improving health through technology

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Using technology to improve healthApril 21, 2015

Sean Landry, Head of Brand & Marketing MeYou Healthhttps://www.linkedin.com/in/[email protected]@slandry1234

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Intro and backgroundBehavior change & engagementProduct overviewResearchTechnologyChallenges!Some gratuitous animations

MeYou Health is a Healthways, Inc. company

#The agenda for this morning.2

Sean LandrySome of the interesting things Ive designed

EONSIRON MOUNTAINOBITS

#First Age Relevant Search EngineBackup and Recovery Data Storage SystemsEven an Obituary Website3

Meyou healthFounded 2009, Boston MA

#I wanted to try my hand at Healthcare Joined in Fall of 2009Employee #14

Healthways Inc.Nashville, TN

#Disease management company founded in 1981Focuses on analyzing claims data to determine who to target Driven by cost savingsHundreds of certified nurses who reach out to patients over the phone

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#We built a company in the South End. Proud to have receivedBoston Globes Top Place to work in 2014. [CLICK]We even allow babies!6

Primary Goal 2009:Delivery of a fully functioning behavior change business platform which engages consumers directly via web and mobile applications.


#2009 A simple idea, not so simple to build..Im a technologist, a few data bases, some UIs and were done right?Wrong. 7

Sean, we are in the behavior change business- Chris Cartter


#Well, I need to get smart about this.

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How to change behavior?According to BJ Fogg

BJ Fogg, PhD. Director, Persuasive Tech Lab Stanford University EasyHARD

#Dots = Do something onceSpans = Do something for a period of timePath = Do something for ever[CLICK]Green = New (try Quinoa)Blue = Do a familiar (flossing)Purple = Increase behavior (eat better)Grey = Decrease behavior intensity (drink less coffee)Black = Stop a behavior (stop smoking)9

How to change behavior?According to BJ Fogg

HIGHMOTIVATION LOW

TIME

Harnessing Motivation waves work by BJ Fogg, Persuasive Technology Lab, Stanford

Motivated to make big changesMore convenient

#Design systems that allow people to place bicycle at the top of the hill when they are at times of high motivation

[CLICK]

Think leaving the movie theater after a great sports movieLet them ride the bike down the hill when they are in periods of low motivation

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Solving the engagement problem


#Changing behavior is only one part of the equation. If you cant engage people you cant have impact.11

Typical health intervention engagementYour run of the mill wellness program

This is awful

#We need to design product that people will actually use.This is a typical Health Portal.Notice the massive drop off.We need to do better12

Our missionSolve the reach part of the equation.Impact = Reach x EffectivenessHow do we build products people will use?

#We need to design product that people will actually use.13

Validated engagementWe need to do better

#The Health and Fitness engagement products traditionally have very low engagement.

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A balance of interventions are neededEngagement is maximized by using both types of interventions.

Defined GoalStep 1Step 2Step 3

FuzzyGoal

Prescription(orchestrated)Exploration(self directed)

#By appealing to different types of users we maximize our ability to engage themSome people prefer prescribed interaction. Step by step guide on how to get fitExploration: Give me a goal and let me explore my way there.

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Which behaviors?


#We know well need engagement and we know we need to change behavior. Now which ones?16

Which behaviors?The ones that cost the most

IMPROVE WELLBEING

EATBETTER

STOPSMOKING

WALKMORE

#Target the ones that are behavioral choices that cost the American healthcare billions of dollars.

Improve Well-BeingEat BetterStop SmokingWalk More17

How the heck do you do that?


#Great, we know what behaviors, know well need high engagement. Now how are we going to get started?18

Assemble a teamCall in the superheroes

DESIGNENGINEERINGPRODUCTDATASCIENCE

#Assemble a team of:Designers, Engineers, Product Managers, Data Architects, and Scientists.

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Where do you start?


#Weve got the team, we, know the behaviors, we know well need engagement know how do you get started?20

Start listening


#Talk to people and ask them lots of questions.21

Define the problem spaceAsk about motivations and barriers

34 participants: 13 men, 21 women24 to 70 years of age; emphasis on 31-50 years oldmixture of family situations/living arrangementspreliminary segmentation: Influencer, Someday, Start Stopper, Caretaker range of motivational levels2 hours or more per week online

#34 participants

Ask them about their well-being: Emotional, Financial, Physical, Community and Purpose

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Lots of listening

In dark rooms

#Lots of time in dark rooms seeing how real people describe their well-beingLooks a lot like this[Click]And like this[Click]Ironically listening to people talk about their well-being isnt great for your own.[Click]Notice the bag of Cheetos

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Mountains of Qualitative Data


#What youre left with is lots of qualitative data. Mountains of it. Papers, video and notes, lots of notes.24

Personas


#Take all that qualitative data and identify patters to describe your users.25

Me Time ImpoverishedValidation SeekerAware and AchievingEnlightened and DiscoveringIdleExcuse MakerEnabled


#Me Time Mostly moms juggling work and family. Looking for something guilt free [CLICK]Validation seeker driven by numbers wants to compare themselves against others [CLICK]Aware and Achieving Already doing the things were targeting. Like being coaches to others [CLICK]Enlightened and Discovering Are interested in learning about themselves [CLICK]Idle Looking for social interactions in a group setting [CLICK]Excuse maker Values privacy, doesnt like to share needs a very low bar [CLICK]Enabled Looking for fast results, likely to want a personal coach or sponsor to help keep them motivated26

Design principlesFor designing well-being productsRealistic about what they ask an individual to do,

Convenient enough to factor into a time-impoverished lifeGive immediate positive feedbackGenuinely branded and positioned for each individual to learn about and improve themselves

#Realistic: This isnt marathon trainingConvenient: It needs to fit into their day. It cant be a time suck Immediate: Give them something they can do right now. Genuine: Cant be quirky or feel outside their comfort zone27

Get to work


#Got all the behaviors, know we need engagement, know our personas now we need to get to work.28

#MeYou Healths process for designing software.Ill review the process at the end if theres time and interest.

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Four ProductsThe ones that cost the most $$

Daily Challenge

Hello200

QuitNet

Walkadoo

#Here is what weve built.

DC: Engage with peoples well being everydayHello 200: Reduce a persons diet by 200 calories each dayQuitNet: Get people to stop smokingWalkadoo: Get people to walk more30

Daily challenge


#Ill introduce each product and do a deep dive on WalkadooDaily Challenge - Video31

Think about the major areas of your life, such as parenting, work, chores, and hobbies. Next, draw a circle and assign a slice equivalent to the percentage of time you spend in each area. For example, if you devote 50% of your time to work, the slice of pie labeled "work" should take up half of your circle.Challenge!Evaluate your priorities by drawing a pie chart of your life.


#Before we move further, I want to give you a sense of what a challenge looks like and introduce a few challenges throughout this talk. Heres the first one. Take a few minutes to complete.

Why it mattersBalance is critical for a healthy, happy life, but it can be hard to achieve. Seeing your life as pieces of a pie can help provide a reality check, and may motivate you to look more carefully at your priorities.Are there some pieces that are too small? Are there ways to increase the size of those pieces, and cut down on others?

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ChallengeMy Chart

#Heres my chart. I think I need to increase my family time. Maybe Ill steal some time from sleep33

Hello 200


#Hello- Video34

quitnet


#QuitNet - Video35

Walkadoo deep dive


#Deep dive into Walkadoo36

walkadoo


#Walkadoo - Video37

Why walking?Its the biggest opportunity

These peopleNo these ones

#Why focus on walking?Its where the people are. The vast majority of Americans are either Sedentary [CLICK][CLICK] or Low active38

Listen some more


#So how do you go about designing a program that gets people to walk more?[CLICK]You listen some more

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Start asking questionsAsk about motivations an barriers

#Interviewed 27 participantsMotivations and BarriersWhere they get their Physical ActivityHow do they think about it?

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Define patternsCreate an experience

#Create an application that helps people move through the behavior change modelAppeals to a large audience. Keeps people engaged.We cam to the conclusion that were going to need a pedometer.41

Its all about devicesWere going to need one


#We learned its all about the devices [CLICK]And were going to need one.STOP FOR A CHALLENGE!42

Show yourself a little love and get a much-needed stretch, to boot! Grab your left shoulder blade with your right hand and your right shoulder blade with your left, as if you were giving yourself a hug. Hold this for a count of 10. If you want to deepen the stretch, walk your fingers toward the middle of your back. Then gently pull your shoulders forward until you feel a stretch in your upper back.Challenge!Hug yourself for a count of 10.


#Why it matters

Stretching your upper back and shoulders builds better posture and relieves stress.If you've been doing housework or gardening, hugging yourself will give your body some relief.The same thing goes for people whose work is more physical, or those sitting at a computer for hours.43

How it all worksComplex systems at work

DEVICESSYNC POINTSTORAGEPUBLIC APIWALKADOO

API

#Ecosystem of wireless devices

Devices collect data on steps. Number of steps and intensity of activity (walking vs. running)Transmit data to a gateway, usually over BluetoothData is stored in the device makers databaseWe access the data through public APIsWe use the step data to power Walkadoo44

Devices?This is just a few

#Which device?We play test a lot of devices. This is a small sample of the devices in the MeYou Health device graveyard. They Vary by:WeightSizeWhat they collectUser Experience45

We built our ownIt wasnt pretty but it worked

#We wanted to achieve a few things

To get smart about how they worked and what makes them differentTo understand the economics of the building a deviceTo prove we could build one for under $5It has all the basic components of todays wireless pedometers

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Prototype deviceDifferent concepts

WristbandCredit cardKey fob

#Early ideas for how we might design a different device [CLICK]Wrist band [CLICK]KEY FOB [CLICK]CREDIT CARD [CLICK]But should we? We were built as a software company.Focusing on hardware would distract us from our core missionIn the end we decided to take a BYOD (Bring your own device) or device agnostic approach to our fitness product.

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Minimum viable product (MVP)Codename Hot Sauce

WIREFRAMEVISUAL DESIGN

#Early wireframes of the first user experience. Code named Hot sauce.We designed a fitness game where you are dealt a card each day with your step goal. Complete the goal. Earn pointsInteract with other members through leaderboards48

RUN SIMULATIONSBased on walking patterns

WALKING SIMULATIONS

#After play testing our our MVP we learned a lot about how people actually walkEven in an office with healthy young adults we found:Lightly active long commutes lots of sittingModerately active mass transit, dog walking etc.Highly active runners/athletesWe used this data to understand how different types of users would interact in one system49

#Cleaned it up to prove the proof of concept.Even with an MVP you need to get people excited with some eye candyPut this website out on a URL to gauge interest 50

Walkadoo is born!What we launched with

Lets walk more together

#After months iterating on a new version of the product ready for consumers and partnersWalkadoo Lets walk more together51

Beyond the mvpWhat we launched with

#Here is what Walkadoo looks like today. Using similar card metaphors with some modifications to the UI and the user experienceWe added points to help normalize the experience for all types of users52

Daily cardsPersonalized goal algorithm

Take most recent 9 days of step informationUse the 60th percentileGamification factor-20% to +5% step goal

#Personalized goals for each member. We learn your walking patternssend you goals based on what we think you will walk and add in some game mechanics.

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Daily cardsPersonalized goals

#Limited: Earn points up to your goalAll or Nothing: Only earn points if you make your goalUnlimited: Earn points all day54

Game mechanics!Points, Levels and Stamps

#Points to teach user preferred interactionsStreaks to encourage adherenceStamps to create a sense of mystery and intrigue Levels to show progression within the system

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socialAs engagement

#Social drives engagement. Think about how youre prompted to return to Facebook and Twitter. Strong engagement from being prompted by a social interaction.Walkie Talkies are a Daily prompt or conversation starters to encourage members to sharePosting milestones or achievements to other members steams to create interaction moments

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Derbies!Competition as motivation

#Derbies provide members the ability to invite 5 other members and engage in a competitive week long walkathon.You can compete at a step derby or a points derby. Points derbies allow all levels to interact. Its like handicapping in golf.It allows everyone to participate on a level playing field.57

The network is the intervention.


#Why is it important for everyone to play together?[CLICK]Creating systems that involve multiple users allows us to engage the network into the intervention. Norming users by introducing them to other people doing model behaviors changes the behavior of the user.58

Behavior is contagious What if we infected the network?

#Dr. Nicholas Cristakis and Dr. James Fowler proved that behavior is contagious both good and bad behaviors. [CLICK]What if we infected the network with healthy behaviors?

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Remember these people?We asked them about their well-being

#Remember these people. Well, we asked them to draw diagrams of the people who effect their well-being.We found some interesting things.60

Open socialUse the whole network

#The drawings identified themselves in the middle of the drawingThe people in the outer circles are people who influence their well-beingDirectional arrows show whether they influence the person in a single direction like a child or a petBidirectional arrows show that they influence each others well-being like a spouse or friend.I documented all the drawings and found43 participants identified 217 people who have some influence in their well-being

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Open socialUse the whole network

#Heres where it gets interestingOf the 217 people in the drawings only 21 were identified as coworkers62

Open social methodologyLarge, diverse social networks power engagement.

Open social allows for the formation of genuine, therapeutic networks comprised of participants who can interact regardless of each individuals health insurance coverage or payer. The network *is* the intervention.

Who influences your well-being?

#Why does that matter?Most workplace wellness programs only allow employees to participate in the program.They are missing 90% of the network who can have an influence.

The blue dots represent a sample of users in a healthcare plan

The red dots represent everyone else in the system.

The lines connecting them represent social interactionsIf the network is the intervention, you need to use the whole network

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Open social at Wal-MartFalling prices and high engagement

Blue nodes are Walmart associates

Red nodes are non-Walmart associates (open social participants)

The lines between them are social interactions of support and encouragement

#Wal-Mart understands how this worksThey have a clear understanding of how friends and family members influence the lives of their associates.This is a sample network graph of Wal-Mart's population interacting on Daily Challenge.To build behavior change through technology, you need to understand the DATALETS TAKE A LOOK AT SOME DATABUT BEFORE WE DO ITS TIME FOR A CHALLENGE!64

Take just a moment to step away from any work or home duties today and send a text or email that just says hi to someone you like. Tell the person you were thinking of him or her, and keep the message short and upbeat.Challenge!Send a short, friendly email or text to get in touch with someone you like.


#Why it mattersSocial interactions play a big part in our emotional and physical health!Studies show that people with a wide circle of friends live longer, healthier lives than people without friends.And having a circle of friends who you interact with regularly helps stave off dementia.Taking a minute out of your day to connect with someone you like will also provide a boost for the recipient of your message - a real win-win!65

7,500,634Total steps as of 4/17/15

#Lets talk Data.Heres a snapshot of me as Walkadoo sees me. We have lots of data onActivity levelSocial InteractionsWhether Im achieving my goalsBut thats just the surface66

So much data!Lots and lots of data

#A product that collects information on social interactions AND on activity collects a lot of dataHeres just a few variable that are collected per user.67

720,060,864Total datapointsAnd thats just me


#As of Thursday of last week there were over 720 million data points collected in WalkadooAnd that was just me.How do you start to make sense of all that data?68

Build toolsMake sense of the data

#You build tools. This is an internal tool used to understand a users activity level over time.This is my data for the last 30 daysThe redline represents my total steps per dayThe green line represents my goal for the day The blue line represents what Walkadoo thought I would walk that day

On the bottom the red line represents walking stepsThe green line represents running steps.You can tell a week ago I started getting up in the morning and going for a short run69

Does it work?


#Ok so weve built a product that has Designed for behavior changeAppeals to walkersOpen to everyone to participateUses game mechanics to keep people engagedBut does it ACTUALLY WORK?70

Prove that it worksRun a trial

#To do that well need to run a Randomize Control Trial to measure the effect.Last fall we conducted a trial on a medium sized business involving 388 participantsWe created two groupsBoth groups were asked to wear their pedometer for a week for a baselineOne group participated in Walkadoo, the other put their pedometer away. 6 Weeks later the control group was asked to wear their pedometer again for another week.We compared the two groups and found that using the pedometer + Walkadoo significantly improved the amount people walkedWhile the study is under embargo while it awaits publication, Wakadoo has proven increase the step count of users enough to have a significant impact on their health.

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Future?


#What is in store for the future?Wearables and fitness devices are moving fast72

Invisible interfacesPassive collection of data, multipurpose wearables

#iPhones 5S and higher have the M7 chip embedded in the hardware to collect activity Wearables will expand to be multipurposeActivity tracking will become passive73

Whats next?Wearables are only getting started

#Wearable heart rate monitor by FitLinxxTemporary tattoo offers needle-free method to monitor glucose levelsThe bathroom that is the Dr.s office74

Questions?


#Questions?75

Thank youSean Landry - Head of Brand & Marketing MeYou Healthhttps://www.linkedin.com/in/[email protected]@slandry1234Were hiring!


#Questions?76