Forget about mHealth reality – look how good the future might be!

An interesting article by Iltifat Husain MD, reporting at iMedical Apps on the research work being conducted at Worcester Polytechnic Institute.

I’ve had a difference of opinion with Iltifat’s perspective of mHealth innovations before and it became quite a protracted debate but as with the Apple twinned devices from iHealth Labs (that went onto make record sales after being picked up by Apple stores) I’m pretty sure he’s once again missing the opportunity by a country mile:

Forget about peripheral mhealth devices, researchers use smartphone video camera to monitor useful vital signs

Of course this focus isn’t new (asides from Azumio’s work there’s also the Smart Agent app from HealthSmart, the Vital Signs camera app for iPad from Philips, even our service 3G Doctor doesn’t require any peripheral devices to put an informed Doctor in your pocket) but as a big fan of peripheral mobile devices to support revolutionary new mHealth services (eg. the Alivecor iPhone ECG case, FireText Smoke Alarm, SendCit non-invasive fall monitor, location based emergency call handling, etc, etc) I think it’s a bit too strong a reflex especially as Iltifat doesn’t mention that he has actually tried the promised new monitoring abilities being developed at WPI for himself yet.

As I mentioned here on my blog 3 years ago, the reality is that all too often the path to adoption in healthcare requires regulatory approval and when you consider the rate at which smartphones are advancing it seems obvious to me that regulation of an accessory is going to be much easier (and financially more feasible) than any converged system approach.

The type of technology used by the Worcester researchers is far and above more useful than a simple heart rate monitor, such as the Instant Heart Rate app. Recently, the Instant Heart app makers received millions in funding – I hope it wasn’t based solely on the heart rate monitor app they have developed. Having a a patient’s heart rate alone isn’t that useful for a clinician, and it’s extremely easy to measure your heart rate on your own, just put your fingers to your wrist or neck

I disagree with this for several reasons:

> Business model

Comparing and contrasting a commercially successful consumer mHealth app developed by a self funded mobile app developer is vastly different to some research that’s been done so far only behind the closed doors of an University.

As someone who has been testing pulse monitoring mobile phones for more than 5 years I think it’s fair to say I’m in a good position to appreciate the work that Azumio have put into designing their Instant Heart Rate app. We should not underestimate or dismiss the value of developing this as a consumer product – making something that people are willing to pay money for is a critically important step change for the healthcare market.

Personally I think it’s a bit harsh to be critical of a mHealth app developer for taking millions in investment especially after Azumio had already done so much pre-investment to prove it’s first mover advantage (8 million + downloads anyone!).

> Clinical Value

“Having a a patient’s heart rate alone isn’t that useful for a clinician” is a statement that ignores the rather obvious fact that this app is designed to be used on a patients mobile device with little/no training. It also ignores the nicely implemented testing reminder alert notifications that Azumio have added. Patients presenting with data are a massive bug bear for their clinicians and the Instant Heart Rate app has worked hard on presentation which helps simplify the sharing of this data.

Iltifat goes on to suggest “it’s extremely easy to measure your heart rate on your own, just put your fingers to your wrist or neck”. I disagree and think Iltifat would do well to consider not only the additional ease of use but also the challenges some patients experience eg. your ability to accurately measure your heart rate can be affected by age, obesity, the presence of disease (eg. diabetes, atherosclerosis), etc.

Of course it’s easy to say my pulse beated X times in the last set amount of time but this needs at least several seconds of concentration in a quiet environment, it can’t measure variation in pulse frequency (which can itself be indicative of serious health risks), it doesn’t automatically document it, it’s not charted so the patient wouldn’t neccessarily be able to say if this is normal/fast, its not automatically documented (something that makes it easy to keep a record of HR, record recovery rate, etc), etc.

As a big plus for the Instant Heart Rate app there’s a lot of value in documentation as it’s extremely easy for a patient to forget to regularly test themselves. Sensitively timed automatic reminders and automated tabling of results removes several major inconveniences for patients.

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