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Posts Tagged ‘mobile health’

The Three G’s of Mapping….Is Healthcare a Leader?

Ok, it’s true.  I’m a closet geek.   I think no one knows how much I love maps. (Lesli Adams, my colleague at Perficient, often describes herself as a geek so this is homage to her).  There are so many different kinds of maps, so which ones do I favor, you ask?  I think the best maps are the three “G’s”,

  1. geospatial,
  2. genomic and
  3. geocaching.

Let me show you how all of these have relevance to healthcare:

Let’s start with geospatial. 

shutterstock_56289301I am fascinated by the heat maps of disease prevalence, patient engagement and demographics that have started to electrify Healthcare.  Duane Schafer, Director of Microsoft Business Intelligence for Perficient, recently revealed a great demo at HIMSS, based on Population Health statistics from ProHealth in Wisconsin.  Using basic tools from the Microsoft stack, Duane was able to visually map important population health statistics from ProHealth and present that data in a way that entices the viewer to explore deeper.  It allows the organization to see, at a glance, major population demographics in their region.  This can then be combined with additional analytics to determine trending of disease in the area, frequencies of patient visits to the Emergency Departments over time and correlations of missed appointments to care gaps in specific chronic disease management.   Geospatial mapping even hit the news recently when a contamination at Lake Champlain caused concern about the risk of spreading disease and therefore assisted with facilitating a rapid Public Health response in this  situation. Of course, there are many more examples but you get the idea. Read the rest of this post »

A Love Letter to Meaningful Use – #HIMSS14

It seems appropriate on Valentine’s Day to write love letters.  This is my letter of adoration to Meaningful Use.  In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills.  My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons.  I could wax poetic about the ease of checking on appointments and reviewing lab results.  The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy.  It was love at first click.

A Love Letter toInstead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic.  I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications!  I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila!  Several hours later, I received an email confirmation from the pharmacy that they were processing my order.  Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software.  I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view.  I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life.  This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. Read the rest of this post »

App Annie Ranks #mHealth

app_annieFrom the fun-loving portal chap that brought us Find a Provider tools that don’t make babies cry (read: Mark Polly), I bring to you a ranking of Mobile Health apps by App Annie.  App Annie a ranking app that uses app store analytics and market intelligence to rank and visualize an app’s download, revenue, ranking, and review data.

But first some mobile health statistics:

  • 91% of US adults have adopted mobile technology (Source: Pew study)
  • 91% of adults keep their phones within arms reach 24/7 (Source: LeadersWest)
  • 75% of US adults even bring their phones to the bathroom (Source: Digiday, 2013)

As you can see, people really like their cellphones.  This love has brought us a bounty of mobile applications, and healthcare is no exception.  Here, I have listed for you, a ranking of those mobile health apps brought to you by App Annie.

Health & Living

Here we are looking at just Heath and Fitness.  Health insurance companies have been investing a great deal in this space for good reason.  As you can see, there are four large health plans that show up in the top 100 apps.  Who else is ranked in the top 50?  Think apps like Nike Fitness Club, Weight Watchers, Fitbit, Period Tracker, Baby Bump, and White Noise Lite.

Screen Shot 2014-02-11 at 2.57.56 PM



Switching over to the medical category we, not surprisingly, have Epic’s MyChart ranked #4, which is primarily charged by all of their healthcare provider customers that offer the MyChart app to their patients.  As shown below, the Mayo Clinic shows up at 106. There are 105 other medical apps more popular that the venerable Mayo Clinic.  These apps include WeedMaps, FRWeed, Epocrates.

Screen Shot 2014-02-11 at 3.02.56 PM


Other applications that are ranked higher in this category include:

  • #201: Novant Health
  • #369: Cleveland Clinic Today
  • #730: Spectrum Health
  • #818: Florida Hopsital ER Wait

The Bottom Line

So, what does this mean for hospitals and health plans considering mobile apps?  If you are a health plan, then you likely need a mobile app in order to take advantage of location services for pharmacy, find a provider, etc.  If you are a major health system, then you can also leverage the large number of potential users by providing a mobile application.  Others might consider specialized mobile applications that are specific to tasks like requesting appointments, refills, location based facility mapping, or information on specific diseases or chronic conditions.  With all of the data pouring in on the success of text messaging programs for health, you should be looking into these programs as well.

Healthcare Gamification: Avoiding Chocolate Covered Broccoli

UntitledLast week, at IBM Connect, I met an individual with the coolest title in all Profession Land: Global Lead for Serious Games.

Her name is Phaedra Boinodiris, and after sitting in on her Birds of a Feather chat, along with a post chat dinner filled with good eats and new friends, I wanted to open up the conversation a bit for all to grow and learn from the gaming knowledge stored in this firecracker of a talent.

I’ll start you off with some stats Phaedra shared:

  • Average age of a gamer:  34
  • Games designed for women: 43% of PC games and 33% in general
  • Households that play video games multiple times per week: 67%

Today your average gamer is not just some young guy locked in his mother’s basement.  Your average gamers include employees, analysts, mothers, and business professionals named Phaedra and Melody.  As Phaedra pointed out, the first game advertising, for Atari, was aimed at the whole family.  Then there was a massive shift that aimed advertising exclusively towards boys.  However, once Nintendo Wii came out you started to see advertisements for the whole family again.

Healthcare at Play

Games are great at explaining complex systems.  There are fewer places one can find complex systems than in the micro and macro worlds of healthcare.  In healthcare we’ve seen games of multiple types.  Here are some great ones:

  1. Games that help modify user behavior: Phaedra pointed out Humana’s pioneer stance in the world of serious games in healthcare with their Horsepower Challenge.  Using the craze the followed games like Dance, Dance, Revolution, Humana used “exergaming” in 2009 to challenge 20 members of Congress and 2,000 5th and 6th graders nationwide as they “raced” across the country by taking steps with a pedometer.  She also harkened back to a healthcare game I mentioned in a post back in 2011, namely Re-Mission.  In Re-Mission, a nanobot named Roxxi is injected into the human body to fight particular types of cancer at the cellular level. Those playing the game are also asked to monitor the patient’s health and report any symptoms to the fictional Dr. West.  Each level of the game informs the player on a variety of treatments and on the importance of staying compliant with medical protocol.  HopeLab trial studies, that were published in peer-reviewed journals, revealed that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy. Most notably are blood test results, that showed the measured level of chemotherapy drugs in blood to be higher in players versus the control group.
  2. Clinical learning labs: These are the types of gaming environments where practitioners can train in virtual learning labs on an avatar.  A great one is foldit: Solving Puzzles for Science.  foldit, funded through a University of Washington grant, is an attempt by game developers to crowdsource scientific research.  Within a few paragraphs of texts, the gamer is educated on what proteins and amino acids are and why their shapes, and what those shapes fold into, are important.  The goal is to have human “protein folders” work on proteins that do not have a known structure.  Scientists can then take folding strategies that human players have come up with while playing the game and automate those strategies to make protein-predicting software that can fight HIV and cancer more effective.  Beyond protein prediction, protein design has even more direct implications to disable a virus.  Thus far there are not many automated approaches to protein design, so foldit’s human folders are a great source of research.

This is all gamification, right?

Gamification is the term we use to describe serious games that go beyond strictly trying to entertain.  They have a “higher purpose”, so to speak.  Designers use game techniques to get players to do something not game-like at all.  The possibilities in healthcare, as shown above, are truly limitless.  However, this has brought us an industry that is absolutely flooded with games.  However, as Phaedra points out, they are crippled by one false assumption created within the foundation of many of these games.  That is:

A gamified experience includes scores, leaderboards, and badge systems.

Let’s be clear.  Games can include scores, leaderboards, and badge systems.  However, not everything that includes scores, leaderboards, and badge systems can be called a game (at least not an effective one).  Instead, they are often just Chocolate Covered Broccoli.  A user will try it out, realize this is not what they ordered, and spit it back out again.

If you want to develop a serious game that works, you must, better than anyone else, understand the purpose of your game.  You must know to whom your game is targeted.  You must devote a lot of time to figuring out what motivates your intended audience.  That understanding must be crystal clear before you even consider how the game should be designed.  Document, in detail, what your experience needs to communicate with the gamer.  What kinds of puzzles best match this experience? Then consider what type of game genre matches these puzzles.  Lastly, consider what platform would need to be used to help the gamer bring action to play.

Building a game that is based on what motivates your audience is what makes a serious game a game.  Otherwise, all you have is Chocolate Colored Broccoli.

If you are interested in gaming, a source you can check out is Phaedra’s new book “Serious Games for Business: Using Gamification to Fully Engage Consumers, Employees and Partners”, which includes contributions by another great mind I met at IBM Connect, namely Peter Fingar.

Digital Experiences Critical to Healthcare Industry Success

The healthcare industry continues to undergo dramatic change due to regulatory reform including Meaningful Use Stage 2, which stipulates requirements and feedback on what a patient portal should be. As a result, we see a challenging dynamic between patients, providers and payers.

An exceptional digital experience is one way to help each stakeholder get through the regulatory transition.


Our principal of portal and social solutions at Perficient, Mike Porter, says “The patient portal may be the most complicated portal one can build due to government regulations, physician requirements and patient needs.” Porter is presenting at IBM Connect 2014 this week. He says about IBM technologies, “Fortunately, the IBM toolset gives us the agility to get around the complications and create great experiences for customers.”

Perficient has developed best practices for implementing exceptional digital experiences for patient and member portals that include the core functions each healthcare organization must implement to succeed

  • compliance
  • integration
  • personalization
  • mobile access
  • physician location information

Read the rest of this post »

Connected Health Trend Countdown: #4 Reaching the Mobile 91%

Top Ten

Quick, grab your mobile phone. It’s pretty close at hand, I’m guessing. Hence, our next trend in the 2014 Connected Health Trend Countdown:

Trend #4: Gamification, Quantified Self, and the Internet of Things

You are undoubtedly part of the 90% of the world’s population that is covered by a commercial wireless signal.  According to Pew research, there is 91% U.S. adult adoption of mobile technology and 56% adoption of smartphones.  This behemoth adoption rate means a couple of things for the healthcare industry:

  1. In any attempt to reach as many consumers as possible it is necessary to be where consumers are in order to “get into the conversations they are already having in their head” as we say in marketing speak.  There is no easier way to reach 91% or more of the population using one medium.  I dare you to find one.
  2. In a world with severe healthcare resource constraints, mobile technology can be a major “force multiplier” by empowering both patients and clinicians with the information they need to make informed decisions that range from  healthy living habits to the monitoring of a disease state.

With a cellphone in almost every hand, the expansion of wireless networks presents  us with an opportunity to reach those who are currently isolated by distance and lack of communication.  How amazing is that?

Now to some definitions.  If you haven’t heard of them before, then here they are:

Care Everywhere

A report titled Gaming to Engage the Healthcare Consumer points to three trends driving healthcare organizations, and health plans in particular, towards gamification.  These include:

  • the trend toward value-based care
  • the increasing role of the patient as consumer
  • the millennial generation as desirable health insurance customers.

As mentioned by mobihealthnews in Four Factors Driving Gamification in Healthcare, a fourth trend, namely the increased proliferation of smartphones and tablets mentioned above, was not mentioned in the report but does underscore the conclusions in the report.

Another study ranked the top ten patient groups that reported the highest adoption of mobile health solutions, which you may find interesting:

  • Cystic fibrosis
  • Growth hormone deficiency
  • Acne
  • Hepatitis C
  • Migraine
  • Crohn’s disease
  • Chronic kidney disease
  • Generalized anxiety disorder
  • Bipolar disorder

Mobile Preventative Health

My personal favorite topic in the area of mobile health is preventative medicine.  A comprehensive review of mobile health studies, including those created by CINAHL, PubMed, EMBASE, MEDLINE, and PsycINFO between January 2005 and August 2010, focused on the effectiveness of mobile health to impact preventive health behaviors.  Study results show that app and text messaging interventions resulted in reductions in body weight, waist circumference, body mass index, sugar-sweetened beverage intake, and television screen time. You can check out more details on the effectiveness of text messaging programs in a post that I wrote entitled “Texting Bridges the Mobile Health Digital Divide.

A really interesting growth area for both mobile and preventative medicine comes in the area of “wearables”.  These are all of those digital devices, FitBits, JawBones, etc. that consumers, as the name implies, wear.  Juniper Research projects that the wearable technology market will be worth $19 billion by 2018. There is ongoing debate over whether mobile health applications and wearables should be governed like traditional medical devices.  Anyone who knows anything about the medical device industry knows that there is barely a movement that can be made without compliance lawyers getting involved.   The FDA issued final guidance on the topic stating that they intend to exercise discretion for the majority of mobile apps since they pose minimal risk to consumers. However, the FDA intends to focus its regulatory oversight on the subset of mobile medical apps that present a greater risk to patients if they do not work as intended.   These are defined as apps that:

  • are intended to be used as an accessory to a regulated medical device – for example, an application that allows a health care professional to make a specific diagnosis by viewing a medical image from a picture archiving and communication system (PACS) on a smartphone or a mobile tablet; or
  • transform a mobile platform into a regulated medical device – for example, an application that turns a smartphone into an electrocardiography (ECG) machine to detect abnormal heart rhythms or determine if a patient is experiencing a heart attack.

Mobile medical apps that undergo FDA review will be assessed using the same regulatory standards and risk-based approach that the agency applies to other medical devices.  One such app is BlueStar.   BlueStar is a prescription only diabetes app that provides reminders for nutrition and medication adherence.  The app works on computers, smartphones, and tablets.

The private market has also generated a Health App Certification Program named Happtique. Happtique has been around for several years, and the program intends to complement the work of the FDA.  They have introduced a set of standards for health apps that fall into that “not so risky” medical app territory.   

Are you still there?  Good.

Getting patients to engage with their practitioners and medical protocol isn’t just some luxury we should all aspire to.    The price tag associated with the disengaged consumer has cost too much for too long.  Now there are great options like gamification that help make adhering to better health practices attractive to consumers.  Whether is it making it easier for the already exhausted cancer patient to follow complicated medical protocol or letting a child win a cartoon monster for taking their asthma medication on time, mobile health provides cost effective options for healthcare’s most expensive problems.


Connected Health Trend Countdown: #7 Care Knows No Bounds

Top TenToday’s entry in the 2014 Connected trend Health countdown takes us far away from home:

Trend #7: Care That Knows No Bounds

It wasn’t so long ago when the general consensus amongst healthcare leaders was ripe with uncertainty regarding the returns to be had from telehealth and remote patient monitoring investments.  It’s only a year or so later and these same telehealth programs are now becoming well established at health systems across the country (and around the world).  It seems that the very concerns holding telehealth back in the not so distant past are the same concepts that are driving it forward today.  As mentioned by Gienna Shaw of Fierce Healthcare, telehealth is saving money and extending the mission of better health.

Life Saving Decisions Made from a Distance

Children’s hospitals across the country have been the fastest adopters of mobile health technology.  Children’s of Philadelphia and Boston Children’s Hospital are considered thought leaders in this area.  However, it was a west coast provider that recently got my attention.  In mid-November, I happened upon an article in the Business Journal about how the telemedicine program at Oregon Health & Science University (OHSU) saved a baby’s life.  7 month old MaLea Fox had a very high fever.  Blood work revealed that she had a virus, but after returning home MaLea’s mother was unable to wake her after four hours.  The on duty physician at Columbia Memorial Hospital in Astoria was able to call for a telemedicine consultation with OHSU’s Dr. Jennifer Needle, a pediatric intensivist.  She exambined the child using a two-way communication system with a “robot-like” device.  Dr. Needle was able to see MaLea’s symptoms, which made her look like a burn victim. MaLea was diagnosed with Memingococcemia, which is a life threatening bacterial infection.  Needle advised having a breathing tube inserted before sending her to Portland by helicopter.  Weather made the transport a challenge, which made intubation a lifesaver in this case.  MaLea spent 111 days in Portland and had her leg amputated above the knee.  She is now doing much better and has no memory of the trauma.

Online Medicine Means Big Business

One area of strong growth in telehealth is the area of online medicine, which is more popularly dubbed “virtual visits”.   According to the Pew Internet and American Life Project, 88% of US adults with Internet access research health information online and 60% say the Internet info influenced a decision about how to manage a health condition. Going online is no longer a one-way stream of information from computer to patient.  We are now in the era of web 2.0, which is empowered by social networking. Patients go online to find meaningful engagement with other epatients and, becoming more and more common, with their providers via secured access patient portals.

The results have shown promising enough to elicit private investment.  Time Warner Business Class recently announced it was venturing into the world of virtual medicine through a partnership with the Cleveland Clinic.  The program is part of Time Warner Cable’s Home Health Monitoring network that was designed to connect healthcare providers to patients in their homes.  It will provide  for secure, encrypted, two-way video conferencing between patients and Cleveland Clinic providers.  

We now live in a world where the local hospital is competing with national leaders.  However, the wonder that is social technology has historically favored David over Goliath.  I’m very interested in seeing where this trend leads us throughout the coming year.


Swallowing Sensors Gives New Meaning to the Quanitifed Self

You’ve heard of wearables in healthcare technology, but have you considered swallowables? Swallowing a piece of electronics is something that people are actually willing to try.

Forrester Research's version of of the famousVitruvian Man

Forrester Research’s version of of the famousVitruvian Man

Just this morning, Intel released results from a very compelling study on a range of consumer interest in electronic “wearables” and monitors. They asked people how willing they are to try:

  • Wrist monitors that can monitor things like respiration, blood pressure, heart rate and more, without a cuff – you’ve seen these in Nike Fuel Band and the FitBit Flex, among others.
  • Toilet sensors – you read that correctly.
  • Prescription bottle sensors
  • Blood pressure cuffs
  • The swallowable sensor
  • and more
Eric Dishman (@EricDishman) of Intel spoke with the Wall Street Journal today about the study by Intel. Watch the video below.
More than 80% of those surveyed said they were willing to share “de-identified data” to help further science and cures, so security of information is as important as ever.

Identity and the Internet of Things – Lessons for Healthcare

Attending Dreamforce in San Francisco last month, I was reminded of an article I read in All Things Digital about the role of Identity and the Internet of Things.  Apparently Marc Benioff,’s CEO, mentioned during a presentation at the Bank of America Merrill Lynch 2013 Technology Conference,  that Phillips, the electronics company long known for staple consumer products like TVs, cameras and audio equipment, was working on a new toothbrush. The toothbrush under development was not just any ordinary toothbrush but included GPS, Wi-Fi and “realtime” feedback on how a person brushes their teeth.  Voila, no more lying to your dentist – self-quantification will rat you out with your own data.

While the concept of “The Internet of Things” like the high-tech toothbrush isn’t new,’s forward thinking CEO was previewing a new trend — connected devices are becoming inextricably tied to identity.  Just like my registration email at Dreamforce using a barcode to speed check-in and attendance at sessions.  My identity Internet-Of-Thingswas tied to a “thing” in the Internet of Things.  Lots of my personal devices are internet-enabled as well, connecting my identity to how far I walk for exercise, where I travel, what hotels I stay at, etc.  In the world of social, devices like the smartphone, activity tracking wristbands, etc. are creating comprehensive profiles of our “real” behaviors like brushing our teeth.

It doesn’t take a big leap to understand the impact of connecting my identity and devices on managing my health or lifestyle.  You can easily imagine a healthcare plan, like Geico does on cars, offering a discounted health plan in exchange for your comprehensive lifestyle profile, or at least lower deductibles for positive behaviors, including taking your medications on time.  The challenge will be making certain that your identity is truly linked to your proper information in healthcare systems and there are clear safeguards in place.  As the article in All Things Digital states

“And to be clear, trust-based relationships with users means that privacy must be accounted for and the right controls must be in place before businesses start collecting and using this data. With the proper opt-in/out privacy controls in place, identity-defining traits like hometown, religious beliefs, relationships status, likes, activities and social graph can be available to marketers and used to drive hyper-relevant marketing campaigns.”

As the list of connected “things” in our lives grows and uses our identity to tie our behavior profile to our healthcare management, the pressure will be increased for outstanding master data management by healthcare providers and healthcare plans.  It is amazingly difficult for healthcare companies to conquer enterprise-level master patient indexes to resolve your one identity and create a combined view of your medical history.  While your smartphone revolves around your Facebook username and password, Twitter log-ins, etc. to know you, the fragmented healthcare system must piece together that you go by your middle name, use a nickname or don’t really know your actual Social Security Number.

Master Data Management and Identity Management for healthcare is literally a matter of life and death, especially for people with medication allergies, chronic conditions like diabetes and people with medical implants like pacemakers.  Dick Chaney took the extreme step of firewalling his wireless connection on his pacemaker, for example, to block terrorists from attacking him based on his device and identity.  While we enjoy the idea of our exercise wrist band taking to our smart thermostat to cool down the house after a run, we need to understand the broader implication of this degree of connectivity into our own safety as patients.

You may laugh the next time that the hospital asks you your name for the umpteenth time or marks the site of your surgery with a marker, but identity matters in healthcare and as that industry becomes more connected like your devices, make sure that your information is correct, up to date and is “real.”  It could literally save your life.

Top 5 Technology Trends in Healthcare – November 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Consolidation and Mergers

Healthcare entities, both payers and providers, have been making an increased effort to capture market share and dominate their geography. Smaller players are being picked up by larger players, consolidating physician practices and health plans. These mergers have driven digital strategy projects and paperless environments, with an increased interest in advertising and public facing websites to try to attract market share. 

Extending Your EMR

Healthcare professionals have been very vocal about the challenges that come along with electronic medical record systems. The workflow in many EMR systems was created by a programmer and works the way it was programmed, not the way healthcare professionals work. Several technology tools were made to extend or approve upon EMRs without ripping the code apart, often by putting it into a browser or allowing it to be mobile.

Read the rest of this post »

Texting Bridges the Mobile Health Digital Divide

Whether it is real or perceived, the digital divide is often used as an excuse for non-adoption of mobile health.  What is the “digital divide” exactly?  The term is meant to describe the differences between people, households, or demographic/socioeconomic groups with regards to access to information technology and the knowledge and skills needed to use the information gained through technology.  Factors such as gender, age, ethnicity, income, and educational attainment are often used when describing the digital divide in the United States.  It isn’t uncommon for me to hear, “…but I don’t think our patients actually use mobile phones.”

Who is using mobile technology?

In fact, there is 91% US adult adoption of mobile technology, which can be compared to 85% adoption a year ago.  Does that mean that 91% of the population has access to textingmobile apps?  Not exactly.  There is a comparative 56% adoption of smart phones.  Even still, not having access to mobile apps does not close the door to the use of mobile to impact population health in a major way.

There are great ways to reach that entire 91% through the use of text messaging as a mobile health tool.  Here are some examples:


Text4baby is a free mobile health service provided by National Healthy Mothers, Healthy Babies Coalition that is aimed at promoting pre-natal and child health through text messaging.  Women who text BABY (BEBE en Español) to 511411 receive three free text messages per week.  These text messages are timed to either due date or a baby’s birth date and continue through pregnancy and up until the baby’s first birthday. The messages address topics like labor signs, prenatal care, developmental milestones, immunizations, nutrition, birth defect prevention, safe sleep, and more.  Text4baby has reached over half a million moms since its launch in 2010.


The emergency department at Los Angeles County Hospital of University of Southern California studied 128 Type 2 diabetes patients to assess the impact of mobile health on a population whose primary source of care is the ER.  These patients, who have long been noted as a significant drain on the healthcare system, were enrolled in TExt-MED (now called myAgileLife) while a similar control group received normal care.  The representative sample was 70% Latino and 14% black in order to accurately sample the population in question.  The experimental group received non-interactive text messages two times a day for six months. The study showed a statistically significant impact on increased medication compliance and decreased emergency room visits.  However, there was not a statistically significant impact on HbA1c hemoglobin levels.  Those results were slightly better for the experimental group, but they still fell within the margin of error.  The results of the study also showed that text intervention was more effective for Spanish speakers than English speakers.

Duke Obesity Prevention Program

Duke University conducted a randomized control pilot study to calculate the impact of daily text messages on weight control among racial and ethnic minority women.  This program enabled daily self-monitoring of diet and physical activities to evaluate the feasibility of text message prevention for weight loss among predominantly black women.  Fifty obese women were either a part of a 6-month intervention using a fully automated system that included text messages and brief feedback and tips or they were part of an education only control group.  Weight was measured for six months.  Nearly 70% of study participants strongly agreed that daily texting was both helpful and easy. 76% felt the frequency of texts was appropriate.  At the end of 6 months, the experimental group lost more weight than the control group.  They also found that greater text message program adherence was associated with a higher percentage of weight loss.

This is where healthcare providers must think like advertisers.  If you wish to change or cause a behavior, then your message and calls to action need to be in those places where your consumers are.  Patients only spend 1% of their time in the clinical care setting.  In person outreach is not enough. However, for 91% of the population, mobile technology is in hand a large portion of every day.  Given the increasing use of mobile devices, text messaging may be one of the most useful tools for the management of weight control, diabetes, pre-natal care and many other conditions that impact population health

10 Mobile Health Apps for Doctors

The FDA’s recent ruling on monitoring mobile medical applications tells us something: there are so many health apps on the market that the FDA has to focus on approving only those which are using mobile technology to make a specific diagnosis or that transform mobile devices into a regulated medical device. So with thousands of applications available, which ones should doctors focus on? Doctor Eric Topol recommends the top mobile apps for doctors to focus on:

EPOCRATES: One of the oldest and most established medical apps, Epocrates gives doctors basic information about drugs, the right dosing for adults and children, and warnings about harmful interactions.

medicalUPTODATE: This app provides reference material doctors can consult when making treatment decisions.

ISABEL: Doctors enter symptoms, and the app lists possible diagnoses as well as medications that could cause the symptoms.

ALIVECOR: This portable heart monitor and app—one of the programs that opened Dr. Topol’s eyes—runs on a patient’s smartphone to produce electrocardiograms.

IHEALTH WIRELESS PULSE OXIMETER: People with trouble sleeping can use this app to record their blood-oxygen level during the night—data that can help a doctor diagnose whether they have sleep apnea.

RESOLUTIONMD: Doctors can look at X-rays and other images on a smartphone or tablet when they use this app

CELLSCOPE OTO: A smartphone becomes an otoscope, the instrument doctors use to look into the ear, thanks to this app and optical device.

ISCRUB: This infection-control app collects and rapidly displays data on whether hospital staff are being scrupulous about washing their hands.

BREAST CANCER DIAGNOSIS GUIDE: Using this app, breast-cancer patients enter and track details of their disease and treatment, from the size of the tumor to the presence or absence of estrogen receptors.

CLINICAM: Increasingly, doctors are using their phones to take photos of a patient’s condition—such as a rash or wound—and to upload the images to the patient’s electronic medical record.
For a more complete overview of each app, check out this article. Are there any that you think are missing?