While it’s not so smart to rely on Dr. Google, a growing number of tools via your smarthphone is helping to track, manage and detect health issues.
It’s all marching toward precision medicine: Apps, sensors, algorithms, bluetooth, photos, video conferencing, tool attachments. Some trends are starting to blend in genetic data and digital records, said Dr. Phil Werschler, a Spokane dermatologist who helped develop a medical app.
A few years ago, he paired with a Spokane radiologist for an acne app allowing consumers to take photos and get a professional diagnosis. While the venture didn’t succeed for different reasons, he learned much about trends.
“What’s going on with all these apps and technology is this concept of precision medicine, which is things like 23andMe for genetic precision medicine, and it includes digital records, which is part of what’s called the big data,” Werschler said.
“It also includes artificial intelligence to go through vast amounts of data and extract information, and then find commonalities and aberrations that might lead to something that is the bigger picture.”
As an example, psoriasis is a common skin condition causing cells to build up rapidly on the surface of the skin. Extra skin cells form scales and red itchy patches that are sometimes painful.
“We’ve learned if you’re diagnosed with psoriasis, statistically you have about four years less life expectancy than someone with the same height, weight, etc., who doesn’t. Now, we tell them to pay attention to blood pressure, inform their doctor, and it’s associated with cardiovascular disease later.
“We wouldn’t know that if we didn’t have the big data. We’re trying to identify genetic subsets.”
Other tech on phones offers better health information or tracking. People can use an app for taking pictures of moles over time that could signal abnormalities for a doctor visit. Weight-management apps track calories and fitness goals.
People with respiratory problems can use smartphone tools on air quality, or another app can measure noise pollution that might cause hearing damage.
Werschler said one UV exposure app lets people enter multiple information fields.
“You can put in age, skin type, how fair you are and how you respond to sun exposure,” he said. “Say you have your kids at Coeur d’Alene Lake and they’re fair-skinned. How long can they be in the sun?
“You put in multiple data and the phone geo locates you and interfaces with the weather. It gives you a UV exposure index based on your personalized history. It might say today it’s safe to stay outside for 90 minutes before taking a break or reapplying sunscreen.”
Such information apps are increasingly helpful, he said. Many patients share data with him.
“They are very reliable, and people can benefit from them usually for free or a nominal fee.”
While many health apps exist, here are a few examples of emerging tools:
The University of Washington researchers are developing an app as a tool for parents at home if they suspect their child has an ear infection.
UW computer scientists and clinicians created technology for smartphones that can detect fluid behind the eardrum. It uses the device’s microphone and speaker along with a cone-shaped paper with the wide end placed around the smartphone’s base. The smaller cone end is held to the ear.
“What happens is the smartphone will emit a few audible chirps, kind of like a bird chirping, into the ear canal, and, based on the reflection, we can tell if there is fluid,” said Justin Chan, one of the researchers and a doctoral student at Paul G. Allen School for Computer Science and Engineering.
“The analogy I like to use is it’s very similar to a wine glass. If the wine glass is empty or half full and you tap on it, it’s going to sound different.”
After testing in a hospital, research found that the app was about 85% accurate at detecting fluid in the ear, said a May 15 study in Science Translational Medicine. The group hopes to get Food and Drug Administration approval by year’s end to market it as early as 2020.
“The motivation for this project is that ear infections are today the leading cause of pediatric health care visits, according to the National Institutes of Health,” Chan added. “The infections are typically caused due to a buildup of fluid in the space called the middle ear that’s behind the ear drum.”
A goal was to design easily accessible technology about as accurate as specialists’ tools so parents and doctors can use it. It could aid people in developing countries lacking medical tools.
“The main benefit is that you can use this in the comfort of home,” Chan said. “We think our app has a very similar function as a thermometer if you suspect your child has a fever.
“You can use our app to have a more objective measure of what the kids’ fluid level is. This could potentially reduce unnecessary visits to the doctor.”
Newer technology paired with an app is helping diabetes patients better manage glucose levels and dispense insulin, said Cheyenne Newsome, clinical assistant professor in pharmacotherapy at Washington State University Spokane.
While continuous glucose monitors have existed at least 10 years, patients have had more options in the past two to three years.
“What is new is a technology where the CGM and an insulin pump talk to each other, and then there’s an algorithm that determines how much insulin should be released,” Newsome said.
“That is really exciting because it kind of functions like an artificial pancreas, which is the organ that’s not releasing insulin correctly.”
The CGM includes a small catheter or sensor that the patient inserts just under the skin, usually on the abdomen or back of an arm. Then a 1-inch by 2-inch patch goes over it to keep the sensor in place. It checks a blood sugar level about every 5 to 10 minutes that’s typically transmitted to a phone app.
And instead of a vial of insulin injected with a needle, patients are using an integrated insulin pump device worn on the body with small tubing inserted to connect an insulin reservoir, she said. “It’s connected also to their smartphone.”
Overall, users can monitor information and share the data with a doctor, caregiver or relatives. People can customize alerts regarding blood sugar levels.
“Another cool aspect is it continues to learn from the patient’s data and habits to improve and customize the algorithms to dial it in even better for the patient,” she said.
A less expensive tool since 2018 is the Freestyle Libre system, also a CGM. “It doesn’t automatically transfer to your phone every 10 minutes like others, but you take your phone and swipe it by where the patch is, and it automatically reads your blood sugar.”
She also encourages people to use smartphones to set medical reminders.
Many common ailments can get diagnosed, and often treated, by virtual care visits when patients connect with a provider via video on a device, Werschler said.
Some workplaces or stores offer a kiosk with a similar approach.
“We always add a caveat,” he said. “If you start to feel worse or get a fever, you need to go in to see a doctor or check back.”
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