Katherine Blondon, MD, PhD student Dept. Health Services University of Washington

Transcription

1 Katherine Blondon, MD, PhD student Dept. Health Services University of Washington March 31, 2012

2 Trends in smartphone use From the patient s perspective From the provider s perspective Medical liability What s new? Conclusion

3 Current research : How mobile technology can improve care coordination for chronic diseases such as diabetes How rewards/incentives can influence behavior change Involves reviewing diabetes apps No conflict of interest for either smartphones or apps

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5 83% of adult Americans have a cell phone Rapid growth for smartphones: 43% mobile phone users in the US

6 Majority of <44 yr olds yr olds = 2 nd fastest growing group! (30%)

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8 Phone, text, s Calendar planner/organizer: Reminders Meds Data collection, logs, graphs Handy, always nearby Engaging, trendy and possibilities for gamification

9 Chronic diseases : 75% of medical costs 18.8 million US adults (8% pop) are diagnosed with diabetes #1 cause of blindness in year olds #1 cause of kidney failure Only 7% follow all recommendations Almanac for chronic disease, 2009 National Diabetes Fact Sheet 2011 (glycemic control, diet, physical activity, meds and disease monitoring) Deakin, Cochrane Database Syst Rev 2005

10 Diabetes prevalence >1.5x higher in blacks and hispanics Smartphones higher education and income: Among $30,000 or less, smartphone ownership in years is equal to national average 44% blacks and Latinos are smartphone users: particularly likely to mostly go online with phone

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12 56-yr old father of 2 children, sells cars Diabetes diagnosed 2 months ago Has a smartphone, but limited use Willing to try cool techy stuff Less willing to change lifestyle

13 What features? Education Tracking /log tools: glucose, meds (insulin and others), blood pressure, weight, diet, labs Graphs Planner/organizer with reminders Advice/social network Feedback from care-provider

14 Can customize units Log for glucose, meds, food, activity and HbA1c Easy graphs of results Can export results or save to a GB account Social network Combined with calorie track integration

15 Logging: Memory of types of entry Actual time/date by default Easy scroll Recorded with prompt to update/send information

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17 Cons: Calorie tracker not reliable (freezes) Weight setting limited to 341lb Graph: scrolls for time, but small font Other options: Tracking of weight and BP possible

18 Social support: forum

19 Comments: Easy navigation, but limited to glucose tracking Graphs for progress

20 App by the UK diabetes association Summary by week or day

21 Pros: Easy tracking Talking points Cons: Units (mmol/l, st & lb!) No meds or BP

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23 Moods

24 32 years old Math teacher in middle school Married, mother of 2 and 4 year old girls Diabetes type I since age 12 Likes technology, because it helps her organize her things 24

25 Good overall menu/ calendar Hydration log Carb and activity logs the data Charts and BP log (only full version)

26 Calendar overall view

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28 Very different design Reminders for meds and glucose checks Can log 2 people

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31 Data exportable: By Customizable Data backup through Google

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35 Numbers (glucose, BP, ) Prone to errors from transcription Usefulness of bluetooth transmissions! Food: Tedious all the time Bad conscience Still searching for solutions!

36 Low cost Short range : 30 ft Low power-consuming wireless network Personal Area Network (PAN)

37 Manual data entry or via bluetooth

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40 Graph options Color coded graphs: Carbs (green) Basal insulin (blue) Bolus insulin (red)

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42 Facilitates data entry through large database Data entry still can be complicated (new food, every meal )

43 Taking pictures of food: another way of tracking, that can help lose weight! Combined with social network (Facebook) Judge what others are eating too!

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48 Primary care physician in small rural town No EMR When his patients go to ER or are admitted, often no discharge summary, or too late Hard to keep up to date with all fields

49 Electronic manual

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51 3 examples: Insulin dose calculator

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57 No federal or state statutes No federal of state courts have published opinions on this matter Plaintiff s attorney Gerald Sterns: [t]his is an area of the law in which there franckly is not very much law at all, and the courts are going to craft it as they go along.

58 Washington medical malpractice statute requires plaintiffs to prove: (1) The healthcare provider failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he or she belongs, in the state of Washington, acting in the same or similar circumstances (2) such failure was a proximate cause of the injury complained of RCW

59 Duty of care : Learned intermediary doctrine Duty to convey manufacturer s warning Failure to convey this to patient Disclaimers: Manufacturers: duty to warn the ultimate user of any dangers in its product (non-delegable) Not overly broad or ambiguous, must not contradict marketing messages Must be visible

60 ? Little regulation of mobile apps: are they medical devices? Apps developed quickly and cheaply Products are unreliable, no assurances about the quality or precision! When the intended use of a mobile app is for the diagnosis of disease, or the cure, treatment or prevention, or is intended to affect the structure or any function of the body of man, the mobile app is a device subject to FDA regulation. FDA Mobile Medical Applications Draft Guidance, 2011

61 Cat.1: Medical Device Data Systems (MDDS) Cat.2: Apps that control the use, function, mode or energy source of an established medical device (imaging, glucose meter) Cat.3: Apps that transform the phone into a regulated medical device, using sensors, displays and attachments (radiology images) Cat.4: Apps that use alarms, make recommendations or create new information by analyzing/interpreting medical data (glucose meter)

62 Does NOT regulate: Medical ebooks Teaching aids, reference materials Apps that are solely used to track general health and wellness (weight loss log)

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64 Glucose meters and smartphones Other tracking technologies Sensing technologies : smart homes

65 FDA approved but not yet for sale Comes with an app Tracks glucose and insulin Possibility of sharing data by Glucose meter works independently

66 Tracks activity and sleep Logs food Calories calculated Syncs automatically Social network

67 Walkathon : donate vaccines Game to stimulate mobility

68 Personal challenges

69 Glucose in saliva! Biochip from Brown University to detect glucose levels No more finger pricks!

70 Northeastern University researchers are studying nanoparticules (tattoo) to track glucose levels Modified case allows iphone to read results No more finger pricks!

71 UW and Microsoft contact lens Detects glucose levels, changes colors Contains electronic component for wireless transmission!

72 Uses sensing from environment to track a person s activities/habits Movement Electricity Water flow Not intrusive P.Rashidi et al, IEEE 2011

73 Mobile technology use is growing rapidly, even in the older population May provide some useful tools for diabetes management for patients: self-management and education communication with providers Different range of tools for providers Liability: apps may not be medically ascertained

74 Providers: Health professionals who treat diabetic patients Individual interviews (~30 min) and/or Focus groups (1.5 hours) Diabetic patients: Smartphones or not years Individual interviews (~30 min) and/or Focus groups (1.5 hours) (240) 8MD-CARE

75 Acknowledgments: Prof. W.Pratt, i-school and Biomedical Health Informatics, UW Savannah Martin, Khader Welaye, Simone de Rochefort and Scott Berfield, Center for Serious Play, UW Bothell Kevin Tavares, Bill Skiffington and Joanna Black, School of Law, UW