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Posted on Jun 16, 2014 in News | 0 comments

Health tracking built in with your new smartphone: a new revolution?

WWDC is a big annual event for all things related to Apple and this year it certainly did not disappoint. We have previously covered many mHealth technologies that are paired to the now ubiquitous smartphone but after the main keynote of the event, it seems that Apple, one of the world’s biggest consumer electronics companies, is ready to throw it’s weight behind mHealth as well.

We previously reported the rumours in February where it was suggested that Apple was incorporating Health related features into iOS. Now, the announcement is official with news of HealthKit. The software platform will be built right into iOS, allowing it to “know” the type of data being shared by different sensor hardware. This should shift the brunt of the user side software development work form device manufacturers, allowing them more resources to produce innovate mHealth hardware.

Not to be outdone, rumours have also started emerging of a similar platform being developed by Google for its Android platform. Rumoured to be dubbed “Google Fit”, the still unannounced platform is expected to be revealed at Google’s developer event, I/O which starts later this month on June 25th.

The wave of activity from the major players in the smartphone industry to back mHealth initiatives may be the beginning of another mHealth revolution. This time, it looks like population at large will be the main beneficiary.

News article by Dr Raffy Halim
Source:
–  Apple: https://www.apple.com/ios/ios8/health/
– Engadget: http://www.engadget.com/2014/06/13/google-launching-google-fit-health-platform/

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Posted on Jun 14, 2014 in News | 0 comments

A doctor’s guide to smarter phone use

Ed: Dr Perera, Editor-in-chief of JMTM has recently written a piece for Avant’s member magazine. The piece from the magazine is presented below.

Most Australian hospitals have yet to develop, let alone enforce, smartphone guidelines. This leaves doctors in a grey zone.

As such, we must take reasonable measures to ensure patient privacy and safety is not compromised.

Apps

A recent survey found that 87%1 of doctors use personal mobile devices for clinical use.
Of those, 62% have medical apps on their smartphones. While having reference materials or calculators at your fingertips is convenient, the quality of medical apps varies significantly. Studies have shown that some are wildly inaccurate, which is why it is so important to verify their accuracy before use.

Journal articles testing the accuracy of
medical apps are regularly published, so before using any app with the potential to influence patient management, search for appropriate evidence on sites such as PubMed (ncbi.nlm.nih.gov/pubmed).

Security measures

It’s not just medical apps we must be wary off: the mobile devices hosting them also pose risks when used inappropriately.

A 2012 study conducted by computer security company Symantec provided some fascinating insights into data accessed on ‘lost’ phones. Known as Project Honey Stick, it placed 47 unsecured smartphones in the public and tracked their use.

Of the ‘lost’ devices:

89% were accessed for personal-related apps and information.

83% were accessed
for business-related apps and information.

70% were accessed for business and personal-related apps and information.

45% attempted to access corporate emails.
Carrying patient data on your phone is the same as carrying it in your briefcase. There are, however, steps you can take to secure this data.

Setting up your phone so a passcode is required to unlock it will protect against most casual data thieves. This way, if it is lost or stolen you can demonstrate reasonable measures were made to protect your data.

You should also enable remote locking or content wiping so, if your phone is lost, you can prevent information from being accessed. How depends on the model, but most devices have this feature. If not, third-party software
is available.

Finally, ensure your phone data is encrypted (stored in a form that requires a PIN to read), otherwise the memory can be read
on a computer.

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Posted on Apr 25, 2014 in News | 2 comments

Application of Smartphone Devices in Ophthalmic Photography

The most recent issue of JMTM included an editorial on clinical photography. One keen reader, Dr John Davis, a Junior Opthalmic Resident at JIPMER has compiled an interesting “how to” article summarising some practical tips.

While the debate on the ethics and legalities of taking clinical photos remains a debated topic, this guide is aimed at increasing the quality of the images, if you do decide to take them.

Guest news post below.

Application of Smartphone Devices in Ophthalmic Photography

Dr John Davis

We live in an age where technology is both advancing fast and becoming more accessible. Smartphones and Mobile Devices is one area where this rapid growth is very visible. The availability of cheaper, faster and more capable mobile computing devices has led to a lot of innovations in every field where it can be applied. Smartphones are becoming ubiquitous, with every Tom, Dick and Harry owning one.

The camera is one of the main features of a smartphone today. Compared to the early days of camera mobiles, smartphone cameras now are quite good for all practical purposes. Also, the device being always available and portable is more important than having the most advanced camera.

Clinical photography

While the built – in camera Apps are quite adequate for most people, it would be wise to download and install a more advanced camera software for your mobile to allow better control of the lighting, focus, exposure, white balance and other settings.

 

Best Android Camera apps

http://www.phonearena.com/news/10-must-have-Android-camera-and-photo-apps_id49911http://lifehacker.com/the-best-photography-apps-for-android-2014-edition-1497507095http://lifestyle9.com/best-camera-apps-for-android-devices/

I would suggest Camera FV-5, ProCapture, Shot Control for Android. Similar software are available for iPhone and Windows mobile and even Nokia(Symbian and Java) too.

Always remember to have adequate lighting (preferably daylight), plain good-contrast background, good focus on the area of interest. Make sure to frame the picture including background, capture at maximum resolution, and take multiple photographs. Use zoom sparingly, especially digital zoom. Go closer to the subject instead of using digital zoom.


When taking before-after photographs, try to take with the same background and lighting. Same clothing and hairstyle would also help, if feasible. Make sure the zoom and other parameters, including exposure and ISO, is also same.

Later, editing can be done to crop out unwanted parts, adjust the resolution and filesize, adjust the background color and delete unwanted photos. Never worry about wasting space on digital photos. It is not like film where every snap counts.

External eye photography

The first and obvious role of an ophthalmologist’s camera/mobile is to take clinical photographs of interesting cases. This might be for future reference, for getting a second opinion, to visually see the change on follow-up, to convince the patient of the pathology, for tele-ophthalmology purposes, for measurements, for legal documentation, etc among other things.

Make sure to take photos with adequate lighting and with good focus(most apps have touch-to-focus an area of interest). Change the focus to Macro mode for taking close up photographs. ISO settings and exposure settings help if you know what you are doing.

Keeping the camera steady is important, and resting your hands against a solid object would help keep it steady. Lighting should be from behind the camera in most cases. An on-screen histogram can show information about bright and dark areas(available in some apps) and make sure to take photos from different angles

Slit Lamp photography

One of the most important, extremely useful, but expensive equipment a young ophthalmologist needs is the slit lamp biomicroscope. It has innumerable uses in ophthalmology, and it is always better to get the best in terms of the optics and capacity for add-ons. If there was a way to get the digital imaging capability of higher end slit lamp microscopes without burning a hole in your bank account, it would be awesome, wouldn’t it ?

Well, many of us might have tried to take photographs through the eye-piece of the slit lamp or other microscopes and partially succeeded, getting good photos once in a while. This works quite well for taking an interesting photo at short notice. We just have to make sure to hold the mobile/camera steady and centered. Adjust the camera forward and backward till the entire field is filled with the image. Turn off the flash, reduce the exposure, touch-to-focus, wait for the white-balance and auto-ISO to adjust to the light and only then click the photo.

To make the job easier, several people have made slit-lamp adaptors for mobiles which is basically a piece of plastic to hold the mobile steady and at the correct distance. You can make your own using discarded bottle caps of the correct size to fit the slit-lamp eyepiece. Readymade ones are also available for sale. For those who know about 3D printing, note that LVPEI has designed and released some adaptor designs on Thingiverse for download and 3d-printing(which is cool, if you have access to a 3D printer).

 

GANANT Open source Hardware Designs

by Ganesh Babu and Anthony Vipin Das from

the LVPEI-MITRA Innovation centre

http://www.thingiverse.com/ganant/designs/

 Once the mobile is in the slit lamp adaptor, you can much more conveniently adjust the advanced camera settings like ISO, exposure and light metering. You can adjust the brightness in the slit lamp, move it forward and backward to focus, all while looking at the image on the phone screen(no need to look through the eyepiece yourself). Try out all combinations of settings and different magnifications and even take videos where necessary.

You can take photographs of lesions on diffuse illumination, slit beam illumination, maybe even specular reflection if your slit lamp and camera are good enough. Cataract grading can be photographically documented, hypopyon, hyphaema can be measured and documented. Corneal ulcers can be followed up with successive photographs. Applanation mires can be photographed. Gonioscopy can be photographed and videographed. A good collection of gonioscopy videos is available on gonioscopy.org . Add your videos to the collection. Fundus examination with 90D or 78D lens can also be photo or videographed.

Online resources for learning gonioscopy

http://www.gonioscopy.org/http://www.youtube.com/results?search_query=gonioscopyhttps://eyetube.net/video/general-gonioscopy-exam-technique/

The same principles can be applied to take photos or videos through all the instruments with an eyepiece, taking care not to damage the lenses. Photographs can be taken through manual keratometers, operating microscope, and some ophthalmoscopes like panoptic which have a large eyepiece.

Indirect fundus photography

 Next, let us see what we will need to take a fundus photo without a slit lamp and 90D. We will need ONLY a 20D lens, steady hands, and obviously the mobile/camera.

Articles on indirect fundus photography

http://www.hindawi.com/journals/joph/2013/518479/http://www.optometry.co.uk/news-and-features/news/?article=5142http://www.bangaloremirror.com/bangalore/others/An-eye-on-the-ball-with-smartphones/articleshow/31551637.cmshttp://med.stanford.edu/ism/2014/march/eyego.html

Just like doing indirect ophthalmoscopy, you can use the mobile as the light source and eyepiece(headset) and focus using the 20D lens. For getting the co-axial illumination, one technique is to turn on the LED flash of the phone and then using the camera. In Samsung phones, just turn on “assistive light”, and then use the camera. Another technique is to use some advanced camera software which allows you to keep the LED “ON” while focusing the photo(but not the default camera app). Yet another technique is to simply take a video with the flash “ON”. The video mode keeps the flash “ON” continuously and you can capture a view of all quadrants in one shot. But the clarity in video may be less than the best, and extracting the photos would mean taking screenshots or frames using a separate software like VLC.

 To make the process of indirect fundus photography easier and more reliable, Robert Chang et al developed a plastic adaptor to hold the 20D lens at the correct distance in front of the mobile. They have named it eyeGo and expect to release it as a 3D printable format just like GANANT from LVPEI did for the slit lamp adaptors.

 Direct fundus photography

There are now portable fundus cameras in the cost range of Rs 4 lakhs, which work just like a direct ophthalmoscope. The Welch Allyn Panoptic ophthalmoscope has an extra add-on to fix an iPhone onto the eyepiece to take photos. We could do the same for any mobile or camera by making sure it fits snugly onto the eyepiece. It might be possible to fix a mobile/camera to a regular direct ophthalmoscope too, but the eyepiece is so small that it has to be centered well to get a usable image.

3 D photography

With the advent of cheaper 3D TVs, 3D mobiles, 3D laptops and other 3D viewing techniques, stereo-photography is another technique which is becoming feasible and practically usable. Stereo photographs are useful not only in fundus photography, but also slit lamp photographs, eye surgery videos and even clinical photographs. It is very much possible to take 3D photographs even with a regular smartphone camera. You just need the right software and technique.

 For clinical photographs, you can use the Inverse Panorama(Object movie) camera mode which is there in the default camera app in Micromax and Xolo phones. Basically, it takes a video while you revolve your camera around an object/subject. And when you play it you can scroll side to side giving you a perception of depth. The files are saved as MPO files which is a standard 3D photo format playable on 3D TVs.

Another software which does essentially the same thing is “Easy 3D Camera”, but you have to make it click each individual photo after moving the mobile by few degrees at a time. This software also has the option to view the photo in various pseudo-3D modes as well as using Red-Blue Glasses if you have them. Try the wiggle mode –  it is a simple yet effective pseudo-3D mode for all practical purposes. Google for wigglegrams if you want to see examples. There are several other software for taking 3D photos from regular smartphones, most of which take only 2 images (left and right eye views)

Slit lamp photography in 3D is more difficult, but basically, if the subject can stay still, using the 3D photo software, take the left image through the left eyepiece and the right image through the right. The additional depth perception will definitely help in diagnosis over a standard 2D photograph.

 3D fundus photography is supported by many desktop fundus cameras. Some have simultaneous left and right image capture, but most need you to take a left image first, followed by the right image after moving the camera around 4 mm to the other end of the pupil. Doing the same in mobile photography appears to be very difficult at present.

Resources for 3D enthusiasts

http://knowyourmeme.com/photos/267742-wigglegrams

http://thoughtcatalog.com/paul-barker/2011/09/mesmerizing-wigglegram-music-video/

http://www.youtube.com/results?search_query=eye+surgery&filters=3d

http://www.truevisionsys.com/ophthalmology.html

http://www.3dlivesurgery.com/microsurgery3d.html

Many of you might have heard of eye surgeries being shown in 3D in special conferences, or even in your own institute if you are lucky. 3D eye surgery videos are also available on youtube. Just go to  Youtube and, after a search, select Filters > Features – 3D. There are many methods to view the 3D, of which I would suggest Red-Blue Glasses if you have them, or Mirror split mode if you have a small mirror. Parallel or cross eyed if you have that much accommodation power. If you do have a 3D TV or 3D laptop, full color proper 3D is available to you.

That is all for now. Do send me your comments and ideas at johndavis AT JIPMER (D0T) net.

 John Davis

JIPMER

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Posted on Mar 11, 2014 in News | 0 comments

mHealth changes endoscope-i

endoscope-i

Endoscopic procedures are getting an mHealth overhaul with a UK based company developing fibre optic endoscope attachments for the iPhone. Endoscope-i (company name) has produced a specific rigid endoscope, light source and adapter that can be coupled with a custom case for iPhone 4/5/5s which acts as the screen for the device. The company isn’t just stopping there: it has released specific iOS apps that can take the image from the phones camera module and optimise the image quality for endoscopy to give optimal performance for the set up.

The rigid endoscopy can be used for ENT as well as veterinary applications in place where mobility is required or access is an issue. To demonstrate the potential of this technology, the company has already sponsored medical teams to conduct clinics in remote Nepal. An interactive map provided by the company shows that the endoscope-i system is already being used in countless far ranging locations from Germany to Argentina.

Several posters and other scientific research is already being conducted on the utility of the device. With more time, this device could become a well validated tool in the modern mHealth arsenal.

Sources:

Endoscope-i Home page http://endoscope-i.com/index.html
Interactive map: https://mapsengine.google.com/map/viewer?mid=zeauNUAeYn6k.k7JrVT9cXnC4&cid=mp&cv=LcyK8MK1VlU.en

by Raffy Halim

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Posted on Feb 11, 2014 in News | 2 comments

The Unrealized Potential of mHealth

The Unrealized Potential of mHealth

Predictions about the rapid growth of the mobile healthcare market in the future are paired with great optimism about what this technology can achieve, but despite the progress that has been made, there are still some significant limitations and concerns that might restrict the uptake of this type of technology. Until these issues can be addressed, the potential of mHealth may remain unrealized.

The Year’s Top Inventions

The growing importance of mHealth and healthcare technology in general is reflected by the inclusion of four healthcare related creations on the list of the 25 best inventions of 2013 produced by Time magazine. The selected healthcare inventions included an artificial pancreas, which can monitor blood glucose levels and control insulin release in response to them to treat type 1 diabetes, and the Rewalk bionic suit, which can translate the user’s shifts in balance and body weight into the movements of powered braceson the limbs and torso, enabling them to stand and walk. Two other healthcare inventions on the list were of more relevance to mobile healthcare. The Argus II combines an artificial retina with a video sensor mounted on a pair of glasses to improve the vision of people affected by retinitis pigmentosa, while the Edible Password Pill created by Motorola demonstrates how technology is being created that can allow communication between the body and mobile devices. The pill is currently being developed simply as a tiny chip that can be swallowed and powered by stomach acid, emitting a password signal so the user can be recognized by asmartphone or computer, but this technology might go on to have application in mHealth and other fields.

Market Growth

These developments in mHealth technology are matched by rapid growth in the value of the mHealth market. Its estimated value in 2012 was $6.7 billion, but it is expected to reach $8.3 billion by the end of 2013. Over the remainder of the decade, increasing investment in healthcare around the world, together with the development of better mHealth applications, is likely to result in even stronger growth. The global mHealth market has been projected to grow to $58.8 billion by the year 2020, which would reflect an annual compound growth rate of 32.3%.

Limitations for mHealth

Despite these signals of a positive future for mHealth, there are still some doubts about how useful the technology may be, at least in its current state. Although many of these doubts are likely to be removed as the technology develops further and as people become more comfortable with using mHealth technologies, they are still significant limiting factors that the industry needs to take account of as they create and promote their products.

The technology itself can be limiting, since mHealth apps will need to be both functional and meaningful if they are to play a significant role in healthcare, rather than simply being novelties. A recent survey of approximately 43,000 mHealth apps available from iTunes found that there were serious limitations in functionality. Only 10% of the apps scored above 40 out of 100 when rated for 25 clinical functionalities, and there were significant gaps in the types of conditions and populations being catered for, with those in greatest need, such as the elderly and people in developing countries, rarely being targeted. Popular mHealth apps were more likely to be used for monitoring diet and weight loss than for serious health conditions. The limited functionality of mHealth apps limited their use, with just five apps representing 15% of all mHealth downloads from the store, and half of the apps having been downloaded fewer than 500 times. The technology on which the apps can be used might also limit the uptake of mHealth products, since consumers are likely to have concerns about relying on mobile devices that could be damaged, run out of power, or lose their signal, for important healthcare services such as monitoring and reminders to take medication. The technology needs to be more reliable if people are to depend on it for their health.

Other significant limiting factors relate to the patient populations who mHealth has the potential to help. Although access to mobile devices capable of supporting mHealth applications is widespread in many parts of the world, there are still gaps in access in poorer populations and in the elderly, whose great need for healthcare services is often matched by a reluctance to adopt new technologies, which can make providing these services through mHealth more difficult. The willingness and ability of target populations to use mHealth products will be a serious limiting factor in the future, and it must be addressed if these technologies are to reach the people who can benefit from them. Mobile healthcare may remain an unrealized technology of the future for some time, before both medical professionals and consumers are willing to adopt and rely on it for their healthcare.

by Evelyn Dunne

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Posted on Feb 10, 2014 in News | 0 comments

Apple to embrace mHealth?

apple mHealth

Though this is purely rumours at present, multiple sources across the internet are reporting that Apple maybe taking a keen interest in the mHealth space with its upcoming devices. Several sources in the tech industry are reporting that the upcoming version of the iPhone and the operating system, iOS 8, will focus heavily on mobile healthcare and fitness. These rumours do not seem far fetched given the surprise addition of the M7 motion coprocessor in the current iPhone 5s, which specifically is geared towards personal tracking.

One of the more interesting aspect of such speculation is the notion that the company is building a wearable device which could be in a watch form-factor. Currently dubbed the “iWatch”, this device is thought to showcase Apple’s aspirations to redefine the mHealth and personal tracking space. If the current job listings are anything to go by, these rumours may have carry some additional weight, since the company recently decided to hire sleep and exercise physiology experts.

Given that the personal tracking industry is currently booming with the release of a myriad of tracking devices such as the FitBit, Zeo & FuelBand, an integrated solution building on the iOS ecosystem makes perfect sense. If Apple can achieve its goals, mHealth will have a global heavyweight company championing its cause.

by Dr Raffy Halim

Sources:

http://9to5mac.com/tag/ios-8/

http://www.theverge.com/2014/1/31/5366242/apple-met-with-the-fda-to-talk-mobile-medical-applications-last-month

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