Mobile Health Technology: Its Future & Its Ethics

Two recent events–Apple’s introduction of iOS 8, Health App, and HealthKit, and  the upgrade of Windows MSN Health & Fitness App for  the Windows Phone–herald significant advances and the eventual ubiquity of mobile apps technology in health and fitness monitoring,  maintenance, care, and personal health information documentation, use, and sharing.

Even before these milestone events, the trend is evident: From December 2013 to June 2014 the growth of mobile health and fitness apps usage nearly doubled that of apps overall; and with these new developments it is certain to accelerate.

AppsUsage_Flurryapps

A recent two-part post on the Public Health Perspectives blog presents an interesting interview with an expert who discusses the future and the ethics of mobile apps technology. The blog includes portions of an EU infographic answering the question, mHealth, what is it? with some amazing statistics.

mHealth allows mobile devices to monitor and collect health data more efficiently, allowing quicker and better treatment and increase prevention. The infographic explains in detail what mHealth does and how it improves the life of patients in the EU.

So, paraphrasing Samuel Jackson: What’s on your mobile device?

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23andMe – ‘Cooing’ and ‘Wooing’

23andMe

If you have considered obtaining your genetic information from 23andMe or elsewhere (and including it in your PHR), then you might want to inform yourself on the issues before proceeding.

If there’s a gene for hubris, the 23andMe crew has certainly got it. Last Friday the U.S. Food and Drug Administration (FDA) ordered the genetic-testing company immediately to stop selling its flagship product, its $99 “Personal Genome Service” kit. In response, the company cooed that its “relationship with the FDA is extremely important to us” and continued hawking its wares as if nothing had happened. Although the agency is right to sound a warning about 23andMe, it’s doing so for the wrong reasons. — Scientific American

While the FDA’s concerns–the safety and efficacy of ‘medical devices’–are important, broader privacy issues have subsequently been raised and discussed in the SA post, comments, and elsewhere.

23andMe Is Terrifying, but Not for the Reasons the FDA Thinks
[November 2013, Scientific American]

More on the 23andMe controversy and genetic privacy, here.

Now, 23andMe is trying to win back FDA favor and approval.

23andMe Tries to Woo the FDA
[July 2014, MIT Technology Review]

Might we expect some form of regulation of genetic testing products and services marketed directly to patients? Regulations such as those provided by the HIPAA Privacy Rule 1 for medical and health information in our medical records (EMR) and personal health records (PHR)?

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1. The HIPAA Privacy Rule is part of the implementation of  HIPAA, the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information, and help the healthcare industry control administrative costs. – Google     → More

Posted in Security & Privacy | 1 Comment

In Case of Emergency

icon_ice The latest additions (and improvement) to the PHR4us weblog are the 1.0 [beta] version of ICEmaker and the new notice, Put ICE on it!, a link to two new pages imploring folks to put ICE (In Case of Emergency) information on  their iOS or Android mobile devices.

ICEmaker

ICEmaker is a free guide and tool for easily organizing, encrypting, accessing, and extracting sensitive, personal information on a small USB flash drive. The USB flash drive can be attached a keychain, carried everywhere, and inserted in laptop or desktop computers for updating and accessing personal health records (PHR) and other information needed In Case of Emergency (ICE). ICEmaker replaces TruCrypt, offering a much more portable approach to creating, maintaining, and accessing encrypted, password-protected personal health information and other ICE information of USB flash drives. ICEmaker may be used on Macintosh, Windows, and Linux platforms.

Put ICE on it!

Also added to PHR4us are two new pages about putting ICE on your iOS or Android mobile devices. The first page, Put ICE on it!, is an introduction to ICE with links to instructions and apps for your iPhone, iPad, or other mobile device. The link, Put ICE on it!, will remain under Notices on the sidebar. The second page,  ICEBlueButton, provides more information about this new, free app and a link to its website.

Put Your ICE Information on the Internet

You can also create a free website with your ICE information with different pages for health care providers, family, and friends. Secure each ICE page with a unique password., then share the link and passwords with those who should have access. Also, put the link (and password for ICE – Healthcare) on your ICE wallet card, stickers, etc. For an example, see a prototype template at http://petstech.wix.com/in-case-of-emergency.

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Posted in Apps, PHR4us Development, USB, USB (encrypted) | Tagged | 1 Comment

Health Apps: Where Do They Make Sense


mha-logoHealth Apps-Where do they make sense?, a white paper published March 2014 and based on a seminar held at the King’s Fund, London, 28 October 2013, summarizes issues related to health apps from the perspectives of patients, standards, and policies.

The seminar’s five key messages:

  • Overhauling healthcare systems–making them patient-centric
  • Engaging doctors in the prescribing of health apps
  • Overseeing quality standards for health apps
  • Ensuring that health apps remain of a high standard throughout their lifetime
  • Considerations for policymakers wishing to oversee health apps

While the context was British healthcare, the messages are easily translated to U.S. and Canadian patients, providers, and healthcare.

read the white paper

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PHR Resulted in Improved Quality of Care and Use of Services

A recent Emory University study concluded,

“Having a personal health record resulted in significantly improved quality of medical care and increased use of medical services among patients. Personal health records could provide a relatively low-cost scalable strategy for improving medical care for patients with comorbid medical and serious mental illnesses.

American Journal of Psychiatry

e-Patient Dave discusses the study’s results and conclusions on the e-patients.net weblog.

Also, see the e-patient.net post, “How Collaborating with Patients Improves Hospital Care”: Guardian.

Posted in Patient Engagement, PHR/EHR | Tagged | 1 Comment

Patients to Have Right to Access Lab Test Result Data – Finally!

For those of us who are trying to develop, maintain, and use a comprehensive patient health record (PHR)–whether it be paper or electronic, using a notebook, file system, HealthVault, or some other electronic PHR–this is really good news: finally, patients have a right to access their test results. 

This significant development, which has been a long-time coming*, is heralded and explained on e-patient.net by health care lawyer and consultant, David Harlow, who chairs the Society for Participatory Medicine’s public policy committee.

As you and I and many other HealthVault users may know, the results of tests contracted out by our healthcare providers to LabCorp can be automatically accessed via the LabCorp Beacon: Patient website and transmitted automatically to a HealthVault PHR via an associated HealthVault app. But for most of us, for most of our tests run by our health providers or other lab services (e.g., LabFirst), test results have not been accessible to us, electronically, even though some information about the tests has been available.

For example, my BlueCross/BlueShield (FEP) insurer recently offered  a new PHR (provided by WedMD health services).  The dates and names of all lab tests performed and submitted for payment appear in the WebMD PHR, but no test results. And even though I may have the results via other means (electronically from LabCorp or on paper from my physician), it appears that it is not possible for me to enter the test results in my WebMD PHR, which is possible in my HealthVault PHR.

So with the new, federally mandated right to access lab results, by October 2014 we should be able to access the results from contracted labs and/or from our healthcare providers and insurers, preferably electronically–hopefully, entered automatically–in the PHR provided by them or in our HealthVault PHR.

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Gimme My Damn Data! → Give Us Our Damn Lab Results!!
In Healthcare, Time To Free The Data → Free The Data: Patients As Consumers

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Synchronicity and ‘Secret Sauce’

sauce_thumbWouldn’t you know: The other day, on our way home from the oncologist nearly 100 miles away, we stopped at our favorite, world class Bar-B-Q joint, Jim ‘N Nick’s.  We ordered big so we’d have enough take-home for at least one more tasty meal. And we bought and brought home, too, a bottle of Jim ‘N Nick’s ‘secret sauce.’

The very next day,  while researching  information on healthcare mobile apps for this weblog, I came across this post: Mobile Health Apps: Pass the Secret Sauce.

[How could I not give it some serious attention? Here’s a hint.]

According to David Harlow, health care lawyer, consultant, and  healthblawger the ‘secret sauce’ for mobile health apps is patient engagement. Says David,

A foundational element necessary to any finding of efficacy and value — even assuming that there is some science or medicine backing up an app, which the IIHI report calls into question for most of the 40,000+ health apps out there — is the secret sauce of patient engagement.

 This synchronicity (a meaningful acausal coincidence) is doubly significant, for just recently I provoked an invitation to write a guest post on PHR for Andrew’s Blog. Andrew Shorr is the host and founder of the outstanding website, Patient Power and author of  The Web-Savvy Patient: An Insider’s Guide to Navigating the Internet When Facing Medical Crisis.

Using David’s delicious metaphor, I’d like to suggest that patient portals and mobile health apps may well become the ‘secret sauce’ for patient power. The recipe is:  patient portals and heath apps → patient engagement → patient power. And that leads to better health outcomes. But, mind you, it won’t be a piece of cake.

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