Digital Doctoring

By Catherine Bolgar

The rapid increase in personal devices and smartphones with sensors and applications that can track various measures of users’ health offers new avenues for preventive care.

Particularly useful are bluetooth-enabled off-the-shelf devices such as weight scales, non-invasive blood pressure monitors or pulse oximeters, as well as regulated medical devices such as on-body devices like insulin pumps, on-body sensors that monitor such things as electrocardiography, temperature or glucose, and even pill bottles that track medications.

Researchers in Japan designed a smartphone app to identify early signs of dementia in the elderly. Argentina, Guatemala and Peru have mobile health (mHealth) initiatives targeting noncommunicable diseases such as cardiovascular disease. In Malawi, an mHealth project for new mothers has helped reduce unnecessary trips to the doctor.

Some mHealth projects give medical professionals less-expensive tools that enable them to reach remote patients in developing countries. The Portable Eye Examination Kit (PEEK) is being tested in Kenya to provide comprehensive ophthalmic testing via a smartphone.

“This is a very exciting, fast-moving field,” says Felipe Lobelo, associate professor of global health at Emory University in Atlanta. “There are many opportunities to integrate mHealth into preventive care for patients. When we say preventive care, it’s not just primary health, like warding off diabetes years from now, but also managing disease for people who have risk factors,” such as getting a person to make lifestyle changes after a heart attack to prevent a subsequent episode.

AliveCor  is one of the first FDA-cleared devices to be cleared by the U.S. Food and Drug Administration (FDA) for smartphones which provides for the monitoring and display of the patient electrocardiography, heart rate and wireless transmission of data to a healthcare provider helping patients to more effectively manage their condition and to be more proactive in their care.

Most wearable devices and smartphone apps are targeted at consumers for general wellness, but aren’t regulated by the FDA or by similar agencies in other countries because they aren’t intended to be used to diagnose diseases.

We see huge health potential and revenue potential if these devices become part of health care,” Dr. Lobelo says. “But for that to happen, serious steps need to be taken for standards for clinical use,” such as ensuring accuracy, security and privacy of the data.

The other hiccup is on the patient/consumer side. “The problem is, people download apps on their phones and stop using them after a week,” says Vibhanshu Abhishek, assistant professor of information systems at Carnegie Mellon University in Pittsburgh. “Engagement is a big issue.”

Dr. Abhishek and some colleagues studied a healthy eating project to see whether mHealth actually improved outcomes. They found that people did a better job of recording what they ate, but that feedback from a dietician significantly improved results, whereas peer support didn’t keep people involved nor did it affect eating habits.

Dr. Abhishek sees five levels of engagement with mHealth devices and apps:

  1. providing general information about the right thing to do.
  2. tracking information about consumers over time and giving a summary, such as steps taken, which are measured against a benchmark.
  3. getting personalized recommendations for improvements based on the tracked data.
  4. predicting life-threatening conditions based on data from the devices, such as high blood pressure or low blood sugar.
  5. giving tracked data to the health-care provider, who can see whether a treatment is working or can give patients advice via an app.

“We’re just now getting to level three,” Dr. Abhishek says.

Digital technology isn’t limited to mHealth. The U.K.’s National Health Service (NHS), a leader in digitization, aims to be largely paperless by 2020, with records connected across services from primary to secondary to social care. Despite a mandate since 2009, not all U.S. health-care providers have switched to electronic health records. Canada remains dependent on paper for many patient records.

Computers excel at data-driven tasks like calls for immunizations and refilling patients’ prescriptions for medications, says Simon de Lusignan, professor of primary care and clinical informatics at the University of Surrey in Guildford, U.K. Data also provides a surveillance system for predicting the winter flu season.

Eventually, we will have long-term data that will provide insight about whether a patient is stable or changing. Computers can assemble data that may be scattered around a clinical record to produce a risk score, which “may help us in how to intervene and manage people,” he adds.

A holistic view of the patient would be progress, says Phil Koczan, chief clinical information officer at UCL Partners, a health science partnership linking higher education and NHS members in the U.K. A diabetes patient might see a specialist for diabetes, a general practitioner for other treatments, and an eye specialist.

The big potential is for joining records up and giving patients sight and control of their records,” Dr. Koczan says. “Technology will link with mobile phones that will record personal health data that’s then made available to clinicians.”

That’s No. 5 on Dr. Abhishek’s levels of engagement, “giving patients the right information so they can act upon it and take the right decisions, and give information in some form to the health-care providers so they can improve the care.”

Dr. Abhishek concludes, “We’re in the very early days of mHealth. Eventually I think it’s going to be a very big component of how we can live healthier lives.”


Catherine Bolgar is a former managing editor of The Wall Street Journal Europe, now working as a freelance writer and editor with WSJ. Custom Studios in EMEA. For more from Catherine Bolgar, along with other industry experts, join the Future Realities discussion on LinkedIn.

Photos courtesy of iStock



Catherine Bolgar is a former managing editor of The Wall Street Journal Europe, now working as a freelance writer and editor with WSJ. Custom Studios in EMEA. For more from Catherine Bolgar, along with other industry experts, join the Future Realities discussion on LinkedIn.