1. 1 RTI International is a trade name of Research Triangle Institute 2951 Flowers Road, Suite 119 ■ Atlanta, Georgia, USA 30341 Phone 770-986-5062e-mail bmassoudi@rti.orgFax 770-234-5030 ActivHealth: A PHR System for At-Risk Sedentary Adults B arbara L. Massoudi, MPH, PhD AMIA Spring Congress May 24, 2007 This work is licensed under a Creative Commons Attribution 3.0 License.Creative Commons Attribution 3.0 License © 2007-2009 RTI International

2. 2 Design Vision  To develop a PHR application to assist sedentary adults in becoming more physically active  Tools will support behavior change mediators within a highly individualized physical activity intervention  Create an easy to use environment that has low initial user learning requirements, but scalability for advanced users  Integrate user input from a wide variety of sources  Modular open-source framework that can be plugged into a larger PHR system

3. 3 Behavior Change Mediators MediatorsPotential Innovation Goal-SettingA system that pulls data from a biomonitor and finds time in a person’s calendar for exercise Self-MonitoringSmall biomonitor providing data on activity level and physiological markers Self-EfficacyRealistic goal-setting system, instant messages from a virtual friend Social SupportSupportive instant messages, GPS device locating nearest exercise facility Rethink ThinkingPodcasts delivering thought-provoking information and instant messages Reward-SettingBiomonitor that tracks “points” and reminds people to reward themselves when a certain point level is reached

4. 4 User/Prototype Sample Population  Phase I  End-user Participants (N=28)  Adult men (39%) and women (61%)  Sedentary lifestyle  At-risk for (43%) or suffering from (57%) chronic disease  Caucasian (86%), Hispanic (7%), African-American (7%)  Low-middle socio-economic status  Healthcare Provider Group (N=8)  Physicians and nurses from the Dallas area  Family practice and internal medicine boarded  Two physical therapists  Personal trainers (N=6)  Structured interviews

5. 5 Phase I - Design Analyses  User-centered design analyses  Facilitated group discussions and structured interviews with potential users  Iterative design that built on past discussion to identify important data features, processes and data needed, for a activity focused PHR application  Technology Scan  Identified a wide variety of possible technical solutions to user needs currently available and in the future  Project HealthDesign workshops  Participated in discussions with other grantees, the design consultancy, the RWJF and others about PHRs  Review of available literature on PHRs

6. 6 Phase I Findings - Personas  Older individual – not concerned about privacy and security issues – Medicare, has time, moderate technology use  Working individual – too busy, high use of technology, concerned about privacy and security – two – formerly active (experience to fall back on, good understanding, unrealistic expectation – weekend warrior) and lifetime sedentary (lack knowledge, understanding, chasing kids around is exercise)  Chronic disease affected – more barriers (real or perceived)  Healthcare provider – primary care setting, believe important, not a lot of time, throw the guidelines at patient  Interventionist (personal trainer) – gym setting, “get in shape”, design workout and possible diet program, workout with or supervise workout, track progress over time, self-pay  Interventionist (physical therapist) – rehab situation after injury, follow-on with general wellness, physical activity advice, minimal, insurance pay, possible self-pay after acute phase

7. 7 Phase I Findings - Task Purpose Analysis Sedentary adults:  Identify goals  Set up accountability  Provide peer communication/support  Identify physical activity partners  Track physical activity (manually or automatically)  Review progress towards goals  Provide automated system feedback/encouragement  Upload any pertinent info to healthcare providers

8. 8 Phase I Findings - Task Purpose Analysis Healthcare provider:  Review patient dashboard report information (2-10 m)  Review goals and suggest some activity plans (optional)  Send encouraging messages (optional)  Make referral to interventionist  Decision support tool for making appropriate recommendation for physical activity

9. 9 Phase I Findings - Task Purpose Analysis Interventionist:  Communication/education with clients  Scheduling clients for appointments (including reminders)  Encouragement/support of clients to engage in physical activity  Review patient data and reports  System task – add new clients

10. 10 Possible Tools & Devices  Web portal for users to access tools, store users’ goals and self-monitoring information  Devices will interface with web tools and include smart phones, PDAs, and iPods®  Biomonitors to capture data on caloric burn, caloric intake, sleep, physical activity duration, total steps taken, etc  Context sensitive messaging simulate virtual “coach” with support, incentives, and congratulations

11. 11 User/Prototype Sample Population  Phase II  End-user Participants (N=5)  Adult men and women with a sedentary lifestyle  Healthcare Provider Group (N=3)  Physician, nurse, and a physical therapist

12. 12 Phase II - Prototyping Plan  Systems Development  Develop web-based tools to address behavior mediators  Populate databases with content  Creating the business rules to define system functions  User-centered Testing  Develop prototype scenarios focused on major components and processes  Conduct an iterative approach to testing  Collect feedback from consumers and healthcare providers  Synthesis  Update systems to respond to user feedback  Develop documentation on findings, recommendations, and work yet to be completed

13. 13 Phase II - System Architecture Presentation Tier Business Tier Data Access Tier Data Tier

14. 14 Phase II - Peak Behind the Curtain ComponentsMakeFake User Information X* Health Status Assessment X* Readiness for Change – Motivation AssessmentX Goal SettingX Physical Activity Tracking X* Rewards and MotivatorsX Community of InterestX ReportingX Decision Support Page (Providers only)X *Partially functional

15. 15 Phase II - Design Showstoppers  Getting users to….  Navigate to the ActivHealth portal  Set up an account including their initial set of goals, rewards, reminders, and preferences  Customizing system tools and experience to the users to the readiness for change

16. 16 Acknowledgements  RTI International  Barbara Massoudi, MPH, PhD, Director, Health Informatics (Project Director)  Murrey Olmsted, PhD, Research Psychologist (Associate Project Director)  Ann Zhang, MS, Senior Software Engineer  The Cooper Institute  Susan Campbell, PhD, Vice President for Education  Ruth Ann Carpenter, MS, Director, Dissemination  Beth Wright, MS, Director, Knowledge Management

17. This work is licensed under a Creative Commons Attribution 3.0 License.Creative Commons Attribution 3.0 License © Research Triangle Institute