The information highway that circles the globe leads straight to your pocket, if you happen to have a smart phone tucked into it. Though it might have sounded like science fiction even a decade ago, today's clinicians, with the aid of a smart phone or a tablet device, can tap into the entirety of medical knowledge.
Practitioners and patients alike have arrived at the four-way intersection of medical science, technology, instant accessibility, and mobility. "The number of U.S. adults who have downloaded a health app is hovering right about 10 percent," said Brian Dolan, citing data from Pew Research Center's Internet and American Life Project.
Dolan, editor and co-founder of MobiHealthNews, a media company reporting on the latest in health-related apps, devices, wireless adaptations, and more, is well-versed in the adoption figures of wireless technology. "Research also shows that more than 80 percent of physicians have smart phones," Dolan said. "It's a little tougher to quantify the number of clinicians using medical apps, but I've never seen a figure lower than 50 percent." He says that much of the available data actually puts that number as high as 80 to 90 percent.
From gaming to health apps
This siren call of health-at-your-fingertips has wooed many Silicon Valley video developers from their gaming thrones. "They're trying to bring some of that entertainment value into medical applications," Dolan explained.
It seems the Centers for Disease Control and Prevention has a similar interest in developing apps that "have game." Just last spring the CDC launched its Flu App Challenge and put up $35,000 in prizes for contestants willing to transform CDC flu data into an "innovative mobile or web app, data visualization, system, tool, or game." The winning entry, Flu-Ville, allows the user to control a flu-besieged city by vaccinating residents, promoting healthy habits, and preventing the spread of infection.
The American Medical Association also got in on competitive action with its 2011 App Challenge seeking "the next great medical app." AMA members voted for their favorite app ideas out of hundreds of entries. Two winning entries emerged - the Rounder app, providing a data capture point for information on hospital patients that allows physicians to easily track patients' progress; and the JAMA Clinical Challenge app, presenting clinical vignettes and images along with medical case information, to serve as a learning tool.
AsthmaMD, available free through iTunes, also has drawn positive attention, not only from app beat reporters like Dolan, but from the federal government as well. In the FCC's 2011 National Broadband Plan, AsthmaMD was singled out as "a case study in the power of consumer health data." What exactly caught the attention of the FCC? The app's helpfulness to a trinity of users: patients, clinicians, and researchers.
Asthma app reduces guesswork
The brainchild of pediatrician Sam Pejham, MD, a professor at the University of California, San Francisco (UCSF), and co-creator, Silicon Valley veteran Salim Madjd, AsthmaMD was introduced in 2010 and already has more than 50,000 users worldwide. "The reception has been way beyond our wildest expectations," Dr. Pejham said.
It works like this: Patients monitor their lung function, measure their peak flow by blowing into a separate device, and then enter the data right into their iPhone, where the data is converted into easy-to-read graphs. With the tap of the screen, that data can be sent to a clinician who can make adjustments to therapy as needed.
"The information is conveyed in a very concise, quick way; there is no wasted time. You can easily see at a glance if there is anything you can do to improve the patient's life," Dr. Pejham said. This translates into faster relief for patients. "So much of the time there's a hit-or-miss approach to finding the right asthma medications. This app takes some of that guesswork out of the equation. We can see exactly how the meds are working, at any time of the day or night, on a graph. It's much easier to make adjustments."
Unprecedented data collection
Since the application collects data and encrypts it for secure "cloud" storage, AsthmaMD is also a powerful tool for research. An access window is available, ".but it is limited to NIH-level research," Dr. Pejham said. "In the past, asthma studies may have looked at 50, even 500 patients. Now researchers can look at data on 50,000 patients in real time. It's unprecedented."
Madjd explained some of the highly practical implications of real-time information gathering: "Environmental factors drastically affect a person's asthma. Both pollution and pollen vary by location, so the ability to map asthma to location is critical. Using your iPhone to check-in to a restaurant is nice, but using your iPhone to mark your location and correlate that to exacerbation of asthma could be life-saving."
He explained that AsthmaMD combines peak flow meter levels with locations, providing a set of data that can help researchers analyze environmental information against changes in asthma conditions "in a way that has never been possible before."
For example, information can be mapped against weather data, such as direction of airflow, to predict the flow of pollutants and allow for a preemptive alert to users. It also would enable researchers to mark areas of consistent asthma issues and help identify the causes behind them. "The data from AsthmaMD gives us the potential to identify pollutant clusters and make that visible on top of Google maps. It could impact how parents of an asthma sufferer would make a housing decision, or alert area residents to take necessary protective actions," Madjd said.
Expansion plans for AsthmaMD are in the works to include a compliance improvement component. "We will make your iPhone nag you about taking your medication when it's time," Madjd said. In addition, a new version will allow users to include their FEV1 data as well.
Dr. Pejham and Madjd have received an NIH-funded study grant through UCSF to see how this app potentially could reduce the rate of readmissions and hospitalizations. "It has been theoretical to this point," Dr. Pejham said. "Now we want to run our findings through the wheels of an NIH-grant to show that it really does make a difference."
It is precisely that still-unknown cause-and-effect that Madjd believes may have the highest impact on health care, ".not just for AsthmaMD, but for other applications that are taking similar approaches in data gathering," said the co-creator. "We are just at the beginning of patient-sourcing of medical data. We already know what impact crowd-sourcing has had on social media. Now combine that with advancements in statistical analysis, machine learning, and artificial intelligence, and we know something great will come out of the immensity of data. Nothing can be more exciting than that."
Hold the phone: blood ox saturation
One idea on the horizon for patient-sourcing of medical data is based on an iPhone pulse rate monitor app, popular with consumers. Ki Chon, a Worcester Polytechnic Institute (WPI), Mass., researcher, has his sights set on turning smart phones into sophisticated medical monitors able to capture and transmit vital physiological data.
Chon, professor and head of biomedical engineering at WPI, and his team have developed a phone app that can measure not only heart rate, but also heart rhythm, respiration rate, and blood oxygen saturation using the phone's built-in video camera. Researchers say the new app yields vital signs as accurate as standard medical monitors now in clinical use.
Michael Cohen, a publicist at WPI, explained the concept simply: "It's all about light, and the way light shines through your finger and reflects back onto the lens of the video camera. Every time there is a heart beat the pulse makes changes in the spectra of light. That is where he (Chon) grabs all this data. He can measure, with the help of the shifting light spectra, respiration rate, blood oxygen saturation levels, and more." Details of the new technology were reported in the paper "Physiological Parameter Monitoring from Optical Recordings with a Mobile Phone," published in October by the journal IEEE Transactions on Biomedical Engineering.
"This gives a patient the ability to carry an accurate physiological monitor anywhere, without additional hardware beyond what's already included in many consumer mobile phones," the authors wrote. "One of the advantages of mobile phone monitoring is that it allows patients to make baseline measurements at any time, building a database that could allow for improved detection of disease states."
The application analyzes video clips recorded while the patient's fingertip is pressed against the lens of a phone's camera. As the camera's light penetrates the skin, it reflects off pulsing blood in the finger and correlates subtle shifts in the color of the reflected light with changes in the patient's vital signs.
To test for accuracy, volunteers at WPI wore standard monitoring devices now in clinical use for measuring respiration, pulse rate, heart rhythm, and blood oxygen content. Simultaneously, they pressed a finger onto the camera lens of a smart phone. The volunteers were asked to perform a variety of breathing exercises while their vital signs were captured. Analysis of the data showed that Chon's new smart phone monitor was as accurate as the traditional devices.
Asked when the app might be available on the market, Cohen said it is still too soon to be specific. "This is really new territory," he said. "But we're hopeful this could be available sometime this year."
Contact Valerie Newitt at vnewitt@advanceweb.com.