Solve the outbreak!

Reblogged from Public Health--Research & Library News:

Do you want to be a disease detective?  the Centers for Disease Control and Prevention (CDC) have released a new app, Solve the Outbreak.

New outbreaks happen every day and CDC’s disease detectives are on the front lines, working 24/7 to save lives and protect people. When a new outbreak happens, disease detectives are sent in to figure out how outbreaks are started, before they can spread. 

Read more… 119 more words

Related articles

• CDC iPad App Lets You Solve Disease Outbreaks (mashable.com)
• New CDC App Turns You into a Disease Outbreak Detective (forbes.com)
• CDC app lets you solve disease outbreaks at home (onlineathens.com)
• Play Disease Detective With New CDC App (medicalnewstoday.com)
• CDC Launches Free App 'Solve the Outbreak' (counselheal.com)
• CDC app turns iPad users into disease detectives (bizjournals.com)

Patients who self track their data: Curb your enthusiasm

From the 17 January 2013 article by KEEGAN DUCHICELA, MD at KevinMD.com

…

1. There’s not strong data to support self-tracking.  We can make some inferences about how self-tracking would work in a clinical setting by looking at the studies done on telemonitoring, which also generates a large volume of attribute-rich data.  Some studies have shown benefit in outcomes, especially for diseases like diabetes, COPD, and hypertension.  However, hard measures like mortality have not been improved by telemonitoring devices.  Data on hospitalization and ED visits, especially in the elderly, have been mixed.  People (especially the engineers who created these wonderful devices and apps) love to think that more data points are better. But to date, we just don’t have a robust set of well controlled studies telling us what self-tracking is useful for, what devices or apps to use, how to interpret the data, or how to integrate it into medical care.

2. Physicians may not want the data.  Imagine that a 45-year old man who had just started exercising after years of inactivity gives their doctor all of their heart rate measurements from the past month.  All 5000 measurements.  There’s no way their physician is going to want to touch that data.  Buried inside those data points will be erroneous and clinically meaningless measurements which, without review and context, will be fodder for trial lawyers when something bad happens.  It’s data overload to the Nth degree, because let’s face it … anything can be tracked.  Once data gets put into the medical record, it’s assumed the physician has reviewed the data and acted on it accordingly.  No one wants something in the patient’s chart that not only has limited medical use but carries substantial legal risk.

Finally, we need to pay physicians to analyze and counsel about the data, similar to how we pay for EKG interpretation or reading an x-ray.   Fee-for-service still rules the roost, and nothing gets done unless someone pays for it…

 

Read the entire article here

There’s no app for that: health apps that don’t work

iTunes Store, impresion en iPhoto y iPhone en México (Photo credit: marcopako )

 
From the 15 November 2012 article at HealthNewsReview.org

 

A report by The New England Center for Investigative Reporting - published by the Washington Post – is headlined, “Many health apps are based on flimsy science at best, and they often do not work.”

It begins:

“When the iTunes store began offering apps that used cellphone light to cure acne, federal investigators knew that hucksters had found a new spot in cyberspace.

“We realized this could be a medium for mischief,” said James Prunty, a Federal Trade Commission attorney who helped pursue the government’s only cases against health-app developers last year, shutting down two acne apps.

Since then, the Food and Drug Administration has been mired in a debate over how to oversee these high-tech products, and government officials have not pursued any other app developers for making medically dubious claims. Now, both the iTunes store and the Google Play store are riddled with health apps that experts say do not work and in some cases could even endanger people.

These apps offer quick fixes for everything from flabby abs to alcoholism, and they promise relief from pain, stress, stuttering and even ringing in the ears. Many of these apps do not follow established medical guidelines, and few have been tested through the sort of clinical research that is standard for less new-fangled treatments sold by other means, a probe by the New England Center for Investigative Reporting has found.”

 

Related articles

 

• There’s an app for anything that ails you, even if it doesn’t work (wcvb.com)
• Medical apps may actually hurt health instead of helping (reporternews.com)
• Calling shenanigans on mobile health apps that make false claims (medcitynews.com)
• FTC finds popular kids apps collect data without telling parents (mercurynews.com)

 

Let’s help patients with the tradeoffs in medicine

Hillary Clinton Health care elderly (Photo credit: Wikipedia)

 

mHealth and mobile heath technologies are all the rage these days. (See my previous post,The Future of Healthcare is Already at Your Fingertips [INFOGRAPHIC]

 

While mobile devices are useful in diagnosing and gathering information (as tracking devices), it is probably best to use them wisely and not let them distract you from all life has to offer.

 

 

 

From the 27 October 2012 article at Kevin MD.com

 

…we need to consider our own tradeoffs as researchers and practitioners when talking about health communication and engaging everyone in their own health. The tradeoff for aiming to engage people more and more is that we run the risk of overwhelming people.

Some of us are like e-Patient Dave: we want full access to all of our data, and, indeed, we should have it. But as someone living with chronic autoimmune illnesses and immersed in a never-ending data stream of self-tracking, monitoring, and constant, moment-to-moment tradeoffs, I acknowledge that I don’t always want to be engaged. I already spend plenty of time dealing with my health data, and sometimes, I would rather find a new hike to do with my kids this weekend than upload more data or peruse more graphs.

In short, let’s help people choose between the butter and the butter money in smart ways, and on their terms.

[Read the entire article here, "butter and butter money" is more or less the translation of a French saying...akin to having cake and eating it too]

Found this comment to be succinct and on target

 

carolynthomas • 20 hours ago

 

Merci bien, Prof Witteman. Despite BuzzKillerSmith’s odd comment here, it seems to me that you have hit upon a critically important link between reality and wishful thinking, between homeowners and your father-in-law contractor, between both patient and physician. (And if these tradeoffs were being as effectively addressed in day-to-day health care as BKS seems to believe, we wouldn’t have stent-happy cardiologists implanting all those unnecessary stents, would we now?)

Your quote “designing for the way people are, not the way we wish they were” seems especially appropriate in the discussion of health care and emerging technology. When I attended Stanford University’s ‘Medicine X’ conference last month, I was astounded by the number of young, tech-savvy “Quantified Self” proponents gushing over The Next Big Thing in health care technology – particularly all those self-tracking smartphone apps. (I shouldn’t have been astounded – we were in the epicentre of Silicon Valley, after all!) Completely missing was any insight from the health tech startups onstage that the demographic most likely to “need” this kind of technology (especially older users living with multiple chronic diseases) is clearly the group least likely to actually use it.[My emphasis] More on this at: “When The Elephant In The Room Has No Smartphone” - http://myheartsisters.org/2012…

So the tradeoffs in emerging health technology are, just as you are doing in both your career and in your diagnosis, to respect the fine line between what’s out there and what we need to do.

 

 

 

Related articles

• What Do You Mean, I Can’t Have It All? (engagingthepatient.com)
• Let’s help patients with the tradeoffs in medicine (kevinmd.com)
• Switched On: Tablets and tradeoffs (engadget.com)
• Addressing Health Literacy: A Variation of Perspectives (engagingthepatient.com)
• How big data is transforming health care and predictive analytics (zdnet.com)
• Making Captured Data Meaningful In the Age of Mobile, Participatory Health (semanticweb.com)
• Patient-Centerness in Healthcare (ehealth.johnwsharp.com)

 

The Future of Healthcare is Already at Your Fingertips [INFOGRAPHIC]

From the 8 August 2012 post at Mashable Lifestyle

The mobile healthcare industry has made significant strides within the healthcare provider community. Rock Health found 75% of small and medium size medical and dental offices will purchase tablets within the next year. And almost 40% of physicians use medical apps on a daily basis.

The digital healthcare field is also alleviating the costs of patientcare and increasing the scale at which doctors and nurses can help people. The healthcare industry is already strained, Ziegler says, and a shortage of primary care physicians in years to come will only exacerbate the problem. She says mobile apps can bridge that gap.

But patients have been slower to realize the impact apps could have, Ziegler says, potentially because the apps force people to take notice of their health.

“No one wants to actively track what they are always doing, so we really want to make the experience passive,” she told us, adding, they are working to make tech and apps that “provide incentives for people to manage health more efficiently.”

Consumers are also generally unaware of how quickly the space of mobile health is growing, David Tao, Chief Research Officer at Greatist, tells Mashable. He says once consumers realize the vast industry already accessible, more consumers will begin utilizing the products.

“Mobile health isn’t a replacement for healthcare, it’s a supplement,” Tao says. “These companies aren’t replacing doctors’ keen eye or experience, but the apps are just bettering communication between doctor and patient.”

Related Resources

• Health and Wellness Information and Tracking Apps (Flahiff’s Health/Medical Resources site)
• Health and Fitness Tracking Apps (Flahiff’s Health/Medical Resource site)
• And these may be helpful when selecting health apps
  • How to Choose A Better Health App (by LEXANDER V. PROKHOROV, MD, PHD  at KevinMD.com on August 8, 2011) contains advice in the following areas
  • Set realistic expectations
  • Avoid apps that promise too much
  • Research the developers
  • Choose apps that use techniques you’ve heard of
  • See what other users say
  • Test apps before committing
• iMedical apps has mobile medical app reviews and commentary by medical professionals. Most apps are about  apps geared toward professionals and are not free.
• The iMedical app forum now includes a medical librarian corner, with some patient/consumer apps
• Evaluating Health/Medical Information
  • The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.
    • The tips include
      • Remember, anyone can publish information on the internet!
      • If something sounds too good to be true, it probably is.
      • If the Web site is primarily about selling a product, the information may be worth checking from another source.
      • Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
      • Check to see how current the information is.
      • Check for accuracy. Does the Web site refer to specific studies or organizations?
  • The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials Topics include
    • General Guidelines for Evaluating Medical Research
    • Getting Information from the Web
    • Talking with your Health Care Provider
  • Additional Resources
    • Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis)
    • How to Evaluate Health Information on the Internet (US National Cancer Institute)9iiu9
    • Quackwatch (a private corporation operated by Stephen Barrett, MD)
  • And a Rumor Control site of Note (in addition to Quackwatch)
    • National Council Against Health Fraud  National Council Against Health Fraud is a nonprofit health agency fousing on health misinformation, fruad, and quackery as public health problems. Links to publications, position papers and more.

Related articles

• Phones, tablets may become most popular tech devices for docs since the stethoscope (infographic) (medcitynews.com)
• Does smartphone = smart healthcare? (docmate.com.au)
• Mobile health apps: a new opportunity for healthcare marketers (worldofdtcmarketing.com)
• More Consumers Get Health Info On Mobile Devices (informationweek.com)
• INFOGRAPHIC: Smartphone = smarter healthcare? (mobile-ent.biz)
• How Smartphones Are Facilitating Better Health Care (thinkprogress.org)
• U.S. HealthWorks Adopts iTriage App to Connect with Patients (prweb.com)
• Who Do You Trust When it Comes to Healthcare Information? [INFOGRAPHIC] (mashable.com)
• How Smartphones Are Changing Health Care (iphonesavior.com)

Self-Tracking May Become Key Element of Personalized Medicine

 

Allan Bailey brought his type 2 diabetes under control for the first time by using a continuous glucose monitor.

 

From the 5 October 2012 article at UCSF News Center

A steady stream of new apps and devices that can be synced to ever-more sophisticated mobile phones is flowing into consumers’ hands, and this technology is revolutionizing the practice of self-tracking, in which individuals measure and collect personal data to improve their heath.

Self-trackers are using these tools to monitor sleep, food intake, exercise, blood sugar and other physiological states and behaviors. In some cases, they are using the data to identify what triggers or worsens flare-ups of chronic health disorders on their own, or with the help of an online community. In others, patients are even working together with physicians and scientists to conduct experiments, pooling their data for analysis that may shed light on the cause or best treatment for their disease.

This phenomenon was explored at a Sept. 28 symposium at Stanford University, where attendees and presenters — including two UCSF physicians — asserted not only that self-tracking can help patients to improve their lives, but also that self-tracking has the potential to change medical practice and the relationship between patients and their health care providers. The event was part of Medicine X 2012, a three-day conference on social media and information technology’s potential impact on medicine..

…

Already 60 percent of U.S. adults are tracking their weight, diet or exercise routine; one-third of adults are tracking some other indicator or symptom, such as blood sugar, blood pressure, headaches or sleep patterns; and one-third of caregivers are monitoring health indicators for loved ones, Fox said…

..

Self-tracking may not be for everyone, Abramson said, but it may be especially helpful for those who are diagnosed with medical problems for which conventional treatment typically offers little benefit; for those with symptoms and syndromes that are not adequately diagnosed through conventional medicine; for those who want to change their behavior; for those who want to identify environmental, dietary, contextual or social contributors to their symptoms; or for those who simply want to be more involved in their own health care.

 

Related articles

• Stanford Medicine X: Reflections on Day 1 (thebiopsy.wordpress.com)
• Bluetooth device to track blood sugar levels (thehindu.com)
• Fora Care to Unveil New Mobile App, Featuring Advanced Mobile Connectivity of FORA Diamond Series Blood Glucose Monitoring System at EASD 2012 in Berlin at Booth #3C41 (demandroid.info)
• Self-tracking may become key element of personalized medicine (medicalxpress.com)

 

The problem with transformative technologies in medicine

http://www.healthxchange.com.sg/healthyliving/HealthatWork/Pages/top-5-health-apps-to-download.aspx

Yesterday I reflagged an item about the  Free UMSkinCheck Mobile App.
While these self check apps are wonderful consumer and patient tools, they are not without “problems”.
This KevinMD.com post outlines health app use challenges as folks gathering data without knowing what to do with and reimbursement issues (physician consultations outside of the office).

Article ends with statement “Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that.”.

The problem with transformative technologies in medicine

by ROB LAMBERTS, MD(KevinMD.com post, 17 July 2012)

Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: “Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks….

…

large number, if not the majority, of ear infections are undiagnosed and clear on their own at home without intervention.  Now add to this a technology which gives us the ability to see all of those undiagnosed ear infections, and we have to muster even more willpower to resist the urge to treat them all.  This is the same problem as we have encountered with PSA testing: be careful gathering data you don’t know how to handle.

But even without considering this important objection to improved data-gathering, there is another problem which stands in the way of this type of technology: reimbursement.  It sounds great to enable people to avoid visits to the doctor’s office by having tools that previously were only accessible at an office visit.  It sounds like a very good way to save money and wasted time spent in waiting rooms with outdated magazines.  But this technology presumes that doctors will be willing to act on this information without seeing the patient in the office.  It presumes we will be willing to offer free care.  If the time I spend sifting through patient-collected data rises exponentially, the payment I get for that time cannot remain at the present level: zero.

If our goal (as it should be) is to spend less money on unnecessary care, we will get to it much faster if we somehow give proper incentive.  Our encounter-based payment system stands in the way of any progress in this area.  The only way most of us get paid is to see people and deal with problems.  This makes doctors reluctant to offer any care outside of this setting, and puts undue pressure on intervention (to justify the encounter to the payors).  Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that….

Related articles

• Will Information Technology Squeeze Physicians Out Of Their Central Role In Health Care? (the healthcareblog.com, July 11, 2012)

  “Turns out that while most of us (90%) would like be able to make a doctor’s appointment and check lab results online….85% of us also still want the option of be able to talk to our physician face-to-face.  These are the finding from a recent 2012 study conducted by Accenture.”"

What is significant about the finding cited above is that patients at least get it.  They understand the value of a having a relationship with a knowledgeable physician or similar health care provider.  In spite of, and for some, because of the plethora of health information outlets on the web people want to know that they always have access to your family doc when the chips are down.”

“Here’s what I mean…based upon some 20+ years working in health care:

From the get go…going back to Hippocrates…health and health care delivery has been about the relationships between people starting with the  physician-patient.relationship.

The most important diagnostic tool a physician has at their disposal is not a smart phone…but their ability to talk with and observe  patients verbal and non-verbal behavior.

 “Talk” is not only how physicians diagnose problems and recommend the appropriate treatments…talk is also how patients are able to engage in the health care.  Perhaps the most overlooked aspect of talk (and touch) during the medical exam is the therapeutic benefits patients derive from being able to express heart-felt fears and concerns to someone who hopefully cares.”

• Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (singularityhub.com)
• Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (forbes.com)
• Back to the Future: Predicting the Future of Healthcare (Part I) (drchrono.com)
• Three mobile tools that could transform how cardiovascular disease is managed (medcitynews.com)
• Company developing #mhealth ECG device for iPhone, ipad raises $10.5M (medcitynews.com)
• Dr Topol to med students: “When I was in medical school, the term “digital” was reserved for the rectal examination” (casesblog.blogspot.com)

[Reblog] Cancer Tracking Goes Mobile – Free UMSkinCheck Mobile App

[Reblog from Taubman Health Science Center Newsblog]

Cancer Tracking Goes Mobile

July 12, 2012 by irinazey

The sun is definitely shining brightly outside – do you know how your skin is affected?

University of Michigan Medical School and University of Michigan Health System have developed a free app to photograph your skin and monitor any suspicious moles or lesions in an effort to make skin cancer screening cheaper, faster, and more convenient for the average person.

Screenshots from UMSkinCheck

Under the supervision of lead developer Dr.  Michael Sabel, UMSkinCheck walks you through a full-body skin self-exam, lets you track moles/lesions for change over time, and set up notification reminders for recurring self-exams. It also comes loaded with information on sun safety and a risk calculator to help determine individual risk based on personalized data.

Read the full story from UMHS here or download the app free from the iTunes storehere.

On a related note, from A blog I follow ,As Our Parent Age- Timely Topics for Adult Children

“Yet another friend has skin cancer. She always used sun blocking lotions, but also enjoyed staying out in the sun for long periods. (I have her permission to write this much.)
My friend tells me that she now understands that sun blocks, no matter how effective or powerful, are only one piece of a skin protection puzzle. Staying out of direct sunlight during the the most intense times of the day is another large puzzle piece.”

This is a good blog to follow, I can’t express it any better than what the author states on the about page

 ”As Our Parents Age is my effort to record the experiences of loving and living with aging parents, but it is also a vehicle to help my husband and me understand and learn more about aging parent caregiving. I am highlighting interesting issues, identifying high quality web resources, and sharing memories. Other posts are on topics that my husband and I would have liked to know more about at the beginning of our foray into the aging child – aging parent phase of life.”

Related articles

• The problem with transformative technologies in medicine

  by ROB LAMBERTS, MD(KevinMD.com)
  “…Now add to this a technology which gives us the ability to see all of those undiagnosed ear infections, and we have to muster even more willpower to resist the urge to treat them all.  This is the same problem as we have encountered with PSA testing: be careful gathering data you don’t know how to handle.

  But even without considering this important objection to improved data-gathering, there is another problem which stands in the way of this type of technology: reimbursement.  It sounds great to enable people to avoid visits to the doctor’s office by having tools that previously were only accessible at an office visit.  It sounds like a very good way to save money and wasted time spent in waiting rooms with outdated magazines.  But this technology presumes that doctors will be willing to act on this information without seeing the patient in the office.  It presumes we will be willing to offer free care.  If the time I spend sifting through patient-collected data rises exponentially, the payment I get for that time cannot remain at the present level: zero.

  If our goal (as it should be) is to spend less money on unnecessary care, we will get to it much faster if we somehow give proper incentive.  Our encounter-based payment system stands in the way of any progress in this area.  The only way most of us get paid is to see people and deal with problems.  This makes doctors reluctant to offer any care outside of this setting, and puts undue pressure on intervention (to justify the encounter to the payors).  Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that…..”
• Skin cancer app tracks changes head to toe (futurity.org)
• Checking For Skin Cancer? There’s An App For That (detroit.cbslocal.com)
• Skin Cancer Self Exam By Use Of Mobile App (medicalnewstoday.com)
• UMSkinCheck – Encouraging you to Take Naked Pictures of Yourself! (coolest-gadgets.com)
• Screen yourself for skin cancer with this free iOS app (news.cnet.com)
• UM Offers New Skin Cancer Mobile App (detroit.cbslocal.com)
• Screen yourself for skin cancer with this free iOS app (news.cnet.com)
• Illness Detection Add-Ons – The ‘UMSkinCheck’ App Can be a Lifesaver (TrendHunter.com) (trendhunter.com)
• Skin Cancer Symptoms (cancercenter.com)
• Skin Cancer Risk Factors (cancercenter.com)

We Can’t App Our Way Into Better Health or Healthcare – Health Is Social

We Can’t App Our Way Into Better Health or Healthcare

From the 9 March 2012 post at Health is Social

It’s cool and all that we can track our every step, our every weight, our every heartbeat, our every glucose reading.

Cooler still is to receive relevant feedback based on all the tracks.

Cooler yet is to gain proper interpretation of what the feedback means.

Even cooler is for us to get healthier and to deliver better care with all this tracking.

That last sentence – it’s not *just* cooler: it’s crux.

We can build all kinds of mobile applications. We can track all sorts of things.

But if we track the wrong things, we’ll simply railroad ourselves – or at least hop on the wrong train.

It’s not enough to track all those pushups and all those marathons.

In fact, how do you know that all those sweaty visits to the gym aren’t slowly making invisible tears in your muscles – how do you know that all those tears aren’t inducing a chronic state of tiny inflammatory processes that one day will lead to a myocardial infarction?

You see, the problems in front of you aren’t the problems in front of you: for an app that tracks your gym activity *might* be blinding you to some other problems.

Building and using more and more apps won’t convey us into better health or healthcare. Yes, they can help nudge and guide us – and that’s important as long as the contexts and processes into which those nudges and guides are the right ones.

An app is a module.

Health is a whole.

 

How Smartphones Could Impact Public Health

(Chart via Pew.)Smartphone owners now outnumber regular cell phone owners for the first time, according to a new study.

From the March 3, 2012 article in the Boston Globe

…

This smartphone proliferation has tremendous potential from a public health perspective. When Ispoke with Frank Moss at Bluefin Labs for the story, he described a day when doctors would simultaneously prescribe medicine with an app to help patients better monitor their care (you can read more of Moss’s ideas about mobile health in his New York Times op-ed). When you consider that smartphone penetration is already higher in African American and Latino communities (49 percent in each group vs. a national average of 46 percent) and that these two groups are historically disadvantaged when it comes to accessing health care (just browse the February headline roundup from the Kaiser Family Foundation for examples of these disparities), it would be revolutionary to begin targeting health care apps and devices to these populations.

When we consider looking that the gadgets being pushed into the marketplace to help us monitor our health (many of which I tried while reporting the story) we forget that they’re all targeting ”fairly affluent people,” says Jane Sarasohn-Kahn, a health economist who often blogs about public health at Health Populi. “When we look at the burden of chronic disease, it’s the African Americans and Latinos, the poor and less-educated, and very old or very young that don’t have access to healthy food or safe places. These populations have spent as much money on their mobile phones [as the rest of the country], but the platform technology hasn’t penetrated into poor urban areas.”

Sarasohn-Kahn hopes that Medicaid will start developing applications to target these populations, and points to the recent move by a former CDC scientist to develop an asthma inhaler outfitted with GPS and Wifi enabled sensors. When distributed in urban populations, the inhalers allow the doctors to better track their patients, and allow epidemiologists to learn more about the health of these groups. Right now, the smartphones are spreading at a rapid clip through the country. We just need to be smart enough to know how to help them nudge us all toward better health….