Smart-phone apps take the Hippocratic Oath

LONDON – At home. On the go. During a meeting. Take your pick. The good doctor gets around these days.

If you have diabetes, asthma or heart disease, there’s almost certainly an elegant smart-phone interface at your disposal.

If you’re overweight or if it’s the scourge of meningitis you fear – or even if you simply don’t know where to look for judicious diagnostic advice and treatment – the wireless medical world is at hand.

Personal devices have, in fact, never been so personal, and developers, doctors, companies and health care providers are all scrambling to figure out how best to harness the increasing convergence of the mobile and the medical.

Still, while consumer interest in the idea of mobile health services is growing, the industry itself is beset with an array of issues: privacy, regulation, standards and even a common sense of where best to focus efforts.

Most in the industry agree that mobile health is first and foremost about chronic-disease management, but there is real divergence over how mobile phones fit within the fragile mobile-health ecosystem, if at all.

On issues such as selection, security, platform, connectivity strategies and a whole host of other coordination-sensitive systems, consensus has yet to emerge – with respect to applications for consumers, but also more broadly for devices and software aimed at the professional health care market.

“The mobile phone, like your wallet and keys, is the one thing you don’t leave home without,” said Brian Dolan, editor and co-founder of mobihealthnews.com, a Web portal that tracks the wireless-medical world.

“The U.S. medical system is an overtaxed system, and we need to extend the reach of health care providers,” Dolan said. “The way to do this is to add connectivity to the patient, no matter where they might be. We need to take advantage of the technology people are already using today – the mobile phone.”

As smart phones move ever closer to PCs, one area where consumers are displaying an interest is in medical-related applications for mobile phones that can be purchased at online destinations such as Apple Inc.’s App Store. But these new offerings are also leaving consumers in something of a never-never land when it comes to making informed decisions.

“There is a huge amount of interest in this area,” said Peter Bentley, creator of the iStethoscope, an app that transforms Apple’s iPhone into a stethoscope, thus permitting monitoring of the heartbeat in just about every conceivable setting (save for extremely noisy ones).

“But regulators are still trying to figure out the blurred distinctions between apps and medical devices,” said Bentley, a computer-science professor at University College London, and “the more established doctors may find the new technology somewhat baffling.”

Smart phones and tablets may not be ready to replace hospital devices just yet, but it’s safe to say that looking ahead, “the marketplace will be dramatically different,” said Joseph White, a U.S.-based medical doctor with an interest in mobile-health issues.

“Bedside EKG, ultrasound, pulse oximetry, blood-pressure monitor, glucose monitor – doctors will eventually have access to these types of monitoring capabilities when they visit patients at home.”

For now, though, apps on “the consumer side that are genuinely finding adoption are fitness-related,” said Dolan.

Broadly speaking, mobile health consists of an array of overlapping technologies and initiatives encompassing computers, patient monitors, PDAs, automated voice-mail technologies and apps for mobile phones.

It spans the business-to-business space as well as the consumer market.

Apps, meanwhile, are essentially just software applications that run on a variety of smart phones, such as the iPhone or Android-based phones, or on tablet computers, such as Dell’s Streak or Samsung’s Galaxy Tab.

The health care industry has long had access to an extensive portfolio of mobility-related products that run the gamut from wearable wireless sensors to personalized pills containing microchips that can tell you at precisely what time your medication hit your stomach. But the medical-app world as it relates to the consumer has only recently started to find its feet.

Ultimately, it’s not yet clear how useful apps will be for diagnostic purposes.

Right now, for consumers, there are “technical limits if you want to use apps to automate diagnoses,” said Bentley. A better use is “triage to suggest when you should see a doctor.”

This is a point echoed by doctors.

“What I find is that many physicians and other health care professionals simply don’t know enough about these apps,” White said. “There is currently no regulatory guidance or certification that tells people that these apps are medically accurate or even useful.”