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Medical Apps

Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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Cancer, Medical Apps, Stanford News, Technology

Using a smartphone and the Folding@home app to advance disease research

Using a smartphone and the Folding@home app to advance disease research


Smartphones now have the power that personal computers had a few years ago, and more and more people have them. So researchers are developing ways to harness that computing power to solve pressing biomedical problems.

As described in a Stanford News piece, Stanford’s Vijay Pande, PhD, in partnership with Sony, recently developed a smartphone app that “folds” proteins while the phone’s owner sleeps. “There are a ton of people with really powerful phones, and if we can use them efficiently, it sets the stage for something really great,” said Pande, a Stanford chemistry professor.

This particular mobile app, called Folding@home, investigates the biology of diseases, including cancer, Alzheimer’s, and Parkinson’s disease. It’s an extension of the Folding@home distributed computing project started in 2007, and it’s now available on GooglePlay.

Disease biology is dependent on proteins, which are complex linear chains of molecules that become “folded up”, like snarled balls of yarn. The chain needs to be absolutely correct; any mutation that shifts a few molecules out of place will cause the protein to not work optimally, not work at all, or, worse, work in a way that does damage to the organism.

Understanding protein configurations is key to developing cures for disease. While real proteins take milliseconds to curl up, simulating this process with computers takes thousands of hours. But if 10,000 people download and use the Folding@home app, and it runs 8 hours a day while the phone is not otherwise in use, the team’s first research question could be solved in three months.

The app’s first focus is a kinase protein found in breast cancer. It seems that different people’s tumors respond differently to the several drugs available; currently, doctors use a guess-and-check method to choose a drug, but information derived from the proteins could enable doctors to choose correctly on the first try. In something as time-sensitive as cancer, this could save lives.

Next up for the app is a project related to Alzheimer’s disease. Eventually, if enough people enroll, the researchers could launch several projects simultaneously, allowing people to choose to take part in one that is personally meaningful.

Image of a protein Argonne National Laboratory

Events, Medical Apps, Medicine X, Stanford News, Technology

Countdown to Medicine X: Specially designed apps to enhance attendees’ conference experience

Countdown to Medicine X: Specially designed apps to enhance attendees’ conference experience

Figure 3 - BlanketLast year’s Stanford Medicine X conference explored ways in which technology could be used to augment the attendees’ experiences. During breaks between sessions, organizers used specially developed software to transform television screens set up in the lobby outside the main auditorium into interactive spaces where participants could exchange ideas. On one screen, attendees used their mobile phones to text their reflections on previous sessions or respond to prompts such as: “What’s your dream for health care?” The texts appeared as yellow sticky notes on a virtual corkboard. Another screen served as a digital journal where participants could text comments about what they learned and have them displayed to a wider audience. As people walked up to the screen to read the contextually relevant content, they naturally started conversations. In an effort to bridge the divide between the people who were physically present at the conference and those who were watching the live-stream from other locations, an additional screen broadcast tweets from around the world in real time.

This year, conference organizers have developed three iPhone apps for Medicine X based on Apple iBeacon, a Bluetooth-powered location system. “When we heard about the iBeacon technology, it was clear that it would fit really well into a conference setting as well as being useful for allowing people to interact with the large-screen displays,” said Michael Fischer, a PhD student in computer science in the MobiSocial Lab at Stanford, who helped develop the app. “We brainstormed all the possible ways that the iBeacon technology could help people participate in the conference and came up with some ideas that we are excited to test out at the upcoming conference.”

In anticipation of this year’s conference, I reached out to Fischer to learn more about how the apps will further enhance attendees’ experience at Medicine X. Below he explains how they will facilitate networking among participants, allow them to provide feedback or rate speakers and serve as a sort of “flight-attendant call button.”

Can you briefly explain how the apps work?

One app allows us to extend the Wellness Room, so that people can request items without having to go to the room and miss part of a session. The Wellness Room provides special amenities, such as warm blankets or a place to rest, to assist patients in managing their conditions during the conference. The room was designed to help patients physically attend the conference who might have otherwise not been able to. For example, a previous ePatient attendee had a medical condition called cryoglobulinemia, which causes proteins known as cryoglobulins to thicken if the ambient temperature drops too low. If this were to occur, it could lead to kidney failure and would be life threatening. So it’s crucial for this patient to keep warm. Using the iBeacon technology we were able to develop a system that allows people to use an iPhone to request a blanket or other item be delivered to their seat. There will be iBeacons on all the tables in the room so that the phone will automatically know where you are sitting. All the requests will be forwarded to a volunteer who will bring the item directly to the table.

Another app will be used during the breaks to help people get to know each other. The application works by displaying short bios on a nearby TV screen. In this way, the screen acts as a type of watering hole that people can gather around. When new people approach, their bios will be added to the screen. When a person leaves the proximity of the screen, the bio will be removed. We’ll have multiple screens set up around the conference. Our hope is that people can find a group that they might not yet be familiar with. The service is opt-in and people can switch to and from stealth mode at any time. Conference-goers will also have the option to forgo this app altogether.

Lastly, we have developed a feature that will be used at check-in. We want to create an experience that will surprise and delight people from the moment they step into the conference. There is a tradition at Stanford during freshman year that when you first come to your dorm, the dorm staff yells out your name. It is pretty big surprise and makes you feel part of the community instantly. We wanted to replicate that experience as best we could for the conference.

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Medical Apps, Stanford News, Technology

A Stanford physician shares his experiences creating evidence-based medical apps

iPad_080814A piece published earlier this week on iMedicalApps spotlights the work of Steven Lin, MD, a clinical instructor in family medicine at Stanford who is the co-creator of two evidence-based medical apps. The first app he helped develop was Ilithyia, a point-of-care clinic prenatal app, and the second is L’Allegro, which helps physicians select the appropriate antidepressant for patients. From the piece:

Dr. Lin first thought about creating an app as an intern when he noted the large gap between what he had learned in medical school and what was happening in practice. He had knowledge but it was often difficult translating that knowledge into point of care practice. He first concentrated on prenatal visits as he wanted to find the evidence base for current practice and make that available to himself as well as his fellow interns.

He started with researching guidelines, community standard of care, and even insurance allowances for visits and labs. He then took this information and made a framework of sorts. Each visit had allotted information- labs, guidance, findings, etc, and this framework became the basis for how he organized his app.

Lin and partner, a programmer who was finishing his final year of high school when they started working together, plan to “work with the Society for Teachers in Family Medicine and plans to create a mobile version of their study cases” for third app.

Previously: Heart bypass or angioplasty? There’s an app for that, A conversation about smart-device use among resident physicians and Stanford AIM Lab launches patient exam iPad app
Photo by Stanford EdTech

Medical Apps, Sleep, Technology

Can sleep trackers help you get a better night's rest?

Can sleep trackers help you get a better night's rest?

As the number of self-tracking gadgets grows, many people are beginning to experiment with monitoring lifestyle habits in an effort to improve their health. In fact, seven in ten American adults say they track at least one health indicator, according to data from the Pew Research Center’s Internet & American Life Project. But there has been some concern about the accuracy of such technology.

A recent CBS News segment took a closer look at the effectiveness of sleep trackers and outlined the differences in information collected by the devices and data collected by sleep specialists in a clinical setting. Stanford sleep expert Michelle Primeau, MD, also commented, “The reason why these devices are so good is [using them] puts greater emphasis on sleep.”

Previously: Why sleeping in on the weekends may not be beneficial to your health, The high price of interrupted sleep on your health, Exploring the benefit of sleep apps and Designing the next generation of sleep devices

Medical Apps, Mental Health

Smartphone app detects changes in mental health patients’ behavioral patterns in real time

texting_070214In an effort to improve diagnosis, treatment and monitoring for mental health patients, researchers have developed a smartphone application that detects changes in patients’ behavioral patterns and transmits them to medical professionals in real time. PsychCentral reports on researchers’ findings showing the app can provide useful insights to health-care providers about patients’ daily activity and mood:

Researchers conducted two clinical trials in which the application was installed on the smartphones of 20 patients suffering from bipolar, unipolar/depressive, or schizoaffective disorders, as well as on the phones of 20 healthy participants.

Over the course of six months, the app acquired data from patients’ phones and sent the information to distant computers, where advanced algorithms analyzed the data to detect changes in patients’ sleep, communication, mobility, and vocal patterns.

The researchers further developed a visualization system that displayed the summarized information to psychiatrists, providing them with instant insight into the behavioral trends of their patients.

Psychiatrists in the trials reported that the system has already positively affected their interaction with patients, offering a useful objective “window” into the patient’s daily routine.

Patients have full control over who is allowed to access the app and information it collects. The system does not acquire or record the content of calls or texts and any identifying parameters of the patient or of his contacts are irreversibly masked and are obviously not used, according to a release.

Photo by jDevaun

Medical Apps, Public Health, Technology

Physicians discuss willingness to write prescriptions for health apps

health_appsThe mobile health market is rapidly growing, and it’s estimated that within five years 50 percent of mobile device users will have downloaded mobile health apps. While past surveys have shown that patients are eager for doctors to recommend such apps, it remains unclear if physicians feel comfortable prescribing them.

Over on MedPage Today, writer Kristina Fiore explores the potential of physicians prescribing health apps, such as BlueStar, which is approved by the U.S. Food and Drug Administration and helps patients monitor diabetes. Several of the clinicians contacted for the story said they are open to the idea, assuming that patients are comfortable using the app and that data shows the app to be effective. From the article:

Sue Kirkman, MD, of the University of North Carolina at Chapel Hill, said a prescription app could be helpful, but its usefulness may be limited in that the patients “who want the app and are willing to enter data and respond to prompts may already be the more proactive ones.”

Kirkman added that she hopes potential insurer reimbursement for apps opens the door wider to support of reimbursement for self-management tools such as contact with diabetes educators.

“Right now, pretty much only face-to-face visits are covered, not the ongoing contacts by phone, fax, email, etc., that are really needed to help someone sustain behavior changes and self-manage their diabetes optimally,” she said.

Previously: Text message reminders shown effective in boosting flu shot rates among pregnant women, Texts may help people with diabetes manage care, Why physicians should consider patients’ privacy before recommending health, fitness apps and Designing a mobile app to help patients and doctors identify personalized food triggers
Photo by Intel Free Press

Cancer, Media, Medical Apps, Technology, Videos

Weekend viewing: A roundup of TED talks on health, fitness and happiness

Weekend viewing: A roundup of TED talks on health, fitness and happiness

In case you haven’t seen it, the Greatist has a nice roundup of top TED Talks on fitness, health and happiness. If, like me, you look for practical tips on how to apply medical research and technology tools to create a healthier life, you might be interested to browse this selection over the weekend.

Among the videos highlighted is a 2011 talk by Daniel Kraft, MD, titled “Medicine’s future? There’s an app for that.” Kraft, an inventor and Stanford School of Medicine-trained physician, is an NIH-funded faculty member affiliated with the Stanford. In this TED talk he discusses apps to track quantified-self metrics and tools to improve personalized medicine. He also surveys ways medical professionals are–or soon will be–using technologies such as robotic surgery, nanomedicine, virtual patient visits, and crowdsourcing data on an exponential scale to address major challenges in health care today.

From the video:

By leveraging these technologies together, I think we’ll enter a new era that I like to call Stage Zero Medicine. And as a cancer doctor, I’m looking forward to being out of a job.

Previously: Why networks of “micro-experts” are a valuable resource for the medical communityBig Data in Biomedicine videos now available onlineBertalan Meskó discusses how mobile technologies can improve the delivery of health care and Stanford surgeon uses robot to increase precision, reduce complications of head and neck procedures
Video by TED

Medical Apps, Nutrition, Technology

Designing a mobile app to help patients and doctors identify personalized food triggers

Designing a mobile app to help patients and doctors identify personalized food triggers

IMG_2894As a fellow in the Stanford Biodesign and Gastroenterology programs, Jasmine Zia, MD, knew she wanted to combine her two passions, medicine and engineering, to create a device that would improve the delivery of patient care. But it wasn’t until she was back in the hospital closely observing the daily challenges of patients and doctors that she and her teammate, Raymond Bonneau, got the idea for an iPhone app to help patients diagnosed with irritable bowel syndrome understand how eating patterns might improve or aggravate their symptoms.

Zia recently presented (.pdf) on the app at Stanford before graduating and accepting a faculty position in the Department of Gastroenterology at the University of Washington in Seattle. In light of the growing popularity of the self-tracking movement, I was interested to learn more about her project and how the app could be used in a clinical setting. Below she discusses designing the app, the role patients played in its development, and a pilot study completed at Stanford.

Can you briefly describe how your mobile app works?

Our app, called Gut Guru, asks patients to log their meals and bowel symptoms every day for two to four weeks. This entered data is presented in a concise and organized manner on a separate screen for both users and their providers to see. Once enough data is acquired from a patient’s diary, a machine learning and pattern recognition algorithm will be applied to this data. Over time, this data will build a predictive model of symptom severity to help identify individualized food triggers.

What motivated your group to develop a tool for identifying food triggers?

Time and time again in my clinics and during hospital rounds, I was struck by how many affected patients, especially those suffering from irritable bowel syndrome (IBS), endorsed having their gastrointestinal symptoms triggered from certain foods. Prior focus groups report up to 70 percent of IBS patients endorsing food triggers. As the medical literature of functional gastrointestinal disorders and food is building, we felt motivated to bridge the gap between what we are learning from research to its practical applications in everyday life for real patients. Instead of giving a huge list of potential foods patients should avoid, we are developing a mobile app to help identify personalized food triggers for patients with irritable bowel syndrome to reduce one’s gastrointestinal symptoms, thereby improving their quality of life.

In designing the app, what specific problems did the team address?

By designing the app, we hope to address [three things]: a more complete and reliable patient food and symptom diary, a more organized presentation of the accumulated data for easier interpretation by both patients and providers, and a more validated and objective methodology for determining personalized trigger foods from a patient’s food and symptom diary.

At present, paper diaries formatted by patients are incomplete due to both limited instructions provided by the busy clinician and low compliance rates associated with the design of freehand pen-and-paper diaries. Prior studies in other chronic disease have clearly demonstrated the superiority of electronic diaries over paper diaries in both completeness and compliance rates.

Patients currently present the data from their food and symptom diaries to their providers in whatever format they choose. Anecdotally, this means pages of disorganized scribbled notes. Providers do not have enough time to go through these paper diaries during a single 20-minute clinic visit.

Finally, clinicians do not receive formal training during their medical career on how to determine individualized trigger foods from a food and symptom diary. There are presently no accepted guidelines instructing providers on how to interpret the data provided from a food and symptom diary.

IBS patients and their medical providers need a more reliable way to individualize dietary modifications to reduce a patient’s bowel symptoms.

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Medical Apps, Patient Care, Technology

Why physicians should consider patients’ privacy before recommending health, fitness apps

Why physicians should consider patients’ privacy before recommending health, fitness apps

smartphone_080613Data from research firm IHS Electronics and Media projects that downloads of health and fitness smartphone apps will grow by 63 percent by 2017. And according to a past survey, the increasing popularity of such apps has translated into doctors beginning to encourage patients to use them. But a recent report (.pdf) suggests that some programs may compromise patients’ privacy, which could put physicians at risk for violations of the Health Insurance Portability and Accountability Act. As described in a recent piece from American Medical News:

Privacy Rights Clearinghouse, a nonprofit advocacy organization in San Francisco, sponsored a study of 43 popular free and paid apps that were made for consumer use. Apps used by health professionals were not part of the study.

The technical evaluation of these apps included an analysis of mobile application privacy policies. Researchers installed and used the apps to see what data were stored on the apps. They also looked at the communication between the apps and the Internet.

Many of the apps sent unencrypted data to advertisers, probably without users’ knowledge. Seventy-two percent of the apps exposed personal information that could include dates of birth, personal location, ZIP codes, medical information, email addresses, first names, friends, interests and weights. Some apps sent information to as many as 10 third parties.

Data were sent to app developers’ websites and third-party sites for analytic and advertising purposes.

More than 75% of free apps and 45% of paid apps used behavioral tracking, usually through third parties, according to the study.

Only about 50% of the free and paid apps had links to a privacy policy. Of these, about half accurately described the technical processes of the apps.

To avoid privacy violations, the report recommends that developers do the following: implement encrypted network connections between the app and any Internet server, abstain from using third-party advertiser or analytics services and take extra care in how they send privacy-sensitive information. In the meantime, one of the experts quoted here says, physicians may want to “avoid recommending apps unless they are well-established to be secure.”

Previously: A look at the “Wild West” of medical apps, Turning to an app to help your health and Health-care consumer apps: helping or hurting?
Photo by Jhaymesisviphotography

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