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Motivation is used by hundreds of thousands of participants at nearly 100 major health promotion programs including the Department of Health and Human Services, the AMA, several major hospital chains, and a "who's who" of the Fortune 100. It is also used by many smaller programs that need to work on a budget.

It includes a participant site with easy-to-use health management tools, an administrative interface with rich data analysis and configuration options, and a sophisticated coaching platform with tools for everything from template-based coaching to biometric data entry to fitness assessment. Motivation even features a Check-In system so that you can integrate attendance data from your health or wellness facility with both biometric data and data from client self-entry (e.g. activity logs, personal goals or HRA/HSA data).

It is an ideal platform for creating a health promotion program portal and includes modules for areas as diverse as online enrollment, Health Risk / Health Status Assessment, content publishing (e.g. posting articles of interest or news from your organization), and activity and pedometer logging. Motivation has flexible, customizable tools that can identify existing health issues, predict future risks, gauge interest and participation in your program, and measure participant goals. Data from any or all of these areas can be used to create and distribute custom bulk email.

Finally, Motivation features a wide assortment of personalized health improvement tools: participants can log activities and workouts, log specialty measures such as glucose or other personal values, participate in an incentive program, be a part of a "Team Lean" or "Team Pedometer" Challenge and, of course, learn more about health and fitness.

Enrollment Workflow in Motivation

Enrollment is a surprisingly varied art and many web portals struggle to get it right. With Motivation, you have many options for data collection at enrollment. We support a rich workflow so you can require (or not):

• Participant demographic data including location and categorization (e.g. employee, spouse, etc.)
• A Consent/Release Form
• The Wellness Profile HRA/HSA
• Medical Readiness for Exercise Screening (ACSM)
• PAR-Q Readiness for Exercise
• Membership Selection
• A Physician Consent Form (PCF) for high risk or all enrollees
• A "High-Risk" release form in lieu of a PCF

Enrollment can be done using only visitor-entered data or we can import data from an HR database so that your members need only "activate" their account (and only people in the database can create accounts). We can also adapt to an HR feed for employees while still permitting spouses and dependents to enroll under the employee's account.

Wellness Profile in Motivation

Motivation features the "Wellness Profile" health risk / health status assessment. The Wellness Profile provides:

• An estimate of controllable risk using the method pioneered by Edington
• Exercise Risk stratification using either the American College of Sports Medicine criteria or the PAR-Q
• Estimates of the total cost of lost productivity using the Health-Related Productivity Loss Index (HPLI)
• Assessments of lifestyle in the areas of physical activity, diet and nutrition, substance use and abuse, social health, psychological/emotional status and spiritual satisfaction
• Medical facility visits, resource use and preventative health visits
• Readiness for change assessment together with barriers - for participants struggling with change
• The HRA can be made GINA Compliant by a simple toggle in the configuration panel
• Fully "Section 508" compliant: accessible to the handicapped
• A rich set of querying tools permit your team to discover patterns in the data

Wellness Profile Results and Analysis

The Wellness Profile plays an important role in your health promotion program for both your participants and your staff. Participants get immediate feedback - including a printable report whose first page is shown here - that they can use to guide action and track progress.

Your staff will use the data collected from your population to guide your health promotion efforts and/or provide feedback to leadership. It is vital that you look upon the HRA as only the first step in your program. That is, taking an HRA has been shown to have a positive effect on attitudes and behaviors but this really just scratches the surface of the potential that the data can unlock. For example, it is not unusual for participants taking the Wellness Profile - especially when it is used in conjunction with a biometric screening program - to discover conditions like hypertension, early signs of CHD or diabetes.

On a broader scale, the issues that you uncover with the Wellness Profile will often make it very clear where your health promotion dollars are best spent. You will have a number of amazing, "live" data analysis tools at your disposal that you can use to see patterns in your data. The results of this analysis can and should guide your programs. You can even pull any cross-section of participants and prepare an instant bulk email drop to invite them for a new program or to provide them with access to your coaching staff.

The results of the Wellness Profile are highly secure and only staff with administrative access to the system and "Protected Health Information" privileges can see the results.

Incentive Program Management in Motivation

Motivation was first crafted as an incentive management system over a decade ago and our long experience managing programs shows in the mature and sophisticated range of tools and options available to you. There are two systems built into Motivation: the classic "bank account" system lets clients build up incentive points in an account until they have enough to redeem for the prize or reward they want - anything from a water bottle to a discount on their contribution to medical coverage. We also feature a beautiful, new, travelogue-style "Great National Parks of the World" program featuring virtual trips to the Table Mountain National Park in South Africa, the Great Barrier Reef in Australia and the Sagarmatha National Park (Mt. Everest) in Nepal (available at additional cost).

Incentive Program Customization

The incentive programs are extremely customizable. Participants can earn points for logging exercise and activity, for pedometer entries, for participation in a Team Challenge program, for completing a questionnaire, for reading articles or for any other activity that you place in the "Wellness Points" area. Typical Wellness Points activities are things like physician check-ups and screenings, participation in seminars or entering into a competition (e.g. a 5K run). You control the points awarded in the program and the points needed to earn a prize or to reach a new level in the Great National Parks program.

Incentive programs can be fully customized to a specific location so that different places or facilities can have different programs. BSDI has also worked with outside incentive prize companies and alternate incentive program vendors; sharing or importing data so that all aspects of your program work together.

Great National Parks of the World

The Great National Parks of the World program is a fun and engaging travelogue with visits to multiple destinations within three of the worlds greatest national parks. The Table Mountain National Park in South Africa is the "easy" level and requires the least number of points to complete (the totals, however, can be configured). The Great Barrier Reef is the "medium" level and features spectacular licensed photography. Finally, the "hard" level features photography from Alan Arnette - one of the world's most respected authorities on the Mt. Everest climb. Alan assisted with the travelogue as well to ensure that the descriptions of the experience were true to the challenges found on Everest. The image on the right is from Alan's climb in 2003.

Activity Logging in Motivation

If you want to increase something - in this case physical activity - then the first step is to measure it. By asking participants to log their activities online and by offering incentive points when they do, you'll be sending a powerful message about the importance of physical activity.

For the vast majority of participants, the single most important action they can take to improve their health is to increase their level of exercise. The American College of Sports Medicine and the American Medical Association have said it best: Exercise is Medicine™ (both, by the way, have used Motivation for their health promotion programs).

Participants will not only get continuous feedback and the "little rewards" from logging their exercise (the positive feedback associated with recording a virtuous activity), they will also be able to see their progress measured in calories and pounds lost over time. If a participant is working with a coach, their log will become part of the record to be discussed at each meeting.

Pedometer Logging in Motivation

Motivation also features a Pedometer Log in which participants can keep records of their daily pedometer readings. As with other areas of the software, participants can define a goal against which they can measure their daily entries and you can give points to participants based on the number of steps completed each day. The pedometer log also features the "Team Pedometer Challenge": a fun and engaging social/team program where your participants contribute to their team's standings by logging their daily steps. The program features a team page where members can see their totals and encourage one another through a team message board. It also features a "standings" page where all teams can see how they stack up in the competition so far.

Custom Logging in Motivation

You can also set up customized logs measuring any single-variable measure you can think of. One group gave away prizes to participants who rode a bike to work (they logged miles ridden each day in the custom log) while another measured progress towards 1,000 minutes of walking, running or jogging. You get a full page to create content for the program as well as a data entry area, a goals definition area and a chart page. You can, of course, define the number of points earned in your incentive program for each unit logged by the participant.

Biometrics in Motivation

Motivation supports a wide variety of biometric measures: from classic biometric screening (e.g. lipid/glucose screening) to fitness testing. Staff members can record:

• Cholesterol
• HDL
• LDL
• Triglycerides
• Glucose
• A1C
• Systolic Blood Pressure
• Diastolic Blood Pressure
• Exercise Systolic/Diastolic Blood Pressure
• Weight
• Height & BMI
• Body Circumferences (13 measures plus WHR)
• Bodyfat (bodyfat pinch methods, bioelectrical impedence, other direct entry)
• Vo2Max (7 estimation methods + direct entry)
• Resting heart rate
• Step test
• Peak expiratory flow
• Strength using a wide variety of popular fitness tests
• Endurance
• Vertical leap
• Flexibility (6 methods)
• Senior functional fitness (Rikli-Jone Senior Fitness Test)
• Youth testing (13 tests from the President's Council and the NCYFS)

Data Collection

Data is collected in Motivation in one of three ways: via client self-entry, staff entry and data import (data integration with outside vendors). Participants are generally responsible for weight and height tracking but can also enter a blood panel or blood pressure reading if they receive this data (this can be disabled if a biometric screening program is in place). Staff members can enter any of the values shown above while direct data integration is generally done only for weight, height, blood panel data and blood pressure.

Fitness Testing

Motivation's Fitness Testing capabilities descend from the legendary Fitness Analyst fitness testing software. The Fitness Analyst was the backbone of BSDI's business throughout the '90s and the early part of this decade and it still dominates the market for Windows-based fitness testing software. The accumulated knowledge gained in creating and updating the Analyst was brought to bear when creating the fitness testing module for Motivation. In particular, we focus not only on accurate, scientifically credible assessment methods, we also ensure that you can track change over time and progress toward a goal for every fitness test.

Motivation, like the Analyst, also produces a beautiful, graphical report that speaks volumes about the professionalism of your assessment program.

Coaching Tools in Motivation

Motivation offers a sophisticated coaching support system with a variety of tools that coaches can use to review client status, record coaching session results and to locate clients in need of coaching. Depending on configuration, the coaching module can provide templates to drive each coaching session (separate templates for the first, second and subsequent sessions). Template-driven coaching doesn't limit the topics that are covered but it does ensure that all of the basics are covered (e.g. discussion of HRA results, setting up next appointment).

The templates also provide quick links to various tools and pages that are likely to be discussed. For example, the participant-side of Motivation features a page for recording a participant's weekly goals and their success in reaching them. The coaching templates have a link to this page so that the coach can both record the initial set of goals and update them (or check the client's updates) over time.

Content Management in Motivation

Motivation is a sophisticated technology for creating health-promotion web sites that are tuned to the specific needs of your program. As such, it provides deep access to the content found in each of the participant-facing areas and a powerful HTML word processor for creating your own content. It is through customizing the content that you will truly make your Motivation site unique and focused on the needs of your participants.

You can create news articles to display at the top of the participant "home" page and set them to automatically expire. If you have the time and staff to create health promotion articles for your organization you can do this as well and organize them by resource category. Clients will then see the content when they explore the "resources" area on the home page (or you can set up links directly to your article). If you find interesting content elsewhere on the web, it is a snap to link to this content in Motivation. as well.

All of the articles can be configured to show for a specific period of time, to show for just men or women, to show only for people of a given age range and to show at just a single location. Of course, you can do none of these things and configure the article or announcement to show for everyone!

Reports and Queries in Motivation

Motivation's greatest strength may be the range of reports that you can produce simply by clicking a few links. These data analysis capabilities are broken down into a set of preconfigured reports: those that are highly formatted or that capture specialty data, and "data centers": free-form data grids with both enormous flexibility and the ability to export results as reports or excel files.

Pre-Formatted Reports

Motivation includes the following pre-formatted reports. Note that, with all of these, you can select any cross-section of your database to include in the report.

General Reports Member List (Client Data Center) Motivation Login Frequency Motivation System Statistics Wellness Plan & Medical Reports Wellness Profile Summary Profile Results (by Answer) Count of Wellness Profiles Analysis of HPLI Data Analysis of HPLI Absenteeism Data Ten Year Risk Detail Check-In Reports Attendance Master Report Busy Hour Analysis Participant Check-In Frequency Participant Check-In Detail Participants Not Checking In Fitness Assessment Reports Fitness Assessment Group Averages Fitness Assessment Group Comparison

Membership Reports Count of Membership Types Class Reports Class Reservations Class Attendees Incentive Program Reports Incentive Points List Team Lean Challenge Reports Team Participant Detail Report Other Reports Pedometer Summary Report

Data Analysis Centers

The Data Analysis Centers are powerful, grid-based data display, filtering, sorting and export tools. They permit you to instantly retrieve any or all of the data in dozens of different areas of the software. You can limit the data being analyzed to just certain fields (e.g. just the heart disease-related fields in the Wellness Profile) and can filter the data so that only records with a certain range of values is returned. For example, you might select only those men at a specific location who have cardiovascular heart disease symptoms but who do not report heart disease. All of the grids permit you to export data to excel, to generate a PDF report, to export to Microsoft Word or to create a CSV file for integration with other software.

The data centers available are shown below with a description for each. Note that the "pivot grids" permit you to select a value (e.g. a count) and then to drag variables into the rows and columns so that you can dynamically show relationships (e.g. the number of HRAs broken down by risk stratification value and gender). If the user does not have PHI priviliges many of these data centers will not appear. Similarly, if you do not collect certain data, then the matching data center will not appear.

Demographics Data	This area features data such as name, address, member type, membership start and end dates, birthdate, gender, and other categories. This is also where you'll find enrollment workflow data such as "Needs Medical" and "Needs Physician Consent."
Wellness Profile 1	If you are using the Wellness Profile, use this link to gain insight into the data you have collected including risk stratification, disease data, CHD symptoms, weight and biometric data.
Wellness Profile 2	If you are using the Wellness Profile, use this link to gain insight into family history, medical system usage and history, lifestyle data, and psychosocial health.
Wellness Profile Summary (Pivot)	Provides a pivot grid showing selected Wellness Profile data.
Wellness Profile Counts (Pivot)	Provides a pivot grid showing the number of Wellness Profiles completed by Location and Unit.
Readiness for Change	The Readiness for Change questionnaire is shown at the end of the Wellness Profile. It collects data about a client's readiness to make lifestyle changes, as well as information about barriers to change, in a variety of areas.
PAR-Q Exercise Risk	Data from the Physical Activity Readiness Questionnaire (PAR-Q) (Readiness for Exercise Data)
ACSM Exercise Risk	The ACSM Readiness for Exercise assessment collects data about a client's medical state and lifestyle in order to estimate their risk of an adverse event during exercise.
PHQ-9	The PHQ-9 Quick Depression Assessment collects data about a client's mental health with a focus on depression.
Activity Log	This data analysis area shows activities logged by the participant.
Daily Activity Summary	This data analysis area shows the summary of daily activity logged by a participant. This data includes facility visits as well as manual activity log entries by the participant.
Blood Chemistry	The Blood Chemistry log collects information about cholesterol, HDL, LDL, Glucose and Triglycerides.
Blood Panel Charts	The Blood Chemistry log collects information about cholesterol, HDL, LDL, Glucose and Triglycerides. This data analysis area displays aggregrate participant counts for blood chemistry levels displayed in chart form.
Blood Pressure	Query client data for systolic and diastolic data as well as participant risk stratification.
Check-In Attendance Counts	Generate a list of participants and their total attendance counts for any date range. Also permits you to restrict by location of attendance and any of the query data.
Body Weight Entries	Query client data for body weight. Shows change over time compared to the first weight entered in the given date range.
Custom Health Promotion Programs	This data analysis area shows entries logged by the participant for all Custom Health Promotion Programs.
Incentive Data	If you have an incentive program, this data analysis area permits you to see all incentive transactions by participant and to filter by type of transaction, date, etc.
Incentive Summary Data	If you have an incentive program, this data analysis area permits you to see the total points and remaining points earned by each participant.
Class Reservation/ Enrollment Data	This data analysis area shows reservations/enrollments by class and date.
Class Attendance Data	This data analysis area shows attendances by class and date.
Equipment/Area Usage	This data analysis area shows equipment/area usage as measured by the check-off list (optionally) shown during Check-In.
Team Lean Challenge	If you are running a Team Lean Challenge, this data analysis area permits you to see the breakdown of weight, weight loss, BMI and blood pressure (if taken) of your teams.
TLC Participants	If you are running a Team Lean Challenge, this data analysis area permits you to see the breakdown of weight, weight loss, BMI and blood pressure for each participant in the program.
Team Pedometer Challenge	If you are running a Team Pedometer Challenge, this Pivot-style data analysis area permits you analyse, filter and sort your teams and/or team members by steps.
Coaching Sessions	The Coaching Sessions area lets you query on the coaching sessions logged by your staff.
Coaching Templates	The data from the advanced Coaching Templates: all coaching records
Coaches Selected by Clients	This area shows the non-administrativecoaches that clients have selected along with their session count totals. It is a pivot grid so that you can analyze by clients, coaches, coach location, staff type, etc.
Participant Interests and Goals	This data analysis area shows the interests and goals of participants.
Participant Weekly Goals	This data analysis area shows the weekly goals of participants.
Participant Quarterly Goals	This data analysis area shows the quarterly goals of participants.
Wellness Plan Goals Summary	This data analysis area shows participants that have completed a wellness plan.
Inactive Participants	This area features demographic data such as name, address, member type, membership start and end dates, etc. for just the "disabled" participants.
Medical / Vital Signs	This area features data from the Vitals Area under the medical measurements area of the Member Services module.
Fitness Assessment	This area features biometric assessment data, as well as staff information, from the Fitness Assessment section of the Member Services module.
Fitness Test	This area features only biometric assessment data from the Fitness Assessment section of the Member Services module. Staff information is not included.
Senior Health Medical	This area features the primary medical information from the senior health assessment.
Senior Health Medical 2	This area features additional information from the senior health assessment that is not included in the Senior Health Medical query.

Security in Motivation

BSDI has an extensive and disciplined program for ensuring that the Motivation Web Application and the data entrusted to BSDI by our clients are protected from unauthorized access, are shielded from attempts to intercept, corrupt or destroy such data, and are protected against loss from hardware failure and/or natural disaster.

The first aspect of our security stance is the requirement that all interactions with the Motivation web portal take place through a secure URL. If you have ever seen a small padlock appear when you were visiting a bank's web site, that is the symbol that the site encrypts the communication between the site and your web browser (seeing "https" in the address line is another). Motivation uses the same strong, 128-bit encryption to ensure that no one can intercept the data that you are entering or receiving from Motivation.

Next, the Motivation web technology itself is subjected to periodic security audits. A security audit is simply a sustained attempt by security professionals to "hack" or otherwise expose inappropriate data from a web site. Motivation was subjected to a SPI Dynamics WebInspect Vulnerability Audit in 2007 and an IBM WatchFire Vulnerability Audit in late 2009. In both cases, the findings were particularly encouraging. For example, after the original WebInspect Audit, we were informed that Motivation was the first application ever audited by our SPI Dynamics team that was fully secure and impenetrable from the outset (SPI Dynamics is now a subsidiary of HP). That is, no security changes were required as a result of this audit: reflecting BSDI’s strong commitment to secure computing and ability to deliver it.

Similarly, Motivation passed the WatchFire audit with an outstanding score: only one possible vulnerability was found out of over 200,000 automated tests (99.999995%). The reported WatchFire vulnerability was manually checked and found to be on the administrative interface (where hacking is hardly relevant given that administrators have full access anyway) and harmless in any event (no exploit was possible – a false positive). Motivation was altered to remove the false positive after the audit was completed.

Your Motivation site will be hosted at either of two top-tier data centers, both of which feature 24x7 monitoring, biometric identification and gating for access to the server room, sophisticated intrusion detection systems and firewalls, and multiple, redundant power and internet connectivity systems. The actual databases are hardened and protected behind a firewall so that they are not accessible from the web. All servers are protected with enterprise anti-virus systems and are kept up to date with Microsoft's periodic operating system / security updates.

Scalability in Motivation

BSDI's server farm is periodically "load-tested" to ensure that there is plenty of excess capacity on each of the servers in case of a burst of activity. We feature multiple "big iron" web and database servers at each data center with redundant, on and off-site backups. On-site backups are made four times per day and sites on our LogicWorks servers are copied off site daily. We also monitor page load and site uptime statistics to ensure that all sites provide fast downloads and posts.