in collaboration with faculty, students, staff at cens, ida sim...

Enabled by >5 x 109 mobile phone users, increasingly with:

GPS, imagers, touch screens, Internet connectivity, app stores

ohmage: an mHealth platform for research and intervention

Nithya Ramanathan, UCLA Computer Science and CENS, [email protected] Estrin, UCLA Computer Science and CENS, [email protected]

In collaboration with faculty, students, staff at CENS, Ida Sim (UCSF)

Phones are proximate, pervasive, programmable, personal;

offer data/interaction in real time, real place, real context

Tuesday, November 8, 2011

mailto:[email protected]




Use mobile devices to enhance health and wellness by extending personalized health interventions and research beyond the reach of traditional clinical care.

all 168 hours of the week...all 1440 minutes of the day...

(not necessarily all 365 days a year...)

Patient is prompted to capture data (habits /activities /measurements/symptoms)

Data streams collected and transported by mobile phone

Processing to distill measures, trends and patterns

Analysis/visualization/feedback to caregivers, EHRs, PHRs

Geocoded and time-stamped self-reports, measurements, and activity traces stored securely to ensure privacy

Feedback to patient

Deborah Estrin, Ida Sim, Michael Swiernik, Mark Hansen, Nithya Ramanathan ...

What is mHealth?


•Mood and energy among breast cancer survivors• Patricia Ganz, MD, UCLA Oncology• Completed Aug, 2011

•Cardiovascular disease risk factors in young moms • Mary Jane Rotheram-Borrus, PhD, Dallas Swendeman, PhD Psychiatry UCLA• Completion target August 2012

•Risk behaviors for people living with HIV • Mary Jane Rotheram-Borrus, PhD, Dallas Swendeman, PhD Psychiatry UCLA • Completion target December 2011

•Diet, mood, exercise in South Asian immigrant populations• Namratha Kandula MD, Medicine Northwestern • Completion target November 2011

•Sleep in university student populations• John Jenkins, Center for Embedded Networked Sensing • Completed June 2011.

Current pilots


Feedback from 135 potential and current users

•Focus groups

•Interviews

•Diverse populations

•Diverse domains

End-user driven design


Focus groups with diverse populations (n=73)

Population Primary focus of focus group discussion

Moms(n=24)

Engaging participation without increasing user burden•Customization of reminder times/locations for convenience•Image capture of food to increase accountability•Set, manage, and monitor progress towards a goal•Light-weight data capture•Primary interaction to take place on the phone

Immigrant Women(n=20)

(Mean age: 42)

Mechanisms to help people achieve a goal•Set, manage, and monitor progress towards a goal•Helpful tips and problem solving (suggested by phone)

People Living with HIV

n=29

1) Privacy and security of data•Password protection on phone a must•Nondescript text to hide the intent of sensitive questions•Location tracking is controversial, granular control a must•Data anonymization for sharing with counselor, coach, medical provider

2) Customizatin of Reminders • Medication adherence reminders, especially using location• Safe sex reminders

Ramanathan, Swendeman, Dawson, Estrin, Rotheram-BorusTuesday, November 8, 2011

• Individualization key design principle to reduce user burden and increase attractiveness and acceptability.

• Reminders, prompts

• Goal setting, motivational messaging, problem solving, and real-time feedback

• Prefs for : Survey completion in the moment, during the day, end of day

• Acceptable and attractive for HIV+ participants:

• Automated and location-based reminders for medication adherence

• Sharing data with healthcare providers

• Concerns for HIV+ participants:

• Privacy protection, especially in monitoring location, illegal drug use, and sexual partner.

• Ameliorated by use scenario, $$ incentives, and password protection.

Themes from focus groups


Post-use Interviews (n=63)

PopulationWould use for personal discovery

Ease of Use:1 (Hard) to 7

Reminders: Helpful:

1(Not Helpful) to 7

# Surveys acceptable /

day

Minutes Complete

Survey

Trouble keeping phone

charged

Moms(n=12) 100% 4.65 5.86 4.22 0.96 15%

Breast Cancer

Survivors(n=27)

78% 6.04 5.5 3.81 1.83 8%

Students(n=24)

88% - - 1 or more <1 67%


Notable feature requests by end-users

• Images

• Triggers

• Buttons

• End of day reflection

• Goal Setting, feedback

• Server vs Phone


Outline

• Motivation

• ohmage: mHealth System

• User studies

• Future directions

9


Dashboard access

Internet

Data collection

Data analysis, privacy preserving storage

Data Flow Across The System


System Architecture

11

AndWellnessApplication Image Capture

Stress Button

GPS ACCELEROMETER

Smart Classifier

Actigraphy

Survey Input

<survey> <title>Alcohol</title> <prompt> <text>How many drinks did you have today?</text> </prompt></survey>

Survey Authoring

Server

<trigger> <title>Lunch</title> <type>Location</text></trigger>

Trigger Authoring


12

Reminders

Social Time Ac'vityPlace

Promptdata collection

Provide feedbackon behaviors

LaunchesInterventions

Hicks, Monibi, Ramanathan, Selsky, et al

Reminders provide one mechanism for personalization


Feedback

Configure

Chart Summaries

Table Summaries

Kris Iyer, Nithya Ramanathan, Deborah Estrin

* To Be Released August, 2011


End-User Dashboards

Correlations in time and space

Correlations across behaviors

Time delayed correlations

Internet

* To Be Released Dec, 2011 * To Be Released Dec, 2011


Actigraphy over space Actigraphy over time

Internet

End-User Dashboards


Researcher Dashboards

Survey Creation

Internet

Participation Population Statistics

* All To Be Released Dec, 2011

05

1015

2025

0.0 0.5 1.0 1.5 2.0 2.5 3.0Survey response rate

Num

ber o

f day

s


Admin Dashboards

Internet

User interaction with phone

Remaining battery on phone

Memory usage on phone

Filter by location, time, user


End-User EngagementEnd-User Engagement

•Engage and motivate users without burdening them or undermining privacy

•24 hour phone operation

Health Community EngagementHealth Community Engagement

•Instrument scalability and re-use

•Rapid exploration and prototyping

Challenges faced by community Our Efforts


End-User EngagementEnd-User Engagement

•Engage and motivate users without burdening them or undermining privacy

•24 hour phone operation

•Light-weight data capture•Actigraphy•Smart triggers•Visualization, analysis dashboards

•Battery-preserving services

Health Community EngagementHealth Community Engagement

•Instrument scalability and re-use

•Rapid exploration and prototyping

•Validity and reliability studies•Rich analytics to contribute to evidence

base on efficacy

•Survey authoring

Challenges faced by community Our Efforts


Outline

• Motivation

• AndWellness: mHealth System

• User studies


20


Measuring Mobility


Breast Cancer Survivors Moms Students

#H

ours

Se

dent

ary

#H

ours

A

ctiv

eActigraphy characteristics, by population

Mi2

Trav

elle

d

05

1015

2025

0 10 20 30 40Users

05

1015

2025

0 5 10 15Users

05

1015

2025

0 5 10 15 20 25Users

05

1015

2025

0 10 20 30 40User ID

05

1015

2025

0 5 10 15Users

05

1015

2025

0 5 10 15 20 25Users

020

4060

80

0 10 20 30 40Users

020

4060

80

0 5 10 15Users


Measuring Participation


Protocol Compliance Measures

Breast Cancer Survivors Moms Students

% A

ctig

raph

y D

ata

Ret

urne

d%

Sur

veys

R

etur

ned

0.0

0.4

0.8

1.2

1.6

2.0

0 10 20 30 40Users

0.0

0.4

0.8

1.2

1.6

2.0

0 5 10 15Users

0.0

0.4

0.8

1.2

1.6

2.0

0 5 10 15 20 25Users

0.0

0.2

0.4

0.6

0.8

1.0

0 10 20 30 40Users

0.0

0.2

0.4

0.6

0.8

1.0

0 5 10 15Users

0.0

0.2

0.4

0.6

0.8

1.0

0 5 10 15 20 25Users


% A

ctig

raph

y D

ata

Ret

urne

d%

Sur

veys

R

etur

ned

0.0

0.4

0.8

1.2

1.6

2.0

0 5 10 15Users

0.0

0.2

0.4

0.6

0.8

1.0

0 5 10 15Users

05

1015

2025

0 5 10 15Users

#H

ours

Se

dent

ary


05

1015

2025

56 58 60 62 63 67 68 69 70 71

User ID

# In

tera

ctio

ns p

er h

our

92 2

22

2 0 15

103

270

1030

5070

9011

0

56 58 60 62 63 67 68 69 70 71

User ID

Tota

l dea

d ba

ttery

(hou

rs)

Power User

Moms

Survey-Only User

Question data quality


010

2030

4050

60

Personal Loan

User Type

# In

tera

ctio

ns p

er h

our

Df Sum Sq Mean Sq F value Pr(>F) Type 1 7951 7951 305.72 < 2.2e−16 ***

050

150

250

350

Personal LoanUser Type

Tota

l dea

d ba

ttery

(hou

rs)

Df Sum Sq Mean Sq F value Pr(>F)type 1 16920 16920 2.5883 0.1219

User engagement improves when people use their own phones


Battery

Mobility

Interaction

Survey

Battery

Mobility

Interaction

Survey

Participant•Minimal interaction, but better with surveys.•Retrospective: “Surveys are easy”

Participant•Power user•Retrospective: “Excess battery drain increased burden.”

Battery

Mobility

Interaction

Survey

Participant •Interacts with phone beyond surveys•Retrospective: “No trouble with battery”


Outline

• Motivation

• AndWellness: mHealth System

• User studies


32


Have you felt stress in the last 2 hours?Yes | No

On Dec 2 at the end of the day, the user will get this message:* You reported less stress than usual today.* You reported less stress than usual on weekdays.

On Dec 4 at the end of the day, the user will get this message* You reported a lot more stress than usual today.* You reported a lot more stress than usual on weekends.


How many hours did you sleep last night?[0-24]

On December 7th, user 55 would see: You slept 1 hour less than usual.You slept 1 hour less than you normally do on weekdays.

On December 4th, user 55 would see:You slept 1 hour more than averageYou slept 1.5 hours more than you normally do on weekends.


Planned pilots and AndWellness features

Collaborator Institution Study Domain AndWellness Features

Bob Bilder, PhD Neuropsychiatry UCLA

Depression Researcher dashboards

Yih-Ing Hser, PhDPsychiatry

UCLARisk behaviors in substance

abuse populations

Cognitive Based Therapy delivery, granular control over

data sharing

Fred Sabb, PhDJim McCracken, MD

Neuroscience, Neuropsychiatry,

UCLA ADHD

Games, and other user engagement

Stacy Lindau, MD Obstetrics, University of Chicago

Community mappingPhone-based incentives, social/competitive goal setting, data sharing, external data layers

Stephanie Kelly, PhD Nursing, Arizona State University

Family-based interventions targeting obesity

Phone based intervention delivery and feedback


Acknowledgments: Collaborators and Sponsors

Collaborators

Technology faculty, PIs: Jeff Burke, Deborah Estrin, Mark Hansen, Martin Lukac, Nithya Ramanathan, Mani Srivastava

Application/domain expert faculty/PIs (Health science): Robert Bilder, Jacqueline Casillas, Scott Comulada, Patricia Ganz, Jenny Kim,Mary Jane Rotheram-Borus, Ida Sim (UCSF), Fred Sabb, Dallas Swendeman, Michael Swiernik

Students, staff: Staff: Betta Dawson, John Jenkins, Mo Monibi, Joshua Selsky, Graduate students: Faisal Alquaddoomi, Hossein Falaki, Brent Flagstaff, John Hicks, Donnie Kim, Min Mun, Katie Shilton,

Sponsors and Partners/Collaborators

UCLA centers: CENS, Global center for families and children, Health Sciences Federal funding: NSF: NETS-FIND Program, NIH

Corporate funding: Google, Intel, MSR, Nokia, T-Mobile, Cisco, Sun (RIP) Foundations/NGOs: The California Endowment


2

Closing remarksHumans in the loop--so user interface design, privacy, visualization, are part of technology agenda.

It takes a healthy research ecosystem to bring information technology innovations to meaningful societal use--Open architectures and platforms are a key building block.

Patient-centric, globally accessible, mHealth platforms could usher in a new age in transnational research, health and wellness.


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