Well, I’m back to regular posts once again after a bunch related to the Dosie Awards. It was a fun competition to run with some very interesting results. I’m looking forward to sharing them with you in a few weeks. The winners will be announced live during the upcoming BDI conference “Social Communications & Healthcare: Case Studies & Roundtables.”  BDI is not directly involved in these awards, but have been kind enough to give me a live audience and venue to announce the winners. If you want to be there in person, you can register here: http://bit.ly/aMAlR4. Use promo code “Dosies” and you can get in for just $155. I’ll announce the winners live during the conference and will follow it up with a blog post as well

But enough about the Dosie’s…

A couple of days ago, The Wall Street Journal published a story called: “How’s Your Health?” Here’s the opening paragraph:

“Keeping track of your health keeps getting easier. New gadgets and online tools are giving people a clearer picture not only of how active they are during the day, but also how well they sleep at night. Web sites let users record all kinds of health-related information and see it analyzed over time. Or remind you when you’re due for a medical test. And there are new sites and mobile applications for people with conditions like asthma or diabetes that require regular monitoring and sharing information with doctors. Here’s a sampling of some of the newest ways people can measure and manage their health.”

Sounds great, right? If only it were that simple.

Many of you commented about my past post, “I’ll Build You an iPhone Medication Tracker App for $10,” and today’s post is related to that one. While I said that I could build you a tracker for $10, I didn’t say it would be good or that people would use it. That’s the rub with these trackers, in order for them to work, people have to use them. Who knew?

There are a bunch of trackers out there that people don’t EVER use and new ones introduced everyday that I can tell you have no hope of working simply because people won’t use them. While their concepts may be great (help people track their conditions or medications and correlate with outcomes), the execution is poor in most cases.

The trackers that have poor execution could all be prevented if people asked themselves one simple question: “Would I do this?’ If the answer is “no,” then  stop. Yes, I know that you want to be able to say you have an iPhone app, but, trust me, your boss will appreciate you saving a ton of wasted money. Some of you might be saying that it doesn’t matter if you would use it or not, as long as your “target audience” will use it. Yes, some people might exert more effort than you in some areas, but most times you’ll be right if you apply some common sense. That is, the vast majority of people will only exert a finite amount of effort in these areas. You need to realize this and minimize the effort required to use your tools.

As a demonstration of how easy it is to figure out which trackers people will use and which they won’t, I’m going to give you a very brief rundown of the five trackers that were profiled in the WSJ article. Then I’m going to ask you to tell me which ones people are going to use over time. The trackers were (in order presented in the article): TheCarrot.com, Fitbit, Keas, Zeo, and AsthmaMD.

• TheCarrot.com — an online journal where use can use one of their 30 trackers for just about every health area. You input all the details by hand via the website or an iPhone app.
• Fitbit — a clip that you wear around during the day and at night that automatically tracks calories burned, counts steps, and even how long you sleep. Data is captured automatically and viewable on their site when you bring the clip within 15 feet of a basestation attached to your PC.
• Keas – tracks data that you input by hand about meals, exercise, etc. and also can import records from a few sites (such as Quest Diagnostics to get your test results). It also provides articles based on how you answer questions. Of interest, Pfizer has entered an alliance with Keas to develop content.
• Zeo – uses a headband you wear at night to automatically capture your sleep patterns. In the morning, the results are instantly displayed on the basestation you place near your bed. More data is available online with additional charts and graphs.
• AsthmaMD — iPhone app that allows users to manually input their symptoms and peak flow counts related to their asthma. Charting is available in the app.

I encourage you to visit each of the sites to get some more details before I quiz you, but I think you can do pretty well without the extra effort.

Here’s the quiz: rank these five trackers in order based on how likely patients are to use them over time.

It’s one of those honor system quizzes, so score your own.

Done?

Good.

So, was that so hard? How did you decide which was most likely to be used over time and which was least likely? My answers in a moment, but first, let me explain my framework for evaluating these types of tools.

What I’ve realized over the past few years is that there’s a simple framework that will show you which trackers might work better than others. When you apply this framework to our quiz, you’ll find that it’s pretty simple to rank the trackers.

Here’s my framework:

Basically, the less work it is for the patient, the more automatic the inputs AND data aggregation or capture, the better. There are a number of different levels within these three broad areas that, when taken together, put every tracker in a nice, neat category. The list below is ordered from most likely to be used over time to least likely:

1. “Fully Automatic” — sensors detect every input and automatically update and aggregate the data. You don’t have to do anything except look at the results.
2. “Semi-Automatic” – close to “Fully Automatic,” in that sensors capture everything but you much attach the device manually to a computer (or otherwise sync the data) in order to get the data off the sensor and see the results.
3. “Routine Integrated” – this requires you to input the information manually, but you input the information using platforms you already use. This might mean updating an application while you’re using Facebook or sending a Tweet or email about your progress. This may or may not include reminders to track your information. Data is automatically aggregated.
4. “Handheld” — focuses on inputting the information using a smartphone such as an iPhone. This utilizes an app-based approach where a user must open an app to input the information. Data is automatically aggregated. (PS: here are 28 other iPhone health trackers)
5. “Desktop” — uses widgets and gadgets that are embedded on your computer desktop so that you are reminded to manually input your information, but can do so without having to go to a website (or even be online in some cases, as it can store your info). Data is automatically aggregated.
6. “On the Web” – users must visit a website (or section of a website) to input their information manually. This may or may not include reminders to track your information. Data is automatically aggregated.
7. “Old Fashioned” — users download (or are given) a paper tracking sheet that they must fill out with their information. Data has to be aggregated by hand. There are no reminders to track your information.

Every tracker fits neatly into one of these seven different levels.

Taking a look at our example trackers (TheCarrot.com, Fitbit, Keas, Zeo, and AsthmaMD), let’s see into which level each of these falls:

• TheCarrot.com — “Handheld” — you have to input all the information on your own, but can use their iPhone app to do it
• Fitbit — “Fully Automatic” — just attach it to your body and then walk past your computer to download all the data
• Keas — “On the Web” — the only way to input information is online, on their Keas website [UPDATE, 4/23: I just found out that you can also input information via SMS. I didn't find this after spending 15 minutes on the site, but the people at Keas sent me this link: https://www.keas.com/plan.html?planId=keas.sms. It let's you text something like “My Weight 180″ to record a new weight of 180 pounds.]
• Zeo –”Fully Automatic” — wear it at night and when you wake up, all your information is displayed on the unit near your bed
• AsthmaMD — “Handheld” — same as The Carrot: you have to input all the information on your own, but can use their iPhone app to do it

Now if you have to order these from most likely to be used over time to least likely, I’d order them this way based on my framework:

1. Zeo — I give this a slight advantage over Fitbit since you see the info instantly when you wake up, no computer necessary
2. Fitbit — the auto-sync that works when you get near your computer is a winner
3. AsthmaMD — there’s a big drop from #2, but I give AsthmaMD the nod simply because it’s less confusing than The Carrot. It does one thing reasonably well
4. TheCarrot.com — close to #3, but falls slightly behind because there are too many options and trackers, which may lead to confusion. Sometimes less really is more. I also came across A TON of bugs using this thing.
5. Keas — while an interesting concept, it relies on the least reliable digital technique to get data from you meaning it’s a tough habit to keep up with since you have to go online to a website to log information. [UPDATE, 4/23: Based on the fact that you can track your information via SMS, I'd be inclined to move Keas up bit, but only for those who use SMS, of course. I like the SMS addition, which I’d actually categorize as “Routine Integrated”, which is even better than “Handheld.” Here’s why: among those who use SMS and are likely to use this feature, SMS is a ubiquitous part of their life. They probably send and receive a bunch of messages per day meaning that they have it SMS open and active pretty regularly. So, it’s pretty simple to send one more SMS message. It’s similar to the Tweetdeck example I mentioned.]

How’d you do on our quiz? I’d bet you had #1 and #2 the same as my list and probably #5 the same. #3 and #4 were a bit trickier I suppose, but what fun would an easy quiz be?

For completeness, here are some examples of the levels that weren’t covered from the five above. Nike+ is a good example of “Semi-automatic.” The sensor in your shoe captures you running data automatically, but you have to manually connect your iPod (which captures the sensor data) to your computer to get the data. Contrast this to Fitbit, which you don’t have to manually connect to anything because the information is sent automatically when you get near the basestation. Maybe that’s the next killer feature for Nike+. An example of “Desktop” comes from Cimzia and their “Wellness Widget.” They’ve also got the “Old Fashioned” example covered with paper-based version of the Widget (link opens PDF).

“Routine Integrated” trackers are still fairly rare, but I think they will grow massively in popularity in the near future. The main idea is that you use the platforms you use all day anyway to track your health instead of adding a new platform (and trying to create a new habit). So, if you’re a big Twitter user and have Tweetdeck open all day, then Tweetwhatyoueat or FitClick might be perfect for you. The main idea of each is that you send a direct message (i.e., private) to a special Twitter account with what you ate and the site aggregates it all for you. So, while your eating lunch at your desk and keeping a close eye on Tweetdeck, you simply send a DM to @fc8 (for FitClick) like this: “Subway 6 inch turkey sub; 2 oz. Doritos”. That’s it. Information tracked. FitClick even tries to add calorie, fat, carbs, protein, etc. information to each entry automatically. This is much simpler than having to go to a site or even use an app since you’ve already got a platform (Twitter in this case) open and active.

I should also add that there are even finer divisions within each level. For example, looking at the “Handheld” level, different iPhone apps can range from fairly automatic to completely manual. AsthmaMD is completely manual. If you don’t input the info, it doesn’t get captured. In contrast, take an app that allows you to track the food you eat each day. One app might have input all the data including the name of the food, portion size, calories, fat content, carbs, and the other nutritional information all by hand. Where you get it from and how much of your life you spend inputting it is your problem. On the other hand, while not fully automatic, is something like PhotoCalorie. This app offers a bit of automation to the process. You take a picture of the food you ate, type what it is, and then the app automatically adds the nutrition information. It’s a nice addition of some automation that saves some steps. No one is going to consistently input nutrition information by hand over time, so this prevents that. A more automatic version would be where the picture alone was enough and the app automatically identified the food and included all the nutrition information. Still a bit beyond the technology we have for image recognition for personal use (the military could probably do this), but something to look for in the future. Point is, the less people have to input on the their own, the better.

One more point, to be fair, the Zeo costs $250 and Fitbit costs $99. All that automation and technology comes at a price. Both Keas and AsthmaMD are free, while TheCarrot.com’s basic services are free, but it has a “premium” version for $5 a month. The cost of the Zeo and Fitbit opposite the others doesn’t come as that much of a surprise when you consider that they are the only trackers that include a piece of hardware, which comes with some manufacturing costs opposite something that’s software only. Plus, you’re paying for the convenience and automation.

As you’re developing the next tracker for your brand (or getting one pitched to you by someone), keep these ideas in mind. It’ll save you from creating something that while well-intentioned, isn’t something that people are going to use consistently and over time. If this is the case, then it really doesn’t matter how fancy the tracker is, people have to use it in order for it to work.

By the way, if you really like the Zeo and wish you had one, but don’t want to part with $250, then I’ve got an answer for you. Register now for the  2010 e-Patient Connections Conference. Turns out that everyone who registers gets a free Zeo. Yes, everyone. Readers of this blog also get another 20% off (that’s about $320) if you use code “rx2010” when you register. I’ll be chairing the social media track of the meeting along with Shwen Gwee.

Possibly related posts (auto-generated):

1. I’ll Build You an iPhone Medication Tracker App for $10
2. Can Your Electric Bill Show Us How to Improve Medication Adherence?
3. Can Social Media Improve Your Health and Save Your Life?