Joe Kvedar asks an excellent question in his post, The Next Phase of Connected Health: Connected Personalized Health:

What are the best variables to consider when taking connected health programs from pilot to scale?

He imagines a matrix with three axes: severity of chronic illness, patient readiness, and technology readiness. That makes sense to me, as did BJ Fogg’s Behavior Model when Alexandra Carmichael described the three elements to me in words: Motivation, Ability, and Trigger.

The element Joe is adding, which is key to health interventions, is the severity of illness (or seriousness of diagnosis). That echoes the findings of the Center for Studying Health System Change: 41% of U.S. adults are “activated patients” (the rest  tend to be passive and may lack the confidence to play an active role in their health). Cancer patients are among the most activated, whereas people living with depression are among the least.

It also resonates with the Chronic Quadrangle described in The Innovator’s Prescription (p. 161 if you are a total health geek and have the book handy). Diseases with immediate consequences vs. deferred consequences are categorized, cross-factored by their dependence on technology dependence vs. behavior dependence. Celiac disease is one example of a condition requiring extensive behavior change and immediate consequences for not complying with the best known therapy. Osteoporosis is on the opposite end of the quadrangle: minimal behavior change is required and consequences are deferred.

I would add yet another question to the conversation about scale: is the application social or not? In other words, is it a grab-and-go information hub (like Google) or is it a place where users are invited to sit down and stay a while (like Facebook)?

Adam Rifkin’s essay, Pandas and Lobsters: Why Google Cannot Build Social Applications… is a must-read on this topic:

After researching what pandas do all day , I was struck by how panda-like we are when we use the Internet.

Roaming a massive world wide web of forests, most of our time is spent searching for delicious bamboo and consuming it. 40 times a day we’ll poop something out — an email, a text message, a status update, maybe even a blog post — and then go back to searching-and-consuming…

The most successful Google applications serve such a utilitarian mandate, too: they encourage users to search for something, consume, and move onto the next thing. Get in, do your business, get out…

Facebook is a lobster trap and your friends are the bait. On social networks we are all lobsters, and lobsters just wanna have fun . Every time a friend shares a status, a link, a like, a comment, or a photo, Facebook has more bait to lure me back.

Which kind of user are you when it comes to health information? How has it changed under different circumstances? If you develop health apps online, are you aiming for pandas or lobsters?  Is it possible to do both?

I’ve started my own list of panda health apps vs. lobster health apps — if certain sites and apps pop into your head, please share them in the comments on