While CMS is focused on patient portals in EHRs to engage patients, patients have been engaging themselves with the aid of smartphones. Smartphones have been supplemented with a variety of external sensors which track health parameters, providing information for the patient to manage their healthcare. These devices attack chronic health issues such as obesity, noncompliance with medication, diabetes, and heart disease.
The first step to improvement is to measure the condition. The first measurement establishes a baseline and continued measurements track how well the program is progressing. “If you cannot measure it, you cannot improve it.” – Lord Kelvin. The mantra is embodied by the Quantified Self movement which promotes “self knowledge through numbers”. This web site serves the QS user community with forums and international meetings. You name it and someone in the QS community has tracked it and reported on it. From weight, fitness, sleep, moods, stress, to reading habits, nothing seems to be left out.
The number of fitness and weight loss apps are legion. Wearable and not wearable sensors aid in measuring and tracking fitness goals.The Fitbit Flex is a wristband that tracks steps, distance, food intake and calories burned during the day and sleep quality at night. It is water resistant and handles laps in the pool.
The Flex automatically syncs the stats wirelessly to computers and smartphones allowing real-time monitoring of progress. It does more than track. Lights on the band show how close one is to reaching the daily goal and when that goal is reached, it vibrates. As motivation, progress can be shared and compared with friends. The wrist band itself is a tangible reminder about fitness and occasionally blinks and vibrates to say stop sitting and move.
In the not wearable category for fitness tracking are the smart scales such as the one from Withings which not only measures weight, but body composition, heart rate and air quality. It measures the body fat percentage and calculates BMI. Standing heart rate is an indicator of improved fitness if it drops over time. Indoor air quality measures temperature and carbon dioxide and sends an alert when it is time to clear the air.
The scale automatically syncs wirelessly to smartphones and tablets to a Withings Health Mate app or several others such as My FitnessPal. The app tracks progress towards goals, sets reminders to weigh in and offers encouragement.
Medication adherence is one of the largest and most expensive problems in healthcare. It is estimated that 50% of the US population take medication on a regular basis and of those, only half take their medications as prescribed. Healthcare costs, caused by improper and unnecessary use of medicines, exceeded $200 billion in 2012, according to the IMS Institute for Healthcare Informatics.
A variety of apps and mobile health tools address the issue of medication noncompliance. Medisafe is a smartphone app that creates a virtual toolbox that holds medications, instructions and refill reminders for regular medications.
Abiogenix has developed a smart pill box, the uBox, that pairs with a smart phone or computer. The box is locked until it’s time to take the medication when it and/or the phone sends a reminder to take the medication and the box is unlocked allowing it to advance to the next dose. The uBox tracks medications taken and notifies family members about missed doses. The locking feature on smart pill boxes combined with the dispenser prevents over dosing
Diabetes management is a difficult issue due to the need to test glucose levels multiple times a day and keep a diary of the results, associated meal times, exercise and other variables. Sanofi’s iBGStar is an iPhone attachment and app that greatly simplifies the testing and data logging process.
The attachment plugs directly into the iPhone, reads the test strip, and reports the result on the attachment and on the phone. The attachment can be used independently from the phone to read the test strip, but connecting the attachment to phone, provides the real benefits.
When plugged into the phone, the phone recognizes an inserted strip, opens the app, and plays a video demonstrating proper sample application technique. After 6 seconds, the result is displayed on the screen and is color coded to emphasize hyperglycemia and hypoglycemia conditions.
The result is auto-tagged for time of day and noted for post breakfast, pre dinner based on meal time pre-sets entered by the patient. Notes can be added to the result by selecting from those on the app, e.g., “light exercise”, “fatty meal” or manually entered. Similar screens allow for entering carbs, insulin and manual blood glucose readings.
Data can be viewed on a trend chart, logbook, or presented as average results over various time periods. Results can be quickly emailed to the healthcare team.
Monitoring heart disease can be done with devices attached to smartphones that can also communicate results to the healthcare team. Blood pressure cuffs controlled by a smartphone app, such as Withings blood pressure monitor, automatically take blood pressure and heart rate and save it to the iPhone or iPad stamped with the time and date. The measurements history can be emailed to a physician for advice.
For more advanced monitoring, the AliveCor Heart Monitor device snaps onto an iPhone like a back and takes a single lead ECG by either placing one’s thumbs on the senors or by placing on the chest. The Heart Monitor sends the ECG wirelessly to the phone where it is displayed and can be sent to an AliveCor server for review by a cardiologist. This device is being prescribed by cardiologists to patients with intermittent events and being used by cardiologists as part of a patient’s exam.
Many more monitoring apps with sensors have been released. One of the more ambitious devices aimed at consumers is the Owlet baby monitor. The Owlet monitors heart rate, blood oxygen levels, temperature, sleep quality, and provides rollover alerts. All this data is collected with a “smart sock” worn by the baby, sent to a smart phone or PC app that syncs with an Owlet server proving access via any web browser.
Another patient engagement phenomena, that may be even more far reaching, is growing use of “peer-to-peer” social networks allowing patients to share data about treatments, how well they worked, and other tips about their specific disease. These networks range from the very specific, e.g., Crohnology for Crohn’s disease with 4200 members to networks with a broad scope of many diseases, such as Patients Like Me with 220,000 members. These sites allow patients to access real data as to what works in the real world and obtain more data than a single physicians experience allows.
The wealth of health and wellness apps and sensors combined with social networks allows patients to collect and monitor more data about their specific conditions and goals than ever before. Plans for management of their disease or for achieving wellness goals can be individually tailored. The result is patients not just engaging in their healthcare, but taking control of their healthcare.
Patients will be better informed and equipped to engage their healthcare team with more data about their condition that any single visit to the office could ever provide. Patients can collect detailed healthcare records and analyze different therapies based on what has worked in their social network. This could level the playing field of the doctor patient relationship.