Post image for Mobile personal health records Capzule and Gazelle arrive with much fanfare – but isolated medical data silos remain

Despite the costs associated and the uncertain financial rewards for physicians, adoption of electronic health records (EHRs) is on the rise. For many practices, it seems the benefits of cheap information retrieval and the protection against audits outweighs the costs of an EHR.  Plus, the monetary incentives of the HITECH act may just sweeten the pot enough for the those still sitting on the fence.

Many EHR implementations include patient portals and some even include full fledged patient health records (PHRs), yet thus far the extent of patient adoption of PHRs has not been as gratifying. The most successful PHRs thus far are those deployed by care providers, especially large ones like Kaiser and Mayo Clinic, which are tethered to the providers’ EHRs and thus are already pre-populated with a patient’s own records. Kaiser’s PHR, in particular, is a rich portal that is often held out as an example of the potential of PHRs.

But what about a simpler approach? Two iPhone apps, Capzule PHR and Gazelle aim to provide a way for patients to store their own health records, including medical conditions, vaccinations and physician contact information. The approach for both apps is fairly similar with screens organized by information type, options to store and display laboratory data, and options for sharing information.

Both apps have gained a significant amount of press recently, most notably Gazelle – due to the large company that made it.  However, both apps have issues overcoming data silos preventing their full functionality.

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Verizon Business recently made a big splash with plans to offer free access and usage of their Medical Data Exchange system to over two million US healthcare providers. Sounds like a pretty generous offer, right? On first pass, I’d certainly have to agree though I have a sneaking suspicion it may not turn out to be quite as altruistic as many of the headlines I saw make it sound. As one report described,

The credentials will allow doctors and clinicians to access medical data via the Verizon Medical Data Exchange through a secure, private inbox. The inbox is part of Verizon’s Healthcare Provider Portal, which it has added to the exchange.

The data exchange system itself is primarily designed to enable exchange of information between different electronic medical record platforms, with this personal inbox component added later. What this offer focuses on is individual healthcare providers and that’s precisely what makes it both interesting and disappointing.

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Post image for Android still trails the iPhone in the world of medical apps – Medical Developers sound off

Android lags behind the iPhone platform in medical app development – both in volume, and in quality. There isn’t even a medical category in the Android marketplace, an issue we wrote about extensively last week.

Developers have relayed to us some of their concerns and technical hurdles in creating medical apps for the Android marketplace. We have complied some of the major themes of their comments – some might actually shock you.
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Post image for Large NIH study fails to show any benefit to “telemedicine” program for heart failure patients – closer look at study methods reveals more

As our recent coverage of the mHealth Summit shows, medicine has developed some pretty lofty expectations for mobile technology in healthcare. A big part of that promise has been in telemedicine, where the opportunity to remotely provide care on a wide range of platforms, including the iPhone, could be a huge asset in chronic disease management. With that hope in mind, a group of researchers at the National Heart, Lung, and Blood Institute (NHLBI) launched a large, multicentered randomized controlled trial to evaluate the benefits of a telemedicine system called Tel-Assurance from Pharos Innovations – basically an automated phone-in system which they used to monitor patients at home for signs and symptoms of worsening disease. Their study showed that within the approximately 1600 patients randomized, there was no significant benefit in terms of death, hospitalization, or length of stay. However, a closer look at the study and its shortcomings suggests that these results may fall far short of being a nail in the coffin for modern telemedicine in heart failure.

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Last week an Australian politician, Victorian Premier John Brumby, announced as part of his health policy platform the distribution of iPads to every physician. He is promising $12 million in funding to buy iPads for every doctor working in Victoria’s [second most populous state in Australia] public hospital system. On initial take, such a proposition seems outlandish.

Critical thoughts that come to mind: What is giving an iPad to every physician going to accomplish if proper teaching and work flow lessons are not taught?  Whats the point in having an iPad if you don’t have the proper software or EMR?  These is no way the program can only cost $12 million if you’re giving an iPad to every physician in the second most populous state in Australia.

While these thoughts do have merit, the state of Victoria is surprisingly one of the best suited places for such a program to thrive due to the following three reasons: (read more)

Post image for Epocrates acquisition of Modality makes sense while Android users could be left out in the cold

Epocrates, the venerable medical reference company, has bought Modality – a prolific iOS app making company.  With the launch of the App Store by Apple, Modality bet big early by focusing on apps and were the first large company in the medical educational app space – boasting titles such as Netters and Procedures Consult and bringing them to life in a mobile and aesthetically pleasing form.  We have reviewed quite a few of their apps and more often than not come away impressed [click on links for full reviews by iMedicalApps].

Although Modality does boast a wide variety of medical apps, they have worked on non-medical apps as well.  It will be interesting to see if this partnership will cause Modality to focus more on the medical and health care aspect of app making or if they will maintain their non-medical educational component.

This is clearly a move that makes sense for Epocrates. From the press release, it appears they are eager to use Modality’s mobile app development expertise for medical app making – possibly for an iPad customized Epocrates app?  Remember, Epocrates still does not have an iPad customized app. To those who might be unaware, Skyscape came out an iPad customized version of their medical reference app many months ago – currently I defer to Skyscape instead of Epocrates when using my iPad to look up medical reference information. (read more)

Sometime in November, Apple will be releasing a new free software update, termed iOS 4.2, that introduces quite a few notable improvements and changes for the iPhone, iPod Touch, and most dramatically, the iPad. This update is especially significant for iPad users because it marks the first meaningful software update since its release in April, and finally brings it on par with the iPhone and iPod Touch in regards to many features – such as multitasking and folders.

We’ve given numerous examples in the past of how the iPad is being used in healthcare and medicine – from all the med students at Stanford and UC-Irvine being given iPads, to a more broad adoption in the health care setting and it’s use in the hospital.

The iPad non withstanding, the update still brings helpful improvements that should make even the iPhone and the iPod Touch more readily equipped for the hospital or clinic. Highlighted below are some of the features that could have an impact on healthcare and how the iPad is used by medical professionals. (read more)

Post image for Dear Google: please make a medical category for apps in the Android Marketplace

Almost a year after Apple launched the iPhone, they added a medical category to their App Store for health care professionals. Surprisingly, the category was added in November of 2008 because of a medical student’s request. The medical student wanted a separate medical category that was different than the current Health & Fitness category – where all the medical apps were being thrown into at the time. Eighty-two applications were then ported over to the medical category from the Health & Fitness category.

It’s been about two years since the Android Marketplace has really taken off – technically the Marketplace launched in late 2008, but really took off in early 2009. Even though it’s been about two years since the launch of Android apps – it appears Google has no intention to differentiate their “Health” category to help the increasing number of health care professionals who are purchasing Android devices find strictly medical applications.

Currently, if you look at the categories in the Android Marketplace, you’ll see 22 – they even have a “Card and Casino” section.  The apps mentioned on Google’s official page obviously are just highlighted ones – there are significantly more – and Google surprisingly has no official method to go through all the apps in the Android Marketplace via your computer.  But even if you look at AndroLib and  Android Zoom, considered the authoritative online catalogs for every android app in the ecosystem, you won’t find a medical category. (read more)

Post image for Bill Gates interview at mHealth – How mobile health can be used to improve healthcare outcomes

[We are reporting this week from the mHealth Summit in Washington DC -- a conference covering the integration of mobile technologies with medical research, information, diagnosis, treatment, and care.]]

One of the highlights of this week’s mHealth Summit was the keynote interview of Bill Gates. While inseparable from his history as founder and leader of Microsoft from 1975 to 2008, his current passion is global health. Through the Bill and Melinda Gates Foundation, which has now given 3.8 billion (with a “b’) of targeted philanthropy into global health since 1994, he and his wife Melinda are helping bring about profound change to the lives of millions around the world. In a meeting dedicated to exploring the power of mobile devices to shape health in developed and developing countries, Bill Gates eloquently refocussed our attention towards the real urgency of saving the millions of our fellow humans who die needlessly, for want of vaccinations or the simplest treatments.

He was interviewed by Kristin M. Tolle, Ph.D. Director of Devices, Sensors and Mobility for Healthcare Microsoft Research. The following are excerpts from this fascinating conversation.

Q: You said the mobile phone is not the panacea for health care. Can you elaborate ?

A: Computing technology has been great for health care, but primarily has been useful for research. It has facilitated vaccine research, which is fantastic, that is THE miracle. But it is hard to measure the effect of technologies in general which have changed research. Advances in the field of  new drugs in the last decade has not been that great. But in areas of interest to the poor, it has been a period of great productivity.

In the case of the cell phone, it can go beyond research since they are present at the point of care. Still, we have to approach this with some humility. There is not always connectivity, people may be too sick to use phones. We have to hold ourselves to some tough metrics. (read more)

Post image for The incredible power of mobile money (mFinance) to help the world’s poor and its possible effect on mHealth

[We are reporting this week from the mHealth Summit in Washington DC - a conference covering the integration of mobile technologies with medical research, information, diagnosis, treatment, and care.]

While much excitement is evident during this week’s mHealth Summit, much of what has actually been demonstrated thus far is small pilot projects either in the US or in developing countries. Few projects involving mobile devices have gained traction to the extent of affecting large, national populations. In contrast, the use of mobile phones for banking has already taken off and is already resulting in profound changes in a few developing countries. The poster child for mobile financial services (MFS), also sometimes called branchless banking (BB) is the mPesa service of Kenya’s biggest mobile provider SafariCom.

In the few short years since its introduction in 2007, mPesa has already enrolled 13 million subscribers in this Eastern African country of 39 million. This extraordinary rate of adoption is no doubt due to the fact that, for the poor, managing money  is a major challenge. Having a simple, trusted way to send money between individuals is thus incredibly valuable, whether sending money to relatives in the village or even to pay for services.

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Post image for Vocel app is FDA approved method for medication compliance reminders and available for over 120 phones

[We are reporting this week from the mHealth Summit in Washington DC. As is typical with large meetings, the breadth of activities and the diversity of attendees is almost as interesting as the subject matter itself. We will highlight some of activities that might be of interest to our readers.]


Vocel is a company which is early in its growth phase but has a very interesting and flexible platform that, if it plays its cards right, it could reach ubiquity in revenue generating transactions in the mHealth field. The company has one major product at this time, PillPhone, which is designed to be a mobile phone equivalent of the low technology pill box. The idea is that users sign up using a simple website what medications they are using. Then, they are given reminders every time time to take one of their pills. To learn more, check out our video interview [at end of the post] with the CEO of Vocel, Carl Washburn.

While this seems mundane enough, and medication reminders are indeed one of the most ubiquitous of mHealth applications, Vocel has three important tricks up its sleeve. The first is that the application platform works on almost any phone. While much of the excitement in medical apps is focussed on iPhone and Android, the reality is that the majority of phones deployed are so-called “feature phones”, such as the ubiquitous flip phones made by Nokia and Motorola. In fact, it may be that the population that takes the most pills is the one more likely to have such a phone rather than a Droid or an iPhone. The technology underlying PillPhone is extensible since it is built on a series of XML fields, which any developer can easily customize. This text file generates a series of screens and questions that are automatically translated to work across 125 types of feature phones as well as smart phones. Vocel built this application platform on top of a secure messaging system which has already been incorporated by the major carriers.

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Post image for mHealth Summit opens with NIH director explaining importance of mobile health and giving a call to action

The explosion of smart phones, originally led by the iPhone 2007, has catalyzed the explosion of mobile medical apps which our readers are surely familiar with. But, along with the proliferation of medical reference apps and interfaces to electronic health records (EHRs), there is a much broader world of mobile medical devices and simpler phone interfaces collectively termed mHealth, which is an area of intense interest for governments, industry and care providers.

This year, this interest has been punctuated by nearly half a dozen different mobile health meetings – many that iMedicalApps has attended and participated in. Perhaps, the largest one of all is now in session in the Washington Convention Center, sponsored in part by the Foundation at National Institutes of Health (FNIH) – an event we are currently attending. This type of sponsorship is an indication of the importance mobile health or mHealth is now reaching. To further accentuate this, the keynote speaker to launch the event was Dr. Francis Collins, the director of the NIH himself.

In a rapidly moving talk, he emphasized that the NIH is taking this field very seriously and demonstrated a graph of the number of annual award in the mHealth space rising rapidly to a high of 150 awards in 2010. This summer, there will be a Summer Institute for 25 investigators for who will spend 5 days intensively learning about mHealth in La Jolla, sponsored by the office of Behavioral and Social Science research. He gave out the website and predicted that entry will be competitive. I would guess applicants did not even wait for his keynote to end before they started applying.

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