Can you live without your phone?

How often have you heard someone say that they ‘couldn’t live without their phone’? Surely it’s just a bit of exaggeration, because they just really rely on their phone for work, or their social life?

After all, with a smartphone you can access the web, take (blurry) photos, play Angry Birds and occasionally check up on the odd work e-mail. But no matter how clever a smartphone is, it is not exactly essential for our mortal existence – but this could be about to change.

Mobile Health (or mHealth) is a broad topic but in general refers to the use of wireless devices – such as smartphones and tablet computers – to support health care and treatment regimes. But the aspect that is really interesting is the use of specially developed apps to convert any smartphone into a real medical device.

Some of these medical apps can enable a smartphone to carry out tasks such as remote health monitoring and care support, whilst others can communicate with add-on devices or peripherals to allow for more complex therapeutic tasks to be undertaken. These could include the diagnosis and treatment of chronic conditions, such as diabetes and asthma. The use of this combined technology is in its early stages, but it has a very real potential to radically change the way we approach standard healthcare in the future.

Manufacturers are making smartphones and tablet computers ever more adaptable with high resolution screens and longer battery lives. You can download games, music, e-books, web-TV and save all of the data (and blurry photos) to remote cloud servers. Mobile apps and these devices go hand-in-hand and we are increasingly using them for work, entertainment and for information – so why not also trust them with our health like any other medical device?

One good reason is that the companies who develop more standard medical devices such as inhalers and injector pens are closely regulated and follow strict directives and guidance. They carry out detailed risk analyses and verification testing to prove that the device is safe, and they undertake large validation studies in order to show that that the devices do what they are supposed to do. The problem is that the teams who develop mobile apps are not used to working to these sorts of standards. After all, if the battery dies during a game of Angry Birds what is the worst that can happen?

The risk of personal data security is also a big concern. Data sent wirelessly can be hard to protect and it’s been well reported that some apps have hidden software that can read your text messages, and even track your location. It’s pretty worrying to think that people could potentially have access to very intimate details on how sick you are. So this is precisely why the US FDA has stepped in to clarify the types of apps which will come under their authority – detailed in the FDA’s draft guidance for Mobile Medical Applications, published in July 2011.

In most cases, this regulation does not apply to those ‘Health and Lifestyle’ apps which are mostly focused on tracking fitness or dieting, and account for around two per cent of the more than 650,000 apps available to download from Apple. Regulation only applies to those apps focused on diagnostics or those that tell you how and when to treat your medical conditions. The hope is that this regulation will not stifle the development of medical apps, but will provide credibility through the knowledge that the benefits and (most importantly) risks to public health have been considered.

As is the way with new technologies, this initial approach is interesting but cautious. Some examples of the first FDA approved apps include the Sanofi iBGStar blood glucose meter and the MIM Software Radiological image processing app.

“You may think that it’s the intention of mHealth tools to take the place of GP’s but that is not the case.”

In reality, not many fully approved apps have actually made it to the market yet. But there are some very good ideas under development which are not too far off such as a special electrode-studded case that turns the iPhone into a heart monitor that users hold in their hands or place on their chests to detect irregular heart rhythms. There is even an edible sensor that emits a tone when swallowed. The tone can be picked up on a patch worn on the outside of the body which then relays the sensor’s data, along with heart rate and body movement of the patent, to a mobile phone for later analysis.

You may think that it’s the intention of mHealth tools to take the place of the GP but that is not the case, as the need for professional assessment and monitoring will always be an essential part of the healthcare process. Rather, the intention is for these technologies to support health professionals, by enabling more ‘remote access care’ (without the need to visit the surgery) to replace routine check-ups and diagnoses.

It’s easy to imagine that the apps that allow people to measure their own blood pressures and heart rates at home will also be able to communicate this data to a doctor, and this will lead to a considerable reduction in the number of home visits required for people with chronic conditions. As it’s the nurses and caregivers that are generally responsible for these visits, they in turn will have more time to dedicate to the primary and palliative care of patients.

The potential for mHealth technologies to improve healthcare in developing countries is also huge not least because it is in these regions where mobile phone ownership is growing more rapidly than anywhere else. Although network speeds currently lag behind those found in developed markets, the use of remote diagnostics monitoring and treatment will undoubtedly help prevent sickness and save lives. Current developments specifically for these markets include an app for a phone-based E. Coli sensor for water and other fluids, which uses a lightweight attachment to the phone’s camera to check the water quality. Commercial manufacture of this device could be only two years away, with the potential for many other similar apps to follow.

Remember how in the ‘future-world’ we learnt that doctors will always have a special machine to help them out? Well maybe mHealth is just that. Whether it is enabling better health management, diagnosis or just improving the patient experience, it’s an exciting concept and it’s only just getting started. So next time someone tells you that they can’t live without their phone you may want to take them a bit more seriously!

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