov/ http://www.intel.com/ https://identity.stanford.edu/overview/emblems http://identity.yale.edu/
  21. https://www.mota.com/mota-smart-ring/
  22. http://www.google.com/glass/start/
  23. http://www.sitemason.com/files/jRSqbK/XOEye%20Logo.png/main.png http://startupbeat.com/wp-content/uploads/2014/04/XOEye-XOne-2.jpg
  24. https://lumoid.com/wear
  25. http://www.forbes.com/sites/leoking/2014/07/15/google-smart-contact-lens-focuses-on-healthcare-billions/?slide=13 http://d0.awsstatic.com/logos/customers/Novartis-logo.jpg https://www.google.com
  26. https://qzprod.files.wordpress.com/2014/01/baghi49cyaaz2ps.jpg?w=1024&amp;h=714
  27. http://imageserver.moviepilot.com/the-usual-suspects-the-usual-suspects-cast-20-years-after-keyser-soze-fooled-us-all.jpeg?width=1920&amp;height=1080