Up until around a decade ago, the idea of letting a digital device play a pivotal role in the way diabetes is controlled and monitored was inconceivable.
Now, it is pretty evident to see how much connected technology can improve day-to-day management for both people with type 1 and type 2 diabetes.
Our Low Carb Program app, for both Android and iOS, is helping a lot of people with type 2 diabetes achieve normal blood sugars and attests to the success of digital coaching in providing support.
In the UK, we’ve had an especially booming digital health tech scene in the last few years. Among the most influential companies in the sector are Cellnovo and uMotif, both of which are nominees in AXA’s prestigious Health Tech & You Awards 2017.
We caught up with the two finalists ahead of the Awards ceremony to ask a few questions about how they engage and address the needs of the entire healthcare ecosystem.
In this in-depth and wide-ranging conversation, we explore:
- Barriers to adoption of digital technology
- Shifting dynamics between users and healthcare professionals
- How mobile health (mhealth) can meet unanswered needs in diabetes self-management
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Our first expert is Bruce Hellman. He is the CEO, co-founder, and mind behind uMotif – the powerful new app turning our phones into mobile medical clinics.
DCUK: Let’s start with the basics. What exactly is uMotif and how does it work?
BRUCE HELLMAN: uMotif is an app that allows people with diabetes, among other categories of users, to track and log important health data, like their blood glucose trends or insulin use, and send it to their healthcare professional.
We can track over 250 symptoms through a range of standard health services questionnaires, and we have biometrics tools for weight, blood pressure, blood glucose and heart rate. Through our device connections, we can link with most commercial wearable devices too.
For most startups right now, the objective is simply to collect the data and use that data to drive adherence. How is uMotif different?
The difference is that uMotif collects, stores AND transmits that data. Our technology is two-way and it’s how people want to use it. Most commonly, users capture their data and can choose to have it sent directly to their doctor.
The doctor or healthcare professional can review the data in-between appointments and send relevant feedback. Remote patient monitoring represents an advantage as sometimes months can go by without a touchpoint with anything. It can also alert doctors if anything is amiss.
True, it’s a win-win situation all around, isn’t it?
Very much so. On one side, we capture large volumes of high quality data from users through tools they love to use. On the other, the data can be used by their doctor in follow ups or research projects – which is always better than working solely from anecdotal data that can’t always be trusted because of self-reporting bias.
Are there any negatives to that?
The biggest challenge with two-way communication is the impact on the health service of the potential or perceived extra burden.
At the same time, uMotif can help to address shortcomings in ongoing care. The app improves doctor-patient communication and helps users feel more in control. It acts as digital health diary which enables them to obtain better follow-up.
The app improves doctor-patient communication and helps users feel more in control – Bruce Hellma, uMotif.
In terms of self-monitoring of blood glucose (SMBG), how can the app help people who are at a very low level of compliance?
Diabetes self-management is multi-faceted and complex, particularly for young people.
We believe that the only way to properly support people to improve compliance will be through the combination of our app services and sensitively and intelligently designed health services that focus on the real needs and motivations of our youth.
uMotif can, for example, send alerts about a missed SMBG check to the user’s smartphone, or alert his or her caregiver.
How do you improve user engagement and keep people accountable?
When we built the app, we directed a lot of our attention to compelling design and services that are easy to use. We wanted people to be drawn to the app rather than feeling forced into using it.
Because the app tries to respond to contextual needs, greater accessibility to the app services whenever and wherever a user needs is important. To that aim, almost all of the uMotif app works in offline mode. This eliminates the need for internet connectivity and is critical for patients who are often on the move.
What are user experiences like with uMotif?
Some of our users have been tracking every single day without fail for periods as long as 400 days, suggesting that the app had become an indispensable tool supporting their goals and something they want to use.
When we interviewed people to find out how they benefited from using the app, they all gave the same answer: logging progress and ups and downs made them think about what had happened during the day and how they felt, making uMotif a very insightful tool that had become part of their daily routine.
What are your predictions for digital health in the diabetes space?
We’re starting to see digital health become a default approach for some.
It is possible that, in a not too distant future, virtual consultations in the form of telephone or video call appointments could be used in place of office visits, eliminating the need to travel for appointments.
Here, at uMotif, we’d like to see more blood glucose monitors being connected, in the same way that users of Fitbit and Withings devices can easily access their own data.
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Speaking of integrated blood glucose monitors, Cellnovo‘s Chief Scientific Officer, Julian Shapley, answered all of our questions about the mobile-enabled insulin pump. Boasting features like a touch-screen controller and a BG meter, the e-connected insulin micro-pump is just like a real digital personal coach.
DCUK: A big promise of m-health in the field of diabetes is analytics helping users understand how daily patterns of activities affect glucose control.
What sort of relative feedback, if any, does the connected insulin pump system provide?
JULIAN SHAPLEY: In its first generatio, activity and carbohydrate data is presented to the user on Cellnovo patient portals available through the web and it will soon be accessible through a secure app interface.
We are currently involved in a number of projects that will accommodate a more tech-savvy type of usage for people who want to understand the data but don’t know how to interpret it.
What’s the plan with that?
The focus will lie on making sense of this data but also making it relevant, actionable and timely through suggestions of adjustments to settings, personalised real-time decision support for things like medication dosing, changes in diet and exercise, and coaching feedback.
Smartphones also produce significant behavioural data and, as part of our personalised decision advice projects, inputs such as mood variability will be utilised in decision support.
What about gamifying the system to make it more interactive and fun? Have you thought of that?
Gamification is gaining momentum and is being seen in a number of new apps as a way to motivate, encourage and educate users.
Personal scoring and the ability to share and compare through social networking is indeed also something that Cellnovo is running through feasibility trials.
How do you measure the success of the connected insulin pump?
We are able to monitor how often and when the data that is generated from the pump’s real time connectivity is being used. Some uses allow for more patient engagement while others are designed to be more passive.
The e-health sector has the potential to drastically reduce the burden on healthcare systems – Julian Shapley, Cellnovo.
Are there any barriers to integrating more connected technology into the system?
It is very important to design medical devices for everyday use with human factors and usability in mind. The complexities of mhealth and creeping featurism in digital healthcare can be an obstacle to its use.
Engineers can have a tendency to design and assume the needs of the user. The challenge is to reconcile the introduction of new features that simplifies diabetes management with the development of a practical and user-friendly platform.
How do you protect user privacy and data security?
Designing products that are safe and secure to use will always be our primary concern. Currently, Cellnovo patient data is retained within the secure Cellnovo platform and is shared with the patients’ healthcare professionals (with consent).
We are however working towards synchronisation with electronic healthcare records. Cellnovo has the capability to share anonymized health data with trusted partners and is working towards safe private data sharing.
What are the risks of sharing user health data with third-party developers?
Healthcare records can be valuable to hackers. It is very important in the design of medical devices to ensure that cyber security and data privacy are designed into systems from the outset.
How do you see connected technology affecting healthcare in the future?
We predict that the e-health sector will grow significantly in the near future and has the potential to drastically reduce the burden on healthcare systems.
We hope that increased connectivity and utilisation of technology will lead in practice to increased efficiency within health services leading to more remote monitoring and consultations.
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Innovation in the diabetes space is coming in a lot of forms from a lot of places. But when it comes to making a difference right now in the lives of many people with both type 1 and type 2 diabetes, mhealth devices might just be the next big thing.
