omg - my pancreas just texted

OMG – My Pancreas Just TextedJohn Pettengill Kjell Reigstad Libby Groettum

OMG – Your Pancreas Just Texted /


Hi, I’m John

Photo by Chris Acuna

OMG – Your Pancreas Just Texted / Photo by flickr user trp0

and I am not a doctor

OMG – Your Pancreas Just Texted / Photo by Dan McCullum

I am not a hospital administrator

OMG – Your Pancreas Just Texted / Photo by ABC & The Walt Disney Company

I have never even seen an episode of Grey’s Anatomy

OMG – Your Pancreas Just Texted / Photo by Sriram Bala

but I am a diabetic


but I am a diabetic

along with 25.8 million other people in the U.S.


there are 2 types of diabetes

type 1 diabetes requires injected medication


type 2 diabetes can be managed without medication

most diabetics are type 2

OMG – Your Pancreas Just Texted / Photo by Pete Prodoehl

I don’t want to make a big deal outta this...


I don’t want to make a big deal outta this...

but we’re kinda experts

OMG – Your Pancreas Just Texted / Photo by Ruben Swieringa

take this for example


salad

bread

meatloaf

potatoes

you see this


8 carbs

25 carbs

15 carbs

45 carbs

we see this


8 carbs

25 carbs

15 carbs

45 carbs

high glycemic index

high glycemic index

medium glycemic index

low glycemic index

and this


salad

bread

meatloaf

potatoes

you see dinner


8 carbs

25 carbs

15 carbs

45 carbs

high glycemic index

high glycemic index

medium glycemic index

low glycemic index

we see disease

OMG – Your Pancreas Just Texted / Photo by flickr user MissTessmacher

we understand how blood sugar should vary over a day

OMG – Your Pancreas Just Texted / Photo by Lynn Schnitzer

and we know why lab values like an A1c are important


so we’re not doctors


but we’re kinda experts

so we’re not doctors

OMG – Your Pancreas Just Texted / Photo by Jonny Wikins

some of us are bigger experts than others

OMG – Your Pancreas Just Texted / Photo by Joe Shlabotnik

of diabetics in the US aren’t managing their blood sugars

67%

Source : Adults in the US above A1C goal of 6.5%, “State of Diabetes in America.” AACE, 2005


that leads to a shorter life and unpleasant complications


we could blame it on them


we could blame it on them

we could say they’re lazy or aren’t trying


we could blame it on all 17 million who are having problems


but that’s too many people having problems


something is wrong

but that’s too many people having problems

OMG – Your Pancreas Just Texted / Photo by Peter Belanger

this is Don Norman

he wrote The Design of Everyday Things

OMG – Your Pancreas Just Texted / Photo by Peter Belanger

“When people have trouble with something, it isn’t their fault—it’s the fault of the design.”

Donald A. Norman


the system has a problem and it’s time to fix it


adults in the US have at least one chronic disease

133 million

Source : Centers for Disease Control and Prevention. Chronic Disease Overview page.Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed January 10, 2011

OMG – Your Pancreas Just Texted / Photo by David Beyer

each year chronic disease costs the U.S.

1.3 billionSource : “The Economic Burden of Chronic Disease on The United States.” Milken Institute, October 2007.

OMG – Your Pancreas Just Texted / Photo by D Sharon Pruitt

and each year chronic disease is responsible for

7out of 10 deathsSource : Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final Data for 2005. National Vital Statistics Reports, 2008. http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

OMG – Your Pancreas Just Texted / Photo by Jay Reed

can technology help us manage chronic disease?

OMG – Your Pancreas Just Texted / Photo by Jay Reed

something has to

can technology help us manage chronic disease?


1/the problem

2/how to fix it

3/an example

4/the wrap up

OMG – Your Pancreas Just Texted / Photo by Kevin Walsh

doctors like to talk about this

OMG – Your Pancreas Just Texted / Photo by Abhishek Jacob

about how this

OMG – Your Pancreas Just Texted / Photo by Aki Hanninen

is affected by that

OMG – Your Pancreas Just Texted / Photo by Judy Baxter

in 21 minute segments we talk about our healthSource : “Primary Care Visit Duration and Quality.” Archives of Internal Medicine. 2009;169(20):1866-1872.

OMG – Your Pancreas Just Texted / Photo by flickr user Susan NYC

but the rest of the time we’re on our own

OMG – Your Pancreas Just Texted / Photo by Phil Gyford

choosing whether or not to order a sugary drink

OMG – Your Pancreas Just Texted / Photo by Alan Chan

or eat any of the bread served with dinner

OMG – Your Pancreas Just Texted / Photo by flickr user larique

doctors aren’t there for any of that

OMG – Your Pancreas Just Texted / Photo by flickr user larique

i’m not saying that doctors aren’t important

OMG – Your Pancreas Just Texted / Photo by Tulane Publications

doctors fill a vital role, they diagnose and prescribe


but that isn’t enough

doctors fill a vital role, they diagnose and prescribe


patients aren’t happy, and aren’t doing well


patients aren’t happy, and aren’t doing well

remember the 67% that’s having trouble

OMG – Your Pancreas Just Texted / Photo by flickr user webgrl

are dissatisfied with their medication regimen

31% of diabetic 45 – 54 year olds in the US

Source : Satisfaction with medication regimen, “Diabetics: Attitudes and Behaviors – US.” Mintel, May 2010. Base : Internet users aged 18+ who have diabetes by gender and age..

OMG – Your Pancreas Just Texted / Photo by Wally Hartshorn

are dissatisfied with their diet or eating plan

57% of diabetic 45 – 54 year olds in the US

Source : Satisfaction with diet/eating plan, “Diabetics: Attitudes and Behaviors – US.” Mintel, May 2010. Base : Internet users aged 18+ who have diabetes by gender and age..

OMG – Your Pancreas Just Texted / Photo by flickr user yuan2003

are dissatisfied with their exercise schedule

64%

Source : Satisfaction with exercise schedule, “Diabetics: Attitudes and Behaviors – US.” Mintel, May 2010. Base : Internet users aged 18+ who have diabetes by gender and age.

of diabetic 45 – 54 year olds in the US

OMG – Your Pancreas Just Texted / Photo by Till Westermayer

31%

64%57%

OMG – Your Pancreas Just Texted / Photo by Chris Riebschlager

it’s the two things doctors can’t write prescriptions for...

that patients are having problems with


turns out that saying “Eat better and exercise” isn’t working


and I don’t think we ever thought it would

OMG – Your Pancreas Just Texted / Photo by Chris Riebschlager

but it’s those 2 thingsthat are most effective preventing diabetes


diet and exercise reduce the chance of developing type 2

58% reduction for those using diet & exercise

Source : DPP, February 2002. Base : Overweight adults with impaired glucose tolerance.


58% reduction for those using diet & exercise

31% reduction for those taking medication

diet and exercise reduce the chance of developing type 2Source : DPP, February 2002. Base : Overweight adults with impaired glucose tolerance.

OMG – Your Pancreas Just Texted / Photo by Seattle Municipal Archives

the system isn’t supporting those lifestyle changes

OMG – Your Pancreas Just Texted / Photo by Ruth Rogers

patients need to be educated


doctors have tried a few different things

OMG – Your Pancreas Just Texted / Photo by Andrew Forgrave

1/5 physicians use group visits to educate their patientsSource : “Expectations Outpace Reality: Physicians’ use of care management tools for patients with chronic conditions.” Center for Studying Health System Change, December 2009.

OMG – Your Pancreas Just Texted / Photo by flickr user CarynNL

1/2 physicians use nonphysician educatorsSource : “Expectations Outpace Reality: Physicians’ use of care management tools for patients with chronic conditions.” Center for Studying Health System Change, December 2009.

OMG – Your Pancreas Just Texted / Photo by Justin O’Neill

3/4 physicians hand out pamphletsSource : “Expectations Outpace Reality: Physicians’ use of care management tools for patients with chronic conditions.” Center for Studying Health System Change, December 2009.

OMG – Your Pancreas Just Texted / Photo by Justin O’Neill

patients do not need pamphlets

3/4 physicians hand out pamphletsSource : “Expectations Outpace Reality: Physicians’ use of care management tools for patients with chronic conditions.” Center for Studying Health System Change, December 2009.

OMG – Your Pancreas Just Texted / Photo by Pewari Naan

patients need something motivating and personable

OMG – Your Pancreas Just Texted / Photo by Tim Moreillon

they need something easy to expand to people everywhere

OMG – Your Pancreas Just Texted / Photo by flickr user Sheryl’s Boys

patients need each other


1/the problem

2/how to fix it

3/an example

4/the wrap up

OMG – Your Pancreas Just Texted / Photo by Hans Põldoja

okay, so web 2.0 to save the day

OMG – Your Pancreas Just Texted / Photo by Hans Põldoja

okay, so web 2.0 to save the day

again

OMG – Your Pancreas Just Texted / Photo by B Zedan

OMG – Your Pancreas Just Texted / Photo by Paul Downey

it’s not much of a stretch for these patients


have looked online for health information

83% of internet users with a chronic disease

Source : Health Information is a Popular Pursuit Online, “Health Topics.” Pew Internet, February 2011. Base : U.S. internet users aged 18+


are looking at user-generated health information

57% of e-patients with a chronic disease

Source : Use of Internet to gather Health Information, “Chronic Disease and the Internet.” Pew Internet, March 2010. Base : U.S. internet users aged 18+


there are some pretty inspiring examples

OMG – Your Pancreas Just Texted / http://en.wheelmap.org/

people are sharing information

OMG – Your Pancreas Just Texted / http://en.wheelmap.org/

OMG – Your Pancreas Just Texted / Wheelmap iPhone App

and making it available everywhere

OMG – Your Pancreas Just Texted / Wheelmap iPhone App

OMG – Your Pancreas Just Texted / http://curetogether.com/migraine/causes/

they’re also comparing results

OMG – Your Pancreas Just Texted / http://curetogether.com/migraine/causes/

OMG – Your Pancreas Just Texted / Photo by Jeff Vogt

there are a lot of tools for diabetics too

OMG – Your Pancreas Just Texted / iPhone Apps : Diabetes Diary, Blood Sugar Diabetes Control

most of them seem to focus on charts and graphs

OMG – Your Pancreas Just Texted / iPhone Apps : Diabetes Manager, BGluMon

testing blood sugar and monitoring food intake is important

OMG – Your Pancreas Just Texted / iPhone Apps : Diabetes Plus, Easy Diabetes

but the charts and graphs we end up with aren’t

OMG – Your Pancreas Just Texted / iPhone Apps : Vree For Diabetes, UTS Diabetes

patients end up focusing on numbers

OMG – Your Pancreas Just Texted / iPhone Apps : Bant, Glucose Charter

and not on the behaviors that create those numbers

OMG – Your Pancreas Just Texted / iPhone Apps : Diamedic, Glucose Buddy

these siloed tools are missing an even bigger point

OMG – Your Pancreas Just Texted / Photo by Steven Yeh

OMG – Your Pancreas Just Texted / Photo by Marieke Kuijjer

OMG – Your Pancreas Just Texted / Photo by flickr user BenSpark

you get the idea


they’re missing other people


being surrounded by a culture of self-care is the best way to change

OMG – Your Pancreas Just Texted / Photo by Brian Rutledge

that’s what makes Weight Watchers work

OMG – Your Pancreas Just Texted / Photo by Marius Watz

and Alcoholics Anonymous

OMG – Your Pancreas Just Texted / Photo by flickr user SuperFantastic

these programs don’t just work, they work betterSource : “Weight loss with self-help compared with a structured commercial program: a randomized trial.”New York Obesity Research Center, 2003. http://www.ncbi.nlm.nih.gov/pubmed/12684357


it’s hard to reinvent your life and habits


especially when it feels like no one else is

it’s hard to reinvent your life and habits


having supporters doesn’t just make change easier


lower chance to have another heart attack if you have close friends*Proven only for the year after first heart attackSource : “Heart attack survivors half as likely to suffer further attacks if they have love and friends.”Medical News Today, April 2004. http://www.medicalnewstoday.com/articles/7280.phpBase : Adults who had a heart attack within a year of the study

50%


diabetics have tried to form their own communities


on places like twitter

http://twitter.com/#search?q=%23bgnow

OMG – Your Pancreas Just Texted / http://twitter.com/#search?q=%23bgnow


and on forums

http://juvenation.org/forums/TopicsActive.aspx

OMG – Your Pancreas Just Texted / http://juvenation.org/forums/TopicsActive.aspx

OMG – Your Pancreas Just Texted / http://www.tudiabetes.org/forum/category/listByTitle


patients are validating each other

http://www.tudiabetes.org/forum/category/listByTitle


user forums also have a lot of helpful info


OMG – Your Pancreas Just Texted / Photo by Emilie Hardman

it’s where you learn what to do about this

OMG – Your Pancreas Just Texted / Photo by flickr user mayhem

and how to find room for a glucose tester on that


but it’s a little bit like the wild wild west



patients have to sift through to find meaningful content


participate in online support groups or forums


Source : Use of Online Support Groups, “Chronic Disease and the Internet.” Pew Internet, March 2010. Base : U.S. internet users aged 18+



participate in online support groups or forums

we can do better than that


Source : Use of Online Support Groups, “Chronic Disease and the Internet.” Pew Internet, March 2010. Base : U.S. internet users aged 18+



we need to remake the tools that manage diabetes


1/the problem

2/how to fix it

3/an example

4/the wrap up


if diabetes is being managed well


it needs to be managed all day long

if diabetes is being managed well


it also has to be managed forever

OMG – Your Pancreas Just Texted / Photo by Diane Hammond

well, as many of you know, forever is a long time

OMG – Your Pancreas Just Texted / http://pasta.blogspot.com/

of blogs have been abandoned

95%

Source : http://www.nytimes.com/2009/06/07/fashion/07blogs.html

OMG – Your Pancreas Just Texted / http://pasta.blogspot.com/

Source : http://www.nytimes.com/2009/06/07/fashion/07blogs.html

OMG – Your Pancreas Just Texted / Photo by Amodiovalerio Verde

of this audience has already broken their new years resolutions

65%

OMG – Your Pancreas Just Texted / Photo by Amodiovalerio Verde

of this audience has already broken their new years resolutions

i made that one up but it sounds totally believable

65%

OMG – Your Pancreas Just Texted / Photo by flickr user abrinsky

people have trouble managing forever

OMG – Your Pancreas Just Texted / Photo by Rosa Say

that’s why we have phrases like one day at a time

OMG – Your Pancreas Just Texted / Photo by Rosa Say

that’s why we have phrases like one day at a time

again, like Weight Watchers or AA

OMG – Your Pancreas Just Texted / Photo by ‘Step by Step’, Intro Credits of the Television Show

and take it step by step

OMG – Your Pancreas Just Texted / Photo by flickr user dincsi

management has to be broken into steps to work


some colleagues and I have made some first steps


we realized three key things


patients are isolated




the current solutions are clinical





forever is really hard



we’ve created a concept that attempts to address these problems



forever is really hard

OMG – Your Pancreas Just Texted / Design by Kjell Reigstad

your doctor can’t come with you, but your phone can

create a “new normal” with a community invested in better self-care


our categories are based upon the things that people already talk about


you’re presented with faces, not with numbers

focused on behavior moving forward, not looking back


a micro-network, full of people in similar situations


commiseration is an important part of dealing with diabetes

users prompted to share the situation behind the sugars


users can gather support to help them get back on track


achievable goals offer more rewards more frequently


provides ideas and encourages snacking


allows users to find the small changes that can fit in their lives now, today

managing diabetes forever is too hard, managing it today we can do


users are reminded that they’re never doing this alone

updating is quick


celebrate the small victories that lead to better management

days aren’t open ended, a user can be “done”


the emotion is what motivates updates, but the data is still important


quickly compare a week’s blood sugar average with activity


mini-goals ground conversations in what daily life is really like


it’s just an idea, a step


but that’s how you start difficult things

it’s just an idea, a step


1/the problem

2/how to fix it

3/an example

4/the wrap up

OMG – Your Pancreas Just Texted / Photo by Adrian Black

we mostly talked about type 2 diabetics today

OMG – Your Pancreas Just Texted / Photo by Adrian Black

we mostly talked about type 2 diabetics today

they need more tools, better tools

OMG – Your Pancreas Just Texted / Photo by flickr user illicit_monkey

but there are patients with heart disease too

OMG – Your Pancreas Just Texted / Photo by flickr user illicit_monkey and Bryan Costin


and Crohn’s

OMG – Your Pancreas Just Texted / Photo by flickr user illicit_monkey, Bryan Costin and Henry M. Diaz


and Crohn’s and arthritis

OMG – Your Pancreas Just Texted / Photo by flickr user illicit_monkey, Bryan Costin, Henry M. Diaz and flickr user theqspeaks


and Crohn’s and arthritis and MS


lives with at least one chronic disease

45% of the U.S. population

Source : Center for Studying Health System Change, 2009.


nearly 1 in 2 people

lives with at least one chronic disease

45% of the U.S. population

Source : Center for Studying Health System Change, 2009.


we need to create new solutions, new tools


the way things worked relied on appointment based care


but chronic diseasesrequire a lot more


patients have to manage their disease every day

but chronic diseasesrequire a lot more

OMG – Your Pancreas Just Texted / Photo by Farid Iqbal Ibrahim

so patients need a tool that is with them every day

OMG – Your Pancreas Just Texted / Photo by Farid Iqbal Ibrahim

so patients need a tool that is with them every day

every moment

OMG – Your Pancreas Just Texted / Photo by Wade Morgen

mobile phones are already there


and more people use them to go online each year

mobile phones are already there


more are online with their phones than last year

13%

Source : Mobile Access 2010, “The use of non-voice data applications has grown significantly over the last year”Pew Internet, July 2010. Base : Cell Phone Ownershttp://pewinternet.org/Reports/2010/Mobile-Access-2010.aspx


we could continue to deliver care three or four times a year


or, we could offer it continuously and conveniently


let’s make mobile health solutions a priority


problems

There is a clinical emphasis on disease and numbers, rather than on lifestyle and patients.

The current model of care doesn’t support patients who must manage chronic disease daily.

Stigma or isolation forces patients to attempt behavioral changes on their own.


fixes

Facilitate the discussions patients are already having.(Just make doing it easier.)

Add ontop of appointment based care a continuous ‘soft touch’ using mobile.

Recording behavior and medication is a lot more interesting if it’s social, rooted in emotion.

Place the emphasis on bite-sized, daily goals to help maintain patient engagement.

OMG – Your Pancreas Just Texted / Photo by Jeramey Jannene

Kjell Reigstad Libby Groettum Kim Cortese Michael Harper Bryan HamiltonElliott Trice Katy Thorbahn

OMG – My Pancreas Just Texted

John Pettengill, Kjell

Reigstad, Libby Groettum

Razorfish

OMG – Your Pancreas Just Texted / Photo by Ethan Lofton

omg - my pancreas just texted

Health & Medicine

texted page

chronic disease overview

ruben swieringa

joe shlabotnik

managechronic disease

jonny wikins

disease control

pete prodoehl