With the explosion of affordable smart phones has dawned a new era of connectivity. Technology drives healthcare, so it seemed inevitable that care would become portable. Up to 40% of new mobile applications are medical, from monitoring to diagnostic tools. Healthcare agencies are realising the potential of data. Businesses see the profit. The release of a new study on the modification of cardiovascular risk marks a transition between theory and practice, where the use of simple media has demonstrated improved patient outcomes. The future of healthcare is in our hands, and the incentives are great.
The theory is simple, use handheld devices to share clinical information with an aim to avoid or treat disease. In a pioneering study, Professor Chow and her team sent text messages reminding their chest patients to undertake healthy behaviours. These messages were simple, and based on established evidence. The results of the study showed that these patients managed to lose weight and experienced a drop in blood pressure and cholesterol, all independent risk factors for a heart attack. Simple, but effective.
The use of media in preventing disease is not new. The role of primary prevention is to reduce the risk of an event; for example reduce smoking to reduce the risk of lung cancer. Secondary prevention is about reducing the risk of recurrence or worsening of a disease; for example using blood pressure medication to reduce the risk of a second heart attack or worsening heart disease. The dissemination of information regarding risk has always aimed to reduce the incidence of bad behaviours that are known to lead to disease, whether it’s to stop smoking or to increase exercise. This area of medicine is known as public health, and public health doctors make changes to policy to increase the health of a population as a whole. This is where medical applications can shine.
The mobile phone industry has provided a new medium for on-the-go, up-to-date and easily accessible information. With it, public heath will blossom. The 24/7 nature of smart phones provides trained medical staff with instantaneous data and the ability to advise treatments and review changes. In the case of Chow this was as simple as reminding her patients to engage in exercise and eat right. The success of such simple measures speaks volumes for the future, where mobile medical apps will begin to talk to your doctor in ways you cannot. Whether measuring blood sugar, diet tracking or recording symptoms, data is the way forward.
We must be careful to use what evidence we have to optimise the future. Previous research into public health initiatives using media suggests that the most successful programmes are simple, adapt to change, target a specific group and are part of a larger programme. These ‘apps’ would be seen as analogous to medication, prescribed for a purpose. The ideal scenario is the measurement of lifestyle, symptoms and medication use in chronic disease to help your doctor stratify treatments and measure response. We take consultation out of the hospital into the world, 24/7. Ideal for the millennial culture and perhaps necessary for the future of the NHS.
These apps are not without danger. Foolhardy attempts to replace clinical attention with ‘self-diagnostic apps’ have led to cancers being missed. It must be made clear that these applications must exist to augment current expertise, not to replace it. The collection of data is important, and will provide a never before seen level of research, where the number of participants increases from a few thousand to the community of Facebook. We must take the good with the bad. Data have the potential to be misread, and with more data comes a greater potential. Experts will have to adapt.
The future of medicine is the enabling of personal healthcare and ease of data collection. Applications designed by professionals, using up-to-date clinical research and allowing for real-time monitoring, will allow us to provide our patients with better treatment. Reduced cost, close patient monitoring and business incentives make this approach extremely attractive to patients, policy makers and business alike. These systems, be it a mood diary or a blood sugar monitor, will fit into a continuum of care ranging from your fingertips to the doctor’s desk. Welcome to the future of health.
Any opinions above are the author's alone. Guidance is based the best available evidence at the time of writing. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. There are no conflicts of interest
Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter
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