Category Archives: Medicine

The Importance of Usability: Putting the Patient First

In addition to developing apps that allow patients to track their lifestyle habits—exercise, diet, sleep patterns, etc—mHealth is also promising in its potential to engage patients in their general health information. Specifically, in the information that is stored in hospital health records. A play on EHRs, Mana Health has developed “a patient portal solution that has been designed for today’s consumer.”

Mana Health is a New York startup that won the opportunity to design the patient portal for the New York eHealth Collaborative, a non-profit organization that works to improve health care for New Yorkers through the development and establishment of electronic health records. Mana Health recently designed an interface that facilitates the sharing of patient data around the state, not only between hospitals, but also from hospital-to-patient. The endeavor is unique because it is not contained in a single healthcare system, but rather will pull information from across the state and consolidate it in a user-friendly “patient portal” platform.

One of the best features of the program, at least in my opinion, is how user-friendly the interface appears to be. While existing electronic medical records (such as Epic) are filled with numbers and abbreviations, Mana Health’s platform is truly geared towards the patient and offers streamlined graphics that illustrate the patient’s relevant health information.

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Mana Health’s platform transforms the complex electronic health record into a personal health record that allows patients easy access to their information: “unlike the clunky PHRs of days past, they said they wanted something that a typical consumer would feel comfortable using.” Their concern for user-centered designs is something that all mHealth developers should strive to emulate. The liberal use of color-coded graphics is a simple way to increase the scope of users, especially to those who may have low health literacy and will serve to benefit from the image-based layout.

As mHealth advances, there are many issues that will continue to spring up. I have addressed several of these in past blog posts—addressing low health literacy, accessing hard-to-reach populations, funding mHealth endeavors—and the creation of user-friendly platforms is yet another point of serious consideration. mHealth is a direct product of creativity and innovation, and these driving forces should not stop at the development of the idea, but carry over into the details of its execution.

Has the Influence of Harry Potter Spread to Medical Education?

As the semester comes to a close, it’s not unusual to see clusters of seniors chatting eagerly about how they’re going to spend their last summer before starting medical school. According to a study done in 2006 by the Mayo clinic, students that enter medical school with mental health profiles similar to their college peers. Although they spend their next few years training and studying on how to improve the health of others, they tend to disregard their own in the process. Reports show decreased attention to getting adequate sleep, meals, recreation and show higher rates of mental distress as student’s progress through medical school.  Sadly, the same study has also shown that depressed students are less likely to reach out for help because of the stigma surrounding mental illness.

With the worrisome consequences of depression in medical students including possible burnout and increased rate of contemplated suicide, it is important to contemplate how a change in culture within the medical school environment can be brought about to tackle some of the stigma surrounding mental illness.

So, what can we do to bring about this change?

Lisolette Dyrbe, M.D., and the lead author of the Mayo study, has encouraged a lot of conversation about the issue.

“It’s certainly important for the student to learn the right coping strategies, time management skills, and stress reduction techniques. All of that is important, but it is not the entire answer. We also have to look at school-level initiatives. There needs to be organizational change.” 

So, how are institutions responding?

Including pass/fail options for courses, reducing volume of course material, and giving students more opportunities to work and teach outside the hospital are just some of the ways that universities are working to lessens the stressful burden on patients. Many programs also provide mandatory resilience and mindfulness courses that teach coping mechanisms and stress management techniques. In addition, other universities have incorporated confidential web sites and hot lines for counseling, hired mental health experts, and have developed elective courses in health and wellness.

But, is this really helping?

Recent studies have examined these changes and have identified an important problem: students aren’t participating. Despite the good intentions of the universities and resources provided to the students, only a few seem to be taking advantage of these opportunities and these, more than likely, aren’t the ones that are in real need of care.

One program, though, has been able to show some success.

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The Student Wellness Program at Vanderbilt medical school, which provides a variety of health and wellness activities, has been seen to improve the health of students by effectively partnering and empowering the medical students themselves into organizing and promoting their own health and interests. The program has allowed the students to be divided into four “colleges,” similar to the Hogwarts houses in Harry Potter, that allow the students to connect and organize activities that provide an outlet outside of the classroom. Dr. Scott Rodgers, the associate dean of medical student affairs describes the aim of the program perfectly and outlines the importance of health and happiness for these students.

“It’s a challenge for anyone to stay healthy and happy. But when doctors are able to stay healthy and happy, that means patients get physicians who are more compassionate and selfless. They end up with doctors who really have the energy to invest time in them.” 

As undergraduate students pursuing careers in medicine, this discussion brings up some interesting conversations. What can we do to better prepare ourselves for medical school going forward? Are there ways that we can contribute to not only helping ourselves and our peers reduce stigma surrounding mental illness but also to improve health within the medical community?




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ePatient Benefits for the Unconvinced Physician

When discussing ePatients, we’ve mostly talked about the patient perspective – how an individual can become more empowered, educated, electronics savvy, etc. – but what about the physicians?

Well, in interacting with ePatients, of course the physician themselves may also learn information they hadn’t known, learn to empathize more with the individuals, and even gain some tech skills in the process. These all sound great, but sometimes when a doctor is over worked and just plain tired from life, I’m sure the last thing they are thinking of is how to learn how to use a new app a patient has just brought in.

The culture of passive medicine is in part carried out by physicians’ attitudes towards such patients. Of course, if your patient is compliant to everything you say and doesn’t question any of your prescriptions or treatment notes – you’re life as a physician isn’t too difficult because everything is a one-way conversation. But with the incorporation of ePatients – the physician has to work to build that two-way relationship, which not all physicians are willing to do.

So for those physicians unconvinced by the new ePatient movement – how about a very concrete and quantifiable benefit? EPatients can help you make money.

Now this sounds a bit crude. Money should not be the core of medicine, but sometimes it is and to some people it is. And in this sense, ePatients can bring in money for physicians by increasing physician referrals.

It has been shown that referrals are most effective through word of mouth. If a previous patient likes the way you work, then you get a referral. It’s just that simple.

Now how do ePatients factor in? Well, if you think about the grand scheme of things, creating an ePatient means a closer relationship formed by the physician and patient by methods of direct and indirect communication. This communication should ideally make the patient feel more secure and welcome in the portion of the healthcare system you have introduced them to. So simply (and idealistically) speaking, you put in effort to be a more engaged doctor in the patient’s life and treatment plan, and eventually they will like you and get you referrals.

Now, all doctors should communicate with their patients because medicine is not just about the biological treatment, but the social and psychological treatment as well. Social aspects of physician-patient interactions can go a long way. But – if you are still not into this ePatient thing – then maybe take into account how the ePatient movement can factor into your business plan. Is it a little more appealing now?

Promoting Patient-Centric Adherence: Emerging mHealth Technologies

Last night we had our final Medical Media Arts Lab presentations—a bittersweet culmination of all of the hard work we as a class have put forth throughout the semester. My group finally had the opportunity to present a detailed plan and accompanying visuals detailing our mobile app solution for improving patient-doctor communication regarding shared treatment plans for Type II diabetics. Professionals in the audience gave us some very valuable feedback and suggestions, which, should the project continue, would greatly improve our existing design and the user experience. Our app focuses on improving patient adherence by creating shared treatment plans that take both the patient and doctor’s needs into consideration. To enhance our design, it was suggested that we add a reward component that provides positive feedback to patients who follow their treatment plans, as well as include an avenue for patients to socialize in an effort to increase motivation and accountability. I assumed that these were components our team would need to develop; however, it turns out that mHealth startups have already started to explore these possibilities, both within the context of diabetes, and for chronic and other health conditions in general.

I came across these emerging businesses on the mHealth News website, outlined in an article entitled “Startups bolster adherence via social networking, mobile apps.” Ayogo and Get Real Health “offer a care coordination platform and mobile application, respectively, that seek to improve on…abysmal adherence statistics.” I was particularly interested in Ayogo, which utilizes a health behavior change and gamification platform called GoodLife to establish meaningful social interactions between patients, patients and their family members, and patients and their doctors around their health condition.


The platform also utilizes psychological triggers and secondary applications to personalize the user experience. The specific mobile app used by Ayogo is called Empower, which “helps patients who are newly diagnosed with a chronic condition to take control of their treatment.” The app organizes the patient’s treatment plan into a ‘health habit curriculum’ that uses behavior change principles, self-reporting, social interactions, and a rewards system to encourage adherent patient behavior.

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The app tries not only to engage patients in their prescribed treatment plans, but also to actually establish new habits in the patient’s daily life by having them complete small activities or games each day that both facilitate the patient-reward system, but also help the program tailor to the patients’ needs. By actively engaging patients with the app through games, rewards, and social features, Empower, and more broadly Ayogo, helps patients improve adherence to their treatment plans.

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It seems that the only missing component is the facilitation of real-time patient-doctor communication about the treatment plan. This app offers what to me seems like a brilliant, innovative proposal to a problem common across nearly all chronic health conditions; however, our development offers that extra, crucial component addressing the in-person patient-doctor encounter. As we move forward, app developers should remain open to learning and growing from the work of other startups. Mobile health is a rapidly growing field that offers much opportunity for profit and competition. However, let us not lose sight of the key stakeholder—the patient. As the race for the next innovation commences, we need to make sure that all possibilities are considered, collaboration is encouraged, and innovation is allowed to reach its full potential.

The Risk That Comes With Too Many Choices

It’s hard to believe that there were no health apps over a decade ago and now new apps are being created everyday, with thousands being created every year. When researching diabetes-tracking applications for our project, I searched diabetes in the iTunes App store and I was given 968 results. When faced with so many choices, we often become overwhelmed and don’t make smart decisions. Barry Schwartz, author of the “Paradox of Choice” summarizes the risk that comes with too many choices by saying:

            “When people have no choice, life is almost unbearable. As the number of available choices increases…the autonomy, control, and liberation this variety brings are powerful and positive. But as the number of choices keeps growing, negative aspects of having a multitude of options begin to appear. As the number of choices grows further, the negatives escalate until we become overloaded. At this point, choice no longer liberates, but debilitates.”




When making a decision on which app to download, we end up relying on information given to us on app reviews or by the price of the app and while this information is useful, it can often be misleading. While an app might be expensive, it perhaps would better suit the users needs than the free app. And while one app works for someone else, every patient has different treatment plans and goals. In the worst scenario, the user becomes so overwhelmed that they don’t end up downloading an app at all. Here are some tips for making a informed decision when choosing an app:

  • Ask your doctor- Although not all physicians will know of useful applications, a physician that is familiar with treating patients with diabetes will probably have heard positive reviews of certain apps. Also, since your physician is familiar with your treatment plan, they will be better able to recommend an app suited to you then some random guest review on iTunes. Also, as the use of health apps becomes more common, physicians are becoming more aware of the variety of apps out there. One diabetes treatment app (BlueStar) even requires a prescription from your doctor!
  • Don’t solely focus on price- While it is often our natural inclination to download the free app, the one that costs $1.99 might be ten times better. This isn’t to say that price is correlated with quality of app, just try to focus on the features of the app instead of the price (as long as the price is reasonable).
  • Focus on the features most important to you- We can be tempted to download an app that offers the most features, but this type of app is often hard to navigate and confusing. Depending on your condition, choose the top three features you want in an app. For example, some diabetes patients want an extensive nutrition tracking feature while others are not interested in this feature. Once you narrow down your priority features, choosing an app will become easier.

Even though making a choice may be difficult, most of the health apps on the market will enable you to take better control of your health and will end up making it easier to manage your condition.


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