Well … some of them are no longer in business (e.g., polka), and the remaining have, for most part re-focused on the “enterprise software” model (e.g. Keas, TheCarrot, and several others). The “enterprise model” is to white label the product to insurance carriers or employer payers as wellness modules. But that begs the question: if a product cannot get consumer traction on it’s own, why would payers want to white label it? The key to effective corporate wellness programs is a high level of employee participation. It is true that some carefully designed wellness programs saved money (like Safeway), but for most companies, it is just something that comes bundled with health insurance, which they have to buy. For a lot of payers / employers we talked to, wellness is just window dressing. In fact, only around 10% of employers even bother to measure the ROI of their existing wellness programs. So, why would they pay extra money to get another solution that probably would not work?

So, why are wellness programs largely ineffective? That is because they are tackling a very hard problem: Human Behavior Change.

Behavior change is the billion dollar question in healthcare, and is the basic value proposition for most consumer healthcare / wellness products. So far, no one has even come close to solve it. Last year’s health 2.0 companies were hot on ODL (Observation of Daily Living) and patient journals. But truth to be told, people who have the will power to keep a food journal probably already live pretty healthy. In Health 2.0, people like to talk that they want to be the mint.com of health information. Yet, mint.com has not demonstrated that it can change people’s behavior when it comes to financial decisions. It just happens to be a company that had a good exit. Information (user generated or provider generated) + analytics alone do not seem to provide the magic formula for changing consumer behavior in either health or financial sectors.

In this year’s Health 2.0, the hot approach is to drive change via social games and high definition video “coaching”. Again, most companies in those two spaces are looking to sell to “corporate wellness programs”. I actually do like the social game angle, and some preliminary research has shown that it might work. But the jury is still out. Ringful is innovating with other companies in this space. We will have a more definitely answer next year.

At Ringful, our approach is to work with existing healthcare providers to support better decision making on the parts of both patients and physicians. We incorporate evidence-based guidelines, and put the doctor inside the feedback loop. We believe that this is an effective approach (Well, Keas sort of experimented with this as well. But I do not believe they have gone far enough). Indeed, a recent PwC survey indicates 40% Americans are interested in paying for personal healthcare applications to communicate with their doctors. (Chilmark Research has an excellent writeup on this survey).

So, if you are a physician or hospital, we’d love to partner with you to make our personal healthcare apps work for your patients and for your practice!

We demonstrated the applications today at the Health 2.0 conference, and it was well received. Go download your FREE copy by searching “pain care” on the iOS App Store or Android Marketplace today!

Speaking of Health 2.0: Tim O’Reilly said in his opening keynote that Health 2.0 is about making sense of data, in particular, real time and personalized data to make better choices. That requires big picture thinking to collect data, connect data, and design new analytics / predictive algorithms. That is exactly what Ringful has been doing with our patient-centered and evidence-based solutions. Stay tuned!

The winning application is a collaborative effort between Ringful Health, Dr. Vishal Kancherla of the North Austin Medical Center, and the Louise H. Batz Patient Safety Foundation. By having practicing pain management physician and patient safety experts on the team, we have developed an application that benefits patients and physicians alike.

An early version of the Pain Care application is already available on the iPhone App Store. An update and the Android version of the app will soon follow next week.

Pain Care is a consumer mobile application that helps chronic pain patients to better manage their symptoms, medications, and better communicate with their physicians. It is based on one of the video scenarios in Project HealthDesign. Building on the HealthDesign story board, we work with pain management specialist Dr. Vishal Kancherla to enhance the design to include decision support analytics that are integral to physician’s workflows.

So, why do we choose pain management? According to the National Institutes of Health, pain is one of our most important national health problems, costing the American public more than $100 billion each year in health care, compensation and litigation. Pain management is also plagued by substance abuse, overdosing, and medical errors. Yet, a recent study (1) shows that many patients receive insufficient pain management. There is clearly something wrong here, but what is it? Can technology help?

Well, as it turns out, pain management is one of the therapeutic areas that really need personalized medicine. According to a study (2), today’s prescription pain medications are only 80% effective. People have different lifestyles, environments, and even genetic makeups. The one-size-fit-all solution does not work well for pain treatments.

In our view, a key aspect of a better and more cost effective pain management solution is to provide better information for physicians and patients to help personalize the treatment options for the most efficacy. That is exactly what our Pain Care application does.

At its core, the Pain Care application is an electronic pain journal for patients. Pain journals are well established tools to help patients manage chronic pain. Many studies have shown that electronic journals far outperform paper journals in both response rate and accuracy (3). In the pain care application, the patient report pain episodes, triggers, and medications. It then correlates all those data to give the patient insight into exactly what causes the pain and what medication / therapy is effective.

With PHR integration, the patient can share data with physicians. Our application provides an automatic natural language summary of the patient history together with analytics charts — they are all designed to fit into pain specialists’ existing decision making workflow, and make it easier for the doctors to come up with personalized treatment options.

We look forward to your feedback. If you are a healthcare provider or insurer in the pain management space, we’d also love to explore opportunities for us to work together!

References

1. American Society for Therapeutic Radiology and Oncology (2008, September 10). Many Cancer Patients Receive Insufficient Pain Management Therapy. ScienceDaily. Retrieved September 9, 2010, from http://www.sciencedaily.com/releases/2008/09/080909122753.htm

2. Brian B. Spear, Margo Heath-Chiozzi and Jeffrey Huff. Clinical application of pharmacogenetics. Trends in Molecular Medicine Volume 7, Issue 5, 1 May 2001, Pages 201-204

3. Tonya M Palermo, Duaré Valenzuela, Paul P Stork. A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability. Pain. Vol 107, Issue 3, Pages 213-219 (February 2004)

“This is very cool. But most of our patients are old and sick, will they use those hip smartphone apps?”

To answer this, our CMO Dr. Shaw and Texas State University professor Dr. Ju Long graciously helped us run a patient survey. The research survey is rather long, but here are some enlightening findings.

Of 163 patients we surveyed, the median age is 62 years old — yes, we specifically targeted a clinic with older patients in town, but that has made our findings all the more remarkable. A full 56% of those patients have smartphones (iPhone, BlackBerry, Android, Windows Mobile)! The median age for those smartphone toting patients is 56.

77% of all patients see the need to keep personal health records. In fact, 56% already use some basic form of PHRs — most of them (53%) just keep the records in a paper folder, and only 4% currently use computerized records. This crowd is ready for some technology empowerment!

Among smartphone users, 54% of patients want to use their smartphones to keep track of medical records, and 5% are willing to pay for such services on a subscription basis.

As we identified at Ringful Health, a powerful use case for smartphone-based healthcare applications is for the patient to keep a daily journal of treatments and outcomes. Examples include Ringful Health’s Pain Manager, Healthy Heart, Asthma Journal, and Pollen Journal applications. So, we asked the patients whether they would keep a medical journal if their doctor asks for it. The answer is that 87% patients, both in the general population and among smartphone users, would at least try to keep the journals. That is great hope for mobile application providers in this field!

Not surprisingly, smartphone users are pretty internet savvy, with 81% of them have searched for healthcare / medical issues online. But at the same time, only about 10% engage in online forums or discussion boards for healthcare issues — highlighting the private nature of healthcare information.

In addition, we found that 74% of patients would like to consult with doctors on the phone. But the majority of them, 61%, would only do so if it is paid by their insurance company. This outlines the challenges of tele-health — a system wide change is needed for tele-health solutions to reach their full potentials in terms of cost saving and improved outcomes.

I have been playing with it since this afternoon. After 5 hours of heavy use (video games, and streaming full length TV shows), the battery still has 62% remaining. I am extremely impressed so far! The games (racing / driving, board, and first person shooter games in particular) are simply stunning. And news / media apps from ABC and New York Times are very well done. While all iPhone apps run on the iPad, it has become obvious to me that apps specifically designed for the iPad gonna add so much value that people will happily pay for them again. It is the same force that drive people to iPhone apps from mobile web sites. In fact, I have already spent more than $30 on iPad apps and deleted most of the iPhone-only apps from my device.

While the iPad is positioned as a media consumption device, it is launched with over 100 medical and healthcare apps. From what I can see, the medical education apps for medical students and physicians are bigger winners since they can really take advantage of the larger screen and new UI to present information much more effectively than before. I think that EMR apps should also benefit tremendously as those apps are quite information intensive with a lot of data input fields in each screen.

On the consumer / personal healthcare side, most apps today are also educational in nature. After all, iPhone’s ubiquity and smaller screen is probably more fitting for simpler “tracker” tools. However, I do see great potentials for more sophisticated personal health records / assessment tools on the iPad. Instead of layers of navigation screens to drill down to a specific lab or family history item, we can now present information in a much more concise fashion.

Furthermore, at Ringful Health, we thrive to provide trackers that actually give actionable intelligence back to the users and their physicians. For those apps (e.g. Pain Manager and Healthy Heart), it is often important to track symptoms, medications, and lab results separately, and then see their correlations in the analytics reports. I believe that the iPad provides a great platform to present this information more effectively.

As Ringful works on our new generation of personal health record apps, we will certainly be targeting the iPad specific optimizations as well as our existing portfolio of iPhone, Blackberry, and Android devices! Stay tuned!

see video

Through our innovative approach to reducing medical costs for employers, while improving employee health and wellness, we are on a short list of Wellness vendors promoted directly by NAHU.

Expect to see Ringful Health participate in a number of Wellness
initiatives spearheaded by NAHU in 2010. We are grateful to Janet
Trautwein and Illana Maze for inviting us to work jointly on improving
healthcare:

“We always appreciate great partners such as Ringful Health to be able to offer resources to our members”

Illana Maze, Sr. Vice President of
Marketing & Development, NAHU

But for mobile app developers, BlackBerry brings back the old nightmare of “device fragmentation”, which, by the way, is happening to Android as well. There are many BlackBerry device models and OS versions, each supporting different screen sizes, hardware accessories (eg camera, GPS), API availability, input methods etc etc. That forces developers to either go to lowest common denominator with bare bone apps that run on all devices, or release a different version of the app for each device.

So, while we are working on BlackBerry versions of our apps, we are really interested in finding out where the “common denominator” is. Is it sufficient for us to target BlackBerry OS 4.6 and above? Or, do we really need to go all the way to OS 4.2 or even OS 4.0? Do we need to release a seperate app for touch screen BlackBerry devices? Can we rely on the BlackBerry AppWorld to distribute our app?

If you are a BlackBerry user, please help out by answering a few quick questions. I think the statistics will help all developers understand the BlackBerry landscape and eventually lead to better apps on BlackBerry.

If you know published statistics of the questions, please leave a comment to this blog entry. Thanks!

Thanks!

The article features two color photos of Ringful products, a user story from our Asthma Journal, and a direct quote from yours truly:

“The basic idea is to help users change their behavior with more transparency and information,” says Michael Yuan, Ringful’s chief executive.

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When I’m looking for a hospital (which isn’t all that often), my iPhone isn’t the first place I look, or the second, but mobile health startup Ringful wants to change that.

For apps like that, a constant question is indeed “why do it on the mobile phone when you can do it on a PC?” Well, the use case I came up with is for the patient to look at hospital reputations while sitting in the primary care doctor’s office waiting for the doctor to write up the referral. If you wait until you go home to research the hospital and found it is not good, you might have to make second trip to your primary care doctor office to change the referral.

What I did not expect is that healthcare providers themselves might also find the application useful. One of our users just left this comment on the app store review section:

As an EMT I like it a lot. I often get patients that refused to be transported to a specific hospital because of what they believe to be substandard level of care. Now I can compare hospitals to see how others feel about them.

Very cool. Savings lives one app at a time!

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(Thanks to Daily Lounge for producing the TV segment)

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