Friday, September 23, 2016

Get ready for National Health IT Week Sept 26-30 #NHITWeek

Have a health IT story to share? National Health IT Week is Sept 26-30 so be sure to follow #NHITWeek and join others who are sharing their passion about health IT! Learn more here:

My critique of the JAMA activity tracker + weight loss study

Originally posted on

Many people have seen reports of the recent JAMA study titled, "Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial." Published in Sept, 2016, this study would appear to be a reflection of recent trends in activity tracking and weight loss strategies. However, the study used an antiquated wearable device that is no longer sold (the BodyMedia FIT which is worn on the upper arm) and it was conducted from 2010-2012. How many people in 2010 were wearing activity trackers? The popular Fitbit Flex launched in May 2013. The Apple Watch launched in April 2015.

Back in 2010, relatively few people wore activity trackers. Moreover, hardly anyone wore them on their upper arm. So although the authors acknowledge that "The multisensor wearable device was worn on the upper arm, which may not reflect the effectiveness of more contemporary devices worn on the wrist..."

The term "effectiveness" is an interesting term for this type of study, since the accuracy of worn activity trackers has wide variability. In order for a digital tool to effectively change behavior in a sustainable way, people have to use it regularly and the device should provide useful feedback to the user.

I've personally tried the BodyMedia Fit and I can attest that:
  1. It draws a lot of attention (maybe not as much as Google Glass, but you'll get a lot of questions from random strangers asking, "what is that on your arm?"). How self-conscious would you be if were constantly telling everyone that you were taking part of a weight loss study? 
  2. It's not something you'll be wearing 24/7 (fabric stretch band around the arm, so you probably won't be taking a shower with it, plus I don't believe that it was water resistant) - so that can impact daily adherence. Plus, the device needs to be charged on a regular basis.
  3. The tracker is not very comfortable (imagine strapping a pager to your upper arm all day). 
  4. The device doesn't really provide any type of useful feedback such as vibration alerts, cues, smart notifications, etc. You may eventually forget that it's there. It's not nearly as engaging as modern activity trackers that have lights, screens, and vibrating alerts.

The authors also state, "the use of wearable technology was not initiated at the onset of the intervention, which may have influenced how the participants adopted and used the technology during their weight loss efforts..." Many people are missing this point. Adoption and engagement are critical factors that can impact the success of any type of sustainable behavior change.

So, if the goal is to sustain lasting behavior changes that will lead to weight loss and healthy eating, then you need to study devices that people will easily wear daily, devices that will provide useful feedback in real-time, and devices that won't make people self-conscious about their attempt to lose weight.

Finally, keep in mind that the study began with intensive weight loss interventions for 6 months (weekly group sessions), then the groups continued to participate in monthly group sessions (and received phone calls, text message reminders, etc.) Most people who choose to purchase and use a wearable device don't gain access to this type of support and structure. Most consumers are curious or they may be in a contemplative stage where they want to see how an activity tracker may help them achieve a healthier lifestyle.

Intensive, structured weight loss programs are great ways to kick-start a new journey towards healthy living, but people need to be taught how to use tools in a way that is natural to their workflow and daily habits. If you're not accustomed to strapping a large device to your arm, then you'll be one of the first ones to stop using the device after a few weeks or months. In contrast, if you normally wear a watch and use a smartphone, then it'll be much easier to wear a device that is simple and that provides useful feedback (such as smart notifications that you can customize so that you don't run into alert fatigue).

In many ways, it's unfortunate that the JAMA article was positioned by the media as a disappointment regarding the "effectiveness" of wearable technology. It's unfortunate that many consumers may now have a misconception regarding how their activity trackers may benefit them.

I'm sure we'll see many more studies in the near future assessing the "effectiveness" of modern activity trackers. Until then, we'll have to wait patiently as people read stories with misleading titles like, "Activity Trackers Are Ineffective at Sustaining Weight Loss" or "Weight Loss On Your Wrist? Fitness Trackers May Not Help" (the BodyMedia device was worn on the arm, not the wrist!)

Friday, May 13, 2016

Ingestible origami surgical robot (a real-world Transformer)

OK, maybe not quite a Transformer. But, researchers at MIT, the University of Sheffield, and the Tokyo Institute of Technology have demonstrated how a tiny origami robot can unfold itself from a swallowed capsule and crawl across the stomach wall to remove a swallowed button battery or patch a wound. The robot is steered by external magnetic fields.

Source: MIT News

Monday, April 4, 2016

Get ready! April 4-10 Is National Public Health Week #NPHW #NPHWForum

These days, one of the big buzzwords in the health IT community is "pop health" (short for population health). Well, public health and pop health are practically sisters! This week is National Public Health Week.

Follow @PublicHealth for the latest updates this week on some exciting public health initiatives and join the conversation. Do you live in a city that's going to participate in the #HealthiestCitiesChallenge?

Advances in technology, big data analytics, and team-based care will lead to improvements in public health. Also, don't forget that public health professionals are also actively involved in quality improvement (QI) projects. The PHQIX (Public Health Quality Improvement Exchange) is a great place to read about some of those projects.

Monday, March 14, 2016

Happy Pi Day! 3.1416 (rounded)

March 14 is a fun day for math enthusiasts who celebrate Pi (3.1416 - if you round up)!

Trying to calculate the area of a circle? The circumference? You'll need Pi for those calculations.

The admissions office at MIT is famous for handing out decisions on Pi day.

Did you also know that  3.14 is Albert Einstein’s birthday?

Celebrate Pi Day with a piece of pie!

Wednesday, March 9, 2016

Unwinding from HIMSS16

I'm finally unwinding after having a great time at HIMSS 2016 (#HIMSS16). My personal highlight was participating in two Dell Healthcare Tweetups with @MandiBPro and @drnic1 as we chatted about some of the evolving trends in health care. We discussed how data-driven care can improve patient outcomes as long as clinicians have access to the right data at the right time and the right place. We still live in a world where interoperability remains a major barrier, but perhaps 2016 will be the year where we make some significant strides in this area through broader collaborations and partnerships across the health IT industry.

At HIMSS this year, you couldn't walk around the conference without seeing signs about population health, data analytics, and precision medicine. We discussed these topics at the Dell Healthcare Tweetups and heard different perspectives on cancer care, mental health, team-based care, and the practice of medicine in community-based settings. More patients are getting engaged in their own health care and we are generating so much health data, but clinicians need to know how to effectively tap into all this data to get meaningful and actionable information that will improve patient outcomes. We're seeing a lot of exciting advances in cancer care, especially around precision medicine and genomics. We also heard about how Dell's Cloud Clinical Archive services are integrating genomics into their core offerings. Speaking of genomics and big data, Dell has a longstanding collaboration with Translational Genomics Research Institute (TGen) and they are empowering clinicians and researchers to fight pediatric cancer. 

Make sure to follow @DellHealth for the latest in health IT and don't miss the 2016 #DoMoreHIT Healthcare Think Tank on Tue, Mar 15 2016 2:00 PM EDT -  5:00 PM EDT

Sunday, February 21, 2016

What is the best master's program for physicians? by @HealthcareWen

This is a guest post by Wen Dombrowski, MD, MBA

(A follow up previous post about Physicians Evolving Role in Health Care )

I am frequently asked by physician leaders and other clinicians interested in nonclinical responsibilities "What is the best master's program that I should pursue?" I am jotting down some thoughts here in hopes that it will benefit more people beyond those who I coach 1:1. This post is not meant to be an exhaustive guide, but rather food for thought for self-reflection.

My answer about what is "the best" educational program for you always depends on What are your goals: Why do you want to pursue more education? What are you hoping to get out of it? What are your short-term & long-term career and personal goals? What gaps are you hoping to fill? What are you interested in learning about?

For example, there are a myriad of different non-clinical roles that a physician participate in different settings, including:
• Hospitals or Clinics
• Managed care organizations
• Software vendors, medical device companies, pharma
• Your own startup
• Government or public health
• Teaching
• Research

Depending on what roles each individual aspires to, their interests, and personal background -- different individuals will prioritize the following differently:
• Focus on learning about healthcare challenges, healthcare regulations, and managing medical staff
• Focus on learning about non-healthcare business knowledge and skills
• Academic theories about business, technology, people management
• Practical knowledge about business, technology, people management

Choosing a master's program isn't just about the name of the school or the letters that will be on the diploma. How much each program focuses on the above domains depends in part on:
• Who is teaching the courses?
• What is the format of the courses? (e.g. focused on reading textbook, or discussing cases, or hands-on practicum)
• What is the curriculum of required and elective courses?
• Who are the classmates in the courses?

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