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Posted on Jul 25, 2014 in Editorial | 0 comments

‘Setting the framework for intelligent apps’

Rahul Chakrabarti, Chandrashan Mahendra Perera

Co-Editors in Chief

Journal MTM 3:2:1, 2014

doi:10.7309/jmtm.3.2.1


It is with great privilege that we present this second issue of the Journal for the year with a poignant publication on the framework of app development by Marvel et al. Many of our readership audience, who themselves are app developers are overtly aware of the need for closer examination of app quality over quantity. Recent reviews of apps in medical subspecialties have highlighted deficiencies in what is largely an unsolicited market. Issues that have emerged on review of medical apps include scientific accuracy of content, achieving the intended objectives, paucity of peer review/ expert involvement, and consideration of the needs the end-user.1,2 Regulation of medical apps in particular is tantamount given they are readily accessible to a public audience. Thus misleading information or inaccuracies of the app may have ramifications upon individual health directly.

In their timely article Marvel et al summarise the important principles of creating mobile applications. Their ‘ten-step’ framework for app development is conceptualised into four phases: App vision, Creation, Dissemination, and Determining Utility. The authors highlight, using the case study of their own app, the issues and challenges considered at each step of app development. Importantly, this article provides a guideline of aspects for clinicians aspiring to develop clinically useful apps. Critically, the authors remind the audience that whilst development of an app is relatively straightforward, it is the planning and review process that is needs greatest attention. The latter is particularly important for apps that are not required to undergo FDA approval and freely enter an otherwise unregulated market.

The FDA has narrowed its focus primarily to apps which function as medical devices, and as such other apps may be subject to less scrutiny. Nevertheless it is important to understand that many of these apps are still being used by medical professionals to aid in daily practice, and the accuracy and reliability of such apps is still of vital importance. With any new development in the medical field, rigorous testing through scientific processes documented in the literature is necessary, and the use of apps should be no different. Whilst many apps claim to achieve certain goals, it is not without objective testing that a clinician should rely upon these apps, and at the Journal of Mobile Technology in Medicine we encourage developers to show evidence of their app’s claimed benefit.

With the surge in simplicity of app development and accessibility to end-users there is a growing emphasis on regulation. We encourage our audience to consider these logical principles to improve the quality of medical apps rather than mislead the public with increasing mediocrity.

References

1. Cheng NM, Chakrabarti R, Kam JK. iPhone applications for eye care professionals: a review of current capabilities and concerns. Telemed J E Health. Apr 2014;20(4):385–7.

2. Franko OI. Smartphone apps for orthopaedic surgeons. Clinical orthopaedics and related research. Jul 2011;469(7):2042–8.

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Posted on Nov 4, 2013 in Editorial | 0 comments

An Update on mHealth Regulation in the United States


Barbara A. Binzak Blumenfeld, PhD, JD1, William A. Garvin, JD1

1Counsels for Buchanan Ingersoll & Rooney PC
www.bipc.com

Journal MTM 2:3:1–3, 2013

10.7309/jmtm.2.3.1


In a previous issue of the Journal of Mobile Technology and Medicine, we provided an overview of the regulation in the United States of mobile health (“mHealth”) and mobile medical applications (“mobile medical apps”).1 On September 25, 2013, the United States Food and Drug Administration (“FDA”) released a Final Guidance for Industry and FDA Staff on Mobile Medical Applications (“Final Mobile Medical Apps Guidance” or “Final Guidance”).2 While the basic framework for regulating mobile medical apps in the United States has remained unchanged from our previous article, the new guidance provides further clarity that should be carefully considered by those developing mobile medical apps.

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Posted on Nov 4, 2013 in Editorial | 0 comments

The utility of mHealth in Medical Imaging


Chandrashan Perera 1, Rahul Chakrabarti 1,2

1Chief Editor, Journal of Mobile Technology in Medicine; 2Centre for Eye Research, University of Melbourne, Melbourne, Australia

Journal MTM 2:3:4–6, 2013

10.7309/jmtm.2.3.2

Introduction

Mobile devices are uniquely positioned to make a significant contribution to medical imaging. Portability, computing power, accessibility and built in internet connectivity are well described advantages of mobile devices.1 There is a growing body of research which supports the use of mHealth technologies for imaging, and a number of novel uses are described in the literature.

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Posted on Jul 24, 2013 in Editorial | 0 comments

Unusual utilisation of mobile technology in medicine


Rafsan Halim1

1Multimedia & News Editor. Journal of Mobile Technology in Medicine, Australia

Corresponding Author: raffy@journalmtm.com

Journal MTM 2:2:1-2, 2013

http://dx.doi.org/10.7309/jmtm.2.1.1


The popularity of mobile technology has grown rapidly over the last few years1 and the integration of mHealth is transitioning from a curiosity to an accepted part of health-care delivery. With the growing number of mHealth applications, systematic reviews have highlighted limitations in evidence for their benefits2. Despite the paucity of high-quality evidence, the unpublished and grey literature is littered with excellent examples of innovative applications and implementations of mHealth that may benefit patients and be of interest for future research. This has spurred interest from developers to think “outside the box” when trying to solve healthcare issues. We bring to the reader’s attention some of these ‘unusual’ applications and the exciting potential offered by new developments.

With iPhone adoption being as high as 59% amongst anaesthetists3, it is a field that ripe for interesting applications of mobile technology. Like other specialties, there are an extensive number of apps and attachable peripherals for the device35 . One particularly innovative use of the device involves the utility of the accelerometer built into the phone6. Reversal from neuromuscular blockade is best measured with a Train-of-four ratio technique, which requires a nerve stimulator and a measurement device for the force generated, such as an accelerometer7. The nerve stimulator causes a short burst of muscle twitches the force of which is related to the degree of muscle paralysis7. Whilst nerve stimulators are easily accessible, accelerometers are generally more difficult to access in the clinical setting. By combining the built in accelerometer in the iPhone along with the iSeismology app (Figure 1), clinicians have developed an alternative way of measuring the aforementioned ratio6.

Figure 1: Nerve stimulator and iSeismology app being used to check Train of Four ratio (6)

Recent interest in augmented reality (AR) technology have resulted in several novel applications. DoctorMole™ is a dermatology smartphone app that aims to aid the assessment of skin moles and diagnosing malignancies. The app can assess a mole through the phones camera and analyse the image via an algorithm for symmetry, border, colour & diameter to estimate the risk of a suspicious lesion being malignant8. Whilst such applications have been shown to have varying degrees of accuracy, potentially resulting in incorrect diagnoses9, it serves as an example for the future potential for AR use.

AR is also being utilised for medical education. The newly unveiled Google Glass™ has featured prominently in technology news and has now been utilised during surgery. A percutaneous endoscopic gastronomy was performed by a surgeon with the live video feed used to educate doctors in training on how to perform the procedure. The device allowed for an “operator view” and the sharing of the endoscopic view as well to enable a better understanding of the procedure for the trainee10.

One of the most unusual applications that has been reported involves the development of highly specialised patient slippers. Termed “smart slippers,” these devices use pressure sensors to analyse gait and identify possible medical issues or high falls risk. The device would then be able to alert the patient’s clinician of such risks or falls via a transmitter11.

These imaginative and unusual applications of mobile technology highlight the potential for further development in the field of mHealth. Furthermore, they help spark the creativity that is essential to such novel implementations of mHealth that will one day become mainstream. We recognise that there will be an inherent limitation in the amount of clinical data available with such developments in the early phases of development, however providing robust clinical data to support the use of any medical technology should be the ultimate endpoint of development. Here at the Journal of Mobile technology in Medicine, we encourage sharing of these new developments with other mHealth researchers through our news section, and eventually with original research data published in the journal.

References

1. Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res 2012;14:e128.

2. Free C, Phillips G, Galli L, et al. The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. PLoS Med 2013;10:e1001362.

3. Dasari KB, White SM, Pateman J. Survey of iPhone usage among anaesthetists in England. Anaesthesia 2011;66:630-1.

4. Cabalag C. The (Ultra)sound of Things to Come. JournalMTM 2012;1:5-7.

5. Mosa ASM, Yoo I, Sheets L. A Systematic Review of Healthcare Applications for Smartphones. BMC Med Inform Decis Mak 2012;12:67.

6. Langford R.iPhone for monitoring neuromuscular function. Anaesthesia 2012;67:552-3.

7. Pharmacology and Physiology in Anesthetic Practice 4(null) ed. Philadelphia: Lippincott Williams & Wilkins.

8. Banova B. The Future of Mobile Technology in Medicine: Innovative Medical Apps. medcitynews.com.2013; http://medcitynews.com/2013/04/the-future-of-mobile-technology-in-medicine-innovative-medical-apps/ (accessed 5 Jun2013).

9. Wolf JA, Moreau JF, Akilov O, et al.  Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013;149:422-6.

10. Grossmann R. OK Glass: Hand me the Scalpel Please … Google Glass During Surgery. @ZGJR Blog. 2013; http://rgrosssz.wordpress.com/2013/06/20/ok-glass-pass-me-the-scalpel-please-googleglass-during-surgery/ (accessed 21 Jun2013).

11. Smar Slippers. Foot-Signature Telemetry in insole to detect or even provent falls. At&T Innovation Space. 2009; http://www.attinnovationspace.com/innovation/story/a7619600 (accessed 20 Jun2013).

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Posted on Apr 19, 2013 in Editorial | 0 comments

The Growth of mHealth in Low Resource Settings


Rahul Chakrabarti1, Chandrashan Perera1
1Editor-In-Chief. Journal of Mobile Technology in Medicine

Corresponding Author: rahul@journalmtm.com

JournalMTM 2:1:1-2, 2013

DOI:10.7309/jmtm.2.1.1


The ever increasing global interest integrating mobile health is evidenced by a shift in the paradigm from one of curiosity to establishing an evidence base for its use. Not surprisingly, over the last past three months there have been several major publications in journals with a broad medical readership that have commented on the evidence for mHealth interventions.  Most notably, Free and colleagues from the London School of Hygiene and Tropical Medicine published two excellent meta-analyses in PLoS Medicine quantifying the effectiveness of mHealth interventions. The studies concluded that presently there are few studies of high methodological quality in the field of mHealth. The limited strength of evidence was in support of using Short Message Service (SMS) reminder to improve patient attendance, facilitating communication amongst health professionals, and improving patient adherence to medication (in the context of anti-retroviral treatment in HIV).(1, 2) The authors highlighted major methodological limitations and lack of scientific rigour in study design and analysis the lack of objective clinical outcomes, and the heterogeneity between reported outcomes amongst studies with similar interventions. Importantly, few studies were conducted in low-resource settings, where mHealth is well positioned to have a large impact.

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