A central issue in healthcare is that a large percentage of patients don’t adhere to their treatment plans and, therefore, suffer less than optimal outcomes. When patients don’t follow their doctor’s instructions, they don’t get better, they take longer than expected to recover, or worse – all outcomes typically more expensive than treating the illness right the first time. For patients living with a chronic disease such as Multiple Sclerosis (MS) or diabetes, non-adherence can lead to more complicated and costly issues.
Say you’re a patient suffering from diabetes and you don’t check your blood sugar levels on a daily basis as outlined in your treatment plan. Odds are, you’ll end up in the ER at some point, which is expensive. And in the long run, complications from diabetes can get pretty gruesome.
These are the types of costly and damaging emergencies that Sara, the Alme Health Coach virtual health assistant, hopes to reduce.
In order for that to happen, though, Alme Health Coach needs to know if you are doing what’s been recommended by your physician. One way for this to happen is for Sara to ask if you have checked your blood sugar level as necessary. While a good start, it certainly has its limitations, as the accuracy of the data that is gathered is entirely dependent on the honesty of the patient. In this situation, and the vast majority of health-related situations, it is an absolute requirement that Sara has accurate information. Her value as a coach will be determined by the quality of information she gathers.
An even better way to ensure that Sara is operating with the most accurate context is to directly integrate with the medical device that you would use to check your blood sugar. While ideal, this is not always an option.
Now, let me introduce you to a company called Estimote. Estimote makes low-energy Bluetooth beacons and stickers. These small wireless sensors can stick to most things and broadcast radio signals that smartphones can detect and translate into contextual variables. Estimote has introduced the idea of a “Nearable”: any physical object with a sensor attached to it that transmits a signal to a smartphone.
I’m particularly interested in the Estimote Stickers because of their size. They are a little larger than a stamp, with a range of about 160 feet and a battery life of about one year. Theoretically, Sara could use these stickers as triggers to launch specific, proactive conversations.
For example, let’s say that you’ve been newly diagnosed with Multiple Sclerosis. As part of your treatment plan, your doctor advises that you lose some weight. By placing an Estimote Sticker on the fridge, Sara can remind you to log your meals in order to keep track of your calories. Add this information to your integrated Fitbit, and Sara has both key inputs to the famous “Calories In, Calories Out” formula. [Editor’s Note: Great minds think alike – Estimote recently tweeted that they posted an article describing a similar setup.]
But we can go a little further.
Sara is designed to be a coach AND a behavioral psychologist – or at least to be able to employ basic behavioral psychology techniques. One of the behavioral psychologists that we studied when developing Sara is BJ Fogg, whose method is popularly termed “Tiny Habits.” Fogg believes his research has shown that “no behavior happens without a trigger.” Furthermore, he believes you can design these triggers, and that triggers incorporating everyday routines have the highest rate of success.
My next example makes use of one of Fogg’s favorite triggers: brushing your teeth.
Going back to the issue of adherence, for a person with Multiple Sclerosis, taking their disease-modifying drug is probably the single most important component of their treatment plan. Therefore, NOT taking their medication can have the single greatest negative impact on their health outcome. Many people claim forgetfulness as the primary reason they don’t take their medication when they should. Scheduling reminders may work some of the time, but Fogg would recommend using the action of brushing your teeth as the trigger to remind you to take your medication, as it is already part of your daily routine. If you place an Estimote Sticker on your toothbrush so that Sara can detect when you brush your teeth, then you've just tied together different approaches to address a key obstacle of adherence and provided Sara with a contextual variable to launch a proactive conversation.
Taking it another step, Sara could actually introduce the concept of “tiny habits” and “triggers” to the patient, helping them select the appropriate routine and trigger for the specific task the patient hopes to accomplish. This would allow her to establish the patient’s commitment to this aspect of their treatment plan – an important step in most behavioral psychology approaches. She could then walk the patient through attaching the Estimote Sticker to their toothbrush to set the contextual variable that Sara will need to proactively remind the patient to take their medication. If an MS patient were to brush their teeth but fail to log their injection, Sara would immediately ask why.
Sara’s potential for integrating with other technologies gives providers flexibility when designing treatment plans – and Estimote is just one of many possibilities. If you have an idea for other emerging technologies that could be part of the Alme Health Coach ecosystem, feel free to reach out to me – increasing patient adherence to treatment plans is one of the most effective ways we can help keep people healthy.
Next IT is not currently affiliated with Estimote.