mHealth Monthly Mashup: Release 8.0 – how to get the most out of mhealth: an interview with Brian Edwards (part 1)

Michael Spitz interviews Brian Edwards

Ignite Health and iMedicalApps.com

Senior mHealth Analyst Brian T. Edwards (@healthgrid) brings a unique industry-based perspective to iMedicalApps.com, the powerhouse of mHealth information and resources, providing commentary and reviews of mobile medical technology and applications. A Chicago-based bioinformatics and mobile health consultant, Brian specializes in business development, public policy, and technology management, and today is our guest expert discussing how healthcare professionals, patients, and pharma can get the most out of mHealth in 2012 and beyond.

Interview summary

MS: Greetings, Brian, and welcome to Pharmaphorum!

BE: My pleasure. Thank you for inviting me.

MS: mHealth has become so big so fast that having to substantiate its usefulness has given way to advising audiences how best to use it. So I’d like to start off by asking what are some immediate and actionable things healthcare professionals can do to help them understand, embrace, and get the most out of the emerging technology?

BE: Healthcare professionals need to be comfortable with the technology and make it an important part of their lives before it can become an integral part of their practice. What comes naturally to a “Digital Native”—someone who literally grew up in a world of computers, Internet, social media, and mobile tech—remains a forced and often uncomfortable experience for Baby Boomers. So adoption begins with acceptance, and acceptance starts with familiarity. I’m 28-years-old, right on the cusp of being a Digital Native but considered middle aged in Silicon Valley. When I attended the mHealth Summit in Washington, DC this year I was one of the youngest people there. That’s a disconnect. And that’s one of our most fundamental challenges in mHealth, as most doctors didn’t grow up with the technology, but need to learn and integrate it into their practices despite being accustomed to more traditional tools.

MS: The latest statistics suggest that healthcare professional adoption rates for smartphones and tablets actually exceed those of the general population—but we’ve clearly only scratched the surface of mHealth’s potential. How can doctors do more?

BE: By embracing passive and active ways to learn, push and pull. Proactively, healthcare professionals can take local classes at community colleges that are quite good at getting folks rapidly up to speed on emerging technologies and interfaces. Within their own offices they should be increasingly receptive to the devices their often younger and more tech-savvy patients have already adopted, ePatients walking in with health apps and digital tools downloaded onto their smartphones and tablets. Physicians should talk to their patients about the devices and how they use them, and ask how educational materials can best be shared. And they should take those learnings and discover the HCP-specific ones best suited to their needs.

MS: Tell us about those health apps, and what doctors should be on the lookout for.

BE: What I like to call “prescription strength” apps will soon become central to a physician’s practice, taking the form of emerging binary body sensor networks capable of providing two-way biofeedback connections with their patients outside of a standard clinical setting. The goal is to make patient monitoring and diagnosis as comprehensive, intuitive, and ubiquitous as possible, ultimately lowering operating expenses and increasing revenue per patient—so physicians will have no choice but to pay attention. The full potential hasn’t been technologically realized yet, but with the advent of the new iOS 5 and iPhone 4s we have the first Bluetooth low-energy smartphone in the US, enabling physicians to do things in an ambulatory care environment they could never do before. Consider the latest ECG patch technology that can measure up to 3 lead signals, tissue-contact impedance, and even includes a 3D-accelerometer for physical activity monitoring, all on an amazingly convenient, minimal energy budget as an example of what this kind of tech can do. Companies like Healthrageous are tapping directly into the “quantified self” movement by combining such cutting edge technology with mHealth’s amazing capacity for patient tracking and real time feedback.

“Physicians should talk to their patients about the devices and how they use them”

MS: That all sounds great, but do these “prescription strength” apps require a prescription? In other words, does the ability to not only gather data but also interpret it and make treatment recommendations place such tools within the “high risk” category of medical devices under the jurisdiction of FDA draft guidance?

BE: Yes, those apps capable of providing the most benefit will likely fall under Class 2 510(k) regulatory jurisdiction, not quite analogous to such embedded medical devices as pacemakers which are Class 3 devices, but worthy of formal clinical review before approval. But such regulation will help ensure they’re safe and effective, and transform the mHealth industry from a venture capitalists’ wild wild west into a more stable and less fragmented world analogous to other high tech industries. Far as the apps and devices themselves go, what’s important to note is that emerging mHealth tools will ultimately connect directly to the Internet, with no reason to have them route through smartphones. For example, the Zephyr BioHarness from AT&amp,T captures 10 vital signs and communicates the data directly to the Web through a built-in secure embedded cellular connectivity.

MS: Those of us working in or for pharma blanch when we hear about the need for such comprehensive FDA regulation, fearing delays and logjams.

BE: Several reviewers and editors at iMedApps.com and I have already recommended to the FDA that they create an approvals system similar to how the AppStore already approves apps. By taking a web-based, very linear and iterative approach the FDA could utilize the same technology and user interface app makers and consumers already use to help simplify and expedite the high-risk health apps approval process.

“Under-promising and over-delivering is key, especially when the FDA is concerned”

MS: Speaking of FDA regulation, what advice do you give mHealth entrepreneurs?

BE: Under-promising and over-delivering is key, especially when the FDA is concerned. Rather than state your new blood pressure monitoring app, for instance, will “advance care by 150 years” it’s much wiser to mention that the tool does a slightly better job of doing what a similar, already approved device did a few years ago. So I tell entrepreneurs to stay modest, stay practical, concentrate less on hyperbole, and more on clinical accuracy and quality. I similarly warn them that many venture capitalists are equally skeptical of big claims, instead favouring practical solutions that have a better chance for favourable return. One example of an app that recently received FDA 510(k) approval is iglucose, which simply and effectively uses a cellular network to upload glucose readings.

MS: What about the mHealth end-user, the patient?

BE: Patients can actually help drive mHealth adoption since they have embraced health apps faster on average than their own physicians. By taking their devices and apps in with them to the point of care experience, patients can actively demonstrate the vitality and viability of the channel: “Here’s my iPad, doc. I use it to access all my healthcare information, and even use it to help monitor and improve my health and wellness. Where are yours?” That kind of pressure would motivate healthcare professionals to go out and get “prescription strength” versions for themselves, driving mHealth from within. Last year’s “Bluetooth Innovation World Cup” revealed finalists in the health and wellness category exemplifying the strength of such apps today, setting a terrific precedent for the healthcare professional community, too.

Part 2 of this article can be viewed here.

About the interviewee and author:

Brian T. Edwards is a Project Manager of East Baton Rouge Parish’s BR-Med Connect Prehospital Telemedicine Network, Brian oversaw the design, development and deployment of a prehospital STEMI network, as well as coordinating the participation of several public agencies and private vendors. Brian is Director of Business Development for Wave Technology Group, a startup developing an ambulatory EEG smartphone app and wearable sensors for real-time remote M2M monitoring of chronic seizure patients by clinical neurologists. Brian is also Associate Director of the US branch of Healthgrid.org, an organization that brings together multidisciplinary thought leaders to promote the use of grid and cloud computing technologies in health care. Brian graduated from DePaul University with a degree in Political Science.

Michael Spitz is VP of Digital Strategy at Ignite Health, with offices located in New York City, New York, and Irvine, California. Spitz combines his passion for technology with more than 15 years of clinical content expertise to help engineer healthcare communications solutions across numerous treatment areas for many of the pharmaceutical industry’s major companies. Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.

How can patients drive mHealth adoption?