What happens when a medical app…vanishes?

You have just entered The App Twilight Zone…. Our readers know that concussion and diagnosis have been a focus of this Editor’s, and validating apps a focus of Editor Charles’, who brought this to my attention. The app’s name: The Sport Concussion Assessment Tool 2 (SCAT2). The news report states: “It contains all the essentials you would want in a concussion app: a graded symptoms checklist, cognitive testing, balance testing, Glasgow coma scale, Maddocks score, baseline score ability, serial evaluation, and password protected information-sharing via email.”  The plot: it was deactivated without warning or notice by the developer, Inovapp (link to sketchy CrunchBase profile) yet still listed on the iTunes store.

What happened? There was a modified standard (SCAT3) developed in 2012, which updated SCAT2 with non-critical additions: indications for emergency management, a slightly more extensive background section, a neck exam and more detailed return-to-play instructions. SCAT3 is only available on (inconvenient) paper. No word from Inovapp on why it discontinued the app nor any plans for updating.

The SCAT2 had gained, in a short time, a following among coaches and sports medical professionals because it was the first app based upon the international standard (Zurich, 2008, 3rd International Conference on Concussion in Sport) transferring a paper assessment tool to an easy to use app. In fact, the NHL (National Hockey League) has its own version. The revised 2012 standards  Users have a right to be upset, but moreover, this points to a glaring shortcoming of medical apps–their developers vanishing into the night without a by-your-leave. And read the comments by (mainly) doctors on securing patient information after the app is used (HIPAA standards) and one physician’s criticism of apps such as this as a ‘crutch’.  A Pointer to the Future we don’t want to see. The authors Irfan Husain and Iltifat Husain, MD are to be congratulated. Popular app being used to manage concussions fails, failing patients (iMedicalApps)

Keeping up with KeepUs

Updated 25 July

Last October we profiled a UK-developed mobile app in beta called KeepUs. We said at the time that it “when installed on an older person’s or a child’s Android smartphone, (it) allows a family member to monitor that person’s both indoor and outdoor activity. Using geolocation, the family member can see that person’s visits (locations can be labeled), level of activity on any given day, alerts (being idle for too long), how much time was spent at each named location over the past two weeks and trends over two months.” For this Editor, it has the potential to supersede PERS of both the traditional and mobile types since it is free/low cost and also fits into an accepted form factor (phone) which increasingly PERS is not. It’s now well out of beta and with some “commercial care institutions” (we are following up). Founder Tom Doris is now inviting 10,000 volunteers to download a free version of the app by going to keepus.com and following the instructions (see at the top ‘go ahead and install the app’ which will take you to Google Play). PDF release.

Update: A follow up with Mr Doris confirms that KeepUs has users in the US, UK, Ireland, India, Turkey, Australia and even Cambodia (!). He explains, “It works the same as you’d expect any normal app and website to work: as long as you have access, KeepUs works fine. It doesn’t need any special hardware, nor does it need any special support from the cellphone network operators.”

Ear implant crossed with gene therapy for auditory repair (AU)

A hopeful Pointer to the Future for those with hearing loss–or, in fact, with nerve damage of other types–is the research out of the University of New South Wales (UNSW) on their developing a DNA-based genetic treatment, delivered by a cochlear implant, to restore hearing in deafened guinea pigs. The recombinant DNA enters the cochlear cells to produce neurotrophins, proteins that cause auditory nerve endings to regenerate, improving pitch perception and tonal range. Unfortunately the effect lasted only a few months, so that further work is required before the treatment even nears human trials. Study co-author Gary Housley also cited other implant-extending usages, such as deep brain stimulation used in Parkinson’s disease treatment and retinal implants. Published this month in Science Translational Medicine (abstract only, subscription required for full access.) The Verge, Engadget (short UNSW video included)

Dermal patch senses, releases meds as needed

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/nnano.2014.38-f1.jpg” thumb_width=”175″ /]A research team from several institutions in South Korea and University of Texas, Austin have developed a dermal patch that not only delivers medication, but in the right dose and right time based upon muscle activity and body temperature. They developed a 2-inch rectangle made of stretchable nanomaterials containing heat-activated silica nanoparticles. The patch monitors muscle activity and body temperature, then releases a controlled dose of a drug. This would make it ideal for conditions such as Parkinson’s Disease where the drug should be timed when muscle tremors begin. At this point, there is no digital health/wireless component for recording, which is also needed. But given the long lead time–it won’t be ready for sale for five years. The Verge. Nature Nanotechnology (abstract only)

Biocompatible batteries for ‘sensors of the future’

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/03/Dissolving-Battery.jpg” thumb_width=”300″ /] Pointer to the Future. Implantable medical sensors and devices have a main drawback–their power source. Current batteries are bulky and must be manually removed. External power transference means fairly bulky outside and inside devices.

What if the sensor and batteries could simply dissolve harmlessly in the body when no longer needed?

Research from John Rogers at the University of Illinois at Urbana-Champaign and his team first led to biodegradable (in the body) electronics in 2012, and now dissolving batteries (above). (more…)

Augmenting human performance in the USAF

A pointer to the future is how the US Air Force is taking a new look at what we call telehealth and they call Human Performance Monitoring. Current sensors are large and complex in measuring heart rate, blood pressure, blood oxygenation and skin temperature–critical data for pilots and other airmen. For instance, the USAF measures O2 in F-22 pilots to determine effects and compensate to keep both man and machine safe. Not only do they want to make sensors smaller–like skin patches–but also these are key to a new concept in aviation medicine called Human Performance Augmentation, which will measure human health status in real time. And both play into Human Systems Integration, which integrates man and machine. The implications here for civilian use are many: miniaturization of sensors into wearables, real time telehealth and machine assistance for human tasks. Performance-detecting Biosensors (Armed With Science)

An essential link to mHealth devices and apps?

Guest columnist Lois Drapin thinks so. She shares her insights on Validic, an emerging company in data integration for payers, providers, preventive wellness companies and pharma;how it evolved from its original concept in consumer health engagement, along with a few pointers its founders have for fellow entrepreneurs.

One of the keystone aspects of “ecosystems” is interoperability and this also applies to the data pipeline that flows from health apps and devices to the appropriate segment of the healthcare delivery system, and eventually, to the users—patients, consumers and/or medical professionals such as physicians and nurses or other clinicians. By now, we all know that the capture and analytics for both “big” and “small” health data are business imperatives for healthcare in the US. With data of this nature, we can embrace our understanding of behavioral change at the individual and population levels. The anticipated outcomes of behavioral change may power operational and cost efficiencies in the healthcare industry.

But data will no longer come from just inside the healthcare delivery system. In addition to the changing technology enablement within the health system, as we all know, data will flow from many things—in fact, The Internet of Things (IoT). This means that data that relates to our lifestyle, wellness and health will pour from the many types of wearable devices not now connected to the heath delivery system. In addition to our computers, tablets, phablets and smartphones, are the many sensors paired with tech innovations such as the wearables— from wristbands, smartwatches, clothing (from shoes to headbands), glasses, contacts, and pendants — to things such as refrigerators, clocks, mattresses, scales, coffee pots, cars, and even, toilets…all of which are predicted to become an important market in the coming years.

Validic, based in Durham, NC, has put itself smack in the middle of that market (more…)

Voice-enabled devices–pointer to the future?

LA billionaire and healthcare investor par excellence Patrick Soon-Shiong (his NantHealth raised $31 million earlier this year and owns Vitality, eviti, iSirona, iCOS) has just made a sizable $8 million investment in Fluential, which is developing a voice interface and speech-optimized recognition software for digital health, wellness, and weight management, to run on anything mobile including wearables, and to be released in the spring of 2014. If this works (and better than Siri), it has major implications across the board in the future shape of both consumer and clinical health tech, especially for older adults and those with mobility concerns. Mobihealthnews.

KeepUs–smartphone-based senior activity monitoring and telecare

KeepUs is a new, free app developed in the UK that when installed on an older person’s or a child’s Android smartphone, allows a family member to monitor that person’s both indoor and outdoor activity. Using geolocation, the family member can see that person’s visits (locations can be labeled), level of activity on any given day, alerts (being idle for too long), how much time was spent at each named location over the past two weeks (if Uncle Ted is spending three hours every day at the pub), and trends over two months. It requires no action from the person being tracked other than to carry the smartphone (certainly less obtrusive than a bulky non-removable watch). The family member/carer installs the app on both phones and controls permissions to view the other person’s activity. The app is in beta, free for individual use in the UK. (more…)

Doctor disciplined for using Skype for telemedicine consults

A family practice physician in eastern Oklahoma was disciplined by the state medical board for using Skype on initial mental health consults. Skype is not approved by the board for telemedicine; other factors were that the patients were not physically seen at any point and that they were prescribed controlled substances (including narcotics). Three of the patients died while under care but the deaths were not attributable to Dr. Trow. It is easy to score the doctor for what could be seen as bad practice in telemedicine, but a mitigating factor is his practice in a remote area of the state and the distance of the patients. Joseph Kvedar, MD of the Center for Connected Health/Partners HealthCare reviews the situation (more…)