Misinformation exacerbates mHealth growing pains

By Neil Versel

Neil VerselLike any rapidly evolving industry, mobile health is suffering some growing pains.

A study published in the September issue of the journal Diabetes Care found that type 2 diabetes patients who were given behavioral coaching with the mobile phone-based WellDoc DiabetesManager system lowered their hemoglobin A1c readings significantly more than those who only received care during occasional doctor visits and through self-management.

If the WellDoc system was linked to clinical decision support, the results were striking. Researchers from the Department of Epidemiology and Public Health at the University of Maryland School of Medicine in Baltimore found that the group of patients whose physicians had access to CDS saw their A1c levels drop by 1.9 percentage points. Those in a control group, who only received traditional, office-based care had a median A1c reduction of 0.7 points.

"To our knowledge, this is the first cluster-randomized study of a mobile diabetes-coaching intervention conducted in a community setting over a 1-year treatment period. Few previous studies of electronic or mobile communication interventions for diabetes were randomized, included a control group or covered 1 year," the researchers wrote.

But it was not all good news. The researchers observed no "convincing" changes in other measures of diabetes control, including blurred vision, pain, depression, and abnormal blood pressure and lipid counts. They hope future studies could focus more on these secondary measures of diabetes control, but for now, there remains plenty of fodder for skeptics in many areas of mobile health.

This week, MedGadget wrote about an "intelligent T-shirt," embedded with sensors, under development in Spain. That prompted Dr. David Albert, the outspoken creator of the iPhone ECG, to tweet the following: "I think LifeShirt proved there is not much of a market beyond first responders and military for monitoring wear."

Yes, LifeShirt more or less pioneered the idea of a wearable, washable monitoring system, but VivoMetrics, which marketed the product, declared bankruptcy in 2009. That won't stop others from trying to make something commercially viable, just like the demise of Google Health hasn't deterred many from pushing mobile personal health records on a public that just doesn't seem to be ready for them.

Maybe the clinician market is where the money is right now. This week, I received a press release from Sprint with the following headline: "A White Smartphone to Match your White Lab Coat; Award-Winning HTC EVO 3D is Available in White." Other than the headline, the press release makes no mention of physicians or anything else medical. Some publicist simply hopes doctors will buy a white smartphone because they wear white coats.

Guess what? Many of them already have bought white smartphones. Apple's iPhone.

I don't blame Sprint for trying, however. Sometimes, though, the hype overwhelms the message. (I'm bracing for a lot of that at next week's Health 2.0 conference in San Francisco, my first foray into Northern California since I laid into Silicon Valley's attitude toward healthcare two months ago.)

Last month, iPad EHR developer DrChrono announced a new round of venture funding, but also pushed the hyperbole envelope a little too far in launching OnPatient, its patient check-in app. The compay called OnPatient a "groundbreaking app that digitizes the medical practice waiting room."

Bad news for DrChrono, but there is nothing "groundbreaking" about software for collecting patient history and transfers the information to an EHR. Instant Medical History, a program from Primetime Medical Software, Columbia, S.C., has been doing this for years. NoMoreClipboard.com and ePatientHistory.com have similar products.

Worse, a video that DrChrono produced to demonstrate its iPad EHR says that the app can help physicians qualify for "tax breaks" for achieving "meaningful use" of EHRs. That's wrong. The money for meaningful use is in the form of Medicare/Medicaid bonus payments, and actually is considered taxable income in most cases. I sure hope it's an honest mistake and not a deliberate attempt to mislead potential customers.

As the Diabetes Care study illustrates, some solid evidence about the efficacy of m-health apps is starting to appear, but there's still plenty of work to do. Give us facts and realistic expectations. Spare us the hyperbole and misinformation.