Will you think outside the box about changing the paradigm proactively?

Before I discuss my thoughts about the merits of new smartphone healthcare apps, I’m just going to get a complaint out of my system.  From the Boston Globe:

Doug McClure, chief technology officer, said the company’s top goal is to educate and motivate and to offer multiple access points — Web, e-mail, and mobile — a wide range of tools, rewards, and peer support.

“We’re trying to leverage technology to help you understand your body and to turn that into something really actionable that improves your wellness,’’ he said.

I don’t know if I could have crafted a more annoying quote if I’d tried.  Let’s tidy that up a bit, shall we?

“We’re trying to leverage use technology to help you understand your body and to turn that into something really actionable helpful that improves your wellness health,’’ he said.

Aaaaah.  Much better.  Now then, on to the substance of the article.

Use of mobile applications, many medical professionals believe, could make an important difference. Multiple small-scale studies have looked at apps and their impact on patient education, engagement, and compliance, with mostly positive, though not conclusive, findings. Researchers at the University of Washington provided eight diabetic patients with services such as feedback on glucose levels and connection to care providers through cellphones and game systems. The study, published last month in the journal Diabetes Technology & Therapeutics, found patients liked using the system and felt more aware of their health needs as a result.

In Toronto, a study of more than 100 heart-failure patients reported that many were comfortable using mobile apps to manage their conditions — though some clinicians had reservations about difficulty of use by some patients, legal issues, and increases in clinical workloads. (The research was published last year in the Journal of Medical Internet Research.)

There are many chronic conditions that benefit from regular monitoring and adjustment.  As an example from pediatrics, monitoring patients’ peak flow rates (a measure of how forcefully a patient can exhale) gives valuable information about how well-controlled their asthma is.  If the rate starts to drop below a certain percentage of the patient’s usual efforts, it’s a sign that there needs to be a change in management.  Yet patients rarely seem to keep a daily measure, and I think I could count on one hand the times I’ve actually seen these data logged.  If smartphone apps will help remind patients to measure things like peak flows or blood sugars, I’m all for it.

I’m a wee bit concerned about those legal issues and increases in clinical workloads.  I already find myself managing patient care via e-mail more than I’d like, and it’s hard to get compensated for that work (at least under the current fee-for-service model).  I can see how messages from hundreds of patients’ smartphones could rapidly become overwhelming.  I also wonder who decides which apps the patient is going to use.  If my patient likes to use an app she’s found that checks her pulse every morning and sends me e-mailed bulletins about her heart rate, what are my obligations to respond?  Am I responsible for getting every app my patients use?

Imagine an app that connects directly to your blood-pressure monitor, scale, or glucometer, and not only shows you how you are doing, but also offers expert advice and alerts your doctor at the first sign of trouble, so he or she can adjust your medication.
Hold the phone!  This does not sound good to me.  Who is offering this “expert advice”?  If it’s the same lot who create the content at WebMD, for example, then maybe my patients should pass.  The world is full of hit-or-miss sources of health information.  And anyone who has ever been in the same room as a person on an oxygen sat monitor will tell you that the “first sign of trouble” is often another way of saying “useless and infuriating alert.”  If we’re going to be expected to respond to alerts from smartphones, I really, really hope those alerts are calibrated to reflect real problems and not some arbitrary and meaningless value.
Dr. John Moore, a researcher at the MIT Media Lab, is building a system named “CollaboRhythm.’’ His apps — so far he’s focused on HIV, hypertension, and diabetes — redefine the doctor-patient relationship, casting it as “person and health coach,’’ with constant interaction.
Excuse me while I go weep quietly in a corner for a moment.  “Person and health coach”?  If this is the model, you’ll forgive me for not rushing right out to sign up for “CollaboRhythm.”  I’d like to cling to my profession’s remaining scraps of dignity, thanks.
Connecting the app to Southcoast’s EMRs, Rattray acknowledged, will take “a few years,’’ and in general, linking doctors to their patients’ apps remains a major challenge. At Mass. General, Parks has to print out her patients’ reports from HeartWise to put it in their charts, and she cannot e-mail them back through the system.
This would be my only other major concern — how will these apps interface with the medical record technology.  I love having an EMR (and if your provider doesn’t use one, you should question why not), but anything there’s an interface with another program, there can be potential for significant problems.    I don’t see myself being an early adopter of these technologies.
I want my patients to be invested in their own healthcare, and if having smartphone apps will increase their compliance or monitoring, then I’m happy to see this niche filled.  I’m curious to see which apps stand the test of time, and seem to offer the most benefit and least irritation.  But I don’t think I’ll wade in myself for the time being.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. All the monitoring and smartphone apps in the world won’t help the person who goes to Olive Garden and has six breadsticks and two plates of oily salad, then eats a pound of pasta with sausage and tops it off with a brownie sundae and two big cups of sugary coffee.

    “I’m a wee bit concerned about those legal issues and increases in clinical workloads.”

    The insurance provider I’ve got has a “personal health coach” who is supposed to manage that sort of thing. The idea is that you don’t inundate your doctor with reports of your bowel movements and morning heart-rate measurements; you send all that to the Personal Health Coach, who isn’t an actual doctor, but is a friendly voice on the telephone whose computer tells her whether or not you need to go see a doctor.

  2. Thanks for the honest insights. This article provides very a good view into the reality and challenges of mhealth. mHealth will happen, but right now there is a lot more hype than reality. Although, there are some very bright spots from new solutions which will provide some value in the future, but as you point out, it will take time.

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