Did you work out today? Skip breakfast? How's your blood pressure? Blood glucose level? Is your heart rate within norms? How about those brainwaves?
Of course, you can't be expected to know all of this at any given moment. But what if you could? What if—wait for it—there was an app for that? Increasingly, the medical profession is turning to smartphone technology to help patients monitor chronic illnesses—saving lives with devices that most of us only use to send text messages and play Angry Birds.
Approximately 80% of Canada's health-care dollars go to the treatment of chronic illnesses. Across the globe, the so-called big five—diabetes, heart disease, respiratory ailments, cancer and mental illness—are expected to cost health-care systems $47 trillion over the next 20 years, according to a 2011 report from the World Economic Forum. That's a huge and mostly unfunded liability, and the cost curve keeps getting steeper.
Dr. Joseph Cafazzo is senior director at the Centre for Global eHealth Innovation at Toronto's University Health Network (UHN). His multidisciplinary team of 70 experienced doctors, nurses, software engineers and designers is on a mission to come up with new technology that will tackle what ails us, before these conditions become acute and we require medical intervention. Keep patients on track with home care and remote monitoring, and they're less likely to end up in the hospital or on expensive drugs.
Enter an iPhone app—developed by the UHN team—called Bant (after Frederick Banting, co-discoverer of insulin) that connects via Bluetooth to a LifeScan glucometer. Diabetic teenagers present a challenge to health professionals such as Dr. Cafazzo, since they typically are reluctant to whip out their blood glucose monitors at school several times a day, prick their fingers and take readings. The Bant app includes gamification elements that reward teens with iTunes store credits every time they use their glucometer.
"Both of my kids are Type 1 diabetics," says Paul Lepage, senior vice-president of Telus Health Solutions, which has provided the devices, data plans and secure, private medical-profile data storage for UHN's Bant trial. "I refer to monitoring blood glucose a bit like tuning a Formula 1 race car. There are a lot of parameters that you have to be tuning because there are so many variables."
Starting in March, 2011, UHN ran a three-month, Health Canada-approved clinical trial of Bant with 20 diabetics aged 12 to 16. With the app, participants monitored their blood 49.6% more frequently—from 2.38 to 3.56 times a day, on average (the target is a minimum of four times). The monitoring picked up 271 three-day abnormal blood-glucose trends (a future version of Bant will reward users for correcting imbalances), and 161 rewards were handed out; 50% of the teens received 10 prizes each from iTunes.
More than a delivery system for free Bruno Mars tracks, the Bant app is a constant reminder to young diabetics that they can keep their condition from worsening if they modify their behaviour. Dr. Cafazzo says his team came up with the idea for the app after observing teen patients in the hospital. "No matter how sick these kids were, they still had their phones with them." And that may be the most powerful insight: Simply staying connected has its own rewards.
The Bant trial is one of several applications utilizing smartphone technology that Dr. Joseph Cafazzo and his University Health Network colleagues are working on.
In another year-long clinical trial that began in 2010, Dr. Cafazzo's team gave self-monitoring blood pressure kits to 110 adults with diabetic hypertension. One-half of the group also received a BlackBerry that connected to the kit wirelessly and forwarded readings to a remote-monitoring team at Toronto's Mount Sinai Hospital. These readings were then sent automatically to the patients' family doctors. While all of the patients fell behind on their monitoring—a common problem for people with this condition—those with the remote patient monitoring (RPM) app achieved a significant drop in their blood pressure readings (lower than the control group's), reducing their risk of mortality by 25%. The simple—and apparently irritating—reminders received by the patients with BlackBerrys helped them to stay engaged.
UHN is also working with Research in Motion on an ambulatory electroencephalograph—wearable scalp sensors, concealed in a hat or even a bandana, that will measure brainwaves—for patients with mental health concerns such as depression or mania. As with the other RPM apps for BlackBerry, users and their health-care providers can be notified of problems as they arise. Add in the use of low-energy Bluetooth (which helps to preserve battery life) and advancements in near-field technology (which can record when the user opens the fridge or a cupboard door, or gets on a scale) and the possibilities appear limitless.
If all this technology does prove effective, though, commercialization represents the next big challenge. Major medical device-makers like Roche and Medtronic sell big insurers and hospitals competing products for thousands of dollars a unit. Both of these client groups are conservative in approach, and it will be tough to sell them on the benefits of purchasing tens of thousands of 99-cent apps for a half-dozen mobile platforms.
Dr. Cafazzo is undaunted. "It's still early days, and it may not matter what we think," he says, because patients are finding their own apps and their own solutions to help them manage their illnesses. The Bant app alone has been downloaded 32,000 times—without any promotion from UHN. "So, in some sense, this may happen without the health-care system picking a champion."