I’ll Have a SOPrDiMoCa

SOPrDiMoCa is not a popular travel destination in Italy, nor is it a seasonal coffee from Starbucks. It is an acronym for Self- Oriented Prevention, Diagnosis, Monitoring, and Care.

SOPrDiMoCa tools help people assess their own risk factors; sort out symptoms and learn what to do next; monitor a wide variety of signs, symptoms, and life events; and adjust their own care. All of these tasks can be done effectively and safely in real time and in one’s own home, and they can save time and cost less than going to a doctor’s office. According to Christensen, Grossman, and Hwang in their book, The Innovator’s Prescription:  A Disruptive Solution for Health Care, “Following the diagnosis and treatment by physicians, in many instances physicians can’t add much additional value beyond teaching patients broad categories of do’s and don’ts. Patients and their families typically must distill from their own experience algorithms of diet and activity that minimize the severity of their symptoms. Patients with these behavior–intensive diseases can generally formulate better algorithms of care through trial and error than their physicians can.”

The trend away from professionalism and centralization and toward simplicity, convenience, and a consumer-focused market is, according to Christensen et al, a natural progression during the “second and third waves of growth” of all industries.  For example, people are questioning why some of the things done in doctors’ offices have to be done there. Alternatively, they go to box stores like Walmart and health stores like CVS Health to receive “retail” clinic care for common ailments. In most cases, it is equivalent, quicker, more convenient, and cheaper. And while they are in these stores, they see a growing list of high-quality products that they can use to test and take care of themselves in aisle 7, SOPrDiMoCa.

The availability of home testing tools is expanding quickly. For example, OPTUM, a subsidiary of UnitedHealthcare, provides an At-Home Kit for members for biometrics. “This easy, self-administered test offers remote employees, spouses and new hires a private way to ‘self-screen, leveraging step-by-step instructions and a screening kit delivered directly to their doorstep.”  The Public Health Foundation of India deploys an android-based mobile system called the Swasthya Slate, which can perform 33 tests, including blood pressure, glucose, hemoglobin, and ECG. It can also test for pregnancy, dengue, and malaria. It retails for Rs 25,000 (or about $400) and has been tested and approved for use by community health workers.  A proponent says, “When we get sick, we won’t need to go—in high temperature and in severe pain—to our doctors’ offices, only to wait in line with patients who have other diseases that we may catch. Our doctors will come to us over the Internet.”  SimulConsult is a diagnostic tool that ingests the complete body of research literature for certain disorders.  The tool prompts doctors to enter information about the patient’s condition. It then generates hypotheses with associated probabilities about what the patient may have.  With a little more translation and technology to make it simpler, it could become a tool for people to use.

People have already adopted a more self-reliant role in other aspects of their lives. They use data and tools, make their own decisions, and prefer to “do-it-yourself” instead of relying on professionals to do their finances (e.g., online banking, electronic tax preparation and filing), travel (e.g., navigating directions, using online travel services), education (e.g., online coursework and degrees), shopping (e.g., buying online), and more. In these areas, technological advances have equipped and enabled people to take on these functions and have “changed cultural expectations regarding what people can learn, know, and do.”  The notion that people will not use data and tools to take a more active and decisive role in their lives has been debunked.

From Slick and Click...to Tick and Stick

Despite the tens of thousands health apps, it is clear that digital health developers are not winning over consumers.   A killer app has not swept the market. Even the commanding iPhone 6 and IOS8 and the Apple Watch may not carry HealthKit in its bountiful wake to ignite consumers’ interest in a digital health revolution.

Thus far, digital health technology for consumers has been slick and focused on making people click.  It is premised on the belief that the great successes with functions and apps delivered through smartphones can spill over into health. But, what people like to do on smartphones is mostly entertainment and social communications: Technology developers:

• Miscalculate that the technology, such as the-data-platform, is a “big deal” and will interest consumers as much as it does techie developers.
• Presume that the click mentality for revenue production derived from advertising and will work in health.
• Perpetuate uni-focused apps, like hailing an Uber cab, buying a product on Amazon, or making an airline reservation, will also work in health. 

These conventions are constraining and not an easy transplant for the health market. Apps perpetuate the characterization of people as extremely distractible, only capable of handling one simple function at a time, and not willing to pay for digital services while accepting the hidden costs of marketing intrusion.

When it comes to changing people’s behavior, technology has to understand what makes people tick and how to make them stick. The big draw of activity sensors seems to be that it lets people know when they reach 10,000 steps with its beeps and this insight can be shared with friends and family.  But, is this simple model really enough to hook people on a sustained program of activity for health? I think not.  Technology can offer so much more.