First Title Slide Using a Tweet

My first title slide using a tweet!
Joyce Lee, MD, MPH; Associate Professor
Pediatric Endocrinology/Child Health Evaluation
and Research Unit (CHEAR)
Mott Children’s Hospital/University of Michigan
Twitter: @joyclee

I don’t have any ties to mobile
application companies
The mobile apps I present are at
my personal whim and don’t
imply endorsement, except for
the patient designed ones
(which I love!!)

I am social media editor for JAMA
Pediatrics but my views do not
represent those of the journal

91%of US adults have a cell phone

56%of US adults have a smartphone

79% 81%
69%
55%
39%
18%
18-24 25-34 35-44 45-54 55-64 65+
Age group
Pew Internet http://goo.gl/icIeSD
Smartphones: a generational thing
that will soon become universal
Smartphone
Ownership
(%)

53%
64%
60%
White African-American Hispanic
Smartphone
Ownership
(%)
Differences in smartphone ownership
are narrowing across race/ethnicity

77%
47%
22%
8%
81%
68%
40%
21%
90% 87%
72%
43%
18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs
< $30k $30k - $74,999k ≥$75k
Smartphone
Ownership
(%)
Differences in smartphone ownership
are narrowing across income

The US consumer spends
2 hr 38 min per day
on smartphones and tablets
http://goo.gl/PCdbol

The US consumer spends
2 hr 38 min per day
on smartphones and tablets
http://goo.gl/PCdbol
Mobile and Social go hand in hand!

http://goo.gl/Inp7j4
Unfortunately this dream is
not even close to the reality
of healthcare right now

What’s a
Medical Mobile Application?

Any of the following for managing health/
wellness:
(1) Software program that runs on smartphones
(2) Accessory that attaches to a smartphone
(3) Software + Accessory
See the FDA final guidance document
http://goo.gl/6ttcF0

3 Types of Medical Mobile Apps
FDA Regulated
Enforcement at FDA Discretion
Not FDA Regulated

(1)  Are intended to be used as an
accessory to a regulated
medical device
(2)  Transform a mobile platform
into a regulated medical device
FDA Regulated

Connecting a glucometer to a
mobile phone turns it into an
FDA-regulated medical device

The AliveCor is an iPhone case
that gives EKG readings;
it had to be FDA-approved

“When the intended use of a mobile app is
for the diagnosis of disease or other
conditions, or the cure, mitigation,
treatment, or prevention of disease, or is
intended to affect the structure or any
function of the body of man, the mobile
app is a device”
-FDA
Intent matters with
FDA regulation

The LED light on your flash is not
FDA regulated, unless you are trying
to use it as an opthalmoscope

Based on this definition, FDA sent this letter
to the makers of the uChek Urine Analyzer
“Please note that though the types of urinalysis dipsticks
you reference for use with your application are cleared,
they are only cleared when interpreted by direct visual
reading. Since your app allows a mobile phone to analyze
the dipsticks, the phone and device as a whole functions as
an automated strip reader. When these dipsticks are read
by an automated strip reader, the dipsticks require new
c l e a r a n c e a s p a r t o f t h e t e s t s y s t e m .”
-FDA

(1)  Help patients/users self-manage their disease
or condition without providing specific
treatment suggestions;
(2)  Provide patients with simple tools to organize
and track their health information;
(3)  Provide easy access to information related to
patient’s health conditions or treatments;


(4)  Help patients document, show or
communicate potential medical conditions to
health care providers;
(5)  Automate simple tasks for health care
providers;
(6)  Enable patients or providers to interact with
Personal Health Records (PHR) or Electronic
Health Record (EHR) system

By definition, tracking/recording apps
for blood sugar may fall into this category,
but apps using self-entered data
don’t seem to be regulated thus far

Not FDA Regulated

(1)  E-book medical textbooks
(2)  Medical flashcards/training
(3)  Patient education apps
(4)  Automation of office operations
(5)  Videoconferencing/email to facilitate
communication betw/ pt & provider

Are medical mobile applications
effective for improving health?

The jury is still out. Most studies have
focused on SMS; formal evaluation of effectiveness
of sensor and smartphone technology on health
outcomes has yet to be done.

Regarding regulation, FTC did crack down
on this appmaker for a false claim that
light emanating from the phone
could treat acne
http://goo.gl/tppRqS

And this study is interesting; even if an app
does not give “medical advice” and is
not technically “regulated”, do patients
interpret it that way and defer seeking
medical attention?
http://goo.gl/1RQcWm

We published a review of commercially
available diabetes apps
http://www.ncbi.nlm.nih.gov/pubmed/
23627878

There are some major problems with
the app search process

Of 480 apps,
50% were relevant
Of 600 apps,
85% were relevant
Searching for “diabetes” is very
different on Android vs. iPhone

Terms in the description are
determined by the app maker:
“Health” “Fitness” “Nutrition”
•  Difficult to customize searches
•  App search algorithms are not
transparent
•  Small numbers of reviews
“Health & Fitness” is a really broad
category presumably defined
by the app maker.
These are the most popular,
But are they evidence-based?
The answer is NO.

When you search, there isn’t much of an
advanced search, and you have to swipe
screen by screen, then you get lazy
and give up after about 10 swipes

How many stars ★★★★★ and or
reviews give you confidence in a
medical mobile app?

App search algorithms are
not transparent

What kinds of diabetes apps
did we find?
(we only looked at the iTunes store
for this part)

Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)

This is the only FDA-approved medical
Management diabetes app that I know of
http://www.welldoc.com/

Comes w/a cute monster, but glucose
is hand entered in the US for now
http://mysugr.com/

This is probably the most useful tool
for mobile downloading of glucose for now,
w/ Android/iPhone/multiple meter
compatibility (yes, cord is clunky)
https://www.glooko.com/

Some pts have had trouble getting
this meter covered by insurance
Technology is not effective if you
don’t have access to it!
http://www.ibgstar.us/

This is the only real-time glucometer I
know of; it has a 2G chip embedded in
the meter that uploads BG to the cloud
in real-time
https://www.telcare.com/

http://www.mynetdiary.comhttp://www.calorieking.com/

Saving for a
future
presentation
!

Finally, what are the
security issues with medical
mobile apps?

Are they HIPAA compliant?
Who knows? Many don’t say

What is being done with my health
data? Who knows?
Who reads the fine print and is the
info even in there?

Can data be shared with the
provider?
Some do by email, but providers
are not supposed to use email
because it’s not secure!

Maybe Google can help you
find an app
#sadstateofmhealthtechnology

Hard to find apps
Too many apps
Uncertain Quality of Apps
Uncertain Benefit of Apps
Apps lack seamless link to provider
The promise of mobile health has
yet to be realized

In the meantime,
there is a diabetes technology
revolution happening right under
our screens

73% of adults are on some kind of
social networking site
Pew Internet http://goo.gl/oP5bKZ
67%
20%
15% 16%
13%
71%
22% 21%
18% 17%
Facebook LinkedIn Pinterest Twitter Instagram
2012 2013
Social
Media
Site Use
(%)

What can I say, this is how I feel:

It’s a microblogging platform,
a place to have a
conversation

First, set up your profile
and choose your name
@_________

First, choose your name
and set up your profile:
Who are you?
What do you care about?

@lphilipson
@HopeWarshaw
@EndoGoddess
@Dermdoc
@kidney_boy
Your name? Your specialty?
It’s up to you

This is not engaging!
“Who is that egghead?”

Show people what you care about and
how to learn more about you

Tweet
You only have 140 characters
to say something

Tweet an article/news/resource
of interest

Use a link shortener to save space

#diabetes
#dsma
#doc
#dblog
#quantifiedself
#mhealth
#dataviz
A #hashtag can mean many
things like a topic or group

Diabetes Online Community (DOC)
myglu.org

#cdtc2014
A #hashtag can be used for
conferences
(I just created one for
this meeting)

You will see the tweets of people
that you follow

My followers will see my tweets

Use mentions to reach out to
specific individuals

Retweet someone else’s tweet
Hit the retweet button (RT will show up);
Change it to MT if you modify the tweet;
h/t “Hat tip” acknowledges who gave u info

So now you know
how to use Social Media,
but why would
a diabetes professional use it?

You don’t feel like tweeting your
morning breakfast

You have better things to do than
put your math skills on display

Neither are you mother monster
(Lady Gaga)

Plus, haven’t you heard that
“social media and medicine
is a dangerous mix”?

60% of US medical schools reported incidents of
students posting unprofessional online content
13% reported violations of patient confidentiality
52% reported student use of profanity
48% reported frankly discriminatory language
39% reported depiction of intoxication
28% reported sexually suggestive material
JAMA, 2012
http://goo.gl/voZFXN

“Professionalism and social media can
be an uneasy mix...”
BMJ, 2012
But there are a few principles
to follow as a healthcare professional
on social media…

If you have a personal account, separate
it from your professional one

Dr. Joyce Lee
Associate Professor
by day
Lady Gaga
by night

“Don’t Lie, Don’t Pry
Don’t Cheat, Can’t Delete
Don’t Steal, Don’t Reveal”
Follow the 12-word Social
Media Policy from the Mayo
Clinic
http://goo.gl/kxNca2

Remember HIPAA!
http://goo.gl/vntKv2
Don’t talk about
patients, even in
general terms
If you wouldn’t say
it in an elevator,
don’t say it online

Why should you consider
taking the plunge?

To learn about new mobile
applications for diabetes

To keep abreast of real-time
diabetes technology news

To troubleshoot
technology issues

To learn how diabetes
technology works
in the real world

To learn about design issues
in diabetes technology

To have a conversation about
design issues in diabetes
technology

To learn about novel real-world
applications of diabetes
technology

http://goo.gl/128wVg
iSeismometer iPhone app + CGM
on nightstand = effective alarm!

http://goo.gl/Y7yGsH
Glucose Sensor + Flovent = Rash-free?

To learn about a patient-
designed future of mobile
technology and data visualization
for diabetes

He used 3 medical devices,
3 activity monitors, a smartphone…

and 10 different software systems to
make his year of visualizations

What a beautiful future for
patient-driven visual design

And for patient-driven
hypotheses and insights

Check out his new app: Meal Memory
http://www.databetes.com/

To witness the incredible
creativity and hacking
capabilities of individuals/families
with diabetes

cloud
CGM
Nightscout is helping
a family manage blood sugars
in a more sophisticated manner
using open-source tools
#wearenotwaiting

http://goo.gl/glAEUA
Check out this DIY Artificial Pancreas!
#wearenotwaiting
#diyps

To advocate as a community for
individuals with diabetes

http://goo.gl/p4hJQt
Check out this blogpost
about #wearenotwaiting

To connect our patients and
families with online communities

“Social media has saved lives in the
diabetes community. It has helped people
who are struggling with their diabetes to
take control and improve their health. It
shows people that there isn’t such a thing
as a “perfect diabetic,” but there can be
an educated and determined one.”
-Kerri Sparling
@sixuntilme

Run by Diabetes Community Advocacy
Foundation

Mobile technology & social media
are changing the paradigm of
who, what, and how health information
is communicated

#theoldmedicine
In clinic, Provider to Patient,
Off-line, 9-5 PM Weekdays only

#thenewmedicine
Outside of clinic, Patient to Patient,
Online, and 24-7

“Someone recently asked me to name the most
exciting innovation in health care today. I think
he was hoping for a sexy technology tip, like an
app that’s catching fire in the expert patient
communities I follow.
Nope.
I’ve said it before and I’ll say it again: the most
exciting innovation of the connected health era
is…people talking with each other.”
http://goo.gl/bu7eOv

Thanks to the students for
doing the homework!
Some got rid of their eggheads!
http://goo.gl/EvzHex

Thanks to:
The Diabetes Online Community
Dr. Klonoff
Healthdesignby.us
Mott Mobile Technology for Enhancing Child Health
I love twitter
Follow me there: @joyclee
http://www.doctorasdesigner.com/

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