Archive for: August 2011

Building Bridges in the City by the Bay - The 2011 Health 2.0 Conference

Aug 29, 2011, 4:13 AM, Posted by Steve Downs

We have a few questions for you.

Every day there are people who are finding new ways and developing new technologies to observe or collect information about themselves that has the power to improve health.

For example, Pioneer’s Project HealthDesign researchers are exploring practical ways for people to collect their own ODLs (observations of daily living) and integrate them into the clinical setting – empowering individuals to be at the center of their own care.

The pioneers at Open mHealth are equally committed to involving individuals in their own health and health care as they create an open learning ecosystem and share innovative technologies to improve everyone’s health.

In another cutting-edge movement, self-trackers who seek “self knowledge through numbers” are gaining insights into their own health and health-related behaviors everyday. The number of tools, apps and devices to help them are increasing exponentially, and it seems as if we’ve only scratched the surface of what people are starting to do by collecting and sharing their health-related data.

Today’s reality is that individuals have the opportunity to have the power of their own health information literally in the palms of their hands. We can point to when our blood pressure was high during the day, how our diet impacted our energy levels or sleep, what movements or behaviors caused a flare-up in back pain.

But how many will choose to track this information? Can self-tracking become mainstream in the next two years? What about five, 10 or 20 years? And if it does, then what do we do?

How do we make sure that information is put to its best use, both for us personally and the population as a whole? As patients, what do we want our doctors to do with our self-generated data? What do our doctors want us to track, and how? How do they integrate it into our diagnoses and treatment plans?

These are some of the questions we’ll be asking this coming week, September 25-28, at the 2011 Health 2.0 Conference in San Francisco. We’re excited to be a sponsor of this event and we’ve brought a diverse group of grantees and friends with us.

We’ve been involved in the broader Health 2.0 space for some time now. Through our investments in programs like Project HealthDesign, Open mHealth and support of groups like Quantified Self, we’ve been trying to bridge the worlds of technologies and health, and the experiences of patients and clinicians.

Over the course of the conference and beyond, we’ll be asking guests to help us tackle several questions that we think are critical if this movement is to reach its full potential—and we’d like your ideas too.

So tell us what you think. Help us answer these questions. Please add your comments below. You can also message us privately at pioneerblog@rwjf.org.

  1. What do you think are the most important challenges to be addressed in order to get more people collecting their own health data and information?
  2. What do you think are the most important hurdles to be overcome for patients to bring this information to their doctors and for it to inform clinical care? 
  3. Of all the things that one can track, what is the one piece of patient-generated data that has the most potential value to both personal health and clinical care?

As we look for opportunities to advance the thoughtful exploration of these practices, your responses will guide us. We value your input and look forward to hearing what you have to say.

What does mEvidence need to look like?

Aug 19, 2011, 4:40 AM, Posted by Al Shar

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There is something magical that happens when talking about mHealth. People start believing all of the wonderful things that a phone, together with the right gadget, can do: remind me to take my medicine, monitor my vitals, inform my doctor when something goes wrong, just plain automatically keep me healthy. The last few years have seen a huge growth in cell phone companies, technology companies, governments, application and device developers rushing to deliver product in this space. Just look at the over 500% increase in attendance between the 2009 and 2010 mHealth Summit (with the 2011 meeting promising to be even larger.) Along with the hype and the hope, people are beginning to ask for evidence and to question the value of growing a collection of isolated gadgets and apps.

I’d say that mHealth is somewhere around the asterisk on the “hype cycle” model developed by Gartner.

With that as context, RWJF’s Pioneer Portfolio, together with NIH, NSF, HHS and McKesson Foundation, organized a one day event to begin the process of advancing the Science of mHealth. What does mEvidence need to look like? What are the right methods to accelerate the evaluation of the efficacy of mHealth technologies?   First steps to address this have largely been focusing on attempts to demonstrate value by using a traditional randomized controlled trial, which is often ill suited to testing the interventions that mHealth enables. (It’s interesting to note that on August 14, Paul Meier died. I’d be interested in knowing what he’d be thinking.) When we first started to plan this meeting, I wondered how interested the field would be. After all, this is the drier, academic side of mobile health. I was surprised! We had 106 responses to our call for whitepapers of which we were able to choose 23. The demand for attendance was such that NIH had to arrange for a webcast.  Perhaps looking at transforming the way conduct research [in light of new technologies] is not so dry after all. While the attendees were predominantly US-based, academic, international and corporate interests were represented. The outcome was even more surprising. The group agreed that this was a good and important direction, that we needed to have a collaborative, ongoing and forward looking agenda and that the Science of mHealth was critical to achieving a high enough plateau of productivity. The group will soon issue a statement of direction and commitment, publish the key outcomes of the meeting and develop a longer-term agenda. We are also developing an online community so that we can keep the discussion going. In a couple of weeks the webinar will be available for people who missed it and we will work to keep the groundswell moving.

I’d be remiss not to include the fact that closely aligned is the ideas and ideals of Open mHealth and the work of Pioneer grantees Ida Sim and Deborah Estrin. Not only were they and a number of people in the open mHealth area participants, they organized a second day to help formulate how they were going to develop and move forward.

This is important and people are paying attention. One way that you can help is to respond to the request from the NIH Director’s Common Fund, which is designed to fund transformative research that is of interest to the health community. The Common Fund officials are looking for the community (that is you!) to weigh in on new ideas for funding. Go here to add your comments.

Another reason to get your flu shot - It can help reduce antibiotic resistance

Aug 17, 2011, 2:33 AM, Posted by RWJF Blog Team

Pioneer grantee Ramanan Laxminarayan, director of Extending the Cure, recently shared his perspective on The Health Care Blog about a new study published in the July issue of Infection Control and Hospital Epidemology. The study shows that antibiotic prescriptions tend to spike during the flu season, even though influenza is caused by a virus and cannot be treated with antibiotics.

According to Extending the Cure, between 500,000 to one million antibiotic prescriptions are filled each year during the flu season for patients who have the flu and no bacterial illness. This overuse is one of the many causes of the recent spike in antibiotic resistant bacteria.

Laxminarayan proposes a simple solution to this problem – get your flu vaccine this year. If you do not contract the flu, then there is no possible way your care provider will needlessly prescribe you antibiotics to treat it.

 What are some other  ways to curtail the epidemic of drug-resistant bacteria, both during this year’s flu season and beyond? We’re interested in hearing your thoughts – leave a comment here or on THCB.

mHealth Evidence Workshop and Webinar, August 16

Aug 15, 2011, 5:11 AM, Posted by RWJF Blog Team

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On August 16 the Pioneer Portfolio, along with the National Institutes of Health, McKesson Foundation and the National Science Foundation will present the mHealth Evidence Workshop in Bethesda, Maryland. This workshop, which will be shared via a free webinar, brings together individuals with diverse expertise in data analysis and experimental design to identify methods that can accelerate the evaluation of the efficacy and safety of mHealth technologies. We at Pioneer, along with many others, believe mHealth has the potential to simultaneously reduce the cost of health care and improve our health. The tremendous interest we’ve received in the event is also a great sign that we’ll have a productive day exploring the potential around design and infrastructure innovations, reality mining and plotting a direction to build upon current innovations.

We plan to use this to generate a research agenda to further guide development of the space. To register for the free webinar please visit Eventbrite. Also, be sure to check back here for a recap of the discussion and next steps. 

Interview with Philip Polgreen

Aug 8, 2011, 11:17 AM, Posted by RWJF Blog Team

 Philip Polgreen, M.D., an associate professor in the Department of Medicine at the University of Iowa Carver College of Medicine, and his colleagues published a study in the May 4, 2011 issue of the scientific journal PLoS ONE showing that Twitter can be used to track influenza activity. Support for the research was provided in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio. Previous work by Polgreen and Forrest Nelson, Ph.D., an economics professor also at the University of Iowa, includes the development of an electronic prediction market that could help public health officials forecast the timing, severity and spread of seasonal influenza and other infectious diseases. In this post, Polgreen answers some questions about the current study’s findings and implications for the future

Q: Why did you look at Twitter and influenza activity?

A: Right now, public health officials report suspected cases of the flu to the Centers for Disease Control and Prevention (CDC), but that process can take several weeks, a lag that gives the flu an opportunity to spread. When reports of the H1N1 virus that causes swine flu started increasing, we wondered if we could tap into the Twitter stream to find evidence of an upswing in cases of the flu in real time. Twitter is a micro-blogging service that allows millions of users to send and read “tweets” on all kinds of information, including, as it turns out, useful information about people suffering from fever and other flu symptoms.

Q: Your team also found that Twitter could be used to track the rapidly evolving public sentiment with respect to H1N1. How did the team come to that conclusion?

 A: We collected and stored tweets containing key words such as “H1N1”, “influenza”, or “swine flu” that were sent at the start of the outbreak. At the start of the outbreak in April 2009, we saw a flurry of tweets, including some expressing fear about the virus. But as time went on, public health messages indicating that the H1N1 virus was not as deadly as expected kicked in and we saw a gradual decline of tweets talking about such concerns.

Q: The study also found that public interest in hand-washing seemed tied to public health messages aimed at slowing the spread of the flu. Can you explain why that finding is important?

A: If this method proves accurate, public health officials may one day use it to find out whether people understand key messages aimed at flu control and prevention. If not, they can tailor the messages to increase the knowledge of, say, the importance of hand-washing, a habit that can protect people from the flu and can contain its spread.

 Q: You also did a second analysis that used Twitter to track disease activity. Can you explain what your team found?

A: We analyzed tweets that contained the words “fever”, “flu”, “muscle aches” and other symptoms, finding that Twitter data could be used to estimate incidence of the flu in real time. In addition, we found that Tweets from people experiencing flu symptoms tracked closely with the information collected by the CDC (data that comes out two to three weeks after people report feeling sick) in both time and location. If this method of tracking disease is confirmed by additional research, public health officials could use it as an early warning of a potential uptick in flu cases in a specific geographic area.

Q: Why is early warning a critical part of protecting the public?

A: Public health officials need as much information as they can gather in order to combat the flu and other infectious diseases. With early warning that a flu strain is particularly virulent in some part of the country or is spreading rapidly in others, public health officials can ramp up production of a vaccine or push out public health messages urging people to line up for a flu shot, which can turn down the dial on the outbreak.

Q: Does this have the potential to accelerate the progress we’ve made in protecting people from the flu or other infectious diseases?

A: Yes. This is one of the first large-scale efforts to investigate if data from Twitter can be used to predict the flu or to track public interest in a disease like H1N1 influenza. Additional research will need to confirm the accuracy of this method and extend it to other infectious diseases. But if all goes well, public health officials may one day be able to tap into the Twitter stream to get real-time information that could pinpoint an outbreak’s location and show when it is starting to spread to other areas of the country. This method will not replace current disease-tracking methods but could augment existing approaches to surveillance.