Scientific mobile health research found severely lacking

By: Neil Versel | Jan 17, 2013        

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Dr Caroline Free also led the efficacy trial for Txt2Stop, a SMS-based smoking cessation service

Dr Caroline Free also led the efficacy trial for Txt2Stop, a SMS-based smoking cessation service

Despite all the hype and promise around mobile healthcare technologies, the scientific evidence supporting clinical efficacy of mobile health continues to fall short, according to two new papers in the journal PLOS Medicine.

British researchers examined 20 years’ worth of published studies on mobile interventions delivered to healthcare consumers and mHealth technologies intended to improve care delivery processes. In both cases, they were underwhelmed with what they found.

“The results for healthcare provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits,” the researchers, led by Dr. Caroline Free, an epidemiologist at the London School of Hygiene & Tropical Medicine, wrote in the latter article. “Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed.”

They found just 42 instances of controlled clinical trials related to care delivery where mobile technology was the primary means of intervention. Not one was considered “high quality,” meaning there was a low risk of bias and the results were statistically or clinically significant.

“None of the trials reported any objective clinical outcome, and the reported results for healthcare provider support interventions are mixed. There may be modest benefits in outcomes regarding correct clinical diagnosis and management delivered via application software, but there were mixed results for medical process outcomes regarding the time taken and completeness of or errors in reports or warning scores,” the report says.

The results were only slightly more positive in the first article. In that case, the British researchers found 75 relevant scientific studies, including 59 trials related to mobile technologies for improving disease management and 26 about changing health behaviors. Just four met the criteria for being of high quality.

They found one high-quality trial that showed improved adherence to antiretroviral therapy – and markedly lower viral load – among HIV-positive patients in Kenya who got text reminders to take their medications. Two trials in the UK with text messaging resulted in more than double the rate of smoking cessation than those in a control group. However, lower-quality trials of SMS for diabetes management found no significant effects on patient weight from the use of mobile technology.

“Multifaceted mobile technology text messaging interventions have been shown to increase adherence to antiretroviral medication in a low-income setting and increase smoking cessation in a high-income setting; these interventions should be considered for inclusion in services in similar settings. Their effects in other settings should be established,” the study says.

“For other mobile technology health interventions delivered to health care consumers, the effects of optimized interventions on long term, clinically important outcomes must be robustly established in randomized controlled trials.”


Blueprint Health reveals 11 startups in its third class

By: Jonah Comstock | Jan 17, 2013        

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blueprintBlueprint Health, a mentor-focused health incubator that offers co-working space in New York City, has announced its Winter 2013 class of startups — its third. Blueprint is a member of TechStars’ Global Accelerator Network. Below are brief descriptions of each of the 11 companies that just joined the accelerator. Each will receive mentorship from big name companies that include Humana, Verizon, and Aetna, $20,000 in funding, office space in Blueprint’s SoHo loft, and more in exchange for 6 percent equity. Here’s what the companies are focused on today:


DocASAP is a service that helps doctors find new patients by partnering with insurers and hospitals, managing their patient directories for them, and then offering doctors in those directories the opportunity to set up online appointment booking directly through the insurer and hospital websites.


forMD is sort of like a special LinkedIn for doctors. It’s a free, private social network for medical professionals which hospitals can use to recruit qualified surgeons and doctors in specialized areas, paying for the privilege. According to Blueprint, the company already has 20 percent of the orthopedic surgeons in the U.S. on its networks.


HealthyOut aims to be a go-between for people on diets and weight loss plans to use online takeout ordering services like GrubHub. They aggregate online ordering sites and provide an interface to search them based on dietary requirements or point systems.


iMedicare is a business to business cost comparison tool, helping insurance companies easily calculate class D Medicare and Medicaid costs and benefits for their customers.


IntelligentM is targeted at the the problem of hospital hygiene and reducing the incidence of preventable hospital infections like MRSA. The company “designs data driven hand hygiene compliance solutions” – essentially making sure hospital staff wash their hands as often as they’re supposed to, using smart bracelets that interact with hygiene stations in the hospital.

Keona Health

Keona Health improves workflow efficiency at clinics by reducing the time spent on non-billable phone triage. Instead, the company offers an online triage system.


LuminateHealth has the goal of getting patient’s lab results directly to the patients, without necessarily having a doctor as an intermediary. They develop tools that make lab test results easier to access digitally and to understand.


MyNewMD is a website aimed at helping pregnant women find new doctors, through a combination of reviews and crowdsourcing. The company plans to move beyond expectant mothers in the future, to a more general physician searching case.


Nurep helps medical device, pharmaceutical, and biotech companies better use mobile technology to interface with customers and sell their products. For instance, the company is developing “Medical FaceTime,” so reps can engage doctors via live video on their iPads.


PadInMotion rents out iPads pre-loaded with books, movies, music and apps for cases where people need entertainment on a temporary basis. One of their big use cases is for bed-ridden hospital patients who find themselves with a lot of time on their hands, but the company also touts its service for traveling families and conference-goers.


TouchSurgery makes apps that surgeons can use to practice their skills. The apps don’t just simulate the technical aspect of surgeries, but also the decisions that have to be made in a surgical situation, something the developers feel current solutions don’t focus on enough.

Blue Button Plus may make its way into MU Stage 3

By: Jonah Comstock | Jan 17, 2013        

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Humetrix iBlueButton app won the ONC's Blue Button Mashup Challenge.

Humetrix iBlueButton app won the ONC's Blue Button Mashup Challenge.

The Office of the National Coordinator for Health Information Technology (ONC) is working to promote more patient engagement and access with their own records. One avenue of this work is with the Meaningful Use Stage 2 guidelines, but the office is also working with data holders and app developers to encourage the development of a patient health data ecosystem through an update and an expansion of the Blue Button program that’s being called Blue Button Plus, the ONC announced in a recent webinar, hosted by the National eHealth Collaborative.

“There’s a lot of democratization of information. Back and forth and sharing and co-creation of knowledge, and some of that has to be spilling over into health,” Lygeia Ricciardi, acting director of the Office of Consumer eHealth, said. “ONC in this context views itself not as the leader of this movement, but as a catalyst, pulling together the various forces moving in this direction in synergistic ways.”

HIPAA already requires that consumers have access to their own records if they request them, but under Meaningful Use Stage 1, they might only be able to access them through an online viewing portal. Stage 2, which will roll out for the earliest EHR adopters at the start of 2013, has a stricter requirement that patients be able to view, download, and transmit their data.

This paves the way, Ricciardi said, for the implementation of Blue Button Plus, which could possibly be a requirement in Stage 3 (the Stage 3 guidelines, which will go into effect in 2016 at the earliest, are not yet set.) Named after the original blue button that was implemented on the VA website starting in 2010, ONC uses the term “Blue Button” to refer to the act of patients downloading their own health records, something that should only become more feasible as providers switch over to EHRs. The ONC advocates that patients have access to their health records to make it easier to keep track of medications, to switch doctors or insurers, or to get care when they’re away from home. Also, when patients have access to their own records, they can spot errors and call to have them corrected.

Data holders that are themselves part of the government — like Medicare and Medicaid, Veterans Affairs, and the military — are implementing Blue Button Plus directly. But the ONC wants to encourage private data holders, such as hospitals, doctors, and private insurers, to make their data available in the same way. Toward that end, it has launched Blue Button Pledge, a partnership which has signed on 450 partners that are either data holders or organizations with a lot of public influence to get the word out about the initiative.

Blue Button Plus, which has previously been referred to as the Automate Blue Button Initiative, will not only make a patient’s health data accessible, it will make it accessible in a mobile and flexible way. Through Blue Button Pledge, the ONC will encourage data holders to format patient data in a consistent way. Whereas right now Blue Button data can only be accessed as an unformatted ASCII text block, Blue Button Plus will be in a data format that third party apps can shape into easy-to-use graphical interfaces, according to ONC. In addition, Blue Button Plus will be designed so consumers can give a third-party app access to their medical records and have it be continually updated, without their needing to sign in every time or manually download their records over and over. Keep reading>>

UnitedHealthcare, Konami bring health games to schools

By: Jonah Comstock | Jan 16, 2013        

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ddr classroomKonami might not be a familiar name in healthcare, but gamers likely recognize the Japanese company as one of the pioneers of the video game industry that successfully transitioned from jukeboxes to arcade games to home video game systems in the 1980s. And now, in partnership with UnitedHealthcare (a division of UnitedHealth Group), the company is entering the field of public health, offering their DanceDanceRevolution Classroom Edition as a pilot in three schools in Florida, Georgia, and Texas.

“It’s part of a broader initiative we have to reduce childhood obesity,” said Will Shanley, Director of Public Relations at UnitedHealthcare. “A big portion of that is the idea of ‘exergaming.’ The reality is that kids need to be engaged in fun and interactive ways. It’s important to meet them where they’re at. Kids enjoy playing videogames. If we can have them have fun and get exercise, it’ll build lifelong habits toward fitness. We think this is one important way we can engage kids.”

DanceDanceRevolution, or DDR, began as an arcade game in Japan in 1998, moving to America and Europe in 1999. It’s since been released for a number of home consoles. To win the game, players must step on one of four arrows in time with the music and onscreen instructions. The game uses popular songs and the dances increase in speed and complexity as the players progress. The ubiquity of the game led to its being used in a number of peer-reviewed studies that showed it could encourage increased physical activity for young people and even be helpful in autism therapy.

Konami announced the classroom edition of DDR in April 2012. The version provides 48 wireless dance mats, enough for a large class, and is connected to a PC rather than a gaming console (as in the home versions). Each mat contains a smart card which can hold data for an individual student, allowing the student and the teacher to track BMI and calories burned playing the game. The teacher enters the students’ age, height, weight, and gender and the mat combines that information with game data to estimate steps taken, caloric burn rate, and other data points, Clara Baum, senior director of marketing and strategic partnerships for Konami, said in an email. The school can set up the system so students and their parents can see all of their data via a secure website.

Konami has also announced upcoming partnerships with the American Diabetes Association, the National Foundation on Fitness, Sports, and Nutrition, and First Lady Michelle Obama’s Let’s Move in Schools campaign, to bring DDR Classroom Edition to more schools. There are dance and physical education curricula built into the system as well, following the standards of the National Association for Sports and Physical Education (NASPE), and school-appropriate music provided by Sony Music. Outside of partnerships, schools can also purchase the system at a variable pricing structure depending on the number of mats needed and whether the school needs a screen and sound system. Baum said the system is already very popular.

“We’re just launching, so limited systems are deployed in classrooms,” she told MobiHealthNews in an email. “But believe it or not, we’re sold out. We’re in full production, but all of those systems are allocated.”

UnitedHealthcare is also launching a pilot program using Xbox Kinect, Shanley said. That program, which is currently gathering efficacy data, will test the potential of exercise videogames in the home as a public health tool in the fight against childhood obesity.

Harvard Medical to power Orca’s reference apps

By: Jonah Comstock | Jan 15, 2013        

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Orca Health HeartDecideMedical reference app and iBook maker Orca Health announced a partnership with Harvard Medical School this week. Starting with Orca’s existing HeartDecide app, Harvard Medical will begin supplying the content for Orca’s interactive apps while Orca continues to focus on design and engineering.

Orca began as a hobby for CEO Matt Berry, whose father is a spine surgeon in Salt Lake City, Utah, where the company is built. Orca’s iOS apps are designed to help educate surgery patients about their bodies and their surgical options, to aid them in making medical decisions. They include 3D models, interactive animations, narrated videos, and a “Find A Specialist” feature, in partnership with provider locator platform DocSpot. The company’s EyeDecide app was named medical app of the year by Apple for 2011.

“We’re no longer a text-based society,” said Berry. “A surgeon shouldn’t give out pamphlets anymore, they ought to prescribe multisensory learning apps.”

The new HeartDecide app will have all new content, some of it from existing Harvard Medical materials and some created expressly for the app by Harvard Medical School physicians. In addition, it will have added features, updated graphics, and a faster download time. Orca’s health content was previously written by Orca’s team of board-certified physicians. Berry said they will stay involved as the company gradually replaces the content in each of the company’s 13 apps with content from Harvard.

Orca is also releasing a series of interactive iBooks on particular cardiovascular conditions like angina and atherosclerosis. These are aimed less for patient education and more as e-textbooks for K-20 education (kindergarten through medical school). They are also written by Harvard Medical doctors, modified from existing special reports.

Berry said Orca and Harvard Medical School were connected through a mutual friend at incubator Rock Health (although Orca didn’t go through that incubator). He said the team at Harvard Medical School shares his views about text becoming obsolete.

“Many things can be explained better with video, interactive animations and spoken voice—not just plain text,” Dr. Anthony Karmaroff, editor in chief of Harvard Medical publishing, said in a statement. “Harvard Medical School believes its partnership with Orca Health will enable people to access, understand and retain high quality health information via state-of-the-art technology.”

In addition to plans for an Android launch in the near future, Berry said the company’s future direction is to create a more comprehensive, linear solution for patient education, moving from a single app, both for patients and for physicians to use as a teaching tool, to separate apps connected by “an Orca cloud that meets in the middle.”

The company’s apps are currently available on iOS devices only, normally at $4.99. To celebrate the partnership with Harvard Medical School, the company is temporarily making all their apps free. The iBooks are $4.99 apiece.

Pew: 35 percent of US adults are online diagnosers

By: Brian Dolan | Jan 15, 2013        

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Brian Dolan, Editor, MobiHealthNewsWhen it comes to looking for health information online, consumers have had fairly consistent behaviors over the past 12 years. A new report, Online Health 2013, from The Pew Research Center’s Internet & American Life Project found that of the 81 percent of US adults who use the internet, 72 percent have gone online to look for health information in the past year. Some 59 percent of that online health information seeker group went online to specifically try to figure out what medical condition they or someone they know has. Pew calls this group “online diagnosers” and it includes about 35 percent of all US adults.

By a two to one margin, these online diagnosers found that the internet is often correct, too. While many of those who sought a self-diagnosis with the help of the internet never ended up going to visit a clinician to double-check, some 41 percent said that a clinician confirmed their diagnosis and 2 percent said a medical professional partially confirmed it. About 18 percent said a medical professional either did not agree or — assumedly to be less confrontational –offered a different diagnosis instead. What kinds of conditions and which sources were best, of course, remain a bit of a mystery based on the Pew data alone.

Pew Associate Director Susannah Fox told MobiHealthNews that one of the questions asked in the survey may benefit from a mobile component in the future:

“The last time you went online to look for health information… How did you begin looking? Did you start… at a search engine such as Google, Bing, or Yahoo; at a site that specializes in health information, like WebMD; at a more general site, like Wikipedia that contains information on all types of topics; at a social network site like Facebook?”

“That question is an adaptation of one that we asked way back in the year 2000 when only 46 percent of American adults had access to the internet,” Fox said. “We got the same results in 2013 essentially. About 8 out of 10 health inquiries online start at a search engine. That was true in the year 2000 and it is true now. I’m not sure I’m going to be able ask this question in the same way in 2014, which is when I think we are going to be at a stage of ubiquitous mobile access. Some of the apps that have been introduced, diagnostic and health information apps — will it be that the marketshare for those will challenge search? That is a question I have and I don’t have data on it yet.”

Fox said that she and her team are thinking through the implications of mobile now even before health apps have really captured the market. When possible, Pew researchers try to write questions that are platform agnostic, which is sometimes successful and sometimes not, Fox said. She said it was difficult in the past, for example, to measure the impact of Twitter without using the site’s actual name. I wonder whether respondents who used their mobiles to look up health information via apps or via their mobile’s browser answered Pew’s questions based only on their desktop usage. More data next year hopefully.

MobiHealthNews writer Jonah Comstock wondered whether voice-enabled apps like Siri, which can help Apple device users to look up any kind of information via the Wolfram Alpha search engine, would have registered among those surveyed as using a search engine to look up health information or as something else entirely. Same goes for the Android-based Google Now predictive search offering. Slowly, the criteria that defines a search engine is changing.

Surprisingly, Pew found that one category of online health services appears to be languishing. Few consumers consulted online sources for information that would help them compare drugs or medical treatments. In 2010 Pew found that some 24 percent of respondents who sought any kind of health information online, used sites that helped them compare drugs and treatments. In 2012 that group dropped to 16 percent of online health seekers. Fox noted in the report that overall review sites online are popular — some 8 out of 10 internet users visit some kind of review site. Seems to me that those working in the online reviews business for drugs and medical treatments might want to consider a pivot.

Considering the ongoing national discussion around public access to scientific journals, Pew’s question about consumers’ experience with health sites and paywalls was a particularly timely one. Fox said she believes it is the first attempt at measuring the public impact of keeping scientific and medical journals behind subscription paywalls: “I don’t think anyone else has asked this question before in a national survey,” she said.

Some 26 percent of online health seekers said they had encountered a paywall. Of that group, only 2 percent ended up paying to gain access to the information, while 83 percent of that group tried to find that same information elsewhere, assumedly for free. The important metric, however, was that 13 percent of that group decided to give up and end their search then and there. It would be fascinating to know what happened next: Did any of those who encountered that paywall become sicker as a result?

“This has been a question of principle so far,” Fox said. “The conversation has not really penetrated the public sphere as much as the elite sphere and yet this has impacted quite a few people who were just trying to get some medical information to make a good decision. That is what the Internet is really for, and it dovetails with all our other findings that the internet is a de facto second opinion.”

Fox said that her favorite question was about who you turned to the last time you had a serious medical issue.

“We get a much clearer picture that, of course, so much of healthcare is hands-on and in-person,” Fox said. “Seventy percent of people got information, care or support from a clinician; 60 percent got information, care, or support from friends or family; 24 percent got information, care or support from others who have the same condition,” she said. “So much of it was offline. The internet is a very important supplement, especially for younger adults and people with high levels of education, but let’s just keep this in perspective.”