My son Andrew is 15 years old, which places him squarely in the ever-confusing, ever-shifting universe of the teenager. He is also a type 1 diabetic – has been since he was five years old. At a time in life when he is constantly trying to test and define his limits, then, being forced to check his blood sugar several times a day and administer doses of insulin doesn’t exactly square with his ideas of personal freedom.
Andrew, I expect, falls into a rather large category of the American public – someone with a chronic health condition who isn’t necessarily compelled to monitor his or her health. This population would benefit the greatest from mobile health tools, but if we leave it up to them to do the monitoring, the effort will likely be wasted.
It’s been said that physicians will only adopt health IT – namely, electronic medical records – if their workload isn’t disrupted. The same can be said for those suffering from a chronic condition. Sure, they say they’ll take steps to improve their lifestyle, but if the going gets tough or even mildly annoying, if the challenges affect their lifestyle, they’ll probably give up. Willpower is tough to teach, and even tougher to maintain.
A certain percentage of the population will adopt mobile healthcare tools and will show improvement. Those are the go-getters, the do-gooders, whatever. They’ll probably succeed no matter what you throw at them. Another fraction, sadly enough, won’t make any effort to adapt. In between lies a vast majority that will be moved only by the right amount of motivation.
As healthcare technology improves, and creative minds come up with tools and solutions that fit seamlessly into a lifestyle while simultaneously improving that lifestyle, mHealth will show benefits. It’ll take time, and probably more than a few failed experiments. Finding the proper balance between motivation and intervention won’t ever be easy.
Will gamification work? I’m not certain. The concept of creating games out of potentially serious medical issues doesn’t sit well with me, despite the fact that Andrew spends more time on his iPhone or in front of his PS3 than I’d like (in contrast, he’s also a high school varsity and premier soccer player and a member of the basketball and baseball squads, so it’s not like he has a sedentary lifestyle). The competitive aspect of a game might be enough to motivate some people with chronic conditions, but the idea that one needs to play a game to improve his or her life seems to rob it of its sincerity. It’s only a game, after all. At least that’s what I’m always telling the kids I coach in soccer.
I recently attended an American Diabetes Association function in which one of the guest speakers was a 30-year-old man who’d begun riding in the ADA’s Tour de Cure, an annual cycling fundraiser held in more than 80 locations around the country. The young man had been a diabetic since his teens, and freely admitted to ignoring his condition for a decade (he said he never tested himself, and administered insulin when he felt it was necessary). He’s now an outwardly healthy, active cyclist and an ardent activist for the ADA.
He’ll also likely suffer severe health consequences – blindness, heart disease, kidney problems – by his 40s and die before he reaches retirement age. Like so many young people, he’d ignored the long-term impact of his actions in order to live life by his terms.
That type of role model is one I could do without for Andrew.
I’m heartened by the new diabetes tools and monitoring software slowly making headway in the market – like Telcare’s wireless blood glucose monitor, which automatically sends blood glucose readings on to the physician and other caregivers without any effort on the patient’s part. Likewise, software solutions that allow Andrew and his doctors (and parents, and nurses, and coaches, and teachers …) to interpret these readings, making connections between highs and lows and events that might be causing these issues, will do more to improve his lifestyle than any fatherly advice or game.
In short, all the incentives in the world might not help if mHealth makes the daily management of a chronic condition even more challenging. But technology that fits seamlessly into one’s lifestyle and provides education rather than enforcement could mean the difference between a tool that works and a tool that is ignored. That, in essence, is what “meaningful use” should be about.