SuperBetter’s McGonigal: Games can lengthen your life

By: Jonah Comstock | Mar 25, 2013        

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speaker-jane-mcgonigal-lgAttendees at Mad*Pow’s Healthcare Experience Design (HXD) 2013 conference in Boston got one freebie that wasn’t in the gift bag: an extra seven-and-a-half minutes of their life. At least, that’s according to SuperBetter founder Jane McGonigal, who took attendees through a demo of the SuperBetter game in her morning keynote.

SuperBetter, a Rock Health startup that’s received a fair amount of media attention, is a website (and iOS app) that helps people dealing with a range of challenges turn their life into a game in order to better face that challenge. McGonigal said the game now has more than 250,000 users. A clinical trial of 40 patients, conducted by The Ohio State University, is currently under way to test the efficacy of SuperBetter for helping patients recover from traumatic brain injuries.

That’s a very appropriate first use case, since the idea for SuperBetter was born out of McGonigal’s own traumatic brain injury. McGonigal said that she invented a rudimentary version of SuperBetter while recovering from post-concussive syndrome, which caused pain and nausea and prevented her from reading, writing, or playing video games, among other things. McGonigal took on the “secret identity” of “Jane the Concussion Slayer,” and recruited friends and family to help her meet small, daily challenges. McGonigal said the game brought her out of suicidal ideation, a common problem among those recovering from a traumatic brain injury.

“Even with a game that simple, within a few days that fog started to lift. [However,] it was not a miracle cure for the symptoms,” she said. “I was still in pain, but I wasn’t suffering.”

McGonigal shared the game in its early stages and was surprised by how many people found the approach helpful for a range of different challenges.

SuperBetter“I wanted to understand how a game so trivial could help so many people in so many different situations,” she said. “A trauma can actually help people. We were experiencing through the game what researchers call post-traumatic growth. Trauma doesn’t doom us forever, it can actually be a springboard.”

McGonigal wanted to develop a system that would enable that kind of growth without requiring the trauma. She says the key mistake that most designers make in attempting to bring about healthy behavior change is to focus on the idea of motivation: “I think motivation is completely beside the point,” she said. “The players, the patients I have worked with, are not lacking motivation. They have motivation in spades.”

Instead, SuperBetter focuses on helping people build up skills like social connectedness, having a challenge mindset, or psychological flexibility. The platform groups these skills into four kinds of resilience — physical, mental, social, and emotional — and uses “quests” to encourage users to develop each area in small ways every day. Data shows that working on this resilience every day can increase life expectancy by 10 years, McGonigal said. Doing some math, that means working on them for an hour would buy those attending her talk and viewing the demo about seven and a half minutes.

McGonigal shared some new statistics about SuperBetter’s user base: 55 percent are male, 45 percent female. The median age is 33, but 11 percent are over the age of 56.  The data also shows that people are using the platform to address big issues: the majority of users say they’re addressing the biggest challenge in their life with SuperBetter. Forty percent use SuperBetter to address something they’ve struggled with for more than five years; 70 percent use it for something they’ve been dealing with for more than a year.

McGonigal’s larger mission is to elevate gaming above its stigma as a time-wasting activity. In her address to HXD, she drew connections between an oft-cited hospice worker’s summation of peoples’ top five deathbed regrets and gaming, noting that each thing people said they wished they’d done more often — spending time with friends, self-expression — could be accomplished with games. As such, she told attendees, there are worst ways to spend your extra seven and a half minutes of life than playing a game.


Post-Epocrates AthenaHealth inks deal with Aetna’s iTriage

By: Brian Dolan | Mar 25, 2013        

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iTriageCloud-based EHR and practice management vendor AthenaHealth inked a deal with Aetna’s mobile health group iTriage to include Athena’s network of providers into iTriage’s symptom navigator, provider locator, and appointment booking app. The partnership is particularly notable because Athena recently completed the acquisition of major medical app developer Epocrates, which counted hundreds of thousands of physicians as users.

AthenaHealth is offering the integration with iTriage as an additional service for those providers who use its patient engagement offering, the AthenaCommunicator. The companies said the goal of the partnership was to connect Athena’s growing network of 40,000 health care providers with iTriage’s more than 8 million consumers.

“iTriage is a powerful tool for both patients and providers. It connects patients in need with caregivers who can treat their ailments quickly and effectively,” Jonathan Bush, CEO and Chairman, AthenaHealth stated.

Those healthcare providers who are customers of AthenaCommunicator and who wish to add iTriage to their bundle, will be able to link their schedules to the app so prospective patients looking to book an appointment are able to do so through the app.

Last year MobiHealthNews reported on an Athena executive’s remarks about how he wished AthenaHealth had been the company that acquired iTriage instead of Aetna.

“First off, hats off to Aetna, they clearly are a fast-moving player, because they beat me to the punch,” AthenaHealth’s VP of corporate development Karl Zachar said at the Health 2.0’s Boston event last May. At that same event Bush made comments that led MobiHealthNews to speculate AthenaHealth might acquire Epocrates, a prediction that, of course, came to fruition earlier this year.

As AthenaHealth works to carefully convince the provider users of its Epocrates apps to become customers of its health IT offerings, this deal with iTriage will help to bolster its patient engagement offerings. While the partnership appears limited to a small slice of AthenHealth customers, it may lead to the equivalent of a partnership between one of the most popular consumer-facing mobile health apps, iTriage, and one of the most popular provider-facing medical apps, Epocrates.

Omada Health lands $4.7M to roll out prediabetes program

By: Neil Versel | Mar 22, 2013        

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Omada Health PreventOmada Health, developer of Prevent, an online and mobile diabetes prevention program, has locked up a $4.7 million, Series A venture financing package. U.S. Venture Partners (USVP) led this round of financing, with the help of the Vertical Group, Founder Collective, NEA, TriplePoint Capital, Kapor Capital and unspecified angel investors, Omada says.

The cash infusion will allow Omada to expand the rollout of the 16-week behavior-modification and weight-loss program for people with prediabetes and eventually expand its services to other disease states, according to the San Francisco-based company, which was part of healthcare business incubator’s Rock Health’s inaugural class in 2011.

“We’re starting with prediabetes,” says CEO Sean Duffy. The company cites figures from the Centers for Disease Control and Prevention that 78 million Americans have prediabetes, namely elevated blood sugar that falls short of true type 2 diabetes.

Preventing that many people from developing type 2 diabetes potentially can save billions of dollars, according to Omada. A 2010 study in Health Affairs found that medical costs for treating prediabetic symptoms are about $443 per person, compared to $9,975 for those who have been diagnosed with diabetes.

The Prevent program, which combines wireless home monitoring devices with online tools, coaching and social media, helps promote lifestyle changes to encourage weight loss and healthy habits. “It can dramatically reduce the risk of going from prediabetes to type 2 diabetes,” Duffy tells MobiHealthNews. “It becomes harder to make the changes the farther you move along the continuum [toward diabetes].”

The system is based more in social science than gamification, according to Duffy. “I think of it more as a class,” he says.

Right now, Omada’s Prevent program is focused squarely on prediabetes because of the potential impact of early intervention. Omada is rolling out Prevent to “a select group of self-insured employers and providers in the United States,” according to a press release, though Duffy says he is not ready to announce those partners’ names. Expect some details about them in about six weeks time.

There will be new disease states “almost certainly” in the future, including type 2 diabetes. “We want to build a lasting, big company,” Duffy says. But do not expect to see the variation for type 2 diabetes until 2014 at the earliest.

The healthcare industry is going to making “smart investments on the right people,” according to Duffy. That means those at the highest risk and with the highest potential reward.

“It’s a high-touch program,” Duffy says. It may not be suitable for someone with end-stage renal disease as a result of advanced diabetes, but these types of interventions are great for patients with a precondition or an early-stage disease.

The business model is to go through employers and insurers, rather than the tougher direct-to-consumer route, but Duffy says Omada has designed its program, app and website to appeal to the masses and will sell to individuals. “We want people to land on the website and say, ‘Wow, this looks pretty interesting,'” Duffy says. “That’s when I know we’ll have succeeded.”

He expresses a belief that a lot of DTC healthcare companies failed because “they didn’t work hard enough to turn their products into something delightful.” Explains Duffy, “You need to draw [consumers] in and make it enjoyable.”

Omada actually is competing with the likes of Dropbox, Facebook, Airbnb and other Silicon Valley companies that hire many consumer-focused Web programmers. “But ours is based in real medical evidence,” Duffy says.

2012: US remote patient monitoring $10.6B market

By: Jonah Comstock | Mar 22, 2013        

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Philips eICU system

Philips eICU system

Kalorama Information released a report this year on remote patient monitoring, stating that the US market increased from $8.9 billion in 2011 to $10.6 billion in 2012, an increase of 19 percent. Kalorama’s numbers looked at what the New York-based research firm calls “advanced remote patient monitoring”, which it defines as technologies that have wireless or remote capabilities and can potentially interact directly with an EHR.

“Patient monitoring systems with advanced features, especially wireless or remote capability, are among the fastest-growing medical devices,” the report’s abstract reads. “The aging population and the associated increases in diseases such as congestive heart disease and diabetes as well as the cost of treating those conditions, is driving sales of these devices. Use of new patient monitoring technologies can result in a need for fewer personnel, increased coverage by existing personnel, and a reduction in errors and are expected to lead to better patient care and the recognition of serious health problems before they become an issue.”

That 19 percent growth tracks with a prediction Kalorama made last July, when it asserted the market would grow by 18 percent annually. That rate would put the US market at $20.9 billion by 2016, the previous report said. That same report indicated there had been a 23 percent annual growth rate between 2007 (when the market was worth $3.9 billion) and 2011’s $8.9 billion.

At the start of 2011, Kalorama predicted that remote monitoring technology would hit $6 billion that year — a prediction that appears to have been surpassed. Back then, the firm was more ambitiously predicting a 26 percent annual growth rate.

If these numbers seem high compared to, for instance, GBI’s March 2012 report, which predicted an $8 billion market in 2017, it could be because Kalorama has an unusually wide definition for remote monitoring: the firm includes some in-hospital patient monitoring in its numbers, not merely telehealth.

“This year we tried something different: we segmented the market between two types of information that customers request from us,” Publisher Bruce Carlson wrote on Kalorama’s blog. “We have a segment on hospital patient monitoring, which is still remote ([patient monitoring] between the rooms or floors or even buildings of a hospital) and telemedicine, where the patient monitoring occurs between patient and provider.”

In addition to US data, Kalorama tracks the global markets in its paid reports. In the same blog post, the firm revealed that worldwide market growth from 2011 to 2012 for advanced patient monitoring was 17 percent.

Medical device companies likelier to win permanent injunctions in patent cases

By: admin | Mar 22, 2013        

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OrionBy Orion Armon, IP Litigation practice group, Cooley LLP

Since 2009, medical device companies obtained permanent injunctions in 80 percent of cases in which courts ruled on post-trial motions for injunctive relief. The medical device injunction win rate was ten percentage points higher than the win rate for patent owners in other technology areas.

Beginning in 2001, companies began filing large numbers of patents on technologies related to mHealth, and patent applications increased dramatically between 2008 and 2012. The number of patents issued by the U.S. Patent Office relating to mHealth increased steadily every year until 2005, then jumped dramatically in 2006, 2010, and 2011, before decreasing slightly in 2012. In an earlier article titled “Is mobile health about to enter a patent thicket?” I discussed these trends and predicted that companies in the mHealth industry may eventually find themselves in a “patent thicket,” in which patent infringement lawsuits are more prevalent than they are today, and patents create significant barriers to entry for new market entrants.

As the threat of more frequent patent-related conflicts looms on the horizon, mHealth companies should consider their strategic positioning on IP issues and take steps to prepare for what lies ahead. A key issue for companies who may sue or be sued for patent infringement is remedies. In other words, if patent infringement lawsuits in the mHealth industry are going to increase in the next few years, what may you win (or lose) as the result of getting into a patent infringement fight? My research indicates that since 2009, medical device companies obtained permanent injunctions in 80 percent of cases in which courts ruled on post-trial motions for injunctive relief. Significantly, the medical device injunction win rate was ten percentage points higher than the win rate for patent owners in other technology areas.

To put these statistics in context, it is helpful to understand the history of permanent injunctive relief in patent infringement lawsuits. Until 2006, a presumption existed in favor of granting permanent injunctions to patent owners who won at trial, and injunctions barring future infringement were granted routinely. In 2006, the law changed when the Supreme Court decided eBay Inc. v. MercExchange, L.L.C., which held that there is no presumption that a permanent injunction should issue in patent cases. Since eBay, patent owners must apply the same four-factor balancing test that applies in other areas of the law to prove their entitlement to injunctive relief. Today, the conventional wisdom is that patent owners who practice their own patents can obtain permanent injunctions against competitors, whereas non-practicing entities cannot, but there is little industry-specific data to help companies assess the likelihood that a permanent injunction will issue if a verdict of patent infringement is entered at trial.

I analyzed patent owner win rates in each of the 90 post-trial motions for permanent injunctions that were decided between 2009 and 2012 to test whether the conventional wisdom holds for medical device makers. I reached two conclusions: First, medical device companies who win at trial obtain permanent injunctions more frequently than other types of patent owners. Medical device makers won permanent injunctions in approximately 80 percent of cases, versus 70 percent for other patent owners. The chart below depicts injunction win rates between 2009 and 2012 for medical device makers versus other types of patent owners: Keep reading>>

Five things we learned from the FDA’s medical app testimony

By: Brian Dolan | Mar 21, 2013        

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FOREMAN2As expected, the third and final (for now, at least) congressional hearing focused on the FDA’s regulation of mobile medical apps was the only one that provided new information for those already well-versed in mobile health. While the past two days of testimonies likely helped members of Congress better understand the concerns of those working or lobbying for the healthcare and technology industries, those testimonies did not reveal anything new about what was actually going on at the FDA.

This morning the FDA’s Christy Foreman, who serves as the Director of the Office of Device Evaluation at the Center for Devices and Radiological Health, shared a number of insights about mobile medical app regulation that before today had not been revealed. Here are five things we learned from the FDA’s testimony during the congressional hearing today:

1. Number of FDA regulated medical apps: The FDA has reviewed approximately 100 mobile medical apps through its regulatory process. (MobiHealthNews pegged it at about 80 in our recent FDA report.)

2. Time it takes for apps to get through 510(k): The FDA estimates that the time it takes for a mobile medical app to get through its 510(k) process is significantly shorter than the average time for most medical devices. Foreman said it takes about 67 days for mobile medical apps.

3. Number of medical apps seeking clearance each year: Foreman also noted that the FDA only reviews about 20 mobile medical apps each year through its medical device regulatory process. Foreman said that means mobile medical apps make up just 0.5 percent of the total medical devices it reviews each year.

4. No Class III mobile medical apps yet: All of the apps cleared by the FDA to date have been considered either Class I or Class II medical devices, Foreman said. The FDA has not found any mobile medical apps to be Class III medical devices yet.

5. When will the final guidance on mobile medical apps be published? Foreman sort of, kind of committed to a deadline for when the final guidance on mobile medical app regulation will be published, but it wasn’t an outright promise. (Considering this hearing was done under oath, it might be understandable that Foreman didn’t want to fully commit.) Foreman said that the FDA had prioritized final guidance for publication this year and that it should be coming out in the coming months. When prompted Foreman said she meant by the end of this fiscal year, which ends on the last day of September for the FDA, but she repeatedly said that it “should” be published by then. The FDA has made hedged predictions about the final guidance being published in the past, but these hearings may serve as a catalyst this time around.

Since Foreman’s comments about the likelihood of the final guidance document being published by the end of the fiscal year were hedged, be sure to read the full exchange between her and Rep. Michael Burgess (R-TX) transcribed below. Keep reading>>