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Jennifer Shine Dyer M.D., M.P.HJennifer Shine Dyer M.D., M.P.H..Chief Medical AdvisorChief Medical Advisor

DuetHealth.com by eProximitiDuetHealth.com by eProximitiColumbus, OhioColumbus, Ohio

December 2011December 2011

Doctor-Patient Use Cases: Mobile Health and Diabetes

• Pediatric Endocrinologist

• Health Behavioralist (MPH)

• Problem-solving technology entrepreneur

• Social media enthusiast (@EndoGoddess)

Bolus Reminder App, 2010Bolus Reminder App, 2010• When: Fall 2010 (never

released in App Store)

• Who: Dyer teen patients with diabetes on insulin

• Why: Automate personalized weekly SMS texting protocol

• How: Master phone has app, patient phones SMS texting only

EndoGoddess App, 2011EndoGoddess App, 2011• When: September 2011, Apple

App Store

• Who: any patients with diabetes on insulin (teens, young adults)

• Why: motivate, educate, trigger behavior of checking glucoses 4X /day

• How: self-entry glucose journal, iTunes rewards, diabetes online community motivating quotes

Meal BolusMeal Bolus

Pump download, missed meal bolusesPump download, missed meal boluses

HypothesisHypothesis

• Weekly personalized and interactive engagement via texting with the physician will improve meal bolus mindfulness and reduce hgba1c % within 3 months (at next clinic visit) in teens with type 1 diabetes.

MethodsMethodsWeekly Texting Protocol (Thursdays at 5pm)Weekly Texting Protocol (Thursdays at 5pm)• Initial greeting message• Customized question unique to each patient’s

interests (how is your lacrosse team playing?, how did your finals go?, how is marching band?, did you have fun 4-wheeling last week?)

• Questions specific to diabetes adherence: glucose testing, meal boluses, frequency of high glucoses, frequency of low glucoses

• Conclusion message stating continuation of text messaging at regularly scheduled time

SubjectsSubjects

ResultsResults

External Internet Services: Facilitate initial programming, Facilitate operations ofExternal Internet Services: Facilitate initial programming, Facilitate operations ofSMS texting delivery and storageSMS texting delivery and storage

Nick

Jonas

Music

Also loves Frappuccinos.

Hey Nick! I’ve added you to my address book!

Cool. Thanks! Keep rockin’ Dr. Dyer.

Nick. Hope the carb counting is going well. I know u love Frappuccinos! :) February 24th

Keep on rocking the boluses, Nick! See you in a few weeks. March 3rd

What IsnWhat Isn’’t Working?...t Working?...

• Bolus adherence and glucose checks decreased over time

• Needed motivation

• Needed reminders

• Needed more support

What Isn’t Working: EngagementWhat Isn’t Working: Engagement

eproximiti.com duethealth.com

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EndoGoddess App EndoGoddess App Hypothesis:Hypothesis:

• Target engagement behavior: glucose checks

• Motivating, educating, triggering this target behavior will lead to improved medication adherence

BJ Fogg’s Health Behavior BJ Fogg’s Health Behavior ModelModel

Literacy (ability)Literacy (ability)

Make the mobile phone give information at the right time:

• Online content without searching

• Frequently used links

• How-to videos

TriggerTrigger

Make the mobile phone DO SOMETHING at the right time:

• Send push notifications

• Add calendar events with alarms

• SMS

• CALL

• (Email)

MotivateMotivate

Make the patient WANT to take their medication:

• Utilize Game Mechanics

• Competition

• Social

SXSW InteractiveSXSW Interactive

Coding at EproximitiCoding at Eproximiti

Download from App StoreDownload from App Store

EndoGoddess App: JournalEndoGoddess App: Journal

EndoGoddess App: Motivation EndoGoddess App: Motivation

• iTunes rewards points

• Friends/family sponsorship

• Social: daily motivational quotes submission

Motivation from Support•iTunes account deposits

•Social Network supportPositive reinforcement from friends & family: Motivation + rewards

Social Business Model: Social Business Model: Using Peer & Family ReinforcementUsing Peer & Family Reinforcement

EndoGoddess App: TriggerEndoGoddess App: Trigger

EndoGoddess App: LiteracyEndoGoddess App: Literacy

Online Communities: DSMA Online Communities: DSMA

Social Networks: DiabetesSocial Networks: Diabetes

EndoGoddess App: Droid version in process…

How many diabetes apps are there?

«diabetes» OR «glucose» search oniTunes Norwegian Market

T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/

ResultsFeature Prevalence (%)

19/49 Apps Free

Mean Price = $4.00

Modal Price = $3.00

T Chomutare, et al. JMIR, 2011. http://www.jmir.org/2011/3/e65/

EndoGoddess App Future?EndoGoddess App Future?• EndoGoddess app RCT

• EndoGoddess Kids App with dog/cat motivation

• ?Partnership with medical device (glucometer)

• ?Partnership with pharma for test strips

• ?EMR partnership and integration

• ?Advertisements

endogoddess.blogspot.com/endogoddess.blogspot.com/

jennifer.dyer@eproximiti.com