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Gamification and Encouraging Healthy Living

There are those that swear by the Quantified Self movement and those that think its bunkum. Having grown up around a grandfather who kept a meticulous daily diary of his bowel movements and sleep patterns, I can totally relate to the pleasures afforded by such healthful navel gazing. But unless the data can be distilled into meaningful information or can be used to effect behavioral change, it is just interesting data, destined to remain the domain of card-carrying data geeks.

Social health networks might just change all that. Dr. Jan Gurley, writing on SFGate, had a great post a couple of weeks ago on the effects we can expect to see with healthcare gamification. She wrote about Mindbloom, a website in beta with about 15000 users, whose CEO wants us to not “run away from something” but to want to run towards good health. To achieve that, Mindbloom has devised a game around the a tree of life, where the actions you report (positive health related changes based on commitments you made), get transformed into virtual rain for the tree, which in turn helps it grow. You can use your good deeds to purchase seeds and raindrops for your friends, and you can collectively inspire one another . Dr. Gurley calls it the Farmville of Health, but yeah, it is pretty similar to those virtual pets (fish, gerbil) you could raise in the early 2000s. As inspiring as this is supposed to be, I can totally imagine someone gaming the system by reporting that they ate a piece of fruit when they didn’t. I think the Achilles Heel of this idea is its reliance on self-reporting. It also veers Chicken Soup for the Soul-ish and that is not really everyone’s cup of tea.

One of the more interesting pieces of nuggets in Dr. Gurley’s post was about how working towards a collective goal as a group helps one travel farther than one would on one’s own (she cites religion, tai-chi in the park and Alcoholics Anonymous as examples of real life social networks that can affect positive behavioral change). The companies Dr. Gurley cites in her blog support this thesis.

Startup Zamzee keeps kids motivated to move by giving them points for ANY movement they make. The referral rates for Zamzee were as high as 50%, and soon involved original participants’ parents and friends. figured that while people fall off the change bandwagon very soon, they would also climb back on if the distance between the ground and the wagon was close enough. A company called Shapeup let people form teams to lose weight, increase exercise or walking. Apparently the game went viral in Rhode Island where 10% of the population participated. Shapeup also creates social health networks for employers. Now, these are programs I would love to know more about.

October 17, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Electronic Health and the Non-Digerati

Everytime we discuss something innovative and interesting to do with our lives, my friend comes up with yet another app or game we should design and market via the App Stores and live richly and happily forever. And I, true to my vaguely creative pursuits, always state that not every problem has a solution rooted in IT or mobile phones or the next iThingamajig. While this is a strange admission to make on a blog that is titled “EMR Thoughts”, bear with me. For example, there are entire classes of problems that IT cannot solve – such as whether the water in a village well is potable, or ensuring that there is enough food for a growing world populace, our collective Farmville skills notwithstanding.

Today I was reading John Moore’s report of the recent SFO Health2Con, where I felt he addressed a health version of the same discussion my friend and I have. More on that later. First the reviews.

Moore says:
– the Health2Con demos sported cleaner interfaces, better UI,
– had more realistic business models (fewer free/Freemium models).

On the not-so-great news side:
– mobile health is cheap and the “it” technology of the moment but Moore doesn’t think anyone’s figured out how to use it,
– demos rarely give enough detail to be instructive,
– And if he cannot deal with any more demos that call for gamification or Facebookization as a way to approach health (I hear him)

Then about midway through the post, he made a comment that made me sit up and take note:

“[Health IT Vendors] want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati [digital literati]

Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system.”

Another post on iHealthbeat clearly examines the motivations behind our health IT thrust.

EMRs/EHRs will make healthcare efficient and reduce costs. Engaged, empowered patients will take charge of their own health and again bring down health costs. These are some assumptions we hold to be true.

The problem with these assumptions that they don’t take into account the non-IT savvy grandmother problem. How do we reach her and others like her? A particularly trenchant comment from commenter Kim Slocum on iHealthBeat says:

We know that half the US population consumes essentially all the nation’s health care resources.

I’m guessing that a large proportion of high car(sic) utilizers are also off-line and currently unreachable via this medium (e.g. dual eligibles and substantial fraction of the Medicare population). If that’s true, a lot of the “Health 2.0” buzz is misguided if it is thought to be a vehicle to bend the cost curve via “consumer engagement.”

Something to think about. John Moore’s post is here, and the iHealthbeat post is here.

October 3, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Future of EHR and the Human Genome

Dr. West has a really interesting post up over on Happy EMR Doctor about EMR Software and the Human Genome. In the post he talks about a new program to help integrate EHR software with genome data. It’s a 4 year project, but I believe is the start of something groundbreaking.

It’s become quite clear to me over the past year that the EHRs of the future will be far more than patient records as recorded by the doctor. Instead, the EHR of the future will include a whole bunch of outside data that is collected by the patient.

Yesterday, we briefly discussed health-logging and that will be a major source of data that doctors can use to treat patients. However, probably even more powerful could be tying EHR software to a person’s genome data.

Once we understand the genome, we will likely be able to treat patients more effectively. We will be able to diagnose patients with more precision. We will be able to treat future issues before they become issues. Imagine if you could prescribe a drug that was unique to that person’s genome. Pretty cool stuff.

We are a long way from this happening, but I can clearly see that it’s the future of healthcare and the best way to leverage the genomic data is to tie it with the EHR and its clinical decision support system.

Unless someone thinks it might be better to have patients bring in their genome data on paper. Oh wait, last I checked you couldn’t do genomic tracking on paper.

August 30, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Data Security in the Age of Self-logged Health

Over at EMR and EHR I have a post going about the self-logging trend, in which people log their medical and other observations on a regular basis. I’m fascinated by the trend, but as an IT person, I shudder at the data nightmares this movement will leash if it becomes widespread.

Quantified Self, a major web hub for self-trackers, has posts on monitoring devicest hat can measures the vitals of people up to 10 meters away, and microsensor embedded mindfulness pills that transmit data to your phone when ingested.

So if someone steals my smartphone, does it mean that not only can s/he spam-text all my friends, but s/he can access all my health logs and PHRs that only my HIPAA compliant provider’s office and EMR systems were supposed to get their hands on?

Indeed, a news story in Med City News says that physical theft, not hacking, is the major concern for mobile storage devices. It’s far easier to flick an iPhone lying on somebody’s desk than to devote the brain- or computing power needed to hack into an EHR system from a reputable vendor.

Med City News reports that during the period from 2009-2011, there were 116 cases of data breaches involving at least 500 patient records (breaches that exposed fewer than 500 records were not included). Physical loss of devices accounted for a whopping 60% of security breaches.

As the Med City News piece notes:

HIPPA violations aren’t happening in the cloud. Rather, they’re happening in the doctor’s office, hospital IT closets, cars, subways, and homes.

Think about how much more this problem can be compounded if health logging becomes practise du jour?

Bottomline: Self-tracking may yet revolutionize healthcare, but could we as individuals potentially jeopardize our own data security? Possibly. It might be a fad among tech geeks but it needs some thinking through from an EMR/EHR perspective.

August 29, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.