Tag: mobile health

Stethoscopes and Smartphones? How Doctors are Using mHealth Apps for Patient Care

By Elizabeth Adams, MA

There was a time when doctors circulated the hallways of hospitals with nothing but a beeper pinned to the waistline of their scrubs.

But today, you might notice your doctor enter the exam room clutching a more advanced communication device – a Smartphone or tablet. A 2014 survey reported that 85% of medical faculty, 90% of medical residents, and 85% of medical students used a Smartphone in a clinical setting1. Modern doctors are increasingly replacing laptops or desktops with Smartphones and tablets2.

Doctors are constantly on their feet, moving throughout hospitals, emergency rooms, or clinics.  They use these devices for variety of job-related tasks, including remote patient monitoring, electronic health record access, e-prescribing, drug reference calculations, reading medical news, and decision-making support3. Now there is a marketplace for health professionals to locate apps designed specifically for clinical practice. In 2011, the iPhone App Store introduced the “Apps for Health Care Professionals” section, which has expanded to include more than 80 app options4.

Here are a few ways doctors are using apps to improve patient care:

 Retrieving Information. Doctors increasingly rely on mhealth to inform complex clinical assessments and decisions. One survey indicated that two-thirds of doctors use medication-interaction assistance apps to aid in the prescription decision-making process5. In addition, medical residents rely on mobile phones in clinical consultation to look up drug information, perform clinical calculations, take notes, or look up clinical guidelines4. Instantaneous access to information can help doctors and trainees make more accurate decisions regarding treatment.

 Communicating with Patients. Electronic health record software, such as Epic (link to: https://www.inova.org/for-physicians/epiccare-apps) – the program used by UNC HealthCare – incorporate apps Haiku and Canto, which facilitate direct correspondence between patients and health care teams. Other third-party apps, such as OhMD (link to: https://www.ohmd.com), TigerText (link to: https://www.tigertext.com/), and Hale (link to: http://hale.co/), are compatible with electronic health record programs and connect patients to doctors through text messaging platforms.

Continuing Education. Mobile continuing education curricula promises to supply doctors and trainees with current medical information and impart recent standards of practice without the time-consuming requirement of sitting at a desktop or in a classroom. In addition, top-tier medical journals, including the New England Journal of Medicine’s This Week app (link to: http://www.nejm.org/doi/full/10.1056/NEJMe1201837) and the American Medical Association’s CPT QuickRef app (link to: https://www.ama-assn.org/practice-management/applying-cpt-codes), deliver scientific articles and guidelines.

 More research is necessary to understand the relationship between mhealth app adoption and improved clinical care outcomes. Smartphones could be considered impediments to patient care, so they must be used with some discretion. But next time your doctor walks in with a tablet or glances at a Smartphone, remember that he or she might be using an app to make better decisions for your health.

References

  1. Ventola, C. Lee. “Mobile Devices and Apps for Health Care Professionals: Uses and Benefits.” Pharmacy and Therapeutics5 (2014): 356–364.
  2. Murfin, M. Know your apps: an evidence-based approach to evaluation of mobile clinical applications. Journal of Physician Assist Education. 2013; 24(3):38-40.
  3. Kaufman, Michele B,PharmD., R.Ph. “Mobile Health Increases as Physicians Seek New Ways to Manage Patients.”Formulary, vol. 47, no. 4, 2012, pp. 161-162, ProQuest, http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/1145903653?accountid=14244.
  4. Dolan, B. Apple’s Top 80 Apps for Doctors, Nurses, and Patients. [Online] November 27, 2012. http://www.mobihealthnews.com/19206/apples-top-80-apps-for-doctors-nurses-patients/
  5. Boruff, J. T. M., & Storie, D. M. M. A. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. Journal of the Medical Library Association, (2014): 102(1), 22-30.

HIV Medication Adherence Apps: Challenges Faced

By Chunyan Li

The success of HIV medications has changed HIV from a fatal disease to a chronic illness. However, like other chronic diseases that require lifetime medication (at least for now), maintaining good adherence to antiretroviral therapy is not easy for HIV-positive people for reasons such as the complex drug regimens, strict requirements on the time of daily medication, and sometimes intolerable side effects. Having a mobile phone-based application to remind patients of daily medication is a good way out, but the effectiveness of such medication adherence apps remains less studied.

One significant challenge that such apps often face is a lack of behavioral science in design. Some experts described the development of many healthcare apps as a “black box”[1], blaming that app developers often focus too much on technology while neglecting behavior change theories or research evidence. One 2016 research study [2] reviewed all health apps on Google Play, Apple App Store and Windows Phone Store, and found that the reviewed 28 eligible health apps only used 5.6 out of the total 37 behavioral change principles on average. Among the four categories of behavior change principles proposed by the researchers (task support, dialogue support, system credibility and social support), the most used principles were about “system credibility” and “task support”, including features like surface credibility, expertise, authority, and providing general information and function of self-monitoring.  The two categories “dialogue support” and “social support”, which require higher user-provider interactivity and more constructive design based on behavioral science, are somehow neglected.

In another systematic review [3] that reviewed all eHealth-based HIV intervention studies (including smartphone-, Web- and general Internet-based interventions), 10 out of the 14 studies that had a component of adherence improvement were smartphone-based. As HIV patients are usually required to take medicines on quite a strict daily schedule, and sometimes even to be in private if HIV/AIDS is heavily stigmatized, smartphone-based apps are better for portability and privacy protection. However, it could also be challenged when people feel unsafe to disclose HIV status or worry about leaving digital footprints on such apps. In lower-income settings where cell phones are shared with family members, using apps to keep track of medication adherence might not be an ideal option for HIV-positive people.

In a qualitative research study about the HIV treatment continuum that I’m recently working on, a frequently-mentioned desired feature of app-based interventions by HIV-positive people is having communication with human counselors. Many adherence apps may have functions of knowledge education, tracking medications and pushing reminders, but lack an emotional support. Living with HIV is a chronic and multidimensional (physical, psychological and cultural) stress, and a successful coping with such a stress requires consistent support from families, friends and health professionals. Though the advantages of health apps include its mass-reach to users and increasing access to care in limited-resource settings, we should never ignore the needs for human caring and support. How to incorporate human support into HIV medication adherence apps could be one of the future research directions.

 

[1] Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2). https://doi.org/10.1371/journal.pmed.1001382

[2] Geuens, J., Swinnen, T. W., Westhovens, R., de Vlam, K., Geurts, L., & Vanden Abeele, V. (2016). A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement. JMIR mHealth and uHealth, 4(4), e118. https://doi.org/10.2196/mhealth.6286

[3] Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care. Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-014-0239-3

 

Apps, Websites, mHealth, Oh My!

Mobile health applications have taken off as opportunities for public health intervention coinciding with the increasing usage of mobile phones and mobile phone applications in everyday life. A search for “mobile app” in the Journal of Medical Internet Research returns over 1,000 results.

While some of these applications are certainly changing the way we approach our health and lifestyles, some of them can also do more harm than good. As a result, the FDA has developed guidance for the development of these applications to ensure their safety.

However, mobile applications aren’t the only option for providing health information and interactive experiences to users on mobile devices, though they’ve become an incredibly popular option. Many mobile applications could likely be created as websites using responsive web design to make them easily viewable from computers, tablets, smartphones, and so on.

This is especially important when thinking about your target audience. While younger audiences might use their phones regularly, older individuals might be less inclined to use a mobile app, but they might visit a website from their computer or tablet.

A website with responsive web design will also work across platforms (so users can switch between their phone, tablet, computer, or other devices) and will likely take less time and money to develop. They’re also easier to update and maintain for longer periods of time.

Also, if any of your users are like me, they might hate downloading yet another app to take up space on their phone. Apps contribute to clutter on your mobile devices and take up storage space that could be used for pictures, music, emails, and other content.

In a rush to utilize new technologies and meet users where they are, some of these mobile health applications have come out poorly.

Turner-McGreivy, et al. (2016), available from PubMed Central, provide a great comparison of responsive-design websites versus mobile applications, including an easy-to-use table.

Download and get your workout done in 7 minutes

Let me introduce interesting apps the New York Times has recently launched for those who feel difficulty coming up with a quick and nice set of workouts.

The apps “Scientific 7-Minute Workout” and “Advanced 7-Minute Workout” offer a set of popular workouts that can be done in only 7 minutes. The composition of workouts were designed based on scientific findings on high intensity interval training by Mr. Jordan and his colleagues. The researchers suggest that high intensity exercises can be still beneficial even if it’s performed in much less time than regular exercises usually take. But, it should be noted that interval training requires brief periods of recovery between each workout, so that the muscles can catch their breath before they get to the next one.

Wonder what’s in it? The Scientific 7-Minute Workout is composed of 12 exercises, and it only requires your body weight, a chair, and a wall: jumping jacks, wall sit, push up, abdominal crunch, step-up onto chair, squat, triceps dip on chair, plank, high knees running in place, lunge, push ups with rotation, and side plank. The advanced version brings more intense workout sets and it requires dumbbells. The exercises are proceeded quite fast (30 seconds for each exercise), and 10 seconds interval exists between each exercise.

Why don’t you download the apps and try it right away?

Your Childhood Dreams of Being a Superhero Can Come True

Imagine getting a text on your way to class that a man just a few blocks over is going into cardiac arrest. You rush to the scene in less than a minute before the fire department even finishes getting off the phone with the panicked spouse. You successful administer compressions for several minutes until professional medical help arrives and then you turn over your patient to the experts.

A few weeks later you walk by the man’s house and see him and his family relaxing on the front porch. The wife recognizes you and her face lights up with a smile. The entire family expresses their gratitude and explains that because you showed up so quickly and knew to do compressions, you saved the man’s life. They amply name you a modern-day superhero.

This scenario is not hypothetical, cities across the United States are implementing the mobile application PulsePoint to engage community members to respond to cardiac emergencies in their area. Application users voluntarily download the application and indicate if they are trained in cardiopulmonary resuscitation (CPR) and if they are willing to provide care in a cardiac emergency. If so, they will receive notifications of such occurrences within a specified radius of their cell phone GPS location. The app also directs users to the nearest Automated External Defibrillator (AED).

Note that PulsePoint is not intended to be a substitute for professional medical care, but an addition to it. It is a community-based program that works in conjunction with established fire departments and ambulance services. The cost is approximately $10,000 at startup and requires an annual fee, but the payout for lives saves and reduced medical costs and complications easily dwarfs this figure.

Even if your community does not use PulsePoint, you can potentially help save lives by learning CPR and how to use an AED. You can also download the American Red Cross First Aid app and become familiar with the some of the emergency protocols.

Photo Source: Wikipedia

A Step in the Right Direction

Mobile fitness trackers are becoming increasingly popular around the world. Parks Associates approximated that 13.6 million fitness trackers were sold in 2013 and project 121 million to be sold in 2018. A Stanford University School of Medicine article, Integrating Mobile Fitness Trackers Into the Practice of Medicine, highlights interests among physicians and other healthcare professionals about utilizing personal fitness tracking data collected with these devices to help them improve and customize patient care during and between doctors’ visits. The benefits of such technologies are encouraging, however the limitations must be reduced before clinical applications can be widely adopted.

Benefits of mobile fitness trackers:

+ Users are motivated to adopt a healthier lifestyle

+ Social networks linked with devices provide platforms for like-minded users to connect

+ Environments of sustainability and accountability are established enabling users to reach and maintain health goals

Limitations of mobile fitness trackers:

– Devices are not regulated by any one organization or agency

– Accuracy of measurements are unconfirmed

– Measurement metrics (e.g. number of steps) may not reflect true health status

As either a user of fitness trackers or a healthcare professional, what are other benefits and limitations you have noticed and how do you see fitness trackers being used in the future?

Photo source: Wikipedia

 

Stethoscopes get a tech upgrade

The word doctor probably brings a stereotypical picture to mind—white coat, stethoscope, and maybe a clipboard with patient files. However technology is changing that picture. You may have noticed that more doctors are utilizing tablets and “filing” or saving notes to electronic health records (EHR) to reduce paperwork, costs, and error, as well as to increase productivity and access to health history. But what about that stethoscope? Yes, technology is changing this classic instrument too.

Eko Devices, a company based at UC-Berkeley, has developed a digital stethoscope, called Eko Core, that detects heart rhythms, uses Bluetooth to stream sounds to a smartphone app, and then transmits the data to a patient’s EHR. This allows doctors to record detailed data for immediate or later review while continuing to provide care to a patient. In addition, the investment of the device and software are infinitesimally small in comparison to costly EKG machines currently used. This savings would permit more heart screenings and potentially earlier detection of life-threatening heart defects.

The next step is to develop a Shazam-like application that could detect abnormalities and alert doctors in real time. These high-tech stethoscopes are currently being used in small practices, teaching hospitals, and locations utilizing other mHealth technologies, such as remote or rural areas. Eko Devices co-founder and chief operating officer, Jason Bellet, summed up the incredible potential of Eko Core when interviewed by mHealth News, “Imagine bringing the ears of a Johns Hopkins cardiologist to a small village in Africa or even a remote clinic in Montana.”

What other medical devices could be technologically updated?

Images source: Blogspot.com and J.Wexler via Bing.com

Health Apps as Parenting Aids

As mobile has become one of the indispensable realms in terms of health care, there are a number of inspiring applications regarding health.  Among those, three new apps provide evidence-based healthy hints for parents who raise children ages 1 to 5. For instance: “Don’t forget it’s time for your child’s 1-year checkup! The doctor will talk to you about how your child is growing and what to expect this year.”

The winners of the Apps4TotsHealth Challenge were announced on Monday in Washington at Health Datapalooza IV, an annual conference sponsored by the Health Data Consortium, a mix of government and private groups, which concentrates on using publicly available data to improve health. (Refer to NYtimes post.)

Check the three winning apps out, all free. Among those three apps, only two has been introduced below since the last one was only available with Google Chrome.

1. Myfamily

This mobile app encourages parents to manage family health with customized recommendations based on each family member’s profile.

Last month, the app incorporated preventive care recommendations from the United States Preventive Services Task Force and others, and it now includes the Centers for Disease Control and Prevention’s pediatric vaccine calendar and the TXT4Tots nutrition and physical activity messages. Users receive text messages as often as every day, in the form of a graphically engaging tip on parenting, nutrition or exercise, or a reminder about a doctor’s visit. Some messages include links to additional information, like healthfinder.gov content related to the well-child visits.

2. TotBytes

“It’s like GPS for parenting,” says Dan Lee, a creator of TotBytes and founder of Breakpoint Health. The mobile app provides the TXT4Tots nutrition and physical activity content as well as the Institute of Medicine’s recommendations for nutrient intake.

TotBytes includes personalized tools and a community of parents to interact with around best recipes, shared challenges and Food and Drug Administration recalls. Users can select items from a pantry, generate age-appropriate meal plans and receive notices about when and what to feed their children, as well as warnings of what not to feed them.

 

Emerging mHealth: path for growth

A recent survey conducted by Princeton Survey Research Associates International shows that mobile health markets with smartphone users would be intriguing with its vast array of potential. The results reported come from a nationwide telephone interview of 3,014 adults living in the United States. A new survey was conducted from August to September 2012. Here are key findings researchers have found:

1. Half of smartphone owners use their devices to get health information.

Fully 85% of U.S. adults own a cell phone. Of those, 53% own smartphones. This translates to 45% of all American adults. One in three cell phone owners (31%) reported they have used their phone to look for health information. Compared to national survey in 2010, seventeen percent of cell phone owners had used their phone to look for health advice. Smartphone users lead this activity: 52% gather health information on their phones, compared with 6% of non-smartphone owners. Interestingly, cell phone owners who are Latino, African American, between the ages of 18 to 49, or hold a college degree are also more likely to gather health information this way.

2. Few receive text alerts about health or medical issues.

A whopping 80% of cell phone owners responded that they send and receive text messages, but just 9% of them say they receive any text updates or alerts about health or medical issues.

3. One-fifth of smartphone owners have health apps. 

Smartphones have enabled the use of mobile software applications to help people track or manage their health. 19% of smartphone owners mentioned they have at least one health app on their phone. Exercise, diet, and weight apps were the most popular types.

With rapidly increasing usage of smartphones, it is true mobile health markets might be definitely one of noticeable markets in the field of health communication. (Please refer to the specific report by Pew Internet and American Life Project.)

Image source: http://www.cdc.gov/mobile/applications/CDCGeneral/promos/cdcmobileapp.html

mHealth: 300 and counting…

According to the Pew Research Center, 50% of adult cell phone users have downloaded applications on their phones; “11% of all adult cell phone users” have reported downloading “an app that helps them manage their health. Researchers are predicting mobile applications are the next line of action in public health. Versani, a marketing and public relation company, conducted a study evaluating the types of mobile health applications being downloaded on two platforms: Andriod and iOS(iPhone). Weight loss and exercise applications were among the top health applications downloaded. Click here for the study.

Unfortunately, there is no data on whether these applications are actually being used and their impact on individual health status. Fortunately for public health researchers and professionals, the study suggests people are interested in being healthy. That’s half the battle! The task now is to optimize the utility of these applications that have the capability of reaching and impacting not only individuals in the United States but worldwide.

The only scary fact is one hundred and fifty applications on each of the platforms (n=300) were reviewed; showing there are plenty voices out there directing people on their health behaviors and giving recommendations. Are these applications public health appropriate? You don’t have to have health certification to create an app!

Researchers and public health agencies now have to pick up the pace to create applications to meet the needs of the public…