Guest Editorial

Take Two Apps and Text Me in the Morning

May 31, 2013 03:00 pm Robert Eidus, M.D.

My patient was prediabetic, and the usual steps to stop the progression toward type 2 diabetes were not working.

Robert Eidus, M.D.

He had tried diet programs and failed.

He had tried group visits for weight loss and failed.

And then, without medications, surgery or any other interventions, the pounds started coming off. In 12 months, he lost 60 pounds. His hemoglobin A1c and lipid levels normalized, and he has kept the weight off for 18 months.

For this patient, the life-changing -- and potentially life-saving -- answer to his health care problem was not found in medical literature, an exam room, an operating room or a self-help book. He found it on his phone.

The patient used a mobile app that features a calorie counter and a diet-and-exercise log to help users meet their fitness goals. Based on those goals and the information logged, the app calculates the number of calories users have consumed and burned throughout the day and informs them how many calories they can consume to remain on target for the day.

I'm not overweight, but if I'm going to recommend an app to patients, I want to make sure it works, so I tried it myself. This app does work, in part, because it reinforces good behaviors.

The point is not that every overweight patient should run out and download this particular app or that you should recommend it to your overweight patients. The point is that apps can make a difference -- if they work.

If Google Maps gets a consumer lost, it's not a complete disaster. But what happens when a patient relies on a medical app that's unreliable? There are more than 17,000 health-related apps available, and the industry has little oversight.

Our patients are using their smartphones to look up medications and supplements and to enter data about their health. They also are using nonmedical apps, such as grocery store planners and bar code scanners, to improve their health. And there are more sophisticated apps they can use to track and share information about factors such as their blood pressure, oxygen saturation level and pulse rate.

There are medical apps for just about everything. So many, in fact, that the FDA is beginning to flex some muscle and rein in app developers whose products claim to diagnose medical conditions, as well as those that function as medical devices. The agency issued draft guidance for certain types of mobile medical apps two years ago, and final guidance is expected later this year.

In the absence of a thorough approval process, countless apps have been developed without medical expertise or proper scrutiny. So how are patients -- or physicians -- supposed to know what actually works?

For me, the question "What apps are you using?" is becoming almost as common in my exam room as "Do you smoke?" I ask patients what they have tried, what has worked and what did not. I've tried a few before giving recommendations to patients.

Apps, of course, aren't just for patients. I have at least six apps I use in my practice for things like reference information (Epocrates) and tools that can assist me (Dragon Dictation). We can network with our colleagues and see what they recommend. We also can simply read what other physicians recommend. iMedicalApps features physician, resident and medical student reviews( of apps based on their own experiences with a product.

Happtique, a mobile health solutions company, has developed a certification program to determine if apps are secure and evidence-based, and the Association of American Medical Colleges has agreed to review apps( that apply for that certification.

Is all this fuss about apps really necessary? Well, consider what some apps are being developed to do.

Although some apps perform functions as simple as reminding patients when to take a pill or how to prepare for a colonoscopy, some apps perform the same functions as medical devices. The latter are the products the FDA has in its sights, and the agency already has approved more than 75 such products.

There are apps that combine tools such as glucose meters, blood pressure cuffs and heart monitors with smartphones, and they have the ability to analyze, display and share the data they collect. Apps allow phones to be used to test blood, sweat, urine and saliva. The implications could be vast( for patient care and reducing costs to the system.

So what's a family physician to make of all this? Well, here's one app you might want to share( with patients. HHS recently recognized myfamily as the winner of its mobile app contest. That app helps manage an entire family's health with customized prevention information and personal health alerts and tracks medical check-ups and vaccinations.

The bottom line? Don't be afraid to explore the numerous possibilities technology is presenting us.

What apps have your patients had success with?

Robert Eidus, M.D., is a member of the AAFP's Commission on Quality and Practice.