Contents. A Welcome from G. Steven Burrill CEO of Burrill & Company

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2 Contents A Welcome from G. Steven Burrill CEO of Burrill & Company A Convergence of Technologies and Opportunities Consumer digital health applications promise to make personalized medicine a reality accelerating the change in the way healthcare is delivered and accessed. By Daniel S. Levine Change Agent for Healthcare If mobile applications are to earn their position in a healthcare providers practice, they must bring value to the equation. By Laura Allen Phillips and Harry Wang Altering Behavior To fix healthcare, not only does the whole system have to change, but individuals have to change. Consumer digital health tools can help make a dent in that formidable challenge. By Arna Ionescu Sleep Unbound New technologies are, for the first time, able to address powerful health and wellness needs. The consumer market lies open, while roadblocks are plenty for patient populations. By Ben Rubin Going Digital Pfizer seeks new way of working with technology companies to realize the great potential of innovations in healthcare. By Usama Malik, Fred Zussa, and Puneet Sapra Disruptive Technology The rapid growth of information in healthcare and medical science poses opportunities not only to improve healthcare, but computing challenges as well. By Michael Welge and Thom H. Dunning, Jr. A National Plan The FCC wants to increase broadband availability in part to bring new healthcare services to underserved areas. By Susan Berson Finding Traction on a Chairlift It may seem new markets are perpetually just a year away, but they do eventually arrive. By Jeffrey Belk About Burrill & Company Publisher G. Steven burrill Editorial Director Peter Winter Editor Daniel S. Levine Assistant Editor Marie Daghlian Art Director Lisa Sullivan Graphic Designer David Fought Director of Events Thea Schwartz Johnson Events Project Manager Jennifer Gregoire Business Development Director Michaela Bjorkman mbjorkman@b-c.com Business Development Director Leslie Errington lerrington@b-c.com

3 Altering Behavior To fix healthcare, not only does the whole system have to change, but individuals have to change. Consumer digital health tools can help make a dent in that formidable challenge. By Arna Ionescu A few years ago, I was helping design a support program for a new cholesterol drug. As part of the process, I spoke with a man who had just returned home from the hospital after a heart attack. He was thrilled to be alive and at home, but his first task surprised me. He ordered his regular monthly supply of deep-dish pizza and sausages from the local restaurant chain. Again, this man didn t want to die. He was only 38 years old and he was smart. He knew that his diet was going to land him in the hospital again, but he couldn t imagine changing his lifestyle. Few people will deny that our healthcare system is crumbling around us. The latest round of insurance premium hikes speaks to fears around instability and lack of sustainability regarding our current healthcare practices. The most daunting part is that no single thing will fix healthcare. A whole system has to change, and as part of that system, individuals have to change. Behavior change is an extremely relevant topic these days. Many of the diseases Americans face are lifestyle diseases that could be avoided, reversed, or eliminated if people made better choices about which behaviors to pursue. If only people would exercise more, eat better and quit smoking, the thinking goes, we could avoid billions of dollars of healthcare costs. No one denies that. Over the years I ve spoken with hundreds of people like the man described above who suffer from preventable chronic illness, and most know they could be free of their disease with just a few changes. But somehow that knowledge doesn t translate to sustained change. Consumer digital health tools can help make a dent in the formidable behavior change challenges that we face. But we have to design the tools right. Consumers are unlikely to stick with a product for long if it creates burden for them. We use prototyping to understand and simulate how a product will behave well before we invest any time and energy into actual implementation. We are working with The National Campaign to Prevent Teen and Unplanned Pregnancy to design a birth control support network a program to help women stay on

4 their contraception until they re ready to have a baby. As part of the program, we designed a robust text messaging system that provides a variety of functions, from sending out urgent information should something go wrong with contraception to regular reminders for contraception maintenance. Rather than specify the whole system and then implement it, we spent a month running a series of simulations that explored the parameters of acceptable text messaging. Through these simulations, we learned about the importance of tone in crafting messages. We learned tricks for getting women to engage and reply back in an effortless manner. And we learned which timing patterns worked most effectively to transmit our messages. All of the resulting knowledge surfaced in our final design. Before we even spent a dime on implementation, we learned how to integrate our ideas and methods seamlessly into women s lives. And that integration or blending is critical. If you don t prototype and then iterate your prototypes as many times as possible, you ll never reach a design that truly fits into people s lives. Prototyping allows you to separate out your conception versus the reality of your customers lives. When prompting people to change their behaviors, fitting into their lives is essential. We re seeing more and more companies use technology to provide a conduit between people, rather than simply offer an isolated technology solution. Technology becomes invisible, and people become visible. People have an enormous capacity to motivate each other: grandchildren motivate grandparents, athletes motivate team members, and life coaches motivate their clients. Competition has shown over and over to be a powerful motivator for change. This is human nature. People have an enormous capacity to motivate each other: grandchildren motivate grandparents, athletes motivate team members, and life coaches motivate their clients. Competition has shown over and over to be a powerful motivator for change. b This is human nature. Consumer digital health tools hoping to help people change can leverage this nature and build community and connection into their core offering. It s important to understand the appropriate kind of connection for your application: Is it among strangers or a personal network? Is it between peers or experts? Is it within the context of competition or support? PatientsLikeMe has done a wonderful job using digital tools as a conduit, rather than a solution. This portal provides a forum for people with rare conditions to connect with one another. Typically, these individuals are isolated and have minimal access to resources, but PatientsLikeMe changes that by providing a central community where individuals can gather. People connect for emotional support, for practical tips on managing their disease, and to find treatment options their doctors may not be aware of. Peers connect with peers, but experts are also present to ensure that information posted is valid and trustworthy. The model works. Not only has the portal helped thousands of people directly, but now researchers are finding critical new information about the long-term effect of various therapies within the data accumulated on the site. Information is great, but it doesn t get us too far if we don t know what it means or what to do with it. With more and

5 more data streams entering our lives, one of the biggest challenges for consumer digital health tools is managing an unprecedented deluge of data. We can t expect consumers to dive into the data and make use of it unless we hold their hand tightly. At a recent conference, I was making the case that healthcare designers and providers need to simplify and then simplify again when creating consumer-facing tools in the healthcare space. Another speaker, someone from a government agency, took a completely different view, saying that healthcare is inherently complex and, thus, there s a limit on how simple we can go. For me, that view is way off the mark, and Conversion Sound, a start-up that I worked with recently, shows why. Conversion Sound was looking to bring hearing aids to underserved populations. Hearing aids are exceptionally expensive, largely because they require fitting by a trained audiologist someone with six years of post-graduate education. Through novel algorithms developed by our client and lots of iterative prototyping by our teams to get the user interface just right, we succeeded in developing a system that allowed a technician with minimal literacy and half a day of training to fit a hearing aid with great results. The simplification process we followed on this project could apply to many others as well. people better care for themselves are not technical. Sadly, the barriers are often legal. Digital consumer health tools have enormous potential to help people make better choices about their behaviors, but the tools have to be designed right. Work with consumers to create your design. Don t fall in love with your technology at the expense of the human interactions you re trying to facilitate. Remember that it s not the abstract data that matters, but what the user has to do and how the actions affect outcomes. We believe that if you keep these principles in mind, you ll be successful. And we hope you ll be successful our healthcare system needs you to be. Arna Ionescu designs solutions to improve healthcare at the global design and innovation firm IDEO. She also teaches in the design program at Stanford University. A common mistake is to provide consumers with all the data available, when really they only need a small subset that is relevant to the moment or better yet, a prompt for what to do in the moment. Consider blood glucose meters. These devices generate enormous amounts of data and some of them are providing complex visualization mechanisms to view longitudinal trends, but most patients only need to look at that data in special circumstances like when meeting with a diabetes nurse educator. Normally, all we need is a single number (current blood glucose level to inform what to eat or how much insulin to take), which seems simple enough. But imagine if we went farther. Imagine if that number were instead presented as an action tailored specifically for a patient rather than a relatively abstract value that takes some effort to translate into action. Then imagine if the person could receive meaningful reinforcement based on subsequent data that showed he or she took the right action. That s powerful, and the barriers that keep these meaningful interactions from happening interactions that could help many more