FierceMobileHealthcare

Debate: Can mobile apps achieve what pills can't?

Susan D. Hall - Contributing Writer — Tue, 15 May 2012 12:47:39 -0400

In a pair of point-counterpoint articles at Forbes, contributors Dave Chase and David Shaywitz face off on the question of whether mobile apps could someday be more effective than prescription drugs--a response to health app company Happtique's plans to build a platform for physicians to "prescribe" apps to their patients.

Chase, the CEO of patient portal and relationship-management company Avado.com, sounds a dire warning that apps pose a huge threat to a lethargic pharma industry. He likens pharma execs to those of the newspaper industry 15 years ago, who saw the landscape changing around them, but did too little to adapt.

Chase urges pharma execs to get out of the stands and put more skin in the game in terms of money and people.

Drawing from his experience as founder of Microsoft's Health platform, Chase points to Xbox and Expedia as the only two true successes from the tens of billions Microsoft has spend on research and development. The key to their success, he believes, was that they were unshackled from Microsoft's other products--not even required to use Windows. Not being required to support core, legacy business freed these units to truly be innovative, he writes.

Shaywitz, a physician-scientist and management consultant who works for a biopharmaceutical company in San Francisco, agrees there are profound opportunities in digital health, but counters that it's not a "magic pill," so to speak. He points to two basic opportunities: through engagement to motivate patients to better behaviors and to improve science through better measurement, and hence better data, at its base.

"The development of an effective vaccine did a lot more for the treatment of polio than applying the best design thinking to the construction of an iron lung ever could," he writes. "I worry a bit that in our fascination with technology and design--which matter a lot for patients in the here and now--we're neglecting the need figure out some way to get at the difficult biological questions that remain at the root of disease."

He, too, sees pharma's willingness to sit on the sidelines as an impediment to revolutionary change. In the end, both writers agree that health improvement will require a combination of old and new techniques.

In a separate Forbes piece, writer Zina Moukheiber notes that though seemingly a natural partner, pharma has lagged behind telecom and health insurance in teaming up with health technology companies.

To learn more:
- read an overview of the issue on Forbes.
- read Chase's commentary
- read Shaywitz's take

Banner, Aetna build mobile tech into ACO program

Sara Jackson — Tue, 15 May 2012 10:42:30 -0400

Health insurer Aetna and Phoenix-based hospital network Banner Health are digging deep into the technology toolbox to boost their evolving accountable care organization partnership.

Seeking ways to reduce costs but improve outcomes, the two groups are building a hefty "technology stack" into the ACO system, and improve physician-patient coordination of care, company officials say.

The partners are installing an across-the-board health information exchange to allow clinicians two-way access--that is, read and input--to the core electronic medical record. Seventeen of Banner's 23 hospitals recently were announced as HIMSS Analytics Stage 7 Award winners.

On the mobile side, they're also installing iTriage to allow patients to pre-register for appointments via smartphone, company officials say. It may be one of the first ACO deployments of the technology since Aetna purchased the company last year.

No word yet on whether smartphone access will be expanded to include EMR- and other network access, however. But it may be the next step, as iTriage has been integrated into Aetna's CarePass platform, which allows patients access to multiple Aetna applications from one central access point.

To learn more:
- read the Aetna/Banner announcement
- here's the HIMSS announcement

Reaching mHealth's Holy Grail: Behavior change

Sara Jackson — Tue, 15 May 2012 06:25:30 -0400

Health apps continue to hit the market in droves, promising your patients faster weight loss, reduced blood pressure, improved cardiac health. But the true Holy Grail of mobile health--getting patients to make healthier choices, stick to health regimens, etc.--remains elusive.

So I dug in to find some real strategies that hospitals and developers can use to truly engage patients in their own healthcare, and turn their mobile phones or tablets into actual instruments of health change.

Perhaps the most important starting point is to make the smartphone a friend, according to Margaret Morris, a clinical psychologist and senior researcher at Intel, in a recent paper. It may sound easy, as most people view their phones as an integral part of their daily lives now.

She likens it to the relationship between a patient and therapist, where the smartphone (and its apps) become a trusted, relied-upon partner in the patient's health. That means changing some of the language, and responses, that patients get from their apps when they make poor choices.

For example, Morris suggests using a cooperative message like "Let's figure out what might be causing the rise in your blood pressure" rather than the more disconnected "Your blood pressure is high; answer the questions below."

Developers also need to incorporate "stigma-free" language and images, so that the app keeps a positive, encouraging tone, rather than a negative, punitive one (the former being far more likely to encourage change than the latter). For example, she recommends using an image of a rising tide as a way to remind cardiac patients of the effects of too much weight gain due to water retention--rather than a picture of a swollen limb.

Never doubt it, the "nag" factor can even affect something as beloved as one's smartphone. "If an app becomes the source of unwelcome advice or beeps, or we feel intruded upon or our response to some app brings unwanted attention to us, we will have no problem circumventing it," says physician Jessie Gruman, blogging for GetBetterHealth.com.

Once the smartphone is a trusted ally in the fight for better health, bring in the big guns--peer pressure. Messages should compare the users' exercise rates, eating habits or other choices to peer groups that the user values. For example, instead of berating a teen user for not exercising, the app can use locators, social network information, and other resources to prompt the teen with a message saying "4 p.m.: 80 percent of teens play sports after school. Join your 16 friends playing soccer in Washington Park."

And make use of new media to get the message across, Morris says. Videos or motivational messages from individuals of similar age or who are involved in similar social or activity circles can encourage the user to step up to difficult choices, as a way to be more like peers they admire.

I told you last month about the American Diabetes Association of Washington testing out this exact idea. With it's ADA/Numera Social app, the association will use Facebook to connect diabetic participants with their friends, family and others as they report their diet compliance, challenge each other to exercise goals, and the like.

If Morris is right, they just might be onto something. - Sara

BYOD continues to challenge hospitals' security boundaries

Sara Jackson — Mon, 14 May 2012 14:28:09 -0400

As "Bring Your Own Device" continues its march into healthcare--remember Aruba Networks' recent data showing 85 percent of hospitals allow BYOD--CIOs continue to adapt their security policies to control a myriad of devices and security settings.

Mobile cheerleader John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, put forward a few new tweaks to his own organization's policy in an post to his Life as a Healthcare CIO blog last week. For instance, Halamka believes that CIOs need to:

Make passwords still top priority: Halamka uses a remote wipe setting for all his organization's Blackberry users--wiping the device after 10 failed password attempts. He notes, however, that this is less possible with Apple and Android devices, where corporate and personal data are more difficult to segregate.

"Given that we cannot selectively purge corporate vs. personal data, we'll likely avoid that setting for now," with anything except Blackberries, he says.

Other experts recommend requiring long, complex passwords--no matter how much clinicians complain--as well as disabling simple passwords like 1234 or ABCD.

Create server settings that query devices as employees log on: What's more, Halamka says, only allow access from those that adhere to your password and other enterprise security settings.

Other BYOD advice we dug up includes:

Put Web filtering and application control technologies on your server: This will allow better control to track users' Web movements, and prevent them from using apps that might leak patient information, suggests Kevin Flynn, marketing manager for security firm Fortinet.

Get a lock on device location: Some vendors like Absolute Software, use locator services like LoJack to help hospitals quickly find devices that have been lost or stolen, according to a February commentary in InformationWeek.

Keep watching for more robust mobile device management: While many tout its value, Kaiser Permanente's senior security architect, Mark Kadrich, recently complained that they simply aren't powerful enough yet to protect an entire enterprise's mobile layout, particularly when much of that is BYOD.

To learn more:
- read Halmaka's blog post
- here's the InformationWeek piece
- dig into the FortiBlog post
- check out eWeek's piece on Aruba's BYOD data

Tablet use continues to increase among docs

Sara Jackson — Mon, 14 May 2012 13:32:42 -0400

Physician use of tablets has grown more than 75 percent in the past year, according to new findings from Manhattan Research published last week. The research company studied the mobile habits of more than 3,000 physicians in the first quarter of 2012, and compared those findings to the same period of 2011.

A full 62 percent of doctors are using tablets--Apple iPads still being the favorite--compared to only 35 percent a year ago, the study found.

Perhaps even more interesting: More than half of those physicians using tablets are employing them at the point of care.

Physicians are evolving in ways we expected--only faster," Monique Levy, Vice President of Research at Manhattan Research, said in a statement. "The skyrocketing adoption rates of tablets alone, especially iPads, means healthcare stakeholders should revisit many of their assumptions about reaching and engaging with this audience."

Levy made a bold prediction to eWeek, saying that 100 percent of physicians ultimately will adopt tablet computing. And other recent data may back her up. eWeek quoted a December 2011 survey by NPD Group that shows about 75 percent of small and midsize physician practices plan to buy tablets this year.

What's interesting here is that physicians still are using mobile devices largely as readers, looking up health information and clinical studies, researching symptoms and drugs, etc., eWeek reports. But far smaller numbers are actually using their mobile devices to access electronic health records or perform other clinical tasks.

One particularly intriguing finding: Physicians may complain about having to use multiple mobile devices--smartphones, tablets, laptops, etc.--but they're using them.

To learn more:
- read the Manhattan Research announcement
- here's the eWeek report

Diabetes management app helps teens improve glucose control

Sara Jackson — Fri, 11 May 2012 14:12:04 -0400

Teenagers using a new diabetes management app called Bant measured their glucose levels 50 percent more often than teens who didn't, according to a new study in the Journal of Medical Internet Research (JMIR).

The study provides the final, published results--and some interesting detail--of a study we told you about last fall by Joseph Cafazzo, researcher and director of the Centre for Global eHealth Innovation at the University Health Network in Toronto, Canada.

The small study provided the iPhone app and an at-home glucose meter to 20 teenagers. Teens were prompted with messages on their phones to take readings at regular intervals. The system also tracked when levels were submitted, and prompted the teen to re-test if they slipped off their schedule. It also suggested lifestyle choices and other behaviors to help with teens who were having trouble sticking with their program.

In designing the app, the team learned a few key parameters to engage and motivate teens. App interactions must be fast, taking seconds, not minutes, to complete. They must be driven by wizards that guide the user to the result, rather than taking a user-directed approach. And data streams should come from automatic remote monitoring and transmission, rather than the user having to enter his or her own data, Cafazzo found.

The program also offered teens reward points for each time they measured their glucose, and awarded users $1 in iTunes rewards for each 200 points. More than 50 percent of the participants earned rewards, according to the study.

The diabetes project isn't the only mobile-enabled study Cafazzo conducted last year. He also tested using text messaging to prompt teens to check their blood pressure. His study identified the key connection between remote monitoring and motivating messaging--namely, that one without the other isn't terribly effective.

To learn more:
- read the JMIR study

Happtique bets docs will prescribe apps if taught how

Sara Jackson — Fri, 11 May 2012 13:48:12 -0400

Mobile health applications distributor Happtique, which earlier this year announced that it was starting an app vetting process, now is taking on an even bigger mHealth challenge--getting doctors to actually prescribe apps to their patients.

The company is testing a mobile platform, mRx, that allows physicians to "prescribe," health apps to their patients, according to a story in eWeek. Doctors can use the platform to distribute the app to patients, and check to see if the patient has downloaded it, although it won't actually track the patient's use of the software, eWeek reports.

"We want to test whether health professionals, when provided with the prescribing technology and a vetted app catalog, will actually integrate apps into their delivery of health care," Happtique CEO Ben Chodor tells eWeek. "Additionally, we want to test whether patients, when provided with an app as part of their health care treatment, prevention and wellness plan, will download the app as prescribed."

Happtique is building a catalog of five to 10 approved apps, and will first focus on heart disease, diabetes and musculoskeletal diseases, officials say. They're also hoping to recruit some physical therapists to test out and use fitness and wellness apps.

Physicians will be trained on how to use the apps, how to integrate them into their care plans, how to explain them to patients, and how to prescribe them through the mRx system, according to Happtique officials.

What will be the most interesting finding of all: Whether prescribed health apps are any stickier than unprescribed ones.

To learn more:
- read the eWeek piece
- here's the Happtique announcement

With rural broadband lagging, some see mHealth solutions in old-school tech

Susan D. Hall - Contributing Writer — Wed, 09 May 2012 10:31:29 -0400

In Eastern South Dakota, patients drive as many as six hours each way to critical access facilities that not only are small, but also as far as 100 miles apart, according to a recent Search Health IT post. Although telehealth can improve access to healthcare in rural areas such as these, access to broadband is still lagging.

"If I'm in San Jose, I have 4G network; if I'm in Wishek, North Dakota [population 1,002], I'm lucky to have 1G," Donald Kosiak Jr., an emergency physician and medical director of Avera eCARE, part of Sioux Falls, S.D.-based Avera Health network, told SearchHealthIT.

Although AT&T and Verizon claim their 4G networks will blanket most of the country within the next two or three years, Kosiak said he foresees a problem for rural communities. "Those little gaps in coverage are where I need to connect," he said.

So what's the solution?

Kosiak said he thinks rural healthcare organizations could forego wireless in favor of old-school T1 lines that already are in place.

"We need to reach out to other industries that are leaps and bounds ahead of us in sharing data and pushing it back and forth," he told SearchHealthIT. "So maybe I can just piggyback off of existing technology that's already in rural communities--banks, high-tech industries, big mills [and] big meat packing plants probably have all sorts of connectivity for data, and maybe the hospital doesn't need [its] own."

To Lean more:
- read the SearchHealthIT article

Nurses use gaming, apps to reach patients

Sara Jackson — Tue, 08 May 2012 11:15:58 -0400

University of Pennsylvania nursing students, as part of a year-long online challenge, have created a series of games to improve patient health. Penn just selected four winners in the challenge, including two intriguing mobile/app games that took first and second place.

"Game-playing is built on many of the same concepts as nursing practice--making connections and sound judgments, fostering engagement, team-building, problem-solving, and planning," says Penn Nursing Dean Afaf Meleis.

The two mobile-enabled games are:

MyDiaText (First Place): The smartphone-based game targets teens who've just been diagnosed with diabetes, to encourage them to check blood sugars, eat healthy, etc., according to its creators. Teens create a profile, and set behavior modification goals within the app, and then receive up to five motivational, or encouraging, reminder texts each week. For users who are sticking with their plan, their messages are congratulatory. For those falling a little behind, the messaging is more encouraging, to motivate the teens to re-start better habits.

The Diabetes Center for Children in Philadelphia plans to start a trial of the app this month. No details yet on how large, or long, the trial will be.

Trigger Busters (Second Place): This app tackles asthma in children, and is more of a video-style game that children can play on Android smartphones.

Children move a character through a city, trying to avoid or clean up dust or other allergens that are chasing them in the game. They receive points for the amount of time they remain clear of trigger items, and can gain energy rewards if they take their inhaler or nebulizer when needed. When the child loses all their energy, they're directed for a hospital visit.

Right now the game offers a keyboard-control version, and another for plug-in game controllers. Developers are working on a touch version for touchscreens as well.

To learn more:
- read the University of Pennsylvania announcement
- check out a description and demo of MyDiaText
- get a look at the TriggerBusters game

Mobile control over implantable medical devices is skin deep

Sara Jackson — Mon, 07 May 2012 20:04:09 -0400

A group of researchers and design experts have created an "implantable user interface" device that when inserted under the skin, can be used to control, communicate with, and stream data from, implanted medical devices like pacemakers and hearing aids. They can even transmit information that the devices collect directly to smartphones or other mobile devices for further transmission to clinicians, according to a story at Txchnologist.com.

The implants also could help patients keep track of the devices, and alert the patient to any problems. Researchers at the University of Toronto, Canada and University of Pottsdam, Germany--plus design company Autodesk Research--have tested different versions of the interfaces, including ones that can be directly tapped through the skin, or activated via light frequencies, or even controlled via audio signals. The research shows that in most cases, the sensors can send and receive instructions through the skin.

"Medical implants already exist, but there are no real ways to easily get the status of these devices, or use them to get information about the state of your health, or be able to control the doses of various drugs," Autodesk researcher Tovi Grossman tells Txchnologist.com.

Implantable user interfaces, while they may now require smartphones or other wireless capability to transmit their data, are actually the next generation of mobile technology, according to the researchers. Under the skin, they're invisible (for any patients who have issues with others knowing they're using the device), protected from the patient's activities, such as swimming or sports, and are always with the user and always "on"--taking human error out of the equation, the researchers say in the report.

Such technology would be a step beyond the some of the latest mobile tech in this arena, like an app that allows physicians to use their iPads to guide nurses through pacemaker adjustments.

To learn more:
- check out the Txchnologist article
- read the study from University of Pottsdam and Autodesk Research

ATA panel tackles ticklish definition of 'mHealth'

Sara Jackson — Mon, 07 May 2012 12:39:06 -0400

A panel of experts at the American Telemedicine Association's 2012 Conference and Exposition in San Jose, Calf., last week took on the daunting task of defining the true scope of mobile health. They came up with some interesting parameters. First, they said, connectivity is clearly key, with mobile health technologies connecting clinicians to patients in one form or another. Another is mobility--determining whether the user is mobile, or the device, or both, and how that affects the functionality of the technology. Dig into their nuanced view of the debate at mHIMSS.org. Article

Emerging nanotechnology, mobile health connections show promise

Sara Jackson — Mon, 07 May 2012 12:15:43 -0400

Exciting things are happening in nanotechnology. That's no surprise. But what's bringing the topic squarely into the wheelhouse of hospital CIOs is a growing connection between nanotechnology and mobile devices.

I found a couple of interesting examples courtesy of Smithsonian.com and iMedicalApps. One, brings together nanotech, cell phones and mapping technology to diagnose infections on the fly. Called Rapid Diagnostic Tests, the new device was developed by researchers at UCLA.

The nanotech-embedded device uses strips that accept the patient's blood and are inserted into a plug-in on the patient's smartphone, which then reads the strip to determine if the patient has HIV, malaria, syphilis or TB. The app also instantly maps the patient's location, and streams the information to a global map that tracks cases around the globe.

The other intriguing example is actually not diagnostic, but technical in nature. It's called Power Felt, which incorporates "nanotubes" into a fabric; the nanotubes provide power for wearable sensors worn by the patient.

The power comes from subtle heat differentials in the ambient temperature, or the patient's body heat, according to iMedicalApps. The nanotubes are small enough to capture those small changes, collect them into large enough charges, and transmit them to the sensors, replacing the need for a separate battery.

There's hope that the heat differentials ultimately could power cell phones, according to iMedicalApps, but the technology isn't quite there yet. Right now, it only can add the equivalent of an extra hour's worth of power per day to the average phone. However, for less power-hungry sensors, it could become the entire power source.

In all, nanotechnology looks to be a powerful driver of change in mobile healthcare, and it's one I plan to keep a close eye on in the year ahead.

What I'm really wondering, though, is whether our readers--CIOs on the frontlines--are using any nanotechnology-augmented devices. If so, what kind? And how are they working out in the real world of providing health services? - Sara

New app helps treat OCD symptoms

Sara Jackson — Fri, 04 May 2012 12:21:21 -0400

A new app, Live OCD Free, that aims to help treat the debilitating symptoms of obsessive-compulsive disorder. The new app, created by physician Kristen Mulcahy at the Cognitive Behavioral Institute of Falmouth, Mass., takes traditional exposure and response prevention therapy and translates it into a smartphone-friendly format for patients to use on the go, according to MassHighTech.com.

The app allows users to set up an "exposure hierarchy" in which they expose themselves to the source of their anxiety in a controlled setting. It then asks them to practice the exposures, reminds them not to give in to their compulsions and monitors their self-reported anxiety levels. Users can trend their anxiety levels, and once they decline, take on more challenging exposures, according to ABCNews.com.

The app also creates progress reports that patients can email to their therapists, MassHighTech notes.

With a $79.99 pricetag the app isn't cheap, but it costs less than a psychiatrists' visit and may be helpful for patients without insurance or other resources for formal treatment, Mulcahy says.

Mulcahy is set to test the app with McLean Hospital in Belmont, Mass., although she's still waiting for final approval from the hospital's board. From there, she hopes to partner with larger facilities to test the program in an outpatient setting, and may expand the concept to apps for other mental health conditions.

Mulcahy isn't the first to tackle anxiety disorders. We told you a few months ago about a Harvard-created app that uses "cognitive bias modification" to help users prevent negative thought cycles, and prevent anxiety spirals.

Unlike Mulcahey's app, which measures symptoms and attempts to have users push through them, the Harvard app tries to re-train the mind to not make the negative associations and to short-circuit anxiety in the first place.

To learn more:
- read the MassHighTech.com story
- check out the ABCNews.com piece

VA giving iPads to caregivers

Sara Jackson — Fri, 04 May 2012 12:16:06 -0400

The Dept. of Veterans' Affairs is testing whether giving iPads to caregivers can improve the care delivered to veterans, according to NextGov.com.

Under the pilot program, Clinic-in-Hand, the VA plans to provide more than 1,000 iPads to family caregivers of patients, to allow them access to VA apps, a recently rolled out mobile EHR (now in testing at Washington Medical Center) and other mobile resources. The idea is to facilitate health communication between not only VA physicians and patients but also with other caregivers, who are a crucial part of the health process.

Those caregivers can't be just anyone, however. According to NextGov.com, a caregiver must be approved as a "primary provider of personal care services" under the Comprehensive Assistance for Family Caregivers program.

No details on how long the pilot itself will run, but the VA plans to have the apps created for the Clinic-in-Hand program available by 2013, according to NextGov.

The program is an interesting expansion of the VA's mobile strategy. Thus far, VA officials have been strictly clinical in focus, handing iPads out by the hundreds, but only to clinicians. This definitely marks the first time the VA has reached out to bring family caregivers into the fold.

To learn more:
- read the NextGov.com story.
- check out GovernmentHealthIT's story on the VA's mobile EHR.

Remote health monitors: Now for your underwear

Sara Jackson — Fri, 04 May 2012 11:41:22 -0400

You knew it was coming, and now it's here: Remote monitoring sensors in your underwear.

Researchers at the University of Arkansas have integrated wearable, nanosensor-powered textiles into a sports bra--called the E-bra--for women, and an undershirt for men.

The sensor itself is actually a small unit that snaps into the bra or t-shirt, and collects data on blood pressure, temperature, respiratory rate and oxygen consumption. Most interesting: It even tracks some brain activity, including readings you normally would get from an ECG that can identify an incipient heart attack.

The dime-sized sensors are made from gold nanowires and flexible, conducting textile nanosensors, according to researchers. Right now, the rest of the unit is a small plastic box that houses an amplifier, antenna, circuit board, microprocessor, Bluetooth module and a battery. Researchers say they are working to replace the rigid box with a smaller, more flexible housing for the components.

The data streams from the sensors to the user's cell phone or smartphone, where apps help the user track and trend the various vital signs. When the app detects out-of-the-norm results, it texts the user an emergency alert.

This of course isn't the first wearable sensor to debut recently. Several were displayed at the Consumer Electronics Show in Las Vegas in January. Most involved small sensors threaded into shirts or armbands or other vehicles. Another we told you about last fall came from Ohio University--a "wearable antenna" sewn into regular clothing that collects biometric data and transmits it via smartphone to clinicians.

What makes the Arkansas offering so interesting is its integration into undergarments, making the sensors virtually invisible, and possibly more likely for users to wear for longer periods of time.

Unfortunately, the case for wearable sensors is by no means closed. A recent study of seniors being remotely monitored at home found readmission rates (for exacerbations) weren't any better for the monitored group than the unmonitored group. We'll have to see if further studies suss out the true value of remote, sensor-based monitoring.

To learn more:
- here's the University of Arkansas statement
- check out the Daily Mail coverage