How Entrepreneurship Can Improve Health – Interview with Jen Dyer: Startup Founder, Pediatrician & Social Media Advocate.

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MedCrunch: Jen, you recently left clinical medicine to become a tech entrepreneur. Do you want to tell us a little bit about your educational and career background?

I started my career in traditional fashion within academic medicine as both a clinical researcher and clinician board-certified in both Pediatrics and Pediatric Endocrinology at Nationwide Children’s Hospital affiliated with The Ohio State University College of Medicine in Columbus, Ohio where I recently earned my MPH degree in health behavior studies. I received my medical degree from The University of Texas Health Science Center at San Antonio in 2000 which was then followed by pediatric internship, residency, and then pediatric endocrinology specialty training in 2000-2006 at The University of Texas Southwestern Medical Center Dallas.

Being a researcher at heart, I approach clinical medicine with a mindset of problem-solving and solution evaluation. In my diabetes clinic, it was an obvious observation about the common problem of teens’ medication non-adherence and the love affair that these same teens have with SMS texting notable during the clinic visits. Reading a study using SMS texting within a pediatric liver transplant program to improve medication adherence inspired me to do the same. I started out using a simple SMS texting protocol with my patients in a small pilot study and then developed a simple app to automate this protocol [initial publication is pending]. However, I then progressed to a more comprehensive app design based on BJ Fogg’s health behavior change model upon which my current app is based. Based on the excitement of my patients and the emerging evidence of mobile health’s clinical impact, I felt that full-time focus on my app development and its implementation process would get the app into patients’ hands faster so I decided to invest completely in my vision as a physician entrepreneur.

MedCrunch: Could you tell us a little bit about what your research was about and what were your findings?

The initial pilot study of three of my own patients assessed the effect over 3 months of a weekly SMS texting protocol personalized to each patient speaking directly from the doctor to the patient. Health outcomes improved: hgbA1C levels dropped from 11% to 9% and adherence to meal insulin boluses improved 3-4 fold after the first 3 months. The successful SMS texting pilot study was featured on CBC’s White Coat Black Art Show , NPR, local television news , TEDx Columbus 2010, Mobile Health News, American Medical News, and Endocrine Today. However, I began to observe that the initial adherence improvement started to disappear after about 6 months among the initial pilot study population before the personalized automation app programming was completed.

MedCrunch: So you came up with your first app to solve that problem. Right?

I hypothesized that although the SMS texting protocol I used was providing reminders or triggers, the patients still needed more. Per BJ Fogg’s behavior change model, three elements must converge at the same moment for a behavior to occur: Motivation, Ability, and Trigger. When a behavior does not occur, at least one of those three elements is missing. My initial SMS texting protocol was only using triggers. Therefore, I am now working in partnership with an Ohio health mobile app developer on the completion of a very exciting diabetes app based on BJ Fogg’s health behaviors model targeting improvement in daily glucose checks which I recently discussed at Stanford’s Mobile Health Meeting ‘What Really Works’ in May 2011.

MedCrunch: Please tell us about your current project. What’s your company called? What’s the product and how does it work?

As an independent consultant with my own company EndoGoddess LLC, I am working with Ohio health mobile app developer DuetHealth of eProximiti on designing and implementing the above app as well as designing and implementing new apps for clients. In other words, DuetHealth creates apps for clients (health systems, doctors’ offices, insurance agencies) that connect patients with their doctors while providing quality information and/or motivational strategies as requested for specific disease processes. Because the software platform is based on the doctor-patient relationship, which is also the foundation of good quality healthcare, the company software is named ‘duet’. The diabetes app product is called ‘Duet EndoGoddess’ which will be available in August on iTunes. The app targets glucose checking 4 times per day as the desired behavior. Patients can plug their glucometers into their smartphone using a USB cord (the same equipment that they use to download their meters on their home computer). They will receive iTunes points monthly for purchasing songs based on their achievement of daily glucose checks which serves as a rewards feedback loop to promote daily glucose checks and consequently improved insulin adherence and diabetes control. We are speaking to several large insurance agencies for testing the app in a large population. The app also provides additional daily motivational graphics, targeted real-time notification of glucoses to desired recipients, original educational content and videos, text reminders featuring clinical goals for diabetes care between visits, and the ability to securely text the physician and members of a designated social network.

MedCrunch: Can you tell us a little bit about your revenue model? How will you make money with the app?

The app will be a free download. The money to pay for iTunes points will come from the patient’s designated support network [friends, family] who are willing to sponsor the patient for the year. The idea is similar to how charities such as the Susan G Komen race participants are sponsored by their friends and family to earn money for breast cancer research. According to the patient’s preference, a monthly progress report can be sent to their sponsors so that they can encourage and reward the patient for their hard work checking their blood sugars daily. It is our hope that insurance agencies and/or advertisers will see the value in the app’s ability to create better health and to prevent complications with diabetes thereby sustaining the revenue model long-term. As with most internet start-up companies, the primary monetary value is within the equity of the company and its ability to solve problems that then leads to investments by venture capitalists thereby allowing the company to grow and spread its value commercially. As diabetes has increased worldwide over the past 30 years, long-term solutions are critical.

MedCrunch: So considering the fact that you actually researched this topic, would it be correct to say that yours is one of the first evidence based apps out there?

The idea is not new, but the implementation and execution to this level in diabetes and mHealth is new. There are a lot of apps for diabetes available in the app store but none that I am aware of that directly connect the patient and the doctor and their glucometer and a designated social network.

MedCrunch: The social part is especially interesting about your business model. You will need a lot of buy-in from all the stakeholders: patients, doctors, relatives, insurance companies. How are you going to get this?

As you know, consumers already love mobile, and apps are now used more than internet browsing. Doctors really like mobile too. In fact, doctors are heavy tech users – early adopters for healthcare technology. In the wake of ACA healthcare reform and payment restructure that penalizes hospital readmissions, insurance companies and hospital systems are rewarding affordable and impactful innovations in quality healthcare such as mobile health. We have already received a lot of interest from insurance companies in using and testing our apps, and have implemented our first duet module at Ohio Health Hospital System in obstetrics with a lot of excitement amongst all parties. I feel that the future is bright for the doctor-patient relationship and its mobile extension!

MedCrunch: Are you the sole founder of your company or do you have partners?

As an independent consultant, I am the sole founder of my company EndoGoddess LLC. I own a share of intellectual property in the Duet EndoGoddess diabetes app.

MedCrunch: Do you already have funding?

I have invested my personal savings to start my business and to make the transition from academics to entrepreneurship. Otherwise, I receive income from my primary client DuetHealth and am speaking to several other potential clients for further consulting work in healthcare social media.

MedCrunch: You are an avid user of Twitter. Can you explain your Twitter use-case to us? How are you making use of it?

I also actively engage and speak nationally about healthcare social media including at the recent South by Southwest (SXSW) Conference in March 2011. I am known to many on twitter as @EndoGoddess and have a youtube channel which I use primarily for advocacy. I maintain social boundaries by using the same standards of professionalism followed by generations of doctors before the advent of the internet. I feel that ‘good health is social’ and that social media provides opportunities for physicians to connect people with authentic improvements in their wellbeing and health which far outweigh the easily-managed perceived risks.

MedCrunch: With all these distractions…Twitter, e-mail, Facebook and so forth, do you think social media is making people less happy, happier or do they have no influence on happiness levels – what do you think?

For me, social media connects me with the reason that I became a doctor: patients. Helping patients empower themselves with knowledge and live their best lives is an absolute honor that gives me great happiness. As will all things, balance is key, and I do recommend taking periodic ‘digital vacations’ to assure that balance…this really works for me.

MedCrunch: Before the interview, you told us that you are doing social media consulting. Could you tell us a little more about it?

The primary part of my healthcare social media consulting involves advocacy and speaking at meetings.

MedCrunch: What is the best advice you got from a mentor or friend?

Dream it then do it.

MedCrunch: Thank you so much for your time!


Jennifer Shine Dyer, MD, MPH is a mobile health physician entrepreneur and consultant. She is a board-certified physician in both Pediatrics and Pediatric Endocrinology previously at Nationwide Children’s Hospital affiliated with The Ohio State University College of Medicine in Columbus, Ohio where she recently earned her MPH degree in health behavior studies. She received her medical degree from The University of Texas Health Science Center at San Antonio in 2000 which was then followed by pediatric internship, residency, and then pediatric endocrinology specialty training in 2000-2006 at The University of Texas Southwestern Medical Center Dallas. She is a Fellow of the American Academy of Pediatrics and was selected as one of ‘2010 America’s Top Pediatricians’ by the Consumers Research Council of America.

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