Mobile health is more evolution than revolution

By: Neil Versel | Apr 26, 2011        

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Neil VerselLast week, online “knowledge forum” Big Think interviewed UCLA engineering professor Aydogan Ozacan of the school’s California NanoSystems Institute in touting the “coming wireless health revolution.” The institute is trying to shrink an optical microscope so it can be attached to a cell phone to help identify infectious diseases in remote and underserved parts of the world. That sounds pretty revolutionary to me.

Then, this week, the VentureBeat blog mentioned “the mobile health revolution” in a story provocatively headlined, “Can your smartphone save your life?” That story covered such developments as wearable wireless sensors and the pilot test in Egypt of the Great Connection Mobile Baby service that sends ultrasound images to patients’ smartphones. That’s also some pretty cool stuff with the potential to be revolutionary.

Sometimes, though, we throw around the word “revolution” a little too haphazardly.

The week before last, I spoke to faculty, residents and students at Meharry Medical College in Nashville, Tenn. It was the fourth time in the past year I’d been asked to give a talk on mobile and wireless healthcare.

Back in September, I spoke to the mHealth Initiative’s 2nd International mHealth Networking Conference on the topic of, “Evolution of the Revolution.” In that presentation, I noted that a Google search of “mhealth revolution” returned 418,000 results. (As I said this month at Meharry, It’s since dropped to about 390,000 results, but I have a feeling that’s because Google has tweaked its search algorithm to filter out a lot of junk.)

If that many posts on the Internet indicate there’s a revolution brewing, it must make it so, right? Well, maybe. Keep reading>>

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Survey: Text messaging preferred for health alerts

By: Brian Dolan | Apr 26, 2011        

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A new survey by the Consumer Health Information Corporation (CHIC) found that for all types of smartphone apps (not just health) 74 percent of apps were no longer used after the tenth try. What’s more, 26 percent of apps were dropped after the first try. Reasons for dropping an app included finding a better one (34.4 percent), its lack of “user friendliness” (32.6 percent), or it not being engaging enough (15.8 percent). The survey included responses from 395 consumers.

Helpfully, CHIC’s survey delved into some of the criteria consumers are looking for in a health app so they don’t relegate the app to their mobile recycling bin: Some 91.1 percent of survey respondents said they wanted an app that provided them with health information, while 58.4 percent would like to manage a health issue via an app and 48.5 percent said they wanted to track their own health. About 79.9 percent said they would be more motivated to use an app that would analyze data they recorded and provide feedback.

While tracking data might be exciting, a large portion of survey takers wanted to use apps to find out info on drugs (42.2 percent) or disease (26.5 percent). Also promising was the finding that 39.8 percent of survey takers would use a health app multiple times a day. For health reminders or alerts, most respondents prefer receiving a text (41.1 percent) or a notice through the smartphone app (20.3 percent) rather than receiving a phone call (1.3 percent) to be reminded about taking medication or perform some other health related task.

The CHIC stats could make for interesting fodder but they are based on a small online survey.

A larger and more comprehensive survey conducted in October by the Pew Internet Project found that of the 85 percent of American adults who use a mobile phone today, 17 percent had used their phone to look up health or medical information. Mobile phone users aged 18 to 29-years-old were found to be much more likely to have searched for health information from their phones: 29 percent of this age group had conducted such a search. At the time about 9 percent of mobile phone users had a software app on their phone that helped them track or manage their health. Keep reading>>

Mobinil tests remote teledermatology in Egypt

By: Brian Dolan | Apr 25, 2011        

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Logical Images VisualDX

Example dermatology app for iPad: Logical Images' VisualDX

Patients outnumber doctors close to 2000 to 1 in Egypt, according to Khaled Bichara Group CEO of Orascom Telecom.

With that figure in mind, doctors in Egypt are using mHealth technology to provide ‘teledermatology’ to patients in low income areas who have not had access to specialists in the past. The pilot program launched as a partnership between Qualcomm’s Wireless Reach initiative, Egyptian mobile operator Mobinil, Click Diagnostics and the Egyptian Ministry of Health.

Using Mobinil’s 3G HSPA mobile broadband network, physicians on location photograph patients’ skin conditions, write up symptoms in text and transmit the information to remote specialists to obtain or confirm diagnosis. Medical staff at the clinics have been given handsets with high-resolution cameras and an application that enables them to send photographs and contextual information about skin conditions an appropriate specialist. The pilot phase of the program is being used to determine the potential success of a large-scale deployment of such a service across Egypt which would provide access to remote experts for a wide range of medical conditions to regions in need.

So far, the pilot results have shown more than 82 percent agreement between remote diagnoses and an in-person confirmation.

Advances in phone camera technology have made it possible in clinics throughout the world to use teledermatology where hi-res photos are required for accurate diagnosis. Prior to the advancement in mobile phones, the special field of dermatology relied on digital cameras, laptops, desktops and wired internet that made the process difficult to deploy and expensive to expand and scale. Small, but powerful smartphone devices combined with 3G broadband make services like these much easier to provide.

“From the beginning, Qualcomm has been committed to the success of this important pilot that demonstrates the use of 3G to support mhealth initiatives,” Moheb Ramsis, senior director of business development for Qualcomm North Africa stated in the release. “By using Mobinil’s state-of-the-art 3G HSPA network and smartphones enabled by Qualcomm’s advanced chipsets, clinics are able to connect to specialists and provide more efficient care to those in need around the world. We are proud to be a part of this program and its esteemed participants in supporting mhealth.”

Not long ago, Mobinil teamed up with Orascom Telecom in partnership with Great Connection to pilot the startup’s Mobile Baby service, which enables medical practitioners to send ultrasound images, video clips and 3D scans to and from referring physicians for remote medical diagnostics. The application works directly from ultrasound machines, with images delivered to any mobile phone via SMS, MMS and email. The service can be used both to get outside expertise on diagnosis as well as to allow patients to share pictures of their ultrasounds with friends and family.

In the US last year an emergency room physician conducted a wound care pilot using mobile phone cameras: Dr. Neal Sikka, an emergency physician at George Washington University, launched a six-month study in May 2010 that aimed to determine how accurately ER doctors and physician assistants could diagnose wounds from images patients took with their own mobile phones. Hollywood-based physician group Wound Technology Network also uses smartphones and 3G-enabled laptops to capture images of wounds for remote care.

For more on Mobinil’s teledermatology pilot, read the release.

VA creates app for post traumatic stress disorder

By: Brian Dolan | Apr 22, 2011        

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VA PTSD coachSomewhere between 11 percent and 20 percent of veterans of the Iraq and Afghanistan wars now have Post Traumatic Stress Disorder (PTSD), according to the U.S. Department of Veteran Affairs (VA). In light of these statistics, the VA has developed an iPhone app to help inform vets and others about PTSD.

The app, called PTSD Coach, offers reliable information on PTSD and treatments right on a patients phone. The app offers tools to screen and track symptoms while offering direct links to help if a user needs it. The app also provides tips and easy-to-use skills to handle stress symptoms in the moment. While the app’s surveys and checklists are valid self-reporting measures, the app is intended for use in conjunction with professional care.

PTSD Coach could also be helpful to family and caregivers of people with PTSD, according to the VA. The department plans to offer a PTSD Family Coach app in the future too. The current app is free to download from the iTunes store and an Android release is slated for June.

PTSD Coach was created by the VA’s National Center for PTSD and the DoD’s National Center for Telehealth and Technology. The NCTT was also behind a similar smartphone application, called T2 Mood Tracker, that helps members of the military who have been deployed track their mood and stress levels. The T2 app specifically tracks anxiety, depression, general well-being, life stress, post traumatic stress and brain injury. Users can also correlate changes to their medication regimen or home or work environment to changes in their moods. The tracking data can help physicians and therapists observe trends and provide treatment instead of relying solely on patient recall.

For more, read InformationWeek’s write-up or check out the VA’s information page.

FDA health app regulation won’t cost $30M

By: Brian Dolan | Apr 21, 2011        

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Brian Dolan, Editor, MobiHealthNewsIn recent months it’s become clear that the media is increasingly turning its attention to mobile health.

The attention, of course, is welcomed by most everyone working in mHealth today, but sometimes it’s painful to read the hyperbole, exaggerations, and misconceptions that are perhaps inevitable with the increase in coverage.

Proteus Biomedical is one company that has noticed this hyperbole. The media often uses words like “Orwellian” and “Big Brother” to describe the company’s medication adherence technology. A recent report over at Dark Daily piqued my interest by stating that Novartis had an exclusive deal with Proteus for all of its drug delivery technology, because we had reported the exclusivity was only for certain use cases, including organ transplant drugs. A rep from one of the companies confirmed the report’s inaccuracy. After all, if it were true it would be tantamount to Novartis acquiring the company, right?

A number of readers called my attention to a Bloomberg report published last week. One reader called the report “totally and completely absurd” among other things.

Bloomberg wrote that the US Food & Drug Administration may regulate the chips in mobile phones along with health apps. They also wrote that FDA clearance of apps and devices could cost device makers more than $30 million a pop. They also quoted someone as stating that the Apple AppStore offered between 20,000 and 30,000 “wellness apps.”

Let’s take these one at a time.

Sure, the FDA has yet to add guidance for ongoing regulation of mobile health apps and devices. It has been suggested that in some cases the FDA could consider smartphones as accessories to medical devices and deserve some regulatory attention. I have yet to hear someone claim that the individual components of smartphones would be subjected to the same review.

What about the costs of such regulation? While some medical devices can cost tens of millions of dollars or even hundreds of millions of dollars, the recent experience of at least two mobile health companies says otherwise. One medical app company and another mobile health device company that secured FDA 510(k) clearance told me that the process cost under $1 million — in the hundreds of thousands of dollars range. Sure, the 510(k) process technically means that the Bloomberg article’s headline is correct and “Apple’s IPhone Health Tool May Get Same FDA Scrutiny as Stents,” but that doesn’t mean it will cost anywhere near as much.

Finally, the article claims that the “online Apple store features 20,000 to 30,000 wellness apps.” That’s one metric we have tracked closely over the years and 20,000 apps, let alone 30,000, is way off the mark. Assuming “wellness” apps are ones intended for use by consumers (could an EMR app for physicians really be a “wellness” app?), our last apps report found that the AppStore offered just under 5,000 health-related apps intended for use by consumers. That was last September. Today, the total number of apps found in the Health/Fitness and Medical categories of the AppStore is still less than 15,000. That number includes those for healthcare professionals, which are usually about 30 percent of the apps, and the miscategorized, which typically hover around 20 percent.

You can watch a Bloomberg video report based on a distillation of the article discussed above over at YouTube. Each of the metrics are discussed in the video. Of course, the video’s introduction is: “I hope you never have to do this, but [if] you need to diagnose a heart attack, well, there is an app for that.”

It’s all downhill from there.

As the discussion heats up around mobile health and the industry enjoys the benefits and pitfalls of sitting atop the Gartner Hype Cycle, let’s do what we can to help the discussion avoid becoming “totally and completely absurd.” Bloomberg, of course, is not alone in the hyperbole but this report was particularly emblematic of the dangers of hype in mHealth. Thanks to those readers who sent it in.

Denver Health, Microsoft, EMC team for diabetes text messaging program

By: Brian Dolan | Apr 21, 2011        

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Microsoft's Jack Hersey

Jack Hersey, GM, US Public Sector Health and Human Services, Microsoft

This week hospital group Denver Health, Microsoft, and EMC announced early results from a text message powered diabetes program that aimed to help patients better self manage their condition.

Denver Health sent patients text message reminders about upcoming appointments and asked patients to text in their daily glucose readings. Denver Health case managers tracked the patients glucose control between the patients’ visits in an attempt to improve condition management, reduce admission rates and reduce costs.

“Denver Health designed the program with the understanding that many of their patients do not have regular access to computers or smartphones. Their Chronic Condition Management platform (CCM), which is built on Microsoft Office SharePoint Server 2007, Microsoft Dynamics CRM and SQL Server 2008, helps doctors and diabetics communicate via text message in between regular office visits,” Jack Hersey, General Manager, U.S. Public Sector Health and Human Services, Microsoft wrote in a recent blog post. “Medical staff establish appropriate reminders in the CCM system, which then automatically sends text message reminders to patients. These reminders prompt patients about their upcoming appointments and remind patients to text in their daily blood glucose readings. This allows Denver Health case managers to track patients’ blood glucose control in between visits. If a patient’s blood glucose levels are too low or too high, clinicians can intervene by directing patients to schedule an office visit to review their health status.”

While the companies were not forthcoming with specific details around the program’s results: Hersey wrote that participating patients are more engaged in the management of their disease, according to Denver Health, and doctors are able to quickly identify patients suffering from dangerously high and low blood sugar readings.

More over at Hersey’s blog post or in the press release below: Keep reading>>