Should Ireland introduce mobile health apps?

With Britain’s NHS about to begin mobile health app trials, should the HSE follow suit, asks Jessica Casey.

AFTER suffering with aches and pains in my shoulders, elbows, wrists, and knees for more than a week, I decide I need the help of a medical professional.

“I have joint pain,” I tell my doctor, who replies reassuringly that it’s sometimes tricky to diagnose the source of joint pain, but it’s rarely anything serious.

My doctor tells me I should partake in some light exercise, follow an anti-inflammatory diet, and take over-the-counter pain medication if the aches persist.

If my symptoms show no improvement in three days, I should organise a follow-up consultation.

And just like that, my worry was gone. I didn’t have to book an appointment or spend time in a waiting room and best of all, my consultation was completely free.

This was because my diagnosis was delivered through ‘Babylon’, a free iPhone app; my “doctor” an artificially intelligent chatbot, with advice compiled from billions of data points.

Welcome to the world of mobile health, mHealth for short — a range of applications and add-ons, designed to transform your smartphone into a portable doctor.

The British National Health Service (NHS) is soon to start trialling Babylon on more than 1.2 million Londoners, as a replacement for its non-emergency 111 helpline.

Using artificial intelligence (AI), the app offers its users a highly accurate, and mostly free, triage service, giving patients access to a virtual health service held in their pocket.

Setting out to democratise health care “by putting an accessible and affordable health service into the hands of every person on earth”, its makers believe the app is on course to become the first robot certified by the UK’s Medicines and Healthcare Products Regulatory Agency to provide medical diagnoses.

Patients can avail of free advice with the app by using the chat option to ask their medical questions, as well as monitoring their own health by logging their details.

It specialises in non- emergency but relatively common ailments such as nausea, digestive disorders, heartburn, dry skin conditions including eczema, back pain, colds and flu, diabetes and thyroid disorders.

However, for serious issues such as severe chest pain, head injuries, shortness of breath, or suicidal thoughts, Babylon advises patients to visit a doctor immediately.

Doctors, who have at least 10 years clinical experience according to the app’s creators, are available via video-call Monday to Saturday between 8am and 8pm at the cost of €8 per month with a subscription account, or €25 for a once-off consultation.

These doctors can even offer patients repeat prescriptions. The app also offers access to therapy sessions via video chat, with experienced counsellors who can help with mental health conditions such as depression and low mood, anxiety, stress, panic attacks, obsessive compulsive disorder, phobias, and bereavement, to name but a few.

The app is a very sophisticated piece of software; Users report their symptoms to the app, and they are then checked against a database.

Diagnosis is based on billions of data points collected from thousands of test consultations.

The app’s creator believes Babylon will ultimately reduce medical misdiagnoses.

“I don’t think it is going to be as good as a doctor,” founder of Babylon Ali Parsa told the Financial Times.

“I think it is going to be 10 times more precise than a doctor. No human brain is ever going to be capable of doing anything of the sort.”

Up to 5% of adult outpatients in the US experience at least one diagnostic error annually, according to a recent report. Here, most medical malpractice claims against GPs are for wrong diagnoses, according to the Royal College of Surgeons in Ireland (RCSI).

Babylon claims the diagnoses offered by the app are 92% accurate.

It’s just one of many digital connected health apps that experts predict are about to revolutionise healthcare.

With 1.7 billion people expected to download health apps by the end of 2017, the mHealth industry is on course to skyrocket. By 2020, PwC predicts the connected health market will be worth over €56bn globally and expects the use of e-prescriptions to grow at a rate of 40% annually. With these programmes you can use your phone to test for a wide range of maladies: from capturing high-resolution images of the back of your eye, to monitoring your child’s stool to detect paediatric liver disease — the free app is aptly named PoopMD.

Last year alone, the US Food and Drug Administration (FDA) approved almost 40 digital health apps and devices, including an add-on that transforms your phone into an ECG, an app-connected home test for male fertility, a bluetooth insulin pen, and a small portable ultrasound connectable to mobile devices.

But can mHealth applications and devices really democratise health care, by helping to ease burdens on services and freeing up space in doctors’ waiting rooms?

It seems the NHS thinks so, as it takes steps to move services towards smartphone tech wherever possible.

“In five years’ time smartphones, or whatever device we use to access information, will take the burden away from the limited number of human specialists we have,” chief clinical information officer of the NHS Keith McNeill said recently.

“People will get really intelligent triage that’s personalised to them from their phones, or be empowered to look after their own chronic conditions like diabetes via home monitoring.”

Diabetes costs €770bn globally per year and with Diabetes Ireland estimating more than 225,000 people live with the disease here, access to advanced home monitoring systems would have massive implications for sufferers.

THE InPen, a Bluetooth- connected, smart insulin pen and mobile app, allows users to track their history and timing of doses, monitor insulin temperature, and calculate dosage accurately.

The creators of the device describe it as a combination of many of the best features of insulin pens and insulin pumps “into one easy-to-use and affordable system”.

Diabetes isn’t the only chronic condition that can be monitored at home. Ireland has one of the highest rates of lung disease in Europe, with almost 400,000 people here suffering from chronic obstructive pulmonary disease (COPD).

Spirometry, using a spirometer to measure lung strength, is a common method used by doctors for testing for and monitoring COPD and other lung diseases including asthma, cystic fibrosis, and chronic bronchitis. The medical community widely accepts that at-home spirometry has multiple benefits, helping improve outcomes for patients, but unfortunately cost has

been a significant barrier to the practice being adopted by patients.

SpiroSmart, from the Ubiquitous Computing Lab (UbiComp) at the University of Washington, is another app among the programmes granted FDA approval last year.

The app effectively removes the need for an expensive spirometer by turning a smartphone into the tool, accessing the device’s microphone, and using it as a sensor. UbiComp also created SpiroCall — a related project for areas where smartphone access is limited. By calling a toll-free service, an ordinary phone can be turned into a spirometer.

MOBILE Health is also challenging traditional diagnostic equipment; offering cheaper, more portable, and easier-to-use alternatives that can be connected to a smartphone.

Lumify from Philips turns an android smartphone or handheld device into an ultrasound scanner with the addition of its plug-in transducer. Philips says the tool can be used in emergency settings to quickly assess critically ill patients, helping professionals to make fast, informed decisions.

The tool can also be used in the imaging of lungs, abdomen, musculoskeletal, and soft-tissue structures.

More portable than traditional diagnostic equipment, the app allows scans to be sent directly to radiologists for future evaluation, or to be held in the corresponding app for future review.

“Lumify has the potential to provide on-demand, point-of-care diagnostics in a more connected environment,” said Bret Nelson, MD and associate professor of emergency medicine at Mount Sinai Hospital in New York.

“I think that convenience and availability will increase the utility of this technology, improving patient care and efficiency.”

Another among the FDA-approved mHealth apps is Trak, described by TechCrunch as “like a Fitbit for sperm”. The first at-home sperm- testing kit and associated app monitors a user’s results over time.

One in six couples will experience trouble conceiving a child and half of these problems originate from male partners.

“Unfortunately, there is a certain stigma and silence associated with male infertility, which often precludes men from seeking proper and timely evaluation and treatment,” said Dr Jamin Brahmbhatt, urologic surgeon and infertility specialist with Orlando Health in Florida.

Using the app, men can compare their results to the population via a cloud-based community of users and receive tailored feedback to help boost their counts. The approved apps also include a range of connectable tools that can transform your phone into a doctor’s kit: An add-on kit from CliniCloud transforms a phone into a digital stethoscope and thermometer that anyone can use.

Heart-rate and temperature are captured in the app and suspicious coughs, wheezes, or temperatures can be sent directly to a doctor for evaluation. The devices don’t even have to touch the skin, so a sleeping child can be left undisturbed.

Another device, the Kardia Mobile, transforms the phone into a portable ECG, with the ability to detect hypertension and atrial fibrillation from a patient’s fingertips.

And mHealth is even challenging traditional laboratory testing.

Described by The Lancet as “a laboratory in your pocket” the Biomeme System transforms an iphone into a mobile DNA lab. The hand-held real-time polymerase chain reaction (PCR) works by creating billions of copies of pathogens’ DNA in a blood sample, tagging them each with a fluorescent dye. The iPhone’s camera can then detect the dye, while the app identifies which virus is present in the sample.

DURING the ebola outbreak in West Africa, PCR was used to identify the virus, but few tests could be utilised in the field.

With a single finger prick, the portable Biomeme system can screen someone in less than two hours.

The Biomeme System also has implications for sexual health.

In Philadelphia, a pilot from the company saw 900 urine samples screened for gonorrhea, chlamydia, and trichomoniasis, tested with an additional kit and an app.

The mobile test was found to be more efficient than traditional lab testing, easier to use, and just as accurate.

According to the HSE, reported wait times for accessing public STD assessments are varied, the most common waiting time for an appointment being two weeks.

If another two weeks are factored in while patients wait to receive results, public patients are potentially waiting a month to find out if they have a disease or infection. The results from the Biomeme are almost instantaneous.

As the NHS starts to encourage its users to avail of mHeath tools wherever possible, the question arises will our own health service follow suit? Although the HSE encourages doctors to embrace computerisation and technology, the organisation has no definite plans to introduce these forms of technology, a spokesperson for the organisation says, adding that the HSE would have to be confident and comfortable that any technologies it chose to promote improve efficiency and accessibility for patients.

A system like Babylon might work in the UK, but the HSE would have to make sure it would suit the Irish system and improve access to services, rather than creating more obstacles, the spokesperson added.

Chief executive of GP Online Aiden Callaly is also cautious.

Aiden Callaly, chief executive of GP Online, says the relationship between GP and patient is sacrosanct.

Launched last year, GP Online, a service from the National Association of General Practitioners (NAGP), allows patients who cannot make it to a surgery a chance to get a face-to-face consultation.

The service has been trialled in remote areas and for patients accessing addiction services, an area with a “huge gap” in available treatments.

Mr Callaly says he is very wary of any process that removes a doctor completely. There are currently services available which doctors do not believe are safe because the consultant has never met the patient and does not know their history, he adds.

While GP Online uses modern technology such as video calling, the service is available with a patient’s own GP. “The key is, the GP is someone you know,” he says.

Patients have to beware of relying on “Google medicine”.

“People have to aware of what they’re doing, like anything. My own view is people need to be careful with what data they store,” he added.

A system like Babylon might work for the NHS, he says, as its doctors are under so much pressure.

However, he added: “Artificial Intelligence, believe me, it’s a dangerous thing. It is absolutely not a replacement. We have GPs with 30, 40 years’ experience and the idea it can be replaced with a piece of software is insane. We’d be against it. The core thing here is that the relationship between GP and patient is sacrosanct. That’s the only way you can have the correct level of care.”

There is no guarantee the use of certain apps will improve the health service, he added, pointing to a recent UK case where a woman paid £180 for three separate video consultations through these apps, and was advised each time to visit a doctor in person.



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