One of the criticisms we often hear about mHealth in general is a general absence of data that validates the emerging devices and systems that are being pitched as transformative.

This, however, is soon to change. AliveCor, who’s ECG recorder is perhaps the most recognizable of the mobile health industry, is currently undertaking studies at Oklahoma University Health Sciences Center. West Wireless Health Institute is launching a year-long study in Mexico to test its Sense4Baby fetal monitoring system.

Two physicians in Australia are now aiming to create a home for this emerging body of literature with their launch of the Journal of Mobile Technology in Medicine. Dr. Chandrashan Perera, a neurosurgery resident, and Dr. Rahul Chakrabarti, currently working on his PhD, are behind this effort, which began after noting the sparse, scattered nature of medical literature around mobile health.

Their hope is that by creating a dedicated forum for this kind of work, they can both help build this body of literature and make it easier to find. This e-journal is planned to be published every three months. They are currently accepting submissions for their first issue, with an inaugural contest that will award cash prizes to the best submissions in addition to publication. The deadline for submission is January 31st. For more information, check out their site.

Its no secret that healthcare providers are adopting tablets at a rapid pace – one survey found that over 25% of physicians own a tablet and that was nearly nine months ago.

This trend, both with tablets and smartphones, has generally been bottom-up; physicians, PA’s, NP’s, nurses, and other healthcare providers are buying consumer devices and bringing them into the clinical world.

However, as Eric Yablonka, CIO of University of Chicago Hospitals put it, “This is not ‘nice to have stuff’ anymore, this is life saving stuff now.”

And so we’ve seen institutions across the country move to implement mobile devices on an enterprise level – from the Johns Hopkins and University of Chicago Internal Medicine residency programs to the entire VA healthcare system. However, Kaiser Health News reports that less than 1% of hospitals have fully functional tablet systems and points out how one of our biggest investments in health IT, the HITECH act, may be part of the reason why.

When the iPhone was first released, it transformed the way people interact with mobile devices – they became something better than just mini-computers. However, as pointed out by Jenny Gold, staff writer at Kaiser Health News,

“The most popular systems don’t yet make apps that allow doctors to use electronic medical records on a tablet the way they would on a desktop or laptop. To use a mobile device effectively requires a complete redesign of the way information is presented, Jonathon Mack, director of clinical research and development at the West Wireless Health Institute, says.”

We would first point out that the assertion isn’t entirely accurate – Epic, Allscripts, and Centricity as well as many cloud based EMR vendors like MacPractice and Dr. Chrono do have iPad and in some cases Android apps. That being said, these apps are, in many cases, limited – some allow read-only viewing for example.

What is often true, though, is that for hospitals, accessing these apps requires substantial additional cost. For example, Epic and Allscripts both require a separate licensing agreement for their mobile platforms. As Mr. Mack points out, many hospitals and healthcare systems have just made major investments in their IT infrastructure, a trend which was accelerated by the HITECH act. As he puts it, “When you look at a health system that has bought into an EMR, they’re not ready to turn the boat around and start over.”

As a result, healthcare providers are very reliant on workarounds to shoehorn tablets into existing infrastructure. For example, apps like Citrix or VMWare enable access to virtual Windows environments on the iPad or Android tablets, allowing access to fully functional EMR’s, radiology viewers, and so on.

In my own experience, while this method works, it just turns these devices into laptops without the keyboard. Windows is designed for computers and laptops; Microsofts release of Windows Phone and abandonment of Windows Mobile is a testament to that.

Despite these obstacles, healthcare providers like Kate Franko, a physician assistant highlighted in the article, are still finding utility for tablets to improve efficiency, patient communication, and more. While there are many issues to be addressed – cost, security, infection control, and so on – tablets are likely to be an increasingly common feature on medical wards and it’s only a matter of time before the IT infrastructure is forced to catch up.

Sanofi-Aventis and AgaMatrix announced that their iPhone blood glucose monitor, iBGStar, had received FDA 510(k) clearance, over a year after received clearance from European regulators.

The device enables users to check their blood glucose and have the results input into associated Diabetes Manager App.

iBGStar is nothing if not slick – it looks like a device that people would want, a real contrast to what many traditional glucometers look like. In addition to capturing that form factor that made the iPhone what it is, the associated app lets user track blood glucose readings, diet, insulin doses – all critical and often lacking data in taking care of patients with diabetes.

On closer look though, one interesting feature is apparent – the iBGStar isn’t really an iPhone glucometer, rather it is a glucometer that transmits to the iPhone via direct connection. According to the press release,

The compact iBGStar™ glucose meter, when plugged directly into the iPhone® or iPod® touch, quickly displays results immediately after testing on the full-color touch screen via the iBGStar™ Diabetes Manager App. iBGStar™ also can be used alone to measure blood glucose levels and results can be synchronized to an iPhone® or iPod® touch at a later time.

So what does this device have that makes it better than others?

I certainly can’t comment on the “Dynamic Electrochemistry technology” that the device uses. In terms of the patient and physician perspective, I see a few benefits.

• Form factor: Its small, sleek, and just all around cool – every little thing that makes a patient more likely to use the device is a step in the right direction. This could be particularly important for younger type 1 diabetics.
• Automating good records: I have trouble making a grocery list, I can’t imagine how to tough it is to record multiple glucometer readings, insulin doses, and dietary information. Perhaps the act of plugging the device into the iPhone will remind people to record some of that other information.
• Just plug it in: No bluetooth syncs, no logging in to anything, no cables – all of which lower the barrier just a little bit more.

Where this device falls short is a lack of any more immediate feedback loops or support. There does not appear to be integration of nutritional information, advice on exercise, information of preventative care. It does color code readings but doesn’t appear to generate actions.

In that sense, I wonder how this ultimately stacks up against glucometers integrated with Macaw, disease management programs like Welldoc, or 2Net integrated MyGlucoHealth which can transmit data to the physician via their EHR.

Each of these platforms seems to automate or otherwise address different parts of the spectrum of diabetes management – collecting the data, transmitting it, interpreting it, and acting on it. If one thing is for sure, diabetes management is finally moving into the 21st century.

The floor of the mHealth Summit was full of devices that have the power to change the way we take care of patients. Macaw, an app from US Preventative Medicine, may well be such an example. It takes advantage of Qualcomm’s 2Net which enables innovators to wirelessly “plug” any device into the 2Net platform and let it handle the transmission and management of the data. By simplifying communication, it promises to accelerate the pace of wireless health innovation.

The question next becomes what do we do with all of that information – how do we sort through the noise and find something useful that we can use to make a difference ? Macaw seeks to address that precise problem. US Preventative Medicine is, in many ways, a behavior management company, providing both general health and disease-specific management with a focus on driving healthy behaviors. Working with Qualcomm, they designed Macaw to be a “personal health monitor” that takes the data collected by pedometers, glucose monitors, and other devices, incorporates it into their health management program, using it in real-time to make a difference in the patient’s life. With 2Net integration, Macaw can collect incredible amounts of data passively and use it to provide the real-time, mobile feedback that mHealth is all about.

We had the opportunity to talk with Ashley Reynolds, SVP of Health and Member Services at the mHealth Summit last week and get a live demo – check it out below!

Some background on US Preventative Medicine

In some ways, US Preventative Medicine is similar to the many disease management companies out there and in fact provides many disease-specific management programs. The difference though is the additional focus on being healthy – exercising, eating right, and so on – and a philosophy that incorporates the idea of “gamification,” i.e. to being engaging and fun, making use something the patient wants to do rather than has to do. That is apparent in Macaw, which has a bright, intuitive, and simple user interface coupled with ample positive reinforcement and incentives for completing tasks like taking the stairs instead of elevator or learning tips to maintain a healthy diet.

What the 2Net Integration means

Lets take the example of a pedometer (Macaw currently uses the 2Net enabled FitLinxx pedometer). Knowing how many steps you take in a day is, on its own, trivia. Users on their own may set their own goals, like walking a certain number of steps per day or even integrate positive reinforcement like a reward for reaching a certain goal.

Macaw however plugs this data into a system. The user, who has set say an exercise goal, can now get feedback on their progress from a health coach, positive reinforcement for reaching milestones, and more. Paired with educational activities within the app, which are also tied to positive reinforcement mechanisms, the pedometer data becomes part of a much bigger feedback loop aimed at driving healthy behavior. What the pedometer enables is the passive collection of relevant data and its the ability to do that without additionally burdening the patient is critical.

Its not hard to imagine how 2Net blood pressure cuffs, blood glucose monitors, weight scales, and other standard monitors fit in to this system. Or take some of the other innovative products we saw that the mHealth Summit, like the asthma inhaler usage monitor from Asthmapolis which tracks when and where a patient uses their inhaler – with Macaw, it enables the ability to drive medication compliance or even flag patient’s heading towards a dangerous exacerbation. 2Net then becomes the glue holding this all together.

Macaw then becomes more than a simple data aggregator where a patient goes to view meaningless data. Rather, its a place where the data is turned into meaningful action, whether that’s encouraging more exercise, improving medication compliance, or flagging concerning trends. Paired with a dynamic support system of health coaches, rewards for desired behaviors, and more, the potential of mHealth moves closer to being realized.

Check out our demo of Macaw below:

The neonatal intensive care unit at St. Jude’s Children’s Hospital, along with several other NICU’s across the country, has implemented a system called Nicview which allows parents to check in on their child from anywhere at practically any time, including via their smartphone. The set up is simple – a webcam which delivers a secure live feed that is accessible from a computer, tablet, or smartphone. It’s not cheap though – installation of each camera is $1,000 and has cost other facilities $30,000 to implement.

The cost to implement the system is well worth it to parents and families though, particularly when their newborns end up in the NICU for weeks or months. One family is even working to raise money to install the system in the local NICU in which they suffered the loss of their child.

Nicview enables parents to access a live streaming video of their child via practically any device including smartphones, which lets a parent literally look in on their child from anywhere and any time. In fact, according to Nicview, half of the sessions originate from iPads, iPhones, Android devices, and other web-enabled mobile devices.

The medical director of St. Jude’s NICU described the physician perspective on this to CNN recently,

“The family feels that they are really connected to their infant, which is important for bonding. In the past, the bonding process had to be instituted every few days,” said Dr. David Hicks, medical director of the neonatal intensive care unit at St. Jude Medical Center. “The family dynamics are improved.”

However, when healthcare institutions across the country are tightening a belt, its certainly natural though to question whether the time is right for implementation of these systems as $30,000 could certainly be make big impacts in other areas. Certainly, the ability for the parents to see their child doesn’t mean that the child will be more likely to do better. But its worth remembering that, particularly with children, we are not only caring for a single patient but rather caring for a whole family.

In touching detail, the parents behind Leighton’s Gift, a drive to raise money to install Nicview in a Texas NICU, explain how their experience with their daughter Leighton, who died of late onset GBS early this past summer, affected them and why the investment is worth it.

The rules in the NICU are very strict. FOR GOOD REASON! These little ones are fragile and need to have limited visitors and stimulation. However, one of the hardest things as a family, was knowing that no one ever got to meet our sweet angel. Even though she was only 3 weeks old, she had her own spunky personality. She always looked our way when we were there. She would kick her little foot over to us and shake it back and forth. She would “hum” (just like her twin brother still does) when we held her. These are just a few of the things that we wish everyone could have seen. “Leighton’s Gift” IS going to make sure that happens for other families. There are so many milestones met in the NICU that will be able to be viewed through Leighton’s Gift. Families will have the opportunity to view IN REAL TIME, these milestone’s (first bath, diaper changes, feedings, cuddle time, etc.). We pray that this project will help make families who are faced with a child in the NICU feel more connected and comfortable when they are not able to be there in person.

For information on donations, click here

In a letter published in the Journal of Emergencies, Trauma, and Shock, physicians in Scotland described the use of a webcam, Skype, and an iPhone 4 to connect a provider in Calgary to an expert over 200 miles away in Aberdeen for assistance in performing a pulmonary ultrasound (full reference below).

As the authors point out, pulmonary ultrasound is becoming an increasingly valuable technique to look for a pneumothorax, evaluate the size of a pleural effusion, and more.

However, even for those that have some experience in this imaging technique, or for that matter, others like ECHO or abdominal ultrasound, its not always easy to tell what you are looking at or whether some finding is actually significant.

Even having put in plenty of central lines at this point in my training, there are still times where I seek a second set of eyes as I ultrasound the internal jugular vein for a suitable insertion site. For a physician in a remote location, whether a small Scottish town or a rural Indian village, a low-cost, simple way to get that kind of help could provide both welcome relief and improved care.

As described in their letter to the editor, system seems to have been relatively easy to set up,

A portable ultrasound (Sonosite 180, Sonosite, Bothell, WA) in Calgary was interfaced to a laptop computer (Aspire 5741, Acer, Kuala Lumpur, Malaysia) via an analogue-to-digital converter (VC-211V, ActionStar LinXcel, Taiwan) [Figure on-line supplement]. Xsplit Broadcaster (SplitMediaLabs ltd, Hong Kong) allowed video-streaming of both an inexpensive head-mounted webcam (LifeCam VX-2000, Microsoft, Washington) and ultrasound over Skype (Skype, Luxembourg), easily viewed on any smartphone.

The pessimist in me notes that HIPAA lawyers would probably be all over this in the United States, as viewing radiology images in Skype falls a little short of FDA approval.

That being said, those are solvable problems in the USA and somewhat irrelevant in the developing world, where the benefits could be substantial.

Image and quotation text from Crawford et al, “Telementorable “just-in-time” lung ultrasound on an iPhone.” J Emerg Trauma Shock. 2011 Oct;4(4):526-7.

New York City has announced a new app challenge aimed at finding innovative ways to use the hundreds of public datasets that it maintains.

The app challenge is entitled BigApps 3.0 and is challenging software developers to create apps that use city data to make NYC better.

The city collects data on everything from the location of WiFi hotspots to a directory of basketball courts. Much in the same way that retrospective analysis of the Women’s Health Initiative data or Framingham data goes well beyond the original intent and has yielded surprising results, NYC hopes that opening its datasets to all the creative minds out there will yield a result that improves the lives of its residents.

A chunk of prize money is also set aside specifically for health apps.

Among the datasets available are: 911 Receiving Hospitals, Health and Nutrition Examination Survey Results (NYC HANES), Community Health Survey (GIS data) 2003-2008, and the Community and Health Survey (SAS data). All of these were found after a cursory review of 250 of the 800+ datasets available. The only requirement is that the app at least use one NYC dataset. What it does beyond that is only limited by the imagination of the app developer.

Entries can be mobile apps, SMS based systems, computer software, or “any software platform broadly available to the public.

The App challenge will give away a total of $50,000 in prize money, divided in several smaller prizes. This includes $4,000 for an “app that best encourages healthy behavior, aids health education and understanding of health trends, and/or improves access to healthcare resources.” Other prizes include

• Best Overall Application: $10,000
• Investors Choice Application: $5,000
• Popular Choice Award: $4,000

The submission deadline in 1/25/12 and winners will be announced at the end of March. Last year’s biggest winners were apps that helped people monitor traffic conditions in realtime, organize pickup sports, and find parking – all of which make sense in NYC. There was no health category last year, so it will be interesting to see the entries that take aim at this category in particular.

Mobisante made its first big waves a little over a year ago with their ultrasound peripheral for smartphones as MobiUS began to accumulate awards all over the country.

After receiving FDA approval earlier this year, the device launched commercially with a reported cost of just under $8,000, comparable to other mobile ultrasound devices but with the additional benefit of wireless connectivity.

We caught up with Mobisante Chief Engineer Nikhil George at the mHealth Summit for a live demonstration of the latest version of the MobiUS device. There are now several different probes available with varying frequencies and also a pairing configuration available with a tablet.

In addition to the demo, we also got an update on their move to support Android devices.

We reported the possibility of Android integration a few weeks ago after reports that Android 4.0 (Ice Cream Sandwich) would enable USB 2.0 host support. As Sailesh Chutani, CEO of Mobisante, told us in an interview then,

“iMedicalApps: What do you think about Android 4.0 and it’s robust support for USB 2.0 hosting?

Sailesh Chutani: The new release of Android does support USB 2.0 host, which makes it suitable for connecting peripherals such as ours. Essentially, Android starts to become a real computing platform a la Windows, which is great for mHealth companies.

iMedicalApps: Are you planning on bringing your Ultrasound Peripheral to Android phones?

Sailesh Chutani: Yes”

Mr. George echoed the sentiment that Mr. Chutani shared with us though that this move will take a lot of work. As Mr. George put it, they broke pretty much every component of the Toshiba device on the road to developing MobiUS, and he expects to do the same with whichever Android device they start with from a wide range of expected and unexpected engineering challenges.

So in short, you will eventually be able to run a Mobisante ultrasound probe on an Android tablet or smartphone, but not in the immediate future.

We also learned that Mobisante is anticipating other diagnostic peripherals moving to smartphones and has built their software in such a way to allow for easier integration of future peripherals. They currently include a feature to take pictures using the smartphone’s camera, images which can be transferred in precisely the same way as the ultrasound images themselves.

While this may not sound like much, its important to remember that this feature not only includes some useful tools like labeling lesions with the diagnosis in question, but it would also be HIPAA compliant.

Check out our live demo below!

Our healthcare system is, in many ways, designed to deal with acute medical issues.

So when a patient facing an exacerbation of a chronic condition – acute volume overload in heart failure or DKA in diabetes – shows up at the hospital, we are well equipped to get that extra fluid off or fix the blood glucose.

We are, however, far less adept at understanding why the exacerbation occurred in the first place and even starting interventions that will keep it from happening again.

So what does this have to do with Ford? Well, one crux off mHealth is making care delivery to patients a continuous rather than episodic endeavor, reaching people in their homes, workplaces, and wherever else they spend time. As Gary Strumolo, Global Manager for Health & Wellness Research, pointed out to us, people spend an incredible amount of time in their cars and Ford is pioneering efforts to bring our cars into the mHealth fold.

Perhaps one of the most interesting insights that Mr. Strumolo shared with us is how Ford got involved in healthcare in the first place. Several years ago, a member of the Ford family, who’s child had diabetes, developed an interest in the continuous blood glucose monitor being developed by Medtronic at the time. At the same time, Ford was at the beginnings of bringing mobile connectivity to its vehicles. From those fortuitously timed developments, the opportunities for Ford in healthcare became apparent.

Ford has thus far partnered with three healthcare groups – Medtronic, Welldoc, and SDI Health. As Mr. Strumolo made clear to us though, Ford is not, nor does it intend to be a healthcare company,

“Ford’s approach to health and wellness in the vehicle is not about trying to take on the role of a healthcare or medical provider, we’re a car company. Our goal is not to interpret the data offered by the experts, but to work with them to develop intelligent ways for Ford vehicles using the power of SYNC. In essence, creating a secondary alert system and alternate outlet for real-time patient coaching services if you will.”

When we asked about his thoughts on pending regulation from the FDA, Mr. Strumolo made it clear that it was not Ford’s intention to have their vehicles become medical devices. Specifically, interpretation of data, alarms, and other similar functions will remain on smartphones and other patient devices. So the alarm for the low blood sugar from the Medtronic continuous blood glucose monitor will still be generated by the device, which will still have an alternative outlet for generating an alarm.

However, the vehicle will now also be able to alert the driver and act as a portal through which the driver can interact with the device. Similar applications for cardiac, pulmonary, neurologic, or really any other sort of monitoring device aren’t difficult to imagine.

According to Mr. Strumolo, Ford intends to keep SYNC device agnostic and thus allow anyone with a useful device to integrate with SYNC. They plan on adopting an Apple-style approach however of carefully screening any proposed device, ensuring that it not only works with SYNC but generates a user experience consistent with their overall vision for the system. As Mr. Strumolo put it, the goal of a driver is to drive from point A to point B, and its important to make sure a SYNC-enabled device doesn’t get in the way.

It does seem that Ford intends to walk a very fine line to avoid making the car a medical device, much like many other manufacturers of consumer products. Functioning as another portal though by which a person can manage their health still has extraordinary value in making chronic disease management a continuous, rather than episodic, endeavor.

Its not hard to imagine someday a heart failure patient’s TV generating a pop-up alert that their weight has been trending up or even a hypertension patient’s refrigerator reminding them how much salt they have had that day. The future looks bright.

UpToDate today announced the release of UpToDate MobileComplete, a new version of its recently released app that brings its 9,000 topic articles and 23,000 graphics to the iPhone.

This familiar resource mades its debut in the mobile world this summer and has already been downloaded by over 42,000 clinicians.

When we reviewed UpToDate Mobile in August, Dr. Amit Patel’s conclusion was pretty simple,

“You can bet that this UpToDate App will make the next edition of our Top 10 Apps for Internal Medicine Physicians”

One of our complaints though with the app was occasionally slow load times for some topics, a consequence of having to pull the content over a WiFi or 3G connection. MobileComplete addresses that complaint, but at a cost. While its not clear how much memory the app will use, the desktop software uses 2GB and we can certainly expect a similarly hefty demand by MobileComplete (Update: The local app, MobileComplete, will require 300MB of memory for text content and 1GB for text and images. Thanks to Vicki Brown for that info).

Now, however, physicians and other healthcare providers who use UpToDate will have a choice – and given the number of users, the way they choose between the two may give us some interesting insight into the relative demand for cloud-based apps vs. local apps.

Many of our favorite apps have had to decide between the two approaches, with CORE going to route of cloud storage of some of its more data-intense content, whereas Modality chose to go with local storage for its Procedures Consult apps. The former approach relies on pretty consistent 3G/4G access or WiFi access. It will be interesting to see the extent to which MobileComplete is adopted – given the sheer number of healthcare providers using UpToDate, it may give us some insight into how connected healthcare providers really are.

The app itself will cost a subscriber an additional $49, a cost I suspect that users in areas of poor 3G connectivity or limited WiFi access will find well worth it. Institutional subscribers still have to wait however, as a mobile app for us is not yet available – a consequence of the customization institutional subscribers often require, according to Vicki Brown (VP, Marketing, UpToDate).

Nonetheless, the continued move to mobile by UpToDate is certainly one that will be welcomed by countless physicians, residents, interns, medical students, nurses, pharmacists, and pretty much every other healthcare provider out there.

Check out our full review here!

According to the CDC, 133 million Americans have at least one chronic disease, and that number was from 2005.

The cost of that disease burden, both in terms of direct medical costs and indirect costs to society, is immense. In a health system that is largely set up to deal with acute illness, we are not only unable to deliver what we know to be the best care, but we also face substantial costs due to system inefficiency.

As Don Casey, CEO of the West Wireless Health Institute, told us in an interview with iMedicalApps,

“…the way to manage chronic disease in our opinion is moving away from infrastructure, expert driven, location-centric care to infrastructure independent care”

Nicole Boramand, VP of Clinical Systems Innovation at West Wireless Health Institute, led a panel of innovators and leaders in remote monitoring who shared their insights into the practical challenges of implementing the remote monitoring systems to deliver this “infrastructure independent care.” Here are some highlights.

The panelists were quick to point out that remote monitoring can only be effective when implemented in the right environment. Dr. Randy Williams, CEO of Pharos Innovations (whose Tel-Assurance system for remote management of a range of chronic disease has been widely adopted), pointed out that remote monitoring is really a way to generate more data – the critical element for efficacy is having the right feedback loops in place to react to the data collected.

Dr. Brett Stauffer, Director of Clinical Decision Support (CDS) for Baylor Health System, additionally noted that implementation of appropriate incentives for everyone – the patients, physicians, nurses, etc – was critical to drive important behaviors, whether its the reducing the incentive to send someone to the hospital at every alarm or encouraging patients to simply participate in the system.

Both Dr. Williams and Dr. Stauffer highlighted the value of having high-volume centers, which allows the care team to build the necessary experience and insights to make the system work at its best. Dr. Williams noted his belief that the presence of a highly experience care coordinator at the successful VA remote monitoring programs was a critical feature.

The other necessity for success will be a culture change among physicians, according to all three panelists. In order to effectively scale these systems up, there will be some requirement for standardization and protocol-driven care, which is often anathema to physicians.

Mr. Claudio Saccavani noted his own experience in trying to determine alarm triggers for weights and blood pressure required him to simply make each physician individually determine alarms for each patient.

Perhaps taking a page out of the Apple and Google playbooks, all three panelists also commented on the need for simplicity and ease of use. For patients, Dr. Williams points out this requires giving patient’s choices that let them decide how to integrate the system into their day to day lives. For physicians, according to Dr. Stauffer, this means making information easy to act on.

One feature of the mHealth Summit has been a focus on specific disease states, with diabetes and heart disease finding a frequent spotlight due to their respective population burden and associated costs.

In a session moderated by Dr. William Riley, a program director in the Division of Cardiovascular Sciences at NHLBHI, leaders in remote monitoring for cardiovascular disease discussed their insights and experience. Several of these proved quite surprising.

The focus on cardiovascular disease has been generally split between heart failure and coronary disease. As far as heart failure goes, much of the focus at the summit has been preventing 30-day readmission for these patients, which will soon become very costly for hospitals.

In contrast, risk factor modification has taken center stage with coronary artery disease, with some hints at future development of novel surveillance modalities for MI’s.

Dr. Joseph Cafazzo, from the Center for Global eHealth Innovation, discussed data collected from a home monitoring system for hypertension. Perhaps one of the most interesting results was that while improvement was seen in SBP, it was achieved without medication changes. A similar study of home monitoring for heart failure showed improvement in physiologic parameters without additional intervention (e.g. medication changes). The conclusion, while somewhat speculative, is that remote monitoring may, in and of itself, drive behavioral changes – like medication compliance and dietary changes – that are beneficial.

However, as far as behavioral changes go (even compliance with the remote monitoring platforms), Dr. Cafazzo notes that certain diseases, in his experience, have been easier to tackle than others. Heart failure and pregnancy, where consequences are immediate, have been areas where compliance is easier to achieve whereas essential hypertension, where consequences are extraordinarily remote, has been more challenging.

These interventions can be quite remote, as demonstrated by Dr. Piette’s study on home blood pressure monitoring that utilized patient calls originating in areas such as Michigan to patients as far away as Venezuela. A stunning conclusion of his study was that a striking difference exists in efficacy based on health literacy–with low literacy patients garnering bigger benefits.

Its no secret that the smartphone is becoming as much of a staple of the physician’s toolkit as, say, the stethoscope. Several studies and surveys have sought to quantify this trend among practicing physicians.

Recently, a group of researchers released the results of a survey of smartphone utilization among residents in ACGME (Accreditation Council for Graduate Medical Education) and the results provide interesting insights into what the future may hold.

We have previously looked at reports on the rate of adoption of smartphones for nurses and practicing physicians. While there is a fair amount of variability, such as between physicians of different specialties, this survey demonstrates that we can expect even higher rates of adoption in the future.

Approximately 8,353 surveys were sent out electronically to residency and fellowship program directors for further distribution among their faculty, fellows, and housestaff. Just over 3,000 responses were submitted. It’s worth noting though that the response rate could not be assessed because there is no way to know how many individuals actually received the survey in the end.

While 85% of respondents reported owning a smartphone, only 56% reported using it in clinical practice. One interesting feature however is breaking this down by training level. Nearly 70% of residents (N = 1,397) reported using their smartphone clinically, while only 39.2% of attendings in practice for more than 15 years (N = 665) reported the same. This is despite only marginally different smartphone ownership rates – 88% among residents and 78% among the attendings. In short, this confirms the intuitive prediction that younger physicians are using smartphones (and likely other mobile technology) at higher rates and are likely to carry this forward as they become practicing physicians.

Another interesting finding was the difference between specialties. Only 52% of surgeons reported using their smartphone clinically, despite an ownership rate of 98% – by far the lowest utilization rate among the specialties queried. Perhaps this is reflective of a deficit of resources targeted at surgeons, particularly those in training. However, it is somewhat surprising that usage of relatively universal resources is presumably then lower among surgeons as well – 75% of all respondents reported using Epocrates, a rate that is doubtlessly far lower among surgeons.

Finally, the survey also assessed what kind of apps respondents wanted. Leading the list were textbook/reference apps, exam review apps, classification/treatment algorithm apps, and general medical knowledge apps. Interestingly, these are mostly categories in which a wide range of apps are already available. One possibility is that this is reflective of the difficulty an individual physician has navigating the app store, where the useful apps that they want are drowned out by the noise of the thousands of other apps available.

To read the full Pubmed article from the source click here.

[Ed. Note: This post will be part of an ongoing series on the efforts of the Johns Hopkins Internal Medicine program to go mobile. Given that Dr. Misra (iMedicalApps senior editor) is part of this effort, we will be able to share an honest, insider perspective that can help others learn from the Hopkins experience. Not only was this permitted by the Hopkins program leadership, it was embraced, and for that we are grateful. ]

Medical training is currently undergoing a dramatic change. Duty hour reforms, increasing financial and regulatory demands, and a healthcare system at the center of a political battle are among the extraordinary pressures being exerted on the traditional training model.

These pressures require that training programs at all levels – from medical school to the most sub-specialized fellowships – rethink how we do pretty much everything.

Recently, the Johns Hopkins Internal Medicine residency program distributed iPads to its housestaff as part of an effort to do just that. The aims of the program are quite broad – to increase the efficiency of in-hospital care, enhance clinical training of residents, improve patient-physician communication, and more.

The mobile platform is relatively young in terms of its utilization in healthcare and many of the potential applications, benefits, and pitfalls remain to be discovered. As this program continues to grow and evolve, iMedicalApps will continue to share the the insider perspective on the Hopkins experience as part of our shared desire to drive this process forward. In this first installment, we’ll start by addressing the question – why the iPad?

Why the iPad

There are many tablet’s out there that are similar, and in some ways, better than the iPad. In fact, Apple is in a legal dispute with Samsung because they claim the Galaxy tab is a repackaged iPad. And the question certainly came up – why not go with another tablet? Android is arguably a more malleable platform than iOS, many of the tablets are cheaper, and there are many more options.  We’ve had great debates on iMedicalApps in the past about this subject.

Here are a few reasons why we went with the iPad.

The iPad has a head start

When looking to launch a mobile platform, you have to consider your audience. And in any clinical practice, that will include a range of familiarity with consumer technologies, specifically in this case tablets. Among those that were already using tablets, all of them were using iPads. That simple detail confers a number of advantages.

First, with the iPad, we have a group of individuals who are already “embedded” within the our audience. So not only had their use of the device already piqued the interest of others, they also were engaged in this program from the beginning. After launch, these individuals can provide both formal and informal help to colleagues who are less familiar with the device and platform.

Second, in terms of program planning and development, we already had a wealth of experience due to using the iPad in our own institution. These early adopters had already problem-solved a number of issues, found some of the potential efficiencies to be gained, and even identified potential new applications and enhancements.

Third, the launch of the iPad program at the University of Chicago was certainly helpful as their program leadership was quite forthcoming with their own experiences.

The choice Android offers wasn’t all that helpful

Choice is a great thing for the average consumer, but not necessarily for an enterprise. In considering Android as an option, several issues arose that led us to conclude that the iPad was the best choice.  One of the main issues — choosing an Android device involves several extra steps.

First, we would likely order a few different devices, test them out, and then, for practical reasons, probably pick one device. Picking more than one would complicate everything from picking accessories to device management by the IT folks. And if were going to choose a single device in the end, then the value of choice for individual housestaff is ultimately lost anyways.

Another argument could be made that Android potentially offers cost-savings in comparison to the iPad. However, we determined early on that we didn’t need the 3G connectivity nor did we need the 32gb memory. Our application of the device is primarily for in-hospital use where WiFi connectivity is available – this makes the 16gb WiFi iPad the natural choice and very competitive in terms of pricing, roughly $500.00.

What about apps?

Apps are a big part of success of any mobile platform. We’ve talked before about how their absence in the Blackberry and Windows environments are an Achille’s heel for those platforms. However, the difference between iPad and Android apps did not end up being a significant factor in the selection of the iPad as our platform of choice.

Perhaps it was the sense of parity between iPad and Android, given that most major apps are available on both. Additionally, the issue of app compatibility across different Android devices was less of a concern since we would most likely only be dealing with one Android device anyways.

These reasons, among others, were major drivers in our selection of the iPad as the platform of choice in our efforts to go mobile. Please share your thoughts and experiences below as we’d love to hear and learn from other efforts.