Center for Health Leadership

New Media Training SeriesUC Berkeley SPH

Mobile workshop11/17/2010

Mike Kirkwoodmike@eek.com

Introduction – Mike Kirkwood

• Mobile– An early innovator in mobile apps (day one Apple apps, over

1 million apps downloaded)– Developed core technology for text reminders with AHA

(American Heart Association) and HealthVault

• Health– Serial speaker at Health 2.0 (tools panel), mHealth

conference, and Quantified Self– Health claims management (large and small payers)– Developer of first iPhone emergency app & PHR (using CCR)

• Technology– Analyst / Author, cloud computing for ReadWriteWeb – Large enterprise technology leader (Sony, Cisco, Intuit)

specializing in real-time agile enterprise (6 patents in enterprise content, data, and metadata)

Workshop objective

• Today, we will survey the mobile health technology landscape, review a real app development project, and kick off the design of our own personal mobile health project

• Participants will:– Understand mobile health landscape– Be able to take a mobile project idea to

peers or technology advisors

Agenda• Introductions• Landscape of M-Health• Examples of mobile phone tools in public health and

healthcare– overview with open Q & ALUNCH

• How mobile phones can be used for health applications– sharing and group discussionBREAK

• Workshop– mobile tool and app design

• Design statement• Wireframes • Brainstorm• Feasibility analysis

• Closing and evaluation

Introductions

• Name• Your role in your

organization• What you are

doing with M-Health

• One reason you are here today

The Survey

• What are some ways to kick-start a project?

• Is HIPAA important?• How is the web connect to mobile

strategy? • What if I have a smart phone, but I

don’t use apps?

Activity

• Set a reminder message to your phone

LANDSCAPE

Why use mobile platform instead of web?

• Graphics engine support (games)

• Maps using location services

• Sales through app store (1 click to buy)

• Push notification to deliver free notifications that can pull open apps

Examples of projects in mHealth

• Text4Baby – Over 100,000 members. First “free send and receive”

• Apps and mHealth challenge, Todd Park @ #mHealth

• Heart 360 releases text reminders for Heart health patients

• Norwegian Government Announces $1 Million for Initiative Using Mobile Technology to Support Maternal Health...Supports Use of Wireless Networks and Devices to Reduce Maternal and Newborn Mortality

Tsunami of activity• Neilsen Report: Teens Text

3,339 Times Per Month! Voice Calling on Phones Going Extinct?

• Mobile phone health apps could improve care in developing countries

• Why your phone is now the doctor in your pocket

• Mobile Health Apps See Weak Adoption Rates

• Innovative strategies and high-tech solutions for sexual health education and STD/HIV prevention

• IT chief sees mHealth moving faster than expected

• Bill Gates keynotes mHealth Summit, focuses on saving children

• Text messages used to reach expectant, new moms

• The Power of Mobile by Susannah Fox | Pew Research Center's Internet ...

• New app zaps auto texting, tracks teens

Tsunami of activity• For Many, Health Apps Are

Just Not Part Of The Routine

• Dear Google: please make a medical category for apps in the Android Marketplace

• Emotional Automation: Bonding with Technology to Improve Health

• Chip-in-a-pill may be approved in 2012

• Busting the paradigm about mobile for health: it’s not just phones and browsers. (Morgan Stanley, April 2010)

• Cleveland Clinic calls wireless telemonitoring of heart disease #6 most important medical innovation of today

• Formation of mHealth Regulatory Coalition: Singular purpose is to create & submit a guidance document to FDA clarifying mHealth hardware...

• Healthcare sector among top adopters of iPad

• Health Insurer Humana's mHealth Program for 60,000 w/Chronic Disease

• Mobile Phone Apps Being Created To Test For STDs

What do you think?

A few videos

http://www.youtube.com/watch?v=OextYih4Z28mHealth - Infectious

Disease in a Mobile Age (MWV34)

http://www.youtube.com/watch?v=PEza09P7bDoMed Apps: It's the

Future- Just Right Now

Some key #mhealth terms

• Smart phone• Phone with OS that

includes full keyboard, applications, and other core services (email, maps, apps)

• SMS• short messaging service,

a commonly supported standard for sending and receiving messages on mobile networks

• Web services• protocols for delivering

data services over the web

• Cloud computing• infrastructure and

computing resources via the Internet

• HIPAA• U.S. law governing health

insurance portability & accounting

• EHR• electronic health record

• Meaningful use• standard for determining

health stimulus incentive qualification over stages of time

Landscape: Longevity planning

Landscape: Self admin tools

Landscape: Wellness

Landscape: Augmenting reality

Landscape: Some challenges

• Fragmentation– Touch-screen apps, no apps, some apps– SMS / MMS– Push notification

• Infrastructure assumptions– Web and services support– Network quality and reliability– SMS fire and forget

• Information management– HIPAA– Tokens, credentials

Landscape: Development

• Building a goal• Developers are closest to canvas• Template for app scope

• Scripting a story with tools• “not pretending” rapid wire-frames – Balsamiq• “reality” wireframe templates - Mockapp

• Development technologies• Web (HTML 5)• SDK (Apple, Android)• Libraries & languages (Unity, Flash)• SMS / Voice (Twilio)

Landscape

• Topics–Mobile trajectory– Health reform– Location is social– Apps in the

market– Connecting the

dots

Landscape - Mobile

• Mobile–Messaging

is network– Texting is

the medium

– iPhone offers baseline• SMS• Email

Landscape - Social

• Social– Games– Our story

is in memory

– Location has a story to tell• People• Places• Things

Landscape - Health

• Health– EHR

stimulus = outcomes

–Measure–Mobile

enterprise• Sensors

drive workflow

Landscape: Connecting the dots

• Health cloud– SMS, Email,

sharing connect

– Apps with sensors log behavior

–Measuring outcomes becomes baseline

SCENARIOReview of a recent real-world mobile health app construction

Scenario – Mobile reminder log

• Scenario overview– Connecting patients who need to take action to

achieve good heart health, working with doctors that observe and react to patient outcomes• Goal• Wireframe example• Application example

• Scenario brainstorm– What could we do next?

• For patient, family, friends• For doctor, nurse• With location, web, games, content, social, AI, …

Scenario: What is the goal?

• Allow people with heart conditions to easily keep track of their risk factors when working with their doctor to monitor their progress

• Conversation guideposts to help modify behaviors

Scenario: How does it work?

• Embedded into web applications, e.g. provider portals

• Joins web account with mobile reminder system

Scenario: Provider workflow

• Trigger new dialog or knowledge sharing

• Brings mobile and web view together

Scenario: Questions or reminders?

Scenario: Medications are tricky

Scenario: Simplify medications

Scenario: Daily expectations

Scenario: Simple user thread

Scenario: Complex user thread

Scenario: Missed reminder action

Scenario: Ask, Log, Confirm

• Proactive SMS reminder

• Smart listener

• Share through web services

Scenario: Anticipated outcomes

• Simple reminders become baseline (like an alarm clock)

• Story telling increases length of use and commitment to action

• Noisy and random is good (frequency dialog vs. numbers and form fields)

Scenario: Community design

• Some steps– Convert

achievable actions into shared currency

– Organize delivery systems• geography• closeness• situational

– Silence is golden

Scenario: Embedded app

Scenario: Question!

Scenario: Conversation threading

Scenario: Confirm dialog

App elaboration: What else?Should it do? Should it not do?

WORKSHOP

Workshop: Agenda

• Activities– App definition• What will your mobile service do?• Wire-frame workshop• Feasibility review• Work in teams, or alone• Ask questions, review similar, invent new

– App review• Peer review (time permitting)

What does your app do?

___________ (name) enables ____________ (group of people) to accomplish ___________________________________(a specific task), while…______________________ (optional:

specific conditions)

[ ] app [ ] sms [ ] service [ ] device

Sample (simple) use caseActors• Doctor• Person• Mobile #• HealthVault• AHA 360 application• Log web service• SMS gateway• Reminder engine• Conversation engine• Actions• Message

Use case steps• Person accepts invitation from

Provider to join HealthVault AHA 360 application

• Person signs up for reminder engine by validating mobile #

• Reminder engine sends reminder message to person

• Person responds to message• Conversation manager

inspects action in message– If understood, log action– If not understood, exit

• Provider requests action log from conversation engine web service

• Provider confirms review and updates person web service

Use case

Actors Use case steps1. -2. -3. -4. -5. -6. -7. -

Application name: On this screen, the user if able to…

Application workflow: The user…

Application name:

Application name:

Application name:

Application name

Application name:

Application name:

Application name:

Application name:

Application name:

Application name:

Application name:

Closing and Evaluation

• One thing you are taking away from today that will be useful for you

• One thing you are going to do to move forward with your M-health project