Discussion started with #mHealth and best apps turning into "prescribing apps" and landing in incentives systems and adoption by patients of the #quantifiedself and #mHealth tools

@andrewspong yes.. I agree... that's also why I think it will need to reside on the physicians website

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Point 1 for @andrewspong certainly the patients just want better tools to self-manage and I agree with you that those are far and few in between but the major costs in the healthcare system are the chronic disease patients and not all of them by far are ePatients. So while I agree that if the technology and the tools and the process is so invisible to the "average" patient, then the incentive of a "good" tool is enough. My only point is that in order to drive the adoption of these tolls in a "mass market" of say diabetics there should be incentives aside from usability put in place.

Point 2 for @hjluks - It would be great if all practitioners were like you and it also would be great if there was a central dashboard for "my health" and certainly there are many companies that tried (i.e Google Health) - I think there are a few challenges:

a. Data is important and this important data is generated at the POD (point of diagnoses - aka practitioner's offices, hospitals, etc), POP (point of prescription - same as above), POT (point of treatment - same as above) - so as you can see your argument is great that the availability of this dashboard needs to start with a tight integration into EMR's

b. Furthermore this data is now generated by patients themselves in a self-reported manner with a multitude of tool, apps, quantified self devices and even games

so the challenge here (and I will leave security and privacy out of this conversation : ) - what are the business models for the "dashboard" provider to integrate all the tools that have no standards, integrate with 300+ ePrescribing and EMR software vendors (just in US) and give patients and physicians access to what I and you think is a great empowerment tool?

As an example - would you, as a practitioner, be willing to pay a PUPM fee out of your pocket to enable patients and therefore enhance your quality of care (by the way not suggestion yours is bad - haha)

Eugene -- re. 1: as far as chronic disease management goes, communities of interest (e.g. the diabetes online community in its many guises) dictate the adoption of devices. The release of new pumps, monitors and #dtech is met be a wave of reviews, and products seem set to survive or perish on the assessment of their utility by their users alone. This is a postmarketing marketplace. Really, no-one seems to care about traditional marketing messages. The users are way ahead of the industry in this regard.

Eugene -- re. 2b. Agree, and (assuming, as you suggest, secure and private channels) with the additional expectations that users committed to quantified self techniques in the management of their health in general are bringing (which includes, and will probably prioritise, the management of disease in those with chronic conditions, but which is not the whole story), the 'keyholder' has to be the patient. Everyone who is permitted to can drive, but the patient has to own the data.

Hm, guys, although I like your extensions in subsuming how and what is to happen with patients "choosing" for apps etc. It might be true, it might not.
Actually, there are some editions too: quality assurance legally seen: i.e. that as soon as an app collects medical/physical data about the person, stores it and/or registers it and send it through to others, it is perceived legally as a medical device: it should be studied, tested and certified. That's a basic starting point. Much of the devices industry will know - but do the most of the app-builders?..

That aside, the one thing that is not (so much) studied is the adoption process by persons using the devices: I guess most studies don't ask much about the "personlization" process of the use of the device as they do about the reliability and validity of the metrics gathered. That is just right, but hence it lacks of insights into the adoption and implementation proces by the patients: what factors will influence a right way of use as well as a compliance in use. I did a study on individual/personal factors that could influence the compliance to diabetes therapy and I concluded that there is room for the hypothesis that there are profiles of opposing patterns of personal influences on compliance. ...

..As long as we don't know these, the design of an app is always a guess to its effectiveness and the its use by the user/patient.
Besides, we do not tend to wna tot discuss the extra complicating factor of how the patient is guided supported in keeping up use and compliance..;-)

agreed... that is the issue with mobile apps in general :-) as well as their potential effectiveness, usefullness, adoption, certification, etc... My initial point that (I think :-)) started this... is simply that when/if the mhealth community develops the apps/devices, obtains certification, POC, adherence, etc that the data should hopefully reside in a central relational database so that the data becomes predictive, useful and "actionable" ... Now... where should that data reside ? MD site? Epic (hope not), etc?

so is Happtique gathering the data on the above: "potential effectiveness, usefullness, adoption, certification, etc..." -

re: platform - i think there will be no one player that OWNS the market and standards of data liberation and sharing will enable this <sigh> one day</sigh>

Thanks Howard and Eugene and Andrew, by the way for the most inspiring discussion! Re. Where data : I am convinced that it is the best place at the patient's! (S)He can gve the doctor access!
Why don't you have a look Howard, if I may suggest, at drimpy.com and see of such could help?
Imho I think that there is the place and possibility for patients to gather to themselves, coached by their professionals of choice, their health data and share it privately with the ones of their choice, learn and share together and get feedback on actions on behaviour, compliance, drawbacks and successes. The safe and private network communication within the platform guaranteed safe and private sharing, exchange, and support.