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Smartphone Medical Apps

“Mobile Health” is a reality that counts millions of users and is in many ways already transforming the relationship between doctor and patient.

July 2014

Smartphone Medical Apps IMALab

The numbers involved are staggering: 500 million medical apps are forecast for 2015. This is the projection for a trend that shows no signs of slowing down: the explosion of “Mobile Health” all over the world.

And we can go further than that: by 2018, 50 percent of the more than 3.4 billion smartphone and tablet users will have downloaded mobile health applications, and these users will of course include health care professionals, consumers and patients.

This article will not focus on transportable medical devices possibly equipped with communication systems, but on apps for Apple and Android smartphones or tablets, either autonomous or connected with body data-gathering systems.

Different kinds of apps exist for different kinds of users: medical students, general practitioners, specialists, patients with countless different pathologies, ordinary citizens and parents or children looking after their loved ones.

These apps have various different kinds of functions connected with health and simple physical wellbeing, ranging from providing information to recording data to detecting bodily conditions to automatically calling a doctor or a hospital in case of imminent danger. Some are free, others cost several hundred dollars for a year's subscription.

A huge number of these apps are focused on medical literature, databases for theme-related medical information, and tools for selecting all kinds of data and info. One of the oldest and most established medical apps, Epocrates, gives doctors basic information about drugs, the right dosing for adults and children, and warnings about harmful interactions. It has replaced many a copy of the Physician's Desk Reference. But this kind of app is the simplest to imagine and understand.

Numerous apps are designed specifically for women: these range from providing reminders to take contraceptive pills, to calculations on ovulation timing – and therefore fertile periods – and the phases of pregnancy. But there lots of other women-orientated apps too: guides to correct nutrition, keep-fit videos, instructions on preparing for childbirth and on caring for new-born babes. And then there are apps that provide nursing mothers with information about the effects of different medicines on breast milk and nursing infants, and there’s even an app that allows anxious parents to post a picture of their baby’s excrement and compare its color with others in a special database, in order to assure themselves that everything is going fine (apparently, this app saves pediatricians an enormous amount of time!).

Consumers can use mobile apps to manage their own health and wellness, for example monitoring weight and body mass indexes, and accessing information on what is required to maintain, lose or gain weight.

Many also help to keep track of daily food intake and measure the calorie consumption achieved by physical exercise as measured by special sensors.

The point is, apps for smartphones and tablets are already changing the way doctors and patients approach health care. Many are designed for the doctors themselves, such as those that provide sophisticated monitors for reading a person's blood pressure, glucose levels or asthma symptoms. Others are intended to help patients — at their doctor's recommendation — gather diagnostic data, for example, or simply to help coordinate care, providing patients with an easy way to keep track of their conditions and treatments.

Some apps can even produce electrocardiograms: patients use sensors which wirelessly communicate with the phone to produce an ECG that can be sent to their doctor.

One tool+app consists of a very small personal mobile 12-lead ECG device designed to enable the detection of heart attacks. This instrument is worn like a bracelet and can take a full ECG in just 30 seconds: the patient simply straps on the belt provided and presses the ‘start’ button. The instrument then uses Bluetooth to send the digitally encoded ECG data to a smartphone or tablet, which uses cellular communication to send it on to a physician or hospital for diagnosis. It also stores patient’s ECGs on their smartphone, so they always have a full and updated record with them. The smartphone can also automatically communicate an at-risk patient’s geographical location, permitting them to be reached quickly in an emergency.

Among the many monitoring activities that apps can perform, here are two interesting examples:

People with trouble sleeping can use an app to record their blood-oxygen level during the night — data that can help a doctor diagnose whether they have sleep apnea, for example. To use the app, patients go to bed wearing a fingertip sensor, which wirelessly links to the phone and keeps track of their blood oxygen levels.

A smartphone can become an otoscope, the instrument doctors use to look inside a patient’s ear, thanks to an app and optical device. Doctors say it's very useful for recording videos of a child's ear and then showing the images to parents to explain their diagnosis. This system reassures the parents, and often helps cut down on unnecessary use of antibiotics.

One of the most important and useful fields for medical apps is that relating to diabetes.

An important part of managing diabetes is managing your diet. When you’re living with diabetes, ingredients matter: “Fooducate” helps you identify which foods are high in sugar, fats, and unnecessary ingredients. Naturally, it would be a lot easier if you could scan a barcode to get the nutrition data on the foods you buy! But this can be done by an app capable of immediately “reading” all the ingredients of any product and of indicating whether it is suitable for a diabetic person or not. And if you’re an insulin user, the app can estimate how much you’ll need for a meal or what you need to get your numbers back on track.

Naturally, there are also numerous apps devoted to communicating and relating with people who suffer from the same illness… but in the age of social networks this should hardly surprise us.

All these extraordinary and extremely useful apps are accompanied by debates about their medical reliability and efficacy and also, naturally, about their privacy implications.

For example, doctors are increasingly using their phones to take photos of some detail regarding a patient's condition — such as a rash or a wound — and then to upload these images to the patient's electronic medical record. This could violate health-care privacy laws if the doctor leaves the photo on his or her personal phone. It’s true, an app exists which sends such photos directly to the patient's electronic medical record without storing them on the phone… but of course, all kinds of problems still remain.

Everyone working in this sector welcomes the idea of developing official guidelines and regulations covering this whole area. In September 2013 the FDA “inaugurated the debate” by publishing a guide called “Mobile Medical Applications”. According to this, not all the Apps connected with health and medicine will be subjected to strict regulation, but only those which have a direct impact upon diagnoses and therapies and which have been classified as High Risk Medical Apps: other Apps will either be “under observation” or simply free of control or observation.

We are happy that the FDA is becoming involved, because finding one’s among 500 million apps is a task nobody can face on their own.