You’ve probably seen it on TV, but it’s not common practice: The patient is immersed in an ice water bath to lower body temperature and draw out symptoms — to determine what the real issues are. After three weeks on the road at various tech conferences, the mobihealthnews team feels like some speakers at The World Health Care Congress in Washington D.C. gave us the ice water bath treatment. And we learned a few things.

During his keynote address yesterday, Novartis CEO Daniel Vasella made a passing comment about technology solutions for overcoming the medication adherence problem, “These solutions are all fine and good, but I do not believe these technical approaches will solve the equation,” Vasella said. “People are not just machines. People are human beings with social, biological and psychological aspects that need to be addressed” if these solutions are to be effective.

That’s enough to send cold shivers down any technophile’s spine, but once you get past the condescending comment that “people are not machines”, Vasella’s point rings true: We can’t expect the technology alone to solve the problem of medication compliance. Caregivers need to work with patients to teach them how to use these new tools, but the industry also needs to do more than find ways to remind patients to take their meds — in Vasella’s opinion, the drivers of non-adherence are much more complicated than simple forgetfulness.

Later in the day, the founder of innovative Web 2.0 company PatientsLikeMe discussed the functionality of the social network and plans moving forward: Also, not too bullish on mobile.

“As I said before, we’re not really a ‘technorati’ platform, so it’s not like our patients are clamoring for an iPhone app,” PatientsLikeMe President, Director and Founder Benjamin Heywood said. “These are people dealing with fundamentally life-changing illnesses. It’s not like ‘Oh fun let’s play with this’. While there is immense value in that platform and obviously the whole world is going to be moving to mobile platforms eventually, we don’t feel the need to be a leader in that space.”

Fair enough. PatientsLikeMe offers a platform where users exchange a good amount of complicated data and long form content — mobile phones are generally suited for shorter content and quicker exchanges.

That said, Heywood’s implication that the mobile phone as a platform for health applications and services is only for the “technorati” or iPhone users is troubling. Most everyone in the emerging mHealth industry would disagree with that categorization, but the stigma is one that the mHealth solutions providers face everyday.

Someone who understands this better than most is Jitterbug Co-founder and Chairwoman Arlene Harris. Jitterbug offers a very easy to use mobile phone service for the less techno-savvy, typically older crowd. Jitterbug is also tackling the mHealth opportunity with gusto: Earlier this year Harris disclosed that Jitterbug has been conducting trials for diabetes management, rheumatoid arthritis management, outpatient post-op support and medication compliance as well as location-based services.

“We want to control the experience of our customers… [who are] techno-phobic, typically older, typically very costly to our healthcare industry,” Harris said back in February. ”Unlike Google or iPhone, we want to make sure that if we offer these services, that they have been sanitized for simplicity.”

So, while Heywood is probably right that bringing the full functionality of PatientsLikeMe to the mobile platform would require a smartphone like the iPhone and would only be accessible to a somewhat techno-savvy user, it is not fair to say that all health services and applications delivered via the mobile platform are for the “technorati.” Companies like Jitterbug and its partners will lead the way toward debunking this misconception.

Here’s hoping it’s not too long before we can throw the “technorati” stigma out with the bath water.

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@WHCC Sermo: Impressed by apps for docs

Physician-only social network Sermo’s Co-founder and Chief Medical Officer Dr. Adam Sharp told attendees at the World Health Care Congress here in Washington D.C. that Sermo has no immediate plans to launch a mobile application for its 103,000 users. Sharp said he was impressed by the mobile apps out there for physicians already, though.

“We don’t have any near-term strategies on mobile,” Sharp explained after prompting from mobihealthnews. “But I think that there are some really good mobile technologies already out there for physicians, like applications for information for providing patient care. That’s not something we’re looking to pursue, because I don’t see any reason to reinvent a very, very good wheel,” Sharp said.

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Novartis CEO and Chairman Daniel Vasella said that technology solutions do not do an adequate job of solving the medical adherence and compliance problem that faces the healthcare and pharmaceutical industries.

Internet programs that provide feedback loops to patients, instruments that can measure biometrics and transmit the data to caregivers, and new pill bottles that can remind you (by text message or blinking lights) to take your medications are not enough, Vasella declared during his keynote at the World Health Care Congress in Washington D.C. this morning.

“These solutions are all fine and good, but I do not believe these technical approaches will solve the equation,” Vasella said. “People are not just machines. People are human beings with social, biological and psychological aspects that need to be addressed” if these solutions are to be effective.

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Clinical trials: Retention, compliance, mobiles

When it comes to successfully completing clinical studies, keeping patients enrolled is crucial. Lengthy trials pose a significant risk of patients dropping out, especially if invasive procedures are involved. In studies that include add-on trials, every patient’s continued participation grows even more valuable. In addition, making sure patients stay on course with all study requirements adds to this burden. While the need for effective retention and compliance measures is clear, they must be targeted to do the job. That’s where mobile technologies can play an effective role.

Over the past several years, messaging services have grown quite sophisticated in offering text, email, and phone reminders, many specializing in medical compliance. Some services allow for various language translations and the integration of voice recordings of hospital staff or a patient’s family members, delivered on schedules dictated by patient preferences. Today, the mobile tech arena has sufficiently ripened to lend a hand with clinical trial patient retention and compliance.

With proper IRB approval, there are several ways to use mobile technologies to assist with subject retention and study adherence. Here’s an overview of possibilities, some in current use already:

Visit Reminders: With busy lives already, trial participants need not experience further complications with having to remember study appointments. Sponsor companies are well advised to adopt automated reminder call programs to ensure study visit adherence.

Compliance Reminders: Consider providing assistance using phone and texting reminders where complicated trial devices or drug dosing instructions are involved. Each message is an opportunity to eliminate an educational deficit. While patients can calibrate the degree of assistance they think they need, the offer of such support goes a long way to ensuring compliance. In one study, text messaging of motivational messages was shown to positively influence diabetes control and study adherence.

Dosing Reminders: Related to the previous point, patients are helped to maintain their drug schedules through the use of mobile tech alerts. From voice to text messages to email, clinical sites can stay in contact with their patients and know they are lending a helping hand with their study participation.

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@WHCC PatientsLikeMe doesn’t like mobile

During a panel discussion here at the World Health Care Congress in Washington D.C., PatientsLikeMe Co-Founder, President and Director Benjamin Heywood briefly described his social networking site’s growing popularity and aims. Heywood also noted that he’s still fascinated that PatientsLikeMe is thrown into the Health 2.0 bucket even though most users of his site are not young “technorati” but those with diseases that typically skew older, like Parkinson’s and ALS. Patients have been drawn to the site, Heywood said, because they cannot get the information they need from other sources. The information vacuum for these patients is remarkable, he said.

During the Q&A period I asked Heywood what his mobile strategy for accessing PatientsLikeMe was. While some mood-related applications may see some mobile related innovations with text messaging, on the whole, Heywood said his users aren’t interested in the mobile platform.

“We are not doing anything directly in mobile right now,” Heywood said. “We have something in our mood community, called InstaMood, which is a very quick thing that we do over email, sort of a ‘How are you right now?’ that layers on top of a very detailed patient-reported mood map that they edit via the Web. We definitely will move that to SMS very quickly and that will be applicable to other diseases; you can imagine that for epilepsy or other things.”

“As I said before, we’re not really a ‘technorati’ platform, so it’s not like our patients are clamoring for an iPhone app,” Heywood said. “These are people dealing with fundamentally life-changing illnesses. It’s not like oh fun let’s play with this. While there is immense value in that platform and obviously the whole world is going to be moving to mobile platforms eventually, we don’t feel the need to be a leader in that space."

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Twice as many physicians use iPhones in 2009

According to a new report from Manhattan Research, the percentage of physicians in the U.S. using smartphones increased to 64 percent. The group increased by 20 percent between 2008 and 2009, the study found. The number of physicians using iPhones doubled, Manhattan Research found.

Despite the growing adoption of Internet-enabled phones with Web browsers, the research firm’s survey also found that physicians’ mobile use has not caused cannibalization of Internet usage on computers. Instead, physicians are spending more time online overall.

“Physicians have always been advanced in terms of their mobile use,” said Monique Levy, Senior Director of Research at Manhattan Research, in a company release. “Nevertheless, growth in smartphone ownership in the last year is remarkable. Mobile is delivering on its promise to allow doctors to be ‘always on’ - which is partly why so many doctors say the Internet is essential to their practice.”

For more details, be sure to register for the Taking the Pulse v9.0 Webinar that Manhattan Research is hosting Tuesday, April 21, 2009 at 11am and 3pm EST.

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Mobile Dieticians: 11 iPhone apps for eating well

Chris Hall has a helpful post on CrumpleItUp that lists eleven iPhone applications that put a “dietician in your pocket” and help track calories and more advanced analyic tools. Here’s Hall’s list, which is organized by cheapest to most expensive app:

1. Lose It! (Free) Distinguishing feature: Set daily calorie budgets and track your progress.

2. Sensei for Weight Loss (Free to Members) Distinguishing feature: Developed by doctors, dieticians, and psychologists.

3. CalorieCheck ($.99) Distinguishing feature: Info from the United States Department of Agriculture for 7,000+ foods.

4. Calorie Pad ($1.99) Distinguishing feature: Track caloric intake from 6,000+ products and menu items from major restaurants.

5. Calorie Abacus ($1.99) Distinguishing feature: Answers question, ”If I am allowed to eat 1,000 calories, what are my options?”

6. LIVESTRONG Calorie Tracker ($2.99) Distinguishing feature: Most popular iPhone calorie tracking app.

7. Nutrition Menue - Calorie Counter ($2.99) Distinguishing feature: Nutritional info for 79,000+ food and restaurant items.

8. Fast Food Calorie Counter ($2.99) Distinguishing feature: Focuses on fast food.

9. Food Diary Calorie Counter ($2.99) Distinguishing feature: Track 90 days worth of daily food intake, while calculating your BMI.

10. Calorie Track ($2.99) Distinguishing feature: Includes data from the United States Department of Agriculture.

11. Calorie Minder ($3.99) Distinguishing feature: Access to over 7,000 foods and 32 kinds of exercises.

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Now training: Seeing eye mobile phones

Qualcomm CEO Paul Jacobs recently offered a vision of future mobile applications that included enhanced reality where mobile phones can use location data and cameras to identify people and places. While Jacobs did not give a time frame for his vision’s realization, it may be much sooner than he thinks.

If you ask iVisit, the precursor technology to the one Jacobs described will be available this summer.

iVisit was spun out from NevenVision a few years ago, just before the latter, which was known for its image recognition technology, was sold to Google. Google went on to buy YouTube a few months later. Ad agencies are still awaiting the launch of relevant video advertisements embedded in YouTube videos and enabled by NevenVision’s smart image recognition technology.

Before NevenVision and iVisit split, the company was called Eyematic. Eyematic’s former CEO Orang Dialameh is now CEO of iVisit, a company focused on mobile conferencing and wellness applications. One of the company’s newest products is called SeeScan/SeeStar, which aims to help the blind and visually impaired to identify their surroundings by using the camera on their mobile phone. The application currently only works on Windows Mobile smartphones, but iVisit plans to expand beyond the platform to other smartphones like the iPhone and Symbian by the end of the year.

iVisit’s applications SeeStar and SeeScan offer visually impaired users a virtual “pair of eyes” and object recognition capabilities that leverage a mobile phone’s camera to detect and recognize specific objects, like currency and packaged goods. SeeStar gives users the option to transmit live video to a remote assistant, which iVisit may provide as a professional service or the live stream could be transmitted to a family, friend or other caregiver. An example of a time when a user may use the live video stream to a remote assistant could be when they get off at the wrong bus stop and have no way of identifying their location. A remote set of real eyes may be more useful than a database full of images in that case.

For consumer goods identification, the application relies on existing databases (like book covers and album covers), but the real key to the app is its ability to store user generated images and labels for later use in identification. A photo of the front of your house with the label “home,” for example, could help a visually impaired person find their way back inside if they were disoriented and trying to figure out which way their front door was. The app would allow the user to hold up the phone’s camera and scan around until the direction of “home” was identified. If the camera was still positioned correctly, the app will repeat “home” until the user stops pointing it at the object. Honing in on “home” as it were.

As Jacobs envisioned in his latest interview, identifying people’s faces would probably be one of the most desirable features of such an application. It just so happens that facial recognition technology is Dialameh’s specialty. Clearly iVisit plans on moving the application’s development in that direction. That’s when things could get very interesting.

Check out a video demo of SeeScan here.

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Qualcomm: Holy Grail is wireless Band-Aids

Investor’s Business Daily posted an interview with Qualcomm CEO Paul Jacobs to discuss the last 25 years of wireless technology innovation and what lies ahead — of course, mHealth figures in prominently to Jacobs’ vision:

“We’re in the early stages. We’re only now getting to these high-speed networks. The price of chips is low enough that we can have consumer electronics and computational capabilities in cell phones,” Jacobs told IBD.

“We’ve been focused on things like how do you improve wellness and the productivity of doctors… Someone from my team told me that the Holy Grail was to have noninvasive sensors, like a wireless Band-Aid, that could monitor how many calories you take in,” Jacobs said. “Another area I’m excited about is this notion of augmented reality. Because phones have connectivity and location awareness capabilities, cameras and other things in the phone, in the future you will be able to hold a phone up and have it look at the world around you and things will be identified for you, including people and places.”

Read more over at IBD (via 3G Doctor Blog).

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Report: Google Health is grossly inaccurate

A recent blog post by Dave deBronkart, better known on the internet as “ePatientDave,” has lit a fire under Google Health (he calls it an “uproar”): Seems the data the Google Health repository pulls from a patient’s health records can be “grossly inaccurate.” Dave’s new Google Health account informed him that his cancer had spread to either his brain or his spine and it also listed a myriad of new conditions and issues his doctors had never mentioned. Seems Google Health has more problems than its “crumpled up paper print out” mobile PHR strategy.

The Boston Globe and numerous tech blogs have picked up deBronkart’s Google Health post, which partially concludes that the errors stem from Google’s practice of pulling some information from the patient’s billing records and insurance data, which is in many cases one of the few already computerized portions of health records today. As the Globe, reports, however, insurance data is often riddled with inaccuracies both because of cumbersome diagnostic coding and billing language and because doctors often code for tests with a disease or condition they are simply trying to rule out. That may be one reason, for example, cancer was found to spread when in fact the bill could have been just for a test to determine whether it had spread.

“Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has,” Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians, told the Globe.

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Two drug companies to trial Proteus this year

According to a report from Signs of the Times, “two major drugs companies” in the UK are set to begin clinical trials of Proteus Biomedical’s wireless pill technology, Raisin. Trials will reportedly commence within the next 12 months.

Imperial College London cardiologist and professor Nick Peters will coordinate the trials.

“This is all about empowering patients and their families because it measures wellness, and people can actually be tracked getting better,” Peters said. “Psychologically speaking, that’s hugely helpful for patients and enormously reassuring for carers. Normally patients would have to be in hospital to get this level of feedback, so the hope is that it frees up beds and saves the NHS money.”

The article lists medication adherence for birth control, post-op management, psychiatric and elderly care as prime use cases for Proteus Biomedical’s Raisin technology, which runs on an electric charge generated by the patient’s stomach acid. The charge is detected through the patient’s body by a sensing patch on the patient’s skin. The patch records the time and date that the pill is digested and also measures some vitals like heart rate, activity and respiratory patterns. The information is then sent to the patient’s mobile phone and then onto the internet for caregivers to review and analyze.

Proteus says that the silicon microchips embedded in the pills can be invisible to patients and can be added to any pill during manufacturing. Last week during a panel discussion mobihealthnews helped organize, Proteus CEO Andrew Thompson described the market opportunity ahead of the company as $100 billion.

For more on the report, read the rest of the article from Signs of the Times.

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