The other day I met with a new startup company that has as its core purpose the improvement of the health of people with chronic and pre-chronic conditions via a cognitive behavioural platform. This is not the first of this kind of solution I have seen, I’m sure it won’t be the last.
Invariably, they all seek to do the following:
1) Aggregate a wide variety of data sources from wearable apps
2) Utilise diaries, journals and other ways of recording situational context
3) Use prompts and notifications to ‘nudge’ behaviour
4) Give access to relevant educational materials
5) Link to care plan goals and involve referring clinicians in a “change” process
As I was taking to them, I tried to put myself in the shoes of a Clinical Services Director, someone who might be a buyer of this type of solution. What became very clear to me as the conversation progressed was this:
The sort of people who will check the app on a daily basis, log their activity and respond to prompts are the sort of people that probably would have followed a physician’s instructions anyway, at least for a while. They are the same people who would have followed the nutritional diet plan and exercise diary that the consultant might have given them.
If that’s the case, and I believe that it is, how does the platform add additional value for the purchasing client, other than capturing more information digitally?
It is my view that the majority of people, perhaps 75%, will not consistently respond positively to advice and directions from their clinicians. The challenge is to stop these people moving up the chronic care pyramid, necessitating more and more costly treatment as their conditions become more acute. That is exactly what these sorts of apps should do, and yet it seems to me that they really only target the 25% who are already amenable to specialist advice.
So how do we reach the others, how to persuade the unpersuadables?
Maybe everyone has been looking in the wrong place.
Currently, the holy grail of this type of solution is to join up as many health related apps as possible, taking the ‘quantified self’ to the broadest and deepest form of data collection possible. The belief being that, if we join up as much personal data as we can, we will achieve previously unknown insights into a patient’s behaviour and personal motivations, enabling us to start to change their approach to managing their health.
The problem is those people who not only won’t use the behaviour change app, but also won’t log the kind of information that the app needs to create the necessary behavioural ‘nudges’. However, many of these same people probably do use the multiple social apps, which record vast amounts of personal data.
- Checking in somewhere on Facebook – we know where you are and what you are doing.
- Capturing images on instagram – we know what you are seeing, doing, eating, etc.
- Posting a tweet – we know what you are thinking about a particular issue and which ones interest you
So, what if a health behaviour change (HBC) app could access the information gathered by the social apps you use, how might it use it?
You’ve just checked in to a Chinese restaurant on Facebook, the HBC app suggests what might be healthy options to choose from the menu. If you are diabetic, it could suggest how much eating a sweet and sour chicken and rice might affect your glucose levels, and the impact that might have on your body.
Perhaps you have recently been diagnosed with atrial fibrillation, and you Tweet about some nasty symptoms that you are now experiencing, the HBC app might suggest ways of managing this and direct you to some easily understandable literature.
Yes, it will be a fine line between being helpful, provocative and annoying, but in a sector that is constantly looking for the next ‘disruptor’, what is really needed is a way to disrupt unhealthy lifestyles and to educate patients to be more informed consumers of healthcare services. And after all, we’re prepared to accept intrusive advertising in our social apps, so why not intrusive health information?