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Medicine goes mobile with smartphone apps, devices
by Staff Writers
Washington (AFP) Feb 19, 2014


'Avatar doctor' is coming, physician-author says
Washington (AFP) Feb 19, 2014 - It's just in fiction for now, but the "avatar doctor," a virtual physician which consults and diagnoses through a smartphone app, is coming, says the author of a new medical thriller.

Robin Cook, a physician and best-selling author known for his books "Coma" and "Outbreak," says his new novel, "Cell," foretells a future where a good deal of medicine can come through an app which can draw from huge medical databases.

"Just about every book I have written has come to pass," Cook told a symposium Wednesday at the Woodrow Wilson Center in Washington as part of his book launch.

"There are already 50,000 medical apps. If you put them together you can have an avatar doctor. And it's going to be pretty darn good."

Cook, who has training in surgery and ophthalmology, said the virtual doctor can be superior in many ways to real-life medical practitioners by being able to sift through billions of studies and records to make a diagnosis and offer a solution.

"It's going to be updated on a daily basis," he said. "We're going to have something that can solve the biggest problems in American health care -- and health care in the world."

Cook said that by using an avatar doctor such as the "iDoc" described in his new book, which launched February 4, patients will be able to have more access to care and have more control over their treatment.

"It's going to democratize medicine," he said. "We have been held hostage by the stakeholders -- the physicians, big pharma, device makers and medical labs. This is going to free us from that."

Cook said the use of a doctor app -- which can connect to heart monitors, blood analyses and other data -- has the potential to reduce unneeded hospital visits or specialist consultations by determining which symptoms suggest real problems and which don't.

"If you think you are having a heart attack, your avatar doctor will look at your EKG, it will know your breathing rate," he said. "It might tell you to go back to sleep."

An app can also reduce the use of ineffective medicines by analyzing genetics and the likely response to various drugs.

"Some people feel you would lose the human touch and that people are not going to accept this. I disagree," he said. "Access and availability are going to trump the human touch."

A medical app with continuous monitoring can also be more effective in helping people quit addictions and predicting problems such as heart attacks, he argued.

As for the plot of "Cell," which revolves around an app which runs amok under the control of an evil insurance company, Cook said that was a way to create suspense and make the story more entertaining.

"Personally, I think this will be a big benefit to mankind," he said of the prospect of virtual doctors. "But there will be bumps in the road."

Thanks to smartphones, email, video games and photo sharing are available at the touch of a finger.

But attach a special case and that same phone can produce an electrocardiogram (EKG) from the electrical impulses in your hand and send it to a doctor.

"It's a neat little device," says E.B. Fox, who uses a heart monitor and app from AliveCor to keep track of his arrhythmia.

The 57-year-old North Carolina resident says he has been using the device since October. If he thinks there is a problem, he can email a reading to his doctor for an evaluation.

"I have no doubt it's saved me one doctor's visit at least," said Fox.

The heart monitor is just one example of progress in the booming mobile health -- or mHealth -- industry, which is changing both the way doctors practice medicine, and the way patients handle medical decisions.

"Mobile apps are one of many mHealth tools that are helping to engage consumers and patients in their own health care," David Collins, senior director of the mobile division at the non-profit Healthcare Information and Management Systems Society, told AFP.

- Slashing health care costs -

Doctors and developers alike are hoping that these mobile apps and devices will lead to lower health care costs.

Health care businesses such as hospitals and insurance companies traditionally focus on quantity, counting the number of patients seen and procedures done.

But as the system shifts and firms try to quantify the quality of care, factors such as whether a patient returns to the hospital within 30 days of treatment come into play, and can affect insurance payouts for care.

The idea is that if patients track their own health, using mobile apps and other tools, the extra data can reduce the numbers of doctor's visits, and make each one more effective.

The Scripps Translational Science Institute in California is in the middle of a study examining the relationship between medical costs and mobile medical devices, specifically in patients with chronic conditions

Participants receive an iPhone and either a blood pressure monitor, heart monitor, or glucose meter to track their high blood pressure, arrhythmia, or diabetes for six months.

Lead researcher Cinnamon Bloss said the team will be looking to see if by monitoring their own symptoms, patients can avoid unnecessary trips to the doctor or emergency room, as Fox has.

- Patient compliance not easy -

A few months into the study, Bloss has already noticed one longstanding problem that persists despite the ease of using mobile apps -- patient compliance.

"We're offering a free phone and device for a disease they already have, but many people don't want to be bothered, don't want to take the time," Bloss said.

And according to Iltifat Husain, the founder of the app review website iMedicalApps.com, a lack of adherence to treatment plans can have significant financial and health-related consequences.

"Patients who are non-compliant end up costing us billions of dollars in the health care system. I see it on a daily basis," he said at an event at the Brookings Institution in Washington.

"I'll see it in patients who come in in essentially a diabetic coma because they weren't taking their medications appropriately."

- Better apps -

As smartphones are increasingly a part of everyday life, even for older Americans, Husain says mobile health tools are improving.

"The quality of medical apps has grown tremendously in the last year or two, due to people having a higher medical app literacy," he told AFP.

That's also due to the guidelines released by the US Food and Drug Administration in September last year, which Husain said were helping to ward off the release of dodgy apps that could put patients at risk.

"Initially you had the Wild West -- now you have a sheriff who's come to town," Husain said.

But in a rapidly growing field that allows massive amounts of data to be collected, Husain offered a few words of caution.

"Just because we can monitor vital signs and other things doesn't necessarily mean we should. It doesn't necessarily mean that it leads to a better outcome," he warned.

"As a society, we need to figure out if we're willing to change the fundamental physician-patient relationship."

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