Sam Brusco, Associate Editor10.11.17
Diabetes is very treatable, but managing it often feels like a full-time job. So many factors affect blood glucose levels that it can seem impossible to track them all. Strict diet and exercise regimens are key to keeping glycemic levels in check, in addition to regular insulin doses for some patients. Some patients have to test their blood glucose multiple times daily. But without a regimen in place, patients are at risk for a whole host of comorbidities. So how do diabetic patients contend with all this?
Livongo Health, which offers a blood glucose monitor with a companion service designed to coach diabetic patients, is one tool that provides guidance. The company’s cellular-connected monitor takes blood sugar readings and transmits the information to its health monitoring services. If the reading is outside of normal range, that person is flagged and recommended to drink some fruit juice or take a walk to bring blood glucose back to normal levels. If too far from the normal range, it alerts a specialist.
Issuing patients “reminders” about managing their disease and alerting a specialist when necessary are just a few of the benefits of using a mobile health (mHealth) tool to proactively manage a chronic illness. mHealth technologies can also save healthcare costs by preventing an unnecessary trip to the emergency room by detecting an inconsistency early. They could also replace a lengthy clinic visit to adjust a treatment, because mHealth platforms typically collect—and sometimes analyze—patient data to determine if a treatment is working.
MPO’s October feature story “I’ll Take My Healthcare ‘To Go,’ Please” explored the trends and technological advances driving the mobile health market as well as some of the latest mHealth platforms available to patients. Matt Lowe, executive vice president of MasterControl, a provider of industry-specific quality and compliance software solutions and services, was among the industry experts interviewed for the article. His complete input is included in the Q&A below.
Sam Brusco: What trends are you noticing in mobile health (mHealth) management?
Matt Lowe: The number of smartphone owners who use mobile health apps is expected to reach 1.7 billion by 2018.1 In 2016, the global number of mHealth apps on the market was approximately 260,000. There are more than 59,000 mHealth app publishers and with demand rising; this number is only going up.2 By the end of this year, the industry is expected to reach $26 billion in revenue.3
Wearables that interact with smartphones are driving a number of innovations. Alphabet Inc.’s life sciences company Verily is making waves in the wearables market. It applied for a patent for a smart device—potentially a watch—which reminds patients to take their medication when they eat. Sensors on the device are used to detect predefined activity data indicative of food consumption. For example, the motions and rotations a human performs when using a knife to cut a piece of meat might be programmed into the device to signal that a person is eating; this would trigger a notification. GPS coordinates and traditional mealtimes might also be triggers. Verily is not limiting itself to wearables. The company is developing stabilizing and leveling handles and utensil attachments, which are designed to help people with hand tremors or limited hand and arm mobility retain dignity, confidence, and independence. They are also working on miniaturized medical devices designed to improve daily life, such as a contact lens with an embedded glucose sensor that allows diabetics to measure the glucose in their tears.
Brusco: In what ways does the use of a mobile digital health tool ease the burden on patients managing their illness? How does it ease the burden on healthcare professionals/caregivers?
Lowe: Clinicians who are under pressure to reduce costs and improve outcomes are in favor of using mHealth tools. Survey results released by the PwC Health Research Institute (HRI) indicate nearly 90 percent of U.S. clinicians think mobile apps will become essential to patient health management over the next five years.4
Seventy-four percent of the HRI respondents said they would be willing to use data streamed from a mobile app or device to check for ear infection; 53 percent were in favor of using a mobile app or device to analyze urine, and 20 percent have already prescribed nutrition and weight loss apps.5
Brusco: Which illnesses in particular are made less burdensome to manage using an mHealth tool, and in what ways does the tool lessen that burden?
Lowe: The technologies and types of applications are increasing as fast as the market is growing. For instance, on the clinician’s side, clinical or diagnosis assistance apps can include symptom checkers, digital imaging (MRI/X-raying) viewing capabilities, electronic chart review, and lab results review and personal health record apps that enable patients to store their medical condition’s data, allergies, and so on.
Remote monitoring apps, such as LifeScan for patients with diabetes, oxygen level remote checkers, remote heart monitoring, and telehealth services, are having a major impact by allowing patients to live their lives and avoid in-person visits that cost tremendous time and money for both patients and providers.
Virtual visits and other telehealth platforms have become powerful tools when fighting and containing fast-moving and dangerous viruses such as the flu. Patients don’t have to leave their homes, which lowers the risk of exposure to others.5
Another large and rapidly growing segment is the personal fitness or wellness category, which many healthcare professionals would consider preventative in nature. These include nutrition apps, health/exercise-tracking, fitness, weight loss apps, and many more.
Brusco: What innovative technologies are making mobile health solutions possible?
Lowe: Innovation is the name of the game in mHealth, and many innovations are centered directly on the smartphone. For example, the Australian company ResApp received funding by the Bill and Melinda Gates Foundation to develop an app that could be used to detect respiratory issues. Essentially, a doctor would ask the patient to cough into a smartphone. The app would help the doctor determine if the patient suffers from conditions such as pneumonia. Other examples in this category are Propeller Health, which combines an inhaler with a high-tech sensor; AsthmaMD, which pairs a peak flow meter and smartphone app; and iSonea, whose device measures and charts a user’s wheeze rate.
We are seeing many non-healthcare companies entering the medical device market, often through the health vehicle. Tech giants Google and Apple are prime examples of non-traditional medical device companies that are entering the space, disrupting the business models of major industry players, and paving the way for other large and small companies to develop new apps.
Mobile app development is particularly attractive to start-ups because apps typically take less time to bring to market and require less (or different) regulatory scrutiny. This is particularly true for apps positioned as wellness devices rather than medical devices. Wellness apps are not regulated, so they allow device makers to expand their product offerings and generate new lines of revenue quickly. However, it can be difficult to determine if a mobile app falls inside or outside the realm of FDA authority, i.e., whether it meets the definition of a medical device under section 201(h) of the Federal Food, Drug, and Cosmetic Act (FD&C Act).
Brusco: What are some of the software advances fueling innovative mHealth technologies?
Lowe: Advances in algorithms linked to clinical data sit at the heart of innovative healthcare benefits to consumers. Machine learning, which is an artificial intelligence technique that constructs algorithms with the ability to learn from data, will help speed and improve app development.
The development of new sensors and leveraging sensors that are standard on smartphones for mHealth applications such as GPS, accelerometers, and a phone's camera which can monitor heartrates will fuel new innovations.
Brusco: What’s the future of mHealth tools?
Lowe: mHealth apps promise to significantly reduce healthcare costs and improve the accuracy of patient care. mHealth technology will mature. As it does, wearables and sensors will be even further miniaturized and specialized, opening the door for more novel applications to be developed.
Personalized medicine is a hot trend that continues to edge closer to mainstream. Pharmacogenomics and genome sequencing could be in the future of mHealth. This would help tailor treatment at never-before-seen levels and reduce billions of dollars in healthcare spending. Without a doubt, the next frontier of medicine may very well be in your pocket, on your smartphone.
References
1Hartford, Jamie, “Will FDA Regulate Your Mobile Medical App?” MD+DI, August 6, 2014.
2TicBiomed, “The mHealth app market is getting crowded reaching the 259.000 apps.” TicBiomed website, Oct. 13, 2016.
3Research2guidance, “Research2guidance mHealth App Developer Economics 2014 Study.” Slideshare, May 22, 2014
4PWC Health Research Institute, “Clinician Survey,” 2014.
5Wicklund, Eric, “Flu Season Turns the Spotlight on mHealth, Telehealth Advances.” mHealth Intelligence.com, Feb. 3, 2017.
6Wicklund, Eric, “App + Smartphone = Diagnostic Tool?” mHealth Intelligence.com, March 11, 2016.
Livongo Health, which offers a blood glucose monitor with a companion service designed to coach diabetic patients, is one tool that provides guidance. The company’s cellular-connected monitor takes blood sugar readings and transmits the information to its health monitoring services. If the reading is outside of normal range, that person is flagged and recommended to drink some fruit juice or take a walk to bring blood glucose back to normal levels. If too far from the normal range, it alerts a specialist.
Issuing patients “reminders” about managing their disease and alerting a specialist when necessary are just a few of the benefits of using a mobile health (mHealth) tool to proactively manage a chronic illness. mHealth technologies can also save healthcare costs by preventing an unnecessary trip to the emergency room by detecting an inconsistency early. They could also replace a lengthy clinic visit to adjust a treatment, because mHealth platforms typically collect—and sometimes analyze—patient data to determine if a treatment is working.
MPO’s October feature story “I’ll Take My Healthcare ‘To Go,’ Please” explored the trends and technological advances driving the mobile health market as well as some of the latest mHealth platforms available to patients. Matt Lowe, executive vice president of MasterControl, a provider of industry-specific quality and compliance software solutions and services, was among the industry experts interviewed for the article. His complete input is included in the Q&A below.
Sam Brusco: What trends are you noticing in mobile health (mHealth) management?
Matt Lowe: The number of smartphone owners who use mobile health apps is expected to reach 1.7 billion by 2018.1 In 2016, the global number of mHealth apps on the market was approximately 260,000. There are more than 59,000 mHealth app publishers and with demand rising; this number is only going up.2 By the end of this year, the industry is expected to reach $26 billion in revenue.3
Wearables that interact with smartphones are driving a number of innovations. Alphabet Inc.’s life sciences company Verily is making waves in the wearables market. It applied for a patent for a smart device—potentially a watch—which reminds patients to take their medication when they eat. Sensors on the device are used to detect predefined activity data indicative of food consumption. For example, the motions and rotations a human performs when using a knife to cut a piece of meat might be programmed into the device to signal that a person is eating; this would trigger a notification. GPS coordinates and traditional mealtimes might also be triggers. Verily is not limiting itself to wearables. The company is developing stabilizing and leveling handles and utensil attachments, which are designed to help people with hand tremors or limited hand and arm mobility retain dignity, confidence, and independence. They are also working on miniaturized medical devices designed to improve daily life, such as a contact lens with an embedded glucose sensor that allows diabetics to measure the glucose in their tears.
Brusco: In what ways does the use of a mobile digital health tool ease the burden on patients managing their illness? How does it ease the burden on healthcare professionals/caregivers?
Lowe: Clinicians who are under pressure to reduce costs and improve outcomes are in favor of using mHealth tools. Survey results released by the PwC Health Research Institute (HRI) indicate nearly 90 percent of U.S. clinicians think mobile apps will become essential to patient health management over the next five years.4
Seventy-four percent of the HRI respondents said they would be willing to use data streamed from a mobile app or device to check for ear infection; 53 percent were in favor of using a mobile app or device to analyze urine, and 20 percent have already prescribed nutrition and weight loss apps.5
Brusco: Which illnesses in particular are made less burdensome to manage using an mHealth tool, and in what ways does the tool lessen that burden?
Lowe: The technologies and types of applications are increasing as fast as the market is growing. For instance, on the clinician’s side, clinical or diagnosis assistance apps can include symptom checkers, digital imaging (MRI/X-raying) viewing capabilities, electronic chart review, and lab results review and personal health record apps that enable patients to store their medical condition’s data, allergies, and so on.
Remote monitoring apps, such as LifeScan for patients with diabetes, oxygen level remote checkers, remote heart monitoring, and telehealth services, are having a major impact by allowing patients to live their lives and avoid in-person visits that cost tremendous time and money for both patients and providers.
Virtual visits and other telehealth platforms have become powerful tools when fighting and containing fast-moving and dangerous viruses such as the flu. Patients don’t have to leave their homes, which lowers the risk of exposure to others.5
Another large and rapidly growing segment is the personal fitness or wellness category, which many healthcare professionals would consider preventative in nature. These include nutrition apps, health/exercise-tracking, fitness, weight loss apps, and many more.
Brusco: What innovative technologies are making mobile health solutions possible?
Lowe: Innovation is the name of the game in mHealth, and many innovations are centered directly on the smartphone. For example, the Australian company ResApp received funding by the Bill and Melinda Gates Foundation to develop an app that could be used to detect respiratory issues. Essentially, a doctor would ask the patient to cough into a smartphone. The app would help the doctor determine if the patient suffers from conditions such as pneumonia. Other examples in this category are Propeller Health, which combines an inhaler with a high-tech sensor; AsthmaMD, which pairs a peak flow meter and smartphone app; and iSonea, whose device measures and charts a user’s wheeze rate.
We are seeing many non-healthcare companies entering the medical device market, often through the health vehicle. Tech giants Google and Apple are prime examples of non-traditional medical device companies that are entering the space, disrupting the business models of major industry players, and paving the way for other large and small companies to develop new apps.
Mobile app development is particularly attractive to start-ups because apps typically take less time to bring to market and require less (or different) regulatory scrutiny. This is particularly true for apps positioned as wellness devices rather than medical devices. Wellness apps are not regulated, so they allow device makers to expand their product offerings and generate new lines of revenue quickly. However, it can be difficult to determine if a mobile app falls inside or outside the realm of FDA authority, i.e., whether it meets the definition of a medical device under section 201(h) of the Federal Food, Drug, and Cosmetic Act (FD&C Act).
Brusco: What are some of the software advances fueling innovative mHealth technologies?
Lowe: Advances in algorithms linked to clinical data sit at the heart of innovative healthcare benefits to consumers. Machine learning, which is an artificial intelligence technique that constructs algorithms with the ability to learn from data, will help speed and improve app development.
The development of new sensors and leveraging sensors that are standard on smartphones for mHealth applications such as GPS, accelerometers, and a phone's camera which can monitor heartrates will fuel new innovations.
Brusco: What’s the future of mHealth tools?
Lowe: mHealth apps promise to significantly reduce healthcare costs and improve the accuracy of patient care. mHealth technology will mature. As it does, wearables and sensors will be even further miniaturized and specialized, opening the door for more novel applications to be developed.
Personalized medicine is a hot trend that continues to edge closer to mainstream. Pharmacogenomics and genome sequencing could be in the future of mHealth. This would help tailor treatment at never-before-seen levels and reduce billions of dollars in healthcare spending. Without a doubt, the next frontier of medicine may very well be in your pocket, on your smartphone.
References
1Hartford, Jamie, “Will FDA Regulate Your Mobile Medical App?” MD+DI, August 6, 2014.
2TicBiomed, “The mHealth app market is getting crowded reaching the 259.000 apps.” TicBiomed website, Oct. 13, 2016.
3Research2guidance, “Research2guidance mHealth App Developer Economics 2014 Study.” Slideshare, May 22, 2014
4PWC Health Research Institute, “Clinician Survey,” 2014.
5Wicklund, Eric, “Flu Season Turns the Spotlight on mHealth, Telehealth Advances.” mHealth Intelligence.com, Feb. 3, 2017.
6Wicklund, Eric, “App + Smartphone = Diagnostic Tool?” mHealth Intelligence.com, March 11, 2016.