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Medical Apps

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

Medical Apps, Patient Care, Technology

Hospice by the Bay releases app to help physicians refer patients to end-of-life care

Hospice by the Bay releases app to help physicians refer patients to end-of-life care

In an effort to make sure patients are properly referred to hospice care, San Francisco-based Hospice by the Bay has introduced a mobile application providing physicians with a criteria for eligibility of care, a drug formulary that reviews how to treat certain symptoms, and guidelines for end-of-life care by type of diagnosis.

The free app is available in the Apple AppStore and the Google Play store. A recent Mobihealthnews post offers more details about the app:

The app also includes educational materials to help physicians feel more comfortable with hospice care, including a video about how to have the hospice care conversation with a patient or family, bios of Hospice by the Bay’s medical directors, and links out to articles about the benefits of hospice and palliative care.

“That’s often a barrier, because it’s a very difficult conversation to have,” [David Zwicky, director of business strategy at Hospice by the Bay] said. “Our medical directors do this day in and day out, and we thought it would be good to give that advice to a clinician.”

Finally, the app allows doctors to hit the “Refer Now” button and either call the hospice on the phone or fill out a form on the app to submit a written referral. Physicians can lock in information about themselves that they might enter over and over again, or they can use the phone number for a consultation, Zwicky said.

Previously: How a Stanford physician became a leading advocate for palliative care, Stanford introduces web-based mini-fellowship program on successful aging, The importance of patient/doctor end-of-life discussions and A Stanford nurse shares her experience in talking to her aging mother about end-of-life decisionsTalking about a loved one’s end-of-life wishes

Medical Apps, Patient Care, Pediatrics

Mobile app helps keep pediatric patients and caregivers in the loop during hospital stays

When survey and focus group results showed that families of patients at Boston Children’s Hospital felt disconnected from health-care providers and, in some cases, couldn’t identify their physician, the hospital embarked on a project to develop a mobile app to help keep caregivers and patients in the loop.

The hospital is nearing completion of a successful pilot test of the app, called MyPassport. During the pilot, a group of 30 patients received loaner iPads with the app pre-loaded onto the tablets. Hospital officials are now planning to release a new version that can be downloaded and used on a patient or parent’s iPhone or Android device. A recent post offers more details about the app:

Among the goals for the app were to provide a “better awareness of tests being done, who their providers are, and what the discharge criteria are” — in other words, what needs to happen in order for them to be released. The app also “helps them organize questions they might have, and get answers before that day’s rounds at 3 p.m.,” [says Hiep Nguyen, MD, a urologist who lead the development of the app.]

Test results show up not as abstract numbers, but along a spectrum of blue, green, or red. (Red being worrisome.)

The app interfaces with two different electronic medical records systems used at Children’s, as well as the hospital’s security database, which supplies photos of all of the docs and nurses. The app also includes pictures of the patient and his or her family, which can be helpful as a reference for harried docs trying to keep their patients straight, Nguyen says. The app replaces a binder full of paper that patients ordinarily receive, which is quite labor-intensive to assemble and maintain.

Future plans call for creating versions of the app for non-English speaking patients and their families.

Previously: Using the iPad to connect ill newborns, parents, Ensuring young dialysis patients make the grade and Developing a smartphone app to monitor lung health
Photo by Philip Dean

Cardiovascular Medicine, Medical Apps, Research, Stanford News, Surgery

Heart bypass or angioplasty? There’s an app for that

Heart bypass or angioplasty? There’s an app for that

A new online tool can help seniors with advanced heart disease decide between two possible medical interventions – Coronary Artery Bypass Graft surgery or Percutaneous Coronary Intervention, a.k.a. angioplasty.

To use the tool, seniors enter in their age, gender, diabetes status, tobacco use and heart disease history. The tool then calculates a predicted five-year survival rate, based on outcomes of similar patients who underwent these procedures. These predictions are derived from data extracted from the medical records of more than 100,000 Medicare patients, and analyzed using a model recently published in a study led by Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford.

I had the pleasure of working with the amazing team of health researchers and programmers who developed this medical decision tool in a little under a month. For me, it was a sneak preview into the future of personalized medicine, where a person can review surgical outcomes of real-world patients with similar health histories, to reach an informed decision on a treatment plan with their physician.

“Studies usually focus on the results for the average patient, and not on how much the results vary among individuals. This model is a step towards personalizing treatment recommendations, based on each individual’s unique characteristics,” Hlatky told me. “The other exciting thing about this new methodology is that with relative ease, it can be applied to other medical conditions such as cancer and stroke.”

Hlatky will present his model and findings at the Institute of Medicine workshop “Observational Studies in a Learning Environment,” which can be viewed via a webcast on April 24-25.

Previously: Is stenting or surgery better for diabetics? New study provides answer, New test for heart disease associated with higher rates of procedures, increased spending and To stent or not to stent: not always an easy answer
Illustration by Dawn Johnson/iStock

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