Patient Engaged: Preventing and Managing Disease With Mobile Technology

Dr. Kevin Campbell

According to a Pew Research Center report released last month, Americans are engaged and connected like never before. Nearly 70 percent own a smartphone, and 45 percent have a tablet-like device. It's clear that almost all of us interact with mobile devices on a daily basis. Wearable sensor technology as well as connected watches and other mobile monitors are becoming more commonplace. And these new devices have the potential to significantly impact health care delivery in the U.S. today.

Data from numerous studies focused on the long-term management of diseases, such as diabetes and high blood pressure, have shown that when patients are engaged and actively participating in their care, outcomes improve. New devices and tools that incorporate the technology and power of the now ubiquitous smartphone have the potential to become an extension of a patient's health care provider and may ultimately change the way in which patients interact with the medical system in the future. Moreover, these devices may allow public health officials to better monitor and screen for diseases in large populations and ultimately help improve preventive strategies and access to care for millions of Americans.

This month, at the American Heart Association's annual Scientific Sessions, a cardiovascular conference that attracts researchers from around the world, data was presented demonstrating that when patients used mobile devices to track diet and activity behaviors -- in combination with remote "coaching" from a health care professional -- they actually made better choices and adopted healthier lifestyles. Specifically, the study showed that those patients who were engaged via mobile devices actually increased fruit and vegetable intake, decreased sedentary screen time and decreased their saturated fat intake. In addition, engaged patients appeared to have increased moderate-to-vigorous physical activity. Mobile engagement helped make all these behavioral and lifestyle changes possible, which will most likely result in lower risk for heart disease over the long term.

While there are only a small number of studies that have systematically evaluated the power of mobile technology in improving the health status of Americans, these devices have great potential to not only help change behavior and track symptoms but also may have significant applications in the treatment and ongoing management of a chronic diseases. Mobile technologies that facilitate self-monitoring and provide real-time feedback may be a key component of preventive medicine in the future.

Medical apps are being created at a rapid pace and the Apple's new HealthKit has created a platform by which data can be collected and shared with health care providers. Many prominent academic institutions are now utilizing mobile technology to conduct important clinical trials that will provide more insight and potential solutions for ongoing public health challenges. As these new technologies emerge at a rapid pace, the question arises: How can consumers choose a particular application or mobile medical device that best suits them?

Safety and efficacy concerns have prompted the Food and Drug Administration to draft a statement on mobile applications and technologies. However, the organization has made it clear that only certain apps will be regulated and reviewed. Apps that "transform" the smartphone or tablet into a medical device will require FDA review, while those that simply track activities or habits will not be subject to the same scrutiny.

The FDA states that an application is "transformed" into a medical device when it enables a sensor or an attachment such that the device can perform patient-specific analysis, diagnosis and monitoring in any way that ultimately provides patient-specific treatment recommendations. The FDA will also regulate any application that connects to and functions as a controller or monitor for a separate medical device. Applications that serve as health trackers, clinical calculators, data collectors or coaching apps will not be regulated.

An example of a mobile-friendly technology that is likely to have an enormous impact on cardiovascular health is the AliveCor mobile ECG system. This device, developed by Dr David Albert, a cardiologist and medical entrepreneur, allows a user to obtain a real-time heart rhythm tracing known as an electrocardiogram -- also referred to as an ECG or EKG -- from their mobile phone. I serve on the medical advisory board for the company, and have come to appreciate the significant impact that mobile devices are likely to have on patients and families in the future.

The AliveCor device has received FDA clearance and the company plans to release another version that will allow health care consumers to obtain a real-time ECG on their Apple wristwatch in the coming year. This type of technology puts a very powerful medical tool in the hands of patients, who are then able to assess their heart rhythm by placing their fingertips on electrodes attached to their smartphone. The ECG can then be transmitted to their physician in order to facilitate medication changes, assist with medical decision-making and help health care providers triage emergencies. Most importantly, the technology allows the patient to better interpret their own symptoms and gauge the impact of certain behaviors on their health status.

Mobile technologies in medicine also allow patients in underserved or under-supplied areas to potentially have access to better care and better tools to manage their disease without substantial cost. For example, in addition to promoting patient engagement and influencing patient lifestyle choices, the AliveCor technology has been shown to help reduce serious complications associated with a particular heart rhythm disorder known as atrial fibrillation.

AF is the most common heart rhythm problem in the world and is associated with a substantial increase in stroke risk. When at risk patients are found to have AF, they are placed on blood thinners to prevent stroke. However, in many cases, the AF may be asymptomatic, patients are unaware of their risk and are ultimately not protected from a devastating event like a major stroke. In small clinical studies, the AliveCor device has been shown to be an effective tool in screening populations for AF and has resulted in the prevention of stroke in a number of patients.

So, while it's clear that there are many benefits to using health-related mobile tools to improve our individual health, the question remains: How can health care consumers navigate the seemingly endless digital offerings available today? Here are a few simple steps for selecting a health-related app for your mobile device:

-- Determine your health and fitness goals and assess your particular needs. Research applications to see which apps are geared toward helping you achieve your specific health goals.

-- Explore how highly apps are rated by previous users. When you go to the App Store to download an app, you can read reviews of other users. These are typically fairly reliable and give examples of pros and cons of any application. In addition, searching the app online may produce a plethora of user reviews.

-- Discuss goals with your physician and determine if a potential app is designed to help with the management of your particular condition, such as Glucose Buddy for diabetes and blood sugar management, AsthmaSense Cloud for managing asthma and Smart Blood Pressure, or SmartBP, to help control hypertension. You might also talk with your doctor about tracking apps, such as MapMyFitness and Apple's HealthKit for activities, diet and exercise. Your health care provider can help you set up the app and establish goals.

Mobile technologies are the future of health care. With more administrative demands placed on doctors and other health care providers, time with patients has become increasingly limited. In order to provide the most comprehensive care, physicians must find other ways to both engage and monitor patients. Devices that can be incorporated into smartphones, tablets and other connected technologies will be a critical part of improving outcomes for patients going forward.

Patients are more Internet savvy and nearly 75 percent of all patients turn to the Internet for information immediately following a visit with a physician. Technology promotes education and knowledge, and when patients are more informed, they are better able to manage their disease. Mobile technologies have the potential to transform health care in the future -- and as health care consumers, we must embrace these technologies and learn to use them to promote better health.