Improving patient care: Smartphones and mobile medical devices

The world is a much different place since the iPhone was released this month just 6 years ago in 2007. Because of our smart mobile devices, we talk, text and tweet, shop wisely, travel expediently, and socialize even when alone. Our smartphones and tablets challenge us with games, amuse us with music and books, and entertain us with television shows and movies. As they have become everyone’s constant companion, patients and parents waiting for medical visits use their mobile devices to play games or read e-mail, play music, text a friend, or watch a video. No one is bored while waiting anymore, and empty time is always put to good use.

This universal devotion to mobile devices provides pediatricians with an opportunity to encourage our patients to improve their health and comply with recommendations. In this installment of Pediatrics V2.0 we’ll detail several of the many medical devices that interface with smartphones. It’s truly amazing how many of these affordable gadgets are now available, and how many more are in development and will be released in the near future.

Computers in disguise

What makes smartphones so “smart” is that they are not just phones; they are powerful portable computers that retrieve or transmit information via telephone or wireless networks. Best of all, smartphones are affordable and integrate seamlessly with other computers and smart devices we possess. This makes smartphones an ideal physician assistant for encouraging patients to follow our recommendations. For example, an overweight teenager may be less than motivated to modify his or her diet and exercise following a conversation with a pediatrician. This may be an entirely different story when the adolescent is informed that “there is an app for that” and a new affordable gadget will help him or her reach specific goals.

The “gamification” of health care is the latest strategy for motivating pediatric patients and their parents to make efforts to adopt a healthier lifestyle. Gamification is driven by data collection and interpretation. Patients use applications and monitoring devices to document compliance with treatment regimens and to visualize progress and goals achieved. As gamification of medical care evolves, we are likely to see patients rewarded for success by insurance companies with cash incentives, reduction in medical care premiums, or other tangible incentives.

New opportunity for diabetes care

One of the best examples of smartphone and medical-device integration is the iBGStar glucose monitoring system from Sanofi-Aventis (Bridgewater, New Jersey). This is a 2-inch-long device that plugs into the bottom of the iPhone and integrates with the iBGStar application. A test strip is inserted into the device and a drop of blood is applied. The patient is rewarded with a snazzy animation as the device calculates the blood glucose and the application displays the result. One can review previous readings and use the application to monitor for trends. The application also lets your diabetic patient input carb counts and insulin dosages. The data displayed in the application clearly illustrates the effect these have on the patient’s readings. Best of all, the user can share the log of information with a nutritionist or medical provider by e-mail. The device is very affordable at $99.

Other smartphone-integrated glucose meters are or will soon be available and provide different connectivity options. The Telcare BGM (Telcare; Concord, Massachusetts), the company’s very popular $150 glucose meter, currently features phone network connectivity and uploads all readings inconspicuously to the cloud. Data can be accessed via the MyTelcare.com Web portal and the data syncs with a smartphone application. Via the Web portal, trends can be reviewed and printed, and the device even reminds users when it’s time to order supplies.

LifeScan Inc (Milpitas, California), which markets a full line of sophisticated glucometers, recently received US Food and Drug Administration clearance to market its OneTouch VerioSync Blood Glucose Monitoring System that will connect to smartphones and tablets via Bluetooth. It is likely to be available by the time you read this.

Getting fit

Over one-third of children in the United States are either overweight or obese, and pediatricians try to encourage overweight children to modify their lifestyle via adoption of healthy eating habits and regular exercise. Mobile technologies have made it possible to gamify fitness and motivate children who welcome competition with friends and interaction with computers.

A very popular kid-oriented mobile fitness device is the Zamzee Activity Meter (Zamzee Co; Redwood City, California). Parents can purchase the mobile device for $30 and “skin” it with appealing designs and colors. The device is clipped to a belt or shoelaces. At intervals, the meter is plugged into a computer via the USB port and the uploaded data is reviewed via a child-friendly Zamzee portal. Children earn points and badges based on goals and can level up when milestones are achieved. Motivation can also be augmented with rewards parents can purchase for children. These can be redeemed at the Zamzee online reward store or can be exchanged for gift cards to Amazon, iTunes, GameStop, and many others. According to the Web site, the effectiveness of the Zamzee device has been studied in more than 448 children over a 6-month period and its use is associated with an average activity increase of 60% compared with non-Zamzee users.

Teenaged patients really like stylish “kicks” (aka sneakers or shoes) and those who are interested in getting fit might be interested in Nike’s full line of smartphone-connectible activity-monitoring products. These include a wireless sensor that fits in a special pouch in the heel of the Nike+ line of sports shoes and communicates wirelessly with an iPad Nano (via a special receiver) or smartphone; a GPS/activity-monitoring watch that plugs into a computer’s USB port; and the new FuelBand system that connects to smartphones via Bluetooth. Prices range from $30 for the sports kits that include a sensor and receiver for an iPod Nano, to $150 for the FuelBand system, to $169 for the Nike+ SportsWatch GPS. All data can be viewed via an application on a smartphone or via the Nike+ Web portal.

In addition to the activity monitors just described, dozens of other fitness-monitoring systems are available. These keep track of distances traveled, calories burned, and many also track other important fitness parameters such as heart rate while exercising and duration and quality of sleep. Time will tell if these ultimately will prove worthwhile for patients who wish to lose weight or improve their level of fitness.

Another interesting device that could potentially facilitate weight loss is the Hapifork, soon to be available from Hong Kong-based Hapilabs Ltd. The device teaches patients to eat at a slower pace. If food is consumed too rapidly, the device vibrates and flashes to warn the user to slow the pace of eating. The device connects to a smartphone via Bluetooth or uploads data to your computer via USB, then syncs with the Hapilabs Online Dashboard, a Web portal that keeps track of how long a meal takes as well as the number of fork servings per meal and the interval between bites. The device comes in a number of appealing colors and can be cleaned in a dishwasher. Many are optimistic that this simple device will make a profound difference in assisting our obese patients to pace themselves during mealtime, so satiety is achieved before overeating occurs. As of this writing, the price of the Hapifork has not been set.

Lastly, Withings.com markets a full line of affordable smartphone-integrated products to help parents monitor the health and well-being of their children. The company sells a full-featured baby monitor that transmits high-resolution video and sound over a wireless network, phone network, or Bluetooth so parents can view their baby on a smartphone anywhere and anytime. Parents can talk with their baby, play a lullaby, and be alerted when the baby cries or fusses. The baby monitor sells for $250. Withings also markets a baby scale that syncs via a wireless network or Bluetooth with computers and smart devices. The app keeps track of feedings and plots the child’s weight gain on gender-specific growth charts. The baby scale is $180, and converts to a child scale simply by removing the cradle.

Withings also sells a $150 fitness scale that monitors weight, body mass index, and heart rate, as well as a smartphone-connected sphygmomanometer. The $129 sphygmomanometer helps patients monitor their blood pressure readings and the effect that medication, diet, and exercise have on improving blood pressure. Data can be shared with providers via e-mail or via a secure patient portal.

Breathing easier

Several mobile devices can assist parents in the home monitoring of children with respiratory problems. For many children, peak flow meters are used to monitor respiratory status, and many smartphone applications such as Asthma Buddy, Asthma MD, and asthmaTrack can be used to track peak flow reading scores, medication use, and exacerbations. Pulse oximeters have come down in price significantly and several are now being sold in pharmacies for as little as $40. These can determine whether an asthma exacerbation is associated with a falling pulse oximeter reading and thus warrants an expedited medical evaluation. The iSpO2 from Masimo (Irvine, California) is the first iPhone-connectible pulse oximeter. It has a special application that displays the pulse oximeter reading along with the pulse and the perfusion index and keeps a log of readings so these can be reviewed with physicians to guide therapy. The device sells for $250.

Asthmapolis (Madison, Wisconsin) is releasing an innovative sensor that fits atop standard controller and rescue inhalers and syncs with a mobile app via Bluetooth. By using the Asthmapolis sensor, patients will be able to provide their physicians with information that documents compliance with controller meds as well as the frequency and location (via GPS) of rescue medication usage. Previously, physicians had to depend on patient and parent reports regarding compliance and exacerbations. The use of the new device and its ability to present objective data may facilitate creation of new personalized strategies for improving asthma management.

Lastly, iSonea Ltd (Melbourne, Australia) manufactures a handheld acoustic monitor called the Wheezometer for documenting asthma symptoms in patients. The device analyzes a 30-second record of a child’s respiratory noises and produces a measurement called the WheezeRATE. The device is being promoted as an adjunct to oximetry, peak flows, and asthma scoring as a means to document the presence of asthma symptoms and response to therapy, both long-term and during acute exacerbations. The company has also announced that it anticipates the production of a new smartphone-connected AirSonea system before the end of this year. The system will link a new version of its respiratory acoustic monitor to a smartphone application that displays the device’s readings.

In the office

Patients are intrigued by all the medical gadgets and gizmos we use in the medical office, and they may be even more interested if you integrate mobile devices into your own practice. The advantage of doing so is that the mobile applications excel at showing patients the significance of measurements. If we show patients that we feel mobile devices are accurate and reliable enough for office use, we encourage patients and parents to consider using mobile health technology at home when indicated.

Of the devices mentioned above, smartphone- or iPod touch-connected glucose meters, pulse oximeters, blood pressure cuffs, and wireless scales and baby scales provide affordable alternatives to our standard office devices. In addition to these, you might also be interested in purchasing a few others that either are presently available or will soon be available.

AliveCor (San Francisco, California) offers a $200 heart monitor that snaps on an iPhone and enables the smartphone to function as a single-lead electrocardiogram (ECG) recorder. The device is either held by the fingers of both hands or placed on a patient’s chest, and the device displays the ECG along with the heart rate. The device can display a continuous ECG and record up to 30 seconds of a rhythm strip that can be captured and electronically transferred via the cloud. Although not a substitute for a Holter monitor, the device is capable of capturing abnormal rhythms in patients you suspect may have a dysrhythmia on auscultation or via a pulse check.

Another device that may be available by the time you read this article is the Remotoscope from CellScope Inc (San Francisco, California), now in development. An attachment to a typical smartphone gives the user the ability to visualize and photograph the tympanic membrane in high resolution. If the optics are as good as I expect, I see the Remotoscope being a useful tool in educating parents about the diagnosis and treatment of otitis media or otitis externa.

Where do we go from here?

Clearly a new age of mobile medical gadgetry is in its infancy and evolving rapidly. We now have the ability to encourage patients to use smartphone-connected devices to lose weight, exercise regularly, and adhere to our recommendations for management of obesity, diabetes, asthma, and hypertension. These devices also provide your practice with the opportunity to gamify some aspects of health care, improving the likelihood that children may adopt a healthier lifestyle.

DR SCHUMAN is adjunct associate professor of pediatrics at the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and an editorial board member for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organization that may have an interest in any part of this article.