Mobile Health: Will it meet its Big Expectations?
Mobile Health understood as the ability to receive and share information about one’s health with the help of mobile devices (such as tablets and smartphones) has created almost a universal excitement. The growth of mobile applications boosted from 40.000 in 2012 to nearly 100.000 in the first quarter of 2014 , that is almost 2.5 times. According to the Research2Guidance study (mHealth App Developer Economics 2014.The State of the Art of mHealth App) the application market is developing with exceptional speed – 15 times faster than the growth rate of stationary internet users .
But has mHealth really met the expectations of patients and caregivers? Apparently not yet. The majority of applications offered to consumers were predominately designed for healthy people aimed to stay so as long as possible. Fitness and Wellness constitute the largest chunk of commercial applications on the market, with respectively 30.9% and 15.5% .
But what is the offering for people who already have problems with their health conditions? Elderly or chronically ill, with ischemic heart disease, COPD or stroke? Although there are promises that applications for chronic diseases will overwhelm the market with 31% share outpacing fitness by 3%, there are still concerns about the quality and functionality of those applications. Will they help people to diagnose their illnesses earlier? Get a better treatment? Or will they remain simple trackers of multiple data assembled by patients from all sorts of medical devices? Data that doctors seldom seriously consider?
I have tried myself several heart rate apps from different app stores. Almost all of them showed drastically different results being extremely sensitive to the exact finger position or pressure inadvertently exerted on the camera. Often the results indicated that I was more dead than alive with my pulse at the level between 30 and 40 bpm.
Is it not the reason why from 40,000+ mHealth apps available in 2012 only two thirds were actually used after being downloaded? 26% were used only once, and almost two thirds were abandoned by the 10th use. The most frequent reason of abandonment: the app was not easy to navigate or lacks useful functionality .
The skepticism in the clinical value of the majority of commercial mHealth apps is supported by the results of the study Comparison of Mobile Apps for the Leading Causes of Death among Different Income Zones: A Review of the Literature and App Stores in June 2013. After reviewing commercial applications from the major app stores (Google play, iTunes, BlackBerry World, and Windows Phone Apps+Game) researchers from the University of Valladolid, Spain came to the conclusion that only 557 applications (out of over 2000 they have initially picked up) were helpful to tackle the leading causes of death in the World. True, only English language applications were considered, but nevertheless given that the total number of commercial health apps at that time was approximately 40.000, less than 1.4 % being related to top major killers of the world seems rather meager.
Applications related to medical diagnostics so far constitute only 1.4% of the total commercial health apps according to the study .
With the emergence of non-invasive medical sensors like ECG or glucose meters, there is a hope that the new wave of health diagnostic applications will appear on the market. At least about half of apps publishers emphasized that the availability of devices and sensors to be connected to an app is the most important requirement for a mHealth application.
A prototype approach to sensor driven solutions was exercised already in 1980 by Biosig Instruments, a Canadian company designing and manufacturing electrophysiological fitness systems. This company has developed a number of devices performing sensor measurements of the body health parameters.
Later the Israeli company LifeWatch, has produced 1 and 3-channel ECG designed for remote arrhythmia monitoring in any location. A German company Infratec, has already in the beginning of 2000 developed a monitor that uses principles of thermal emission spectroscopy and noninvasive measurement of tympanic membrane glucose concentration in diabetes patients . The list of the examples can be prolonged.
So what does stop us from mHealth Eldorado? Four things are coming to mind.
- Reliability of sensors and devices. Today even standard blood pressure devices may show the results differing by 20mm/Hg, this substantial inaccuracy being considered an acceptable error. So if a blood pressure is 140 or 160, it is within the same error margins i.e. basically the same value. Will physicians trust the results of portable mobile ECG or blood pressure devices obtained with such accuracy?
- Understanding that patient is not a hub to stuff his living environment with an abundance of applications and sensors. A widely acceptable secure and open platform is required to provide people with an easy single entry point connection to multiple applications, databases and devices through open APIs.
- Visibility and easy access to mobile health applications instead of a prolonged search through multiple sites and App Stores.
- Sustainable business model that will allow physicians to receive reimbursements for online medical services they provide as well as the clear understanding of responsibilities. For example, if remote diagnostics had a negative impact on a patient, who is responsible? The distant consultant, physician in charge, an application or a system developer?
But the new wave of much more sophisticated sensors related to diagnostics is irrevocably approaching. The scientists from the Weizmann Institute in Israel have recently made a breakthrough with a microscopic device that operates autonomously inside bacterial cells. The device“scans” the cell to see if all genes in it are expressed as they should. The detected malfunctioning molecule will cause a disruption in gene expression thus allowing one to diagnose the danger on a very early stage .
The recent Samsung Simband cloud platformthat will enable to “gather vital diagnostic information – from your heart rate to your skin’s electrical conductivity, 24 hours a day, seven days a week” is one of the newest promises of the sensor driven healthcare.
Apple is about to announce in October 2014 its mobile HealthKit that will connect a vast array of healthcare devices and applications, from monitoring your activity level, heart rate and weight to your chronic medical conditions such as high blood pressure and diabetes.
Microsoft is coming with a Surface Smart Watch that will include multiple sensors such as heart rate monitor, accelerometer, gyroscope, GPS and a galvanic skin response detector (to measure the changes in the electrical resistance in the skin using sweat). The received integral information can be connected to Microsoft Health Vault, an open platform for storing and sharing health related data like images, medications and vital signs.
If all promises are fulfilled, a different paradigm of healthcare will evolve as compared to today’s mainstream medicine. The development of non-intrusive sensor-based techniques of picking up parallel information from multiple body areas in real time, thus measuring the distributed state of human health can provide better understanding of the organism stability margins, the emergence of diseases as well as ensure more patient safety under drug and physiotherapy prescription .
Hopefully, with big vendors like Apple, Microsoft or Samsung stepping into the game, the barriers will be surpassed and some of us may enjoy the transformation of Mobile Health into the trustworthy Measurable Health.
1.mHealth App Developer Economics 2014.The State of the Art of mHealth App Publishing http://research2guidance.com/r2g/mHealth-App-Developer-Economics-2014.pdf.
2.MobileSmith. Patient Engagement and Mobile Aps http://www.mobilesmith.com/wp-content/uploads/2014/01/Patient-Engagement-with-Mobile-Apps-The-DIY-Guide.pdf.
3. mHealth App Developer Economics 2014.The State of the Art of mHealth App Publishing http://research2guidance.com/r2g/mHealth-App-Developer-Economics-2014.pdf.
6.Mobile Health: A Conceptual view. Horizon Research http://www.hrpub.org/journals/article_info.php?aid=1273.