Presentation on mHealth & wearables given on Hilton Head Island for the South Carolina Society of Health-System Pharmacists 2015 Annual Meeting.

1. Kevin A. Clauson, PharmD @kevinclauson
Next Gen Pharmacy
mHealth, Wearables & Invisibles

2. I have more
optimism about
the future of
pharmacy than some
people feel is
merited

3. Objectives
1. Describe the mobile health (mHealth) arena
and its relevance to pharmacy practice.
2. Contrast the paternalistic and participatory
medicine models as they relate to mHealth.
3. Discuss the use of mHealth applications (apps)
and wearables to enhance patient self-care.
4. Summarize hurdles associated with mHealth
in pharmacy.

4. mHealth Arena

5. Am J Health Syst Pharm 2013;70(15):1348-52.
mHealth is the use of mobile devices
and global networks to deliver health
services and information

6. Kairos
Fogg BJ. Persuasive Technology: Using Computers
to Change What We Think and Do, 2002.
Καιρος: Greek god of the favorable moment
Leveraging
mobile
technology to
facilitate
behavior change

7. Dimension Factor mHealth tool(s)
Social and economic Limited English language
proficiency
Medical encounter app (MediBabble); Mobile
medical translator (Jibbigo)
Health care system Lack of positive
reinforcement
HealthPrize; Mango Health; Memotext
Condition-related Depression Mobilyze
Therapy-related Complexity of medication
regimen
AdhereTech; eMedonline; eTect; Helius;
Pillboxie
Patient-related Alcohol or substance abuse Alcohol–Comprehensive Health
Enhancement Support System (A-CHESS
Mobile Platform)
mHealth tools to address factors in
medication non-adherence by dimension
Chapter 33. mHealth and Pharmacy in Healthcare.
mHealth Multidisciplinary Verticals, 2014.

8. Wearables are an accessory that
enable personalized mobile
information processing
Conf Proc IEEE Eng Med Biol Soc 2014;2014:4155-8.

9. 2005 2007 2009 2011 2013 2015

10. www.bionicly.com/digital-health-hype-cycle

11. PharmacyPractice2015;1(1):23,25.

12. Longwoods White Paper, October 2014.

13. Participatory
Medicine

14. Paternalistic approach to healthcare*
*Legacy model Health Aff 2014;33(9):1627-34.

15. Participatory Medicine
“Movement in which networked patients
shift from being mere passengers to
responsible drivers of their health, and in
which providers encourage and value them
as full partners.”
www.participatorymedicine.org

16. Source: The Accenture Connected Health Pulse Survey, 2012 (n=1,100).
Prescriptions
Appointments
Patients want to refill Rxs via digital channels:
Patients want to manage via digital channels:
73%
72%
72%
68%
Mobile
Mobile
Website
Website
90% of patients want online
access to health information
and education

17. Consumers want to use health apps
Source: Consumer Health Information Corporation, April 2011 (n=395)
Percent

18. mHealth & Wearables

19. ‘Bridge’ Technology

21. pillboxie.tumblr.com

22. adheretech.com

23. etectbio.com

24. Wearable Categories
• Fitness trackers
• Smart watch/hybrids
• Health-focused wearables
• Productivity wearables
• Wearables with health applications

25. www.fitbit.com

26. www.fitbit.com

28. Misfit Shine
www.misfit.com
Misfit Flash

30. www.hioscar.com

31. The $12 Fitness Tracker
www.pivotalliving.com

32. Kids’ activity can be
converted into:
– coins
– ibitz game points
– Device unlock time
App compliant with Children’s Online Privacy and Protection Act
(child’s activity information cannot be shared with anyone besides the parent)

33. www.getwuf.com

34. www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf
1Nike+ Fuelband, 2Fitbit Ultra,
3Jawbone UP, 4BodyMedia FitCore,
5Adidas MiCoach
1 2
3
4 5
10 men and 10 women
ages 18-44 wore all
devices to measure steps
and energy expenditure

35. Comparison of steps taken measured using hand counting
compared to steps taken from the activity devices
Devices Treadmill
Walking
Treadmill
Running
Elliptical Agility
Actual 2425+/-177.9 3182+/-173.9 2631+/-371.5 805+/-51.9
Jawbone UP 2403+/-176.6 3186+/-171.5 2627+/-359.0 783+/-110.1
Nike
Fuelband
2273+/-154.8* 3169+/-171.2 2580+/-458.7 533+/-70.4*
Fit Ultra 2425+/-177.2 2990+/-313.0* 2630+/-370.6 645+/-90.0*
NL-2000i 2425+/-178.0 2869+/-247.1* 2477+/-471.1* 671+/-106.9*
www.acefitness.org/certifiednews/images/article/pdfs/ACE_ActivityTrkr_Study.pdf
Values represent means +/- standard deviation
*Significantly different than actual steps (p<0.05)

36. Device Observations
Galaxy S4 Moves App 28
iPhone 5s Moves App 28
iPhone 5s Health Mate 27
iPhone 5s Fitbit App 27
Nike Fuelband 28
Jawbone UP24 28
Fitbit Flex 28
Fitbit One 26
Fitbit Zip 27
Digi-Walker SW-200 28
JAMA 2015;313(6):625-626.
500 1000 1500 2000
App
Mean number of steps
Device outcomes for 1500 step trials

37. Fitbit activity tracker

38. Microsoft Band + Health app
www.microsoft.com/microsoft-band/en-us

40. www.apple.com/watch

41. “…what I, as a CIO, need to do is gather the
data on your… devices in your home, and
understand what I can do to keep you well.”
“You will, through the device that you have,
your mobile phone, be able to use
middleware integration to the various
kinds of telemetry in your home, and
therefore [have] a single point of
interaction between your phone and the
EHR.”
– John Halamka, M.D.
Chief Information Officer of Beth Israel
Deaconess Medical Center
mobihealthnews.com

42. Middleware
in action

43. Apple HealthKit Institutional Partners

44. Apple HealthKit App Partners
EVERYONE
except
( )
Ok, not really but it can seem that way

45. https://itunes.apple.com/us/app/mychart/id382952264?mt=8

46. Smartphone share by platform in U.S.
Source: comScore MobiLens Mobile Metrix September 2014

47. Mimo Baby Smart Monitor

49. Stress, autism, epilepsy, PTSD, depression, and anxiety

50. www.mota.com

51. Boogio
Game
controller
Gait
analysis
Fall risk
www.boogio.com

53. www.xoeye.com

54. lumoid.com/wear

55. Wearables InvisiblesEvolution of body computing

56. By 2017, 30 percent of
wearables will be invisible*
*invisible = unobtrusive to the eye
Predicts 2015: New Business Opportunities and Complexity on the Rise in Consumer Devices Market

57. Smart contact lenses for diabetes

58. Hurdles with mHealth
and Wearables

59. 83%
!
83% of consumers
have difficulty using
their intelligent
devices
22% said their wearables
didn’t set up properly
24% said the devices were
too complicated to use
21% said the devices
didn’t work as advertised
Accenture. Engaging the Digital Consumer in the New Connected World, 2014.

60. One million Fitbit Forces
recalled in 2014

61. (but this was likely due to
hygiene, not product defect)

62. Are we isolating future generations with devices?

63. (maybe things haven’t changed as
much as we think)

64. Privacy
Security Interoperability
Regulatory
Financial

65. Could the holy
grail become
the pois ned
chalice?
EHR
Wearable data

66. Summary points
1. mHealth and wearables offer pharmacy the
potential to engage patients and enhance
positive health behaviors
2. Data from wearables can help fill in the
blanks for the (majority of) health that
happens outside the health care system
3. It is early days for wearables and invisibles
and there is a paucity of effectiveness data

67. Images
• http://a.tgcdn.net/images/products/zoom/eabe_half_full_optimi
st_glass.jpg
• http://reasonradionetwork.com/images/2012/04/opportunity.jpg
• http://www.google.com/trends/explore#q=wearable%20technolo
gy&cmpt=q&tz=
• http://www.myvirtualpaper.com/doc/pharmacy-
practice/pp_february_2014/2014043001/23.html#22
• http://www.longwoods.com/articles/images/TELUS%20Sante_v2
.pdf
• http://www.walgreens.com/store/c/walgreens-activity-
tracker/ID=prod6256835-product
• http://www.walgreens.com/topic/balancerewards/balance-
program-details.jsp
• http://geopalz.com/
• https://geopalz.com/wordpress/wp-
content/uploads/2013/09/POWERKEY-PRODUCT.jpg
• http://sr63parrot.caregroup.org/cmi/headshots/jhalamka_1744.j
pg
• http://www.pcmag.com/article2/0,2817,2470591,00.asp
• http://upload.wikimedia.org/wikipedia/en/d/d4/Fitbit_logo.jpg
• http://www.gizmag.com/mimo-baby-monitor-
ces/30277/pictures#3
• https://static-content1.empatica.com/XvPNd/img/carousel-
iphone.jpg
• http://www.google.com/glass/start/
• http://www.forbes.com/sites/leoking/2014/07/15/google-smart-
contact-lens-focuses-on-healthcare-billions/?slide=13
• http://d0.awsstatic.com/logos/customers/Novartis-logo.jpg
• https://qzprod.files.wordpress.com/2014/01/baghi49cyaaz2ps.jpg?w=1024&h=714
•
http://imageserver.moviepilot.com/the-usual-suspects-the-usual-suspects-cast-
20-years-after-keyser-soze-fooled-us-all.jpeg?width=1920&height=1080

68. Questions?
Kevin A. Clauson, PharmD @kevinclauson