Design and Best Use of mHealth Apps

Chosing the right mHealth App can be confusing.
Chosing the right mHealth App can be confusing.

Chosing the right mHealth app can be confusing. Today, we see an array of health & mHealth mobile apps designed for consumers. But are you using them correctly, or are you wasting your precious time and money?

Whether it be for monitoring of exercise, fitness, or weight loss, or for more serious conditions like diabetes, sleep disorders, or shunt malfunction in hydrocephalus, consumers and developers would be wise to better understand how health and mHealth apps can benefit one’s health. The biggest problem I see is how health and mHealth apps are categorized, which then determines how they will be used. So I have written up a few suggestions to better help consumers and developers in selecting their mHealth apps. I have grouped health and mHealth apps into three (3) categories.

mHealth Technology, are we there yet?
mHealth Technology, are we there yet?

First, a little info about me. I am an early designer and pioneer of a 1997 neuromonitoring app, the DiaCeph Test, intended to run as a dedicated PDA device. I worked in nuclear medicine technology from 1976 to 1992. My specialty was setting up very technical medical instrumentation for best use. But a brain injury & CNS shunt for hydrocephalus in 1992 changed all that, and I became involved in artificial intelligence (AI) in assistive cognitive applications, and in mHealth apps for hydrocephalus monitoring. In 1997, I designed and patented one of the earliest mHealth apps, the DiaCeph Test. It was to run on a PDA. I was not able to raise enough funding for development and FDA guidance, but offer free paper FORMS and user INSTRUCTIONS, plus provide consults to individuals with hydrocephalus and their families. The link below explains these services.

Hydrocephalus & NPH Monitoring by Stephen Dolle/Dolle Communications

This also includes global health information on hydrocephalus. From 17 years earlier work and consulting in nuclear medicine, I’m well versed in medical software and UIs for medical technology. Today, I am also a drum circle facilitator, and put on drumming workshops for a number of medical conditions. Furthering our understanding of cognitive therapies and cognitive accessibility will play an increasingly important role in designing future mobile apps and interfaces, or UIs.

mHealth designs & monitoring must be tailored to the medical condition and patient.
mHealth designs & monitoring must be tailored to the medical condition and patient.
Cognitive Accessibility accommodations er CognitiveAccessibility.org
Cognitive Accessibility accommodations er CognitiveAccessibility.org

First Health App Category:

Apps that only provide medical resource information, i.e. WebMD, Medscape. They are generally not harmful if from a respectable source. Still, there are dangers in relying on a single site and piece of advise. I prefer to search for medical sites on the web, where topics will be hyper-linked to other web pages. This way you’re not limited by one app. One of my favorite sites is MayoClinic.com. I like their format. You should become familiar with an array of health & medicine sites, where you’ll come to know who you can trust and which formats you prefer. Now that you’re reading up on health and medicine, it’s time to select an app you might use to help track everyday things like exercise & fitness, or nutrition and weight loss. These apps I put into my Second Health Category. But if you have a chronic medical condition, or are being evaluated for some new serious medical disorder, then you’ll want to skip to my Third Health Category.

WebMD mHealth app and solutions in health and medicine
WebMD mHealth app and solutions in health and medicine
The Mayo Clinic web site offers an easy to understand interface & wealth of reliable health and medical information.
The Mayo Clinic web site offers an easy to understand interface & wealth of reliable health and medical information.

Second Health App Category:

Apps that collect information on health, fitness, nutrition, sleep, and stress management, plus a few more not mentioned here. For the most part, these apps do not serve a medical purpose, unless you are being treated by a physician or therapist who will review the data. So if you plan to use them for this purpose, you should really skip up to the third catagory. This second app category is perhaps more intriguing, than medically useful. And it then raises the question, What are you going to do with the data? Unless you are working with a trainer, therapist, or physician who knows how to interpret them, and will advise you accordingly, you may be wasting your time. Once your results reveal a true health issue, then you’ll need to move up to the third category.

Third Health App Category:

Apps for disease management, which is my specialty. Here you track specific data for a specific medical condition via an app designed to monitor your condition. But you should really be working with a physician or specialist who can interpret the data and treat you. You may also have to pay extra fees. Otherwise, you will likely be left with useless data, and no specialist to act on it. I recommend physician concierge services where you can pre-arrange apps, and then interact via email and telephone. Besides concierge services, some physicians will communicate with you via email, which can be very helpful. Disease management apps also help in the prevention of medical errors and incorrect diagnosis. We’re still in the early years for these apps. But in time, they will become an integral part of patient care in the management of chronic disease.

Below, is my blog discussing how weather apps can be used to manage migraine and triggers due to dramatic change in barometric pressure. The barometric pressure image below is a screenshot of my Elecont HD app from Jan. 31, 2016, where the curve reveals a dramatic fall, and then rise, in barometric pressure which can cause migraine and related problems for persons with an array of neurological disorders, including, hydrocephalus, which I live with. This blog discusses migraine in depth and how weather apps are an effective tool in managing these health challenges. Also SEE my blog on how decibel meter apps can help with sound induced headache due to sensory processing disorder. Coming soon: Integration of Brain Wave Readers in neurology apps.

Mobile Wealther Apps help in Managing Weather related Migraine Headache

Barometric Pressure graph reveals steep drop and rise which can trigger micraine headache
Barometric Pressure graph reveals steep drop and rise which can trigger micraine headache

I initially wrote this blog in response to an April 16, 2015, article in the New York Times technology section, which wrote about health and mHealth apps and whether they are good for everyone. Sadly, I found their conclusions and recommendations vague and incomplete. But without a comments section, I ended up writing my response on LinkedIn, and then on my blog here. The title of the NY Times article was:

Report Questions Whether Health Apps Benefit Healthy People

Women play and entrain with dolphins on this boat excursion out of Dana Point, CA.
Women play and entrain with dolphins on this boat excursion out of Dana Point, CA.

On March 23, 2016, the New York Times “On Technology” magazine ran an interesting story on women’s use of mHealth apps for managing women’s health. I found it provocative in that it delved into the female psyche & biology of women, and perhaps a superior ability to entrain to one another (McClintock Effect, synchonicity of monthly cycles).

New York Times: Women more Honest w/ Phones than Doctors

The article then cites a study of over 130 women who were more comfortable keeping personal health information in an app, than sharing with doctors. Is this an aberation? Perhaps not. It has been shown in multiple studies how women are more early “adopters,” and how women more readily entrain to one another than their male counterparts. But it’s unclear if men similarly are less willing to share medical information with doctors. In either case, I think these findings give us insight into design preferences in  mHealth apps.

As for women being more able to entrain with each other, I can attest to this from my work with drum circles. They are more emotionally connected. It definately comes through in my work with drum circles, or “group drumming.”

Whatever your needs are, I hope you find a health or mHealth app that works for you, and find a physician or therapist to interpret your results, and advise you medically. If you’re an mHealth developer, I hope you learned something here you can use in your development and marketing of mobile apps.

As far as prep on my DiaCeph Test app for hydrocephalus, I am mostly done with my Creative Brief/App Proposal. If I can advise (consult for) others on mHealth app development, I am happy to do so.

The DiaCeph app was designed initially for a PDA before mobile data apps were available. Still, its diagnostic design is state of the art today. This could also be coupled for monitoring of migraine, EEG readings, SPD, PTSD, and other app functionality. Below, is my blog on the DiaCeph Test.

Below are links to my recommended neuro apps for Hydrocephalus

eWealther HD App by Elecont for managing Migraine Headache

Metal & EMF Detector – App Smart Tools app measures magnetic fields of electronic & magnetic devices in one’s living environment that could alter the setting of a programmable CNS Shunt for Hydrocephalus

  Sound Meter – Smart Tools Decibel Meter app measures the loudness of sound helpful in SPD or sensory processing disorder.

Smart Tools Page on the Android Play Store

Smart Tools Apps on the iTunes Apple Store.

You may contact me below if interested in speaking to me about my work with drumming therapy, app development, or speaking in the neurosciences.

Stephen Dolle

Tel. (949) 642-4592

Email: contact[at]dollecommunications[dot]com

Dolle Communications

Contact Stephen Dolle
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Overcoming Barriers in the Adoption of mHealth Mobile Apps

I wrote an in-depth response to the “12 barriers” presented in the blog below on the LinkedIn Mobile Health Association group, and am posting my discussion public here.

The title of the blog post is “12 Barriers to Adopting Mobile Technologies in the Healthcare Industry”
http://www.integratedchange.net/barriers-to-adopting-mobile-technologies-in-the-healthcare-industry

This blog presents a nice concise overview of the issues, and I took it as an opportunity to share my knowledge on the subject. As to my qualifications, I designed & patented one of the first mobile health apps in 1997, the DiaCeph Test, a disease management & diagnostic app for the disorder hydrocephalus. It was to run as a stand-alone app on a PDA. I formed my start-up company, DiaCeph, Inc., and for 3 or 4 years I followed all of the developments during those years. Today, mobile data apps are different from the earlier stand-alone & PC applications. However, we can learn a great deal from those early years, and individuals such as myself have experience in working earlier apps. So, it’s just a matter of picking up where we left off. As such, I feel that I have an astute understanding of mHealth app prospects today.

The blog lists 12 distinct barriers that need to be addressed in order for mobile health, or Mhealth apps, to be put into widespread use.

1) Security
2) Health Devices
3) Remote Places
4) NHS Network – N3
5) Difficulty Understanding the Technology:
6) Difficulty for NHS Staff
7) Hacking
8) Lack of Incentives for GPs
9) Mobile Does Not Mean Only Mobile
10) User-Friendly
11) Human Appeal
12) Lack of Support

Let me begin by addressing No. 8: Lack of Incentives for GPs (Physicians). Just as it were proposed 15 years ago, I believe it still holds true today. There needs to be a reimbursement code & fee for physicians to examine patient data from health apps, particularly, disease management apps for chronic illness. If the app provides [invaluable] clinical information that the physician would not otherwise have, the app data must be viewed as clinical testing. Even though the results might only require a quick check or interpretation, there is an interpretation taking place and doing so could/should involve a fee (esp. where there are no other charges for the monitoring). Another way physicians could earn a fee, is thru cost savings and capitation in managed care practices.

In chronic illness, which today accounts for 75% of all health care spending, health apps can make an invaluable contribution to clinical care & outcomes. Digital monitoring has been used in CHF, asthma, diabetes, and a few other disorders with good success. But there’s not yet been the widespread and seamless integration to drive the needed adoption and support.

As to No. 3 Remote Places: I believe “text apps” could be used on standard phones, and operate a bit like my earlier DiaCeph app on a PDA, and the resulting file texted to a care facility.

With most of the other barriers, notwithstanding those of security (which in my view applies to all mobile data), the challenges I believe can be answered by physician and plan reimbursement, which will then drive adoption.

Briefly, my view of apps is in one of three (3) categories: 1) Fitness & light wellness; 2) Disease Management; and 3) PHR or personal health records. The latter category poses the key hurdles with secutity, whereas the 2nd category is for management of chronic illness, which is critical to care outcomes, and is also where much of my experience lies.

If physicians are reimbursed for reviewing or interpreting app data in chronic illness (which I believe can happen), then physicians will lead adoption and tech support – which is how it should be. App recommendations, use, adoption and support will then go thru their office, much in the way prescriptions are written thru their office today. I also envision “app centers” where patients can get support and the latest user information on apps. These app centers could also serve of the types of apps, relieving AT&T, Verizon, and Sprint of this responsibility. Just imagine the marketing efforts that would ensue to physicians, the reimbursement, and the value-cost savings in medicine. We’ve seen leaps and bounds of progress in UIs and adoption of apps in only a few years. So many users are ready for this next wave of technology. It’s the seniors and slow learners next that must be brought on board tech and mobile apps. But just imagine what a coordinated effort could do. There’s so much money & cost savings at stake in mHealth not to do this. Yet, UIs and accessibility must improve.

One of my pet peeves is “cognitive accessibility” of web sites, apps, and product labeling, and store shelves. It is an area that I became involve in, and advocate and write about, as a result of a brain injury and CNS shunt placement in 1992 (I have underwent 12 shunt revisions to date). Times when I am tired or otherwise not feeling well, I have limited patience for misdirection and poorly designed UIs. I have become particularly adept in cognition, artificial intelligence, and learning. In recent years, though, much of my work has been with drumming for the brain. Yet, I am an accomplished neuroscientist & patient advocate, and as mobile technology has progressed, it has attracted my interest. I earlier spent 17 years in nuclear medicine imaging and worked with some of the most poorly designed instrument interfaces you could imagine. Having been adept in technology enabled me to apply it to my needs post brain injury. Plus, 35 years ago, I considered going into instrument design work. All of this affords me a unique perspective with mobile apps & mHealth today. I also provide neurological consults around the world with paper forms based on my DiaCeph design. So I know how mHealth would fit into care.

In closing, I believe we have 90% of the information that is needed to make mobile health succeed today. We must primarily solve the outstanding integration, platform differences, and security issues. Once this is done, the developments will transend the millions of mobile apps coming available, and making them much more integrated, and much more secure. Dare to dream!

Stephen

Orange County is Fast Becoming a Boon for Tech Startups

Last night, I attended Start-up Events Orange County’s event, Women in Tech Part 2, and was very impressed. I found a great variety of mobile app, gaming, web-enabled, and personal & social tech-ware. There is no doubt the OC is fast becoming a haven for tech startups, of course, with a little help from the big success of the Oculus Rift virtual reality gaming, and their acquisition by Facebook. And these smart girls are really cute too!

Startup Events Orange County

Irvine, CA
1,325 OCpreneurs

Startup Events Orange County is a fluid collective of networks, highly customizable to suit customized events. . .sometimes about startups, sometimes about entrepreneurship, s…

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I was able to peruse and talk with most all of the exhibitors, some 15-20 up & coming tech startups, that I expect to be around next year. One of the exhibitors, LynxFit, was there with a Google Glass set up for fitness training. Another, Zuul Labs, showcased their 1st art gaming app, Tall Tails, and shared how their using coffee & their new gaming app to save rescued dogs. Another, MotorMood, makes a LED device to go in the rear window of your car to let other drivers know what you’re feeling.

I continue to stay abreast of area tech and frequent several of the tech Meetups. I am still hoping to develop my earlier DiaCeph mHealth test for hydrocephalus as a mobile data app. I’m also offering to consult for groups involved in mHealth, and others involved in assistive cognitive technology and cognitive accessibility. My entire 40 year career has been in tech, from my years in nuclear medicine technology (1975-1992), where I became a guru of sorts and founded my own company, to my design of the DiaCeph Test, and efforts with assistive technology, mobile apps, and now cognitive accessibility. My skills with tech in nuclear medicine were so well established, that my first job out of college I set up a nuclear medicine department from scratch, then taught staff physicians about it.

It was in 1997 (after my brain injury & living with shunt complications), that I designed & patent my DiaCeph test, originally because of hidden issues with my Delta anti-siphon shunt – which I petitioned FDA on in 1996. I was having problems, and nobody would revise me – because there was no diagnostic proof of a shunt problem. I designed DiaCeph in 1997 as a stand-alone PDA app – and I was in fact, one of the earliest people to design a mobile type of app. It just took tech 15 years to catch up with me. Many of the things I wanted to do previously in assistive apps, are now more possible today. And the business model for DiaCeph as a data app is almost completely different today. As a data app, it would still be ahead of most mHealth apps today. My biggest concerns are the costs of coding & development, and getting it done within the restrictions of new FDA guidance.

If I had my caruthers, I’d create “open-source” CNS brain shunts with new features and capabilities, and tell the FDA to go pound sand! Their Phase II and PMA regulations are much to blame for many of the current shunt problems.

Sometime soon I will publish new content on my DiaCeph Test, and content on other brain apps & such I’ve used and can endorse. I only have so much time, and currently have quite a few projects demanding my time. My neurosurgeon, Dr. Muhonen, has also asked if I might be able to create a mobile app or other means to read the setting of programmable shunts. It looks unlikely that it can be done via the phone itself. It would have to include an accessory plug-in or some stand-alone reading mechanism. I’m not sure if you heard, but it was discovered a few weeks ago that my Certas valve suffered a changed setting and may have gone on for 4-5 months undetected. That was fun!

I am still doing my drum circle facilitation work. But I am being much more selective now to better account for my time. I’ve got some new applications & methods in drumming, and will write about them when the time is right. I am pleased to know they are a lot of people doing drumming today because of my efforts.

Here’s a link from one tech startup from the event I expect to use.

http://www.yourkidvid.com/

Stephen