There are many different health and wellness companies offering cash incentives to individuals to make healthy decisions, whether it is losing weight or quitting smoking cigarettes.

However, what good is giving someone a cash reward for being healthy when they could spend that cash on anything, including cigarettes, beer and fast food cheeseburgers ? The team from United Preference (@utdpreference),one of the resident startups at Chicago’s Healthbox digital health incubator, plans to use the concept of Tailored Spend to answer this question and advance health care in the process.

United Preference has a vision to become the currency behind the many incentive driven programs launched by health & wellness groups and employer organizations to encourage members and employees to live healthier lifestyles. To do this, the company creates pre-paid debit card products which can be customized to be usable only to purchase particular categories of health-related goods.

As a B2B company, United Preference is looking to partner with large employers and payer groups who already use incentive-based programs. They would offer them branded cards which can be tailored to fit the healthy spending needs of each of their members. The company also has plans to develop a mobile app that uses NFC technology to make payments, or simply become a card in a user’s Google Wallet.

I had the pleasure to visit Healthbox (@health_box) to interview the United Preference team. The company was founded by Mark and Pamela Hall (middle and right in picture below) who are husband and wife as well as long time business partners and is based out of Princeton, NJ. Please see the transcript of our conversation below.

(Editors note: Mark and Pamela, much like many married couples and business partners, tended to start and finish each others sentences, so while all of the dialogue below is attributed to Mark, it was clear there is a team of two behind United Preference)

BTE: When did you start United Preference? What is the inspiration behind the business?

Mark Hall: We launched in October of last year, so we have been around for about three months. Our main office is in Princeton, NJ, and now we have Chad Hendry (left in picture above) based out of our Chicago office. The inspiration for United Preference comes out of our background, Pamela and I are also married and business partners. We have launched many technology, media and financial services businesses in the past, I actually launched the first pre-paid credit card with Russell Simmons, and late last year Pamela and I started thinking and talking about tailored spending and how we could tailor specific card products so they could only be used to purchase things like healthy foods or products and services that incentivize healthy behaviors. Out in the marketplace today we see diabetes, obesity, smoking and several other chronic conditions creating a problem that costs $450 billion annually nationwide.

The health plans and employers are spending $60 billion annually to try to incentivize better behaviors because it’s cheaper to pay somebody to be healthy than it is to pay for their bypass surgery in 6-18 months.   One way to incentivize healthy behavior is cash money, and reward-based incentives. The challenge is if you give them cash they can use that on anything from candy bars to cigarettes and booze, which is not necessarily conducive to a healthy outcome. We asked the question, ‘how do you give people cash incentives in a way that you can tailor how they are able to spend that money?’ For instance, maybe they would only be able to spend the money on items that motivate them to achieve specific milestones on the path toward a healthier lifestyle such as weight loss or smoking cessation.

One of the things we came up with is what we call progressive consumer spending, which is simply giving people tailored cash incentives to buy things that they like. We recognize that no two people are the same and no two people are going to be motivated by the same thing. For somebody who is interested in consumer electronics, if we can align them with that particular incentive and deliver that incentive in the form of cash which can be spent on the new iPad that they want, for instance, and we can encourage the behavior of quitting smoking or losing weight. To encourage that with positive incentives you are almost tapping into an emotional realm of having a positive experience while doing something that is likely unpleasant. The reason people don’t stop smoking much of the time is because its an emotionally unpleasant experience. But if you can get your cash rewards, because we know that cash works, and give them something they want and tie it into a more positive experience we hope that at the end the result will be more positive results.

What we have found from conducting focus groups is that people are really motivated by incentives early in the process, but at some point they become emotionally disconnected from that, so we are thinking about ways to change that. We really started this company with the idea of how can we revolutionize health care using tailored spending and how can we get a footprint big enough to truly impact the lives of millions of people. That is the first conversation we had about this and it remains the core of our objectives today.

By Tim Bredrup

Kaiser Permanente, the largest managed care organization in the United States, has unveiled an Android app and mobile-optimized website through which its 9 million patients can access their own medical information anywhere in the world on their mobile devices for free.  Information and services provided include: lab results, diagnostic information, secure email access to doctors, ordering of prescription refills, scheduling appointments and locating of healthcare facilities. It is also possible for family members to get access on behalf of a patient and accomplish the same tasks.

press release | www.KaiserPermanente.com

[Ed. We are proud to welcome Dr. Perry Payne to the iMedicalApps team. Dr. Payne brings a keen clinical and academic perspective to our coverage of mobile health]

by: Perry W. Payne, MD, JD

Teenage smoking is an old, persistent public health problem with about 20% of teens smoking today, but the National Cancer Institute (NCI) thinks that it has a new way to help teens quit: texting.

In an effort to tap into what all parents of teenagers know is the main mode of communication for teenagers these days, NCI recently introduced a new smoking cessation support program called Smokefree TXT. The initiative is viewed as a key component of the US Department of Health and Human Services’ efforts to create mobile health programs that improve the health of Americans.

In addition, this program comes just in time for any New Year’s resolutions by teens and their parents to curb a habit which is well known as a cause of multiple health problems.

What is Smokefree TXT?

Smokefree TXT is a free, twenty four hour service that provides teens who are trying to quit smoking with encouragement, advice, and tips to support their efforts. It is managed by the National Cancer Institute and paid for by American taxpayers. When teens sign up for the service, they are provided a quit date.

Teens receive various useful messages from that point on. On the website for Smokefree TXT, teens are told by the writers of the website that “We’re NOT going to tell you what to do.” The goal appears to be helping teens take control of their health. The text messages they receive are likely to empower them and counter any messages that promote teen smoking. Teens who continue the service until their quit date will continue receiving messages for up to six weeks.

NCI indicates that this cessation support during the first few weeks beyond quitting is important based on existing research. What’s not clear from the information provided by NCI is how teens can stop the messages if they decide not to quit or if the messages are not actually helping them or worse harming them in some way.

How can a teen sign up?

Teens as young as 13 years of age can sign up for the free service in two ways: online at teen.smokefree.gov and by texting QUIT to iQUIT (47848). Along with SmokeFree TXT, teens can also sign up for cessation information using a variety of social networking tools (i.e. Twitter, Facebook, etc.) on the website.

NCI is also releasing a smartphone application called QuitSTARTin early 2012 which will be an interactive guide that provides cessation information for teens, tracks cravings, and monitors quit attempts. When teens sign up for Smokefree TXT, they agree to a terms of service and privacy policy which do not mention their parents.

Will it Work?

The potential of Smokefree TXT making a dent in the smoking prevalence for teens is unclear. The NCI cites no research studies to support this service in their press release. In addition, the iMedicalApps Team conducted a quick search of MEDLINE using the terms “cessation support and teen” and found only 1 article from New Zealand focused on teens calling a quit line. By contrast, “cessation support” alone yielded 148 references.

There are numerous questions raised by this service.

• Will it be useful for lower income teens who are less likely to have unlimited texting plans, but much more likely to smoke?
• How should it be marketed to teens?
• Who do they text their questions to?
• Since the teens are minors, what role do their parents play in signing them up for the service and will this inhibit their use of it?

These and other questions could be addressed by a good evaluation of this service. Whether that will occur remains to be seen. Much could be learned by this effort if the NCI evaluates it well. However, without such an evaluation and with virtually no prior studies, the evidentiary basis appears to be weak at best for this type of intervention but it may still be useful given the high level of cell phone use among teens. In 2008, teens texted an average of 2,272 text messages per month according to the NY Times.

Should physicians recommend it?

Whether physicians should recommend this or not seems to be a clinical judgment call. There is no clear evidence to support the intervention, but for teens who need more support than they currently have, the advice is coming from a reputable source that is using the best evidence available to help teens. In addition, the tool costs nothing (beyond the cell phone plan) and given the lack of cheap alternatives to curb smoking, this may be worth a try.

CES is hosted by the Consumer Electronics Association (CEA), which is a trade association promoting growth in the $186 billion consumer electronics industry. There are more then 2000 companies that make up CEA from across the globe. The trade show is hosted annually and displays various products and designs that will be released to the public in the near future.

One of the exciting announcements was the Qualcomm processor dubbed Snapdragon, which will be in a range of devices including televisions, e-readers and mobile medical devices.

Paul Jacobs, CEO of Qualcomm, gave his keynote speech, emphasizing the growing mobile industry and used a half-dozen volunteers to show off various devices that use its Snapdragon chip.

Emerging markets in developing countries are an important focus to Qualcomm as people in those countries are more mobile-centric then in modern countries. Jacobs believes that in 2015, almost half of all smartphones will ship to emerging markets. Because Snapdragon chips are less expensive, price-sensitive consumers in those countries will be more apt to take advantage of them.

“Qualcomm expects that the mobile business will become a $1.3 trillion industry and that another 1.3 billion new mobile connections will emerge in the coming years.”

The Snapdragon processor currently powers 300 different devices in its current iteration, with another 350 in development. The Snapdragon S4 will drive the next generation of devices, including TVs and notebooks, according to Jacobs.

Eric Topol, chief academic officer for Scripps Health, also made an appearance onstage next to Jacobs. The iMedicalapps team had the privilege of interviewing Dr. Topol at the mHealth Summit where he noted that we are witnessing the beginning of a coalescence of two fields, where medicine can leverage the digitial infrastructure. Dr. Topol took the stage at CES to show off a device that can monitor pulse using an attachment and a smartphone.

“Topol also showed off a wrist device that can monitor heart rate, blood pressure, respiratory rate, and temperature. Jacobs called it an ICU on your watch. In addition, Topol sees a future in embedded sensors that go into your body and, for example, could detect a possible heart attack long before it happens.”

Another interesting announcement from Paul Jacobs was the announcement of the Qualcomm Tricorder X Prize. The goal of this $10 million global contest is to design a product, popularized from the Star Trek series, that integrates precision diagnostic technologies, making reliable health diagnoses available directly to “health consumers” in their homes.

This device will be a tool capable of capturing key health metrics and diagnosing a set of 15 diseases. Metrics for health measurement will include blood pressure, respiratory rate, and temperature. The device will also collect large volumes of data from ongoing measurement of health states. It will do this using the latest technology which includes wireless sensors, imaging technologies, and portable, non-invasive laboratory replacements.

Most likely, the device will be powered by Qualcomm Snapdragon processors and technology.

Sources: CNET and Qualcomm Tricorder X Prize Contest Page

One of the major announcements at last week’s mHealth Summit was made by Qualcomm who introduced a new platform for wirelessly connecting medical devices. The 2net platform abstracts away the details of connecting a sensor to a cloud-based server.

Right now, if a company develops a great  lightweight sensor to measure, say, walking speed, it will also have to engineer a way for that information to be transferred wirelessly, sometimes across a couple of stops, to its eventual destination somewhere on a server. Although these same challenges repeat for every device, each company has to “reinvent the wheel”.

Additionally, once it arrives at the company’s servers that rich collection of data would still be isolated – in a “data silo”. If another company comes along with a terrific heart rate sensor and suggests, “why don’t we combine the two data streams and make a useful new app”, not only would they have to recreate the entire chain of communication for themselves, the two companies would have to agree to methods for their two servers to talk and share information.

2Net makes almost all of the above problems go away. It opens up a world of seamlessly connected wireless devices that allows application developers and sensor designers to concentrate on their work and “outsource” all the communication and data storage needs. Already within the Qualcomm pavilion on the exhibit floor, there were already several companies taking advantage of the new “2net” platform.

This is a big deal.

Actually, Qualcomm made three concurrent announcements. First, they are spinning off their Qualcomm Wireless Health division formally into a wholly owned subsidiary, Qualcomm Life. Also announced was the creation of a $100M venture fund for connected wireless companies called the Qualcomm Life Fund. The fund will invest in the following areas:

• Body worn or implantable biosensors or devices for vertically focused applications like chronic disease care, medication compliance and fitness or wellness
• Integrated system providers that do remote diagnosis, monitoring, or specialize in independent living
• Mobile software health IT applications
• Health Informatics/Analytics

The fund has already announced five investments; AliveCor, Air Strip Technologies, Cambridge Temperature Concepts, Telcare and WorkSmart Labs, four of which were present at the Summit.

The exciting announcement, however, is the 2net platform. The goal of the platform is to make it simple for medical devices of all kinds, whether they measure oxygen saturation, weight, blood pressure, etc., to get their data to where it belongs. We had the opportunity to learn about 2net with Chris Talbot, Senior Director, Business Development for Qualcomm Life. We will soon publish our interview with Rick Valencia, VP and General Manager and Qualcomm Life about its history, business goals and possible partners.

There are four ways that data can be transmitted using the 2net system.

1. The 2net Hub – a standalone gateway hub for the home
2. Medical devices with an embedded cellular component
3. Medical data sent from mobile phones
4. Via the internet from other servers using application programming interfaces (APIs)

The 2net hub

The 2net hub is a device which has prongs for a wall outlet, two LED lights … and that’s it. Built into it are four radios, 2g/3g cellular, WiFi, Bluetooth and Ant+ (a low power radio protocol used mostly for exercise equipment). It can communicate with any 2net aware device in the house, using any of the above radios, and transmit the data via cellular communication to the 2net platform.

Although many people do not realize this, Qualcomm is one of the largest MVNOs in the world (mobile virtual network operator). This means that it buys cellular bandwidth from the likes of AT&T and Verizon and resells or uses it on behalf of its customers, which is how the 2net hub communicates to the 2net servers. The result is that the maker of, for example, a home sphygmanometer can build into the device any kind of radio – bluetooth, WiFi, etc. and it  has to do is make it able to communicate with the 2net hub.

After that, Qualcomm Life will make sure it arrives at their server. The consumer does not have to worry about setting up a WiFi network, pairing Bluetooth, etc. It is plug-and-forget. This also accelerates advances in the device marketplace because consumers will find it easier to swap one device for another.

The 2net hub, by design, is a fixed point device. For mobile devices, there are two other methods to connect to the 2net platform. One is via a cell phone acting as a gateway. In this case, Qualcomm Life provides a set of code to be added to a health or medical app that directs sensor data to the 2net servers using the cellular network. Another method is embedded cellular chips inside devices which themselves connect to the cellular network. This is analogous to an Amazon Kindle which has an imbedded cellular chip for downloading books but (of course) does not make phone calls.

Finally, any server on the internet can feed information directly into the 2net servers using application programming interfaces (APIs). This would be useful in the case of, say, a patient health record (PHR) uploading data to 2net for the purposes of displaying it on a mobile app somewhere else. In fact, it is this bidirectional ability of the cloud based service that will allow for a wealth of yet to be imagined data mashups valuable for populations and individuals.  This is the most exciting part of this new platform.

It is this potential to aggregate all kinds of biometric and user entered data that is making possible the Macaw app which is an impressive demonstration of how a mobile device can aggregate a wide swath of biometric data and guide an individual into reducing risk of preventible illness. It is a powerful and comprehensive tool based on the Prevention Plan to decrease your health risks–which we will profile in an accompanying article.

The APIs that allow streamlined data sharing to and from other servers was also via an integration into a web based EHR, Hello Health by Myca. As can be seen below, there is a live dashboard  aggregating input from several different sensors simultaneously, including blood pressure, asthma inhaler puffs, glucose, weight, etc.

The volume of biometric data is expected to massively increase in the near future. Currently, data transmission is a patchwork of independently created proprietary solutions. Just imagine the number of  communication subsystems within any single hospital connecting medical devices. Qualcomm is stepping into this disordered marketplace, taking advantage of its global scale and multiple decades of leadership in wireless communication to offer a unifying platform.

Although the system is not based on open protocols managed by a standards body, such as the W3C for the internet, a simple and reliable system that companies large and small could subscribe to could well be the catalyst to launch the next big phase of the mHealth revolution.

Verizon is actively pursuing wireless and digital solutions for the healthcare industry.

Leveraging key assets such as its nationwide cellular network as well as increasing its 4G LTE presence, Verizon aims to streamline clinician workflows which will not only affect the quality of care, but will also decrease costs.

Verizon Wireless is focused on developing solutions to reduce the economic and human cost of chronic disease as well as the prevalent challenge to accessing healthcare for prevention, treatment and follow-up maintenance.

The imedicalapps team has previously reported on ways in which Verizon is affecting the mHealth landscape. We noted that Verizon has unveiled a new HD video conferencing tool, called FuzeMeeting which allows users to collaborate with documents, video, and images face-to-face, all in an intuitive experience on any mobile device or desktop. We also described an upgrade to Verizon’s Universal Indentify Service (UIS) for healthcare. This upgrade allows secure access to electronic health records and health information exchanges on smartphones running Apple OS, Android, Windows Mobile and Blackberry.

Verizon Wireless operates one of the nation’s largest 4G LTE and 3G networks. The company is headquartered in Basking Ridge, N.J. and has nearly 83,000 employees nationwide. The company serves 107.7 million total wireless connections, including 90.7 million retail customers. Verizon is positioning itself as a major player in this expanding healthcare market not only because it makes smart business sense, but also because there is a great need to improve healthcare outcomes and efficiencies.

“Each year, more than 200,000 Americans die due to preventable, treatable chronic diseases. The broad challenges across our nation for accessing healthcare for routine care are often rooted in geographic, equipment or medical professional availability. On average, it takes about 20 days to schedule and complete a visit with a primary care physician. This problem will only be exacerbated by the growing shortage of healthcare professionals over the next several years.”

Additionally, Verizon is developing a digital care management solution focused on chronic care management. It will utilize a cloud-based platform to connect different medical devices from partners such as Entra Health.

Entra Health Systems is an international applied technology company whose mandate is to improve healthcare management. Entra Health provides technologies that improve patient care while at the same time reducing the burden on healthcare providers. One of their products, MyGlucoHealth meter, is the first FDA cleared Bluetooth®-enabled blood glucose meter.

What will make the overall solution suite offered by Verizon stand out from the crowd is the ability to integrate biometric devices from best-of-breed providers and deliver personalized care plans to users directly via their own personal mobile devices.

Michael Tighe, the executive director of mHealth solutions for Verizon Wireless, explains their commitment.

“Verizon Wireless is committed to the healthcare vertical, and we feel that medical practitioners need the best network to accomplish their goals and run efficient practices. Our depth of knowledge stems from team members who have strong backgrounds in the healthcare industry. We have engaged in conversations with healthcare professionals of all levels and worked together from the ground up to deliver the right solutions from a technology standpoint.”

Verizon Wireless will be showcasing its Digital Healthcare Solutions suite at the 2011 mHealth Summit in Washington, D.C. , from Dec. 5-7 (Booth #303). On Dec. 6, John Stratton , executive vice president and chief operating officer of Verizon Wireless, was a keynote speaker offering Verizon’s approach to mHealth.

Source: Press Release

My goal while attending the mHealth Summit in Washington DC this week is to understand the business models behind the companies at the forefront of this exciting emerging field.

At the top of my list of panel discussions to attend was Business Model Challenges for the Deployment of mHealth Solutions: The Provider Perspective featuring the following very influential mHealth thought leaders:

Moderator
Zia Agha - VA San Diego Healthcare Systems

Presenters
Julie Kling – Humana, Inc.
Eric Fennel – Center for Medicare and Medicaid Services, CMMI
James Brehm - Compass Intelligence, LLC
Steve Heilman - Norton Healthcare

The first presenter was Julie Kling, mobile business lead at Humana, which is one of the most impressive organizations on the mHealth landscape, particularly among payer groups. Kling, the mobile business executive lead at Humana, discussed four major categories of mobile strategy inputs at Humana – customer, brand, business and trends. The company is very much focused on developing mHealth products that have a direct consumer use and benefit, particularly with regards to the specifics of their plans and coverage (i.e. copay for specific services or pharmaceuticals).

Humana has internally developed over a dozen dedicated mobile apps across numerous categories. Of all health insurance providers, Humana is by far the most innovative player in the mobile space as far as I am concerned, and their early embrace of games for health is just one example of the company’s innovative edge.

According to Kling, “eVisits” are in early stages across the US, using real-time or asynchronous services, on-demand web-based video conferencing, and usually for non-emergent questions, prescription processing and chronic disease management. Mobile technology has evolved by leaps and bounds in other industries–the healthcare industry is only just beginning to leverage it.

Next up was Eric Fennel from the Center for Medicare and Medicaid Innovation Center.  The center was established to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid and CHIP while preserving or enhancing the quality of care.

The program’s mission can be summed up in their Three I’s Strategy:

-Incentives – Test new care and payment models
-Improvement – Rapidly serve better care
-Ideas – Innovate and create new models

The models the Innovation Center will test require fundamental changes in the structure of healthcare delivery. Unfortunately, we did not get a chance to hear what CMS envisions these changes will look like.

Next we heard from James Brehm of Compass Intelligence, a market research firm focused on the wireless health sector. James estimated the total size of the US wireless healthcare market to be approximately $12 billion, a much larger number than I have seen anywhere else before but encouraging nonetheless.

One point Brehm made that I thought was particularly interesting was that healthcare today, like it or not, is like buying a car without knowing how much its going to cost. Its almost impossible to even imagine making such a consequential purchase without knowing the long-term costs, but I think the metaphor is apt and highlights the glaring flaws in the current delivery model.

Small practices or rural practices are characterized by older physicians who are very comfortable with their practice and don’t have a ton of interest in mobile, but are willing to learn. Many large and urban practices are the opposite, with younger more aggressive physicians who embrace mobile technology in practice.

Standards and collection of data need to be standardized and training around these new devices, services, processes and procedures is also necessary. Best practices are currently unclear to physicians and providers and will slowly be established.

Finally, Steve Heilman, CMIO at Norton Healthcare, an integrated delivery network of 5 hospitals with several hundred physicians, highlighted the fact that core infrastructure is a key challenge faced by providers, as is mobile device management, specifically the management of many devices across many platforms, a point I touch on further below.

One exciting and hopeful fact Heilman shared from his experiences as a CMIO is that telemedicine consults have proven to pay just as well as an office visit. However, its not easy to sell the infrastructure necessary to provide face-to-face telemedicine services to hospital CEOs.

Mobile technology provides market differentiation and sets an organization apart, but groups need to be prepared to manage the culture shift this engenders. When you begin offering these innovative solutions patients will come to expect them all the time, and its not always easy to consistently provide technology that is in early stages and evolving literally day-to-day.

Data ownership was raised as a critical issue. Who owns patient data? I think the consensus among panelists was clearly that patients own their data, but little was shared about what each individuals organization does to provide patients with assurance that the data belongs to them.

One particularly good question asked by an audience member was, “What proof points do you need to see before you start adopting technologies in your organization and how long does it take to make those decisions?”  To sum up the panelists responses, right now we are undergoing a culture change on the provider side. Health plans are testing these models because they want to achieve greater efficiency. If we (as providers) can provide mobile services that help us better compete you can be sure we will adopt these technologies.

Obviously, integration of all of these emerging devices is also a critical aspect of developing sustainable mHealth business models and it seemed clear that all of the panelists had experiences in this respect that proved more challenging than they maybe had anticipated.

Heilman closed his presentation by asserting “we are trying to become as device agnostic as possible, because its the wild wild west out there right now with everyone bringing their own mobile device to work”, though I got the distinct impression that this is a reluctant effort due to the expense and complexity involved with supporting hundreds of different devices. He emphasized the need for hospitals to be able to support these mobile devices, but it is no small investment to build the internal capabilities to provide such support to hundreds of different devices running various operating systems.

This is a critical point because most providers don’t mandate physicians use specific devices. Physicians are going out and buying their own mobile devices which they hope to use in practice but often times they find their hospital does not support said device.

In response to a question from an app developer about what advise the panel has for first time health app developers, Julie Kling echoed Heilman when she recommended first and foremost that companies develop device agnostic applications.

All in all, the panel was a bit disappointing since very little regarding the actual business models of the presenting organizations was actually shared. I came away from the panel with very little new knowledge. A business model to me answers one of two questions, and often times both; (1) How do we make money? and/or (2) How do we save money? Sadly, there was little to be gleaned from the speakers regarding the actual business models they have attempted to deploy, successful or not.

The mHealth Summit 2011 is in full swing and there are many exciting booths and demonstrations available to see. We recently reported that ResolutionMD has received FDA clearance for its mobile radiology viewing system. The platform is available as a free downloadable demo “lite” version via iTunes.

Calgary Scientific, makers of ResolutionMD, are here at the mHealth Summit and were kind enough to give the imedicalapps team a live demonstration of the app, including some of its marqee features.

The video below demonstrates what the technology can do and is a live demonstration of ResolutionMD.

 Key points about their imaging solution include:

• The imaging data is NOT copied, it is left on the source PACS (i.e. hospital or imaging center)
• A temporary copy of the data is created on a dedicated server
• The server is usually housed by the specific entity that owns the PACS
• Calgary Scientific does not sell its product directly, ResolutionMD is resold by large PACS vendors such as GE and Fujitsu
• All image processing–including 2d and 3d reconstructions–are performed on the server side, saving system resources
• A session can be opened with an iPad or various Android tablets, allowing the rendered images to be displayed
• Images can also be viewed on a web browser, which currently has more capabilities and functionality than the mobile app counterparts
• For security purposes, no data is stored on the mobile device. Instead, when the session is closed nothing is retained
• Since the images are rendered remotely, two devices can view the same images simultaneously as well as share controls

This last feature is especially exciting since a radiologist can be viewing an image on his/her iPad, send an email invite to a physician inviting him to open a simultaneous session and actually go through the slices and point at the findings of interest.

At this time, it is not clear if this platform will be extended to small imaging centers and physician practices with digital radiology capabilities.

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.

The third annual mHealth Summit kicked off today in Washington DC.

The list of keynote speakers is an all-star list of influential leaders in health and wireless medicine.

After an introduction by Robert Kaplan, PhD from the NIH and Scott Campbell, PhD from the FNIH, Patricia Mecheal, PhD, executive director of the mHealth Alliance highlighted the progress mobile health is allowing less developed countries to tackle their health problems such as malaria and other communicable diseases.

Patricia Mecheal also mentioned how mobile technologies have helped gender inequalities, explaining that she herself is now a patron of mobile apps for expectant mothers.

The two keynote speakers on the first day were Kathleen Sebelius, secretary of the US Health & Human Services and Eric Topol, MD.

Both speakers had clear messages for the attendees but it was Dr. Topol who really gave a rousing and inspirational keynote that touched on nearly every aspect of the digital revolution in medicine.

[Ed. Note: check out our recent interviews with Patty Mechael and Eric Topol. The following is excerpted from their speeches.]

Kathleen Sebelius

Virtually every American now has a cell phone with smarthphones comprising nearly half of these phones. We are used to using smartphones to get directions or choose where to eat but now we are increasingly using them to track and manage our health. The iTunes app store has 12,000 apps for health. But as technology goes, this is not big news. What is exciting is that this is happening where the rate of innovation has been slower, namely medicine.

While technology has improved the consumer experience almost everywhere, such as banks and ATMs, healthcare has stubbornly held on to “cabinets and hanging files”. Whereas we have some of the best doctors, nurses and technology in the world, and the highest spending, Americans still live with illness and die younger than in many countries. At the same time, doctors and nurses are frustrated by the demands of care. Healthcare costs have stressed families and have led to difficult choices at all levels of government.

Part of the problem is lack of information. Patients cannot access their information, which is stored in offices. They cannot find information on medications or find specialists. Doctors way too often have inadequate information on their patients, about their diabetes management, or what happened recently while they were in the emergency department.

This is why the president launched early in his term an effort to improve health IT in this country. Since 2009, the share of office electronic health records has gone from 17% to 34%, with 52% saying they plan on adopting them. We are on pace to triple the use of EHRs. This is a huge change. Mobile health is the natural extension of this change. We need to bring these advances to pockets and purses. Mobile health allows us to reach populations previously hard to reach such as African Americans, Latinos and others.

People are happy to leave some portion of their healthcare  in the hands of professionals. They are happy to leave scalpels and lasers in the hands of surgeons. However, we should be involved in diet, quitting smoking, choosing a doctor. It has been incredibly inspiring to see developers come up with tools to do this such as iTriage, which is helping consumers find health care facilities as easily as finding a restaurant as well as Pillbox, which is helping people identify pills. This is not just impacting patients. For physicians, a smartphone with Epocrates is almost as necessary as a stethoscope.

Yet, I believe we have a long way to go. We in administration ask what can do to accelerate the development of this technology. Now, we believe the biggest force for innovation is America’s entrepreneurs. Government has a role too, as  it can drive research to develop the context for this technology. It can be a catalyst. The rapid adoption of EHRs is an example. The benefits of EHRs have been well known, yet adoption was very low in 2009, even in a sector that is 17% of GDP. We helped remove obstacles.

First, we developed a national platform with interoperable systems. We built regional Health Information Exchanges (HIEs) for institutions that did not have access to IT expertise. We then put in financial incentives for doctors and hospitals. What was especially important was developing meaningful use standards that, for the first time in this country, can track the outcomes of interventions. Along the way, we created 50,000 new jobs in this field.

When government targets it resources effectively, we can make major changes. We are making vast amounts of data available to those of you in this room. Until recently it was hidden, scattered across websites and publications. We unlocked the data and built a central clearinghouse at www.healthdata.gov. There has been an incredible response, with dozens of apps built and we are just getting started. Much of this is due to the incredible ingenuity of Todd Parks, serial entrepreneur within HHS.

Earlier this year we challenged developers to develop apps for young people to avoid dating violence. One out of five women in college report some sort of assault. If young people can create a flash mob, why not use the technology to protect themselves?  Today I want to congratulate two winners of our “Apps against Abuse” challenge: Circle of 6 and OnWatch. We are also working on Text4Babies, which has helped 250,000 moms.

Today, I ask all of you to help move all health technologies forward–not just mobile. These technologies will be embraced by consumers if they feel that their information is safe. At the FDA, we are practicing safe regulation, so that mobile software keeps health information secure. We need your help in both of these areas. We are talking about using the biggest technology breakthroughs of our time and applying it to our biggest challenges. As China and India grow their middle class, they will also need these technologies for their consumers. There is no reason we cannot be the ones to provide those technologies. The future is in sight.

Thank you.

Eric Topol, MD

It is wonderful to be here, representing the West Wireless Health Institute, whose mission is to lower the cost of health care.

[shows slide of 16th century fresco] This image demonstrates the word “Kairos”, the greek word for “supreme moment”. We are at this most momentous time in medicine due to this inflection point because of the intersection of the digital & the medical world, which is sort of a cocoon. These two worlds are now merging.

There is a tremendous digital infrastructure already built [shows slide of iPod, Blackberry, iPhone, Kindle and iPad]. This affects shopping, thinking and behaviors. There is a new species “homo distractus” [shows cartoon of twins in utero texting to each other]. We have gone from zero to 800m users on Facebook since 2004, soon it will be more than a billion, and from 0 to 250m Tweets per day on Twitter in a few years. Occupy Wall Street is a street movement propelled by social networks. Why can’t there be a similar movement for health?

A patient recently posted her picture on Facebook. Somebody far away made the rare diagnosis of Kawasaki disease using just the photo. In online patient communities like PatientsLikeMe, many patients are gleaning more support and information from their peers than their doctors. We have trillions of gigabytes of data, we have supercomputers like Watson that can process 200m pages per second. Wellpoint has even contracted with Watson for challenging diagnoses.

Joseph Schumpeter, an Austrian economist from last century, coined the term “Creative Destruction”. This is the Kairos. We see it in newspapers and magazines. Johns Hopkins is closing Welch Medical Library since all their content is going digital. When I was training there, I lived in that building.

We are also seeing the beginning of wireless sensors. These include the Nike running sensor and the Jawbone UP. The Zeo sensor tracks sleep continuously, you can see I woke up many times last night as I was excited about today. The Withings weight scale can send data directly to providers, same with the Agamatrix glucometer. There is even now available continuous glucose monitoring every five minutes using a sophisticated skin patch.

The AliveCor device allows ECG measurement simply using by utilizing a case on the outside of an iPhone. [He demonstrates his own ECG live on stage by holding the phone in his hands] I used one of these recently during a plane flight to diagnose someone with a heart attack. [He places the credit card sized sensor against his chest]

You can see my heart rate is faster than it was before – look a PVC!  This will engender a culture of “e-hypochondriacs” [laughter].

You can also use Skin Scan to take a picture of a mole and get a text back saying whether it is good or bad. The Cell Scope can make a medical microscope out of a cell phone for under $50. Using microfluidics and nanoelectronics, you can now sample saliva for genetics. This is what has been termed “the incredible shrinking laboratory”.

Eyenetra.com sells a $2 app that makes it possible to diagnose near- and far-sightedness, it was invented by MIT. The Sensimed Triggerfish can monitor continuous interocular pressure. Tears can be tested to measure glucose. Today, a big announcement from Qualcomm will allow data aggregation using a cloud-based service.

The future is global non-communicable diseases– not Tb, HIV & malaria. The future is cardiovascular and cancer worldwide, which have mHealth strategies. In Isaacson’s biography of Steve Jobs, he says he is excited for his son Reed since “the biggest innovations in the 21st century will be the intersection of biology and technology”. We will soon have the complete $1000 genome in 2 hours is the future. Nicholas Volker, a child born in Milwaukee, Wisconsin was about to die due to multiple infections and sepsis. Finally, one of his doctors suggested they sequence his genome, and found the genetic source of his problem. He is now cured and healthy at age six.

DNA Electronics makes a handheld device that analyzes a portion of genome using saliva. It can tell what dose of plavix should be used or if an alternative is preferable. It can help avoid the rare and devastating side effect of Steven-Johnson syndrome which can be seen with Tegretol (carbamezapine) whose susceptibility is due to a known allele. We now have breakthrough drugs for cystic fibrosis for the 3-4% of patients with a particular gene. We also know that some fraction of the 347 million diabetics in the world are resistant to metformin.

[shows stethoscope] This is a stethoscope. It was invented in 1847. I have not used one in two years. I have a miniature ultrasound in my pocket that allows me to see the heart, why just listen to lub-dub when I can see the hear? [he demonstrates by showing his own echocardiogram live on stage]

Why do we know when something will go wrong in our cars but not in ourselves? We can’t tell if an artery is going to crack, we only can see plaques. Yet arteries that crack often only have partial blockages. This is why Tim Russert had a normal stress test just weeks before he died suddenly of a ruptured left anterior descending coronary artery. How can we tell ahead of time?

Now we can by looking at molecular expression of endothelial cells. This can be detected with a nanosensor the size of a grain of sand, connected to an app. We will be able to detect cancer cells and immune the destruction of islet cells for diabetes. Embedded nanosensors are a big part of the future. This is the superconvergence of genomics, imaging, internet, social netowrking and wireless sensors.

It is the biggest convergence of our lives.

The mobile healthcare market in Asia is growing and expected to reach $7 billion by 2017, according to a study by the Global System for Mobile Communications Association (GSMA) and PriceWaterCoopers.

Jeanine Vos, who heads the mobile health unit at the GSMA believes that such technology will further penetrate the Asian market.

“We foresee that market opportunities can reach $7 billion by 2017 (from under $500 million now)…We are really at the start of a take-off. Companies that stand to gain from the expansion of mobile technologies for healthcare purposes include mobile operators, device manufacturers, software developers and healthcare providers.”

As noted in previous posts, the GSMA spans more than 220 countries and connects connects nearly 800 of the world’s mobile operators, as well as more than 200 companies in the broader mobile ecosystem.

Some of these companies include handset makers, software companies, equipment providers, Internet companies, and media organizations.

Mobile phone technology can be used by doctors to help make diagnoses and monitor the health of their patients. The technology can help treat chronic diseases such as diabetes and heart disease. There is also demand for wearable devices, for example those that can be used to track patients with Alzheimer’s disease. According to Vos:

“For Alzheimer’s disease patients, they can be followed around the city and people can also contact emergency services, call the call center…solutions that help the elderly live independently for longer in their own homes.”

Barriers still exist, however, in convincing governments as well as clinicians in various regions.

“The healthcare challenges and needs are highly diverse across the region. A key challenge is … in (achieving) adoption by governments and medical professionals. To reach scale and adoption, what will be important is that governments and regulators across the region promote policies that enable healthcare reform to be supported by mobile technologies.”

Source: Reuters 

The mHealth Summit is the largest annual gathering dedicated to mHealth in the world and convenes a global group of researchers, health professionals & industry. As a media partner for the Summit, iMedicalApps will be presenting an exclusive series of interviews with keynote and prominent speakers between now and the December meeting titled “mHealth Leaders speak to iMedicalApps”.

Joseph Kvedar, MD, is the Founder and Director of the Center for Connected Health, which was established in 1995 by Partners HealthCare.

Partners was founded by Massachusetts General Hospital and Brigham and Women’s Hospital, and is a principal teaching affiliate of Harvard Medical School.

The Center’s mission is to “develop new strategies to move health care from the hospital and doctor’s office into the day-to-day lives of patients.” Dr. Kvedar will be speaking in the Super Sessions at the Summit on “Mobile Health in the Clinical Enterprise”.

Read below to learn more about the fascinating work being done at the Center for Connected Health and his thoughts on the mHealth Summit.

Why are you participating in the mHealth Summit?

The growth in this sector has been extraordinary in the last that two or three years. From a patient perspective, the power of having mobile technology always on, always networked, in the palm of your hand and very personal just really does open up a whole new opportunity for the delivery of health care that we just have never thought about.

What do you hope to get out of it?

I think safe to say in this space the mHealth Summit is one of the biggest meetings, so there is going to be great content, and there are going to be great networking opportunities. I hope to get insights into the field, to take the pulse of what’s happening and to with colleagues working in the same area to inspire new concepts and business relationships.

Could you please share a few thoughts on the potential of mHealth to improve health?

I have been at it seventeen years and we just couldn’t conceive of the opportunity that today’s smart phones, as an example, give us in terms of just-in-time care delivery and just-in-time messaging and the opportunity to educate people when they needed the most and on and on. So I do think there is something here, I do think it’s a — it’s really profound and it is going to have an enormous effect on not just the health care industry, but all industries.

Mobile technology is with you and we are always connected so that we can use it as a tool to sense all kinds of things about you and collect them and aggregate them and then give you insight into your lifestyle which will be important for health care.

Tell me about the Center for Connected Health

We changed our name in 2006 from Partners Telemedicine because we evolved from the concept of traditional telemedicine and got into some of these other areas, so we thought we need to really have a different term for what we do. We would say that mHealth and connected health aren’t exactly the same. But mobile enables us to push our vision so much faster, in such a more compelling way that it’s incredibly exciting. Now what we do here is we are very focused on opportunities for really two things.

One is self care and insights into lifestyle change and behavior change and all those sort of things that will take your population that’s headed for chronic illness and reverse that trend. And then the second is just-in-time care or the ability of a health care provider to manage a population of patients and then reach into the moment and find you and say, “hey, look it’s me, I am just looking over your data, and it looks to me like — you know, I see this trend over the last three days of your blood glucose reading, let’s have a chat about what’s going on” and do that teaching in the moment that you just can almost never do during office visits. You’ve got an appointment at 3 pm on Friday afternoon and that’s when you show up and if you are not sick then it’s a quick visit, but if you go home in the next week you get sick, tough luck.

It seems the Center works both on the provider and the consumer side

So we are definitely a hybrid organization, that’s part of what is fun about it. We do have an academic side, true, but as a division of Information Systems at Partners Healthcare, one of our missions is to keep the organization three to five — more like five to seven – years ahead of the curve on these technologies. So, as we move into a world of accountable care and capitation, all of a sudden it’s become very, very plausible that we use a lot of these programs to extend ourselves across greater population of patients and take care of them effectively outside of the office. It’s really about creating innovative programs that get us into the care coordination world as opposed to the office visit world.

Then we have what I call our external facing side. We do some research grants, we do some cutting edge research, we have four or five things going on right now that are fairly large scale implementation trials of either an interesting technology or a care model. We are doing something with social networking and Facebook in asthma for instance.

We are doing something with an ingestible biosensor that measures certain things, and whether that’s effective for changing behavior. We are doing some things with a medication adherence device that scans pills and tells you whether you took the right pill or if you filled the bin wrong, its a very, very smart device. So we do that work and it is either funded by research grants or by the companies themselves.

And then we have a consulting practice, particularly for early stage firms. But a variety of organizations hire us to help them to either get their products sorted out and determine how they fit in the marketplace or possibly to do a feasibility trial or a clinical trial. We sometimes help people with their business plan, we connect them with funders.

We aren’t an official incubator in that sense but we do a lot of those things. We also have a close associate who can help people sort out their investment strategies. So we do bleed over into the start up world. I tell people our mission is to accelerate the adoption of connected health and that can be by moving things forward in the commercial sector or it can be right here in our own delivery system.

How can connected medical devices reduce health care costs ? Have you seen some examples?

Well, I alluded to this in the very beginning, we have this hypothesis that our patients and consumers – people don’t have to be already sick to be part of this phenomenon – they are our biggest untapped resource. And the way that we believe that we’re going to fundamentally lower the cost of care or decrease the demand in an already overtaxed system is by offloading more and more of the responsibility on to individuals. And they will be happy to do it because who cares more about your health than you do?

The statistics that I like to throw out here are that 56% of the health care expenses in this country are labor. In the last, I want to say, ten years the economy in general has increased labor productivity by 1.8% whereas health care has fallen by 0.8% creating an almost three percentage point difference in the overall productivity of workers in our economy and what’s going on in health care.

So we really have an enormous opportunity to use our healthcare labor across more individuals and keep more individuals healthy, lowering the demand and lowering the cost. We think mobile health, and of course “connected health” our brand of mobile health, has that opportunity. It has to do with feedback loops, it has to do with just in time care. We are seeing it happen, and have great data in our own patient populations that’s showing this can happen and that’s the direction we are pushing everything we are doing.

Do you think capitated and global payment structures will help or hinder adoption of these technologies?

I would say it will be a boost because providers, when they really are capitated, will very quickly realize that their most precious resource is their brick and mortar and they simply don’t need to have everybody come in for every sore throat, flu shot, blood pressure check. We did all those things for years partly because we couldn’t think any differently but also probably because the cash register rings every time you go – that’s the only way the cash register rings. So you know if you get us out of that, where you are going to get paid a flat rate to take care of this population and the goal then is to sign up more people because the more people you sign up the more you get paid and yet be more efficient, this stuff will take off like a rocket.

It seems there is an mHealth conference somewhere every other week. What do you believe sets the mHealth Summit apart?

I think the that has to do really with the fact that there’s such a heavy emphasis on the NIH side. And that brings a different crowd to the table,. You have Health 2.0, which I know is not mobile meeting but there certainly is plenty of mobile technology present there. Health 2.0 is mostly about startup land. There is also the Wireless Life Science Alliance which is really more traditional pharma and device companies and how they are moving into wireless.

We run a meeting here, the Connected Health Symposium which is really about policy and psychology around growing the connected health market. I think the reason the mHealth Summit can attract thousands of people is because it attracts people from the foundation side, it attracts people from the public health side, and it attracts people from the various institutes at NIH. So it’s a different crowd and they are thinking about the problems differently. I am a big huge believer in the whole ecosystem and I am an equal opportunity networker. There are people here that I wouldn’t necessarily get to see at other meetings.

[Ed. In addition to his role at the Center for Connected Health, Dr. Kvedar is a past President and Board member of the American Telemedicine Association (ATA) and a Past Chair of the American Academy of Dermatology (AAD) Task Force on Telemedicine. In 2009, Dr. Kvedar was honored by the ATA with its Individual Leadership Award, recognizing his significant contributions to connected health and telemedicine. Mass High Tech, The Journal of New England Technology named Dr. Kvedar an All-Star in the field of healthcare. ]

[The mHealth Summit is the largest annual gathering dedicated to mHealth in the world and convenes a global group of researchers, health professionals & industry. As a media partner for the Summit, iMedicalApps will be presenting an exclusive series of interviews with keynote and prominent speakers titled "mHealth leaders speak to iMedicalApps" between now and the December meeting.]

It is hard to easily comprehend the depth and breadth of Dr. Topol’s career. He has been a major figure in cardiology, genomics and wireless health while also assuming leadership positions in landmark institutions such as the Cleveland Clinic and the Scripps Institute in La Jolla.

As chairman of cardiology at the Cleveland Clinic, he led the program to become number one for heart care. He was lead investigator on numerous national & worldwide cardiovascular clinical trials and started a medical school at the Clinic. He was also among the first physicians nationwide to call attention to the potential cardiac dangers of Vioxx. His very public criticism of Merck and the FDA brought to light the intimate but not always visible connections between the pharmaceutical industry and academic medicine.

Later he moved to San Diego, where he currently serves as director of the Scripps Translational Science Institute, Chief Academic Officer for Scripps Health and Professor of Translational Genomics. He has been a leading proponent of wireless medicine for more than a decade. He co-founded the West Wireless Health Institute with Gary and Mary West who contributed the initial $45m gift to start the Institute and have since committed an additional $100m to found a not-for-profit venture fund for wireless health companies. He currently serves as Vice Chairman of the Institute which is dedicated to “innovating, validating, and advocating for the use of technologies including wireless medical devices to transform medicine.” Be sure to check out our recent interview of WWHI chief executive Don Casey.

Dr. Topol is delivering the opening keynote for the mHealth Summit on December 5. His new book “The Creative Destruction of Medicine” is also making its debut at the Summit as an e-book, available to meeting attendees. Read below to hear his thoughts on the mHealth Summit and wireless platforms’ potential to improve health & transform the practice of medicine.

Why are you participating in the mHealth Summit?

I am excited to be participating in the mHealth Summit because this is a gathering of the really interested people in this space from all over the world, and it is the one that is most exciting in making a vast difference in the future of medicine.

Could you please share a few thoughts on the potential of mHealth to improve health?

The story here is that a remarkable digital intrastructure has been built and yet the medical world is in a separate orbit, a cocoon of sorts. This is the beginning of a coalescence of a these two fields, where medicine can leverage this fantastic digitial infrastructure. Not just wireless but the idea that you can digitize the whole human being. We’re used to digitizing books and movies but now we can digitize people with wireless sensors, advanced medical imaging, even genomic sequencing. mHealth is a way to take this forward, because now we’re talking about a mobile platform, a way of getting that data on any individual, to individualize their care, to allow prevention of significant illnesses. This is a unique opportunity, the most exciting time in medicine ever.

There are a lot of mobile meetings out there, what makes the mHealth Summit special ?

Well, I think this is the meeting. The term “summit” is used pretty liberally but this one is the real deal. It brings together people from all over the world who are interested in fostering global health through mHealth, this is an unparalleled gathering of people and exchange of ideas.

What do you hope to get out of the mHealth Summit ?

To me, it is a great opportunity to meet so many people in this mHealth community, the thought leaders, and to try to help catalyze going forward. It is exciting for me because I have a book coming out called “The Creative Destruction of Medicine”, about how the digital revolution will create better health care. This book will be available at the mHealth Summit electronically, exclusively for the meeting. In my address, I can only cover so much but this book gets into all the nitty gritty. This is such an extraordinary time in medicine. My hope is that I can help catalyze this movement which is based not in the physician community but rather in the consumer, in the public. And it is not just United States, but rather global.

In your TED talk you said that in the last two years we have learned more about disease than in all the previous eras, what did you mean by that ?

Since 2007, due to the acceleration of knowledge of our genomic underpinning – the root causes of disease – we have advanced our knowledge so exponentially that it transcends all of the history of medicine. Now that we can sequence a human being wholly, every one of the 6 billion base pairs, we can get full disclosure on each individual. That includes the prevention of diseases that might otherwise occur in that person but also what drugs might be useful, and those that would induce a serious side effect.

And all this kind of information can be stored on someone’s smart phone. There are now prototypes of devices that look like a smartphone but that are actually capable of genetic sequencing. A handheld device will be able to sequence portions of the genome, such as a possible cancer mutation or to see if a bacteria is resistant to certain antibiotics. In the next few years, using sequencing chips, these devices will be capable of sequencing a whole genome. Really a remarkable convergence between genomics and mobile technologies.

Can mobile technologies help less wealthy countries leapfrog some of their health challenges ?

Absolutely. As a cardiologist, I can look at the cardiac rhytm of anyone in the world. I can tell them if they are in atrial fibrillation, another arrhythmia or that they don’t have an arrhythmia. And that’s just the beginning. Next year, we’ll be able to look at all their vital signs. The fact is that we have leveled the playing field for practicing medicine. We can communicate through our smartphones, these amazing mini computers, to render diagnosis and care. That extends to making the diagnosis of infectious diseases, through add-ons to the smart phone, there is limitless potential here.

You have the opportunity for any patient in the world to connect with an expert to get guidance. That is something we never had before because we could not transmit that data. We just didn’t have the data. We couldn’t capture it, much less transmit and share it. For example using the V-scan, a high resolution ultrasound device, somebody can do an ultrasound in India and put it on their phone so I can look at it. I can see every structure of that person’s heart, abdomen or fetal structures. All this is done in real time.

This article stems from a conversation we[Iltifat Husain, Felasfa Wodajo] had with Mike Foley, executive director of the Bluetooth SIG – a group that develops universal bluetooth standards

Bluetooth technology allows devices to communicate and transfer key information wirelessly. The recent released of the Bluetooth 4.0 standard contains many specifications that could seriously increase adoption of the standard among medical device manufacturers. For example, the new standard calls on bluetooth devices to maintain power for weeks to months without a charge.

Imagine walking into the MICU or NICU, or any other ICU unit, and not seeing mountains of wires connected to your patients.  Rather, they have small bluetooth sensors attached to them, synced wirelessly to display monitors next to them.

Transporting patients to imaging rooms and other locations would be a breeze, you would cut down the risk of bacterial infections from the lengthy wires, and you wouldn’t have to worry about people tripping on wires.  These are just a few of the potential benefits.

Background

The Bluetooth standard has been around since 1999 when first Ericsson and then, quickly, other manufacturers of mobile devices and cell phones came together to specify a standard for near-distance wireless connectivity.

The Main Features of Bluetooth:

- Operates in the 2.4GHz frequency band without a license for wireless communication.
- Real-time data transfer usually possible between 10-100 meters
- Close proximity not required as with infrared data (IrDA) communication devices as Bluetooth doesn’t suffer from interference from obstacles such as walls.
- Supports both point-to-point wireless connections between mobile phones and personal computers, as well as point-to-multipoint connections to anable ad hoc local wireless networks.

The standard has been very popular with just about every cell phone manufacturer supporting it in the majority of devices. Due to its low power usage and very cheap, bulk produced electronics, it has been incorporated in many types of devices, ranging from the ubiquitous wireless headsets for telephones to popular consumer fitness devices such as the Nike-iPod/iPhone sensor that measures distances run by joggers.

In 2006, the Bluetooth Special Interest Group (SIG), which is the consortium of industry supporters responsible for developing the standard, set to build a standard to incorporate use of medical devices. This was a natural fit for the specification since device to device communication is an everyday occurrence in hospitals and doctors’ offices – as mentioned above.

The specification is now complete with 30-40 vendors already qualified to support it and we’re hopeful they will bring useful products to market.

Integration – the “Health Device Profile”

Over 20 types of Bluetooth profiles already exist and have been adopted in varying degrees by manufacturers. These include the Advanced Audio Distribution Profile (A2DP) – allows use of stereo headphones to listen to music over Bluetooth, the Hands-Free Profile (HFP) – allows hands free dialing inside a car, and the File Transfer Profile (FTP) – allows transfer of files over Bluetooth.

The recently released Health Device Profile (HDP) is specifically tailored for medical applications by incorporating the available Institute of Electrical and Electronics Engineers (IEEE) specifications for medical device connections directly into the specification. What this means is manufacturers that already use IEEE standards for their medical devices (e.g. pulse-ox, glucose meters, etc), can transition their device connectivity easily onto the Bluetooth HDP.

Many device-specific IEEE specifications already exist for personal health devices, such as weight scales, thermometers, and glucometers. In fact, many manufacturers were already using Bluetooth wireless connectivity for such devices in the marketplace but use their own proprietary protocols for encapsulating the data. What the HDP allows is standardization of the data format, increasing interoperability and, hopefully, leading to a flourishing market of health related devices using wireless communication.

Bluetooth advantages

When asked why choose Bluetooth over other wireless communication standards, Dr. Foley responded cost and power consumption. While Wi-Fi connectivity is ubiquitous throughout hospitals and now most offices, the power needed to maintain a wi-fi connection precludes its use in tiny medical devices with minimal capacity for battery storage. More expensive devices, such as cell phones, can afford to maintain a cellular connection, such as 3G or EDGE, but this cost would prevent widespread adoption in small, potentially disposable medical devices, where the additional cost of wireless electronics has to be limited to a few dollars.

Manager devices

The vision of HDP is that a nearby manager device (“sink” in HDP terminology) would be responsible for aggregating and transmitting information collected from one or more Bluetooth devices. Thus, a device by the bedside could collect information from multiple patient sensors and transmit it over the hospital Wi-FI network to doctors and nurses.

Potentially exciting is the prospect that a nearby mobile device, such as a smartphone, would be the aggregating device. Thus, a continuous reading of, say, movement (i.e. exercise) or heart rhythm data, could be collected and forwarded to the cloud for review by the person or her physician. This is where the promise of HDP to affect the consumer medical space lies – an always connected, mobile interface into useful lifestyle and medical information that can help patients and physicians.

Plus, no more tripping over wires.

Iltifat Husain contributed to this article.