To move into the future, providers must understand the implications of new technologies, such as mobile devices, that can measure and track consumers’ health.
By John R. Patrick, D.H.A.
In 1976, Seymour Cray introduced the first supercomputer, the Cray-1. It was the most powerful computer at the time, and it was super in many respects. It cost $5 million to $10 million, weighed more than 5 tons and used as much electricity as 10 homes. Super as it was, the Cray-1 had no app store, could not play a song or make a phone call. Scientists and researchers embraced the Cray-1 because it enabled them to perform scientific simulations and explore data at a speed not previously possible.
Fast forward four decades from the introduction of the Cray-1 to the Apple and Android smartphones of today. We call them phones, but they are really computers; supercomputers 100-plus times more powerful than the Cray-1. Hundreds of millions of people around the world carry these personal supercomputers (PSCs) in a pocket or purse.
One benefit of PSCs allows users to take more responsibility for their health with the aid of new mobile health (mHealth) apps and devices. By measuring and tracking health, consumers will collect more data about themselves than ever before. Although some providers may not be totally comfortable with consumer technology for self-diagnosis, new technologies will lead to a new model of collaboration between patient and physician, and parents will extend the use of mHealth to their kids.
People are finding that when they track their health, they feel more empowered to improve it. According to "Tracking for Health," from the Pew Research Internet Project, more than half of Americans track weight, diet or exercise. To keep up, innovators are developing new apps and devices at a frenetic pace.
According to FDA industry estimates, 500 million smartphone users worldwide will be using a health care application by 2016, and by 2018, 50 percent of the more than 3.4 billion smartphone and tablet users, including health care professionals, consumers and patients, will have downloaded mobile health applications.
The emergence of mHeaLth apps and devices
The term "regulation" is unfavorable to many technology innovators who fear the government will inhibit getting new ideas to market. But when it comes to health care, regulation is a different story. In 2013, the FDA defined Mobile Medical Apps (MMAs) as those that can turn a smartphone or tablet into an established health care device or supplement to that device, such as a portable EKG monitor.
The FDA sees the widespread adoption and use of mobile technologies as an important way to create new channels to improve health and the delivery of health care services. This has led to an explosion of FDA-approved health care apps and devices connected to PSCs—the agency has approved more than 150 to date. These apps and devices in turn enable a consumer-led revolution in health care. Here are just a handful of developments in mHealth technology:
Cardiology. In 2014, St. Louis Children's Hospital trained 30 families of patients with irregular heartbeats on how to use the mobile electrocardiogram device, AliveCor, to record the heart's electrical activity. The heart monitor sensing device attaches to the back of a smartphone, and the patient places a couple of fingers from each hand on the sensors so the iPhone can create a 30-second EKG. Researchers at St. Louis Children's found the device generated quality tracings, and doctors used the information to make changes to treatments remotely, helping many patients avoid trips to the hospital and reducing readmissions. Ninety-five percent of patients and families also found it easy and convenient to use.
Ear infections. Wilbur Lam, M.D., developed the CellScope Oto to snap onto the phone over the camera lens, turning the phone into an otoscope. The smartphone analyzes a picture of a child's ear canal and diagnoses ear infections. Parents can then email the result to a doctor to confirm diagnosis. Compare this to making an appointment, driving across town and sitting in the waiting room.
"Ultimately, parents could receive a diagnosis at home and forgo the late-night trips to the emergency room," says Lam, who is a physician at Children's Healthcare of Atlanta and an assistant professor of pediatrics at Emory School of Medicine. The device has the potential to save money for families and health care providers.
Ear infections affect 75 percent of children by age 6, making it the most common diagnosis for preschoolers, and they result in more than 15 million office visits per year in the United States and thousands of prescriptions for antibiotics, which are sometimes not needed.
Blood tests. The ease and conveniences of mHealth will eventually extend to blood tests. A team of engineers at Cornell University developed a device called Nutriphone that fits over a smartphone's powerful megapixel camera, which enables the phone to become a detection device that can analyze small blood samples from test strips. Here's how it works: A consumer can extract a single drop of blood onto a strip, the camera takes a photo of the strip, and the PSC performs a colorimetric analysis displaying the cholesterol level in a matter of seconds.
Molecular testing. A San Diego startup named Cue developed a compact, consumer-oriented device, which can detect five biological conditions at a molecular level including inflammation, vitamin D, fertility, influenza and testosterone. There's no lab in this diagnostic loop requiring the user to send off samples. Instead, the device itself is the lab, and it lives at home by connecting to a smartphone. This "deep health tracker" monitors users' health at a molecular level rather than monitoring signals like heart rate or blood pressure.
Asthma care. Propeller Health, an FDA-cleared digital health solution for chronic respiratory disease, and Arizona Care Network, a physician and health system collaboration, which includes Phoenix Children's Hospital, became the first Accountable Care Organization (ACO) to offer the Propeller platform to its members with chronic obstructive pulmonary disease.
Propeller has a smart inhaler that reports the latitude and longitude at the time of an inhalation, and the data from the inhaler flows from a smartphone to the cloud.
Temperature monitoring. Kinsa developed a smart thermometer that is thin, flexible and plugs into the audio jack of an iPhone or Android smartphone. The smartphone retains a record of the temperature for one or more family members, and users can annotate the information it gathers with other symptoms such as chills or a headache.
Users can then email a log from multiple days to a doctor for review. The device also has a way to track illnesses and symptoms for schools through a population health component. The goal is to help track and stop the spread of illnesses.
For example, alerts like area children coming down with strep throat prompted parents to go to a doctor faster to get throat cultures. The interest in sharing data about local outbreaks of illnesses such as flu has led a few health IT companies to develop apps to make this easier. HealthMap, an initiative launched at Boston Children's Hospital, is collaborating with companies and groups to monitor illnesses. The hospital is also working with Yelp to track foodborne illnesses.
The human genome. Illumina, a company aiming to change the global landscape of genomics products, laid out a vision for a consumer genomics product. The company says it can build a DNA chip that plugs into a smartphone, bringing genetic medicine into the world of mHealth. Of course, this raises many ethics questions, but some things are certain: The price of sequencing will decline, and the availability of big data about humans will be commonplace.
Beyond smartphones. Researchers at Northwestern University in Evanston, Ill., and the University of Illinois at Urbana-Champaign developed a wearable, wireless, skin-like device they say can monitor cardiovascular status, blood flow, and temperature and skin hydration level. The small device, approximately five centimeters square, can be placed directly on the skin and worn 24/7 for around-the-clock health monitoring. The wireless technology uses thousands of tiny liquid crystals on a flexible substrate to sense heat. When the device turns color, the wearer knows something is awry.
Providers should consider key questions and develop a strategy to ensure mHealth has a positive influence on the care they deliver in the future. Some will choose to be leaders, and others will choose to be fast followers. Some will be more cautious. All providers need to understand new technologies and their implications:
- How can children's hospitals utilize mHealth to reduce the cost of care for patients with chronic illnesses?
- How should children's hospitals communicate and urge caution so consumers take the data they gather to their provider before making conclusions about treatment?
- How can hospitals use mHealth data to design a population health strategy?
- Should a hospital integrate the EMR with devices like smartphones and the Apple Watch?
The pace of adoption will accelerate, and self-monitoring and self-diagnosis are here to stay. A new model of collaboration between patient and provider is emerging. An effective strategy to embrace mHealth should be a priority for all providers.
John R. Patrick, D.H.A., is president of Attitude LLC, a health care and technology company, and former vice president of IT at IBM. Send questions or comments to firstname.lastname@example.org.