Driving the effort for an mHealth evidence base, Medicine 2.0 is around the corner

Here at iMedicalApps, we’ve made no secret of our belief that much of what we are seeing emerging in mobile health is in need of a guiding evidence base. Fortunately from the time that we published our first app review more than four years ago to now, we have seen a significant rise in interest in doing just that.

Among the factors helping drive this movement is the emergence of focused forums in which researchers, clinicians, and entrepreneurs can share and debate their work. Medicine 2.0, now in its 6th year, is one of the leading venues for mobile health research today.

To further our mission of promoting and disseminating mobile health tools that have positive impacts on the care of our patients, iMedicalApps will be awarding its second award for outstanding research at Medicine 2.0.

While we have not yet announced the finalists for the award, here are some of the projects that have caught our eye.

Diabetes During Pregnancy: Effect of MHealth Remote Monitoring of Blood Glucose on Glycemic Control – A Randomized Controlled Trial.

In this study, Dr. Joseph Cafazzo and his team from the Center of Global eHealth Innovation lead a randomized controlled, unblinded study of approximately 100 pregnant women with either gestational or pre-existent diabetes. They developed a closed loop system in which a bluetooth enabled glucometer transmitted readings via a smartphone to a central server which automatically responded based on pre-defined algorithms. In their study, they found a statistically significant improvement in blood glucose control in the intervention arm though noted that they could not detect a meaningful improvement in pregnancy outcomes.

Smarter Hospital Team Communication: Smartphone Group Text Messaging Improves Efficacy, Workflow, and Provider Satisfaction

Conducted at Stanford University, this study evaluated the implementation of a text-messaging based communication system for a multidisciplinary healthcare team. Though endpoints based on user perception of efficacy are somewhat soft, they reported very positive uptake of the system and perceived improvements. A great example of how thoughtful evaluation can reveal unexpected insights, they noted that most of the negative comments could be tied to a lack of necessary WiFi or 3G coverage in the hospital – an important insight to guide how these systems can be used.

SMARTHealth India: Development and Evaluation of an Electronic Clinical Decision Support System for Cardiovascular Diseases in India

While many of us think of infectious diseases as the principal scourge of the developing world, cardiovascular disease is in fact the leading cause of mortality internationally. The reality is, however, that much of what it takes to reduce cardiovascular morbidity and mortality requires chronic medications and intensive behavioral interventions. In a country like India, where there are 0.6 physicians per 1000 people, it is critical to engage other health workers in this effort. In this study, researchers based in the UK and Australia developed, field tested, and iteratively modified-based on collected data-a platform for field workers to screen individuals for cardiovascular risk and refer for further management. While they found that they were effectively able to identify high risk patients and refer them for further care, they also found that only 30% of these referred patients actually made it to the clinic. Their results offer us a stark reminder that mobile health interventions, like any care process, do not operate in a vacuum and the importance of thoughtful evaluation in mobile health.

Conclusion

These days, I spend much of my time reading and learning about 10,000+ patient, randomized, double-blinded, placebo controlled trials with elaborate acronyms. Mobile health is not there and it’s arguable whether it even should be. Claiming, however, that the technology simply evolves too fast or that the space is too complex for thoughtful evaluation and research, is little more than a cop out. As these researchers have shown us, it is very possible to study these interventions and use those insights to design a better system.

Author:

Satish Misra, MD

Satish is a Cardiology Fellow at the Johns Hopkins Hospital. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology can change the way healthcare is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.

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One Response to Driving the effort for an mHealth evidence base, Medicine 2.0 is around the corner

  1. Natalie hodge August 18, 2013 at 11:22 am #

    Most of the useful applications for patient care come from the cc backed consumer space. It is only through trial and error that I found these help patients. In our business we find that academic partnership is necessary to create a research driven and evidence based organization to create platform mobile wellness tools. The for profit entity validates product with customers, and the academic side secures NIH funding to study health effects of the app.

    More on that at http://www.personalmedicineplus.com

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