Why iPhone connected blood pressure cuffs featured at CES are over hyped

I love mobile technology — it’s just one of the reasons I started iMedicalApps. There are so many ways mobile technology can be used for patient care, and we’ve highlighted this on a weekly basis.

You can use mobile technology for real time medical data gathering, to explain complex pathology with easy to understand multimedia for patients, to transmit EKG data to an emergency room while en route to the hospital, and a litany of other things.

But there are obvious limitations to mobile medical technology as well, especially in regards to changing lifestyle and behavior, something that has plagued medical professionals since the dawn of preventive medicine.

Last week at CES (Consumer electronic show), two blood pressure peripherals for the iPhone from competing companies received significant attention. CNN even listed the devices as a “top 10″ buzz worthy device that was unveiled at CES.

One of the devices is from a start-up in California, iHealth Labs, and they unveiled the iHealth Blood Pressure Dock. The company touts the product being used for daily blood pressure measurements, and a physician spokesman for the company states how patients will measure their blood pressure more frequently now since the device is tethered to their phone — a device that gets frequently.

To be clear, this is a interesting and fascinating technology.  You can plug a blood pressure cuff into your phone, an app opens up, automatically recording and tracking your blood pressure, and also giving you the option to Twitter or Facebook out your recordings — the thought being you can use social networking “peer pressure” as an incentive to lower your readings.  More importantly, you can e-mail the results directly to your physician.

So this means patients surely will check their blood pressure more frequently — not necessarily, and more than likely no.

First of all, if you have a patient that can afford an iPhone and the accompanying data plan, plus the more expensive blood pressure cuff, approximately $100 — you already have a patient that is more likely to be empowered.  Lets look at the actual research data behind this to make more sense of why this would have minimal impact on compliance.

Data shows that just over 30% of iPhone users are above the age of 45.  So out of the total iPhone population, you are looking at approximately 30% of users who would actually be in the age range to use the device — and that’s giving a favorable age bracket.  In reality, the 55 or over age group would be the real target age group, only 14% of the iPhone demographic.

Now lets look at more data about the iPhone and affluence.  iPhone users as a whole are more affluent than not only the normal population, but in comparison to other smart phone owners — with an average household income of $100,000.  There is data that shows compliance to physician recommendations, such as medications and blood pressure checks is less in lower income households.  Some of the reasons being access to health care and expensive of medications.

So basically, those who would be in a position to buy these iPhone blood pressure peripherals are more likely to be compliant patients anyways, and would most likely be checking their blood pressure as prescribed.  Obviously, there will be anecdotal examples that will counter this, but from a populations approach — you most likely wouldn’t see any significant change.

So from a preliminary standpoint, these blood pressure cuffs are very interesting and a very niche product — but certainly not the game changers they are being touted as by many news sites.

iPhone blood pressure peripheral details from company websites:

iHealth

Withings

Sources: (Please refer to links provided in story for sources of data, hyperlinks are also given below)

http://tech.fortune.cnn.com/2010/02/25/6-ways-iphone-and-android-users-differ/

http://www.mediapost.com/publications/?fa=Articles.showArticle&art_aid=132409

http://www.jstor.org/pss/3592905

Author:

Iltifat Husain, MD

Founder, Editor-in-Chief of iMedicalApps.com. Emergency Medicine Faculty and Director of Mobile App curriculum at Wake Forest School of Medicine.

Follow Me

View Comments

28 Responses to Why iPhone connected blood pressure cuffs featured at CES are over hyped

  1. Alexander Protonotarios January 12, 2011 at 6:14 am #

    Agreed, this gadget is more about creating a “need” rather than fulfilling one.

  2. thuc January 12, 2011 at 6:37 am #

    very interesting points. but i believe that innovative change is the starting point for re-molding the current norm. as more fanfare and data is covered, more patients will be aware of the possibilities for controlling their health, and patient empowerment will increase. it all starts out small with the early adopters and eventually the late majority will come around. i agree, not soon like you said, but one day. im hopeful. :)

  3. Christopher Monnier January 12, 2011 at 8:56 am #

    I agree with Thuc–innovative change is possible because nothing is static–everything’s dynamic. iPhone users will age, already-old people will adopt iPhones in greater numbers, and iPhones will likely continue to be available at a variety of pricepoints. Already, the iPhone 3GS is availalble for $50 for a 2-year contract.

    Additionally, early adopters can demonstrate the value of new innovations and open up “down-market” opportunities. Maybe 60 year olds living with heart failure won’t have a Withings blood pressure cuff and an iPhone, but they may have something similar that connects to the micro-USB port on their talk-and-text phone. Or maybe providers and payers will see the value of easy and enjoyable blood pressure monitoring products such as the Withings/iPhone solution and will subsidize the cost to their patients.

    A classic example of an innovation that in its early stages could have been called a solution for rich people that didn’t really serve an existing need is Twitter. But after early adopters demonstrated its utility, Twitter began being used as a tool for political organization in Iran and other parts of the world. And in the US, according to this Pew study (http://pewinternet.org/Reports… “minority internet users are more than twice as likely to use Twitter as are white internet users,” bucking the “digital divide” trend that has been around since the advent of the world wide web.

    I’m not expecting an instant revolution, but I do think that iPhone-connected peripherals will accelerate improvements in the quality and cost-effectiveness of healthcare.

    • Felasfa Wodajo January 12, 2011 at 9:35 am #

      Thank you all for a insightful and lively discussion. That by itself is an encouraging sign for the future !

    • Iltifat Husain January 13, 2011 at 11:23 am #

      “iPhone-connected peripherals will accelerate improvements in the quality and cost-effectiveness of healthcare.”

      -This is what I think is the real utility of these types of devices Chris. I’m always trying to explain to administrators that you don’t have to reinvent the wheel. Why not use existing technology to make health care products cheaper?

      An example are the multiple articles we’ve written on speech therapy apps that are significantly cheaper on the iPad, yet most insurance companies fail to reimburse for them:

      /20…

      Apple and other device manufacturers have already created an “economies of scale” — and instead of the medical industry making new hardware, that is often times significantly inferior, they should focus on the software.

      Now if a company created a blood pressure peripheral that was significantly cheaper for phones because it used the computing power on the iPhone — then, that would be a start.

      In general though, we need to be cognizant that technology does have limitations, and we shouldn’t assume that “cool things” increase compliance. We need to look at the data first, and approach these things in a systematic way. That said, these types of products are definitely a first step — and definitely needed. But again, we need to make sure we don’t overhype them, and understand their limitations.

      • thuc January 13, 2011 at 2:31 pm #

        you’re definitely right. we need research and data to properly interpret whether the peripherals will increase compliance and any other effect that is important.

        cant say it does until its proven. right?

        but, cant get the data unless more people use it. cant get more people to use it if they dont know about it. i dont think its overhype, its just press releases and social media doing its thing. the more people that know about it, the more will try it, the more data you’ll get, and then we’ll eventually know if it’s good or not.

        in the meantime, i hope production hurries up so i can give it a try. :)

  4. Jonathan Richman January 13, 2011 at 11:13 am #

    One more thing to consider (for the record, I completely agree with the analysis here)…the real interesting thing for me is a totally different trend. More and more electronics are being produced that are “dumb”. That is, they don’t have any processing power or even digital components themselves, but rather rely on another device for this. In this case, the blood pressure monitor is useless without the electronics of the iPhone, which handles all the computing. There were a number of devices at CES that used this concept. The idea being that you always have your main computer (which happens to also be your phone) with you and you plug it into “dumb” devices and terminals.

    • Iltifat Husain January 13, 2011 at 11:25 am #

      Definitely Jonathan — I think the key in this is the cost. Will these types of peripherals allow for a cheaper cost, since the computing power is done by a phone? I talk about this in more detail in my above comments.

      • thuc January 13, 2011 at 2:36 pm #

        i hope it’s going to make things less expensive. i think it already has.

        whats your value for cheaper cost?

        currently, the blood pressure device used at our residency clinic is the kind that costs about 700 on amazon. the Withings blood pressure cuff is 130 and the iHealth is 99.

        • Iltifat Husain January 13, 2011 at 2:38 pm #

          You can get cheaper blood pressure monitors online via amazon and
          other websites.

        • thuc January 14, 2011 at 6:35 am #

          yea thats true. but there isnt a current blood pressure cuff cheaper on amazon that also offers recording, graphing, & patient education in one device.

          but its true, there are cheaper cuffs out there. why my clinic doesnt use the cheap stuff is beyond me. it would help overhead to stay low.

        • Iltifat Husain January 14, 2011 at 7:01 am #

          Yea there is, it’s $75 and doesn’t require an iPhone:

          http://www.amazon.com/Omron-HE

        • Iltifat Husain January 14, 2011 at 7:24 am #

          Also, that $75 BP will work even if you decide not to have an iPhone any longer. Another point I didn’t make earlier. Cell phone peripherals being tethered have one huge disadvantage – if your device breaks, how are you going to record your BP, or from a more practical sense, do you have to buy another $100+ peripheral when you decide to have an Android phone?

          You’re so right about questioning why clinics themselves don’t get cheaper cuffs, another reason why so many things in our health care system are so bloated.

        • thuc January 14, 2011 at 7:27 am #

          oops didnt see this till after i posted that last comment.

          thats true, you are right, that would be a problem if your cell breaks. 3G doctor did say that he thinks this beginning will make companies create ways to work on the other smartphone OS’s.

        • thuc January 14, 2011 at 7:25 am #

          its pretty bulky. requires a PC instead. requires usb connection. equaling more steps. health management software given by product is not web-based = less accessible. took a look at images of the software in action and didn’t see any patient education section. let me know if you see different.

          the Omron blood pressure cuff you listed is $120 on the actual company website. so it will be interesting to see how low the iHealth and Withings cuff will become on Amazon.

        • Iltifat Husain January 14, 2011 at 7:29 am #

          Right, good points, but the key thing is everyone can actually use it. Also,
          it allows for tracking BP and many other tools. In regards to the
          educational component — there are many free apps for that on the iPhone.

        • thuc January 14, 2011 at 8:20 am #

          yea thats true !

    • thuc January 13, 2011 at 2:24 pm #

      i haven’t thought about it from that point of view. but from a house-call standpoint, i would appreciate having one device to accept many peripherals. it would make my medical bag lighter and cut some of the steps out of my workflow.

  5. David Doherty January 14, 2011 at 6:09 am #

    Hi Iltifat,

    Thanks for starting some great dialogue. A client of ours wrote to me on reading your post and I offered my advice which is in sharp contrast to your opinions. I thought I’d share these on my blog and thought you’d be interested in considering them: http://t.co/yIiHu2C

    PS Hope you don’t mind me posting a link but it’s a bit too long winded to add as a comment ;)

    • Iltifat Husain January 14, 2011 at 8:10 am #

      Thanks for sharing this David!

      Just a few points to make.

      1) As you mentioned, you have a business relationship in the mobile arena, so naturally I understand you would want to offer a counter argument. Some would argue I have a conflict of interest as well because our content is based on mobile technology and I should be pushing it constantly, but I try to use data in my arguments to at least try and prevent this – and I try to come from an academic perspective (my interest), not a business one.

      2) You mentioned on the outset of your article that “it’s not surprising I’m going into emergency medicine”, etc. I would also mention the reason I decided to get a masters in public health is so I would have a firm grasp on prevention and populations based medicine — so the data I used in this article was coming from a comprehensive standpoint, not just how this device could be used in the emergency setting (which it really wouldn’t). Also, in emergency medicine we often see the perils of what happens to patients when prevention is not done properly, so I would argue we have a tremendous understanding of how important it is.

      3) Smartphone owners are more affluent then the general population, by the data I presented. If you find something to counter this I would appreciate it.

      4) The example you cite, of mothers who are pregnant benefiting from this type of monitor is interesting. I think again, as I mentioned, this would fall into the small niche segment I mentioned. But BP monitoring for all women taking contraceptives is a bit of a odd stretch when it comes to reality. The USPTF states monitoring should start above age 18 — but at the same time, from a realistic standpoint, should all those above 18 buy this cuff and monitor their blood pressure daily or weekly? We need to be practical as well.

      5) You mentioned an anecdotal example of a patient who is not as affluent having a smartphone. Do you have some data behind this? Also, there is more data out there showing the age demographics of iPhone skews to the younger demographics.

      6) I think the business case you make for this is interesting. But again, my focus isn’t in the business side of this and how much money these peripherals could make and how they would be great for companies to market. One of the reason I decided to get a masters in public health was so I could approach medicine from a populations based perspective. I think there is great hope for mobile technology in regards to the general population as a whole — not just iPhone users — and I mentioned these examples earlier. I read countless numbers of studies on obesity and intervention programs that people thought would definitely work, but did not. As mentioned in the article, changing health related behavior is a very difficult task.

      My main point though: I think this technology is interesting and will fill a niche. But I think there is something left to be said about the $75 dollar amazon BP peripheral that also can track your blood pressure for you. If you want BP education there are plenty of free applications for this, even by reputed interest groups. (As an earlier commenter wrote, this is really creating a need, not really fulfilling one).

      And also, what about if you decide not to have an iPhone anymore, or if your contract runs out, or if you can’t afford the phone anymore. Or, if your device breaks. Do you have to buy another $100+ peripheral for your Android phone, or another $100 peripheral for your Blackberry phone? There is lack of standards on these devices and this only hurts the medical peripheral market. Even the bluetooth standards for different devices are not in sync yet.

      So yes, I’m excited to see what / who actually purchases these devices, but I’m also cognizant that they are not game changers for the population as a whole — yet. In the future could they be? Sure, but in the current, they haven’t proven anything, they are too new to do this.

      A recent example. For those using oral contraceptives, sending text messages and education on oral contraceptive use will increase adherence to oral contraceptives right? No — a RCT recently showed this:

      http://journals.lww.com/greenj

      Another RCT currently underway out of Columbia is gong to look at this further, but again — just because it makes sense, doesn’t mean the data shows it will benefit.

      The only way we can successfully implement mobile technology is if we understand the limitations behind it — and understand that just because something is “cool”, doesn’t mean it will really have a significant impact — at least from a populations based perspective.

      • Iltifat Husain January 14, 2011 at 8:17 am #

        Also, I forgot to include this article as well. A review that questions the diagnostic and monitoring efficacy of even doing ambulatory blood pressure measuring for hypertension. It even gives a cost analysis as well.

        http://www.annals.org/content/

      • thuc January 14, 2011 at 8:18 am #

        nice, well thought out reply. you two make good points.

        Iltifat, you remind a little bit of dr. gordon moore and dr. jay parkinson with their research-centric, data interpretative attitudes. :) jay has an MPH too, go figure! nice.

      • med_doc January 14, 2011 at 5:31 pm #

        Ahem to this! This stuff is nice, but we need to live in reality also. Will be exciting to see these new BP cuffs in action.

        At the same time, because of the fact that it can only connect to one phone makes it very unlikely I’d actually recommend it to my patients.

    • Med_doc January 14, 2011 at 5:38 pm #

      Wow, completely disagree with this article from a business angle. I don’t see how viable this would be. I feel glucose meters might be a really interesting business model due to the importance of the tight glucose regulation and how much it fluctuates. My patients do a far better job with their glucose logs then their blood pressure ones, and such few of my patients who use home blood pressure monitors actually have a smart phone.

    • Martin Lake January 18, 2012 at 4:00 am #

      Android please. never likely to own a iphone as I would need to be on 100k to be that thoughtless about money. Android can do what Iphone can’t because it doesn’t target the elite and puts function over form.

  6. Bob Pyke August 24, 2012 at 5:25 am #

    I am often shocked and amazed that pt’s and nurses will spend 19.99 on a sethoscope or 29.99 for a electronic B/P cuff think there is thay they are no different the the more expensive and reputable equipment.

  7. Chris January 24, 2013 at 6:15 pm #

    I have a stupid question…how accurate are the electronic BP cuffs compared to manual cuffs? Would it be worth getting this if you already have a manual cuff (and you know how to use it)?

Leave a Reply

Your email address will not be published. Required fields are marked *