Need a Diagnosis or Checkup? Your Smartphone Is On Call

When Anna McCollister-Slipp was diagnosed with Type 1 diabetes in 1985, she was in a constant battle with the unknown. Her blood glucose levels could fluctuate dramatically -- and unpredictably -- due to stress, lack of sleep, even being stuck in traffic. These days, McCollister-Slipp feels more in control. She wears an insulin pump that can be adjusted quickly to compensate for eating or exercise, a continuous glucose monitor with a sensor embedded in her abdomen so she can see immediately what stressors cause her readings to jump, a standard glucose meter that she uses to take readings seven times a day, and a Bluetooth-enabled blood pressure monitor. A digital scale tracks her weight, hydration level and percentage of body fat; and activity trackers monitor her exercise and sleep. A smartphone collects the key data on blood pressure and the readings from her digital scale and activity devices, so she can see how one factor influences another and adjust her behavior or medications accordingly. "I'm the chief executive of my own health," she says, "and digital technology gives me a way to do that job much more precisely."

McCollister-Slipp, who co-founded the health data analysis company Galileo Analytics after working in health care communications and public affairs, is on the leading edge of what Scripps Health cardiologist Eric Topol calls "the biggest shake-up in the history of medicine" -- an era in which patients will employ sophisticated diagnostic and monitoring technology on themselves, increasingly using the smartphones in their pockets. Topol is the author of "The Creative Destruction of Medicine," a look at how mobile and wireless technologies will transform the field. Because the cost of treating chronic illnesses and their complications represents some 75 percent of the nation's estimated $2.8 trillion annual health care bill, according to the Centers for Disease Control and Prevention, inexpensive tools that effectively manage conditions such as diabetes and heart disease could have a major impact not only on health, but also on the budget. "I prescribe apps more often than drugs these days," Topol says.

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And apps are proliferating to help users improve their health. The vast majority are food-and-activity trackers for healthy people who just need to drop a few pounds. For example, Lose It! gives users a calorie budget for the day, lets them enter information simply by scanning bar codes on food packages, and encourages them to share their progress with friends on Facebook and Twitter.

But a significant number of smartphone applications and attachments now assist with medical monitoring. They can record basic heart readings (iStethoscope, for instance, uses the microphone to listen to heart sounds) and blood oxygen levels, and take a picture of the inside of the ear so that a remote doctor can tell whether there's an infection. Several apps record users' sleep cycles by measuring how much they move around during the night. Propeller Health recently got a green light from the Food and Drug Administration for an asthma inhaler system that syncs with a smartphone to store data on symptoms and medication usage, compares a person's usage with his or her baseline and clinical guidelines, and alerts parents or a health care provider when trouble is brewing. AliveCor sells an electrocardiogram attachment that converts electrical impulses from a user's fingertips into ultrasound signals transmitted to a smartphone's microphone, so people with heart problems can check their heart rhythms when they feel an irregularity. They can email the electrocardiogram tracing to their physician for immediate feedback on what they should do, rather than simply rush to the emergency room.

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"We're going to pick up a lot of stuff we weren't aware of before," Topol predicts, citing an Australian study of people who gave themselves electrocardiograms using a simple drugstore device: Fifteen in 1,000 detected a previously undiscovered heartbeat irregularity called atrial fibrillation that put them at high risk for stroke.

More innovations are on the way. The Swiss company Qloudlab has patented a technology that lets patients put a drop of blood on special film on their phone to measure coagulation -- vital information for people who take blood thinners. Apple's new Health app for iOS 8 will display and track heart rate, calories burned, sleep, blood sugar and other health indicators, and its new HealthKit tool will allow data from other developers' apps and devices to feed into the Health app. The company is widely expected to introduce a smartwatch this fall. On the horizon, too, are drug patches that release medication based on biometric readings taken by the patches, and sensors that go into the bloodstream and pick up the first signs of cancer or a heart attack, transmitting the information to a computer or smartphone.

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The common theme? Better health outcomes with less need to see the doctor. Danny Sands, a primary care physician at Boston's Beth Israel Deaconess Medical Center who also consults on the intersection of information technology and health care, believes that it makes no sense to have a chronically ill patient visit an office three or four times a year and make crucial medical decisions based on those scraps of data. "We need to gather information in an ongoing way," Sands says. "Frequent small touches make the difference, whether they're through devices, email, text messages or videoconferencing."

It works for Kenneth Treleani, 68, a patient of Topol's in Irvine, California. He sends his blood pressure readings to his iPhone four to six times a day, using an iHealth blood pressure cuff, and transmits his readings via an app to Topol's office every two to three weeks. "I can let him know where I am with my blood pressure program without having to get in the car to drive down to see him," Treleani says. More to the point, Topol has used the information to tweak Treleani's medication and get his systolic pressure down from 175 to the 130s.

And in the face of an impending shortage of primary care physicians, these technologies can stretch that supply while also improving care, says Douglas Wood, medical director of the Center for Innovation at the Mayo Clinic. For example, a care team could track blood sugar readings transmitted by a diabetes patient and be in touch immediately upon spotting a problem, keeping the patient out of the hospital and free of complications. "We can help people make better decisions when they are dealing with multiple chronic conditions and multiple options," he says, noting that home monitoring and other technologies help Mayo physicians care for four times the number of patients they could otherwise handle, and the patients are more satisfied. At Montefiore Medical Center in New York City, thousands of patients with diabetes and congestive heart failure are overseen by case managers who check recent test results, track data uploaded from monitoring equipment and, if they spot a problem, call the patient right away.

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Several obstacles stand in the way of the mobile revolution, however. Two big ones: inconsistent data standards and a system of paying for care still favoring office visits. McCollister-Slipp is drowning in data from her many gadgets but can't yet put it all together into a complete picture. Some of her apps store information only in her phone, with no way to export it to her computer or to send it to her doctor. "It's critical to have this information all in one place so that you can understand patterns," she says.

As for payment, providers still generally are compensated for the number of services they provide, rather than for keeping their patients well, says Farzad Mostashari, former national coordinator for health information technology at the Department of Health and Human Services and now a visiting fellow at the Brookings Institution. "You can monitor your heart 24/7 and send me your EKG strip whenever you feel funny? I don't get paid for that," he says, articulating a familiar refrain in the medical community.

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But that is changing. Increasingly, providers will be rewarded for keeping patients healthy and out of the hospital. Medicare has also taken a few steps toward addressing the problem by imposing penalties on hospitals that readmit too many people, creating an incentive to head off problems more effectively. As more doctors are "paid to take good care of you and keep you happy," says Sands, medicine will welcome all kinds of innovations to keep patients healthy from afar.