Mango Health takes aim at medication adherence with game design principles

By: Jonah Comstock | Apr 3, 2013        

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Mango Health Mango Health, a Rock Health startup focused on using gamification principles to tackle medication adherence, launched its titular app after months of beta testing, a 16-week pilot, and not a small amount of hype. The company has raised $3 million so far.

Medication adherence is considered to be a $290 billion dollar per year problem, and it’s one that a number of mobile apps and connected devices have tried to tackle. Mango CEO and co-founder Jason Oberfest told MobiHealthNews that he thinks Mango is approaching the problem in an original way, owing to his and co-founder Gerald Cheong’s background at game company ngmoco.

“My sense of adherence initiatives in the industry is they’ve tended to focus on two primary areas: On the one side, better tracking of patient consumption of medication, and on the other side analysis of back-office patient data to identify at risk populations,” he said. “Our feeling is that the root cause of nonadherence is behavioral, and those approaches don’t address that.”

With Mango’s app, users enter their medications or supplements, timing, and doses. Like many existing adherence apps, Mango can remind patients when its time to take their medication. It also automatically alerts them to potentially dangerous interactions between medications, or with food and drink. The app also includes a personal health journal.

But it’s the game design principles that the founders hope will set the app apart. The app has an in-game currency users can earn by taking medications on time, and a leveling up system. By leveling and saving up, users can unlock real-world rewards with Mango’s partners, including donations to charities and rewards at stores like Target (which Mango just recently announced as a partner). The app also presents users with basic comparisons of their adherence against people with similar medication regiments or conditions.

Mango Health’s brand partners benefit from the partnership, Oberfest said, both because they have a general interest in improving people’s health and because health-oriented consumers are generally good customers to have, and Mango serves as a channel to get them into partners’ stores.

While many medication adherence technologies target older people with their products, Mango’s target demographic is 35 to 55-year-olds who were recently diagnosed with a chronic disease, according to Oberfest, although the pilot included users as young as 24 and as old as their late 70s. He said the pilot was very promising.

“For me, the most important measure is unaided return rate,” the number of people who continue to come back and use the app without prompting, said Oberfest, “And the unaided return rate that we were seeing was spectacularly good from my perspective. It far exceeded our expectations and was orders of magnitude more successful than the most successful social games we know of.”

Oberfest says the company has big plans going forward. Ultimately, he said, they plan to move beyond medication adherence to become “a hub for personal health management.” The company hopes to work with app and device companies tackling other health areas, as well as employers, payers, and providers. Expansion into Android devices is planned eventually as well, he said, although the company isn’t ready to commit to a timetable.

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Study tests limits of public health texting efficacy

By: Jonah Comstock | Apr 2, 2013        

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Baby Bump TextA new study from the University of Pittsburgh School of Medicine, published in the journal Obstetrics and Gynecology, found that text messaging was ineffective at changing the minds of pregnant women who were not intending to get the influenza vaccine. In their study of 158 urban, low-income pregnant women, researchers found that text messages had no effect on whether expectant mothers got the vaccine, a treatment doctors consider to be especially important for expectant mothers.

“We know that pregnant women have a really increased risk, and we know that the vaccine is very safe and very effective, and despite that it’s vastly underutilized,” study author Dr. Michelle Moniz told MobiHealthNews.

All participants in the study received health text messages regularly, containing tips and information about pregnancy. However, only the intervention group received text messages specifically educating and instructing them about the flu vaccine. In both groups, only 32 percent of women got the vaccine, according to the clinic’s records.

The participants in the study were overwhelmingly low-income, uninsured, and unmarried women with a high school education or less, the kind of underserved population often targeted in texting interventions. The study specifically excluded women who had already gotten the vaccine, or who stated their intent to get it at their initial appointment.

The women’s stated reasons for not receiving the vaccine might shed some light on why the text messages were ineffective. Twenty-three percent said they were afraid of vaccine side effects, 15 percent said they disliked shots, and another 15 percent said they had a previous bad experience with the flu vaccine.

With the exception of side effects, these aren’t reasons that can necessarily be fixed with education. Text messages can be effective at reminding people of things they already know they should do, or for educating people about things they don’t know. However, they might not be the best vehicle for persuading people to do something they have already decided against, for whatever reason.

“Despite these concerns, more than half [of the study participants] reported that they would get or consider getting the flu shot if it were recommended to them by their prenatal care provider,” Moniz wrote in the paper. “The text messaging program assessed in this investigation did not translate into higher maternal vaccination rates, suggesting that it was not an effective replacement for direct face-to-face recommendation of influenza vaccination.”

In actuality, Moniz told MobiHealthNews, the vaccine is considered very safe and effective and is recommended for pregnant women by both the CDC and the American College of Obstetricians and Gynecologists. There’s even mounting evidence that the vaccine conveys neonatal benefits to the unborn child. Although the text messages in the intervention did include assurances about the safety and effectiveness of the vaccine, they didn’t delve deeply into specifics, nor did they include any tailored messaging. Moniz believes that adjusting the content could have a better effect.

“This has been documented again and again in studies looking at influenza vaccination in obstetric populations,” Moniz said. “The most powerful tool is clear, unequivocal support of a provider. … It might be this intervention would work if we sent messages more frequently, or if we stated specifically ‘your doctor (by name) wants you to get the flu shot.'”

Despite the lack of uptick in vaccination, the participants in both groups responded positively to the text messages, with 90 percent saying they liked the messages, 89 percent saying they found them helpful, and more than 70 percent saying the messages increased their satisfaction with their prenatal care.

“Although generally we’re very enthusiastic about the technology, I think it’s important that we continue to approach this in a rigorously scientific way and try to better understand the potential benefits and the potential limitations of this technology,” Moniz told MobiHealthNews.

10 iPhone hearing aid apps that preceded BioAid

By: Jonah Comstock | Apr 2, 2013        

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bioaidA British team at the University of Essex recently announced the launch of a free, open source app called BioAid to explore the project of turning the iPhone into a hearing aid.

The core concept is very simple, and has, in fact, been thought of and implemented by various companies at least since 2009: Smartphones have built in microphones and they can play audio through headphones. By creating an app that simply takes the audio feed from the microphone, amplifies it, and plays it in the headphones, you can create a rudimentary hearing aid.

From there you can add additional features that bring the app closer to what a real hearing aid does — algorithms that filter out certain noises or selectively amplify certain frequencies, for instance, or recording features that let you play back something you might have missed. Of course, how well a hearing aid app works depends not just on the app itself, but also on hardware: When the New York Times wrote about apps as a hearing aid substitute last May , they profiled a man who used a $5 iPhone app — but with a $100 external microphone and a $150 pair of headphones.

BioAid is novel in that its developers are offering it for free in order to solicit feedback from users to continue to develop the algorithm that mimics the normal noise filtering of the human brain. Also, the app both amplifies quiet sounds and de-amplifies loud ones. The team hopes to change the way hearing care is delivered. The app also allows the user to save different amplification profiles, something other apps on the market don’t offer — for instance, one for watching television at home and another for meeting friends at a crowded bar.

“The mobile phone is a great platform for rapidly transferring hearing aid technology from the laboratory to the hands of the public,” Nick Clark, one of the UK-based developers, said in a statement. “Standard hearing aids, which can cost thousands of pounds, are only dispensed by a professional after a hearing test. BioAid offers a simple alternative accessible to anyone with an iPhone or iPod. The hearing test is replaced by an exploratory process, allowing users to find which setting works best for them. In the short term, people unsure about visiting a hearing care professional might be swayed to do so by BioAid, which can only be a good thing.”

Here’s a list of iPhone apps available through the US app store that use the built-in microphone and headphone jack to help people with hearing loss. Some are regularly updated, others appear to be “zombie apps.” Some are free, while others cost up to $35. Some claim to be hearing aids, others shun that label. At least one is made by a hearing aid company. Keep reading>>

New York-Presbyterian CIO mobilizes inpatient nurses

By: Neil Versel | Apr 2, 2013        

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New York Presbyterian CIO Aurelia BoyerNew York-Presbyterian Hospital has big plans for PatientTouch, a platform from San Diego-based PatientSafe Solutions, to help mobilize its electronic health record, improve communication among clinicians, coordinate care and close the loop in medication ordering and administration.

It is a huge undertaking for sure, given that NYP actually includes four hospitals in Manhattan and one in suburban White Plains, NY, with a total of 2,409 inpatient beds. But clinicians have been clamoring for hand-held devices to make their jobs easier. “It’s what the nursing staff was looking for,” says Senior VP and CIO Aurelia Boyer, a registered nurse.

PatientSafe makes a medical-grade attachment for the iPhone or iPod Touch called PatientTouch as well as supporting apps. The software is for what the company calls “patient care orchestration,” with three main services, according to CEO Joe Condurso.

The first is positive patient identification, or PPID, which essentially is barcode scanning at the point of care to assure the right person is receiving the right medication, test or service. New York-Presbyterian is migrating to PPID access across all of its facilities, according to Condurso, starting with medication administration, lab specimen collection and infant care. NYP is the first site to use PatientSafe’s infant care app, for matching mother to baby and for handling milk products, he says.

PatientTouch also helps clinicians execute care plans, Condurso says. A series of workflow applications help with sharing care plans among care teams, assignment of clinicians to patients and the conversion of physician orders to specific tasks for nurses, for example. This, he says, can help reduce length of stay.

Additionally, the technology facilitates communication among clinicians, with secure clinical messaging and, when paired with a clinical decision support system, alerts and alarms. Voice-over-IP (VoIP) is available on the iPhone only.

This kind of communication goes beyond the “unified communication” that had been the goal of many in hospital environments a few years ago, according to Boyer. “Now you’ve got to bring in the collaboration to really make that sing and dance,” she says. Keep reading>>

Blue Cross Blue Shield-backed incubator Healthbox unveils its second Boston class

By: Jonah Comstock | Apr 2, 2013        

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caringinplaceDigital health accelerator Healthbox announced its second Boston class this week. The accelerator’s Boston program is one of three along with its original site in Chicago and London, which had its demo day in January. Just like last time, Healthbox’s partner for the Boston class is Blue Cross Blue Shield of Massachusetts.

Healthbox announced that with this class they’re extending their 14-week program to 16 weeks. The 10 new startups have already completed a two-week boot camp. The teams will receive $50,000 in seed capital, mentorship opportunities, help with market testing and end user research, and local office space. In exchange, Healthbox receives 7 percent equity in each company.

The 2013 class contains a mixture of consumer-facing diagnostic and sensor technologies and hospital and homecare administration technologies. Here are the 10 members of the newest Healthbox class:

3Derm Systems is tackling the area of mobile dermatology, a topic that’s become something of a go-to example for risky mobile health applications. 3Derm’s offering currently doesn’t provide automatic feedback, it merely makes it easier for patients to photograph their own skin with a mounted device, which then transmits photographs to a professional for assessment.

Caring In Place is developing a mobile app for people caring for seniors. The app gives the user a questionnaire about the needs of the person being cared for, and from there generates checklists and to-do lists for providing care and support. That list can then be shared among multiple caregivers (like an aged parent’s various children and grandchildren) who can also share care updates on a social stream.

Casagem is focused on mobile tools for the homecare industry. The company will provide tablets and data-processing software tools to make mandatory onsite data collection for homecare nurses easier and more precise.

Cellanyx Diagnostics is using a new set of biomarkers, chips and software to develop a new urine test that could predict prostate cancer.

Epion Health provides a tablet-based point of care system for hospital intake and discharge. “We fully integrate with Electronic Medical Record and Practice Management systems to reduce administrative costs and increase efficiencies,” the company says on their website.

Hospitalytics aims to improve operating room efficiency with software that will predict how likely it is that a room will be needed at a given time, and allow OR managers to allocate staff and managers optimally.

Lean Wagon is (per their website) “a team of engineers, foodies, health specialists, and marketers” with the goal of making it easier to connect with personal health coaching. The company will offer interactive online coaching to employees of companies they work with.

MyProxy is a web platform for creating, managing, and updating advanced directives and healthcare proxies, to help patients prepare for end of life care.

Sensing Strip, a stealth company that doesn’t yet have a website, is apparently building the next big thing in wearable sensors: health sensor tape. According to Healthbox, the tape can use micro-electronics to “sense and wirelessly transmit real-time ambulatory, cardiac, respiratory, or a variety of other data to a smart phone or tablet.”

Theravid is a web-based communication tool for physical therapists to improve patient adherence. The platform uses videos and other web-based demos to educate patients about exercises.

Cochrane study misses the mark on efficacy data for digital diabetes interventions

By: Jonah Comstock | Apr 1, 2013        

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WellDoc DiabetesManagerA recent meta-analysis from The Cochrane Library found that computer-based interventions for Type 2 diabetes provide, at best, a small improvement from traditional care methods. The analysis, based on 16 studies, found that the interventions reduced A1C (the standard measure for blood glucose control) by 0.2 percent, although that rose to 0.5 percent for mobile-based interventions. Measures of other outcomes, such as weight and quality of life, weren’t statistically significant.

Researchers looked at 16 studies with a total of 3,758 participants, culled from nine databases of published papers or theses, going back as far as 1997. The analysis was limited to adult-focused, computer-based interventions for Type 2 diabetes that included randomized control trials (RCTs). Studies were also excluded if their intervention didn’t focus on self-management, such as if they primarily used computers to connect patients with human caregivers.

The review seems, on the surface, to be somewhat disheartening for mobile health, a field where diabetes management is considered one of the most promising avenues. Companies like WellDoc and Omada Health stress the efficacy research that underlies their products. Ginger.io is currently working on a pilot for mobile diabetes management, as well.

However, the differences between the various interventions in the study are considerable, to the point where it’s hard to say how valuable the data really is. Even the study authors acknowledge this point in the paper.

“Given the heterogeneity in design, reporting and effect of computer-based interventions it is also important to find the most effective components or behaviour change techniques to achieve the desired impact,” they wrote.

Some of the interventions included in the meta-analysis only used the computers to present information (which the control group received on printouts) with no interactive component. In others, the computer intervention was a social network of some kind, with the study designed to look at the effect of online social support on diabetes management. Some were tracking programs or text-messaging interventions; one even used pagers. The study included WellDoc’s two efficacy studies, alongside a 1997 study that used a touchscreen kiosk patients interacted with only twice.

The studies included were unified by form, not content. It might be comparable to a meta-analysis on drugs in general for a given condition. Among the most interesting findings of the analysis is, in fact, the .3 percent jump in A1C effectiveness for mobile vs. nonmobile interventions. However, the 16 interventions the study looked at included only four mobile interventions, two of which were the WellDoc studies.

“It is not clear why interventions delivered over mobile phones appear to be more effective,” wrote the authors. “It could be due to convenience (and therefore adherence), intensity of the interventions (mobile phone interventions were more likely to have multiple daily contacts) or the behavior change techniques used by the interventions (mobile phone interventions were more likely to use cues to prompt behavior and provide rapid feedback afterwards).”

While meta-analyses can be a good benchmark for trends and efficacy data, this one may be too broad in scope to make any conclusions about the general effectiveness of digital diabetes tools.