Information Technology Reference
In-Depth Information
can even do this using regular email if they wish. More sophisticated apps such as the
iHealth™ Blood Pressure Dock actually collect the data, in this case by connecting
to the company's FDA cleared wrist blood pressure measurement device. This com-
pany also offers a digital scale that communicates wirelessly with an iPhone via
Bluetooth®. [
21
] Data collection by Smartphones may potentially even include an
ECG. At least one company has announced a technology in which the ECG leads are
embedded in a special Smartphone case. This approach has not yet been FDA cleared.
[
22
] Given the sophistication of these apps, it should not be surprising that the FDA
is considering what its involvement in regulating mobile health applications should
be and it is currently soliciting public comment before issuing regulations. [
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]
There are examples of the phone being used as a health measurement device.
A group at Georgia Tech Research Institute is developing iTrem, an app that measures
patient's tremors using the accelerometers built into Smartphones. [
24
] SkinScan™
uses the Smartphone's camera to take pictures of lesions of concern to the patient and
even analyzes them to advise the patient if they need to see a dermatologist. [
25
]
Other apps are offered for use by clinicians. One assists in interpreting ECGs.
[
26
] Apps are being offered as devices for use in hospitals and even in critical care.
At least one company is marketing an FDA-cleared platform that allows waveforms
from patient monitoring systems to be accessed by their clinician via a Smartphone
or tablet computer. [
27
]
This technology will become more embedded in healthcare delivery over time,
particularly as the apps implement the data representation and transport standards
that are increasingly in use by EHR systems. They also introduce obvious new prob-
lems in securing and insuring the privacy of PHI and in verifying the trust necessary
to know that health data is being sent where it is intended to go.
Before leaving health apps it is worth noting that there is some, but not yet a lot,
of evidence that mobile phones, and specifically their SMS text messaging capabil-
ity, can be used to change patient behavior, a critical issue in prevention and man-
agement of chronic disease. A 2009 literature review of 14 studies that met the
inclusion criteria found that behavior change interventions delivered by SMS can
have positive short-term outcome but suggested that more and better research was
needed. [
28
] Preliminary results of an ongoing literature review here at Georgia
Tech found 21 studies published in 27 papers looking at the use of SMS to improve
diabetes management and indicates that there is not yet a consensus about what
works. [
29
] One recent and widely publicized study suggests that SMS text messag-
ing can be cost effectively used to achieve at least short term reductions in smoking.
[
30
] Similar results were found by a group of Georgia Tech researchers for manage-
ment of pediatric asthma patients. [
31
]
I am aware of no studies in peer reviewed journals on the impact of actual mobile
apps on patient behavior or clinical outcomes. A significant challenge for the “app”
model is understanding what in the design of an application makes it effective, par-
ticularly in terms of patient engagement. Health communication research and psy-
chology research, such as social cognitive theory, have long sought to understand
what influences human behavior, and more to the point, what influences a person to
change their behavior. Health apps offer the possibility to answer long standing
questions by making it possible to monitor what information a person pays attention