Where’s the Beef? The Need for Evidence and Systems-Change in the Health IT Movement

After its use as an advertising slogan, “where’s the beef?” became an all-purpose phrase questioning the substance of an idea, event, or product. Along these lines – even if slightly passé – I have been thinking a lot lately about the spirit of the movement to release health data and invite technology developers and entrepreneurs to create tools and apps based on this data.

Recently, I had a chance to remotely attend the 2nd annual Health Data Forum put on by the US Department of Health and Human Services (HHS) and the Institute of Medicine (streamed at the most recent unNiched(micro) breakfast held in early June). It was a great demonstration of the current movement and commitment on behalf of the government – spear-headed by Todd Park – to free health data and engage entrepreneurs to create applications and other tools that will help people take more ownership over their own health. It was a great event – achieving the goal of discussing and evolving the health IT movement. However, for me,  two major issues emerged from this forum – 1.) the need for the creation of evidence-based tools, and 2.) the need to contextualize these health apps in order for them to actually impact behavior change.

To the first issue – with this release of health data, a plethora of various applications and tools are being created. This is an incredible opportunity and really demonstrates the ingenuity and entrepreneurship that the American business ecosystem is known for. However, what is critical with this surge of technology development is the need for evidence-based tools and resources – tools that are built on existing health behavior change models and knowledge, have been tested, have shown results and are endorsed or acknowledged by legitimate health institutions. There seems to be a rush to get concepts to market and while this has its benefits – allowing the user base to drive an app’s iterative development – it also doesn’t really allow for testing prior to launch so that people can identify it as a proven health intervention tool. The creation of these apps and tools should not stop – there are lessons to be learned from building and testing health technology in this way – but it also needs to include a stronger focus on showing the evidence behind them.

To the second issue – these applications and tools cannot exist within a vacuum. Many of them can be successful amongst folks that may already be health-conscious and use these tools as an extension of that interest because they add value to their lives in some way. For those that may not naturally be inclined to focus on their health, however, these apps do not provide much utility on their own. Moreover, they are cannot replace or work around legitimate barriers that people who want to be healthier may face which make it hard to do so. Therefore, there is a need for changes in the context within which these apps operate. This freeing of health data is an important step in the progression towards self-efficacy and empowerment but this movement is based on individual behavior change and this is hard to accomplish if solely dependent upon the individual. Without changes to the real world context, i.e. creation of walkable or bikeable paths or access to fresh fruits and vegetables, having an app that counts steps taken or measures calories in/out, won’t make much of a difference if people cannot walk places anyway. The development of environmental and systems change needs to accompany the technology.

So I ask the health and technology communities – can we include conversations around evidence-based research and environmental and systems change alongside the technology discussions? Or in other words, I’d like to know, “Where’s the Beef?”

This post was originally posted to Path of the Blue Eye’s WalkingthePath blog.

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