mHealth: Revolution or Evolution?

Last year, a physician in a remote Polish town visited a baby with a systemic bacterial infection. After a regular physical exam, the patient appeared to be healthy, so the doctor was going to end the appointment, but since he had a new ultrasound by Philips Lumify, he quickly scanned the child’s heart. The results were astonishing: there was a fluid afflux in a sac containing the heart. It’s a life-threatening emergency that requires immediate hospitalization. Detecting that fluid early literally saved the child’s life, letting him smile, laugh and grow further after the treatment.

Looking at the evolution of diagnostic devices, it’s becoming clear that they get more and more miniaturized, digitized and connected. Remember the time when Dr. Karl Theodore Dussik worked on transmission ultrasound investigation of the brain in Austria in 1942, the instruments took up almost the space of an entire room. Now the size decreased, and its movability improved.

In the past, the ultimate goal of medical tools was to somehow measure health parameters and record the results. Currently, the question is how to measure them more accurately and in a more patient-friendly way, even in low-resource regions, remote areas or emergencies.

Already, the cheaper and lightweight equipment is impacting the lives of people throughout the world, from medical schools’ anatomy classes to isolated battlefields. And it’s only the beginning! Researchers claim that in the nearest future ultrasound technology will be used not just for imaging but for actual treatment of disease. For example, ultrasound could create a force field similar to a “tractor beam,” to move objects around inside the body without invasive surgery, said Mike Bailey, a University of Washington associate professor and a senior principal engineer in the Center for Industrial and Medical Ultrasound. When combined with artificial intelligence, mobile ultrasound devices have the potential to become automated tools for diagnosis.

To be clear, the handheld versions aren’t a replacement for the larger models that come with larger computing power. For example, an emergency room physician might use a handheld to quickly see if there’s a foreign body inserted into a patient, or if there’s fluid around the lung. But a patient who needs a full ultrasound workup with measurements would likely still use the larger models.

Beyond ultrasound, many more diagnostic devices have turned into palm-sized gadgets, for example, the Viatom Checkme Pro, the closest tool to the medical tricorder, or the Clinicloud and the Eko Core both replacing the traditional stethoscope.

How it all started? From Healthcare 1.0 to Healthcare 3.0

For sure, mHealth wasn’t created in 7 days. This could have happened only in the Bible, however, mHealth has a nice history too.

It all started with Healthcare 1.0, a time when the industry was dominated by paper records, non-experimental, fixed set of practices and treatments. The era was concentrated on the human side as compared to the technological one.

Healthcare 2.0 started when the abundance of paperwork and the human effort involved in every step from admission to post-treatment formalities came to the peak. These were the 2000s, and Healthcare 2.0 gradually reduced the human interaction to an extent that the technology has taken the dominant seat in every process.

However, it wasn’t perfect. A lack of human connection between technology and people has put the first brick in the foundation of Healthcare 3.0. The goal was to remain human while being super technological. And it was achieved with the help of so-called mHealth that stepped into the arena. 

What is mHealth?

Well, as the term implies, it is “mobile health”, i.e. the health services offered over and through mobile devices. However, it’s an extremely wide category, which encompasses everything from a Fitbit app to a video chat with your doctor. According to Visiongain, mHealth includes the following:

1. Using smartphones to collect health data, whether clinical, behavioral, or lifestyle, and at the community and individual level;
2. Connect providers, researchers, and patients with healthcare information;
3. Real-time monitoring of patient vital signs;
4. Telemedicine.

What we experience now?

Well, the situation is that more than 80% of Americans today have mobile phones, and more than 50% own smartphones, with the latter percentage projected to grow to more than 80% within 10 years. 

Moreover, nearly half of American adults also have at least one chronic medical condition, and this number is also growing. Chronic conditions result in poor medical outcomes as well as in increased cost and usage of healthcare services, not only for older adults but also for all age groups. The helping hand in such a situation is, curiously enough, mobile health!

Because of the ubiquitous nature of mobile devices, and the fact that many Americans cannot leave home without them, their potential role in medicine and rehabilitation continues to become more evident. Recent statistics show that 83% of smartphones are always turned on and always with the user.

Why Smartphones? Why mHealth?

1. There are hosts of mobile devices on the market. For each taste, color, and pocket. They’ve become an inevitable part of our life.
2. As people carry smartphones throughout the day, the phones can collect ecological momentary assessment (EMA) data, which are the data obtained in real time when a person is in his/her natural environment. Often, EMAs are used to reveal ecological momentary interventions (EMIs) timely and deliver treatment when a symptom or need is identified.
3. Smartphones can connect to external devices either directly or wirelessly. These external devices can be placed on or within the body to sense, sample, process, or transmit physiological signals (temperature, heart rate, blood pressure, oxygen saturation, electrocardiography, electromyography, energy expenditure, glucose level, and environmental conditions). Various forms of wireless sensors, such as accelerometers, gyroscopes, and force sensors, can be used to record physical activity, movement, or walk patterns. This information could help a doctor to monitor the patient’s adherence to exercise programs and send him [the patient] back the notifications for motivation.
4. Finally, smartphones also contain numerous internal sensors (f.e., global positioning system, gyroscope, oscillometer) that could be used with external devices to allow doctors to monitor a variety of contextual factors about a patient's activities. These sensor data can be combined with EMA data using machine learning systems to enable context-appropriate responses (f.e., delivering timely feedback, providing guidance during therapy) without relying on the patient to initiate such therapeutic interactions.

What types of mHealth apps are out there?

Myriads, you’d say. Eleven, I’d specify.

1. Clinical assistance apps – allow doctors to check EHRs or access lab results during an appointment, as well as demonstrate a patient his/her exams to explain the roots of the disease and the prescribed treatment.

Some examples of clinical assistance apps are:

• Mobile MIM: iOS
• syngo.via WebViewer: iOS
• DrawMD: iOS

2. Monitoring apps – allow a doctor to keep an eye on the behavior or symptoms of a patient remotely. For example, a patient could use an app to take an electrocardiogram (ECG) and then send the results to his or her doctor. Monitoring apps also give doctors telehealth capacities, an increasingly popular option right now.

• American Well: iOS
• InTouchHealth: iOS
• AirStrip-Patient Monitoring: iOS

3. Reminder apps – remind patients of appointments or medications. Sometimes reminder apps come as part of an EHR package or as part of a larger app, but they are also available independently.

• Talksoft Connect: iOS and Android
• My PillBox: Android
• OnPatient: iOS and Android

4. Reference/database apps – allow doctors to look up drug dosages, symptoms or current forms of CPT, ICD and HCPCS codes.

• Epocrates: iOS and Android
• AAP Red Book: iOS and Android
• UpToDate: iOS and Android

5. Healthy life apps - help people lead a healthier lifestyle by tracking their progress in activities such as diet, weight loss, or exercise programs. They are probably the most popular mHealth apps, especially those focused on fitness.

• Carrot Fit: iOS
• Glow: iOS and Android
• Fitbit: iOS and Android

6. Efficiency/communication apps – allow doctors to communicate within and between medical facilities, foster interoperability, collaboration, and, ultimately, better patient care. For example, using a communication app allows a doctor to securely send information about a patient to a specialist at another facility. They also allow for a more efficient workflow in the medical practice, something many doctors are striving for.

• Doximity: iOS and Android
• DocbookMD: iOS and Android
• OnPage: iOS and Android

7. General facility information apps – give patients and family members general information about the facility (hospital/clinic/rehab center, etc.), the services it offers, and the amenities it provides. An app could include a map of the hospital and surrounding neighborhood or a list of available doctors at the facility.

• MyWay by Boston Children’s Hospital: iOS and Android
• Britain’s Finest & Home Care: iOS
• Patient by Mayo Clinic: iOS and Android

8. Patient portal apps – give patients mobile access to their electronic medical records and allow for easier patient-doctor communication. They often come as part of an EMR software package.

• NextGen Patient Portal–Comes as part of the NextGen EHR software system.
• PortalConnect by Hello Health–A free app but available only to users of one of the Hello Health software solutions.
• InteliChart Patient Portal: iOS and Android–Sold independently but integrable with a wide variety of EHR systems.

9. Specialty-specific apps – aimed at particular healthcare specialty, like cardiology, oncology, orthopedics, etc.

• GoCheck Kids (Pediatric photoscreening)
• EZ Derm (Dermatology): iOS–Can only be used as an element of EZDERM EHR software.
• CancerRX (Oncology): iOS

10. Telehealth apps – allow users to talk directly to doctors and therapists.

• Teladoc
• DoctorOnDemand
• HealthTap
• Pingmd

The next frontier in telemedicine is to offer it without a doctor. Like shopping bots that offer personalized product recommendations, medicine bots will use AI to monitor and diagnose patients’ conditions.

11. Preventive apps – record physiological data using your phone’s built-in camera, microphone, and speaker to diagnose conditions and prevent diseases.

• Cerora headset measures brainwaves and tracks eye movement. It connects to the app, which uses your phone’s internal sensors to test patients’ balance and reaction times to determine brain health and help doctors diagnose concussions and other neurodegenerative diseases.
• Cellscope’s smartphone attachment allows parents to see the inside of their kids’ ears, take a photo, and send it to their doctor.
• Medtronic uses IBM’s Watson artificial intelligence system to predict diabetic patients’ blood-sugar levels. By combining data from Medtronic’s insulin pumps and glucose monitors, diet information, and activity trackers data, Medtronic can predict dips and spikes up to three hours before they happen.

Note! Although mobile technology shows great promise in mHealth, it is paramount to have a strong medical evidence base to support mobile applications. Without accurate data, the results should be interpreted with big caution. 

 Elinext also contributes to mHealth development being involved in several interesting custom projects. You could always examine our case studies here or ask me directly for a consultation.

Final words

mHealth revolutionized the digital world, and medicine has benefited from it immensely. Although having the information available electronically has numerous benefits, it has a lot of responsibility too. Therefore, it’s pivotal to use only HIPAA-compliant apps and follow several security practices, like user authentication controls, remote and automatic lock and wipe capabilities, encryption and a thorough BYOD policy. The essential dumping of data to a secure external hard drive may be a good safekeeping habit for extra protection too.