We wanted flying cars, instead we got 140 characters
– Peter Thiel, legendary venture capitalist
Humanity has made amazing strides in the last few decades, but many are beginning to question whether we have lost our ability to innovate in the spaces that need it the most. Healthcare is one of the most painful examples. Even the very first step, scheduling an appointment, can be a frustrating and drawn out process. Why is one of the most important aspects of our well being so neglected by the innovation economy?
The barriers are not just technical, ones that technologists are used to conquering with time and tenacity. The intimidating list includes:
- Huge regulatory issues, including HIPAA (which charges $50,000 per violation minimum)
- Challenges selling enterprise software to risk-averse medical systems
- The difficulty of putting oneself in a user’s shoes
- How could you imagine what it’s like to be a surgeon, and reach inside of a person’s abdomen to sew their organs together?
This is most stark when considering mobile technology, a space where eye popping gains made in consumer technology. It’s particularly well suited for one of the challenges of healthcare: That it happens in the large, poorly organized, and unreliable physical world. Not only that, but most health issues can’t just be fixed during a visit to a well-equipped clinic. They require constant touch points with the patient, requiring treatments to be available to them 24/7.
Leveraging mobile technology that patients have within arms reach nearly every waking second makes all the sense in the world. But do these technologies work? Using clinical trials (the exact same scientific method used to prove the effectiveness of a new pharmaceutical) researchers are testing mobile health-based clinical interventions.
Mobile Health clinical trial proposals have grown 30% in the last 12 months, as compared to the 12 months before
It feels like overkill for “technology” that can be as simple as a morning text message reminding patients to take their medicine. But when people’s lives are at stake, it’s critical that we understand what really works. And they’re doing so with remarkable rapidity, compared to even just a few years ago:
Time series look at the number of studies proposed to the US National Institute of Health which include mobile technology in their public summary
In some cases, the mobile application is a small part of a complex rehabilitation program. For example, patients who had undergone a risky heart surgery were given postoperative care that included a variety of mobile follow-up methodologies, including text messages.
Abstract: In this randomised, double-blind, pilot study, the investigators aim to assess whether a telerehabilitation strategy could improve outcomes among patients with recent heart surgery. Included participants will receive a comprehensive rehabilitation programme comprised of physical therapy, nutritional counselling, psychological assistance in addition to standard medical care. After 12 sessions of physical therapy, patients will be randomised to receive telerehabilitation with a portable EKG device and a smartphone application or usual care. The primary endpoint for this study is the exercise capacity of included participants, which will be assessed using an ergospirometer at 4 and 8 weeks after randomisation.
Sometimes, the trials focused on basic science, even questioning some of our most fundamental assumptions about health and fitness. One trial wanted to test assumptions about how much energy a person really does use in a normal day, taking advantage of a smart phone’s ability to literally count their every step.
Abstract: The aim of this study was to find functions for estimating energy expenditure in free-living conditions. This method was based on accelerometry data acquired from a smartphone worn in a trouser pocket. The developed functions have been compared to the estimations provided by research devices named Armband and Actiheart.
Each of these types of study, including treatment of disease, support for those suffering from a chronic condition, and a variety of other focuses (including Health Services Research, Diagnostic and Screening) has grown in the last few years, although ‘prevention’ appears to be shrinking as a proportion
The most stark shift in data is the rise of the Mobile App in this research. It’s interesting that, although the iPhone was introduced in 2007, it wasn’t until mid-2012 that we saw researchers explicitly referencing apps in their abstracts. They may have wanted to wait until a sufficient portion of the population could be counted on to have a smartphone before emphasizing their use. It’s also important to remember that smartphone usage is likely anti-correlated with healthcare usage, because elderly patients are generally going to be late adopters.
Apps aren’t the only ways that advanced technology can be integrated with the phone. Additional hardware can also be added to the phone, tapping its screen and processing power. A great example is Kinsa, which writes about its thermometer and app:
The idea behind Kinsa and our mobile app is not to reinvent the wheel. We took the thermometer – an already ubiquitous health tool in the home – and made it smarter by connecting it to a mobile phone.
It’s clear that the impacts of this technology on research will be tremendous, but there are further questions to be considered when working with the medical establishment.
- Culture: fail-fast innovation can mesh with the understandably cautious approach that doctors take when lives are in their hands.
- Privacy: Almost everyone has, at least once, inadvertently shared more widely than expected on a social network, or let their smart phone ‘outsmart’ them.
- Regulation: Lawmakers have a tough job in this modern world, as every one of the systems that they regulate becomes more complex. The intersection between two of them is bound to be even harder to comprehend.
All of this is why the brave companies (both enterprise and startups) in the mobile health space have to both be walking a tight rope between risk and innovation, while constantly pushing the boundaries of what’s possible. It’s amazing to think what has been achieved in such a short time and, if the scientific research is any indication, what we have to look forward to.