Mobile Health Revolution - Lifestyle Change

We have made long strides in reducing mortality associated with cardiovascular diseases in the last 30 years. As a biomedical engineers, I would proudly attribute the success to ICD, cardiac pacemaker, and many other interventional procedures and new drugs that save lives. Once a while, there is an inconvenient argument that suggests the successful campaign on anti-tobacco use may have played as an important role as all of advances in medical technologies. That will be a difficult debate without a lot of data for cause-effect, but there is no debate that lifestyle is the most important factor that influences lifelong health.

In today’s calling to reduce overall healthcare cost, innovations that improve our lifestyle is also the biggest opportunity for mobile health solutions.

First to share a personal anecdote. I started to record daily weight about 10 years ago. After enough entries, I began to plot them, and monitored the trend more closely. To my disappointment, the weight did not drop. However, the standard deviation, or the day-to-day change, reduced overtime. The frequent monitoring provides a feedback to adjust diet, and remind me not to have that second piece of apple pie.

I see a good mobile health solution here. The App I am using today (‘My Weight HD’ or the FitBit system) provides some but an incomplete solution. I like to have a weight scale that sends data wirelessly to my cellphone after each weight. I need an App that provides simple tools to annotate, analyze and trend. This is a solution I would happily pay now, because I know it will help me keep a healthy weight, and avoid paying a lot more in the future in care for high blood pressure, diabetes, or sleep apnea. In the last 10 years, I did not lose any weight, but thanks to that little excel sheet, I did not gain any weight either.

The revolution in mobile health is in its solutions to empower healthcare consumer to be more knowledgeable about our own health, and provide tools for us to manage our own health. It is that one apple a day that keeps doctors away, one of the most effective way to reduce healthcare cost.

iPhone ECG

It was exciting to hear the iPhone ECG was approved by the FDA early this month. This device has two electrodes that are built in a case for an iPhone, which can then record, display and also transmit ECG over a mobile network.

Mobile ECG or telephonic ECG are not new. There was a Nokia phone with ECG recording that was tested more than 10 years ago in a clinical study to see if EMR service can save time and improve outcome for heart attack. These studies later supported the current guideline from AHA that requires pre-hospital ECG for emergency services in patients with symptoms of heart attack. It makes sense when signs for ischemia can be identified from ECG, the information can save precious time in getting patients to a hospital that can provide treatment immediately.

I am more excited about the possibility of having an over-the-counter version of the iPhone ECG, which is not available now, but may become available next year. It is not immediately clear yet how the iPhone ECG will be used. Here are some thoughts …

I used to attend the international electrocardiography society conference when I was a graduate student in the late 90s. For several years, the theme for the conference has been “Was ECG still relevant?”. It was an irony for an ECG expert society to ask that question, but in reality, the ECG has become obsolete in most of cardiac services. Echocardiography, CT and MRI provide much more precise diagnostic information for treatment. I don’t expect the iPhone ECG to improve the diagnostic capability over the existing 12-lead ECG systems. That’s not the future.

The future of iPhone ECG is in its potential to provide services to empower us as a consumer for healthcare. In an early post, I argue that one of the reasons we cannot leave health care to a free market is because we are not equipped with enough knowledge to choose doctors or care providers freely. The health equipment shelf at Walgreen today has very few items, thermometer, glucose meter, blood pressure cuff, and none comes with a service. When we get sick today, there is very little choice but going to see a doctor. The trend of rising healthcare cost is not stopping. Recently, we have seen a new trend in the US for consolidation of large hospital systems that integrate diagnostics and treatment. That’s bad news for consumers.

iPhone ECG by itself will be limited to provide diagnostic value, but I see a future that a slew of health equipments that are available in consumer products. There will be independent diagnostic services that can help you become more knowledgeable about your conditions, and when you do decide to go to see a doctor, instead of waiting in the lobby for an hour, your doctor can't wait to see your iPhone.