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Smartphones and the Future Of Home-Based Telemedicine For

Patients With Chronic Diseases

!!Abstract

Chronic disease management poses a big challenge to healthcare providers.

Improving the quality of patient’s health, controlling cost and tracking patients

progress are some of the challenges to name a few.

The focus of this paper will be on the current commercial peripherals attached to

smartphones that could play role managing chronic disease patients by allowing

the information exchange between the patients and their physicians in home-

based telemedicine settings.

Objective

To provide an overview of the potential use of the smartphone in telemedicine,

emphasizing on the use of commercial peripherals, sensors and applications

only, and to discuss the benefits and the possible challenges for such use.

Background

The huge rise in smartphone sales in recent years has revolutionized

communication; it is one of the fastest growing sectors in the technology industry.

A smartphone is a mobile phone with advanced functionality beyond making

phone calls and sending messages. It has the capability to display photos,

videos, send and receive e-mail, surf the Web, and run third-party applications,

(Smartphone, 2010). Compared to standard mobile phones, smartphones have

larger screen and more powerful processors. (Phone Scoop, 2013). Nowadays

smartphones replace the need for many devices, such as computer, camera,

music device, watch, pager, calendar and PDAs to name few.

!

(Ritholtz, 2013)

A smartphone not only combines the technology of all devices, but it makes it

significantly accessible to consumers because of its size and affordability, and

ease of use.

In recent years, smartphones have become more powerful and widely used.

There are at least 165 million active Android and IOS devices in the U.S. They

are used by 78% of the adult population (age 15-64) (Blodget, 2012). In

healthcare environment more than 81% of physicians are using smartphones.

(DOLAN, 2011) .

Telemedicine is one field of healthcare that can benefit the most from this

technology; as healthcare reform encourages the patient centered medical home,

and stage 2 of the meaningful use required by HITECH act focuses more on

rigorous health information exchange (HealthIT.gov Meaningful Use).

The challenge that chronic disease patients face is the need to manage their

disease on daily basis; home based telemedicine presents as very valuable

alternate way for them to communicate with nurses and doctors and to monitor

their disease.

!Smartphone applications today give an idea of how it will eventually be used in

telemedicine. Below I will review some examples of gadgets that revolutionized

the currently used monitoring devices that exist in the market.

!AliveCor Heart Monitor:

The FDA has approved AliveCor as a heart monitor device. When patient

touches the sensors on the iPhone case AliveECG application simply records,

displays, stores, and transfers (ECG)

rhythm strips to accurately diagnose AF,

making this an ideal enabling technology

for community screening programs to

detect silent AF. Screening programs utilizing this device could have a substantial

impact on reducing ischemic stroke related to previously undiagnosed AF. (Lau,

et al., 2012) (Alivecor, 2013)

This device has limitations in the acute evaluation of chest pain associated with

heart attacks. A single lead will miss many real ischemic events and also there is

an increased rate of false positives. (Misra, 2013)

!IBGStar:

Sanofi diabetes launched a blood glucose meter that can be

connected to the iPhone to easily display, manage and sharing

diabetes information. The app gives log tables, graphs, and

averages. Patients can share the information stored on the app

with the healthcare team while on the go, (iBGStar, 2012). The

collected information also could be synchronized with patient’s

PHR stored in Microsoft HealthVault, which may help make better-informed

diabetes-related decisions.

!Withings Blood Pressure Monitor:

This device creates a new link between

technology and usability. The blood pressure

monitor connected to the iPhone simplifies the

daily tracking of blood pressure. (Withings, 2011)

Patients can measure blood pressure and heart rate. All measurements are

recorded along with the date. A graph can be shared with the physician. (Wan,

2011). Patients can activate synchronization with Microsoft HealthVault so that all

records are in one place. (Withings, 2011)

Kinsa Smart Thermometer:

Kinsa Smart Thermometer gives patients more than just

a temperature reading. It can also tell them what

illnesses are going around, what they might have, and

what they can do about it. (Indiegogo, 2013). This device

is not commercially available yet.

!Ds32a:

This application opens great possibilities for the use

of digital stethoscope. It shows the digital sound recording on the iPhone, Patient

can save it, and share it with his physician. (Saenz, 2010)

Discussion:

The market for new and innovative application peripheral is endless, the potential

is high and the market is very new.

The goal mostly is to find the peripherals that are reasonably priced and easy to

use for the end consumer, also the end consumer needs to have a reason to buy

such a peripheral.

I do believe that chronic disease patients will benefit from these applications,

because not only they measure and record, some of them also synchronize the

data with the patient personal medical record, so the patient will have centralized

records and graphs that can be shared with healthcare team.

Advantages:

• Cost effective: ECG for instance will cost an average of $1,500 if done in a

clinic setting (New Choice Health, 2012), but it will cost a fraction of that

when using an iPhone peripheral (AliveCor price is $199)

• Cost savings: Monitoring chronic patients is key in managing their overall

outcome, these applications will allow the nurses and doctors to get an

accurate view of the patient’s health over time.

• Accessibility: Patients with chronic disease living far from medical centers

will benefit the most using these applications since it will help avoiding

unnecessary transfers from home to the hospital.

• Reliability and accuracy: The information is saved and sent to the patient’s

PHR, which will only make the PHR more accurate and organized. It is

very crucial to the physician to not depend on the patient’s notes and have

access to unbiased data.

• Medical home: Based on the changes in health care it would be easier for

physicians to monitor and control their chronic disease patient panel that

are utilizing peripheral devices to record their data.

!

Challenges:

• Penetration: according to recent census there is 40 million people over the

age of 65, 80% of them have one chronic condition, and 50% have at least

two (Centers for Disease Control and Prevention, 2011). Research

suggests that Smartphones penetration rate for people over age 65 is

between 16% and 42% only.

!

This segment of the society also might face difficulties adopting this

technology and they might not be willing to change the old fashion way of

monitoring.

• Security: there is a challenge with such crucial medical information be on the

cloud. Not all of the above applications are HIPAA compliant. Concerns

about privacy and information quality, may delay the deployment of this

technology for remote health monitoring. (Shin, 2012)

• Dependability: these applications are dependent on wireless Internet so the

need for infrastructure is crucial in rural areas.

• Training and setup: although smartphones are easy to use, not all of elderly

patients are capable of doing so. The need for coaching is key to

guarantee success.

• Lag of PHR use: Once people start using personalized health records,

doctors might find it more rewarding to tap into that if they believe they will

receive more accurate data.

• Insurance coverage: Most if not all insurances do not cover the use of

peripherals such as blood pressure monitor (Denker & Wolfrum, 2010)

which would add to the consumer cost to utilize such devices. However

this might change once insurance companies have enough data on usage

and how its use will cut cost like I have explained in the advantages.

• Cost: There is also the cost of the smartphones and the connectivity plans to

the Internet. This might be one of the biggest obstacles for penetration with

the consumers.

• Time: it takes time to educate new consumers to utilize new technology, and

it will take time for physicians to view all the data collected by the new

technology without interruption the routine clinical workflow.

Conclusion:

It is clear that smartphones have the potential to integrate into the healthcare

field. These devices provide a wealth of information and resources to physicians,

while also speeding communication and improving efficiency.

Peripheral devices that attach to smartphones used by chronically ill patients

might have a better chance of penetration than other peripheral devices seldom

used by the consumer.

In the new changes of healthcare and the adoption of the medical home I think

we will see much more adaptation of these devices where physicians are more

incentivized to monitor their chronic patients regularly to prevent major medical

events.

The way I see it, there will be more companies and more competition to produce

the latest and best product, which will benefit the consumer, and in the long run

will reduce the cost of healthcare in the US.

!

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