One major contributing factor to the skyrocketing cost of health care in the US is the high rate of readmission among patients.

A recent Dartmouth Atlas Project report found that 2009 30-day surgical readmission rates were 12.9 percent, unchanged from 2004, while 30-day medical readmission rates rose to 16.1 percent in 2009 from 15.9 percent in 2004.

The study also found that patients failed to see a primary care physician within two weeks of discharge, a step that can often help avoid readmission and improve outcomes.

Pipette (@usepipette) is using mobile technology to try and address this problem and enable clinicians to keep close tabs on their patients during the critical 30-day period following discharge from inpatient setting. Their mobile application suite, which covers 100 percent of mobile devices using a variety of SMS, native apps and web apps, enables clinicians to passively capture crucial patient feedback regarding their day-to-day recovery.

The goal behind Pipette’s platform is to provide payers and providers a system that reduces costs, improves patient care and enables a reliable and effective method for improving patient compliance and outcomes. The best word to describe the company’s platform is “empowering”, both patients and clinicians, to take control of the recovery process.

Pipette was a member of the first class of startups at the Rock Health incubator and one of the few in that group with a clinical orientation. Co-founders Ryan Panchadsaram (@rypan) and Jimmy Do (@jimmydo) saw a clear opportunity to disrupt healthcare and together left their jobs at Microsoft and jumped into the startup scene of Silicon Valley.

I believe there is tremendous value in developing mobile applications that passively collect crucial, context-specific patient data that is otherwise only recorded in clinical settings, so I was thrilled to have a chance to speak with Ryan and hear his vision for Pipette.

See my conversation with Ryan below:

BTE: What is the inspiration behind Pipette? What exactly is the technology you guys offer?

Ryan: The inspiration for Pipette comes from what is lacking in the healthcare system today. When a patient gets discharged from a hospital the care team has no idea of what is happening with that patient when they are at home, no clue if they are actually making progress toward recovery. What we wanted to do was build tools that would empower a patient during their recovery and enable care teams to see how a patient is recovering.

We entered the Rock Health program back in June with an idea and a small prototype of it and we were able to iterate on that idea and build a product over the last five months. The Rock Health partners helped us understand what the pain points were and how to approach the space. What we ultimately created is a platform to monitor a patient post-discharge that coaches a patient in the right direction and if things go wrong with the recovery we are able to notify the care team.

BTE: So these are apps you guys are developing?

Ryan: You can think of them as apps because they run on a patient’s phone, but our technology is special because it runs across all platforms including iOS, Android, laptops, desktops, SMS and we have spent a good amount of time making sure we can reach as many devices as possible. We learned pretty quickly that if you just build for one platform its not sufficient for healthcare. When you build a health solution, you need to reach the majority of the patient population.

BTE: So what are the next steps for you coming out of the Rock Health program? Do you plan to stay out in the Bay Area?

Ryan: The next step for us is kicking off these pilots. It’s an exciting time for us because we’ll be actively working with a few of the Rock Health partners to trial, iterate, and improve our product. Essentially, we get to act like a consumer startup in healthcare, which is incredibly rare. My co-founder and I will be staying in the Bay Area. We were living here before we started Pipette when we worked at Microsoft in Mountain View, so we will definitely be staying around here.

BTE: So do you guys just collect patient information about pain thresholds or do you collect other patient data as well?

Ryan: We try to collect all of the information necessary to make the patient’s next doctor visit more meaningful and we also try to take that information and use our technology to predict valuable things on the hospital side. For instance, we can tell the hospital which six patients need attention now, then we tell them the five who, if they have time, they should call and check up on because they are not going in the right direction. So there is a lot of information that goes into our technology, it’s not simply a data collection tool, there is an intelligence element to it.

BTE: You mentioned earlier that you had one idea in terms of who would pay for your product going into the Rock Health program and ended up learning you needed to take a different approach. What helped to help you learn that lesson?

Ryan: Going into it we thought doctors and hospitals would be our primary customer. We assumed they would jump at the opportunity to better communicate with their patients, I mean, why wouldn’t a hospital want to provide a higher level of care? During the first couple months of the program we had a chance to talk to mentors, as well as conduct a series of interviews and we started pitching it as a communication tool between doctors and patients and it wasn’t getting the doctors excited, it wasn’t getting the administrators excited. They were like, ‘well, we don’t want to introduce more forms of communication because there are other channels for it, why would we want to add this extra burden?’

Through that understanding we had to reassess what problem we were actually trying to solve. We determined it wasn’t really a communication problem but rather we were solving for this event that happens, or the complication that happens. We realized that the people who felt the impact of these complications the most was the payer group as well as the consumer, the patient themselves, since they are the ones who actually feel the pain and have to be readmitted to the hospital. So just being able to have a bouncing board and being able to iterate our pitch in these early days of the Rock Health program helped us create the offering we have today.

BTE: So that is a big part of the value proposition of the Rock Health program, giving you access to all of the people you need to talk to while you work through your business model?

Ryan: Right, and knowing we were wrong in the first week in the program was invaluable! Every decision we have made while developing our product was the result of feedback we received from those early conversations and interviews. We were really able to identify specifically what problems needed to be solved.

I would encourage future Rock Health companies to take a step back in the first month when they are here and really question what they are doing and the fundamentals behind it. When you enter a three month program, you are running full speed the whole time and don’t really get that extra time you need to question what you are doing. The fact that Rock Health has a five-month program allows you to get that time and really do that self-assessment.

mHealth Research Daily with Tim Bredrup

Flagstaff Medical Center recently launched a yearlong pilot project that remotely monitors patients via Android and Bluetooth technologies in efforts of reduce their chance of being readmitted to the hospital. It’s aimed at a population that often skips regular checkups or lacks the money or transportation needed to get prescription medication. The project uses wireless technology and health-monitoring devices to remotely keep the hospital advised of the patients’ conditions.

Fifty people are being sent home with an Android phone and equipment to check their blood pressure, weight, heart activity and oxygen levels. For those who don’t have electricity, they also get a solar charger. The devices send the readings straight to the phone, which sends them directly to a hospital nurse who can then look at the data and determine whether a follow-up call or text is needed.

press release | www.flagstaffmedicalcenter.com

The medical education learning environment is rapidly evolving with the development of mobile technology, high speed internet and the improved connectivity with learning institutions.

These developments have enabled huge growth in less traditional learning tools such as online textbooks, anatomy videos, video lectures and a whole host of other resources. Podmedics is a site designed by UK foundation doctor Ed Wallitt and contains a vast range of podcasts for medical students and junior doctors alike.

Podmedics is a website, which means that it is accessible from home computers, iOS devices, Android devices etc. In fact, PodMedics should be accessible from most modern devices with an internet connection.

Once you have registered on the site, it is possible to search all podcasts, view all lectures or navigate by specialty. There is an excellent range of specialties available ranging from Cardiology to Rheumatology and extra sections dedicated to Surgery, Clinical Specialties and Clinical Sciences.

In total there are over 150 different podcasts available.

There is also an excellent set of notes for Surgery and Clinical Pharmacology which are at ideal level for medical students on their rotations (please note that the guidelines contained are for the UK and may differ elsewhere).

The podcasts are an excellent learning resource and offer an alternative style to those who prefer audio-visual learning rather than pure text. Each podcast has an associated slideshow and is narrated clearly. Each podcast varies in length between 10mins and 50mins depending on the subject being covered.

The level of detail in each is appropriate for advanced medical students and junior doctors. Overall I found the podcasts engaging and informative and a great way to fill a few moments of spare time or learn more about a patient I had recently seen.

Each podcast has attractive animations which showcase the essential learning points for each topic. It is an annoyance, though, that there is no native app for Podmedics. While an internet connection is required in order to view the podcasts, it is also possible to download the audio or video from the website to your computer or mobile device for offline watching. This is a useful workaround but not ideal or straightforward for busy clinicians.

Podmedics is soon to be updated and will include a brand new interface, new notes system with pdf export, recommended order to watch podcasts in, and a podcast tracking system to track which podcasts each user has watched.

Price:

• Registration on the Podmedics website is free and allows 7 days access
• Upgrading to a full subscription costs £30 per year (Approx $50)

Likes:

• Wide selection of podcasts available
• Playable on a range of devices

Dislikes:

• Podcasts require an active internet connection/not straightforward to watch offline
• No native app

Overall Rating:

• Podmedics is a superb resource for medical students and junior doctors alike
• The wide selection of topics, appropriate level of content and variation in length means the podcasts can be used for a quick reminder or a more detailed discussion of a particular topic

Site

There are few, if any, large corporations that use mobile technology to engage their customers as effectively as Louisville, KY-based health insurer Humana.

The company’s Games 4 Health program is among the most innovative mobile health programs anywhere and the projects like B-Cycle are revolutionizing bike sharing and incentivizing healthy lifestyles.

I recently had a chance to hear Julie Kling, head of mobile strategy for Humana, outline the company’s strategy during a panel discussion at the December mHealth Summit in Washington, DC. I was very impressed by her understanding of how mobile technology can improve customer engagement and provide information to patients at critical points in the care delivery process. What was clear from the panel is that other large health plans and wellness organizations could stand to learn a great deal from Humana.

I was able to interview Julie Kling following the mHealth Summit to gain some insights on how Humana develops its mobile apps, what specific problems they hope to solve for their members with their mobile products and services, and how her experience as a nurse helps inform her vision for keeping Humana on the cutting edge of mHealth innovation.

See the transcript of my discussion with Julie Kling below.

BTE: How does your background as a nurse effect your perspective and inform your strategy decisions at Humana?

Julie Kling: I think I have a real world experience that helps me to understand what the needs are from both a patients perspective as well as the members here at Humana. I understand what the challenges are in managing a chronic illness and its impact on a persons well-being and all of the factors that go into that individuals health.

Humana has this well-being strategy which not only takes into account the patients health, including emotional, physical and spiritual, but also focuses on belonging, security and purpose, and as a nurse that all makes a lot of sense to me in terms of helping to support people managing their life and lifestyle. That is what we are really trying to do by building a mobile capability that really addresses the needs that an individual has and helps to provide those supportive capabilities.

BTE: As a consumer, the first thing that springs to mind when I think of health insurance is cost. At Humana do you use mobile to give your members tools to help manage or even lower the cost of their plan?

Julie Kling: I think there are quite a few components or features that are there to help people make better health care decisions that may impact their financial accountability for their health care. One of those I mentioned in my presentation at the mHealth Summit allows users to see what the costs are for a particular drug their doctor is about to prescribe them.

I had a very personal experience with this when I had a doctor prescribing me a drug that cost $140/month, and I went and did a simple search on our website and was able to find a $4/month alternative, and if I had been able to do that while I was at the doctor’s office it certainly would have helped me and its part of the reason why we want to have that feature available to our members.

We did some consumer research and we found our members were primarily interested in tools that can help them manage their costs, so you will see that type of information featured in our mobile apps, for example members can view their health savings account balance and immediately upon using their health savings account they will see the transaction in their mobile app so they can see precisely how much they have available to use to cover prescriptions or other services.

Our members can use the app to find out how close they are to meeting their deductible. In fact, one member sent us a note via the iPhone market to tell us that they were going in for surgery at a hospital and the hospital had asked them to pay $2400 dollars up front before the surgery and they were able to show that they had met their deductible just by using the app so they weren’t required to pay the $2400 before their surgery. These are just a few examples of how people can really manage the financial component of their health care by using the MyHumana app.

BTE: How do you build the apps, do you have an internal team of developers at Humana or do you partner with other companies on different projects?

Julie Kling: We actually do build internally. Our MyHumana app is built internally, we have a couple technical teams that focus exclusively on mobile, but that doesn’t mean we don’t partner on occasion. If its something that we don’t consider a core competency, which for us is our claims rescinding, our birth benefits and health benefits, but there are some things where we will partner. For example, we partnered with other groups to help us build our health games and Humana Fit app. We really look at every situation and determine whether or not its something we want to deliver quickly, and do we have the core  competency to achieve that. So its truly a combination of both strategies.

BTE: One thing I encounter a lot are entrepreneurs with great products that would be great potential partners for Humana, but they don’t know how to engage you guys, so my question is how do they engage Humana for a special partnership in the areas that don’t fit into your core competencies? How do they know what particular expertise or technologies Humana is in need of?

Julie Kling: We actually have a strategic vendor management process and they can reach out to me and I can connect them into that process and let them know how we are doing and what our roadmap looks like and whether or not we really have that need. The needs we have a really driven by our overarching strategy and goals, so we have a process that brings people in. I can tell you, I get calls, emails and invitations every day from potential partners, but sometimes it takes time and effort to figure out where there is alignment and how that relates to the needs we have.

BTE: What is the next step in Humana’s mobile strategy? Do you have any new products in the pipeline or near-term goals?

Julie Kling: I think that as we continue to shift toward becoming a well-being organization you will see more activity from us on that front. One example is a company we recently launched called Vitality, which is a well-being and rewards program, and we will be seeing more and more mobile capabilities that relate to Humana Vitality, help people make good food choices and exercising. We want to move further into managing chronic illness and are going to be testing out biometric monitoring so we can have real data we can use to help them manage their conditions and work with their doctor to manage their conditions, which is really exciting and unique.

You will see us moving further into the sales cycle with the launch of a feature called “click to speak to an agent” which allows potential members to go to our mobile site and click on a button which connects them to an agent and enables them to see if they want to purchase any of Humana’s products or services. We are also going to start enabling potential members to get a quote through our mobile site by answering a series of questions to determine precisely what the costs would be for one or more of the products we offer, be it medical, or vision, or dental, all the information needed to make informed decisions about their coverage.

BTE: How do you get potential customers to visit your mobile site to get quoted for Humana’s services?

Julie Kling: We are doing a couple of things. First, we see a lot of people come to our site directly, many of whom are not Humana members but are just interested in finding out whether Humana’s products and services are potentially valuable and what they would cost. We are also testing out a text messaging campaign where we will do radio ads and those radio adds will allow listeners to get a short code which they can text in to get additional information and will be able to talk to a representative and purchase our insurance products. So we don’t really buy search engine ads, but we do use radio ads and we do see a lot of direct traffic.

BTE: So you guys have both native apps for all major platforms as well as an HTML5-based mobile web app?

Julie Kling: We do have an HTML5 mobile website, and I would describe what we offer as hybrid apps or wrapper apps where we use the same capabilities you find on the mobile website and we have enhanced it with some of the native capabilities you have on iOS and Android. You can think of it as a mobile frame that goes around the mobile website that has the same HTML5 capabilities which enables us to quickly deliver what we have on the mobile website to an app, which is a great way to ensure you are being efficient about your development.

Body Media has partnered with IBM to use Big Blue’s Decision Management platform to help patients meet their personal fitness and weight loss goals by integrating biofeedback features into the Body Media FIT Armband.

Biofeedback will be an increasingly important feature in all body area network technologies if they expect to gain traction with consumers. This feature from Body Media could have a Siri-like effect on the body area network market.

It may reset the bar for innovation and force competitors to incorporate biofeedback and machine learning technology into their products to remain at the cutting edge, much like Android must respond swiftly to Siri and the other innovative breakthroughs made by the iPhone4S.

The new FIT coach component of the BodyMedia FIT Activity Manager software is the first solution of its kind that can calculate and deliver information on:

• Whether users are missing, meeting or beating their targets for burning calories daily
• Multiple activity options for making up shortfalls in daily goals for burning calories (e.g. “Hop on the treadmill and walk for about one hour at a speed of four mph and you should hit your goal for burning calories today”)
• Nutritional analysis of each day’s eating patterns, along with relevant recommendations for correcting problems such as excess fat intake
• Overall progress towards the users’ weight loss goals, along with advice to stay on course

“Our BodyMedia FIT Armbands have tracked calorie burn for hundreds of thousands of people trying to lose weight, but we wanted to also help consumers understand how all of this data could effect their fitness goals,” said Christine Robins, CEO, BodyMedia. “By using IBM’s software, the new system now provides daily advice tailored to each user’s specific activities, food consumption and weight loss goals to keep them on track.”

The big winner if Body Media is able to turn machine learning and biofeedback into a feature that excites consumers will be IBM, who in the near-term will be able to license their software Body Media, and ultimately to developers of other personal fitness devices.

“As the marriage of fitness and technology becomes more and more pervasive, we continue to see companies rely on software to distinguish their products in a crowded marketplace,” said Bruce Anderson, general manager, Global Electronics Industry, IBM. “With the help of IBM analytics, BodyMedia has been able to provide users with the insight to make sense of all the information they’ve been tracking and turn it into actionable progress towards their weight loss objectives. This is providing their clients with a fitness experience that no other company can offer.”

In 2011 we did a review of the first interactive medical textbook, reported on major investments by mainstream publishers in digital platforms, and wrote extensively on the the distribution of iPads and other tablets to medical students, residents, and physicians.

Here at iMedicalApps we are always interested in ways to utilize mobile technology for a positive purpose — changing the way that healthcare professionals are trained certainly falls into that category.

CourseSmart offers a huge range of online digital textbooks which are easily accessible on a range of devices. We have previously introduced CourseSmart and recently reviewed the platform, concluding with some mixed impressions. We also had a chance to talk to CourseSmart’s Chief Marketing Officer, Jill Ambrose and ask her a few questions about CourseSmart and get some insight into the transformation of medical education.

Please tell us a little bit about the background and initial founding of CourseSmart

CourseSmart was founded in 2007 when a group of six higher education publishers partnered together to offer faculty a textbook evaluation service and students a new choice for buying and accessing their required textbooks online. The publishers included Pearson, Cengage Learning, McGraw-Hill Education, John Wiley & Sons, Houghton Mifflin and Bedford, Freeman and Worth Publishing Group (Macmillan).
Today, the company is recognized as the world’s largest provider of eTextbooks and digital course materials with more than 30 higher education publisher partners and over 20,000 eTextbooks and eResources available to our 2.5 million users.

What is the vision for CourseSmart as a company?

Our vision has always been to expand access to higher education and improve learning outcomes by connecting content producers with content users in the higher education space and offer:

• significant savings
• device agnostic access both online and offline
• superior reading experience
• advanced app technology
• unmatched campus integration.

The way in which students and faculty are consuming course materials is changing rapidly and we pride ourselves in staying ahead of these trends. We have a long list of industry firsts that include the first iPhone app in August of 2009, the first iPad app in April of 2010 and the first Android app in April of 2011, and the first mobile web app last month among others. We are continually enhancing our offering across all platforms and devices that connect users with our content.

CourseSmart has an enormous range of titles available-could you elaborate on the process by which titles are selected and transferred to electronic form?

We believe content is critical and a main differentiator between us and many of our competitors. How important is your offering to students if they can’t get the titles necessary to pass the class?

We rely on our publisher partners to provide the most current course materials in use today to ensure students are able to find their required course materials in digital form and can take advantage of all of the digital efficiencies that accompany our eTextbooks, including guaranteed, upfront savings of up to 60% when compared to print textbooks, anytime, anywhere access via any computer or web-enabled device, as well as the ability to “cache” their eTextbooks for usage offline. Our expertise in this end to end workflow allows us to obtain the content in a PDF file along with various metadata associated with the title. Our proprietary system manages the content ingestion and publishing processes so that students and faculty alike can find what they need quickly.

The reviews on iTunes of your CourseSmart iPad app seem largely negative with criticism directed toward a lack of multitasking, the repeated sign-in and a number of other issues. Do you feel that these reviews are justified?

Being the first to market with apps for the iPhone, iPad and Android, we have blazed the trail for many followers in the industry. Being first often means you have to anticipate the best features before the device is even in the market such as the iPad app. We get many of them right and listen carefully to our customers.

We take all feedback into account as we develop the next iterations of our mobile offerings to ensure we have the best offering on the market. The rating on each version of the iPad app is higher than the former version demonstrating our commitment to continuous improvement. As we develop features to satisfy our customers’ needs, new feature needs arise. The requests that you are seeing in the reviews today are currently being evaluated for future development. We continuously strive to enhance our offerings to remain the top destination for accessing digital learning materials.

Has CourseSmart linked up with any medical schools to integrate technology and learning?

CourseSmart has partnered with hundreds of institutions to offer a comprehensive solution across a broad range of disciplines, and we have worked with several medical schools that now offer digital course materials specifically for their medical programs. As background, CourseSmart’s eTextbook platform can integrate with an institution’s learning management system, student information system or campus portal, enabling faculty and students to integrate their digital course materials directly into their workflow.

Where do you see the future of medical education?

Like the rest of the higher education industry, I believe many courses taught outside the lab or hospital will move online, offering flexibility to students. In addition, simulations and interactive learning will provide additional practical learning environments for students. Real time mobility of information will be a source for learning while in medical school with applications that will extend into future examination and operating rooms.

What does the future hold for CourseSmart?

We at CourseSmart will continue to innovate and provide a robust offering for the devices and platforms that are most in demand. The continued proliferation of Web-enabled mobile devices and campus WiFi will drive eTextbook and other digital materials growth. We will also see the growth of course materials with integrated assessment and automatic feedback for students (eResources) as they are utilized to improve learning outcomes.

Is there anything else you feel our readers should know about CourseSmart?

CourseSmart’s primary goal has always been to connect content providers with content users at the lowest cost possible in an effort to increase access to course materials and improve learning outcomes.

While eTextbook adoption is growing rapidly, many students still prefer print textbooks and this makes page fidelity crucial. CourseSmart enables all students, whether they are using a digital or print edition, to literally be on the same page. Further, CourseSmart’s eResources provide students with engaging experiences that result in higher learning outcomes. It’s not just about what’s “fun and interesting” in their eTextbooks but rather, what truly helps them to engage and ultimately, the comprehension of that learning experience.

Coursesmart Website

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.

Many university providers and educators around the world have embraced digital course materials in order to supplement existing course materials. Many now aim to go beyond merely distributing PDF notes or making lectures available online and use platforms like the iPad to teach medicine in new ways.

CourseSmart, a venture founded in 2007 and supported by many leading publishers, aims to provide eTextbooks and digital learning tools to students across America. CourseSmart is one of the largest provider of digital course materials and their catalog includes over 90% of the core textbooks in use today by North American Universities.

CourseSmart’s business model is based around providing easy, instant access to a vast range of texts. They have signed up an impressive number of publishers including Pearson, McGraw-Hill, Elsevier, John Wiley & Sons, Macmillan, Lippincott, Wilkins & Williams amongst many others. A quick search of their medical section revealed over 190 texts purely in the medicine category.

It is straightforward to search for and add a text to your ‘cart’ which subsequently becomes your ‘bookshelf’ once you have paid for your book. Interestingly, CourseSmart works on an annual rental basis so the user is essentially paying for one years worth of access to a specific title.

The additional eResources provide a variety of digital content and tools created for the end user and include:

• Links to other websites for content associated with a particular course
• Online quizzes or exercises
• Simulations and online videos

CourseSmart also partners with institutions to try and integrate their digital materials into the specific course, “thereby improving productivity and performance for students and instructors alike.” Students can access the eTextbooks via the web or on a range of mobile devices such as the iPad, iPhone and Android. The web reader boasts an impressive interface including the ability to annotate, highlight, search, copy, share and print.

The actual eTextbooks are high quality scans of the original books and easy to navigate. One aspect which is useful is the fact that CourseSmart eTextbooks maintain the valuable aspects of the print textbook including page numbers and page layout thus enabling students to quickly and easily switch between physical and electronic versions. Student are also likely to be pleased with the monetary savings available due to the fact that CourseSmart tests cost on average, 60% less than a printed textbook (source).

CourseSmart has certainly put their stamp on the particularly exciting development of online textbooks and resources. The wide range of medical textbooks available and ease of accessibility are sure to help ensure CourseSmart become a popular resource for both students and educators. CourseSmart enables instructors to be more productive and facilitates instant access to essential learning materials for students.

Stay tuned for a review of the CourseSmart system in action, an interview and a comparison between CourseSmart and their competitors.

Link: Coursemart

One of the major technological advances over the past 2 years has been the major growth in cloud storage. Cloud storage is defined by Wikipedia as “a model of networked online storage where data is stored on virtualized pools of storage which are generally hosted by third parties”.

What this means is your data is stored on large data servers and transferred over the internet, which is accessible from everywhere with internet connectivity.

There has been a massive growth in the number of companies offering these services, with notable examples including Apple’s iCloud, Box.net, SugarSync, Mozy, Google Docs, and the focus of this particular article, Dropbox.

Dropbox is a web-based file hosting service that uses cloud storage to enable users to store and share files and folders across the internet using active file synchronization. Signing up for the basic Dropbox service is free and gives each user 2GB of online storage space.

The attraction of Dropbox is the downloadable client which creates a folder on your computer called ‘Dropbox’. Any files or folders placed within this folder will be automatically uploaded to Dropbox’s servers (as long as you have adequate space). This folder (and all its contents) are now accessible from a range of sources including the official Dropbox Apps for iOS, Android, Windows Phone 7, Blackberry as well as a web based client which is accessed via Dropbox.com.

The attraction of Dropbox is it is a hassle free method of carrying around all your files which can be downloaded and viewed on a mobile device at any time. This is done by using the Dropbox folder as ‘My Documents’ and therefore any documents located here are accessible from anywhere.

Dropbox maintains a folder on your computer which is automatically synced over the internet to Dropbox. Anything placed in this folder such as PDFs, documents, photos is accessible using the free Dropbox app on your iPad (or other mobile device).

The syncing is bi-directional and carried out automatically, meaning that if you add a PDF of a particular Sepsis Protocol on your home desktop, it will be available for viewing on your iPad without any extra work.

Similarly, if you upload a file into the mobile Dropbox app, then it will appear on your home computer automatically, without any extra work. The mobile Dropbox app acts as a file viewer and can view many different file types which allows easy access to all your files on the go.

Another major attraction is the simple method of sharing files using Dropbox. It is possible to create an individual link to any document in a particular Dropbox folder, which can then be shared with anyone.

Alternatively, it is possible to share a whole folder with someone whereby the contents of that folder will be synchronized between both computers automatically.

So how can all this be applied to medicine and physicians?

The immediate attraction of Dropbox for healthcare professionals is the ability to access files and folders from anywhere. It is no longer necessary to carry around a USB stick to transfer documents as these can be easily uploaded using the web interface on any computer.

Letters and documents can be written and edited from anywhere which is always useful for busy physicians on the go.  Often times we do not have access to a dedicated computer or laptop since we are often moving from floor to floor in a hospital.

The main reason that Dropbox is an essential app is it serves a unique role linking your files and folders on your home computer to your mobile medical device over the air. Apple has not included a robust file management system on its iOS devices, therefore it can be challenging to transfer documents both to and from these devices.

Many apps now use Dropbox as a primary means to import and export files. For example, the GoodReader PDF management app can access your Dropbox account and sync files, folders and any annotations made on your iDevice to your home computer, saving the hassle of transferring each document manually.

Lectures can be downloaded, annotated and automatically uploaded, keeping files uncluttered and easy to manage. Dropbox is the easiest way to transfer files between your iDevices.

Dropbox is the all important wireless link between your files and your mobile device.

One area where Dropbox could have a significant impact is medical literature management. Wouldn’t it be useful to keep your collections of academic papers, lecture notes and interesting case reports in one central location that ensures your files are always up to date regardless of what device you are using (mobile or desktop)? Dropbox allows you to accomplish this and much more. Stay tuned for our upcoming review of PDF management apps.

So where does Dropbox fall short? As with all cloud storage options, there are two major concerns: Reliability and Security.

It is difficult to entrust your data to a company such as Dropbox if you are concerned you may not be able to access it when you want — you certainly want guarantees that no else is able to access it. One of the main precautions to take when using cloud storage is to be careful when uploading sensitive information. This is particularly relevant to healthcare professionals given the absolute reliance and trust of patient confidentiality.

Dropbox, like many providers, offers secure 256bit encryption which should be adequate to protect your data, but it essentially comes down to the individuals ability to trust an external company with their sensitive data.

Cloud storage and cloud based computing are going to be the next big thing in regards to technological advancement. We can already see this being introduced with iCloud storing documents, photos, calendars and email in the ‘cloud’.

Features such as Apple’s Siri and Amazon’s Silk web browser are offloading heavy computer processing to servers in the cloud in order to reduce the CPU load on the individual mobile devices. Taking advantage of a cloud storage service such as Dropbox will allow health care providers to improve productivity and help improve file management (especially in regards to medical literature) — providing that all important link between desktop and mobile device.

Price:

The basic 2GB online storage is free and there are a number of paid packages available to increase the space as needed. Dropbox also run a referral system allowing you to get extra space for free when you invite your friends/colleagues. All the apps for the mobile devices are free.

Further reading: Using Dropbox and OsiriX on the iPad to view radiology images in the operating room

iTunes link
Android link
www.dropbox.com

by Ravi Nerella, MBBS, MD

Christian Zibreg recently wrote an article on 9to5mac.com talking about a potential new app, Alien Dalvik, that will allow users the ability to run Android apps on an iPad and for that matter, on any iOS device.

Christian asks the obvious question, “Why would you want to run Android apps on your iPad?”

He proceeds to answer that question as follows:

“Apple’s iOS software boss Scott Forstall said at Monday’s iPhone 4S introduction that about 140,000 out of the 500,000 apps available in the App Store have been specifically created with iPad in mind. Android apps also aren’t as pretty or delightful as their iOS counterparts, but the fact that most are either free or ad-supported should mean something so we expect some folks will give Alien Dalvik a try.”

I do agree with his answer but I think there are probably other reasons why one would want to run apps from Android on iOS. After all, isn’t that what we do currently with Windows virtualization on Macs now that we have programs such as Apple’s own Boot Camp, Parallels and VMWare’s Fusion?

Wasn’t a similar question, that went something like “Why would anyone want to run Windows on a Mac?”, asked with a certain amount of disdain when this concept was first introduced? Now it is widely accepted and even embraced, though I know there are some probably, like me, who shudder at the very thought of running Windows on my Mac (which I have not and probably never will do).

First, I believe that given the current state of tablets, it’s a very relevant question. So far, there has yet to emerge a worthy contender to take on the iPad. HP’s Touchpad came and went (though I don’t know if it ever really arrived). Next, RIMs Playbook also appears to be DOA. The iMedicalApps team previously reviewed the Playbook and found it intriguing, but not a viable solution for physicians.

Then there is Samsung’s Galaxy Tab, its latest version being the Galaxy Tab 10.1, Motorola’s Xoom and HTC’s Flyer (also reviewed). Each has made an appearance and, of course, the latest entry into this crowded field of tablets is Amazon’s Kindle Fire.

The one thing that is clear, for whatever reason, is that these tablets have not been able to make enough of an impression to entice people to buy them. Android phones are very popular, but why has this not translated into the tablet market also? Given the continued interest in the iPad, it makes sense especially from a developers perspective, to open up the Android Marketplace to iOS customers.

The Android market may not have as many apps as Apple’s App Store, but there are many more free apps compared to the App Store as well as various apps that iOS users have probably not heard of. The likelihood that there will be droves of people installing this app on their iOS devices is slim. I agree that there will be those who will at least try this app out as Christian Zibreg clearly points out, and they may find that they like apps from the Android marketplace.

Who knows, it may catch on. In a few years, we may look back as we do now and be surprised that it actually caught on. The downside that I see from my own perspective is the security issues related to Android apps as it is an open market, with malware being a particular concern. This is however a similar, though not identical, issue to what was said of Windows virtualization and that has taken off.

The app, Alien Dalvik, as strange as the name is, has not yet been released and apparently will be demoed at an upcoming CTIA conference. It will be interesting to see what happens.  Stay tuned for future updates on this.

Dr. Nerella is a Physician Informaticist, currently practicing as an internal medicine hospitalist while working full-time in medical informatics. As a healthcare provider who both actively cares for patients and deals with health IT on the frontlines, we are thrilled to share his perspective on iMedicalApps.

It has been very difficult to cut through the understandable distractions provided by the recent passing of Steve Jobs to analyze the product Apple launched last week, the iPhone 4S.

When the device hits stores tomorrow it will probably be the least scrutinized new product Apple has launched in years, however there is one new element you will find in the new iPhone which might be seen in retrospect as the feature which brings body area network technologies to American consumers by Christmas 2011- Bluetooth 4.0.

The BLE standard was first announced by the Bluetooth Special Interest Group (SIG) in June 2010 with the hallmark features of the new protocol listed as :

• Ultra-low peak, average and idle mode power consumption
• Ability to run for years on standard coin-cell batteries
• Low cost
• Multi-vendor interoperability
• Enhanced range

Apple has been the first consumer device maker to begin embedding Bluetooth 4.0 in their products, starting with the MacBook Air and Mac Mini in July. By embedding Bluetooth 4.0 in their devices first, Apple has forced their competitors to follow their lead and integrate the technology into the next generation of Smartphone. More importantly, Apple has created a viable consumer base for developers of applications in the largely unexplored realm of body computing and wearable sensor networks.

IMS Research predicts the decision by Apple to pioneer BLE in their iPhone 4S device should be a huge stimulus for developers of emerging mobile health devices incorporating low energy technology. They anticipate the shipment of greater than 370 million units by the end of 2012, and 1.6 billion by 2015. It is anticipated wireless medical applications will be the most attractive opportunity for realizing the value of the new low energy protocol.

Several companies have already developed Bluetooth Low Energy chip sets including Broadcom, CSR, Texas Instruments, and Nordic Semiconductor among others. The first Bluetooth 4.0 heart rate monitor, developed using a Nordic Semiconductor chip set, was announced this past June (pictured below).

Bluetooth 4.0 enabled devices are backwards compatible, thus BLE will not be replacing the existing Bluetooth protocol used for most wireless interaction on mobile devices for higher latency activity. Instead the chip set includes “Closed Bluetooth”, “Bluetooth Highspeed”, and “Bluetooth Low Energy” in one unified stack.

High speed mode is based on Wi-Fi, while the classic mode supports legacy protocols, ensuring all existing Bluetooth enabled devices will work seamlessly with the new low energy technology. The advantages of the new standard become clear when you compare BLE head-to-head with other personal area network communications technologies.

BLE has big advantages over Near Field Communication (NFC), which is presently one of the leading low-powered wireless communication technologies on the market, the largest being range of the technologies, NFC (0.2 meters) and BLE (50 meters).

For the first time the medical community has good reason to believe the body computing future we have speculated and analyzed might be finally upon us.

Further reading:

Last year iMedicalApps was asked to interview Mike Foley, the executive director of the Bluetooth Special Interest Group. He wanted to reach out to our readers and let them know the huge implications Bluetooth 4.0 has for the medical community.  The following is the interview we did with him: Bluetooth 4.0 is admitted to the hospital – Potential to revolutionize health care devices

One effect of the growing mHealth industry is the creation of interesting new ways in which patients, physicians, and other stakeholders are being connected – patients and physicians via FaceTime, connecting physicians to eachother, and even patients to their insurance company. HealthTap is a unique medical service launched on Tuesday that adds yet another dimension to how we communicate by allowing patients to get in direct contact with an expert physician for free via a smartphone.

The free HealthTap Express app available for both iOS and Android is a question and answer style app where patients can ask any questions and receive help from an expert physician who has volunteered to help via this service. There are over 5000 US-licensed physicians taking part in the scheme already and it is expected that many more will join soon.

As the folks at healthTap describe it,

5,000 doctors at your fingertips – with no waiting room, no copay, anytime, anywhere – for free! In addition, HealthTap Express allows people to get answers to any health question from thousands of America’s best doctors, at home or on the go, and gives doctors a Virtual Practice, where they answer real patient questions in real time, helping build their reputation, attract new patients and improve the quality of care.

HealthTap’s free web and mobile applications enable 24/7 access to personalized, relevant health information to help users find the best care and make better decisions about their health and well-being. Physicians participate on HealthTap to better serve existing patients and connect with potential new patients, all whilst demonstrating their expertise and commitment to helping people everywhere. In addition, they can build a social media presence – something many current physicians struggle with, yet is going to be increasingly important to building and maintaining patient panels.

Take a patient with sickle cell disease (SCD) living in a low-prevalence area. The absence of high-volume referral centers may mean a delay or lack of potential beneficial treatments. It’s not hard to imagine how a young patient with SCD may connect with a distant hematologist and discover available therapy. One could imagine the same scenario repeated itself for a patient with a rare malignancy in a low-prevalence area. An active physician on this kind of platform could reach patients all over the country.

As always, though, the elephant in the room is liability. healthTap appears to try to get around this by making it extraordinarily clear that there is no “patient-physician” relationship created. As they state in their Terms of Use,

While HealthTap Medical Experts are not your personal doctor or healthcare provider, and they do not practice medicine on or through HealthTap, they can be a resource for reliable, relevant general health information. You can even find tips (created by experts and others) that may be useful for you, which you can use to create your personalized health checklist.

And if that wasn’t clear enough,

We do not offer medical advice and are not a doctor. HealthTap is not a doctor and the use of HealthTap does not create a doctor-patient relationship.

HealthTap Express illustrates yet another way mobile technology can be used to improve doctor-patient communication. With the recent news that FaceTime is HIPAA compliant, one could argue that we are getting ever closer to the ability to conduct entirely virtual clinics. With the advent of HealthTap Express, patients will no longer need to resort to trawling google for a condition that explains their symptoms.

Source: HealthTap

Satish Misra, MD contributed to this post

With the recent hurricane affecting the lives of numerous people on the East Coast, we are reminded of the plethora of apps that position themselves as being useful during these disaster type scenarios. You might remember the Pocket First Aid app we reviewed last year — the one that helped save a mans life in Haiti.

While different situations are going to call for different actions,  the App Store and Android Market are full of apps that can be used in an emergency situation.

The question then becomes how to sift through all the various apps and decide which ones are worth using and which ones should be tossed away.  TechNewsDaily provided a solid list of some apps that might be useful.  

In an emergency situation, first-aid treatment is vital for those who need it and numerous apps are avaible to for this:

“Popular first aid apps for Android users include First Aid (free), Pocket First Aid and CPR ($2.99) and Emergency First Aid Guide ($0.99). For iPhone and iPad users, try American Medical Aid ($2.99), Pocket First Aid and CPR ($3.99) and First Aid Guide ($1.99).”

Additionally, a good plan is just as critical to keeping yourself safe and healthy as being able to treat wounds.

“For Android users, check out Disaster Readiness ($0.99), Disaster Survival Guide ($1.36), Survival Preparedness ($0.99), Emergency Kit Organizer (free) and Are You Ready? (free), an app from the Federal Emergency Management Agency. iPhone and iPad users should try Emergency Supply List ($0.99), Disaster Survival ($0.99) and Disaster Alert (free).”

Disasters are unforseen events that have a dramatic impact on people’s lives. While nobody wants to experience them, there is some, albeit small, comfort in knowing that there are apps availabe to assist during these events. There is even an app to convert text into morse code which may come in handy–you never know. We will do our own review of useful apps in disaster scenarios in the future.

Source:  TechNews Daily

Smart MIMAS, a tablet and server system developed by KDDI Labs, gives clinicians the ability to view high quality medical images on their android devices and tablets. Images can be sent securely to specialists whether at a hospital, at home or on the road. This is invaluable in the case of an emergency, since quick and accurate instructions can be relayed to staff back at the hospital. However, this system goes far beyond just viewing.

“This system has three main features. One is that images can be viewed quickly. The second feature is that images can be sent at high speed. And the third feature is that it’s very secure. Regarding the first feature, high-speed viewing, this system uses unique memory management technology to enable large images to be viewed quickly. As for the second feature, high-speed transmission, a CTU image contains a very large amount of information, with over 4,000 gradation levels in a single picture. Usually, physicians in the hospital adjust those levels to see the ones they want. But if the pictures are used on a mobile device, then with the Internet until now, the number of levels was limited due to JPEG compression. So physicians couldn’t adjust the pictures they received. Our system uses JPEG2000, so the compression preserves as many levels as possible. That makes it possible to adjust the gradation on a tablet or smartphone. Regarding the third feature, security, we’ve used KDDI’s own encryption technology to achieve a very advanced level of security.”

As can be seen, this system will dramatically impact the way physicians access medical images, and will give more flexibility in what settings the images are viewed. The image quality is also very high, decreasing errors related to misinterpreting an illegible image. Multiple test images can be compared easily and quickly, allowing for an accurate diagnosis.

“There may be only a few specialists in a hospital, or they may not come to the hospital very often. In that case, if there’s an emergency, a specialist can look at pictures while outside the hospital, and tell staff on the spot what to do. The specialist can also tell staff, “I’m coming back in. Get everything ready for surgery.” I think that’s a big advantage of this system. In provincial areas, lack of physicians can be a problem, so I think there will be a great many cases like that from now on. And in such cases, a specialist at another local hospital can provide support. We think Smart MIMAS could be utilized for that kind of
support.”

The cost to hospital administrators for Smart MIMAS will run around $65,000 for both the server and tablets. KDDI aims to supply 20 sets to hospitals by the end of the year.

Source: diginfo.tv