Just over half of surveyed patients feel, mobile health applications makes health care more convenient. Slightly fewer than 50% of patients think mobile health improves the quality of care, increases their control of care, and decreases personal expenses.
Georges Clemenceau, 20th century physician and French President said, “War is too important to be left to the generals”. It may be “medical care is too important to be left to the doctors.”
It’s a Big World Out There
Almost half of all Americans have smartphones. And that number will be soaring in the next few…uh, what time is it now? So too, and so true for consumer health apps. Currently there are almost 14,000 apps for your phone or tablet and that’s as of Monday August 5, 11am, 2012. By the time you are reading this, there will be more.
It’s also an expensive world out there. For a measly $300, I can download a complete guide to these apps and take you through the amazing maze. Well, that’s not going to happen. Alternatively I could assist you nice folks by downloading them at an average of two bucks a shot. Well, that comes to $28,000 and several months of research. Yup, that ain’t gonna happen either.
A Guide to Consumer Apps
What I can do is break down the apps into categories. Mobile health applications come in a variety of flavors. There are apps for Cardio, Fitness, Diet, Stress (I could use one now), Strength Training, Women’s Health, Mental Health (see Stress app above), Chronic Conditions, Calculators, Sleep, Emergency Care, Smoking Cessation and Medication Adherence.
We already know that doctors don’t want you using apps. 64% of physicians “worry that mHealth makes patients too independent.” With mobile technology, “consumers are now empowered with information on price, services, wait times, and quality. … So they start making decisions like they would in any other marketplace.” A Marketplace? That’s exactly what medicine isn’t. It is exactly what medicine should be. Yes, you can comparison shop for your own coronary artery bypass. The tools are there. First comes skill, and then comes costs. You can get both. Many get neither. Your relationship with your doctors should be a transaction not a genuflection.
One Doctor Under God (sometimes)
We doctors don’t like to give up our independence. We don’t want lose our lofty prestige and elitism that’s ranked (at least by us) as just under the clergy’s. Some of us think of ourselves higher than the clergy. You know…the clergymen’s boss.
Medical care eludes the classic economic rules of supply and demand. But apps are a force to reintroduce the concept of competition back in the medical marketplace. Comparing the quality and cost of services are just the start. Consumers voting with their feet and walking out on docs and spreading the word about those who don’t stack up will change the quality and the cost for the better.
A Caveat: A flight manual doesn’t make you a pilot
Know what? There may be some legitimate dangers out there. Eight years of spent in specialized training and years more of patient care means that we correctly consider ourselves better qualified to diagnose and treat disease than you guys. A flight manual doesn’t make you a pilot. Google searches are woefully unfiltered and mobile apps are best used as reference. Reference eliminates deference from the patient doctor transaction. These and other tools make you a partner in your care. You are partners …not solo, amateur, fly by the seat of your pants, hobby practitioners. You can manage your own health, and part of that is picking the right doc to watch your back. The lack of regulation of these consumer apps is cause for concern “few tools … met our criteria for effectiveness, usefulness, sustainability and usability.”
“Currently, consumers are really on their own when it comes to finding high-quality, worthwhile apps, and it’s mostly trial and error.” Hmm, errors? Mistakes are okay with choosing the wrong menu item. But they are not so okay when choosing a medical path.
You know how much I hate the Nexium commercial that tells you to do your job and let the doctors do theirs. It’s patronizing and demeaning (it’s nice to know that doctors have not cornered the market on these two attributes). But medicine is not a ‘do-it-yourself’ world. The dangers are especially evident when half of us use social media for health information. To me a medical tweet is as unreliable as a general Google search.
Mobile health technology is growing at 25%/year. Venture capitalists, health insurers, drug companies and, oh yeah, patients value them. But the FDA is getting heartburn over their unmonitored proliferation.
Reviewing every app is not possible. Not every app needs regulation. Apps used only as reference guides do not need the FDA’s fingerprints all over them. But an app that turns a smartphone into a medical device or controls medical devices needs oversight. You know a smartphone can scan your credit card; they can also scan your gallbladder!
The FDA will start regulating potentially dangerous medical apps. And even though I can’t do it, real experts will start peer reviews of medical apps gauging their design and content.
10 smart choices
They are smart because they are not mine. There are too many and I don’t have the chops. But MobiHealthNews.com and its editor, Brian Dolan are experts.
Here’s what they came up with: This comes almost verbatim, right from their website.
iTriage (free) Helps you evaluate any troubling symptoms and then suggests the best, nearest health-care facilities; gives you the wait times at some emergency rooms.
GoodRx (free). Can compare prescription drug prices at virtually every pharmacy in the United States. Also provides coupons and cost-saving tips.
ZocDoc (free). Makes it easier to find nearby doctors who accept your insurance plan and to book appointments, even at the last minute. I have this downloaded and have spoken with the company. This is one great outfit.
RunKeeper (free). Tracks your pace, distance, time and heart rate during runs and other fitness activities, and lets you share the information with friends.
LoseIt! (free). Helps motivate dieters by allowing them to set and log their daily caloric intake by doing such things as scanning the bar codes of foods they eat.
Withings WiFi Scale ($159 for the scale; the app is free). Monitors your weight, BMI, body fat percentage and other health data when used with the associated wireless scale.
iBGStar Diabetes Manager ($75 for the meter; the app is free). Track your blood glucose levels and insulin usage and share information and trends with your healthcare team with this app and its iPhone-enabled glucose meter.
iHealth Blood Pressure Dock ($99.95 for the cuff; the app is free). An iPhone-enabled blood pressure cuff measures your systolic and diastolic pressure, heart rate and other vital signs with this app, which generates interactive graphs and tracks your numbers.
Beam Brush (just received FDA clearance; will cost $50). A Bluetooth-enabled toothbrush and app tracks how often , and how long you brush your teeth, serves as a timer so you can do 30 seconds in each quadrant of your mouth and even lets you program your favorite song to brush to. May I recommend Mongolian Throat Singing?
Zeo Mobile (headband is $149; the app is free). A sensor-embedded headband monitors your sleep patterns, including time in REM and deep sleep, and the app offers advice on how to become a better snoozer.
How can you judge an app? Here, are a few suggestions from the venerable British Medical Journal.
Questions to ask before downloading an app.
Clinical decision making
• Is it produced by a medical publisher? For example, apps adopted by a medical journal or publisher.
• Is it regularly updated?
• Is it properly referenced?
• Are the authors listed?
• Is it possible to give feedback?
• Is the content peer reviewed?
• Has it been recommended by your tutor, university, or healthcare institution?
• Is the app’s primary purpose to inform the health professional (and not patients)?
• Does the app require you to input patient specific data, and could this compromise patients’ privacy?
Conflicts of interests
• Do you know where the app is from? Is it produced by a drug company or a non-commercial organization?