Category Archives: Mobile health/mhealth
The recent mHealth Summit simultaneously showcased new mobile health apps and technologies, while presenters at workshops questioned just how ready the technology and the medical community are for each other. A new collaborative article by NPR and Kaiser Health News continues that discussion by addressing one doctor’s iPad pros and cons. The reporting will add to the questions and answers health departments, agencies, practices and hospitals field as they consider acquiring new technology.
>> Read the article.
Bonus question: Where do you stand in weighing the pros and cons of new technology for health and health care?
If you’re tweeting this holiday season, some public health experts think tweets about flu shots, flu outbreaks and even flu misinformation (such as the benefit of antibiotics for the flu; there is none) could go a long way toward helping track and fight the flu. A new post on the “Pioneering Ideas” site, the online forum of the Robert Wood Johnson Foundation’s Pioneer portfolio, calls attention to new research that finds that twitter can update information on the spread of flu—and misperceptions of the flu—much faster than traditional public health tracking methods, including those used by the Centers for Disease Control and Prevention.
Read the post here.
The redesign of the Centers for Disease Control and Prevention (CDC) website home page, launched last week, is a small part of the CDC’s social media efforts. NewPublicHealth spoke to Karen Morrione, Senior Adviser for Research and Strategy in the electronic media branch at CDC, about new efforts and the reasons they are important for helping improve health in the U.S.
NewPublicHealth: Why did CDC recently redesign its home page?
Karen Morrione: We wanted a much more modern look and I think we got it. We also wanted to make sure that we incorporated our social media into the home page.
NPH: What makes exposing site users to social media so prominently so critical?
Karen Morrione: One of the things we’ve learned from recent research is that people who need health information are typically getting that health information as much online and through social media as they are from their physicians. So, it’s important for CDC to be where people are looking for information. In fact, that has been our guiding vision in electronic media for quite some time. We want to be where our citizens are. We want to make sure that they have access to us no matter what channel they’re looking at and no matter how they prefer to consume their information. Electronic media is successful when it helps people make positive behavior change. And the most important thing is to have information that is evidence-based and is credible.
Organizers of the recent mHealth Summit are already planning for next year’s meeting, while attendees are processing what they heard, saw, touched and downloaded. For both, and for anyone interested in mHealth who didn’t make it to this year’s meeting, a recent blog post on Pioneering Ideas, the online forum of the Robert Wood Johnson Foundation’ s Pioneer Portfolio, is a valuable overview. The post, by Al Shar, PH.D., MA, is a educated summary on the potential and the caution that shared the same landscape at the mHealth meeting.
Read the post here.
Robert Kaplan, PhD, the director of the Office of Behavioral and Social Sciences at the National Institutes of Health was a recent keynote speaker at the mHealth Summit that focused on new mobile technologies for tracking and potentially improving health behaviors. NewPublicHealth spoke with Dr. Kaplan about these early days of the mHealth industry and research needed to support the field.
NewPublicHealth: What's the contribution of mHealth to thestudy of health outcomes?
Robert Kaplan: It allows us to bring the laboratory to people. For a lot of years we have had to study people under laboratory conditions. Mobile technology can let us study people in the environments in which they live. For example, a simple question such as, on average, how much pain have you experienced over the last thirty days, requires memory over thirty days and we expect them to remember equally across those days and then ask them to average that. We think responses to that question are not meaningful. But, with a little electronic device, people can be asked how much pain they’re experiencing right then, at predetermined or random intervals over 30 days, and that would be more meaningful data.
Other uses include epidemiologic studies. We often ask people to recall what they ate over the last 24 hours. If I had to do that, my recall of what I ate and portion size would not be that accurate. Now people can use a cell phone to photograph their various meals, which are then analyzed for protein, calories, carbohydrates and fat. It’s not as good as it will be, but it can store the data and give a history that shows what a person is eating and how that might impact their health. Other uses of mHealth technology include satellite technology that tells us how much people move as they travel around their community, which helps estimate whether certain parks are designed for more physical activities that others.
NPH: Are you concerned about overpromise when it comes to mHealth?
The one sure thing about the mHealth summit is that this is a field still in its early days. But attendance of first-time exhibitors Verizon, Qualcomm and AT&T, who each showed some new health monitoring apps and connectivity systems, was good news for the industry and the conference. More important, says Tom Brewer, project manager at the Northwest Regional Telehealth Resource Center, is the opportunity these big companies bring in helping smaller telecommunications systems fit into their larger networks. Brewer says that expanding telehealth and mHealth opportunities could improve connectivity and access for consumers in areas where broadband is limited.
Numbers underscore the nascent phase of the mHealth field. At a session yesterday on the value of mHealth, attendees were reminded that a month after download, only 6 percent of public health apps are still in use. From a business model, the purchase is completed. But from a public health standpoint, the promise of the app for diabetes or glucose monitoring, or calorie counts or smoking cessation, for example, has largely been lost, says Brewer. At least one app firm on the exhibit floor confirmed those numbers. A million of their apps have been downloaded in the last four years, but only 7 percent are still in use.
Yvonne Hunt, PhD, MPH, of the National Cancer Institute says that simply underscores the need for testing and evidence so that apps are designed with best practices and remain in use. (Read our Q&A with Dr. Hunt.) One way to increase use might be with automatic updates to downloaded apps, an option from several firms and a good question for providers to research before recommending an app.
Technology to watch:
- Cffone—mobile website for kids with cystic fibrosis that helps connect patients with each other and encourages adherence to treatment regimens.
- NIH alcohol consumption app that will be launched in early 2012—lets users key in the alcohol type and portion size in their drinks so they can see if they’re exceeding recommended daily limits and track their intake over time. Drinkers are often unaware of how much alcohol they’re consuming in a day or month, of the risks it can pose, such as impaired driving, exacerbated health concerns and drug interactions.
This morning, Surgeon General Regina Benjamin, MD, delivered the keynote address at the mHealth Summit, and announced the new Healthy Apps Challenge, in collaboration with the Office of the National Coordinator for Health Information Technology, to encourage developers and innovators to create mobile and other technological applications to help complement the nation's first National Prevention Strategy.
>>Read our Q&A with the Surgeon General on the launch of the National Prevention Strategy.
>>Hear from Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, on the potential of health technology for public health.
The new app challenge is looking for apps that will engage individuals with tailored health information and empower users to eat healthy, get active and improve their emotional wellbeing – and enjoy it! Dr. Benjamin emphasized that last point. "Joy is so important," said Dr. Benjamin. "We each have to find our own joy in health." Dr. Benjamin finds her joy in dancing, and said she encourages her colleagues to have 60-second dance parties at work as a fun way to take a physical activity break.
Though the Surgeon General applauded the potential for technology to improve the public's health, she also called for a broader, system-wide change, as outlined by the National Prevention Strategy. "In addition to state-of-the-art medicine and technology, we need a new approach in our communities that focuses on the things outside the doctor's office that keep us healthy, from healthy housing to transportation to access to healthy foods," said Dr. Benjamin. "That calls for the nation to take a more holistic, integrated approach to health."
Dr. Benjamin said the National Prevention Strategy brings together 17 federal agencies from across government, together with stakeholders from the private and community sectors, to help move the nation, "from a system focused on sickness and disease to one focused on prevention. We need to stop the illness before it starts."
Dr. Benjamin told the story of how when she was sworn in as Surgeon General, much of her family couldn’t be there with her to celebrate. Both of her parents had passed away from preventable, chronic diseases. "I don’t want anyone else to suffer the loss of a loved one for something that could be prevented," said Dr. Benjamin.
After a soft launch a few months ago, yesterday the National Cancer Institute officially introduced SmokefreeTXT, a free (for those with unlimited texting plans) smoking cessation service that provides 24/7 encouragement, advice, and tips to teens trying to quit smoking.
Once they sign up, teens receive text messages timed according to their selected quit date. Following their quit date, they continue receiving texts for up to six weeks. Yvonne Hunt, PhD, MPH, program director of the Tobacco Control Research Branch at the National Cancer Institute’s Division of Cancer Control and Population Sciences, says that is a critical piece of the SmokefreeTXT service because research shows that cessation support continues to be important beyond the first few weeks of quitting. Teens can sign up online at teen.smokefree.gov or text QUIT to iQUIT (47848).
Hunt presented at the mHealth Summit yesterday on the topic of "The Intersection of Mobile Health and Public Health: Towards Greater Understanding and Collaboration." NewPublicHealth spoke with Yvonne Hunt about the new mobile program and the potential for mHealth in public health.
>>Follow NewPublicHealth coverage of the mHealth Summit in Washington, D.C.
NewPublicHealth: What do we know so far about the potential for the text messaging approach to quitting smoking and influencing other health behaviors?
Yvonne Hunt: At this point the key word is promise or potential. We’re just at the beginning of understanding how mHealth interventions affect quit rates for teens and adults. I share the enthusiasm of the developers at the mHealth summit because especially with teens we think we have the potential to connect audiences to cessation support in a way we haven’t been able to before, that has great promise.
The content of the text messaging program is evidence-based, it’s been tested. What we’re waiting for is whether the new platform—text messaging—has an impact on quitting. Either as a stand-alone program or as perhaps integrated with other services. The real value may be to link to other evidence-based services.
NPH: Could getting texts outside their social lives be seen as unwanted by teens?
Yvonne Hunt: That is one of the empirical questions. Our hypothesis is that because teens live and die by their phones, we can make an inroad. But it’s possible they may view it as spam. What may give us an edge is that they have to request the service.
NPH: How are you doing that?
Yvonne Hunt: We have a pretty comprehensive marketing and promotion strategy. We’ll be rolling out a social media strategy including Facebook, Twitter and a tumblr page. And I think this will be an important test of the potential for mHealth programs to impact unhealthy behaviors among teens and promote healthy behaviors. SmokefreeTXT is a key component of the U.S. Department of Health and Human Services' efforts to develop mobile health programs and is one of the key features of the new SmokeFree Teen initiative, an extension of NCI’s smoking cessation website, SmokeFree.gov. In January 2012, SmokeFree Teen will launch a free Smartphone application, QuitSTART—an interactive quit guide for teens that delivers cessation and mood management tips, tracks cravings and monitors quit attempts on several mobile platforms.
Not surprisingly, there were some striking numbers tossed around on morning one of the third annual mHealth Summit today, including the number of worldwide Facebook users—800 million—and the percentage of U.S. households with cell phones—about 90 percent.
That Facebook number has great mHealth applicability. Keynote speaker Eric Topol, MD, vice chair of West Wireless Health Institute, a conference sponsor, told the story of a little boy whose doctors couldn’t diagnose his illness, until his mother put a photo of him—and his skin swelling—on Facebook and got back the accurate diagnosis of Kawasaki’s Disease, an autoimmune disease that can be fatal. That example is an important one because Facebook is relatively inexpensive to access. Other technologies discussed at the opening keynote today—including a smartphone heart imaging app that Dr. Topol says he has used for two years instead of a stethoscope, might take longer to adopt as physicians learn to use, store and charge patients and providers for the images.
Numbers do speak to the growth of the industry. Attendees at this year’s meeting grew from 2,400 last year to 3,600 in 2011, according to Scott Campbell, PhD, Executive Director and CEO of the Foundation for the National Institutes of Health, another conference sponsor.
The wow factor was certainly on the screen this morning—Smartphone microscope apps, and chip-loaded contact lenses to monitor glaucoma, for example. But speakers acknowledged that adoption is still in its early phases, even as the usefulness is quantifiable. Robert Kaplan, PhD, Director of the Office of Behavioral and Social Sciences Research at the National Institutes of Health, noted, for example that 63 percent of deaths worldwide are now the result of non-communicable diseases. "In order to combat these trends we need new tools and strategies and new innovations," says Kaplan, who added that "we believe that mHealth and wireless technologies are an essential part of our future. For example, research centers are looking at sensors and wireless phones to help monitor health in rural locations."
Kaplan made a strong case for scrutiny: "physicians are stubborn and they want evidence—we need evidence to document the benefits of health and I look forward to what lies ahead."
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius acknowledged the relative slow growth of technology in medicine, "healthcare has stubbornly hung onto its cabinets and hanging files." But, Sebelius pointed out, "when innovation is slow, so is improvement. Americans still live sicker and die sooner than many people in nations around the world."
Sebelius focused on electronic health records and pointed out that part out that part of the healthcare problem is a lack of access to information about their own health, health information and how to find help. HHS says adoption has moved from 17 percent in 2009 to 34 percent and is on pace to triple shortly. "mHealth," says Sebelius, "is the natural extension of this trend."
Where government can play a critical role, says Sebelius, is in providing and driving research and as a catalyst. Benefits extend beyond health of individuals—Sebelius says 50,000 new jobs have been created by the growth of electronic health records.
Sebelius told the attendees that they can help move these technologies and their benefits forward, by being supportive of all innovations, not just those that involve health tools, such as "helping move toward patient-centered health systems." And, she added, the technologies will only be embraced if individuals know they’re safe and private.
>>Follow our continued coverage of the mHealth Summit.
The third annual mHealth Summit starts today. The summit brings together more than 3,600 leaders in government, the private sector, academia, health care providers and not-for-profit organizations to advance collaboration in the use of wireless technology to improve health outcomes in the U.S. and abroad. In advance of the meeting, NewPublicHealth spoke with Susannah Fox, associate director of digital strategy at the Pew Internet & American Life Project and contributor to the health blog, e-patients.net, about advances in mobile health and what’s yet to come.
>>NewPublicHealth will be covering the conference, talking with attendees and reporting from the ground of the mHealth Summit. Follow our coverage here.
NewPublicHealth: Where on its trajectory is mHealth?
Susannah Fox: About 85 percent of American adults have a cell phone. While many are still used only for phone calls, a third of the cell phone population has a Smartphone. It’s significant that that the audience is growing and what we thought last year about mHealth already has to be updated.
Last year only 17 percent of cell phone users used their devices to look up health information, so that’s a place where there is room for growth. By comparison, about 70 percent send and/or receive text messages and about 40 percent access the internet.
NPH: What will spur greater growth?
Susannah Fox: We’ll see some demographic changes. As people currently in their 20s, who are significant users of mobile devices, move ahead into different stages of their life, that can change how many people are doing mHealth searches.
The other thing that could change is that on the supply side, more organizations are making sure their websites and other content is mobile ready, making sure it’s possible to read something or forward something or share it on a social network site. And, add in mobile users to internet use and the differences between white adults and African American adults, for example, disappears. Mobile use could have an effect on other digital divides in the future, but for now, our research shows that its greatest effect is among minorities. For example, use of cell phones or mobile digital devices to find health information is 21 percent for Latino adults, but only 13 percent for White adults.
NPH: What else from a health perspective would someone use their mobile device for?
Susannah Fox: Going beyond search, there is text messaging and the opportunity for creating public health messages that are interesting and engaging and funny and that people want to forward to their friends.
In the health app market, up to date data shows us it’s pretty stable. Eleven percent of all adult cell phone users have downloaded an app that helps them manage their health, a statistically insignificant difference from the 9 percent of adult cell users who reported having used a mobile health app in September 2010.
And a new report shows that mobile enables people to be location-aware and let them find information that relates to exactly where you are at any time of the day or night. This could have an impact on health searches such as looking for clinics and providers.
We’re still really at the early adopter stage for online health though—social media, engagement in e-patient networks, health apps. It’s still a small group that really is engaged to share with others, or is tracking some aspect of their health on their mobile device. We’re watching to see when it will engage a wider population—will it be a monitor that reports to you? Or perhaps when clinicians engage and encourage patients to go online.