Post on 07-May-2015
description
My first title slide using a tweet!
Joyce Lee, MD, MPH; Associate Professor Pediatric Endocrinology/Child Health Evaluation
and Research Unit (CHEAR) Mott Children’s Hospital/University of Michigan
Twitter: @joyclee
I don’t have any ties to mobile application companies
The mobile apps I present are at
my personal whim and don’t imply endorsement, except for
the patient designed ones (which I love!!)
I am social media editor for JAMA Pediatrics but my views do not represent those of the journal
91% of US adults have a cell phone
56% of US adults have a smartphone
79% 81%
69%
55%
39%
18%
18-24 25-34 35-44 45-54 55-64 65+
Age group
Pew Internet http://goo.gl/icIeSD
Smartphones: a generational thing that will soon become universal
Smartphone Ownership
(%)
53%
64% 60%
White African-American Hispanic
Pew Internet http://goo.gl/icIeSD
Smartphone Ownership
(%)
Differences in smartphone ownership are narrowing across race/ethnicity
77%
47%
22%
8%
81%
68%
40%
21%
90% 87%
72%
43%
18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs
< $30k $30k - $74,999k ≥$75k
Pew Internet http://goo.gl/icIeSD
Smartphone Ownership
(%)
Differences in smartphone ownership are narrowing across income
The US consumer spends 2 hr 38 min per day
on smartphones and tablets
http://goo.gl/PCdbol
The US consumer spends 2 hr 38 min per day
on smartphones and tablets
http://goo.gl/PCdbol
Mobile and Social go hand in hand!
I believe they can but…
http://goo.gl/Inp7j4
Unfortunately this dream is not even close to the reality
of healthcare right now
What’s a Medical Mobile Application?
Any of the following for managing health/wellness:
(1) Software program that runs on smartphones
(2) Accessory that attaches to a smartphone (3) Software + Accessory
See the FDA final guidance document http://goo.gl/6ttcF0
3 Types of Medical Mobile Apps
FDA Regulated
Enforcement at FDA Discretion
Not FDA Regulated
3 Types of Medical Mobile Apps
FDA Regulated
Enforcement at FDA Discretion
Not FDA Regulated
(1) Are intended to be used as an accessory to a regulated medical device
(2) Transform a mobile platform into a regulated medical device
FDA Regulated
Connecting a glucometer to a mobile phone turns it into an
FDA-regulated medical device
The AliveCor is an iPhone case that gives EKG readings;
it had to be FDA-approved
“When the intended use of a mobile app is for the diagnosis of disease or other conditions, or the cure, mitigation, treatment, or prevention of disease, or is intended to affect the structure or any function of the body of man, the mobile app is a device”
-FDA
Intent matters with FDA regulation
The LED light on your flash is not FDA regulated, unless you are trying
to use it as an opthalmoscope
Based on this definition, FDA sent this letter to the makers of the uChek Urine Analyzer
“Please note that though the types of urinalysis dipsticks you reference for use with your application are cleared, they are only cleared when interpreted by direct visual reading. Since your app allows a mobile phone to analyze the dipsticks, the phone and device as a whole functions as an automated strip reader. When these dipsticks are read by an automated strip reader, the dipsticks require new clearance as part of the test system.” -FDA
3 Types of Medical Mobile Apps
FDA Regulated
Enforcement at FDA Discretion
Not FDA Regulated
(1) Help patients/users self-manage their disease or condition without providing specific treatment suggestions;
(2) Provide patients with simple tools to organize and track their health information;
(3) Provide easy access to information related to patient’s health conditions or treatments;
Enforcement at FDA Discretion
Enforcement at FDA Discretion
(4) Help patients document, show or communicate potential medical conditions to health care providers;
(5) Automate simple tasks for health care providers;
(6) Enable patients or providers to interact with Personal Health Records (PHR) or Electronic Health Record (EHR) system
By definition, tracking/recording apps for blood sugar may fall into this category,
but apps using self-entered data don’t seem to be regulated thus far
3 Types of Medical Mobile Apps
FDA Regulated
Enforcement at FDA Discretion
Not FDA Regulated
Not FDA Regulated (1) E-book medical textbooks
(2) Medical flashcards/training
(3) Patient education apps
(4) Automation of office operations
(5) Videoconferencing/email to facilitate communication betw/ pt & provider
Are medical mobile applications effective for improving health?
The jury is still out. Most studies have focused on SMS; formal evaluation of effectiveness
of sensor and smartphone technology on health outcomes has yet to be done.
Regarding regulation, FTC did crack down on this appmaker for a false claim that
light emanating from the phone could treat acne
http://goo.gl/tppRqS
And this study is interesting; even if an app does not give “medical advice” and is not technically “regulated”, do patients interpret it that way and defer seeking
medical attention?
http://goo.gl/1RQcWm
We published a review of commercially available diabetes apps
http://www.ncbi.nlm.nih.gov/pubmed/23627878
There are some major problems with the app search process
Of 480 apps, 50% were relevant
Of 600 apps, 85% were relevant
Searching for “diabetes” is very different on Android vs. iPhone
Terms in the description are determined by the app maker: “Health” “Fitness” “Nutrition” • Difficult to customize searches • App search algorithms are not
transparent • Small numbers of reviews
“Health & Fitness” is a really broad category presumably defined
by the app maker. These are the most popular,
But are they evidence-based? The answer is NO.
When you search, there isn’t much of an advanced search, and you have to swipe
screen by screen, then you get lazy and give up after about 10 swipes
How many stars ★★★★★ and or reviews give you confidence in a
medical mobile app?
App search algorithms are not transparent
What kinds of diabetes apps did we find?
(we only looked at the iTunes store for this part)
Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
This is the only FDA-approved medical Management diabetes app that I know of
http://www.welldoc.com/
Tracking & Visualization (33%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
Teaching/training (22%)
Medical Management (<1%)
Comes w/a cute monster, but glucose is hand entered in the US for now
http://mysugr.com/
This is probably the most useful tool for mobile downloading of glucose for now,
w/ Android/iPhone/multiple meter compatibility (yes, cord is clunky)
https://www.glooko.com/
Some pts have had trouble getting this meter covered by insurance Technology is not effective if you
don’t have access to it!
http://www.ibgstar.us/
This is the only real-time glucometer I know of; it has a 2G chip embedded in the meter that uploads BG to the cloud
in real-time
https://www.telcare.com/
Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
http://www.mynetdiary.com http://www.calorieking.com/
Medical Management (<1%)
Tracking & Visualization (33%)
Teaching/training (22%)
Nutritional References (8%)
Physician Directed Apps (8%)
Social forums/blogs (5%)
Saving for a future
presentation!
Finally, what are the security issues with medical
mobile apps?
Are they HIPAA compliant? Who knows? Many don’t say
What is being done with my health data? Who knows?
Who reads the fine print and is the info even in there?
Can data be shared with the provider?
Some do by email, but providers are not supposed to use email
because it’s not secure!
Maybe Google can help you find an app
#sadstateofmhealthtechnology
Hard to find apps Too many apps
Uncertain Quality of Apps Uncertain Benefit of Apps
Apps lack seamless link to provider
The promise of mobile health has yet to be realized
In the meantime, there is a diabetes technology
revolution happening right under our screens
Social Media
73% of adults are on some kind of social networking site
Pew Internet http://goo.gl/oP5bKZ
67%
20% 15% 16%
13%
71%
22% 21% 18% 17%
Facebook LinkedIn Pinterest Twitter Instagram
2012
2013 Social Media
Site Use (%)
What can I say, this is how I feel:
What is Twitter?
It’s a microblogging platform, a place to have a conversation
How do you use Twitter?
First, set up your profile and choose your name
@_________
First, choose your name and set up your profile:
Who are you?
What do you care about?
@lphilipson
@HopeWarshaw @EndoGoddess
@Dermdoc @kidney_boy
Your name? Your specialty? It’s up to you
This is not engaging!
“Who is that egghead?”
Show people what you care about and how to learn more about you
To tweet, hit this button
Tweet
You only have 140 characters to say something
Tweet an article/news/resource of interest
Use a link shortener to save space
Use #hashtags
#diabetes #dsma #doc
#dblog #quantifiedself
#mhealth #dataviz
A #hashtag can mean many things like a topic or group
Diabetes Online Community (DOC)
myglu.org
#cdtc2014
A #hashtag can be used for conferences
(I just created one for this meeting)
To follow and to be followed
You will see the tweets of people that you follow
My followers will see my tweets
Use mentions to reach out to specific individuals
Retweet someone else’s tweet
Hit the retweet button (RT will show up); Change it to MT if you modify the tweet;
h/t “Hat tip” acknowledges who gave u info
So now you know how to use Social Media,
but why would a diabetes professional use it?
You don’t feel like tweeting your morning breakfast
You’re not Miley Cyrus
You have better things to do than put your math skills on
display
Neither are you mother monster (Lady Gaga)
Plus, haven’t you heard that “social media and medicine
is a dangerous mix”?
60% of US medical schools reported incidents of students posting unprofessional online content 13% reported violations of patient confidentiality 52% reported student use of profanity 48% reported frankly discriminatory language 39% reported depiction of intoxication 28% reported sexually suggestive material
JAMA, 2012
http://goo.gl/voZFXN
“Professionalism and social media can be an uneasy mix...”
BMJ, 2012
But there are a few principles to follow as a healthcare professional
on social media…
If you have a personal account, separate it from your professional one
Dr. Joyce Lee Associate Professor
by day
Lady Gaga by night
“Don’t Lie, Don’t Pry Don’t Cheat, Can’t Delete Don’t Steal, Don’t Reveal”
Follow the 12-word Social Media Policy from the Mayo Clinic
http://goo.gl/kxNca2
Remember HIPAA!
http://goo.gl/vntKv2
Don’t talk about patients, even in
general terms
If you wouldn’t say it in an elevator, don’t say it online
Why should you consider taking the plunge?
To learn about new mobile applications for diabetes
To keep abreast of real-time diabetes technology news
To troubleshoot technology issues
To learn how diabetes technology works in the real world
To learn about design issues in diabetes
technology
To have a conversation about design issues in diabetes
technology
To learn about novel real-world applications of diabetes
technology
http://goo.gl/128wVg
iSeismometer iPhone app + CGM on nightstand = effective alarm!
To learn about a patient-designed future of mobile
technology and data visualization for diabetes
He used 3 medical devices, 3 activity monitors, a smartphone…
and 10 different software systems to make his year of visualizations
What a beautiful future for patient-driven visual design
And for patient-driven hypotheses and insights
To witness the incredible creativity and hacking
capabilities of individuals/families with diabetes
cloud
CGM
Nightscout is helping a family manage blood sugars
in a more sophisticated manner using open-source tools
#wearenotwaiting
http://goo.gl/glAEUA
Check out this DIY Artificial Pancreas! #wearenotwaiting
#diyps
To advocate as a community for individuals with diabetes
To connect our patients and families with online
communities
“Social media has saved lives in the diabetes community. It has helped people who are struggling with their diabetes to take control and improve their health. It shows people that there isn’t such a thing as a “perfect diabetic,” but there can be an educated and determined one.”
-Kerri Sparling
@sixuntilme
Run by Diabetes Community Advocacy Foundation
Mobile technology & social media are changing the paradigm of
who, what, and how health information is communicated
#theoldmedicine In clinic, Provider to Patient,
Off-line, 9-5 PM Weekdays only
#thenewmedicine Outside of clinic, Patient to Patient,
Online, and 24-7
“Someone recently asked me to name the most exciting innovation in health care today. I think he was hoping for a sexy technology tip, like an app that’s catching fire in the expert patient communities I follow. Nope. I’ve said it before and I’ll say it again: the most exciting innovation of the connected health era is…people talking with each other.”
http://goo.gl/bu7eOv
Thanks to the students for doing the homework!
Some got rid of their eggheads! http://goo.gl/EvzHex
Thanks to: The Diabetes Online Community
Dr. Klonoff Healthdesignby.us
Mott Mobile Technology for Enhancing Child Health
I love twitter Follow me there: @joyclee
http://joyceisplayingontheinter.net/