Apps and wearables – developments over the summer

Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. It is reassuring therefore that the MHRA were ahead of the game in tackling this the moment the paper was published. Hopefully there is growing recognition in Europe of the benefits of CE certification, although in the US avoiding FDA regulation is still attracting readers (even the FDA wants to avoid wearables).

Any piece on apps always has to have its health warning so this time I have dug deep to find Artur Olesch of the Polish Healthcare Journal, who reminds us of all the bad things that health & wellness apps can do. Nothing I’ve not been told before though a good summary and a nice graphic.

Back on the positive, there’s a new FDA-approved video game called Cognivue that’s been invented that claims to detect the early signs of dementia in 10 minutes, and a video game called Project Evo that many believe will help cure ADHD (that has yet to go through the FDA).

An email from Alex Wyke alerted this editor recently to the top five apps viewed on MyHealthApps in 2014-5, which are, with the top-ranked first: Know your heart rhythm, Toilet finder, Glucose companion free,  My medication passport and Glucool diabetes premium. And whilst we’re on lists, here is a rather condescending list of the 11 essential apps that seniors should have. There also a list of the 10 enterprise apps that Apple & IBM have put together here (analysts it seems are “unconvinced”). Just hanging on to the mention of seniors, one of the less surprising pieces of news recently is the finding by the International Longevity Centre, a UK think tank, that the health costs of ageing will shoot up without technological innovation. (Isn’t it obvious from the demographics?) Certainly if innovation is introduced insensitively, costs will rise, as this amusing video we have linked previously shows. Meanwhile at Coventry University, there’s an urging to encourage seniors to play “mobile serious games”.

Continuing in with the positive, it’s also good to see that the American Heart Association has concluded that mobile technology may help people improve health behaviors. As they say:

Smartphone applications and wearable sensors have the potential to help people make healthier lifestyle choices, but scientific evidence of mobile health technologies’ effectiveness for reducing risk factors for heart disease and stroke is limited…

In other words, if we understand it right, vital signs measurement plays second fiddle to behaviour change: no wonder the WSD was less than fully effective! Talking about the WSD, those management consultants who disappeared from the digital health space afterwards are, as we observed last year, back telling everyone how to do it all over. Entitled “EY’s new thinking on health” is a particularly depressing article in the Malta Independent that suggests the paper has swallowed a particularly unfocused press release whole; it leaves the reader wondering both what is new and whether EY do think on the topic.

Hanging on for one more story to the WSD thread, it’s nice to see Philips (that this reviewer chose for the Newham WSD telehealth project in 2006) has established a new partnership with Cheshire and Wirral Partnership NHS Foundation Trust and NHS West Cheshire Clinical Commissioning Group to launch the Supported Self Care Champion Project in Cheshire. This is designed, according to the blurb, to provide state-of-the-art telehealth support programmes and equipment to the region.

A small spot of genuine disruption is exposed in this clip about new healthcare startup Pager that claims to be bringing back the house-call. TTA was recently emailed a link to a nice video of the recently introduced Dr Now service in the UK (that this editor has previously been asked to advise) seems to be heading in a similar direction. There’s even a virtual nurse, Molly, now. As a senior (though not yet in need of the list of 11 essential apps mentioned earlier), I occasionally reflect on how technology has enabled services that when I was young were taken for granted, and then became hopelessly uneconomic – the regular grocery deliveries, the GP house-calls and all the other services that came to our door in rural Cheshire. The only one missing now is the tinker who used to sharpen all our knives on his bicycle wheel-driven grindstone.

The clip that more people emailed me about than any other this summer was that from Ipsos-Mori entitle the Digital Doctor report 2015. This “sought to uncover how Doctors feel about digital health, and how they see its role developing in the future”. There are sufficiently interesting statistics in the report (eg 25% of believe wellbeing apps will be a part of future treatment plans, 13% don’t) for this editor to wonder as to the basis of it, so I wrote asking for numbers, selection criteria and the response rates from the doctors approached (not always noted for having time on their hands to answer questionnaires). Sadly all I was given were numbers: 56 in the UK, 42 in Germany & 33 in France. Now I’m no qualified statistician, however I’d need some pretty powerful other information on selection & response rate before believing that 56 doctors in the UK (I am presuming they are GPs although the communication I got back occasionally referred to HCPs, so they may not be) is a representative sample of the 35,000 GPs currently practising, and even more so for the other two countries where the ratios are worse.

Before we leave medical apps, it’s just worth mentioning EE’s five key factors for developing them – an excellent summary.

One product bridging the app/wearables divide is the Leman Micro smartphone sensor plus app that is now being publicly described on their website. When built in to the next generation of smartphones, it will mean that all the vital signs (except of course weight) can be collected by a smartphone without any need for peripherals: I can hardly wait! In similar vein (oops), it’s good to see that the Alivecor heart monitor and ECG app, which achieved Class IIa CE certification in January 2015, have been the subject of a very positive NICE Medtech Innovation Briefing (MIB). This Leman economic summary paper from Chris Elliott wraps up both products, suggesting huge benefits to world health from improved circulatory system management. (It continues to amaze as to what smartphones can already do, too – for example the University of Queensland in Australia is actively developing a smartphone app called ResApp that can diagnose asthma and pneumonia in patients by analyzing the sound signatures of just four or five coughs.)

Staying  briefly on the app/wearables topic, St. Jude Medical has now received CE certification of its “Industry’s First” neuromodulation trial system that employs Apple and Bluetooth wireless technology linking a smartphone app to a spinal cord stimulator.

Fully on the wearables side, a group in Singapore has come with a sensor-enabled adult diaper, which, slightly surprisingly, is being toted as a new innovation by developers IBN (haven’t they had them for babies for a while?). The case for “hearables” is well made in this Retaildive article that points out that earbuds are “the only piece of wearable tech to have gained ubiquity and social acceptance,” and they are just about to get much smarter. Wearables for kids seem to be developing fast, too – this article has an interesting selection, with a strong focus on education. Another article describes the Cicret bracelet that turns your wrist into a tablet computer – amazing!

Ralph Lauren’s heart-sensing shirts are being released in the US on August 27th – another example of the obsession of many wearable manufacturers with youth, whereas older people are arguably the greater potential beneficiaries. News that King’s College Hospital, London, is one of three new organisations using the Apple Watch with patients has regular correspondent Prof Mike Short wondering whether the NHS would accept an IBM Mobile First approach, and if so under what conditions?

News also that Doppel, the mood-changing wearable has achieved its Kickstarter target.

Stretching the definition of wearables slightly comes this ingeniously simple Timesulin cap to fit on insulin pens to remind users when they took their last dose, as well as this SCiO almost-too-good-to-be-true tiny spectrometer, available later in 2015, that can determine the molecular fingerprint of an object, food composition being highlighted in the Blastr article; composition is apparently displayed on your smartphone. Equally hard to accept are the Eyejuster adjustable focus reading glasses that you can change (within limits) to your own vision needs, already available. Stretching the wearables definition past breaking point, it would seem churlish not just to pop in the video of the first ever FAA-approved medicine delivery by a Flirtey drone.

About as tenuous as the last link comes news too of the hugely impressive Theranos securing FDA waiver to take its blood tests out of the lab, so promoting point-of-care-testing (POCT) further.

And finally, this mobihealthnews item entitled Class action lawsuit alleges Fitbit misled buyers with inaccurate sleep tracking, and this Iowa State university study on activity tracker accuracy reminds me that my Jawbone UP3 stopped tracking my sleep completely after just eight days from purchase. Worse is that their support organisation ignores all attempts to contact them – perhaps they could even learn a thing or two from EasyJet’s approach to customers? I suspect that the recently announced Google wristband aimed at clinical use will prove more reliable.

Many thanks to Prof Mike Short, Alex Wyke, Dee Sullivan, Dr Nicholas Robinson & Graham De’ath who tipped me off to many of the above stories.



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