Tag Archives for mhealth
I was all set this week to write a post about all the cool new toys coming out to track your health at the Consumer Electronics Show. For the uninitiated, CES is a massive trade show where companies set up demos in a huge Vegas convention hall, and all you can read on the tech blogs all week is about gadgets that have just arrived, and will soon be on the market, ready to change your life. Of course, most of these new products never do see the light of day, and what you get is a lot of hype for products that, by and large, you never hear about again.
And I never thought the health market had a niche there, but they do. My hunch is that health technologies probably didn’t have much presence at CES until the iPhone came along, because CES is so heavily gadget-focused. But whatever the case is, health gadgets are all the rage there now. For instance, there’s the
- iPhone ECG: “The AliveCor iPhonECG is a slim case that fits over a smart phone. Low-power electrodes on the case are pressed against the fingers or chest of a person to display electrical activity of the heart.”
- iPhone Blood Pressure Cuff: Actually, there’s another one of these, and they both debuted at CES.
- Then of course, there’s the CES announcement that a fingertip pulse oximeter will integrate with Microsoft Health Vault in coming months. You can pick one up for the low-low price of $265 USD.
There’s more where that came from. But back to my point: does any of this hype matter? Should we really be spending our time and energy worrying about the newest gadgets on one week of the year?
The only reason why I’m even bothering to ask (assuming the answer is usually, “Sure, why not?) is because I read a really nice column by Farhad Manjoo entitled “The most worthless week in tech.” Observe:
In private, gadget reporters will tell you that covering the show is a tremendous hassle and rarely yields any interesting news. But because CES demos make for great headlines and visuals—hey look, Steve Ballmer unveiled a tablet PC even before Apple did!—and because of the sheer volume of new stuff to post about, CES is a boon for gadget blog traffic and a honeypot for advertisers…
So, why is CES so dependably dreary? It’s the curse of that old Yogi Berra joke—nobody goes there anymore; it’s too crowded. If you’re a big tech company with something truly great to push, you’d be foolish to tell the world at CES.
He goes on to argue that CES is just fodder for “bogus hype” and that the things that truly matter take place at other times of the year. In fact, thanks to the web, they can take place whenever you want. If what you have is going to change tech or health care, it doesn’t matter if you announce it from a press conference in Vegas or on your blog from your basement. If it’s great, it’s great. If it’s not, well, just because you have live audience can’t change that.
Being a somewhat gadget-loving guy myself, reading that article in the middle of the week last week kinda put a damper on things for me, so I thought I’d save it just in case, to give you one last hoorah with CES and all the glitz and glam. And now that it’s over, this year, I’ll be paying attention all year long. Looking not just for the latest gadget to take my blood pressure, but something that has some potential to make my life and yours truly better.
I’ve been pondering Apple’s new patent to identify (and subsequently humiliate) so-called “unauthorized” users of their mobile devices like iPhones and iPads. Essentially, Apple is seeking to patent technology that will detect an “unauthorized” user and use that as an OK to wipe data off of the device, activate the camera to expose and publish incriminating information to prevent them from using the device for evil. Ars Technica reports:
If the various analyses detect someone who is not authorized to use the device, it could set off a number of automated features designed to protect the device’s data, suss out the offending party, and alert the device owner. Sensitive data could be backed up to a remote server and the device could be wiped. The device could automatically snap pictures of the unauthorized user and record the GPS coordinates of the device, as well as log keystrokes, phone calls, or other activity. That information could be sent along with an alert to any useful service, such as e-mail, voicemail, Twitter, Facebook, or a “cloud service” like MobileMe.
At first, this sounds pretty good, especially if you get your iPhone swiped by a bicycle thief. The problem, though, is the shady definition of “unauthorized”: are we talking about a physical thief, a hacker who has taken control of your device remotely, or maybe just a regular user who has jailbroken their device (which is legal now by the way)?
Based on Apple’s public stance on jailbreaking, I am tempted to think that the latter will be deemed unauthorized. Coupled with Apple’s bizarre and inconsistent application approval process, in my opinion, iOS is becoming an increasingly uncomfortable platform to use.
mHealth applications designed to run on smartphones are already in a tenuous position because they have to balance the competing demands of cellular carriers, data security and platform divergence (eg iPhone vs Android vs Blackberry). But because the iPhone has been popular among physicians (and everyone else) for some time, the critical mass of users and developers has arrived. For now, the users are happy and there has been an explosion of helpful, informative and intuitive apps for the iOS platform. This is good.
Indeed, it is even argueable that the Apple’s ability to remotely seize a device is an useful security measure, especially for those devices that may have access to sensitive patient or hospital data. However, there are a number of flaws in that argument including:
- Redundancy: Patient data is stored on an external server, not on the mobile device itself. Rare would be the case that an unauthorized user, unless also armed with several username/password combinations, would have access to sensitive data in the first place (especially on an iPhone, which has very little capability for local file storage beyond what is available in iTunes).
- The Wrong Enforcers: If anyone should have the capability to seize and disarm your device it should be your employer or the institution being hacked, not the cell carrier of the device and least of all the manufacturer of the device. Imagine if all the corporate laptops in the world could be shut down by Dell or Lenovo at a moment’s notice.
- Big Brother: This sort of infringement on basic tenets of ownership is more akin to a piece of rented equipment than something you’ve actually purchased. This is partly caused by carrier agreements,but even if you purchase an iPhone outright (for $599!) you gain no extra control. Apple seems to be giving you the $199 plus $70+ privilege to rent out an iPhone for specific, pre-approved tasks. And if you fall outside of them, they have the means to shut you down. Let me put it this way: Will it be the case in the future that I can’t install Linux on my MacBook if I am so inclined? Will they seize my laptop remotely, too, and install a fresh copy of OS X (while taking my picture with the webcam and emailing it to the Better Business Bureau)?
mHealth and its potential for groundbreaking technological applications has enough to worry about with assuaging the privacy concerns of governments and care providers, not to mention patients themselves. Adding the Machiavellian policies of iOS development and, with this patent, “unauthorized” iPhone usage is an unneeded stumbling block. (Speaking pragmatically, if you don’t want to jailbreak your device, then who cares? But open software philosophy is about more than just getting the job done.)
Of course, control and “security” as offered by Apple’s patent may be just what mHealth needs, especially to convince worried stakeholders. But as other competitors become stronger in the space (eg, the Cisco Cius tablet which has some pre-release corporate promise) and Apple’s stranglehold on mobile app development gets weakened by Android, we may be seeing more diversity in the medical smartphone development space soon. However, until med schools stop giving out iPads, and until it stops being more fun and useful than troublesome to use them, it’s going to be an interesting ride.
As services that rely on GPS-tracking and location-based data — Foursquare and Gowalla come to mind — become more popular, and services like Google Latitude and the upcoming Facebook Places start vying for a piece of the traffic, will mobile health providers be able to get in on the action? ReadWriteWeb seems to think so:
From emergency to non-emergency to everyday preventative health care, location tracking technologies could make a big impact on our health and well-being in the future. While two million consumers use Foursquare today to find the best nearby coffee shops and bars, what if in the future they used it to locate the best pediatricians, emergency clinics, or even restaurants that catered to their unique health needs? Some intersection between location and health care has already begun, but what we’ve seen so far is likely only the beginning.
I’ve long been skeptical of the usefulness of location-based services like Foursquare. For a while there, it was really just a game. A way for smartphone toters to annoy their friends, or shame them, on Twitter and Facebook by showing them what restaurant they visited for lunch. (Not making it any easier on those of us trying to convince colleagues of the professional usefulness of social media.) Now, however, companies like Starbucks are launching coupons, and a new company called GroupTabs is linking the popular Groupon service with location-based apps to give deals to users who can “prove” by means of a check-in, that they’re enjoying the establishment’s wares.
Moving into the health sphere, location-based stuff seems like it may translate well and, in fact, the seeds of location-based health have been around for quite a while. For those in the US who need to find a cheap doctor in-network (bless their souls) or someone in Vancouver trying to find a family doctor accepting new patients (good luck), these location-based media may find a niche. For pragmatic travellers, the application pictured above uses augmented reality to plot the location of the nearest public AED.
But there are problems to the mobile health side of things as well:
“Ultimately, I think we’re going to need to be platform independent, even device independent,” Ahier argues. “We’re going to need to be able to use an Ubuntu netbook, an iPad, etc. Our EHR (electronic health records) are going to have to run on all those.”
Compounding the compatibility problems is the fact that most health information is regulated by some form of government oversight (HIPAA, PIPEDA, you name it). So not only do mobile health developers have to join the platform wars between Apple and Android, Flash and HTML5, native and web apps (not to mention cloud computing), but they will also have to ensure that privacy and confidentiality are taken more seriously than heavy hitters and potential future partners, Google and Facebook, have previously been known for.
I don’t relish the long road ahead, but I very much look forward to seeing the innovations on the other side.
I remembered late last night that I could upgrade my 3GS to the new operating system version that allows multitasking among other things. So that meant I had to stay up to install it. And now it means I’ve spent a little amount of time to tell you what I think so far.
Multitasking is just OK — but it’s probably not Apple’s fault. You really need an iOS 4-ready app to make it work right. If an app is ready, it will save its complete state when you switch, so when you go back you don’t lose any data. But if it isn’t, the app’s behaviour may be unknown. For example, if you’re viewing a drug in Epocrates and switch away, the app will take you back to the start. PubMed on Tap will remember the search you completed recently, but not the article you were viewing.
As for the other features, there are a couple handy improvements. Though it doesn’t come on by default, the messaging app will now count your characters for you (go to Settings –> Messaging to turn it on). The camera will now zoom (tap the screen. Sweet). A unified inbox in the mail app will probably help for institutional users with mutiple accounts (though now I forward everything through gmail anyway…).
IMO the best immediate improvement to iOS 4 is the ability to put apps in folders. It even names the folder by default based on the type of apps you put in it (i.e. when you drag one game on top of another to make a folder, it knows). You can change the name, of course, to anything you want. I’m a neat freak, and I won’t lie to you, having all those apps scattered around everywhere with nowhere to go bothered me. Now I can just get upset about how there’s a max of 12 apps in a folder…
Overall, definitely a welcome upgrade with some excellent features. And as more apps upgrade to fast-switching it will get even better (and once Pandora comes to Canada…)
The PLoS Medicine iPhone app has been out for a couple months now, but as I was pondering it the other day, I thought I would use it as an example in a larger thought on mobile apps in health libraries.
AS an app, PLoS Medicine works just fine. It has the functions that most apps have established as standard now: ability to browse articles by subject; simple searching (a little too simple in my opinion); a way to save articles to an inside the app (a “Favorites” menu for quick access); and a way to get the articles outside of the app (direct link sent to email only). Full-text is available both formatted to the iPhone screen, or as the original .pdf.
The strangest thing about the app is its insistence on displaying lists of articles as title only (see screenshots below). This goes not only against most display conventions that list citations as (at least) author name and title, but it also seems to undercut the researchers involved by not attaching their names to the citations on the iPhone (author names are readily available on the web interface). This omission also
cripples impacts the search function of the app.
But my beef with these apps is a little larger than just title display. It just isn’t practical to dedicate pages of my phone’s home screen to every open access (or paid access, for that matter) journal that I love and want to read. PLoS One, PLoS Biology, NEJM, JAMA, whatever–if all these journals start producing apps like this one then we have a serious problem of selection (though it gives us bloggers a few more reviews to write…). With the blinding proliferation of individual journal apps, the fragmentation of the literature grows, and the utility of all of them decreases. We need a durable solution to finding aggregated research on mobile handsets (more on this below).
This problem is not limited to journals. E-books are often this way, with many books released as individual apps. Anyone with an iPhone or similar app-driven device knows this problem with newspaper apps, all breathlessly trying to compete for the Top News App spot. Magazines are starting to catch on as well, with the release of at least Time, Wired and the New Yorker for iPad.
So as a librarian I would recommend two things to my users: one, forget journal apps unless you love ‘em and find a way to search an aggregator instead. Mobile PubMed works OK on the iPhone; PubMed on Tap is better because you can save citations to collections in the app itself, and also email them. (Be aware that PubMed on Tap is not owned or operated by NLM; the PubMed database is simply harvested by the app.) One potentially useful app would be a PLoS Medicine-like app across all the journals in the DOAJ. That way the positives of open-access apps (full content in-app most notably) would be extended beyond a single title, into a much larger chunk of the open-access arena.
Second, I would recommend a more open and durable solution like setting up RSS Alerts for those can’t-miss journals and dumping them into Google Reader, or again a paid RSS app with a little more functionality, like Reeder.
A partnership between the British Columbia Health Ministry, the British Columbia Medical Association and the UBC eHealth Strategy office has produced a mobile clinical guidelines app, CliniPEARLS.
CliniPEARLS does one thing and does it pretty well: it provides clinicians with mobile access to the BC Guidelines and Protocols Committee (GPAC) guidelines. According to the home page, BC Cancer Agency guidelines are under development for addition as well. So though there is a relatively short list of guidelines available through the app right now, it is quite new (Blackberry version released 12/2009; iPhone, 3/2010) and more are on the way.
The app separates guidelines into their clinical specialties, and also presents an alphabetical list of guidelines for browsing. The structure an individual guideline is separated into many hierarchical pages (see screenshots below). This structure makes for more clicks (or pokes) than may be ideal, but it preserves the specificity of each topic page, and prevents a mobile user from getting lost in a long skinny page of text. One potential problem here is that the text, particularly the links, on these pages is quite small. This might not be a problem for the scrolling hand of a Blackberry, but requires deft aim with a thumb or index finger on an iPhone (which I used to test this out).
The search function has an intuitive interface, and will likely become more useful as the list of available guidelines grows. Additionally, you can bookmark frequently referenced guidelines and pages for quick access. A unique feature is that you can filter any of the guidelines “on” or “off,” which allows you to tailor the list of guidelines to your interest or specialty. Again as of now, filtering the list may not be necessary, but as more guidelines are added into the CliniPEARLS database, this feature will likely prove to be an excellent bit of foresight.
As the mobile marketplace continues to flood with medical applications from all variety of vendors, pharmaceutical companies and other (not-)for-profit entities, CliniPEARLS is a great example of how to enable clinicians to access localized and government-approved clinical information at the point-of-care.
CliniPEARLS is available for Blackberry, iPhone/iPod Touch, Palm and Windows Mobile. Instructions for signing up (an account is required to obtain the latest guideline updates) are available here.
Yesterday I came across a TEDMED talk from early February, by Eric Topol, a cardiologist and director of the Scripps Translational Science Institute. And you know how those TED videos are: once you start, you can’t stop.
The video caught my eye for a few reasons:
- Wireless health is linked to, but not the same as, mobile health. When we talk about ‘mHealth’, it may have to do more with developing countries and delivering services via mobile phones, than it does with transmitting vital signs and other “physiological metrics,” as Topol calls them, to an iPhone. (For more on the varying shades of m, e, and other ‘healths’, see this excellent blog post).
- It exposed me to two excellent magazine issues that have dealt with the rapid development and exposure of many different types of people to mobile and wireless technology, for health but also for banking and even agriculture. The first is the Wired Issue from July 2009, which is free and covers many of the health tracking technologies; and the other is the September 26, 2009, issue of the Economist which covers developing countries and emerging markets for mobiles (not free, but you can get a 14 day trial in short order). There are several articles in both those issues that are excellent food for your mobile thought.
- Also, I really want that alarm clock/sleep monitor. I bet I’m a good dreamer, too.
Another excellent TEDMED video was the first one they released from David Blaine, the monotone magician. I know he is a little out there, but he has a great story on trying to set the world record for holding your breath. And now we wait for David Pogue, I guess.