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Protecting mobile health innovations from regulation | mobihealthnews

Protecting mobile health innovations from regulation | mobihealthnews | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

by Bradley Merrill Thompson

As just about everyone knows, last week the FDA published its final guidance on mobile medical apps. That guidance explains in plain English the types of mHealth apps the agency regulates. Over the coming weeks, many of us will be dissecting that guidance to assess what it really means and how the guidance affects the numerous apps already released, as well as those on the drawing board. I have made plans to meet with various mobile medical app developers in the next few weeks to hear their questions regarding how this guidance should be applied, and I plan to post my findings as we start peeling the onion of our understanding.

But the guidance, really only address the scope of FDA regulation; it does not explain how the various regulations are actually applied to mobile apps.

This fall, with help from ONC and FCC, FDA will draft the government’s strategy for how to regulate mHealth. In doing so, FDA might consider such things as which types of regulated apps need to undergo FDA premarket clearance, and how the quality system regulations will be applied to mobile apps. In formulating the government’s strategy, the agencies are supposed to encourage continued innovation in mHealth as much as possible. The question is, how should they do that?

It seems to me they ought to start by understanding the factors that drive innovation in mHealth. So what are those factors, beyond the availability of pizza?

In this post, I’m going to share what I think are some best practices that support innovation. But I’m merely an observer, not a participant, so I would love it if readers would tear these thoughts apart and put forth what you’ve seen as the key drivers of innovation. Here we are not talking about macroeconomics and policy such as the availability of venture capital and good IP protection, but rather microeconomics and company conditions that need to exist for innovation to thrive. After giving readers some time to comment, I will offer a second post on how these factors mesh with FDA requirements, in an effort to identify those FDA requirements that need to be modernized. 

The Nature of Innovation in mHealth

I divide the universe of factors important to innovation into two broad categories, specifically (1) the act and process of innovating and (2) the business model for supporting innovation.

The Act and Process of Innovating

I have tried to collect best practices from leading companies in mHealth to discern how they succeed in innovation.  I’m sure this is only a partial list, but hopefully it represents a good start in identifying what needs to be protected and allowed to flourish.

Collaboration among app developers, clinicians, medical device developers and scientists of many sorts.  Collaboration is the wellspring of innovation. Perhaps in some areas of technology, innovation can occur from a lone, brilliant scientist tinkering late at night in his own lab. But in the area of mHealth, true innovation uniformly comes from collaboration among very disparate sets of expertise. After all, mHealth often is about connecting the patient to this data, and often to his caregiver.Finding talent wherever it might be.  In a sense, this is a continuation of the collaboration need, but here I am focused on the fact that the needed experts might be dispersed around the world.  In other areas of technology development, it’s more traditional to bring everyone together under one roof to facilitate the development process. In IT, it’s quite common not to bring everyone together physically but to let them interact virtually throughout the United States and the world.Tinkering and experimentation, with feedback loops.  Any form of engineering requires the development of prototypes, but software development in particular involves the development of beta versions that can be tested in real world situations in order to obtain feedback and strengthen the technology. Consequently, to make real progress in mHealth, we need to ensure that that tinkering and experimentation can continue in some appropriate way.Major breakthroughs followed by many, many incremental improvements. The pace of innovation is uneven. Certainly there are inspirations in which new technologies are created, or new uses for existing technology are identified. But those breakthroughs typically are followed by a significant number of incremental enhancements over sometimes a prolonged period.Nonlinear process. Creative minds tend to zig and zag. If you add to that collaboration where many people are working together, innovation tends to happen here and there, not necessarily according to some linear process.  Regulatory restrictions, for example, in the name of a quality system that attempt to make development a purely linear process are doomed to cause confusion and unnecessary burden.Short product lifecycles. Indeed, this is simply the other side of the coin from the rapid progress in mHealth technology.  But it’s important also to understand and appreciate the cultural impact that the short lifecycles have on the developers themselves. Developers thrive in an environment in which change is constant, and progress is something that can be made virtually every day.  Fundamentally changing that culture and environment by imposing regulatory obligations that would dramatically lengthen the product lifecycles would have a tremendous stifling impact on the exciting cultures that exist in these technology developers’ organizations.Sensible technology standards driven by industry.  The promise of mHealth depends tremendously on the interoperability of medical devices and IT systems. Thus, for mHealth to flourish, the developers of these technologies need to agree upon common standards to be used.  While this in a sense constrains innovation, industry organizations are in a position to develop the standards in a way that balances the need for innovation with the need for standardization.Modularization of software.  It never makes sense to reinvent the wheel.  Software development is no exception.  Over the last few decades hundreds of thousands of software developers have created literally millions of software programs that accomplish a mind-boggling range of tasks. It simply doesn’t make sense to ignore those existing software modules when developing new programs.  So instead, developers stitch together existing programs and then add a new innovative coding to do whatever is new or different that the developer wants to accomplish.  Sometimes this is done by drawing those modules together into a single program, and sometimes it is effectively accomplished by a software program being designed to interact with other software on a given platform, such as a mobile phone.  A simple example is a software application on a mobile phone making use of the existing program that tracks date and time.  Any regulation needs to appreciate this fundamental design dynamic. 
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Mobile Health: How Mobile Phones Support Health Care
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89% of US physicians would recommend a health app to a patient

89% of US physicians would recommend a health app to a patient | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

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Dave Burianek's comment, May 15, 8:45 AM
I think this is interesting.. and as we think about the whole integrated care delivery model, this data and information will play a critical part. Of those practices that Humana will own or be part of in a significant way, I believe we can make this happen. For those docs with small practices, we would need to find the right motivation to have them leverage this info. Do we offer it to them? such as ipads for usage during an office visit? we have to make it simple yet provide the best information so they could provide the best quality of care.
Scott Normandin's comment, May 16, 10:24 PM
the question begs: is/are applications that make access to health care the domain of the younger generation, or as some would content, are applications an additional level of complication to our senior population. Personal experience from the lens of my parents is that "absent" a vetted and universally adopted application that supports a universal view for all, this may by perceived as the "new best new toy" and fade with time. Our seniors; albeit are digital immigrants, working their way into the development of new technologies clumsily, whereas Gen X/Y find the technology adaptable, available and importantly expendable when the next best thing comes available. What defines consumerization: speed of development and release, or the ability to support end users?
Scott Normandin's comment, May 16, 10:24 PM
the question begs: is/are applications that make access to health care the domain of the younger generation, or as some would content, are applications an additional level of complication to our senior population. Personal experience from the lens of my parents is that "absent" a vetted and universally adopted application that supports a universal view for all, this may by perceived as the "new best new toy" and fade with time. Our seniors; albeit are digital immigrants, working their way into the development of new technologies clumsily, whereas Gen X/Y find the technology adaptable, available and importantly expendable when the next best thing comes available. What defines consumerization: speed of development and release, or the ability to support end users?
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Games in Health Encourage Children to Get Active

Games in Health Encourage Children to Get Active | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
JOIN For ME Engages and Educates Kids about Weight Management

We’ve all been in the same boat – you’re running on the treadmill, seemingly for ages, yet you glance at the clock and it’s only been three minutes. We want to live a healthy lifestyle, but sometimes it can be so boring. We especially want to set a good example for today’s youth, as childhood obesity rates are soaring and children are at a higher risk for developing dangerous health issues like diabetes. The question is: if we are bored with our attempt at a healthy lifestyle, why should we expect children to embrace it?

It’s true that an overwhelming majority of children today spend their time sitting in front of televisions and computers. They cling to their electronics as a drowning man would cling to a life raft. Parents become frustrated when their attempts to engage their kids in a more active lifestyle result in failure. How can you interest your child in going for a run when they are completely enthralled in a group chat on their phone about the doubtlessly dramatic occurrences of the day at school? How do you pull a kid out of a virtual world where they are saving soldiers or fighting monsters to toss around the old football? Why not incorporate the technology that kids love so much into a new, healthy lifestyle? The answer to the challenge of getting our kids to embrace physical activity is to offer them this activity in a package that will appeal to them. We’ve seen a great gamification example in Zamzee, and, very recently, LeapFrog, both in the kids’ wearables category. What

Study: Does Gaming Help Obese Children Increase Physical Activity?

Many health care groups have recognized the benefits of games in health. UnitedHealth Group recently participated in a pediatric study of the benefits of gaming in their weight-management program, JOIN for ME. JOIN for ME encourages overweight children to engage in physical activity and set realistic goals that help to reach a healthy weight. Half of the participants in JOIN for ME’s program received an XBox Kinect console and two games in order to evaluate the effects that physical gaming can have on weight loss.

Study Results

The program was effective for both groups in the study, but the group using the Xbox Kinect had higher weight loss. The children enjoyed the use of the games, and did not feel as if they were being forced to exercise while they were playing. They had not been given any specific amounts of time that had to be dedicated to the games, so all of the time spent on the physically active gaming was done of their own accord. Deneen Vojta, a UnitedHealth Group executive physician, spoke highly of the study’s results:

“The results suggest that using active gaming in a weight treatment program may be an effective strategy to promote physical activity and healthy weight among overweight and obese youth.”

One participant, Ravyn Hill, liked the fact that the games provided a way to exercise without being bored:

“I used to think exercise was boring, but when I play games with the Xbox, I don’t think of it as exercise and I still get the benefits to my health. The Xbox Kinect helped me be more active, particularly during the winter when it can be harder to be outside. This program really worked for me.”

Ravyn lost almost 8 pounds during the four-month study period.

JOIN for ME is also educating children who have excessive weight and their families on healthy eating habits, choosing the right foods and portion sizes through classes at community centers and schools nationwide.

Several games have been launched in recent years to help motivate Americans to live a healthy lifestyle. Many of these exercise-based games are still geared toward adults, though, and we still struggle to implement higher levels of activity in children. Researching and using the technology that so interests youth is a very successful answer to the problem.

 

 


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Getting started in social media for healthcare professionals

Many doctors are already online. Many don't know where to begin. The purpose of this presentation is to help you start your professional use of social media.

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10 Digital Health Trends Over The Next 20 Years

10 Digital Health Trends Over The Next 20 Years | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Earlier this week I participated in the world’s first online digital health conference, Digital Health Pulse, organized by digital health consultancy, Enspektos. Speaking at the event were some of the great and the good involved in digital health today and it was an honor to be a part of such an esteemed line-up of people.

My talk focussed on digital health over the next 20 years from a consumer perspective and what I believe will be the top ten trends taking place over that period. You can see them in more detail in the presentation below but for the sake of this post they are:

THE SELF

1. PERSONAL GENOMICS
2. BODY DATA
3. BIOHACKING
4. BRAIN 2.0

THE ENVIRONMENT

5. THE SMART HOME
6. THE HEALTH INFORMATION AGE
7. BIONIC BABY

BECOMING BIONIC

8. WEARABLES, INGESTIBLES AND IMPLANTABLES
9. HUMAN AUGMENTATION
10. BECOMING BIONIC

 


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Pfizer Forms a Strategic Alliance with CliniWorks to Develop Population Health Management Platform

Pfizer Forms a Strategic Alliance with CliniWorks to Develop Population Health Management Platform | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

CliniWorks today announced a strategic alliance between and Pfizer Inc.to jointly advance the parties’ respective capabilities in working with healthcare provider organizations to identify and close clinical or quality gaps to improve population health. The two companies are partnering to develop a population health management platform solution that leverages CliniWorks’ technologies in disparate data aggregation and Natural Language Processing (which interprets free text information) of de-identified healthcare data and Pfizer’s scientific, clinical and disease expertise. This platform will aim to enable large medical groups and integrated delivery system institutions to deliver near real-time and more efficient and effective quality healthcare, as well as improve patient engagement or activation, reaching the Centers for Medicare and Medicaid (CMS) Triple Aim. The development work will be partially supported by a grant received by CliniWorks and Pfizer from the BIRD Foundation ( www.birdf.com ).

Nitzan Sneh, CliniWorks CEO, said, “Pfizer’s leadership position in global healthcare and patient care complements our technology capabilities and, collectively, will bring about significant efficiencies for healthcare delivery organizations involved in the continuum of patient care.”

“This alliance builds on our existing relationship with CliniWorks and will allow us to collaborate with our key customers in innovative and impactful ways to potentially improve healthcare delivery and patient outcomes,” said Teresa Griesing, VP North America Medical Affairs, Pfizer Global Innovation Pharma Business Unit.                                           

 

Pfizer Forms a Strategic Alliance with CliniWorks to Develop Population Health Management Platform by Jasmine Pennic


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Big Data in Healthcare and How Kaiser Permanente Uses It - Infinit Healthcare

Big Data in Healthcare and How Kaiser Permanente Uses It - Infinit Healthcare | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
Even if big data faces much controversy and open data still has so many hurdles to go through in the healthcare industry, there is no doubt that this progress has pushed the industry straight into the information age and California's Kaiser Permanente is showing what can be done with the huge influx of data they are receiving.

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Predictions: Top mHealth App Categories in 5 Years - HITECH Answers

Predictions: Top mHealth App Categories in 5 Years - HITECH Answers | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
What Benefits Will They Bring?

By Tom Sullivan, Executive Editor, Government Health IT
Twitter: @GovHITEditor

It’s becoming almost cliché to suggest that at some point in the future fitness apps and devices will no longer comprise the lion’s share of mobile health technologies. What’s less understood, perhaps, is what mHealth opportunities exist for doctors and hospitals moving forward.

What will be the predominant apps healthcare providers actually use? And what benefit will those bring?

“Traditional healthcare players like physicians and hospitals are the top ranked distribution channel for mHealth apps in the next five years,” according to a report from research2guidance. “The underlying assumption is that within this time frame mHealth apps will have become well integrated into the healthcare processes.”

Indeed, leading that charge will be remote monitoring technologies and consultation apps, the Berlin-based firm predicted, so it matches that mHealth apps will help providers save money by reducing non-compliance and readmissions.

What’s more, respondents of an R2G survey suggested that mHealth will enable providers to improve treatment outcomes, slow healthcare costs, enhance patient-doctor interactions and arm patients with technology that helps them take better care of themselves.

“The likelihood that soon doctors and patients will meet in the doctor’s office to talk about apps which could support medical treatments is very high, given the high penetration rate of smartphones and tablets among doctors and the interest patients show in mHealth apps,” the report explained. “It also means that not only will new players such as sensor vendors or mHealth data aggregators enter the healthcare market, but also that they will become the dominant participants.”

And while the global mHealth market faces substantial obstacles, such as data security and standards, R2G also projected that it will continue growing like gangbusters, from $2.4 billion today to some $26 billion by 2017.

What other mHealth apps, devices, or innovative uses are poised to grab a slice of that big pie?

This article was originally published on Government Health IT and is republished here with permission.

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The Revolutionary Health App Has Not Yet Arrived

The Revolutionary Health App Has Not Yet Arrived | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
Health-related apps and devices are flooding the digital market. A recent BI Intelligence analysis foundthat "health and fitness app usage has grown at nearly twice the rate of app usage overall through the first half of 2014."

But increased usage doesn't necessarily correlate with quality. According to an October 2013 report released by the IMS Institute for Healthcare Informatics, most consumer-oriented health apps are severely lacking when it comes to functionality, or what they actually allow users to do.

Counting steps is fun, for example, but eventually, apps that do only one thing will be seen more as toys than as the transformative health technology some people seem to think they are.

The real killer app probably won't be an app at all. It will be whatever device successfully combines the limited functionality that so many apps have into an integrated platform that can actually change people's health and habits in a holistic way. Unless a device or health platform is integrated into people's daily routines, over a long period of time, it's unlikely to have a measurable effect on health.

Google and Apple have both recently announced plans to release online health platforms, Google Fit and Health Kit, respectively, which may well make that crucial leap in terms of functionality and integration. 

Many Apps, Few Functions

Right now, before the release of Google and Apple's new ventures, the health app landscape is largely disappointing.

The IMS Institute report looked at 16,275 health- and fitness-related apps on the iTunes store that were widely available to consumers. Most were limited in scope and only had one main function: providing information. Less than 2,500 apps were able to both provide information and track user data. And an even smaller number of apps had a reminder/alert function.

As the report found, apps that just give users information aren't enough. That kind of technology is disposable.

What people want is one thing that tracks their steps, measures their heart rate, reminds them to take their medications, gives them recommendations on how to change their diet or boost their fitness, and so on — something that really adds value and is both useful and convenient.

If you make it easy for people get healthy, they just might. But if it's too complicated or convoluted, people probably won't stick with it.

The Evolution of Wearables

That's where wearables are coming into play. Wearables are sensor devices that record the user's data — like heartbeat, steps taken, calories burned, etc. Some examples of health-related wearables are fitness trackers like Nike's FuelBand and Jawbone's Up Band.

But such trackers can only do so much. "Beyond the whole counting-your-steps contest," CNET noted, "bands just don't do a great job of helping you get more active."

That's why, as Fortune and others have reported, fitness bands are likely to be eclipsed by smart watches, like the Apple iWatch to be released in October.

According to Macrumors.com, the iWatch will likely "be able to measure multiple different health-related metrics like steps taken, calories burned, sleep quality, heart rate, and more" through as many as 10 different sensors. These capabilities overlap with some already existing fitness trackers.

But the iWatch differs in two key ways: It is multifunctional — more than just a fitness device — and it aims to be fully integrated into people's minute-by-minute habits. Its health functions are much more comprehensive than what's been offered before, and the user will be able to experience those health functions as a seamless part of the do-everything platform.

Pair that with a superior user interface, and the device itself has the potential to become as indispensible as a smartphone, as woven into the fabric of our daily routines. That's the only way health apps will really become a part of our lives — and powerful enough to change them.

In the end, the best test of whether a health device has succeeded may be whether or not users count it on their short list of essential items.

In an interview with Fortune, Sonny Vu, CEO of Misfit, (a start up company developing developing wearable sensor products and services) proposes what he calls the "turn around test" as the ultimate success of a wearable device, meaning that the user would "turn around" if he or she left the device at home.

This is where companies like Apple and Google have a leg up on the competition: If they can turn people's already-indispensable watches or smartphones into the ultimate health devices, we might soon reach a time when health tech isn't just another fun app, but as essential and as ordinary as Facebook or email.


Read more: http://www.businessinsider.com/functionality-is-key-to-the-future-of-health-apps-2014-6#ixzz36QsVrb2O

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Health app to arrive still

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Infographic: Future of Healthcare

Infographic: Future of Healthcare | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
The Future of Healthcare: The Connected HospitalShare this infographic:

New advances in technology are radically transforming the way healthcare is delivered and managed. These changes extend from the point of care to payment and reimbursement - improving outcomes and overall provider and payer effectiveness. Delivering this patient experience requires providers to connect with their patients, and across healthcare systems in new ways. And with Meaningful Use deadlines continuing to loom large, the cost of not doing so is clear. Read on to find out how connected hospitals are meeting this challenge. 

Learn more about Healthcare Integration Solutions from MuleSoft »

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How to Grow the Supply of Healthcare

"For two or three generations, we've almost completely ignored the supply side" of health care, warns Robert Graboyes, an economist who specializes in health care issues. That's especially...
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Startup wants to fix nutrition communication gap between MDs, parents, children

Startup wants to fix nutrition communication gap between MDs, parents, children | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

A Carnegie Mellon University startup wants to make it easier for physicians to talk about  preventing and reducing obesity with children and their families. It wants to make these conversations less challenging, confrontational and defensive.

The public health program by Fitwits uses a mix of goofy cartoon character role models (Elvis Pretzley, anyone?), gaming and multimedia presentations to improve health literacy to encourage healthy choices among elementary school students and their families. For example, for every Fitwit role model there seems to be an antithetical Nitwit character making bad nutritional choices.

Fitwits is part of the university’s ‘For-Profit’ technology transfer program. Its Fitwits is the product of a five-year research project by Carnegie Mellon’s School of Design, according to the company’s website. It was developed in collaboration with University of Pittsburgh Medical Center St. Margaret’s Family Health Centers in the wake of some pretty stark stats.

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In the U.S., obese children aged 6 to 11 years old rose from 7 percent in 1980 to 18 percent in 2012, according to the Centers for Disease Control.

Although there’s a strong emphasis on portion size, improving nutrition literacy for kids and adults is also a big part of it.

The program is currently part of a national trial with a health insurer, which could be Highmark. Two executive appointments, in addition to being graduates of Carnegie-Mellon’s business school, were also members of the Highmark Health Services leadership team. Alistair Rock will serve as CEO and Adam Jenkins will act as head of finance, innovation and strategic planning.

The program is aimed at 9- to 12-year-olds and is designed for three settings: elementary schools, doctors offices and families.

A gaming component is designed to be played by parents and their children. A multimedia program is led by teachers, and physicians use flashcards to test children on what they’ve learned.

In addition to making it easier for physicians, the program sets out to encourage behavior change at an early age and make a lasting impact.

The size of the challenge — making parents more aware of their children’s and their own nutritional needs–  illustrated by the sheer number of startups and volume of research around this issue. It will be interesting to evaluate the health of the students that participate in these programs in a few years time to see if it has a lasting impact.


Read more: http://medcitynews.com/2014/07/startup-wants-fix-nutrition-communication-gap-mds-parents-children/#ixzz36FRuGkdT
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Why a "Switzerland Approach" Might Become a Key Part of Wearable Health Platforms

Why a "Switzerland Approach" Might Become a Key Part of Wearable Health Platforms | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

It’s been a few weeks since Apple’s announcement about its Health app, the consumer electronics giants’ new dashboard for capturing health data; and HealthKit, its foray into establishing a healthcare integration platform for wearables and other sensor-generated data.

In February, Optum’s acquisition of Audax was market validation for using mobile and rich media features as one approach to helping plan members to get and stay healthy.  Since then, several other well know information technology players have put their chips on the table relative to announcements about connected, wearable health solutions.

Google.  This week Google announced Google Fit as a hub for data connectivity with fitness tracking wearables and cross-platform APIs that developers can use to provide consumers with the means to better keep track of their fitness goals.  This is Google’s second act in health, and with their previously announced diabetic-sensor-in-a-contact-lens, they seem to have a well thought out technology and product strategy.Microsoft.  In February, Microsoft added to its quietly evolving Healthvault platform by announcing the Bing Health & Fitness App, a fitness and medical reference tracker focused on wellness.Salesforce.com. Also this month, the CRM market leader began messaging around its abilities as a healthcare platform with a focus on mobile.  Salesforce.com is not to be trifled with, and while they’ve been quietly amplifying their healthcare footprint via application partners in recent years, the timing of their announcement is notable.Samsung.  In May, Samsung began several announcements (SAMI – Samsung Architecture for Multimodal Interactions; its ‘Voice of the Body’ initiative; and gear like the Simband sensor watch); and built on its focus of becoming a global leader in healthcare with mobile at the forefront.WebMD.  In conjunction with Apple’s announcement, WebMD Healthy Target was announced as an iOS feature that will allow users to track biometric data from sources such as wearable activity, glucose and other trackers.  Goal setting, progress reports and other summaries are part of the package.

Consumers who use tracking tools and related sites like these are typically individuals already in tune with their health.  At first glance, it’s hard not to wonder how much useful data are being generated and not already being captured by the likes of DigiFit, Jiff, Health Advocate, LiveHealthier, MapMyFitness, RedBrick, RunKeeper, ShapeUp, Vitality, Viverea and WellTok.  A well-deserved nod to the consumer appeal of Apple, but if you’re already engaged in monitoring your health by using one of these great tools, why migrate?

Does harmonizing data between wearables and enterprise health systems call for a “Switzerland” strategy?  As the volumes of healthcare data grow and sensors become more sophisticated, the importance of broader interoperability and data integration between wearables and enterprise healthcare engines (EMR, claims, clinical and population health management) are growing too.

The need is founded on managing risk for members / patients and knowing as much as possible about these consumers or a population.  Microsoft’s Healthvault struggled and Google Health outright failed because both vendors assumed consumers would actively enter health data into their tools, creating a useful database.

The two most interesting aspects of the Apple announcement were the endorsement from Mayo Clinic and an undefined partnership with Epic.  On the surface, Apple and Epic don’t have a lot in common with very different underlying technologies, so a shared developer ecosystem is hard to imagine.

However, the usefulness of Apple Health Kit might boil down to whether it can extract a patient’s clinical data from Epic, securely sync that data with an iPhone such that it’s simple for the patient, and make that data portable so it can be leveraged by other healthcare professionals who are serving that patient.

Apple aside, the ramifications of how wearable data can be used is wide ranging as payers and providers look to manage risk — and employers consider how their wellness models might include rewards for monitoring and reporting activity levels to help employees be healthy and spend less on healthcare.

Additionally, we think the ability to enhance data interoperability regardless of technology or device is increasingly important.  One new player in the healthcare interoperability stack is Validic, who is integrating both provider and payer enterprise systems with consumer wearables and allowing their clients to in fact, be Switzerland.

The simple graphic below depicts how some of the current announcements in consumer health platforms may begin to realign because of the influence of wearables, and emphasize the growing importance of healthcare interoperability and workflows.

 

What about the FDA?  Through sources close to TripleTree, we’re aware of how the FDA has been refining and expanding its definitions of a ‘health app’ versus a ‘diagnostic app’.  In some reports surrounding the Apple HealthKit announcement, it appears that Apple asked the FDA about their approaches to messaging for healthcare solutions on the iPhone and iPad.  Just having an app gathering data is not a conclusion of anything medical. So while we’re in the early but exciting innings of connected health and wearables, there is still little evidence validating the accuracy of the hundreds of sensors and thousands of apps in the market.

Regardless, in the quest for harvesting consumer healthcare data, wearable devices, digital apps and consumer services will remain front and center in transforming health and healthcare.  Convenience and the ability to engage consumers on their terms will carry the day because in connected health without convenience, there is no engagement.

Regardless of the quickened pace of investment which we recently summarized, the noise around this area of the market is loud and will be confusing for several quarters.  Fortunately, macro-economic forces have a way of shaking out the solutions that are half-baked, so as leading approaches and solutions emerge we’ll review and opine about them.

Until then, let us know what you think.


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Laurent FLOURET's curator insight, June 30, 8:58 AM

What I call "from silos to legos"...

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What Do Doctors Think Of Apple's HealthKit?

What Do Doctors Think Of Apple's HealthKit? | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

It has tremendous potential.

I watched the keynote, and initially Healthkit seemed fairly unremarkable, just another way for consumer apps like Nike+ and sleep trackers to output their data into pretty charts. A cursory look at their website (Apple – iOS 8 – Health) would seem to support the view that Healthkit is targeted at those obsessed with the “quantified self” movement:

Calories burned? Sleep? Heart rate? This type of fitness-oriented data isn’t particularly interesting, as it’s been done before in a thousand different iterations, starting with pen and paper. Why should I care?

We’re then shown this screen, however, and from a clinical perspective, there are 4 key points of interest, particularly since Epic Systems (one of the largest EMR vendors in the nation) was mentioned in the keynote:

There’s also this:

Suddenly, I’m interested.

Imagine if with just your phone, you could travel with all of your former imaging studies (e.g. chest X-rays, CT scans). Your verified vaccination records. Your biopsy results. Your list of allergies. Your lab tests from the last 10, 15, 20 years. All the medications and doses you’ve ever been on, for what time period, and why. Your heart rate and blood pressure measurements from every clinic visit you’ve ever made.

What if all of this was kept in the cloud, with instant access through your phone?

What if, with Touch ID, you could grant access to this wealth of data to any new physician/system, with a single tap of your finger?

Take a moment to see how medical records currently go from institution to institution. Then come back and think about this. This could be revolutionary.

The lung cancer patient in New York who wants to move to Michigan to be closer with her extended family now has significantly more peace of mind, knowing that her health data can easily move with her. She doesn’t have to drudge through the paperwork to release her own medical records from her prior hospital system. She doesn’t have to make a separate trip to the radiology department to have them burn her a CD/DVD of all of her imaging. She doesn’t have to burden her new oncologist with the task of sifting through hundreds of sheets of results by hand, as she can release them into the new EMR with a single tap of a finger. She doesn’t have to worry about whether the images on the disc will be compatible with her new radiologist’s system, as the cloud automatically adjusts the data format to match.

The trauma patient who arrives in a lower-acuity ER after a motor vehicle accident and is found to have a severe unstable ankle fracture on imaging can now be more easily transferred to a higher-level hospital with orthopedic surgery on call. The patient has his X-rays in the cloud. Within minutes of arrival at the new hospital, he opens his phone and grants access to the X-rays to his surgeon. The surgeon downloads them onto his Retina display iPad, quickly assessing the nature of the fracture to determine whether or not the patient requires emergent operation. Again: no drudging through paperwork. No waiting to process a CD/DVD. Less hassle. More clinical care.

I feel that Healthkit might well be the first step in creating something akin to a universal EMR. If Apple pulls this off with the right partners, they could potentially solve one of the single worst problems in healthcare today: the inability to easily transfer patient records from one care location to another.

This question originally appeared on Quora: What do doctors think of HealthKit? More questions:

Medicine and Healthcare:Is it true that oncologists refuse to be treated for terminal cancer? Doctors:What do doctors think about 23andme?Apple:Why did Tim Cook need to attack Android at WWDC 2014?


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EuroHealthNet's curator insight, June 28, 10:29 AM

Welcome in the era of patient centricity 

Antoine POIGNANT, MD

Marisa Maiocchi's curator insight, July 2, 7:07 AM

Me parece una exageración solo para fanáticos del estilo de vida saludable. Una cosa es cuidar la salud y otra muy distinta es estar pendiente de parámetros vitales...  ¿Y qué de las horas que se dedican al trabajo, a la familia, a la recreación? ¿Y qué de emplear el tiempo en hacer cosas que nos gustan? ¿Vendrá con un medidor de felicidad o de alegría?

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Study shows effectiveness of an app in improving total daily steps - iMedicalApps

Study shows effectiveness of an app in improving total daily steps - iMedicalApps | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Researchers in Ireland evaluated the use of an Android smartphone app to increase patients’ activity levels, as measured by step count.

When it comes to tackling the epidemic of obesity and its associated morbidities, promoting active lifestyles is key. For many patients, setting specific achievable goals is a helpful tool in accomplishing that.

Here, researchers from the National University of Ireland and University of Aberdeen selected an app to trial among patients followed at three primary care centers to evaluate whether it could be effective in increasing activity levels. Over the roughly two month period, they found a 22% increase in basal activity levels.

A total of 90 patients using Android devices were randomized to either an intervention group which used the smartphone app or a control group. To pick the intervention app, researchers scored available pedometer apps based on three general criteria including

Automatic feedback and trackingVisually appealing displayGoal setting functionality and feedback

Based on these criteria, they selected the Accupedo-Pro Pedometer app. All patients received up front education and counseling. After a one week run in period, patients in the intervention group were taught how to use the app. Beyond that, all patients received the same education and follow up including sharing data at the same intervals.

They found a mean difference in improvement in step count between the intervention and control groups of 2017 steps, or a 22% increase in mean step count. Other parameters followed including BMI and blood pressure did not significantly change however.

Interestingly, they found that both groups had an initial increase in step count but the control group quickly returned essentially to baseline while the intervention group continued to improve.

There are several useful takeaways from this study. First, it suggests that use of a low-cost smartphone app can help reinforce and sustain behavioral interventions. Second, it highlights the importance of “app training,” or helping patients understand how to use an app to achieve a specific goal.

As the researchers noted, 90% of Americans who own mobile phones carry their devices 24 hours a day. Here, they demonstrate how some of that time can be used to make meaningful improvements in health.

Author:Satish Misra, MD

Satish is a Cardiology Fellow at the Johns Hopkins Hospital in Baltimore, Maryland. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology offers an opportunity to change the way health care is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.

Glynn LG, Hayes PS, Casey M, Glynn F, Alvarez-Iglesias A, Newell J, OLaighin G, Heaney D, O’Donnell M, Murphy AW. Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. Br J Gen Pract. 2014 Jul;64(624):e384-91. doi: 10.3399/bjgp14X680461.

 

 


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Wearables: A Solution Searching For Problems?

Wearables: A Solution Searching For Problems? | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Wearables, devices used to sense data and process it into information, are generating quite the buzz in healthcare these days. But down the line, does that buzz come with a sting?

Frank X. Speidel, MD

In Wearable Tech News, Tony Rizzo reports wearable technology spending predictions of $50 billion by 2018. He also reports on a ground-breaking, glucose-sensing contact lens for diabetics that will be a “true solution for a very real medical problem that affects hundreds of millions of people.”

By 2016, wearable wireless medical device sales will reach more than 100 million devices, according to a Cisco blog on the future of mobility in healthcare. The importance of these devices is that healthcare professionals can access critical data via mobile apps before, during and after a patient’s hospitalization, thus boosting the speed and accuracy of patient care, the blog says.

 

In acute situations, such as a patient’s complaint of sudden heart pain or chest tightening, wearables may allow doctors to “see” patients remotely to determine the seriousness of the discomfort, said Lydia Leavett in a Forbes article on wearables.

The Age of Wearables has a few caveats, though – note that a doctor “can,” “could,” “may” or “potentially” be able to monitor a patient from a wearable, as the products are still under development. One product cites unpublished research as support, and another uses a modality, thermography, that the National Cancer Institute states has no additional benefit for breast cancer screening.

There is also an almost entertaining naivety from some writers of the complexities of wearables. Speaking of FDA approval for a smart contact lens, one writer said it would be easy because “these devices are benign, with really small embedded sensors, so their risk is nonexistent.” Really? For decades, I have watched the simple contact lens cause conjunctivitis, keratitis and corneal ulcers. And concerns abound about low-level, electro-magnetic radiation and cataract formation in the human lens. I suspect the FDA will have significant interest in smart contact lenses.

I’ve also seen the misunderstanding that physicians are eagerly awaiting and prepared for a tsunami of clinical data from their patients.

“The vision is the doctor is sitting waiting for all this, and the doctors aren’t,” said Dr. Michael Blum, Associate Vice Chancellor of Informatics at UCSF School of Medicine to PC World. “They are running around with their hair on fire trying to do what they do right now.” I agree with Dr. Blum.

The new, intense focus on wearables is the engagement of the general public, both the ill and the well, and how they collect and transmit patient information to physicians and EHRs. This presents two challenges:

1. Are physicians prepared for this tidal wave of data and information?

Are algorithms ready to receive, store, analyze and respond to this data? The “alarm fatigue” effect is real – and well documented. In Medical Design Technology, GlobalLogic Director of Program/Account Management Jeremy Schroetter said the solution is “… careful data analysis and algorithms in order to provide physicians with the information they need…” The remedy is to apply smart business intelligence to this data flood, but a staggering undertaking to achieve. Until then, we are quenching our thirst from a fire hose.

2. What is the true cost of the data surge versus its benefits?

And who will pay for it? Consider a micro-transmitter that when attached to a medication and ingested signals a wearable device, which records the ingestion date and time and coincident heart rate of the patient. A log-in summary of this information can be provided to the patient and their physician. We can quantify the cost of obtaining this information. What is the value of the information? Is compliance or noncompliance with drug therapy not already known to the patient? Is it really information if we already know it? Is the value of this product then actually as a motivator?

The cost of wearables is more than simply the cost of the device and maintenance.  We need to recognize the cost the care provider incurs in receiving, storing, analyzing and responding to the information.

Helping patients understand their health information also costs money. Providing the patient access to information about themselves empowers the patient, but without providing education with it, access to information just isn’t fair.

None of this should dismiss wearables as the “pet rock” of healthcare information technology. We stand on the verge of an artificial pancreas for diabetics. We have decades of experience with insulin infusion pumps. CGM, continuous glucose monitoring, is no longer new. Although currently “under development,” the fusion of these two technologies is both achievable and hugely clinically meaningful.

Like all healthcare information technology, wearables have huge potential – married to massive challenges. 

Frank X. Speidel, MD, MBA, FACEP is Chief Medical Officer for Healthcare IT Leaders, a consultancy and HIT staff augmentation firm that matches IT talent to hospitals and health systems for EMR, ICD-10 and analytic engagements.

 

photo credit: IntelFreePress via cc

Wearables: A Solution Searching For Problems? by Frank SPEIDEL, MD


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Mobile Game From Former EA Devs Taking On Teenage Eating Disorders

Mobile Game From Former EA Devs Taking On Teenage Eating Disorders | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

High School Story, the iOS and Android game from former Electronic Arts developers that previously took a stand against cyberbullying, is now aiming to raise awareness for another issue affecting teenagers: eating disorders.

Pixelberry Studios has partnered with the National Eating Disorders Association to create a new in-game storyline centered around eating disorders. The game will also offer educational resources to the estimated 20 million teenagers across the United States who are not happy with their bodies.

The new version of High School Story available today follows a character named Mia. After hearing an insensitive comment about her body type, she takes up an unhealthy diet and exercise regimen. She even edits her yearbook to make herself appear thinner.

Through High School Story's new narrative around Mia--researched by Pixelberry and NEDA--players will learn all about the causes and consequences of body image issues. The game will even allow players to reach out directly to the NEDA through the app.

Pixelberry says High School Story's previous anti-bully campaign helped 2.5 million teens learn more about cyberbullying prevention. In addition, Pixelberry adds that more than 100 players every week were directed to professional counselors through the game and that it raised over $250,000 for an anti-bullying charity.

To go deeper into what the new eating disorder content means for High School Story, we caught up with Pixelberry co-founder Oliver Miao. Our conversation is posted in full below.

 

GameSpot: What led you to want to tackle the issue of teenage eating disorders in High School Story?

Oliver Miao: The first inspiration came from our players, some of whom wrote to us to ask that we address the issue. Those requests really resonated with our writers, many of which also struggled with body image issues during their high school years or knew of people that had. Once we decided to tackle that issue, we were also inspired by real-life stories of teens who had done things like lobby fashion magazines to stop publishing photoshopped photos.

 

GS: What does your partnership with the National Eating Disorders Association let you accomplish that you couldn't before?

OM: We’re very happy that we've been able to partner with NEDA. First, they helped us make make sure our messaging around body image issues and eating disorders is accurate and helpful by providing us feedback based on the issues they've encountered. They also allow us to give our players direct support about these issues without having to leave the game. Whenever a player writes in to our in-game support system with a question about eating disorders, helpline staff from NEDA will respond. Lastly, they worked with us to create an in-game FAQ players can read to learn more about these issues.

On the other side of things, we now have over 10 million players, many of whom are teenagers. With our platform, we’re able to help an organization like NEDA reach a large number of teens through a channel that's otherwise hard to reach. In this regard, we're able to educate and support millions of teens about issues that are relevant and important to them.

 

GS: What kind of response have you seen from users who maybe download the game and don't necessarily know that it's tackling the kinds of social/health issues that it does?

OM: We strive to make High School Story fun first and find ways to layer in socially impactful elements afterwards. These particular quests are purposely introduced later in the game, so that when players engage these quests they’re hopefully already connected to the characters and can therefore draw more of a personal understanding to the issues these characters are facing.

So most players come to the game not because it addresses these specific issues, but because it's fun and because it speaks to their interests in general. And when they come across the quests about cyberbullying and body image, we find that most of them are really excited and happy. Not because those quests are 'socially impactful,' but because they address issues that are important to them and their friends.

GS: What kinds of data do you have that shows High School Story is actually making a difference in the way you want it to?

OM: We look at this in several ways. We have metrics that track how many players complete our special quests. We're also providing a prominent in-game link to NEDA's teen-focused site, Proud2BMe, and we'll be able to see how many teens use it. We hope to get statistics from NEDA about how many teens reach out to them after playing our game, and we also pay very close attention to our players' reviews.

The body image features are new, so we don't have any comprehensive results from them yet. But similar results from our earlier anti-cyberbullying campaign show that it's been a big success. Over 2.5 million people have played our cyberbullying-themed quest. Through the support of our players, we've already raised over $250,000 for The Cybersmile Foundation, a non-profit we partnered with for that campaign. Cybersmile also told us that after the launch of the quest, every week over 100 of our players reach out to them for help. These are often teens who are being bullied, self hurting, or even thinking about suicide. With NEDA, we are really hoping that we can have the same type of impact with teens who are facing challenges with body image or eating disorders.

Oliver Miao

 

 

GS:. Are there any specific 'success stories' you can share that have come from High School Story?

One of the first times we saw the effect High School Story could have on players was when a player wrote in telling us that she had recently moved to a school in a new country and had been struggling with fitting in. After playing our game, she realized that she liked who she was and didn't have to fit in to feel good about herself. It was a very heartwarming moment for us.

We've also had several incidences of lives actually being saved because of High School Story. The first time it happened was from a player who wrote directly to us that we were able to encourage to seek professional help. Our partner Cybersmile has also shared amazing stories with us, including a time they were able to help a High School Story player who was right on the precipice of hurting themselves.

Every time we hear one of these stories, we're amazed that the work we do really is making a difference. It's an incredible feeling.

 

GS:. Why did you decide to make the Mia character female instead of male?

OM: Over 60% of High School Story's players are female, and research has shown that by the time they are 17, nearly 4 out of 5 females have had body image issues. We hope that by making the Mia character female, a majority of our players can more easily identify with her and be more willing to reach out for help, if they need it.

At the same time, we recognize that these issues affect both men and women, so our writers crafted the story to appeal to both our male and female players.

GS: You've taken a stand against cyberbullying and now you're raising awareness about the dangers of eating disorders -- What other social/health issues are you looking at for future versions of High School Story?

OM: For the time being, we're focusing on body image, and are continuing to address cyberbullying as well. When we take on serious issues like these, we want to show long-term commitment to them. This gives our players time to engage with the new content and respond to it at a pace that they're comfortable with. It also allows us to build strong relationships with our nonprofit partners.

That said, we definitely plan to continue with these types of campaigns in the future. In fact, we’re about to launch a "Your Voice" feature that lets our players first share their thoughts on fun topics, like music and memes, and then later share their opinions on current events and other more serious topics. Our hope with this feature is to encourage teens to develop their voices on important issues and to discuss these issues with their friends and communities.


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COM SALUD's curator insight, July 10, 7:46 AM

Los juegos de salud encaminados a concienciar sobre estilo de vida saludables son un arma efectiva de educación pero el resultado es muy superior si se parte de un juego popular existente que se adapta a los argumentos de concienciación.

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Case study: Big data improves cardiology diagnoses by 17%

Case study: Big data improves cardiology diagnoses by 17% | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

he human brain may be nature’s finest computer, but artificial intelligences fed on big dataare making a convincing challenge for the crown.  In the realm of healthcare, natural language processing, associative intelligence, and machine learning are revolutionizing the way physicians make decisions and diagnose complex patients, significantly improving accuracy and catching deadly issues before symptoms even present themselves.

 In this case study examining the impact of big data analytics on clinical decision making, Dr. Partho Sengupta, Director of Cardiac Ultrasound Research and Associate Professor of Medicine in Cardiology at the Mount Sinai Hospital, has used an associative memory engine from Saffron Technology to crunch enormous datasets for more accurate diagnoses.  Using 10,000 attributes collected from 90 metrics in six different locations of the heart, all produced by a single, one-second heartbeat, the analytics technology has been able to find patterns and pinpoint disease states more quickly and accurately than even the most highly-trained physicians.Dr. Sengupta explained his ongoing work with big data analytics to HealthITAnalytics, and discussed the impact such technologies can have on cardiology patients and their outcomes.What were the underlying medical issues you were trying to solve with this study?One of the most commonly ordered diagnostic tests in cardiology is the echocardiogram.  We were amazed at the amount of information that was coming in during each patient consultation, so the biggest challenge was how to make the information, which is extremely rich, easily understandable and use it in real-time in patient care scenarios.  Working with Saffron, we decided that we will look into a scenario which is extremely complex which usually requires a lot of expertise, and it usually is associated with fairly complex sets of information.We decided to do a pilot test with two diseases: cardiomyopathy, which affects the heart, and pericarditis, which masquerades as if the heart is involved, but actually the heart muscle is not involved.  Both diseases present with heart failure, and patients are very complex in their assessments.  If you make the correct diagnosis the treatments are very disparate, very different. For pericarditis, you would do a surgery, whereas if it’s cardiomyopathy, it’s a different course.  It’s medical management or a heart transplant.Misdiagnosis of these conditions is a fatal error, because if you make the wrong decision, you’re going to send a patient who’s going to be treatable by surgery to get a heart transplant and vice versa.  If you open up a patient because you think they have pericarditis, and then you have to close the patient because the patient didn’t have the thickening of the membranes around the heart, that’s expensive for the hospital and puts the patient at an unnecessary risk of complications.  So that’s why we use this particular technology on these diseases, because the risk of not diagnosing this disease properly is immense.How can clinical analytics supplement human intelligence to identify patterns and make diagnoses?For the study, we took a lot of the ultrasound information, which is the first step for diagnosing these patients.  We took the information, which is extremely complex and started working on that using the natural intelligence platform to see if we could come up unique characterization of the disease, so that the information can be clustered for pattern recognition.  You use a lot of intuitive skills to go through these datasets.  I was interested in seeing how processing this data through clinical analytics can provide better decision support.The problem is that the data is scattered everywhere.  It’s in the EMR, but everything is still in siloes.  So either you have to make an effort to look in the EMR, then look into the e-measures, which may be existing on another system, look at the PACS system, and the himself patient is somewhere else.  So, they’re all in different locations.  How do we take all the information just coming from different sources and merge them together, so that we can apply it right away to the patient in real-time?  That’s what we are currently focused on.Let’s say I just analyzed an echocardiogram of a patient and I track the information into am Excel file.  You open that Excel file, and it will have about 30 columns and 50 to 60 rows. What we do right now is go row by row, and it’s very painful.  But the analytics engine takes an entire dataset all at once, and then comes out with these rich associations. Based upon its previous learning, using its associative memory capabilities, it can tell that this dataset looks like this disease, and that dataset looks like another disease.This kind of an application can be done for any scenario.  For example, diabetes can produce some very early changes in the heart muscle which the patient doesn’t even know about.  He’s completely asymptomatic.  You might have a signal present in this big data, but you might not be able to discover it on your own.  You might not even really be looking for it, but when you process it through a complex analytics engine, you might be able to come up with some kind of signal that will show the early disease state.Diseases come in clusters, so heart disease, cancer, Alzheimer’s, they don’t come independently.  They all together in one given patient, so my hope is that in future we will be able to take all the risk factors, which are common for these diseases, which are growing to epidemic proportions, and we will be able to deliver forecasting models based upon them.That’s kind of the vision.  I think it would be really terrific to have a forecasting model, so then this patient has such risk factors, goes into the hospital for, let’s say a knee surgery, what are his chances he’s going to develop a heart attack when he comes out of the surgery?  That’s the kind of the risk modeling we’ll be very interested to develop in the future.After using the clinical analytics engine to examine the data, what results did you find?In the initial pilot phase, when I did my own statistical algorithms, we had about 73% ability to differentiate the two diseases.  But when the initial pilot run happened, we were very pleased to see that there was a discrimination of 90% between the two datasets and without any human intervention. What that means is that the highly complex analyses that were done produced a discrimination which exceeded human ability to diagnose the two conditions.  Having said that, you have to be extremely cautious, but it’s very exciting that machine learning and learning intelligence platforms can reach the ability to do this differentiation, if not exceed it.Related White Papers:Webcast: Gain Deeper Insight into your EMR with Care Systems Analytics from VMwareActionable Analytics: 10 Steps to Improve Profitability and Patient ExperienceImprove Outcomes with the VMware Care Systems Analytics SolutionPredictions for Big Data in Large and Small PracticesHL7 Survival GuideBrowse all White PapersRelated Articles:NIH to boost role of genomics in research, clinical analyticsGenomics, big data can thrive through CDS, analytics tools2.5 petabytes of centralized cancer data to accelerate genomicsNew law would increase access to Medicare data for analyticsHow big pharma uses big data to develop better drugs
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Review of orthopaedic surgery app for physical exam of the knee

Review of orthopaedic surgery app for physical exam of the knee | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

The physical exam is especially important to orthopaedic specialists. There are numerous eponyms and unique maneuvers that complicate the understanding of the orthopaedic exam. The American Academy of Orthopaedic Surgeons (AAOS) has attempted to clarify the intricacies of common physical exam maneuvers with a series of mobile apps. This review follows a previous review on the AAOS physical exam of the shoulder and focuses on the exam of the knee.

The application is produced by the American Academy of Orthopaedic Surgeons. The AAOS is one of the largest and most trusted medical specialty societies in the Unites States. The AAOS has a long tradition of producing quality educational content. They were one of the first specialty societies to use mobile technology as a means for member education.

User Interface

The app opens with a disclaimer, credits, and then a list of exam sections on the main menu. The sections include: inspection, palpation, muscle testing, range of motion, and special tests.

Selecting any topic heading from the list takes you to more information. The Special Tests tab has several good maneuvers including pivot-shift, anterior/posterior drawer, McMurray, Ober’s test and eight other common tests. The inspection/palpation tab covers basic exam topics.

Selecting a maneuver reveals a short description of the exam maneuver with associated references. The content in these descriptions is referenced well with many up-to-date articles on the topic.

Additionally, most maneuvers have the listed specificity and sensitivity in the description section which helps in the understanding of the clinical utility of that exam.

In the upper right corner is a tab that connects to the exam video. Every exam topic has an associated video of the physical exam maneuver. The quality of the video and audio is good but short and without demonstrations of pathology.

Similarly, there are no pictures or diagrams to enhance the explanations of the exam maneuvers. The app covers most of the common exam tests and is ideal for the beginner or intermediate healthcare professional learning to perform the knee exam. There would be utility for review or consolidating the information in a single app for the more experienced clinician.

Healthcare workers that would benefit from the app

Any healthcare worker who has a role in performing orthopaedic knee exam maneuvers.

 

Price$8.99Likes

Short, to the point, explanations of exam maneuvers with references.
Good quality videos demonstrating exam techniques.

Dislikes

No images or diagrams of the exam maneuvers.
No search function.

Overall

This application is easy to use, delivers well on its intended purpose, and covers several common exam maneuvers in orthopaedics. There is slightly more content in this app compared to the similar AAOS shoulder app. The app design is simple and straightforward., however, the amount of content is limited and could be enhanced with images and diagrams of techniques. Having the information consolidated into one location with this app will be beneficial to some practitioners. E.g. currently AAOS has multiple apps for multiple body parts, it would make sense for them to put their Shoulder, Knee, and Spine apps into one consolidated app.

Overall ScoreUser Interface

The information is presented in a list format interface that is easy to navigate. With a few clicks, the user can navigate to topics of interest and view the associated video example.

Multimedia Usage

The videos are good quality but could be enhanced with pathologic videos or positive findings. Similarly, images and diagrams would improve teaching the exam maneuvers.

Price

The application is not cheap, but not expensive when taking into account the multimedia content included and the quality of content.

Real World Applicability

This is a good application for quick review of common shoulder maneuvers, practical to use in practice.

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iPhone 5

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Google Glass + EHR = A winning combination for doctors? | mHealthNews

Google Glass + EHR = A winning combination for doctors? | mHealthNews | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

mHealth advocates have been debating for some time whether Google Glass will offer meaningful value to physicians, or if it will be just another high-tech toy that fades away when doctors can't fit it into their workflow. With the recent news that Google Glass is now integrating with an EHR, that argument has just been kicked up a notch.

Drchrono, the Mountain View, Calif.-based developer of a free EHR platform that can be accessed via the iPad, iPhone and other mobile devices, calls its new integration the first wearable health record (WHR). Michael Nusimow, the company's co-founder and CEO, argues that it fits ideally into the physician's workflow because doctors need to accurately capture the patient encounter and can't always be typing away on a tablet or laptop.

"You can't use a tablet during surgeries," he told mHealth News during a recent interview. "It's hands-free technology" that answers the physician's desire for a device that can capture data in real-time, at the point of care, and seamlessly push that data into the patient record.

Nusimow, who has been a Google Explorer since the company first offered the high-tech glasses to a cadre of specially selected users roughly two years ago, said Google Glass enables physicians to have more natural conversations with their patients. In clinical settings such as the OR, it enables the physician to call up decision support tools or take photos or videos without changing the workflow.

"The goal is to make this ubiquitous, not onerous," Nusimow said. "From my point of view this is one more tool that (the physician) can have to document patient care."

Google Glass' ability to capture a doctor's first-person perspctive makes the technology incredibly relevant, according to Bill Metaxas, who has been piloting the Google Glass-drchrono integration in his San Francisco clinic.

"Images and video make the electronic health record both more meaningful and useful, and help memorialize an encounter much more powerfully than a narrative report," Metaxas told mHealth News. "Ultimately, consultations and interchange of information between doctors will happen through secure hangouts, allowing more thorough consultations and improving patient care."

The partnership also drew a positive response from Box, a developer of cloud-based secure content sharing technology and an investor in drchrono.

“Doctors want better workflow for capturing clinical documentation. Glass provides faster alternatives to standard data collection and capture," said Missy Krasner, managing director of healthcare and life sciences at Box, in a press release. "By partnering with Box, drchrono can broaden its data-sharing options by allowing relevant medical content to be securely shared with patients, family members and other providers involved in patient care.”

Since its unveiling, Google Glass has certainly been a disruptive element in healthcare. It has captured the imaginations of entrepreneurs and clinicians from Maine to California and beyond, spawning incubator clinics like Palomar health's Glassomics lab, high-profile trials, even instances where doctors have tried out the technology on their own (and, in some cases, had their hands slapped by administrators).

In assessing the value of Google Glass, critics have wondered if it's capturing relevant data for the health record, or just compiling unstructured information that would have to be filtered and entered at a later date by the physician or a scribe – thereby wasting time and money.

When the drchrono-Google Glass integration was unveiled, one commenter to a story posted in Healthcare IT News (a sister publication of mHealth News under the HIMSS Media umbrella) scoffed at the perceived value to physicians.

"Google glass is an interesting device with huge privacy and social acceptance issues," wrote the commenter, identified as MD H. "As I think back to encounters I have had with my physician over the years taking pictures, recording and streaming are three things that I wouldn't want him doing during an encounter. I think that the time savings associated with Glass will be minimal, it will lead to additional layers of time sucking documentation."

"History shows us again and again that whenever a new technology is introduced into the healthcare arena, medico-legal paranoia will always encourage 'just one more' layer of documentation and record keeping on an already overburdened medical care practitioner," MG H concluded.

Metaxas disagreed.

"Doctors work to help their patients, and Glass can help make medical documentation more robust," he argued. "The laws governing the inappropriate disclosure of health information exist to preclude such events. The privacy settings are no more complex than those on current smartphones; ultimately it's always up to the doctor to ensure that the device is used appropriately."

Nusimow agrees that Google Glass is "exciting but also challenging" and points out that clinicians have to know what they can and can't do with the devices. "You're building on bleeding-edge technology that is changing everyday," he pointed out.

That's exactly Nusimow and co-founder Daniel Kivatinos were thinking when they launched the drchrono EHR on the iPad platform in 2010.

"If there's new technology, we're going to build on it," Nusimow said. "And it was obvious that Google Glass was capturing the attention of doctors."

Related articles:

5 steps to getting payers and providers to tap mHealth apps

3 sensor startups collecting population health data

FCC: 'Telemedicine, it's coming'


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9 best medical apps to keep you healthy

9 best medical apps to keep you healthy | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Pouring over a smartphone indoors for hours playing games, watching videos, and texting can have adverse affects on health. But you’re on your phone anyway, so you might as well check in on your physical well-being with this list of medical apps. Some of these apps will help you find and understand pharmaceuticals, while others work to diagnose your symptoms or teach you how to be more efficient in an emergency. All of these apps can make you more informed, but shouldn’t replace a doctor for medical advice or calling for help in case of an emergency.

If you’re downloading apps already, you might as well check out our lists of best news apps, best food and drink apps, best music apps, best apps for iPhone and best apps for Android.

Microdemex

iOS | Android

Free

Microdemex is a simple pharmaceutical reference app with features such as proper drug dosage and medicine recommendations. You can search the name of a specific drug to find out how it should be taken, as well as any potential side effects. You can also search by ailment for drug recommendations that will combat your medical problem, from the standard fever to lice control. Microdemex is comprehensive yet simplistic, so anyone can quickly find what they’re looking for.

UpToDate

iOS | Android

Free

For someone studying medicine, working as a medical professional, or just interested in medical news, UpToDate is a great way to keep track of medical advancements and news. You can look at the “What’s New” section to peruse headlines, or you can search for specific topics. Along with articles, UpToDate contains videos on medical procedures. You can bookmark or email andy page, so you can start a conversation with a colleague or refer back to it on your own.

Johns Hopkins ABX Guide

iOS | Android 

Free

A comprehensive reference app, Johns Hopkins ABX Guide lets you search for information on medications and treatments for various illnesses. Plug in a drug and see a list of recommended dosages, side effects, and restrictions on behavior while you’re taking it. The app also has evidence-based recommendations, giving you an idea of whether or not it is right for your lifestyle. Its best feature may be a table that breaks down the cost of each drug.

Mobile First Aid

Windows

Free

What should you do if you see someone choking at a restaurant or someone collapses in the park? Mobile First Aid will offer quick tips about how you can help someone before paramedics arrive. You can study the information so you know it before someone is in need, or pull out the app before stepping in to help. On the first page, you can choose from a list of emergencies and it will walk you through what you should do. It also includes a button to call for help.

MyChart

iOS | Android

Free

MyChart gives lets you have your medical records on your phone at all times. You can access which vaccinations you’ve had and when, the last time you visited the doctor, and which prescriptions you’re taking. You can even send a non-urgent message to your clinic and receive a response within a couple days, schedule appointments via the app, and request prescription refills. If you can’t get access to a smartphone, you can see all your information online.

Epocrates

iOS | Android 

Free

Epocrates takes reference apps to a whole new level. It includes basic functions like information regarding side effects and dosage, but it also allows you to contact the manufacturer directly. If you are having a hard time finding your medication, you can use the app to find providers and insurance information. Another nice feature helps you identify pills with imprint codes or a physical description so you’ll never take Vicodin instead of allergy medicine again.

Doctor on Demand

iOS | Android

Free 

If you have ever wanted a doctor in your pocket, Doctor on Demand is for you. Instantly connect with doctors in video chats or audio calls. Simply enter your symptoms and you will be directed to a licensed doctor. The app is free, but the call will run you $40 for 15 minutes. Doctors can give medical advice and also prescribe medicine. You can’t choose which doctor you will be talking with, so if you like to get to know your doctors, this isn’t the app for you.

GlassesOff

iOS

Free

Though not directly a medical app, GlassOff works to save you a visit to the optometrist. The app uses eye exercises to train your eyes so they stay sharp for as long as possible. After taking a short test so the app can assess your existing vision, you participate in daily training sessions designed as a workout for your eyes. The app is initially free and comes with a one week free trial, but after that the price is raised to $69.99 for a year.

Skinvision

Android 

Free

Skin cancer is the most common cancer in America and one of the easiest to detect. Alhough you should be mindful of when your body changes, going to the doctor every time you develop a new mole isn’t necessary. Instead, try out Skinvision. You take a picture of a questionable mole or other skin mark, and the app determines whether or not it could be dangerous. Skinvison also keeps track of curious moles by creating an archive of pictures of them so you can spot changes.


Read more: http://www.digitaltrends.com/mobile/best-medical-apps/#ixzz36WVbbZCu
Follow us: @digitaltrends on Twitter | digitaltrendsftw on Facebook

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Jim Murphy's curator insight, July 4, 5:03 PM

list is growing and growing

Bettina Gifford's curator insight, July 4, 6:13 PM

Best Medical Apps, what do you think? 

Jay Ostrowski's curator insight, July 5, 9:38 AM

A long list of mental health apps can be found at www.telementalhealthcomparisons.com/apps

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Survey: 80 percent of smartphone users want to interact with doctors on mobile devices

Survey: 80 percent of smartphone users want to interact with doctors on mobile devices | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Eighty percent of smartphone users are interested in using their smartphones to interact with health care providers, according to a FICO survey of 2,239 adult smartphone users from the UK, Australia, Brazil, China, France, Germany, India, Italy, Japan, Korea, Mexico, Russia, Turkey, and the United States.

The survey analyzed how consumers prefer to interact with health care providers on mobile devices, online and in-person.

“The way health care organizations communicate with people is changing, as individuals become more and more sophisticated about using information technology to make health-related decisions,” Stuart Wells, FICO’s chief product and technology officer said in a statement. “People are especially interested in mobile services that can help them manage their personal health and shop for health care services. The leading health care providers are increasingly turning to mobile technologies to meet this demand, and to engage frequently and proactively with consumers.”

Of those that want to do more health-related tasks on their smartphones, 80 percent already receive reminders of upcoming appointments, 60 percent receive reminders to arrange appointments and health checks, 40 percent receive reminders to take medication, 34 percent use their smartphones to look for medical advice, and 32 percent receive reminders to monitor personal health risks.

The survey also found that 56 percent of people trust health care organizations with their personal data, 71 percent of smartphone users are “open to offers of relevant healthcare services from businesses”, and 53 percent are open to provider-initiated communications.

Currently, FICO noted, 54 percent of smartphone owners do not receive reminders to take their medications on any channel, 12 percent of consumers don’t receive reminders to arrange an appointment or health check, and only 7 percent do not receive reminders about upcoming appointments.

Smartphone users were also interested with interacting with their physician remotely. Almost two-thirds of respondents would rather receive medical advice on mobile devices instead of going to the doctor’s office.


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Helen Adams's curator insight, July 3, 4:22 AM

Now that depends on what they mean by "interact", are they meaning consultation with their HCP or accessing test results and repeat prescriptions.

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Patients Want Digital from Pharma | PM360

Patients Want Digital from Pharma | PM360 | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
Patients Want Digital from Pharma
by Sam Welch on June 9th, 2014


 

New survey data released by Accenture found that more than 75% of consumers expect drug companies to provide additional services that complement their medical products.

Digital platforms are frequently mentioned as the preferred method of contact. Sixty-nine percent of respondents said they’d prefer information from pharma companies via email, followed by printed materials (66%), websites (48%), mobile apps (44%) and social media (38%). Print media made the list, though patients have made it clear that they are seeking resources through digital channels.

Of interest to marketers, the data show that 64% of patients are willing to trade personal information to get free, relevant content. Not only should we engage around this opportunity, this indicates that marketers can achieve access to more customer data in order to personalize information to each patient’s needs. And digital expands opportunities to track outcomes and tailor content to the individual.

Consumers want more tools to manage their healthcare. If we’re really moving into an age where “an app a day can keep the doctor away,” then we must address this need to make valuable tools available to patients.

Read the full Accenture report here.



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Laurent FLOURET's curator insight, July 2, 6:30 AM

At this stage, it is beyond the wake up call...

Bettina Gifford's curator insight, July 2, 6:55 PM
Are you meeting patient needs with digital support?
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Accenture Mobility Digital Trends 2014

Digital Trends Craig McNeil / Philippe Bonneton February 2014 Accenture Digital

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Bettina Gifford's curator insight, July 3, 5:33 PM

Mobile communication campaigns  have to be  in budget...

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Massive pan-African mobile health advice and analysis service launches

Massive pan-African mobile health advice and analysis service launches | Mobile Health: How Mobile Phones Support Health Care | Scoop.it
Massive pan-African mobile health advice and analysis service launches

 

The GSMA, the group of mobile operators and companies dedicated to standardising mobile phone communications,  has unveiled a Mobile for Development mHealth programme, which will provide various mHealth health care services to women and children across Sub-Saharan Africa.

The list of partners involved includes tech companies like Gemalto, Samsung and MTN, along with health specialists  Hello Doctor, Lifesaver, Mobenzi, Mobilium and Omega Diagnostics. Initially, the program will focus on maternal and child health in seven countries: Côte d’Ivoire, Ghana, Nigeria, Rwanda, South Africa, Uganda and Zambia. A second phase planned for next year includes Kenya, Malawi, Mozambique and Tanzania.

From the press release:

“This new mobile ecosystem partnership, developed by the GSMA, is committed to connecting the mobile and health industries to develop commercially sustainable mHealth services that meet public health needs,” said Tom Phillips, the Chief Regulatory Officer of GSMA, said in a press statement, “The companies in this partnership are working to deliver the objectives of the United Nations Every Women Every Child Global Strategy, as well as the Global Nutrition for Growth Compact, in the areas of nutrition and maternal and child health. We call on mobile ecosystem players, health providers, governments, NGOs, civil society and others to work with us to launch life-saving mobile health services.

The main thrust of the initiative appears to be subsidised Samsung phones and tablets with free data connections via MTN. Where it gets interesting is in the embedded apps for healthcare promised, and discounted accessories such as monitors that attach to phones to test the CD4 count of HIV sufferers in the field – something that cuts down on weeks of lab time.

It’s intriguing news and one of the most ambitious plans to use mobile phones for health we’ve heard of yet. We’ll be following up in due course.

[Image - Shutterstock]


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Talk to a virtual doctor on your iPad

Talk to a virtual doctor on your iPad | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Imagine for a moment that your allergies have been troubling you for the past few days. What do you do? Complain on Facebook? Probably. Make an appointment with your doctor? Maybe. Talk to a virtual doctor on your iPad? Never. Well, soon you will.

A company called Geppetto Avatars is about to turn health care on its head with virtual physician's assistants that very well could be smarter than any doctor who ever walked the Earth. In one of the company's allergy applications, a sympathetic young doctor named Sophie talks you through air quality and the pollen index in your neighborhood. Then, she makes sure that you're taking your prescriptions right. When you tell her you're feeling really bad, she gives a gentle "mmm-hmmm," to let you know she's been there and wants nothing more than to help you feel better.

Except she hasn't been there. Because she's a computer program.

If you saw the move Her, it's a lot like that. Only better, because this virtual chick won't break your heart. If anything, she'll try to fix it.

FUTURE OF MEDICAL WORK: The computer will see you now

The thought of using computers to help keep us healthy isn't new or even all that novel: Let's face it, when it comes to raw data, computers are smarter than us. They might not be able to take over the world, Terminator-style, but IBM's Watson shamed its human competition on Jeopardy, and that's pretty close.

The wealth of wisdom housed on connected hard drives around the globe is simply more than a human brain can handle. When you go to the doctor, you have access to a fraction of that knowledge, and while health care professionals know a heck of a lot more than the average person, it seems safe to say that more is better when it comes to your well-being.

But computer programs have always lacked the ability to read body language, non-verbal cues, and all those parts of communication that make us human. Just asking Siri for directions to the nearest pizza place is a far cry from getting advice from a virtual robot on something as serious as your health. At best, we're often left hoping for a response that borders on intelligent — as the computer crunches key words and text strings — trying to mix and match words versus meaning.

Geppetto Avatars tackles the human component. Just as your real doctor learns from the tone of your voice and your facial expressions, so does Sophie. The system uses your device's camera and microphone to see and hear what you say, then uses natural language processing, sentiment analysis and voice-to-text recognition to analyze the meaning behind your words. If you sound down in the dumps about a health issue, you'll get a sympathetic response from your virtual practitioner, and if you're super happy about a new exercise plan, the digital doc will share your excitement.

As with most AI applications, the more you use it, the better job it does at reading you — picking up whether your voice is hoarse or your breathing labored, or whether you sound worried or anxious. The hope is that with some training, it will be able to detect your mood, read your state of mind, and respond accordingly with one of its tens of thousands of recorded answers. It will also share your information with your real, living health care professionals.

Geppetto's founders say the idea here is not to replace your doctor, but to provide tools for both patient and practitioner to get the information they need. In addition to applications for allergies, Geppetto's working on versions of Sophie to work with kids with asthma, people with diabetes and arthritis, and developing a product targeting Parkinson's disease.

If this all seems really far-fetched, consider this: Geppetto creators say their Avatars will be talking with people within three to five months. The founders also told us that they're in a daily patent race with Apple, Google, Microsoft and a handful of other massive tech companies working on similar applications to move ahead with a more realistic relationship between computers and man. So … this is likely just the tip of the communicating, mood-reading, mind-interpreting Avatar iceberg.

Jennifer Jolly is an Emmy Award-winning consumer tech contributor and host of USA TODAY's digital video show TECH NOW. E-mail her at techcomments@usatoday.com. Follow her on Twitter: @JenniferJolly.


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mHealth App Growth Nearly Double Overall Mobile Market

mHealth App Growth Nearly Double Overall Mobile Market | Mobile Health: How Mobile Phones Support Health Care | Scoop.it

Consumer use of mobile health and fitness apps in the first half of 2014 is almost double that of the mobile platform market in general, according to mobile analytics and optimization vendor Flurry.

"We have studied the usage of over 6,800 iPhone and iPad apps listed in the health and fitness category on Flurry’s platform and we have seen a 62 percent increase in usage of health and fitness apps over the past six months," Flurry CEO Simon Khalaf writes in a blog post. "This compares to 33 percent increase in usage, measured in sessions, for the mobile app industry in general. Growth in health and fitness is 87 percent faster than the industry, which is itself growing at an astounding rate."

Khalaf says the trend was a stark turnaround from 2013, in which general mobile app use grew by 115 percent, while health and fitness app use increased by only 49 percent.

The company's analysis found two factors encouraging the rapid groth of mobile health and fitness apps: the ability of smartphones to replace discrete devices as the hardware platform for the apps, and the integration of the apps--such as MapMyFitness--with social networking platforms.

The audience segment leading the mobile health app charge, according to Khalaf, was mothers aged 25-54 who are sports fans and who also lead healthy lifestyles.

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SusanThorn's curator insight, June 30, 7:32 AM

Mobil apps for a mobil society.