The Right to Bear Arms and the Right to Bear...Candy Bars?!

A bill to come before panel members is H. 3297, an effort to curb obesity rates in children. The bill would restrict snacks sold in K-12 schools to 200 calories with less than 35 percent of their calories from fat and 35 percent of their weight from sugar. Treats sold as part of fundraising events would be exempt.

From: "Legislators aim to curb childhood obesity rates | The Augusta Chronicle."

State senators in Columbia, South Carolina are examining whether or not they will legislate what snacks can be sold in state schools.

Fascinating. Won't this also restrict the schools potential share in revenues in vending machine sales? Wonder how that will affect the state schools' facilities budgets, if at all?

There *are* companies that focus on healthy vending machine food, however, not sure how budget conscious they are...

Back to the same old conundrum when looking at incentivizing healthier behaviors by altering supply rather than working on the much-harder-to-pin demand. Who pays for this legislation? What choices does it impact?

I'd like to see the return of recess as a built in hourly part of kids' days nationwide in addition to restricting what they can buy out of a machine on school grounds, especially since we aren't *yet legislating what they can grab for free from cabinets at home...


Posted via web from Jen's Posterous

Social Contagion and the COMPASS Program

The focus will really be on connections with others who have healthful eating habits and activity patterns in their own communities – neighborhoods, schools and home,” Wilfley said.

Nifty. Worth a read. See especially the portion at the bottom where study participant Allen talks about her behavior changes after having "no discipline."

Posted via web from Jen's Posterous

What's New in iPhone OS: iPhone OS 3.2

Applications running on iPad have several new options for presenting content and receiving input from the user. For information and guidelines about how to use these new features, be sure to consult iPad Human Interface Guidelines.


Popovers are floating views that reside above your application’s window and help you organize the contents of your user interface. Popovers help to eliminate the clutter that might occur in applications that need to display important controls or information in an unobtrusive way that does not distract from the main content.

The benefit of using a popover is that:

  • It appears only in response to specific user interactions and is dismissed automatically when the user taps outside of its bounds. This behavior makes the popover less obtrusive to the user.

  • It typically covers only a small portion of the screen and so does not obscure as much of the underlying content as a modal view might.

For more information about using popovers in your application, see Views and View Controllers in iPad Programming Guide.

Split Views

The UISplitViewController class is a new container view controller that you use to manage two side-by-side content views. These content views are typically used to create a master-detail interface, whereby selecting an item in one view causes the other view to display detailed information about the selection. The views themselves are managed by view controllers that you provide.

The split view controller coordinates any interactions between your view controllers and the system. For example, when the user rotates the device, the split view controller rotates both view controllers together, forwarding any needed notifications to both of them.

For more information about split views, including how to use them in your applications, see Views and View Controllers in iPad Programming Guide.

Custom Input Views

Instances of the UIResponder class now support the ability to display custom input and accessory views when they become the first responder. Now, you can provide input views for any of your custom views and have them presented automatically by the system. (Previously, the keyboard was the only supported input view, and it was supported only by text view and text field objects.)

In addition to input views, you can also provide a custom accessory view to display above the input view. Accessory views are commonly used to provide additional buttons and controls when the keyboard is displayed. The explicit support now provided by responder objects makes it easy to animate your accessory views into position.

For more information about how to configure and use custom input and accessory views, see Custom Text Processing and Input in iPad Programming Guide and the UIResponder Class Reference.

External Display Support

An iPad can be connected to an external display through a set of supported cables. When connected, the associated screen can be used by the application to display content. Information about the screen, including its supported resolutions, is accessible through the interfaces of the UIKit framework. You also use that framework to associate your application’s windows with one screen or another.

  • The UIScreen class provides support for retrieving screen objects for all available screens (including the device’s main screen). Each screen object contains information about the properties of the screen itself, including the dimensions that correctly take into account the size and pixel aspect ratio of the screen.

  • The UIScreenMode class provides information about one particular size and pixel aspect ratio setting of a screen.

  • Windows (represented by the UIWindow class) can now be assigned to a specific screen.

For more information about the support offered by these classes, see the individual class descriptions in UIKit Framework Reference.

Gesture Recognizers

Gesture recognizers are objects that you attach to views and use to detect common types of gestures. After attaching it to your view, you tell it what action you want performed when the gesture occurs. The gesture recognizer object then tracks the raw events and applies the system-defined heuristics for what the given gesture should be. Prior to gesture recognizers, the process for detecting a gesture involved tracking the raw stream of touch events coming to your view and applying potentially complicated heuristics to determine whether the events represented the given gesture.

UIKit now includes a UIGestureRecognizer class that defines the basic behavior for all gesture recognizers. You can define your own custom gesture recognizer subclasses or use one of the system-supplied subclasses to handle any of the following standard gestures:

  • Tapping (any number of taps)

  • Pinching in and out (for zooming)

  • Panning or dragging

  • Swiping (in any direction)

  • Rotating (fingers moving in opposite directions)

  • Long presses

For more information about using gesture recognizers in your application, see Gesture Recognizers in iPad Programming Guide.

Improved Text Support

In iPhone OS 3.2, there is significant new support for text input and rendering. This support is provided for applications, such as word processors, that need more sophisticated text-handling capabilities.

Core Text

The Core Text framework (CoreText.framework) contains a set of simple, high-performance C-based interfaces for laying out text and handling fonts. The Core Text framework provides a complete text layout engine that you can use to manage the placement of text on the screen. The text you manage can also be styled with different fonts and rendering attributes.

This framework is intended for use by applications that require sophisticated text handling capabilities, such as word processing applications. If your application requires only simple text input and display, you should continue to use the existing classes of the UIKit framework.

For more information about using the Core Text interfaces, see Core Text Programming Guide and Core Text Reference Collection.

Text Input Support

The UIKit framework (UIKit.framework) includes new protocols that allow you to implement custom text-input objects. If you are implementing an application that requires sophisticated text-handling capabilities, you can use these protocols to implement new views and controls for receiving incoming text. Depending on your needs, there are different protocols for receiving text input. Which protocols you use will depend on the complexity of your user interface.

  • The UIKeyInput protocol lets you define simple objects (like text fields) that are capable of character-by-character input.

  • The UITextInput protocol lets you define complex text views that support multiple lines of text, selections, pasteboard operations, and more.

For more information about how to use the text input support to implement your own custom objects, see Custom Text Processing and Input in iPad Programming Guide.

Custom Font Support

Applications that want to use custom fonts can now include those fonts in their application bundle and register those fonts with the system by including the UIAppFonts key in their Info.plist file. The value of this key is an array of strings identifying the font files in the application’s bundle. When the system sees the key, it loads the specified fonts and makes them available to the application.

For more information about the keys you can include in your application’s Info.plist file, see Information Property List Key Reference.

ICU Regular-Expression Support

The BSD layer of iPhone OS now exposes a modified version of 4.2 of the International Components for Unicode (ICU) libraries. ICU is an open-source project for Unicode support and software internationalization. The installed version of ICU includes only those header files necessary to support regular expressions.

For more information about using the functions of the ICU 4.2 library, see the documentation and user guide at http://icu-project.org/apiref/icu4c/index.html.

File and Document Support

In iPhone OS 3.2, there is new support for exchanging and opening files. This support makes it easier to implement more document-centric applications, similar to what you might find on a desktop computer, while still maintaining a simplified interface for your users.

File-Sharing Support

Applications that want to share files with the user can now do so using the file-sharing support in iPhone OS 3.2. Here’s how it works:

  1. An application indicates that it wants to share files by including the UIFileSharingEnabled key in its Info.plist file.

  2. It puts whatever files it wants to share in its Documents/Shared directory.

  3. When the device is plugged into the user’s computer, a mount point is added to the system and the contents of any shared directories appear on the user’s desktop.

  4. Users can modify the contents of this directory freely by copying files out, deleting files, or dragging new files in.

Applications that support file sharing should recognize when files have been added to the directory or removed and respond appropriately. For example, if the user added files to the directory, your iPad application might make those files available from its interface. You should never expect the user to go searching for files in this directory, nor should your application rely on any files being in this directory. It is strictly for sharing files with the user’s computer.

For detailed information about how to support file sharing in your own applications, see The Core Application in iPad Programming Guide

Document Support

An application can now register the file types it supports with the system and receive notifications when a file of the given type needs to be opened. It does this by including the CFBundleDocumentTypes key in its Info.plist file. An application that registers one or more file types may also be expected to open files of those types at some point later. It does this by implementing the application:didFinishLaunchingWithOptions: method in its application delegate and look for a file in the UIApplicationLaunchOptionsURLKey key of the provided dictionary.

Complimenting the ability to open files of known types is the addition of the UIDocumentInteractionController class in the UIKit framework. This class provides a user-based interaction model for managing files that your application does not know how to open. The document interaction controller provides options for previewing the contents of a file in place or opening it in another application. Document interaction controllers are particularly useful for email applications or applications that may download files from the network.

For more information about supporting documents, see The Core Application in iPad Programming Guide.

PDF Generation

The UIKit framework (UIKit.framework) includes new functions for generating PDF files and data objects from your application’s custom content. You can use this support to generate PDF-based content for use within your application or for storing to the local disk. The UIKit functions manage the setup and pagination for the PDF data. You provide the actual content using the same native platform graphics technologies (UIKit, Core Graphics, Core Text, and so on) already available for drawing to the screen. (You cannot draw to a PDF context directly using OpenGL commands. However, you can transfer the pixels of your rendered content to a CGImageRef data type and draw that.)

For more information about how to use the new UIKit functions to create PDF content, see Graphics and Drawing in iPad Programming Guide.

Xcode Tools

Xcode includes new features to make developing applications that run on iPad much simpler, including the following:

  • Xcode simplifies the process of sharing code between your iPhone and iPad applications by helping you update your existing iPhone projects to include the necessary files to support iPad. The Transition command (in the Project menu) creates a new target for the iPad and modifies a copy of your project’s nib files to support the larger screen size. For more information on how to use this command, see iPad Programming Guide.

  • Xcode simplifies the validation and submission process of your applications by allowing you to debug signed applications.

  • You can now easily transfer your iPhone developer identity information to a new computer. The Organizer window includes an option to export your profile and certificate information. To begin developing on a new computer, all you have to do is import the resulting data file into Xcode on that computer.

  • Interface Builder supports the new view controllers and window sizes available for iPad.

API Changes

The following frameworks and technologies include additional incremental changes.

UIKit Framework Changes

The UIKit framework includes the following additions:

Media Player Framework Changes

The video classes in the Media Player framework (MediaPlayer.framework) have been redesigned to give you more control over the presentation of video content. Instead of simply playing a video full screen, the MPMoviePlayerController class now vends a view that you can incorporate into your interface however you want. This class also includes more sophisticated support for managing and controlling the playback of movies.

For situations where you want a simpler alternative to movie presentation, you can now use the MPMoviePlayerViewController class. This new class provides a view controller-based wrapper for a movie interface and is for applications that want the same basic behavior offered by the older movie player controller design.

For information about the new classes available in this framework, see Media Player Framework Reference.

Core Animation Changes

The Core Animation technology (defined in QuartzCore.framework) includes the following additional features:

MapKit Framework Changes

The MKReverseGeocoder class now includes a placemark property for accessing the placemark that was computed by the reverse geocoding service. You can use this property to retrieve placemark information after the results are reported to the associated delegate object.

Foundation Framework Changes

The NSString class now includes the ability to search the text of a string using regular expressions. The NSStringCompareOptions type includes a new flag called NSRegularExpressionSearch, which you can use in conjunction with the following methods:

When you pass the NSRegularExpressionSearch as an option, the search string is interpreted as a regular expression instead of a string literal. The regular expression syntax conforms to the syntax used by the International Components for Unicode (ICU) library. When performing regular expression searches, the only other options you can include in the mask parameter are the NSCaseInsensitiveSearch and the NSAnchoredSearch flags.

Because some regular expressions can trigger a match but still return a zero-length range, you should check both the location and range length of the result. If a match was unsuccessful, the search methods always return a range whose location is set to NSNotFound and whose length is 0.

For more information about the NSString class and its methods, see NSString Class Reference. For more information about regular expressions in the ICU library, go to http://site.icu-project.org/.

Last updated: 2010-01-22

For those of you without dev accounts...take a peek.

The placeholder for geolocation is particularly interesting...as is the warning in new Apple developer agreement that location data may not be secure.

Posted via web from Jen's Posterous

Highway to Hell, or Health? En Deutschland Microsoft HealthVault + Siemens to Hold Sway

According to those interviewed in Germany, the Connector program, despite enormous sums spent (estimates put it at ~$2.25B) was doomed from the start as it was “politically not doable” due to its top-down strategy (sounds like the NHIN), inability to move rapidly in response to market changes and extreme reluctance of physicians to support open transparency and exchange of patient records across Connector.  Similar to the US (challenges RHIOs face), German physicians fear data liquidity of PHI may lead to loss of control of the relationship (he/she who owns the data, owns the relationship) and subsequently, potential loss of business.

In Germany, all citizens have a right to obtain copies of their medical records and most payers provide incentives to physicians to encourage them to provide records to their patients.  In practice, however, the German software companies Chilmark interviewed universally stated that most consumers do not bother asking for their records and due to the aforementioned issues/concerns regarding transparency, few physicians encourage it.  Therefore, Germany also shares with the US a PHR market today that is very immature and requiring a significant amount of consumer education and physician adoption/engagement.  Siemens has a long road ahead.

From "Update: Siemens Brings HealthVault to Europe « Chilmark Research."

Posted via web from Jen's Posterous


Group Therapy - TIME

The next logical step? Teach patients to be better scientists.

From an excellent article: "Group Therapy - TIME."

Big high five to Gilles of ACOR, @ePatientDave, and Jamie of Patientslikeme.com.

Great job guys, and great article TIME. Patients 2.0? ePatients? Whatever we call it, it seems to be working...

But will people who are sometimes (not often) patients take the same level of personal responsibility for knowledge generation and care coordination? I hope so. I think the "if we build it, they will come" rule applies here, now more than ever.

Amateur scientists we may be, but ePatients are sharing and testing hypotheses about what works for specific conditions in a personal-medicine context.

The question is whether or not the clinical environment will take Patients 2.0 seriously, and realize what an underutilized resource they've got at hand.

I sure hope they do. For their sake, and ours.

Posted via web from Jen's Posterous

Hacking Healthy Activity Rewards + Data Self Entry, Contagion-Style

""We have become very good at engineering physical activity out of our lives, and the price of this is staggering" says Richard J. Jackson, a professor at the University of California Los Angeles School of Public Health, who considers stair-climbing a superior and cheaper alternative to a gym membership.""

This quote is from "If You Build It, They Will Walk: Re-engineering slowness back into building design," in the most recent issue of GOOD Magazine (p.43). 

We're on the right track with rebuilding more ways to move into the physical and architectural infrastructures in our lives, but it's an expensive proposition to redesign a room, a building, or a city block to encourage folks to engage in more movement. 

Here at Contagion Health, we don't believe you even need stairs to re-engineer your life to fit in more physical activity; you just need some motivation.

Turns out using your existing relationships to re-engineer more physical activity into your life actually works: a challenge from friends, not equipment (or the lack thereof), may be the best way to incentivize you (and me!) to move more. 

Current 'disease' and wellness management companies may be in danger of making the same mistake patriarchal medicine has made: assuming they know best what motivates the individual to make a healthier choice.

The incentives they offer us to complete surveys, enter personal biometric data, or fill out a 'health assessment form' appear in our email inboxes with titles like "Win a $10 Starbucks gift card!" or "

We think, quite frankly, that's a load of bull.

Some of us respond well to hierarchy. This means our docs tell us what to do, and because they're docs, we'll do it. We also may work in bigger companies with clearly defined role and responsibility matrices, and we like being told what to do.

Some of us respond well to anarchy. This means when the chips are *really* down, we respond proactively, organizing our own information and medical records. This may surprise people who know us and think we're too abstract to focus. We may work in startups, or as consultants, and we hate being told what to do. 

Most of us are probably somewhere in between. The main point here is that people are different. And what motivates different people to do different things is very different.

Sometimes seeing the contagious spread of your actions or opinions on a map motivates us...check out the mentions of #getupandmove on Humana's TPS Report here: http://crumpleitup.com/tps/searches/show/4999.>

While that makes me want to complete a challenge, it might not make you want to complete one. And therein lies the rub...

We think it's the worst kind of hubris for a personal health applications company trumpeting a 'patient focus' to preset incentives for patients. 

Who's gonna know what motivates me? My friends and family. They will know I don't care about being Mayor of something on Foursquare, or about leader board stats, but that I like to know where they are and read "tips" about the places they go every day. 

Most of us lead pretty stable, white-bread lives. Even if the data about our lives shows we go the same places, eat similar foods, make similar purchases, and tend to not like to take prescription medications, what motivates us to do something doesn't remain static.

Life circumstances, changes in jobs, relationships, all of these things mean that sometimes the $5 an employer wellness program like Accolade, run by MediKeeper, may actually motivate me to click through a custom, employer-designed survey, but sometimes it won't.

Reason? Maybe I'm too busy. Maybe I can't remember my employer email or login info. Maybe it doesn't do much for me and the survey is too long. Maybe I'm chatting with a friend or updating my blog so I hit delete instead.

If a personal health applications company built something that would let my coworkers, friends or family motivate me to fill out that survey and get an incentive that's personally relevant to me (and contextually relevant to the relationship, say they get $5 too) chances are I'd do it AND they'd do it. 

Example: Contagion Health builds an employer wellness program based on the Getupandmove.me platform for a small San Francisco YCombinator startup.

The startup is launching a huge new app, guerilla marketing style, at SXSW 2010. We create a few preset options for challenges like "Wear a company logo tattoo on forehead and do 5 jumping jacks" or "Ask biggest web celeb you can find what their most embarrassing moment was and then turn in 5 circles" or "Do 10 cartwheels down the convention center hallways daily, while you film with a Flipvideo camera."

But the most interesting challenges happen when the employees can create custom challenges. I'll give a scenario...

Let's say I know a coworker at this startup (or the founder even) is going to attend SXSWs music festival for the first time, and that they're trying to find new musicians to see. I can offer to do 15 pushups and send them an iTunes gift certificate to download "The Straight and Narrow" by Canadian group "The Deep Dark Woods" if they'll run from the CalTrain next Friday. 

We don't know if this will work, but we're betting you have a more realistic idea of the flavor of incentives your friends and family will respond to.

Our goal is to code things that let you do that - without fancy equipment, or space-age 'slow' staircases - and get out of your way. 

Designing for movement matters. The good news is that we aren't limited to physical user interfaces to make that happen. 


Happy trails-



PS - Yeah. We will be doing some crazy #getupandmove challenges at SXSW.

If you'll be there, shoot me a mail: jensmccabe@contagionhealth.com. GUAM street team volunteers will get swag, YouTube infamy, and some seriously small calorie burns. 


Posted via web from Get Up and Move!


Early "Redefining Patienthood" Research...Your Biases, Whatever They Are (Patient, Provider), Are Probably Wrong

Check out this website I found at docs.google.com

From semantic analysis (messy) layered over work with the Health Strategy Innovation Cell, which was brave enough to take me on as an experiential Kisaut Fellow this year ( Kisaut means "anchor" in Inuit lingo, for those who know about the 'hit' point of my patient narrative) .

Much more to come.

Posted via web from Jen's Posterous

Getupandmove.me: All Up in Ur Facebooks Messin' with Ur Microchoices!!!

From @tgoetz's "The Decision Tree: How Smarter Choices Lead to Better Health | Magazine."

Today we're live with Getupandmove.me version 3.0, which brings Facebook to the microhealth challenge party.

Now you can choose to challenge your friends+family on Twitter, Facebook, or both. Just wait til we go all SMS on yer mobilz...

Basic overview of the changed user experience:

1. If you're a current guammie, we'll ask you to choose to sign in with Twitter or Facebook. We'd like to suggest you choose the social networking site you use most often.

2. Next you'll be prompted to 'merge' your accounts. You won't notice too much difference in what you see after that...

3. Then you should become a fan of the Get Up and Move Facebook page here to talk about challenges, tell us what you think we should build, etc.

Getupandmove.me is about taking your social inputs, making the process fun, and giving you a way to motivate others to make a teensy weensy healthy decision, with an end result you can both feel good about.

The only decision more dangerous than an unhealthy one is the one you don't think about before making.

The good news is you don't have to make those kinds of healthy decisions alone anymore.

See you on the Facebook!

Posted via web from Jen's Posterous

Why Getupandmove.me Works: Built for Competition and, More Importantly, To Make Moving Fun

Those who value excellence and hard work generally do better than others on specific tasks when they are reminded of those values. But when a task is presented as fun, researchers report in a new study, the same individuals often do worse than those who are less motivated to achieve.

From research published in Journal of Personality and Social Psychology, reviewed on @PhysOrg: "Those less motivated to achieve will excel on tasks seen as fun."

High achievers were not the folks we had in mind when we designed #getupandmove.

Nope, to be quite frank, we were thinking of couch potatoes (or more accurately in our cases) computer chair couch potatoes who like fun interesting things but are easily bored by routine.

This means we built for people like us - not thinking we'd also attract interest from regular runners who 'level up' and use hyperactive sites like Skimble, RunThere, DailyMile, Nike+, and Livestrong.

But, amazingly, these A players showed up and started moving. And lo and behold, they started getting others to move with them.

In the GUAM movement ecosystem we have found these folks to be some of our most active challengers.

Contrary to some recent research (http://www.physorg.com/news183125915.html) the most 'empathic' and sensitive of our "Type A" superusers also seem to be naturally *modifying* their challenges to appear fun to those who are not freaky about working out for 2 hours a day.

After all, most of us using getupandmove.me *KNOW* the people we are challenging (within 3 degrees of separation).

The beautiful thing about a getupandmove.me challenge is each user brings to the platform two intrinsic motivators: Their existing and desired level of fitness and their existing and desired level of fun.

The unconstrained nature of the way we designed the unscripted challenge format makes both users take responsibility for their actions, but ALSO for their motivations.

This means when 'confronted' with a GUAM challenge, each user just naturally thinks about what motivates them to move, whether it's a fun-seeking, social reward sourcing, or competitive mindset. And then they seem to tap on their existing mental model to get the challenge done.

We then combine that with extrinsic social motivators that enable users to tap into the motivational forces of friends and family - relationships, after all, may be the best Rx for preventive health...are communities and tribes nature's perfect medicine? And can we 'design' personalized medicine using social networks as the drug delivery system of choice?

I think we can. I think we are.

But what I think doesn't matter so much. YOU are our Darwins. Follow us on Facebook to find out how we're doing and help shape the next evolutionary versions of getupandmove.me.

We're babes in the woods of behavioral economics. And while getupandmove.me originated as a simple game, I'm finding one thing constant - fun+social works as a formula for encouraging healthier individual behaviors. For me, for my family, for my cofounder, for my friends, and I hope for you.

Now excuse me - speaking of fun, I have some pole kicks to deliver...:)

Posted via web from Get Up and Move!

No, This is Not My Halloween Costume. She is A Nerdcore Learning Tool for Med Students. Seriously.

The brilliant crew at Nerdcore Learning is launching a very special fantasy game, called "The Healing Blade," to help hardcore geeky med students learn about safe antibiotic use.

That's right. This art has a purpose.

And it's probably not the one you're thinking. (Ladies, there are some nifty male characters too. The Nerdcore gang, while unfortunately burdened with an excess of XY gametes, didn't forget about us entirely).

Think WoW or 'Magik: The Gathering' for docs. Nerdcore's Health Blade card game will be launching March 11th at AMSA.

Since I'll be hitting the streets of #sxsw that day with @shazow @limedaring @oldbailey @edbennett and #getupandmove, I figured I'd start blowing your minds *now* about the future of 'gaming for health.'

Hint: It ain't always about helping the PATIENTS learn!

Another Hint: It ain't always about going with an mHealth app first.

If you're headed to that mecca of medical socializing AMSA (*cough cough* my TEDMED friends, @beccacamp et. al.) visit the Nerdcore crew at Booth 1.

I got a sneak preview of the game last night and the art, attention to symbolic detail, and back narrative are gonna give Cameron's Avatar a run for its money, especially given the fact that this game was built by 2 docs (one Hopkins, one 'recovering' HIT guru and an Ozzie med student programming wizard).

In their words: "We’re a publishing start-up devoted to developing unique study-aids for medical students. The best part is that a portion of the proceeds from Nerdcore Learning go to support a charity that we helped establish called the HOPEConnectsKIDS Research Initiative."

I have a feeling my new friends at the NBME (holler @ambermontanano @r0wsbud and @jillianketterer) should check this out. FYI yo!

To say these guys are doing amazing things in a hidebound system doesn't even *begin* to cover the constraints they're breaking out of to build this kind of thing.

You should follow them on Twitter:
Hon = @dr1337
Francis = @MedSimple
Arun = @arunmathewsmd

And you should check out their Board Review Medical Mnemonics iPhone app ($1.99) in the iTunes App Store.

This little vixen, by the way, is Ceftriazone. She is broad-spectrum, isn't she? :)

Posted via web from Jen's Posterous


Biggest Challenge for mHealth App Makers? Getting a Place to Test the Damn Things...

In an emerging industry like mobile healthcare, the more data demonstrating the efficacy of technology, the better. MedApps, maker of remote patient monitoring devices, will be collecting such data on patients with congestive heart failure in an attempt to show that daily monitoring of discharged patients can reduce readmission rates and ER utilization.

Scottsdale, Ariz.-based MedApps will test its HealthPAL wireless EMR connectivity tool and web-based HealthCOM portal on CHF patients discharged from Meridian Health hospitals in New Jersey as part of a disease management pilot. The systems will monitor patient vital signs and symptoms immediately after discharge and, the company says, provide patient-specific education and support. The devices also should be able to help Meridian care managers identify complications and symptoms so patients can get the necessary outpatient care before the problem develops into something requiring hospital admission.

From: "MedApps to test remote monitoring of CHF patients - FierceMobileHealthcare."

Your greatest challenge as an mHealth developer is probably *not* development - at least not of the coding variety.

It's getting in the door to talk to clinical and academic organizations that are looking to partner and pilot these devices in a patient care setting.

Think about this earlier rather than later and begin to connect with these folks where they live, work and breathe.

Clue - it ain't hackathons.

Posted via web from Jen's Posterous

Four Common Models of Innovation - For Each Healthcare Social Media Strategy Know Which One You're Targeting

There are four common models of innovation diffusion: pure inertia (a constant percentage of those who haven’t adopted adopt in each period), social influence (common in sociology, where consumers adopt based on the percentage of other consumers who have adopted), contagion (common in marketing research, where consumers adopt after coming into contact with information about the good), and social learning (common in economics, where consumers adopt after Bayesian learning about the true utility of the innovation). Young notes that, even when agents are heterogeneous, these models imply rates of adoption that lead to different shapes of the adoption curve; for instance, pure inertia must be strictly concave.

From: "“Innovation Diffusion in Heterogeneous Populations,” H.P. Young (2009) « A Fine Theorem."

Posted via web from Jen's Posterous


Forget Monsters in the Closet. Your Kids Should be Scared of Monsters You Put in the Medicine Cabinet.

The number of children aged 2 to 5 who have been diagnosed with bipolar disorder and prescribed powerful antipsychotic drugs has doubled over the past decade, according to research released on Friday.

From: "Bipolar diagnosis jumps in young children: study | Reuters."

Posted via web from Jen's Posterous

Tribes and Black Swans and Smoking-Oh My! Social Contagion Strikes Again

A couple of months ago, about 80 people – some of whom knew each other and some of whom did not – gathered in a small lecture room at Nuffield College, Oxford, to hear a man give a lecture about how, if one of them suddenly got fat, the chances are that others would get fat, too. The same applied to happiness: if someone in the room spent the next week elated, that joy would probably become infectious. And the same for smoking: if a man in the room finally managed to quit, the chances were good that his friend sitting two rows in front of him would quit as well. And then, a short while later, a friend of his friend whom he didn't know would do the same thing.

The lecture was given by Dr Nicholas Christakis, a professor from Harvard who had flown over to expand on theories that he once thought of as "cockamamie". His talk examined the power of social networks to influence our behaviour, and suggested that our actions were only partly determined by our own free will. Increasingly, something he called "social contagion" seemed to be getting the upper hand.

Free will + tribal behavior + epigenetics.

Now wonder we're having problems understanding how to incentivize healthier everyday behaviors and articulate a new paradigm of choice + control aware care...

Posted via web from Jen's Posterous

Telecare Gaining a Tiny Toehold?

A Veterans Affairs Department medical center is using telecommunications technology to expand its psychiatry practice to a Vermont community health clinic near the U.S.-Canadian border, allowing for one-on-one consultations between doctor and patient 128 miles apart.

In a pilot project, Andrew Pomerantz and six other psychiatrists and psychologists at the VA Medical Center in White River Junction, Vt., are counseling patients from the Northern Tier Center for Health's clinic in Richford, Vt., through Web cameras, reaching people who sometimes went without such services.

The service, which will be expanded to three sites in New Hampshire, is available to veterans, members of the Vermont National Guard and their families.

The VA center has been using tele-psychiatry—which dates to the 1960s—with patients at a Bennington, Vt., VA clinic for several years. But this is the first time the VA has partnered with an outside entity to provide the care.

In November, the VA installed a high-speed line allowing direct audio-visual communication, a 27-inch TV screen and a Web camera and microphone in the Richford clinic. Associated Press

Fascinating. An American-Well like concept being piloted at a Vermont VA.

If National Guard members and their families begin to use the service with any discernible uptake this may help blow some arguments about the 'tech literacy' of users required for telehealth adoption right out of the water.

Posted via web from Jen's Posterous

Management & Performance Evaluations: How to Invoke the Neocortex?

Argyris’s business consultants are using their neocortex when analyzing their clients’ business and their amygdala when responding to management’s feedback on their own performance.

From: "Kent Bottles: Why Smart People Don’t Learn from Failures « ICSI Health Care Blog."

Great post by Kent Bottles. If I haven't failed at at least 1 of my current projects per quarter I'm not pushing myself enough. It's not easy to admit, but I'll keep failing to keep learning how to be happy and fulfilled and 'successful.'

If you've ever been through a performance evaluation where the 'fear system' (amygdala) takes control, chances are you've responded defensively to criticism that, examined calmly and rationally, could very much help your self-awareness. Notice I didn't say safety, or job security.

Another unfortunate result from many current management and organizational behavior eval methodologies means that at *least* 50% of the time, criticism of an employee or team member reflects the *manager's* fears, rather than performance shortcomings.

Your job, unfortunately, is to sift through the psycho-social and behavioral assumptions that guide your boss's fears.

True 'double loop' learning is one-sided. I'd argue we need 'triple loop learning' (at minimum) that takes into account 1. the cultural/work environs 2. the individual being evaluated and 3. the manager or leader doing the evaluating.

Sometimes 'failing' simply means admitting you don't fit where you've landed. Remember, being fired, or coming up short, is not the worst thing that could happen.

You could fail to realize you're unhappy, unfulfilled, and living someone else's version of 'success.'

Posted via web from Jen's Posterous

Must Read: Why Global Healthcare Folks Should Care about Whether Martha Coakley Gets Elected

If the Democrats lose this seat they will lose vote #60 in the Senate for President Obama’s healthcare bill.

If they lose vote #60 President Obama's health-care bill the bill will unravel.

From: "Repairing the Healthcare System: Something Fishy Is Going On!"

Doc Feld does it again.

Posted via web from Jen's Posterous


Sleeping Dragon: Personal Biometric Tracking Startups Beware...the FDA?

What to do if you’re an EnteroMedics Inc. investor?

The company, which is developing a device that uses electricity to treat obesity and diabetes, Thursday said data from a key clinical trial showed its VBLOC therapy “remain encouraging, with signs of clinically meaningful weight loss and control of obesity.” Furthermore, patients using a more advanced version of the Maestro device for 14  hours a day lost weight and demonstrated significantly reduced levels of HbA1c (glycated hemoglobin) levels in the blood.

Sounds good. One major problem: EnteroMedics is a company dangling precariously off a cliff. Last fall, Enter0Medics said initial results from its Empower clinical study failed to meet its goals.

From: "EnteroMedics Inc.’s fate now in the hands of the FDA. Your guess is as good as mine: MedCity News."

Wonder what will happen if the FDA starts evaluating marketing claims made by personal biometric tracking devices like FitBit, WakeMate, etc?

Posted via web from Jen's Posterous

E-Health Europe :: Italians develop fall prevention system

Italian researchers have developed a new wearable wireless sensor to monitor, detect and help prevent whether a person has suffered a fall.

The new technology, developed by a team of researchers at the University of Bologna in Italy as part of the EU funded SensAction-AAL project, consists of a wireless monitor work around the waist.

The device uses gyroscopes and accelerometers to sense an individual’s motion and position and detect any falls. The device can then trigger an alarm and issue an alert when someone falls, sending an alert to the emergency services, doctors or relatives using SMS and email messaging or by Bluetooth.

The Italian team have developed software that can detect falls where the person has been unable to get up, it therefore can be used by those who are more prone to stroke, heart attack or are suffering from other serious health conditions.

Lorenzo Chiari, a researcher for the project, said: “Falls in which a person does not get up, so called unrecovered falls, are usually a sign that they need immediate assistance.”

Chiari added: “But detecting them remotely is not easy. The main challenge is developing a software algorithm that can differentiate between an unrecovered fall and something less serious.”

The system can also be used to assist people undergoing rehabilitation programmes by encouraging them to perform prescribed exercises.

The system can use the sensors to monitor movement and then translate it back as signals, such as sounds and vibrations emitted via an audio headset or small vibrating actuators on different parts of the body.

Chiari added: “One application involves using the device as an MP3 player so the user can listen to their favourite music while exercising. If they move incorrectly the music will become distorted, change volume or tempo.”

The system has been piloted with people of sufferers of Parkinson’s disease at three different sites in the Netherlands, Germany and Israel, where according to the research team, users have been overwhelmingly positive in their evaluation.

The device is currently being commercialised, however the consortium is interested in finding investment partners so tat they can conduct more extensive clinical trial to develop a full commercial system.

From: "E-Health Europe :: Italians develop fall prevention system."


See in particular the application for the MP3 player where if the user goes 'off tempo' the music is distorted.

Amazing tool with potential for runners (Nike+, RunThere, Skimble, DailyMile, getupandmove.me).

@boltyboy think SenseAction-ALL folks would make fascinating addition to Health 2.0 Paris lineup!

Posted via web from Jen's Posterous

Number 1 Way to Lose Pounds - Don't Sit Still

If you've made a vow to lose those extra pounds this year, here are some fresh approaches. A few food swaps, a bit more movement, and some easy behavioral changes can make a big difference. 1. Don't Sit Still. Make a conscious effort to move more on a daily basis, whether it's cleaning the house or taking the stairs. It's more important than formal exercise when it comes to losing weight.

At getupandmove.me, this is our whole reason for being. Literally, and figuratively.

We build for that 'pre' workout space, for those pesky in between times during your day where you could be doing thousands of things OTHER than working out.

We build to help you do anything *but* sit still, right at the branching node of a hundred small potential decision trees you navigate on a daily basis.

Facebook integration with http://getupandmove.me is coming next week.

Then group challenges and a challenge 'pool' where you can 'pick up' a new friend and move together.

Speaking of moving together, @ePatientDave is reporting he's lost 10 pounds since starting to use his EXISTING, self-selected group of friends and family on Twitter to #getupandmove.

Myself, I've dropped 3.

"Make a conscious effort to move." Yeah. But luckily you don't have to do it alone.

Your friendly founders are always up for a challenge - or 20. Move it and lose it!


Posted via web from Get Up and Move!

Ladies - Seeing the Glass Half Full May Be Your Path to Better Health?

A recent study showed that a sunnier outlook on life is associated with a lower risk of heart disease and mortality. Evidence suggests optimism is protective and that pessimism seems to be detrimental, when it comes to the development of disease and future outcomes. What's a little less clear is what the mechanisms are, or how that protective effect occurs. Environment plays some role in the equation. Socioeconomic status was strongly tied to level of optimism: The women with the most-positive outlook on life tended to be wealthier, more educated, in better shape, and less likely to smoke or to be overweight. Socioeconomic status was the most related to attitude, but even after controlling for that, attitude was still related to health, so there's something else going on. Several factors are probably at play. Your psychology has a direct effect on physiology -- impacting blood pressure, heart rate, stress hormone levels, and immune function, all of which can contribute to disease and mortality. Higher levels of pessimism are linked to unfavorable changes in inflammatory markers and white blood cells. Optimistic types are more likely to engage in healthy behaviors such as eating well, exercising more, and smoking less. They're also more likely to have better social relationships. Finally, there's some evidence that optimistic women tend to adhere more strictly to medical advice and treatment plans.

From: "Friday, January 15, 2010 | DCPCA Health News Alert."

So, in addition to the semi structured data entry we ask patients to do on PHRs related to family history, we should add a section to determine whether or not the individual is generally an optimist or a pessimist?

Fascinating. One more way in which individual behaviors and social contagion influence personal + population-based health campaigns.

Posted via web from Jen's Posterous


I Heart Infographics - Especially Mobile App Store Ones...

Personality (Yours) Makes a Difference If You're Considering Becoming a Doc...

“The noncognitive, personality domain is an untapped area for medical school admissions,” said Deniz S. Ones, a professor of psychology at the University of Minnesota and one of the authors of the study. “We typically address it in a more haphazard way than we do cognitive ability, relying on recommendations, essays and either structured or unstructured interviews. We need to close the loop on all of this.”

Some schools have tried to use a quantitative rating system to evaluate applicant essays and letters of recommendation, but the results remain inconsistent. “Even with these attempts to make the process more sophisticated, there is no standardization,” Dr. Ones said. “Some references might emphasize conscientiousness, and some interviewers might focus on extraversion. That nonstandardization has costs in terms of making wrong decisions based on personality characteristics.”

By using standardized assessments of personality, a medical school admissions committee can get a better sense of how a candidate stands relative to others. “If I know someone is not just stress-prone, but stress-prone at the 95th percentile rather than the 65th,” Dr. Ones said, “I would have to ask myself if that person could handle the stress of medicine.”

From: "Doctor and Patient - Looking Beyond MCATs to Pick Future Doctors - NYTimes.com."

Thanks @neilparikh for the link!

How will we assess future care providers on behavioral domains? Cognition, it seems, isn't all that counts when it comes to effective, empathic patient care and communications. Shocker.

Posted via web from Jen's Posterous

Participatory Medicine? Naw. Choice + Control Aware Care.

As Mr. Bush sees it, the profound problem with U.S. health care is that there's "no landscape of choices, or choosers." Due to the complexity of America's third-party laundromat for health dollars—your doctor's clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—"few doctors in America know the actual value of the services they render.

From: "Weekend Interview with Jonathan Bush: Health Care's 'Radical Improver' - WSJ.com."

And you wonder why I'm so obsessed with incentivizing healthier microchoices, in real time, at the individual, 'entry level,' 'everyday' decision-making schema...

Posted via web from Jen's Posterous

Contagion Design Challenge: How to Make Mail Order Pharmacy Refills "Fun?"

The researchers found that 84.7 percent of patients who received their medications by mail at least two-thirds of the time stuck to their physician-prescribed regimen, compared with 76.9 percent of those who picked up their medications at traditional "brick-and-mortar" Kaiser Permanente pharmacies.

"The results were consistent for all three classes of medication, including medications to control diabetes, and high cholesterol," said co-investigator Julie A. Schmittdiel, Ph.D., a research scientist with the Kaiser Permanente research division.

From: "Use of mail-order pharmacies use could improve patients' medication adherence."

This is a pretty interesting study in terms of adherence...

Posted via web from Jen's Posterous

Got Mono (or Had it)? Interesting New Proteomics Research + Epstein-Barr

Professor Wolfgang Hammerschmidt, head of the Department of Gene Vectors at Helmholtz Zentrum München, explained: "We have now identified the crucial function of the viral BZLF1 protein: It activates the genes of EBV, which are essential for the proliferation of ." About 70 different genes are switched off during the latent phase because certain DNA segments are chemically modified: Some DNA building blocks carry methyl groups. They are a kind of stop signal for the cell apparatus, so that these genes cannot be converted into protein.

“BZLF1 can detect these methylation patterns in the DNA,” said Markus Kalla, lead author of the study. With its DNA binding domain, the protein binds directly to the methylated DNA sequence. A second domain of BZLF1 is responsible for the reactivation of the gene. “Such a mechanism was not known before,” Wolfgang Hammerschmidt said. Previous research assumed that the methyl groups had to be removed from the DNA building blocks before the transcription factors could bind to the regulatory DNA sequence and thus activate the gene.

The researchers’ findings indicate that BZLF1 avoids this hurdle. Accordingly, BZLF1 appears to be essential for establishing and maintaining latency, but also for escaping from it.

From: "Key Mechanism for the Proliferation of Epstein-Barr Virus Discovered."

Posted via web from Jen's Posterous


Apple and Epic, Sitting in a Tree...Part II

After three months of rumors, details surrounding Epic Systems’ partnership with Apple for a mobile phone-based electronic health record (EHR) application have come to light: Just a few days ago, Epic System’s iPhone application, called Haiku, became available on Apple’s AppStore.

“Haiku provides authorized clinical users of Epic’s Electronic Health Record with secure access to clinic schedules, hospital patient lists, health summaries, test results and notes. Haiku also supports dictation and In Basket access. Haiku works on both the iPhone and iPod touch,” according to the app’s description on the AppStore.

“Your organization needs to license Haiku and be on Epic’s Summer 2009 version and will determine the exact feature set and any applicable charges for your use of Haiku. If you are unsure whether you can use Haiku, please contact your administrative staff,” the app description advises.

Last September, the Wall Street Journal broke the news that Apple and Epic had been quietly conducting a trial at Stanford Hospital & Clinics, in Palo Alto, California to “test software that will let medical staff access patient charts on Apple’s iPhone.” As the Haiku app description above makes clear, it does much more than that.

From: "Epic Systems launches iPhone EHR app, Haiku | mobihealthnews."

Whoa. What PHR integration is next? Will Steve rule the market after all?

This slide (19/21) from 2007 looks strangely prescient...http://www.slideshare.net/jenmccabegorman/body-of-knowledge-building-click-through-health-ignite-boulder-presentation

Posted via web from Jen's Posterous

Patients demand: 'Give us our damned data'

From: "Patients demand: 'Give us our damned data'" - part of CNN.com's "Empowered Patient" series.

Thanks so much to Elizabeth Cohen, CNN Senior Medical Correspondent, our great photographer Floyd (who met Regina Holliday and I at DCA airport as I was en route from Philly and the NBME to SFO and home), and the amazing medical mural artist and advocate @reginaholliday (photo right), who's jackets act as a Red Badge of Courage for me during difficult events where it's often disheartening to talk about the state (or lack) of 'patient-centric' care enabled by health IT.

Regina, this is not an easy job, or calling, or however you want to describe it.

Your work literally keeps me going, and reminds me of the power and responsibility each individual can have in enabling 'participatory medicine' and choice+control aware care in our own lives, and in the healthcare system.

Thank you.

Posted via web from Jen's Posterous


Must Read Review of Silvers Summit @ CES 2010….

One of the most important takeaways from the Silvers Summit panels was that all of the entrepreneurs presenting products was their focus on the melding of hardware, software AND SERVICE.  While some tech companies do not offer great tech support (think of Dell a few years ago) nor want you to call their support lines, these ‘elder tech’ companies not only want their users to call, they consider it part of their competitive advantage.  These entrepreneurs focused on their hardware/software design (and outsourced the manufacturing) but also went to great lengths to win the loyalty is the service through support / installation / maintenance.  Hard to imagine Apple, Sony or Panasonic having a separate support line for the 55+ market when their focus is to get you off and on as fast as possible.

At the end of the conference, I sat there and thought about how 1.5 years ago my mother did not want an Apple Iphone and now she is convincing her friends and sisters to upgrade to an Iphone when their contracts are up.  As much as people may bitch about how un-“senior friendly” the user interface on the Iphone, my 60+ mother loves it for a number of reasons even though her eyes are going bad and even her sisters who are in their seventies are getting on the bandwagon after they get trained.  At first they say “I don’t need all these things” and after 6 months the attitudes change.  For her, there will be no going back to a simple cell phone.  While she may not be the “norm”, she’s proof that those who are initially resistant can adapt with training and time.

Will seniors adapt to these ‘unfriendly’ interfaces by necessity (or no other choice) at first and then by choice after sometime?  Probably. 

From: " Review Of Senior Technology Products & Silvers Summit @ CES 2010….."

Great points. "For her, there will be no going back to a simple cell phone..."

A good reminder that agism sucks, and is generally misplaced. The first people I knew using Skype were my GRANDPARENTS. My dad moved to Minnesota and VoIP was a quick, cheap, easy way for them to communicate.

Check your assumptions about age and consumer health technology at the door.

Posted via web from Jen's Posterous


Tomorrow's w3rk: Innovating for the Future of Medical Assessment and Learning

The Center for Innovation, established in May 2001, is a unit of the NBME that is charged with development of new products and services and exploration of new ventures that facilitate NBME’s strategic vision and mission. The Center monitors relevant trends and technologies, implements proof-of-concept projects, and seeks collaboration with a variety of outside entities. In addition, it administers the Edward J. Stemmler Medical Education Research Fund (Stemmler Fund).

The Center, one of five major NBME units, obtains strategic, tactical and technical counsel from its Advisory Committee, and funding and approval from the NBME Executive Board. In pursuing its goals, the Center involves other NBME staff and external organizations sharing common strategic visions.

At the 2001 NBME Annual Meeting, the national faculty constituted by the Board prioritized seven areas for strategic initiatives: professionalism, “designer” assessment tools, generalist competencies, global services, cultural competence, evaluation of programs and systems, and continuous, point-of-learning products

From: "NBME® : Research : Center for Innovation."

Some of you may have been wondering why I'm racing all over the East Coast this week...

Monday I'll be a guest of the NBME's Center for Innovation in Philadelphia.

Be prepared for a few random live questions via Twitter - in particular I'll be calling on the ePatient community in the afternoon as we look ahead at how to integrate participatory medicine, patient and caregiver perspectives.

BIG ePatient w00t!

Posted via web from Jen's Posterous