Kvedar: How to get health apps right

BOSTON—Mobile health could transform healthcare but “only if we get it right,” said Joseph Kvedar, MD, director of the Center for Connected Health at its 2014 symposium on Oct. 24.

He acknowledged the “exuberance” coming from companies such as Apple and Samsung but noted the low adoption, that Samsung Health is on its third generation and Aetna discontinued its CarePass program in August. “There’s a theme here.”

The success of Instagram and Snapchat have a lot of entrepreneurs thinking that developing a health app is easy. The typical design strategy is giving people what they want but health apps attract fit, connected people, not the people who really need them.

Health apps are different. Kvedar cited studies that indicate that although 1 in 10 adults owns a fitness tracker, within six months one-third of the devices end up in the drawer and more than 80 percent of downloaded health apps are abandoned within two weeks. “Even though we know people need these apps, they don’t always want them.”

Kvedar discussed a study in which patients simply had to push a button to upload their blood pressure measurement. Another group had passive data upload. “Other research shows that uploads correlate with outcomes. Uploads are important, but people who had to push the button were three times less likely to upload. We check our smartphones more than 100 times a day but pushing a button for health improvement is too hard.”

Clearly, he said, health apps are very different. “People who design the apps are stuck in a world where we think as long as we educate you, you’ll be inspired. We can’t confuse education with inspiration.”

At this point, mobile health might become just another tech bubble, he said. A lot of investment dollars are going into products that don’t work very well. “The bad news is no company has this right. The good news is some companies are doing some things right some of the time.”

Kvedar cited three factors to increase the potential of mHealth’s success. Frictionless technology is one.  Most successful apps are designed not to require a user manual. “No health apps are that way,” said Kvedar. “That’s a challenge. If I can’t get you to push a button, can I get you to link with Bluetooth? That’s a big problem to solve.”

Social is “probably the most important motivator. It’s powerful because we’re all part of a tribe.” Social includes multiple dimensions such as camaraderie, competition and visibility. Camaraderie in this sense means gathering people with a disease together and letting them help each other. There are many examples of apps that use competition to motivate users. “They always work. I don’t know if that is sustainable but there’s something there. That’s something we should harness in product design.” Visibility ties to users not wanting to disappoint their providers. They are not going to share bad things, however, if there are anchors that are objective—such as blood pressure cuffs.

“People up their game if the information is shared.” One Center for Connected Health project—BPConnect—resulted in 69 percent of participants reducing their blood pressure, he said. “People are more motivated by being watched.”

Successful health apps have relevance to everyday life, use subconscious triggers, go where the consumer is, focus on near-term goals and have state-of-the-art design, Kvedar said.

Healthcare can learn from one banking tool, he said. Teradata has developed an algorithm that finds people who have missed one mortgage payment, the theory being that they can get those people back on schedule but those who have missed two payments are a lost cause. “We learn from them because it’s a lot like getting you to do something healthy.”

So, whether 2015 is the year for mobile health is yet to be determined but Kvedar said we can’t just translate consumer apps. “If we don’t get engagement right, mobile health will go down in history as yet another tech bubble. We have to get this right and this has all to do with this engagement story.”