How your mobile phone could help keep you healthy

Jonathan Cho, chief of the National Cancer Institute’s Communications Technology Branch, is the first to concede that the agency’s flagship Cancer.gov Web site isn’t designed for mobile devices with bandwidth- and screen-size constraints.

However, many people still pursue the cumbersome experience. He said nearly 150,000 users attempted to navigate the Web site with a mobile device in June. They used everything from Apple iPhones to more obscure handsets.

“The demand is there,” Cho said. “People are looking for cancer information on their mobile devices.”

Cell phones of all types are becoming conduits for health care information. But phones can do much more than access data. The smart-phone variety can run advanced applications and provide an increasingly robust set of features, such as touch screens, high-resolution cameras and Global Positioning System-based location trackers. Developers now seek to create health care applications that take advantage of those capabilities.

The public’s widespread use of mobile devices makes them a natural platform for health care information and applications. Market research firm Canalys estimates that 55.2 million smart phones shipped worldwide in the first quarter of 2010. Also, physicians are among the most eager adopters. In July, Spyglass Consulting Group reported that 94 percent of the U.S. doctors it interviewed use smart phones to “communicate, manage personal and business workflows, and access medical information.”

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A number of government agencies are targeting mobile devices — smart phones in particular — for a range of possible health care uses. For example, the National Cancer Institute (NCI) plans to develop a set of mobile applications for its main constituents: cancer patients, health care professionals and researchers. Other agencies and government-funded initiatives seek to harness mobile technology to improve access to specialist care, treat psychiatric disorders and expand home-based health care options.

As interesting as the opportunities are, officials have a number of problems to deal with when justifying investments in mobile capabilities — from the basic effectiveness of proposed applications to worries about the security and privacy of personal health care information.

The smart phone as outreach tool

When NCI started retooling its Cancer.gov Web site, the agency polled users on what they’d like to see in the next iteration. In many cases, what they wanted was greater mobile access to information.

Cho said he wasn’t surprised. “We were somewhat expecting it,” he said. “If you look at social networking tools — Facebook, Twitter — they are being used more and more from mobile devices. The excitement was already palpable around what we could do with mobile.”

NCI kicked off the evolution of Cancer.gov last year. With user input as a guide, the agency’s project team identified a handful of objectives that it could accomplish in six months. Mobile applications made the short list. Cho said the team then divided the mobile category into three distinct user groups: patients, friends and family; health care professionals; and researchers.

The agency now plans to develop mobile app concept designs for each user group.

“We really have to delve into use-case scenarios,” Cho said, noting that the process involves determining what information users need at certain times.

The Web team has 50,000 pages of Cancer.gov content to consider as it decides which resources to include in a mobile application.

However, the apps will go beyond providing content from the Web site. Cho said they will also provide functionality geared toward a particular audience. For example, an app for researchers could contain a collaboration tool for brainstorming a new clinical trial. Another possibility is enabling Cancer.gov’s live-chat feature on mobile devices. Live chat could let users talk to an expert who can help answer their questions about cancer.

Cho said he is hopeful that the team will be able to share concept designs with users this fall, with application development beginning early next year. The plan is to build both browser-based applications and apps that run on a given mobile device. Platforms under consideration include Apple’s iPhone and iPad along with Research in Motion’s BlackBerry and phones that run Google’s Android operating system.

“We don’t want to be platform-specific,” Cho said.

The agency has resources in house to handle the initial development phase but might seek additional help to add more complex functionality later, he said.

Future prospects: Home health care

The Veterans Affairs Department, an early adopter of electronic health records, is now exploring the potential of smart phones in e-health.

Dr. Adam Darkins, chief consultant for care coordination at VA, said he believes mobile technology could find a role in home telehealth and chronic disease management.

Telehealth services are already routine at VA. The agency serves 43,000 veterans in their homes via the technology. Patients use a special computer terminal about the size of a hardcover book to relay health data to a VA care coordinator via telephone lines and broadband connections.

Darkins said he believes the existing base of mobile devices could support other telehealth applications — for example, to help veterans stay home and out of nursing homes. The next leap would be to use mobile devices to provide chronic care management.

In VA’s case, that means tracking patients with diabetes, which Darkins said 20 percent of veteran patients have, congestive heart failure, high blood pressure, chronic obstructive pulmonary disease and depression. He envisions an incremental progression toward using mobile technologies in home telehealth, with the first baby step in that direction being interactive voice response.

IVR systems prompt users to respond to a series of questions or menu options. VA has issued a request for proposals for fielding an IVR system that would let veterans call a phone number and answer a series of health questions on topics such as weight, glucose levels and blood pressure. Patients could use cell phones or smart phones to report information to VA the way they now do through the home telehealth hub.

According to the RFP, the IVR solution “must provide for veteran patients…to self-manage their chronic condition” while enabling care coordinators to manage and treat a range of symptoms and chronic conditions. The IVR approach would let VA extend home telehealth services without needing to rely on the hub device or the presence of landline service in veterans’ homes, according to the solicitation.

In addition, IVR would serve as a steppingstone toward introducing Web-based telehealth applications on smart phones, Darkins said.

But a few problems will need to be dealt with before mobile technology in telehealth becomes widespread, not the least of which are privacy and security. Harry Doyle, senior client delivery executive at Force 3, an IT solutions company, said agencies that field smart-phone applications should consider the nature of the information to be communicated. When applications involve personal health information, an agency should conduct a risk analysis, develop a risk mitigation approach, and issue policies and procedures.

In addition, as with any emerging technology, the clinical effectiveness of cell phone-based applications must be evaluated. And their use raises some difficult questions about whether mobile phones and their health care applications should be considered medical devices.

“It becomes a question of whether a regulatory agency like [the Food and Drug Administration] needs to regulate those kinds of technologies,” Darkins said.

However, he said he believes it is likely that many health care applications will appear on mobile devices during the next few years.

“It is logically where we are headed in terms of the telehealth program,” he said. “It’s not difficult to see where this is going. The real challenge is always how you get there.”