mhealth perspectives towards 2015

mHealth perspectives towards 2015and

Professor Ilkka Korhonen

Department of Biomedical Engineering

Tampere University of Technology, Tampere, Finland

September 1st, 2011

EMBC 2011

Key messages

1. Chronic disease prevention and management is our biggest challenge To efficiently prevent and manage them a behavioral change is needed

2. Co-creation of health – citizen to be understood as a key co-producer of health

3. Personal health systems and mHealth are key tools to support co-production of health

a) Smart phone as a platform

b) Connected devices

c) Persuasive technologies

d) Challenge: from data to decision support

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CHRONIC DISEASE CHALLENGE

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Chronic conditions

• According to the WHO, 77% of the disease burden in Europe are accounted for disorders related to lifestyles.

• Prevalence of chronic conditions is rapidly increasing

• Chronic or long-term conditions make >70% of all health care costs• Costs due complications caused

(partially) by sub-optimal management• Investment on better management return of investment through decreased # of complications

Direct healthcare costs in Finland:Cardiovascular 17%Mental health 13%Respiratory 11%Lost production in Finland:Mental health 22%Musculo-sceletal 22%

CITIZEN AS A CO-PRODUCER OF HEALTH

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Citizen behavior and health outcomes are closely linked

• Behavioral changes would significantly reduce life style diseases and improve wellbeing• 70–90% of cardiovascular disease, type II diabetes and

stroke would be avoided (Willet, 2002)

• Individuals with healthy lifestyles:• 50% reduction in health care costs (Pronk et al., 1999)• 14 longer expected life time (Khaw, 2009)

• Behavioral change requires interventions to lifestyles• Life style changes cannot be prescribed – they have to

be marketed and promoted• Life style is very personal and impacted by complex

motivational and value-based factors• Personal health systems facilitate behavioral change

Actual health outcomes are largely produced by the citizen behaviors – not by health care procedures (alone)

• Also other stakeholders in the society

Determinants of health status

Health Care(10%)

Environmental(5%)Behavioral

(40%)

Social(15%)

Genetic(30%)

McGinnis et al., Health Affairs 21(2), 2002

Century of behavior change

“The 19th Century has been called the Century of Hygiene. That is, in the 19th Century more lives were saved or extended due to an improved understanding of hygiene and public health than to any other single cause.

The 20th Century was the Century of Medicine. Vaccines, antibiotics, transfusions, and chemotherapy all helped to contribute to longer, healthier lives. In 1900, the life expectancy of an American was 49 years. In 2000, it was 77 years.

The 21st century will be the Century of Behavior Change. Medicine is still making fundamental discoveries that can extend lives, but changing daily, long-term behavior is the key to adding years and quality to our lives. This will involve reducing risky behavior and making changes in exercise and nutrition.”

Brian Wansink, Cornell University

PERSONAL HEALTH SYSTEMSCatalysing behavioral change with

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Personal Health Systems = Health and Wellness Technologies

Designed for the Consumer

Monitoring + Connectivity + Analysis + Feedback

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Engineering building blocks:mHealth, personal monitoring, wearable monitoring, signal processing and interpretation

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Services and technologies designed in parallel

ServicesServices TechnologiesTechnologies

Services create needs for new technology products

Technologies enable new services

Environment: Organisational structures, laws, regulations, guidelines, advocacy groups, media

© Niilo Saranummi, VTT

1. Self-monitoring

2. Personal and personalised feedback

3. Persuation

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PHS Keys

Benefits of self-monitoring

• Daily weight monitoring helps in weigh loss and weight maintenance (Kayman et al., 1990; Linde et al., 2004; Wing et al., 2006)

• Regular diet and energy consumption monitoring supports weight loss and may decrease food intake (Baker & Kirschenbaum, 1993; Perri et al., 1989; Foreyt, 2005)

• Step monitoring increases exercising and improved body composition and blood pressure (Bravata et al., 2007; Clemes 2009)

• Self-monitoring is the most effieicnt method for getting rid of bad habits (Quinn, 2010)

Wing et al., 2006

From monitoring to personal feedback via intelligent analysis

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persuation - nudging

• Knowledge-behavior gap: most citizen have sufficient information about healthy lifestyles but this information does not transform into behaviors• It is unlikely that more information alone would

significantly improve the situation

• Reasons? Human being is not a rational actor• Most of our daily behaviors are automatic – not

deliberate – decisions Organise environment and information to help to make better automatic decisions!

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Framing effects matter

Source: Dan Ariely, Predictably Irrational (2008)

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Setup:• Normal weight and overweight consumers• Ads shown before lunch

• Car insurance adds (control)• Exercise adds

• Eaten calories measured

• Consumers unaware of actual purpose ofthe study (“ad rating study”)

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Arranging and framing information helps people to make better choices

Choice architectures matter use them deliberately in design!

MHEALTH TRENDSSmart phone as a key platform for PHS

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Phases of ICT development

MOBILE INTERNETMobile took the lead with smart phones, tablets, embedded SIMsLocation-awareness and gadget integrationMobile broadband with capacity and quality issuesCloudConsumer- and utility-drivenSize bigger than in cycle #4Gigatrend (global)Three or four architectures:Emb, web, app, broadcast cacheNew ecosystem-centric business models

PCs connected to InternetFixed broadbandConsumer- and business-drivenMegatrend (OECD -centric)One architecture: WebNew business models

20101996-1981-1970s-

PCs Slow or no connectionsBusiness-drivenOne architecture: Client-ServerOffice automation and process development

Connected life

Connecting world to the Intenet

Connecting people

Inflection points

Main-frame

Mini PC

Internet

Internet 2.0

(c) Matti Mäkelin, Nexec Oy, Finland

“History suggests the mobile Internet has potential to create / destroy more wealth than prior computing cycles based on 10x user multiplier effect. Regarding pace of change, more users will likely connect to the Internet via mobile devices than desktop PCs within 5 years”. Morgan Stanley (The Mobile Internet Report, 2009)

In fact, the sales of smart phones exceeded the sales of PCs in February 2011.

“The dominant design is the Internet and the future of mobility is the future of Internet” (Matti Mäkelin, Nexec Oy)

Smart phones

• Inherently personal• ”Always” at hand• Contextual• Perceived as trusted store for personal information• Good for consuming content• Excellent for short notes and measurements• Excellent as hubs for connected sensors• Designed for connectivity and communication• Rich UI

Smart phones are the media for large scale consumer targeted eHealth services

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mHealth application market today• Share of mHealth apps is 3% of the total, i.e. ~17000 apps• Usually the business model is the pay-per-download• Ratio of paid/total mHealth application is 70-90%, which is 10-20% higher

than the average for all applications.

mHealth market is taking off seriously

(Mobile Health Market Report 2010-2015, research2guidance, Nov 2010)

• 1.4B smartphone users in 2015• 500 million users have downloaded at least one mHealth application by 2015• mHealth market revenue will grow to US$ 6 billion by the end of 2015• New smartphone based mHealth market model gives a push for the traditional mHealth

market to advance from the trial stage• Total number of downloaded mHealth applications will grow from 275 million (2010) to

almost 1.4 billion (2015), from which 15% are paid.

mHealth application categories(Source: Research4guidance 2010)

Traditional vs. new mHealth market model

(c) Research4guidance 2010

mHealth is democratic

mHealth reduces provider revenues

Source: Healthhcare unwired, New business models delivering care anywhere, Health Research Institute, PricewaterhouseCoopers, September 2010

Take home messages

• Century of behavior change• Chronic disease prevention and management will not

succeed without the citizen as an active participant – co-producer of health

• Consumer health – design eHealth solutions for the citizen • Behavioral psychology and economics, marketing, design

• We must focus on improving health (instead of improving just healthcare)

• mHealth = eHealth – convergence• Smart phone is the future way of accessing Internet• Game will change within next 5 years• Great challenge: automation of data processing and feedback

• mHealth will destroy old business – and create new• In which category do you want to be?

(c) Frog design 2010

Thank you!

Ilkka Korhonen

Professor

Dept Biomedical Engineering

Tampere University of Finland

[email protected]