Researchers: Use of mobiles for health has not been fully explored

By: Neil Versel | Jun 3, 2013        

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Pipette Mobile Health AppThe volume of scientific research about mobile healthcare technology has grown as the field itself has exploded, but the quality and focus of academic studies has not kept pace with the speed of innovation, a review of 10 years’ worth of published literature suggests.

“Mobile technology, with its diffusion and characteristics, holds a great potential for health care applications. However the use of mobile phones in health care delivery has not been fully explored, and the diverse outcomes of mHealth have barely been documented,” says a study appearing in the Journal of Medical Internet Research. “Although some literature reviews cover one part or the other of the field, an overall picture is still missing, possibly due to the field’s constant evolution,” according to a team of Swiss researchers.

“Studies are becoming more theoretically sound,” corresponding author Maddalena Fiordelli, a postdoctoral research fellow at the Institute of Communication and Health at the University of Lugano, Switzerland, tells MobiHealthNews. “On the other hand,” she adds, “it seems that research is not keeping up.”

Notably, according to the paper, the number of English-language articles in scientific journals about mobile health nearly doubled between 2007 and 2008, coinciding with the introduction of the iPhone. “But there are not many studies about apps,” Fiordelli says.

JMIR mHealth Research

In fact, Fiordelli and two colleagues found not a single scientific paper published through early 2012 that evaluated a smartphone app in general release through an app store, just a few pieces of software developed “ad hoc” for research purposes. “So what is publicly available has not been evaluated, and what has been evaluated is not publicly available,” the study notes.

“Newer and more advanced technologies were tested; however, the potential of smartphones does not seem to have been fully exploited yet,” according to the study. “Indeed, half of the included studies applied very basic features of mobile phones, such as text messaging, which corroborates evidence already established in the field.”

Furthermore, the bulk of the research during the 10-year review period looked at care of chronic diseases, with less than 20 percent each focusing on prevention and wellbeing or acute conditions. “[I]t would be advisable to explore the impact of mobile health for acute conditions as well,” the researchers write.

“Because of their wireless cellular communication capability, mobile phones allow users to have continuous, interactive communication from any location. In our view, this characteristic of mobile phones makes them an ideal tool to address in real-time the specific needs of patients experiencing acute conditions.”

On the positive side, the researchers report that more studies have focused on the impact mobile technology has had on health outcomes since the dawn of what they call the “new generation of smartphones” in 2007. Fiordelli says the scientific community needs to “evaluate really systematically what mobile health means for health.”

She also would like future research to examine how mobile technologies can help the elderly, and plans on running such a study herself. “This could be really powerful in facing social isolation,” Fiordelli says.

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Polar launches stride-sensing activity tracker for runners

By: Jonah Comstock | May 30, 2013        

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Polar Stride Sensor Bluetooth SmartPolar, the longtime makers of heartrate-monitoring watches and chest straps, has launched a Bluetooth Smart-enabled, iPhone-connected activity tracker. The Polar Stride Sensor Bluetooth Smart is a small device that clips to the shoe and tracks stride-length, speed, running cadence, and distance.

Activity tracker maker Fitbit notably uses Bluetooth Smart in its devices, but while Fitbit is geared at tracking all-day, every-day movement, Polar is catering to the the dedicated runner crowd, tracking indicators that the company calls “intelligent training data.”

The data collects can be accessed via an iPhone 4S, iPhone 5, iPod touch, iPad and iPad mini, or any Bluetooth SmartReady device, according to the product page. On an iPhone, it’s compatible with Polar’s training app called Polar Beat. Polar Beat recently added a “smart coaching” feature that helps runners improve their efficiency from run to run. Polar also has a free personal training website.

The device is water- and shock-resistant and tracks speed and distance without using a GPS, which both reduces power requirements and also allows it to function in indoor or remote areas areas without a strong data signal. The device costs $79.99.

Polar launched its original s3+ stride sensor in the fall of 2006, but it is only compatible with particular Polar sports watches. Polar also launched a Bluetooth Smart chest strap heartrate sensor, the H7, in June 2012.

When Bluetooth SIG chief marketing officer Suke Jawanda spoke to MobiHealthNews about the technology in April, he cited the H7 as an example of how impactful the low energy consumption can be.

“Polar created a Bluetooth heart rate monitor,” Jawanda said at the time. “Under normal use cases, the coin cell battery that was powering that heart rate monitor would only last a few months. That same heart rate chest strap now, with Bluetooth Smart, is going to last a couple of years.”

At the time, IMS research projected that by 2016 more consumer medical devices would use Bluetooth Smart for wireless than any other technology. Last week, ON World released a report on sports and fitness trackers, predicting that 500 million mobile fitness and health sensors will ship in 2017, with two-thirds for activity tracking.

HealthTap takes on app curation, prescribing

By: Jonah Comstock | May 30, 2013        

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HealthTap Tablet Member AppRxNow that the shake-up at Happtique has called into question their future as a consumer-facing health app curator, it didn’t take long for another company to step up.

Palo-Alto-based HealthTap, the doctor question and answer service, care provider directory and referral service is branching out once more. In the company’s newest offering, AppRx, HealthTap’s claimed 40,000 physician users will have the opportunity to evaluate health and medical apps in the iOS and Google Play stores, and those reviews will be available to HealthTap’s non-doctor customers.

“Doctors will go into this sea of mobile apps that all of us are so excited about for so many reasons and do something that all of us wish we had the ability to do which is to sort through these 40,000 health-related Android and iOS apps,” HealthTap CEO Ron Gutman told MobiHealthNews. “It’s hard [for Apple and Android] to make sense of the apps and help people find the right apps for them, but the fact that they don’t specialize in health is really a big challenge.”

HealthTap’s approach is quite a bit different from Happtique’s. The app developers aren’t involved in the process at all. HealthTap has created its own, new interface for viewing the Apple and Android app stores.

Whereas both Apple and Android only break apps into two categories, the often confusing “health” and “medical,” HealthTap breaks apps into doctor or consumer categories as well as 30 granular categories including calorie counters, period trackers, vaccine reminders, and pregnancy apps. They are tagged with the same tagging system as HealthTap’s Q&A platform, so consumers can move between the two.

Doctors on the HealthTap network have access to an interface where they can scroll through a list of apps and either recommend them or not, and then optionally write a review to explain their choice. Their reviews won’t enter the system until they’ve written at least 30 and those 30 have been looked over by a specially chosen group of physicians in the system that HealthTap refers to as a “medical review board”. After that, doctors will be able to review apps on their own.

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uChek app is currently FDA registered as Class I device

By: Brian Dolan | May 30, 2013        

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uChekFollowing MobiHealthNews’ coverage of the rare action that FDA took last week by sending a medical app developer an “It has come to our attention” letter that instructs it to seek 510(k) clearance for its urine analysis app, two readers wrote in to point out that Biosense Technologies, the maker of the app, had indeed already registered it as a Class I medical device with the FDA. The company says as much in their FAQ as we pointed out last week, but we can also now verify that claim since its registration is noted on FDA’s website (read it here).

Biosense co-founder Myshkin Ingawale has also reached out to MobiHealthNews in the past few days with a statement: “We are in receipt of the letter from the US FDA,” Ingawale wrote. “We intend to work very closely with the US FDA over the coming months to ensure that we continue to deliver accurate, affordable and convenient diagnostics across the world. Apart from this, we will not be commenting on any aspect of our communication with the US FDA.”

In his letter to Ingawale, FDA Deputy Director James Woods made no mention of uChek’s Class 1 registration, which seems like an obvious oversight.

“We have conducted a review of our files, and have been unable to identify any Food and Drug Administration (FDA) clearance number for the uChek Urine analyzer,” Woods wrote. “We request that you provide us with the FDA clearance number for the uChek Urine analyzer. If you do not believe that you are required to obtain FDA clearance for the uChek Urine analyzer, please provide us with the basis for that determination.”

Registration as a Class 1 is very different from getting clearance as a Class II device, of course, and the use of the word “clearance” in the letter is understood to mean the FDA found no Class II 510(k) clearance number for the app. Still, if you’re going to send a public letter to the company, why not mention the fact that it registered as Class I instead?

The company’s uChek system includes an iPhone app and a color-coded mat. It works with a handful of already FDA cleared test strips from Siemens and Bayer. The uChek user puts the test strip on the mat — which contains color samples to normalize lighting conditions — and then snaps a picture with their smartphone camera. The app analyzes the strip colors against the swatches on the mat, and returns data about glucose, protein, ketone levels, and more in the sample as well as diseases detected. The user can save readings and track data over time. The app is still available in the AppStore and its description states it should only be used by or with a healthcare professional.

Since the news of the FDA’s letter broke, MobiHealthNews columnist and mHealth regulatory expert Bradley Merrill Thompson outlined the reasons why the action will help advance mobile health.

Walgreens finds mobile customers to be better customers

By: Neil Versel | May 30, 2013        

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Walgreens iPad appPharmacy chain Walgreen Co. already has said that mobile technology is an integral part of its strategy for driving more traffic into its 8,300 stores nationwide. Internal company research shows why.

Data recently presented by Tim McCauley, senior director for mobile commerce at Deerfield, Ill.-based Walgreens indicates that customers who engage with Walgreens in person, online and via mobile apps spend six times more than those who only visit stores. Even those who just use the apps before visiting stores and not Walgreens websites generate four times the sales than store-only customers.

“This has definitely exceeded our expectations,” McCauley tells MobiHealthNews.

And thus the retail pharmacy giant is betting heavily on mobility. “We take mobile very seriously,” McCauley says. “We want [customers] to engage with us by using our app.”

Walgreens has 10 mobile apps and mobile websites, including versions of its flagship app for Amazon Kindle and native apps for iPad and Android tablets, as well as a medication reminder app and pill tracker called RxMindMe. And they are proving highly popular, according to a presentation McCauley gave this month at an event called the Mcommerce Summit.

The Walgreens app was on Apple’s list of top 100 apps for 2012 and won an Appy award for “best retail mobile app” at South by Southwest 2013 in March.

Walgreens gets upwards of 12 million visits a week to its online sites — Walgreens.com, Drugstore.com, Beauty.com, SkinStore.com and VisionDirect.com — and half come from mobile devices, McCauley reports.

More than half of online refill requests come through a mobile app, up from 10 percent in 2010. McCauley says the chain fills a mobile prescription request every second. McCauley says customers appear to love the speed and convenience of ordering refills by scanning the bar code on pill bottles with their phone’s or tablet’s camera.

Mobile refilling by scanning outpaces online refill requests at all times of day except between 8 a.m. and 6 p.m. and a brief point around 3:30 a.m., McCauley notes, highlighting the convenience factor of mobile devices during off hours. “Convenience is definitely a key,” he says.

Mobility fits nicely into the Walgreens’ three main corporate strategies: delivering what the company calls the “well experience” for its customers; transforming community pharmacy into a hub of healthcare and health information; and creating an “unprecedented global platform,” according to McCauley.

Walgreens wants to “concentrate engagement” in its app, with features including a pill reminder, mobile refilling, ordering photographic services and a means of tracking points from the chain’s Balance Rewards loyalty card, he explains.

Part of transforming the community pharmacy means making the drugstore a one-stop shop for all kinds of minor health services, with pharmacists dispensing advice to the extent of their licenses and nurse practitioners treating routine ailments at walk-in clinics, McCauley explains.

Pill tracking and refill reminders help improve medication adherence, which is good for patients and pharmacies alike. “We want to make sure our customers take their medications as directed by doctors,” McCauley says. Unfilled prescriptions also represent lost sales, and whenever a prescription is filled but not picked up, Walgreens has to absorb the cost of restocking the medication.

The Walgreens mobile apps help customers find retail locations and hours, refill prescriptions, set personal medication reminders, look up medication information, order photographic services and make appointments at in-store Take Care Health System clinics. These apps provide access to a digital version of Walgreens’ popular weekly advertising circulars and allow users to create shopping lists, including list reminders. Inside the store, customers can see aisle maps of specific branches so they can easily find what they need, and also find mobile coupons.

In February, Walgreens released an application programming interface (API) so software developers can build the prescription scanning and refilling technology into their own apps and connect with Walgreens stores. “We’ve come to realize the speed of innovation through our developer program,” McCauley says.

Mary Meeker: Wearables and digital health ramping up

By: Brian Dolan | May 30, 2013        

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Brian Dolan, Editor, MobiHealthNewsEach year technology analyst and Kleiner Perkins investor Mary Meeker shares her take on the state of the internet, the adoption rates of various technologies, and her predictions for the coming years. These days, this sweeping presentation often takes place at The Wall Street Journal’s AllThings:D conference, and it serves as a pulse check of sorts for those in tech circles.

This year Meeker made a number of mentions of wearables and digital health, but her higher level adoption metrics should be of interest to MobiHealthNews readers, too.

Of course, most of the growth in new internet users is coming from emerging markets, especially China, but the USA now has about 244 million internet users — or about 78 percent of the population — and it added about 18 million over the course of the past four years.

On the mobile front — Meeker noted that smartphone operating systems “made in the USA” like Apple iOS, Windows Phone, and Android now command about 88 percent of the world market, up from 5 percent in 2005 when European and Canadian operating systems ruled the day. Meeker also described the rapid acceleration of data created by mobile devices, which includes a growing amount of photo data and an increasing amount of video. For example, about 550 million photos are uploaded and shared each day across Facebook, Snapchat, Instagram, and Flickr.

One last important mobile metric: A year ago Meeker reported that 10 percent of all internet traffic was from mobile devices, now it’s up to 15 percent. Meeker expects that 150 percent growth to continue year-over-year or accelerate.

According to Meeker, Jawbone UP users interact with the activity tracking device’s smartphone app an average of five times per day. In aggregate, Jawbone UP users are capturing data on billions of steps each day and 700,000 or more hours of sleep each night.

MyFitnessPal, a diet and fitness community site and platform, has seen an increasing number of “API calls” for its data from its application partners month-over-month. Meeker’s chart for this data shows MyFitnessPal’s API calls went from about 15 million in February, to 25 million in March, to more than 50 million in April.

The slide that comes after the MyFitnessPal and Jawbone UP data shows that “behavior patterns” like smoking and obesity or inactivity account for about 40 percent of premature deaths as of 2007. More than any other premature death cause, according to Meeker.

Americans are also called out for being “underachievers” when it comes to “sharing everything” online. The world average from a country-by-country poll was 24 percent — that’s how many people claim they “share everything” or “most things” online. Saudi Arabia topped the list with a more 60 percent of those surveyed agreeing, while the US was well below the average with just 15 percent. The concept of “sharing everything” will be an interesting metric to follow once quantified self tools get to be more mass market and the public understands just how much they will be able to share in the coming years.

Be sure to read through Meeker’s entire 117 slide presentation over at Slideshare.