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发表于 2014-9-9 20:47:45
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Part II: Speed The Real Promise of Mobile Health Apps
Mobile devices have the potential to become powerful medical tools
Jul 1, 2012 |By Francis Collins
Time2
As a volunteer in a trial of mobile health technology, I can attest that it's incredibly cool to pick up your iPhone, fire up an application to monitor your heart rate and rhythm, and then beam your ECG reading to a cardiologist halfway around the globe. As a physician-scientist, I also know that cool technology is not necessarily synonymous with good science or sound health practices and that therein lies a challenge.
The use of cell phones and wireless sensors to gather and access health data has grown quickly in recent years. Popular mHealth apps are used for counting calories, gauging nutrition, tracking workouts, calculating body mass index and quitting smoking. These worthy efforts pale next to the potential of mHealth to aid in medical research and health care.
Mobile devices offer remarkably attractive low-cost, real-time ways to assess disease, movement, images, behavior, social interactions, environmental toxins, metabolites and a host of other physiological variables. Many mHealth technologies could be put to highly innovative uses in biomedical research; at the same time, biomedical research could help build the foundation of evidence that so many mHealth applications currently lack.
Because mobile devices are miniaturized and require little energy to operate, they have the power to bring the research laboratory to the patient in ways never before possible. For instance, clinical trial participants can avoid the inconvenience of visiting research facilities, writing down their daily activities or wearing clunky monitors. Scientists would also get higher-quality data because written diaries and questionnaires about exercise, diet, pain, and so forth, are notoriously unreliable. Real-time continuous biological, behavioral and environmental data can greatly improve understanding of the underlying cause of disease. Combining mHealth data with GPS data could also lead to early detection and warning systems for outbreaks of illnesses related to environmental exposures or infectious agents.
Wireless sensors could help scientists keep track of sleep patterns at home, instead of their having to rely on lab-based studies or self-reporting. Doctors could monitor blood pressure during daily activities, which is when it matters most, rather than in a clinic. Washable tattoos embedded with nanosensors could take blood glucose and sodium readings for transmission via a smartphone.[361 words]
Time3
To make all this happen, health researchers, technology developers and software designers must pull together to find ways of evaluating new technologies. The National Institutes of Health is working to build the interdisciplinary research capacity needed to establish an evidence base for the benefits and risks associated with mHealth technologies.
Maintaining privacy and security of health data is a challenge that calls for research. How do we protect trial participants and ordinary consumers without adversely affecting research and quality of care? Who will set rules for privacy of mHealth data? Who will provide protections if privacy is breached?
We must also learn how people are actually using mHealth in their everyday lives. I suspect that, right now, the majority of users are much like me, treating their new apps as gee-whiz toys rather than as valuable tools for improving their health. I am convinced, however, that the real potential of mHealth lies with much more committed users, such as the children with type 1 diabetes who took part in a yearlong, case-control study of wireless technologies to monitor and manage blood glucose levels. That study, published in Diabetes Care, showed that youngsters who used the automated system had significantly better glycemic control and diabetes self-management skills than those who did not. Now that's an mHealth moment worth getting excited about.[220 words]
source:
http://www.scientificamerican.com/article/real-promise-mobile-health-apps/
Inside the Technology That Can Turn Your Smartphone into a Personal Doctor
The fantastic tricorder device that “Bones” used to scan aliens on “Star Trek” is nearly at hand—in your cellphone
By Ariel Sabar
Smithsonian Magazine | Subscribe
May 2014
Time4
Episode one of “Star Trek,” Stardate 1513.1. Chief medical officer Leonard “Bones” McCoy beams onto a desolate planet, M-113, with orders to perform a routine physical on Prof. Robert Crater, an ill-tempered archaeologist who wishes McCoy would just go away.
“Doubtless the good surgeon will enjoy prodding and poking us with his arcane machinery,” Crater snipes.
Think again, Crater: Prodding and poking is so last millennium.
Dr. McCoy packs a medical “tricorder.” Wand the body with this hand-held computer, and seconds later it coughs up the particulars of a patient’s condition.
“The machine is capable of almost anything,” McCoy says. As he sweeps the device across Crater’s chest and back, it purrs like a blissed-out electronic cat. In the 23rd century—as pictured by television writers in the late 1960s—that purr was a sign that a very sophisticated machine was working.
The tricorder-like devices in the UCLA engineering labs of Aydogan Ozcan don’t purr. Nor do they cause the shoulder strain of the cassette recorder-size clunkers of Trekkie lore. But in other respects, they’re the closest thing yet to the real McCoy.
Ozcan’s sleek gizmos, which fit onto the back of a smartphone, count thousands of red and white blood cells in seconds; screen urine for signs of kidney disease; spot viruses like HIV and influenza in a smear of blood; and test water for bacteria, parasites and toxic chemicals. Another phone attachment, the iTube, scanned for microscopic specks of allergy-causing peanut in what one of Ozcan’s journal articles last year described as “3 different kinds of Mrs. Fields Cookies.”
When I visited Ozcan on the UCLA campus, a dozen of the devices were arrayed like museum pieces in an illuminated glass display case in a corner of his laboratory. The ones in the original “Star Trek” series resembled antediluvian Walkmen. Ozcan’s devices are the size of a lipstick case or matchbox.
“This is honestly one of our first hacks,” he told me with a touch of nostalgia, pulling out a six-year-old Nokia phone that he’d somehow retooled into a lens-free digital microscope. He says “hack” because he takes technology already in our pockets—the smartphone, another gadget anticipated by “Star Trek’s” inaugural episode—and cheaply reworks it into lightweight, automated versions of the bulky instruments found in medical laboratories.
At the rate he’s going, Ozcan, who at 35 already holds the title of UCLA chancellor’s professor, may soon hack the whole clinical lab. He wants nothing less than to make it small and cheap enough—and so idiot- and klutz-proof—that we can carry it in our pocket like loose change.[433 words]
***
Time5
I’d visited Ozcan during a week in January when temperatures tripped into the 80s. So when one of his postdocs, Qingshan Wei, a 32-year-old with stylish clip-on shades, asked if I wanted to scope out the waves in Marina del Rey, I raised no objection.
Our “scope” was a Samsung Galaxy with an attachment that turned the phone’s camera into a mercury detection system. The toxic metal can build up in fish, and water tests can serve as an early warning system. “We want to detect mercury in water before it goes into the food chain,” Wei told me.
We splashed barefoot into shin-deep surf, and Wei pipetted seawater into a small plastic box on the back of the phone. Inside were a pair of LEDs that fired red and green beams of light through the water sample and onto the phone’s camera chip. An app scrutinized the subtle shifts in color intensity, and four seconds later, results flashed on the screen.
Two months earlier, mercury levels at this very spot had been worrisome. Today, the phone told us, the water was safe.
Similar tests performed by a full-scale environmental laboratory are very expensive, Wei told me. They also require schlepping the sample to the lab, for a complicated analysis called inductively coupled plasma-mass spectrometry. “For this,” Wei said, nodding at the mercury tester, which cost $37 and was made by a 3-D printer, “we write a smart application. You just sample, click open the application, follow the instructions and click ‘analyze this.’”
The brains of the system are Ozcan’s algorithms, which turn the phone’s humdrum camera into a powerful optical instrument that sees what the eye can’t, then tells us how worried to be. His devices—because they piggyback on GPS-enabled smartphones—no sooner test a sample than they can send time- and location-stamped results to your doctor, an environmental agency or, say, Google Maps. Supply the technology to enough of the world’s three billion mobile subscribers, and you’ve got battalions of citizen scientists beaming up health and environmental data from across the globe in real time.
Ozcan’s software funnels the data into a continually updating map where epidemiologists, public health officials and your uncle Murray could follow the spread of a disease or chemical spill live, the way our smartphones already use our speed and location to crowd-source data for mobile traffic apps. Ozcan’s goal: to chart the world’s invisible threats—the pollutants in water, the allergens in food, the pathogens in air—as panoramically as traffic or weather.[421 words]
source:
http://www.smithsonianmag.com/innovation/inside-technology-can-turn-your-smartphone-personal-doctor-180951177/#FBCvAXKdTxIwFbT2.99
Will Any Health App Ever Really Succeed?
There are wildly successful apps for mapping, sending e-mail, and catapulting birds. Why aren’t there any for health care?
By Rachel Metz on September 24, 2013
Time6
Geoffrey Clapp thinks a mobile app can make health care better—so much so, in fact, that his upcoming app is called just that: Better.
The app is being tested at the Mayo Clinic, which is an investor in Clapp’s startup, and is slated to launch in October. It aims to let people use a smartphone to reach a doctor, find a diagnosis, or keep track of their medical records. Storing personal medical data and using health-tracking features will be free, but users will be charged monthly fees for instant access to nurses and health coaches.
Better, also the name of the company, is among a slew of health and fitness companies concentrating on the mobile Internet market. So far, however, health apps have failed to take off. To the disappointment of “e-health” advocates who hope to see such apps transform the medical landscape, the number of Americans using technology to track their health or fitness didn’t change between 2010 and early 2013, according to data from the Pew Internet & American Life Project.
Business models have been elusive, too. Google launched the Web application Google Health in 2008 as a way for people to corral their health records online, but it was not widely adopted, and it shut down last year. Patients battling health problems complain that phone app developers have yet to develop truly useful products.
One of Better’s basic goals is giving people easy access to their health records by smartphone, something that’s becoming possible as hospitals shift from paper to electronic records. Such information may be useful to have on hand not only when dealing with a serious disease but also at unexpected times, such as when an administrator asks for a child’s vaccination report on the first day of school. Clapp thinks easy and quick access to medical information will cut down on health-care costs by advising people, for instance, when a visit to the emergency room is called for or when seeing their regular doctor will suffice.
Paul Limburg, a Mayo Clinic doctor who is working with Better, says the app addresses some patients’ complaints that health care is too confusing and sometimes hard to access. The Minnesota health center has already made more than 75 health-related apps available.[375 words]
[The remaining]
Better, which Clapp says will be available first on the iPhone, will include a version of Mayo’s online symptom checker, as well as access to location-based data like local pollen counts and lists of healthy restaurants in your area. The app will also give Mayo Clinic patients direct access to their health records. Because it supports other standards for transmitting patient data, such as Blue Button, it could work with other hospital systems as well.
To generate revenue, Clapp says, the app will offer access to paid services: customers may be able to push a button to speak by phone to a trained nurse, or get help coördinating tests and doctor appointments at the Mayo Clinic. Clapp wouldn’t disclose the pricing scheme, but he said an average customer might pay around $125 per month for what he called “medical concierge services.”
Laurence Baker, a professor of health research and policy at Stanford University, says that while there’s “tremendous potential” in organizing patient medical records, it may be difficult to get parties such as insurance companies, doctors, and hospitals to share the data, and to get patients to use and trust apps that include such information.
Clapp says that Better still needs to iron out some legal details to secure patient records electronically and ensure compliance with different states’ rules (for example, some states allow telemedicine across state lines only via videoconference, while others allow the practice over audio). But about 500 patients, doctors, and nurses are already testing the app, he says, using it to track pregnancy, diabetes, hypertension, or their children’s health.[263 words]
source:
http://www.technologyreview.com/news/518911/will-any-health-app-ever-really-succeed/
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