Commentary: Fear and Loathing in mHealth

By: Brian Dolan | Feb 26, 2009        

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MiM iPhone AppA rep from Kaiser Permanente captured the sentiment earlier this month when he said: It’s easy to see how far behind the healthcare industry is on adopting technologies when a pilot using text messaging is labeled “innovation.”

It’s especially frustrating when a mobile phone–that clearly changed the way the world sees mobile phones–with nearly 1,000 healthcare, fitness and medical applications is ignored outright by many healthcare IT luminaries because it’s popular (and easy) to say that all the healthcare applications available for the iPhone are “junk”. Really? Out of 1,000 applications you know this? When probed many who claim to know all iPhone apps are junk will also admit they do not have an iPhone. I’d like to chalk this grievance up to the “eminence over evidence” crutch that Netspective CEO Shahid N. Shah has done well to root out over at The Healthcare IT Guy blog. The concept is that too many in the healthcare field use their eminence as the push of their argument rather than actual evidence of their point–”Trust me, iPhone applications for healthcare are junk.” Too many ‘trust me’s, Shah has contended, may be one of the drivers behind much of the EBM talk as of late.

“The iPhone is the missing link between a good mobile solution and a (potentially) fully-loaded healthcare application platform,” Parks Associates Director of Health & Mobility Research Harry Wang told mobihealthnews recently. “It’s very exciting to have the iPhone and the AppStore providing users wellness-related personal care apps because they are easy to discover, download, and put on the phone.” Wang exaplained that right now most of the healthcare apps are wellness and fitness apps, but you cannot remove those from the realm of healthcare or apps that actually help treat patients with acute care. “The big trend is moving toward helping patients prevent and manage,” he continued. “Most of the iPhone applications are fitness-focused today, but that will change as phones begin to track vital signs like with biosensors like glucose monitors, ECGs and so on. Apps are being developed to do that and some already are out there.”

Wang said that suping up the mobile phone to become a better preventative device is relatively easy on the hardware side. The software is the hard part: Developers need to make sure that vital signs are correctly captured, categorized and sent to the appropriate person for monitoring. Software developers can leverage their skills from producing other apps for entertainment, but when it comes to healthcare there is a different set of skills involved, too. Here are three best practices Wang offered up for iPhone healthcare developers:

1) Be aware of adding biosensor modules to the handset (through USB, for example), because you may need to increase process power, too.

2) When the sensor captures data, what format will it transfer the data in? Leverage known standards for healthcare data–don’t add more formats to the fray and increase the fragmentation in the marketplace.

3) In most cases there will be a need to simplify the process of reviewing data. Do physicians really want a data dump of all of the user’s vital signs? Maybe but maybe not. Same goes for users.

The opportunity for the iPhone and similarly capable phones to help physicians manage their workflow, check reference guides, read medical journals and more is already here–the applications await your download. The next generation of mobile applications that effectively monitor users’ chronic conditions and vital signs while informing them on best practices for staying fit and healthy are on the way. So feel free to dig in and download today, but let’s hold our tongues just a little longer on the “Trust me, iPhone healthcare apps are junk” talk, because whether Your Eminence knows it or not, there’s an entire industry working to prove you wrong. -Brian

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  • http://www.oam2.com Jonathan Briden

    It is also surprising how few healthcare providers too are taking advantage of even basic text capabilities as appointment reminders.

    I am quite surprised when my doctor or dentist has their receptionist call me to remind me of my upcoming appointment. Needless to say the call always seems to come just as I’m sitting down to dinner, or otherwise have my hands full.

    It would be far more convenient to just get a text message. The message also serves as a record of the exact date and time of the appointment.

    It would not only be more convenient for me if they had automated SMS text reminders, it would also save them a lot of time and effort.

    There’s plenty of options available, some are a bit on the expensive side, and some providers do try to squeeze money out of you with overpriced SMS costs, but in Australia at least we have a very good low cost solution in the OAM2 Appointment Diary.

    It is an appointment diary, and it has SMS text reminders which can be automated. It’s also got lots of other features including an inbuilt email mailing list which can be used for newsletters, promotions and so on.

    (Jonathan Briden is Sales Manager for Digex Australia, suppliers of the OAM2 Appointment Diary)

  • http://mobihealthnews.com Brian Dolan

    Jonathan I absolutely agree–We’ve mentioned the text message appointment opportunities many times in this publication and it’s certainly the low hanging fruit in this industry, especially when compared to the slow-growing fruit of some iPhone applications (but some are ready now, too!).

    The cost savings and time savings are hard to refute. I think this application is inevitable.

  • http://www.retinacheck.com Dan Feinberg

    Both the “junk” and “everything” views of iPhone health are at the extreme. Rather than battle from the extremes, we should look at where the line in the middle falls between health applications where iPhone health shifts paradigms, where iPhone health is only a minor savings in weight, and where iPhone health is just a way to get publicity but doesn’t really help.

    I suggest looking at a value-added chain. An iPhone already fully supports the sending, receiving, and storing of text messages. If I break my scheduling system down, we are left with new hardware and software on the provider side adding value, and the receipt and storage of text messages on the patient side adding value. Since the patient already has the iPhone to receive and store text messages, it adds meaningful value to the system.

    But contrast that with glucose readings. A patient has a stack of meter strips and a handful of lancets, as well as syringes and vials of insulin. Plus, a digital meter that uses the strips, stores the values, and can transmit them by connecting them to my computer’s USB port. If we re-envision that system with an iPhone, what value does the iPhone bring? It replaces my computer? I already have a computer. I already have a glucose meter. It allows me to send the readings from wherever I am at any time? WHO CARES?!? That sounds like a meaningful improvement, but any patient with diabetes whose blood glucose is so out of control that an instant consultation would be an improvement over a weekly or monthly review of the data stored in my meter should call an ambulance, not an iPhone application store.

    The reason some healthcare people sneer at iPhone health is because of medicine, not technology, along with the perception that iPhone lovers don’t get the difference. The lack of incremental value of instantaneous transmission of glucose data when my meter already stores the data is a good example, but I will address another:

    ECG. What value does the iPhone itself really add? I have a box in an ambulance with six ECG leads that can transmit the data to an ER doc who can tell me which of the medications I’m holding should be administered. What part will the iPhone replace? The box? What difference does that make? If we replace the ambulance and the handful of intravenous medications with an iPhone, what are we left with? A pocket full of six leads that are difficult to place properly, and the ability to spend twelve minutes finally getting the leads properly placed before transmitting the data to find out whether or not I should have called an ambulance twelve minutes ago. That does not sound like an improvement.

    One day soon, someone will sell a nanotechnology chip that can detect 5,000 different pathogens for quick diagnosis. That will be great, but what does the iPhone really add? We must be careful to distinguish between systems where the iPhone’s inherent capabilities add significant value and the systems where there is a high value step that ultimately (and incidentally) connects to an iPhone.