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mHealth: Finding our MagicBand

by Hannah Galvin, MD, Senior Manager, Clinical Effectiveness

If you’ve been to Walt Disney World in the past year (or you know someone who has), you’ve probably heard about the Bands. In 2013, Disney debuted its $1 billion MyMagic+ experience, a comprehensive experiment in wearable technology, data collection, user experience, and crowd control.

This time last year, about a week before my trip, I received my personalized waterproof, radio frequency identification (RFID) ticketing bracelet called Disney MagicBand. As a self-professed Gadget Geek, I was almost as excited about the technology as I was about heading to Space Mountain. My wristband acted as my hotel room key, my Park ticket, my FastPass (a service allowing guests to reserve access to rides/shows), and my dining plan card — all in one. I could make or change FastPass or restaurant reservations from my iPhone mobile app or desktop website. When a photographer snapped my picture with Buzz Lightyear, the photo showed up on my web account for download. And if I wanted a sweatshirt or pair of Mickey ears — fear not — my MagicBand synced with my credit card for quick and easy purchasing with only a PIN number.

But as much as boosting impulse buys highlights Disney’s incredible business acumen, the true brilliance of MyMagic+ is in the data collection. Every wrist swipe gathered information on my preferences and where I traveled within the resort at any given time. According to Bloomberg Businessweek, the intel collected helps Disney determine how to better staff rides and make decisions about things like restaurant menus and souvenir inventory. They report, “the new system helped the Magic Kingdom park accommodate 3,000 additional daily guests during the Christmas holiday season by reducing congestion around the most popular attractions.”

So what’s Disney’s secret to rapidly achieving these types of measurable effects? Preliminary outcomes studies on medical wearables are still mixed: a promising 2012 study showed home blood pressure telemonitoring via smartphone, combined with self-care messaging, improved BP control for diabetic patients with uncontrolled hypertension. But an October study comparing the effects of a mHealth-supported exercise intervention with a simple prescription for exercise showed that the control group actually had greater improvements in BP at 12 weeks, and that results were similar between the two groups by a year. A recent article in Wired notes that although sales of mobile health devices continue to increase, they’re used mostly by Gadget Geeks like me and not by those with chronic conditions or the underserved — those whose medical needs are greatest and which continue to strain the resources of the health care system. Why are wearables working for the Mouse but lagging behind when it comes to our mission in health care?

Sustained Engagement (or lack thereof) is a commonly-referenced issue. Strategy consulting firm Endeavour Partners conducted a survey and found that as of September 2013, 1 in 10 American adults owned a wearable activity tracker. Yet more than half of consumers no longer used their device, and a third stopped using the device within six months of receiving it...rates which proved similar when re-examined through June 2014.

People vacation for a week or so at a time — short enough for Magic Bands to still retain their cool factor...and even if they didn’t, Disney promotes many of the same strategies the Endeavor team looked toward in order to encourage prolonged use: social motivation, habit formation, and goal reinforcement. Still, the consultants’ final conclusion was that the health-related wearables on the market today just don’t meet everyone’s needs, and that the technological improvements and changes in the business landscape necessary to promote widespread, long-term adoption are going to take some time.

Open systems, in reality, demand patience. Disney has a relatively closed structure with a captive audience. Outside the walls of the Magic Kingdom, technology tends to follow certain trends of maturity and adoption, a process which takes time to unfold. As of 2014, it seems the market’s interest in mobile health monitoring may be temporarily waning, with an estimated 5-10 years until true productivity is reached. During that time, further innovation is needed to improve on current technologies. The feedback loop necessary for continued progress is also slower in a larger network - and in a more complex industry, particularly one with strict regulatory mechanisms in place. Although Disney can apply their data directly to their own processes and operations, researchers in a more diverse ecosystem can’t operate in a vacuum.

Interoperability would ideally allow for this kind of shared collection of data, as well as collaboration on its analysis and utilization. It is also probably the biggest hurdle to successfully applying mobile technologies (or any new innovation) across the health care landscape. MyMagic+ is able to be expansive in scope because it has one parent company and all the components are designed to be interoperable.

The free market is fantastic for innovation, but sometimes not so great for achieving our goals in health care. If every U.S. adult owned and faithfully used one of the wearable health trackers out there, perhaps we all would exercise more and keep better track of our blood pressures. And maybe this would lead to some degree of outcome improvement across the population — but it might take us quite a while to figure it out or determine what variables to adjust along the way. Right now, we’re just not getting the full value out of these (or any) devices. Disney doesn’t only use MagicBands for ticketing to keep lines moving - they use them for everything; they collect data throughout and apply it directly to advance their processes. In order to improve health care outcomes, we should also be trying to squeeze all the versatility possible out of wearable and mobile technology, and applying that same feedback loop.

Earlier this year, ONC published its 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, in which they suggest a future role for patients managing and sharing information from personal electronic devices as part of a larger, integrated health IT ecosystem. They describe a multifaceted approach, addressing information exchange between the individual patient, the medical practice, the larger population, and the public as a whole. This type of interconnected system is, of course, the real difference between Disney’s success with MyMagic+ and our industry’s limited, more scattered successes in the mobile health space.

The full realization of mobile health monitoring is certainly going to take time, but as we move forward, I believe a clear focus on interoperability is ultimately going to drive the types of favorable outcomes we can achieve. As a vast and diverse industry, we may never be able to reach the type of unified purpose and singular communication that an individual company can possess in delivering results, but through an integrated exchange of information, we can certainly make this a Small(er) World — and our impact a lot more profound.

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