Follow This

FOLLOW THIS: Dr. Jennifer Shine Dyer

[by Kendra Hovey]

Meditate, laugh, spend time with friends, eat salmon, sit less, and get your Vitamin D. This prescription doesn’t sound so bad; it might even be fun. Yet, many of us struggle to follow even simple health habits. But what if doctor’s orders are not so fun—what if they’re, in fact, a big fat drag? And what if you’re a teenager, your friends aren’t having to do it, and slacking off may not get you into real trouble until the ancient age of 30?

For those who live with it, “#diabetes sucks.” At the very least, the lifelong daily regimen to stay healthy is challenging. Denial is tempting, more so for teenagers. Pediatric endocrinologist Dr. Jen Shine Dyer gets this. She also gets the very real consequences—disability, early death. So to help her patients follow doctor’s orders, she “met them where they’re at”—she texted them. And it worked.

Dyer shared her texting experiment at the 2010 TEDxColumbus, where she also unveiled her prototype EndoGoddess app that would enable other doctors to offer similar automated, yet personal, patient support with presumably similar positive results.

So a year and a half later, is her hypothesis true, “is texting good health?” The answer seems to be yes…and no. Dr. Dyer has learned a lot since then. Her idea has evolved. So has she.

So what has she learned? Small personal bursts of physician support get powerful results, but that power begins to dim after about three months. The text and the personal relationship behind it was a trigger, but for a sustained effect, two more things were needed: motivation and literacy. Her evolved version of the EndoGoddess app has all three. When users check blood sugar levels regularly, they get points (eventually to be used as credit at the iTunes Store). Along with this “gamefication” motivation, the app also includes educational and inspirational information and it connects users to online diabetes communities—an increasingly essential source of social support and “real-time empathy.”

Another change: this app is for the patient, not the doctor. “The patients are already looking,” she says, “they are ready for change.” The switch did come with a compromise. Instead of just being texting-capable, users now need a smartphone, or an iPod Touch—a popular device among teens.

Dyer’s original inspiration is not exactly lost; it just comes through the backdoor. Because it can be used to log every blood sugar check, the app functions as a manifest of the often unseen but difficult day-to-day work diabetes demands. This can be enlightening to family and friends, who then may become more supportive. Also as family and friends contribute to the user’s iTunes account, they can become more invested, connected and educated. Or, as Dyer puts it, “When Grandma puts in $5, she might be more likely to say ‘I’m proud of you.’”

Immediately following TEDxColumbus, Dyer was inundated with offers to develop the app. She ignored every one, but then, after six months, decided to partner with the Columbus start-up Duet Health. “We’re on the same page,” she says. Released last fall, the 99-cent app has been downloaded over 500 times, and has a 4+ rating.

And why, exactly, is it called the EndoGoddess? Patients typically refer to their endocrinologists as “my Endo.” One of Dyer’s, a young girl who approved of her doctor’s fashion sense, took to calling Dyer “my EndoGoddess.” The nickname is also Dyer’s online identity.

Asked if the name might be a barrier for some, Dyer shares that half of all users are male. Though she makes the point that they are, like her, early adopters: “As a group, we’re not the most usual bunch of people.”

The next major evolution for the EndoGoddess app will be the integration of a medical device—the glucometer. Likely, this won’t be available until 2013, as it will need FDA approval. For now, Dyer has a clinical trial to run. “I’m a numbers person,” she says, “the field of mobile health is exciting, but as a doctor what I care about is that it improves health care, and we need to have a measure of that.” The 3-month self-funded trial is set to begin this month. She hopes to also run a longer trial, but has bumped into the problem that perplexes many providers of mobile and online content: funding.

On hiatus from practicing medicine, Dyer’s been doing a lot of travelling and talking. At SXSW in March and a D.C. conference in April, in late May she is off to Paris to present at Doctors 2.0 (over the winter there was even a TV audition). A doctor when she spoke at TEDxColumbus, Dyer is now also a tech entrepreneur and mHealth pioneer. As such, she has a frontline perspective on new mobile health solutions. Follow This will continue to follow her, especially as new policies and patient-centered incentives are due to go into effect. It’s going to get interesting, she predicts, and exciting and, she says, “good for patients.”

Kendra Hovey is editor and head writer at Follow This. On Twitter @KendraHovey, she blogs at