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Health-oriented smartphone apps draw caution



The airline passenger was in deep trouble — not breathing, no heart rate — when a fellow passenger, Raina Merchandise, then a resident in emergency medicine, tried to save his life.

“The patient survived the flight, but, sadly, not much longer,” said Merchandise, who performed cardiopulmonary resuscitation on the passenger.

That was seven years ago.

Now Merchandise, a University of Pennsylvania physician whose research centers on resuscitation, is developing a mobile-phone app that would, with one push of a button, provide oral instructions for CPR. The app would even say, “Press, press, press,” to allow the right rhythm for chest compressions.

More and more these days, the same smartphone technology that allows tourists to find the best latte nearby and bystanders to become instant video journalists at a natural disaster is making its way into medicine and health.

It’s a big business. Pricewaterhouse Coopers’ Health Research Institute estimates the annual consumer market for remote/mobile monitoring devices to be $7.7 billion to $34 billion, based on its surveys. In August, Apple iTunes reported that 10,000 medical, health-care, and fitness applications were available for download.

That’s just the consumer market; there are already many examples of wireless technology used by doctors, hospitals, and other health-care providers.

The benefits are many, but there are questions as well.

“So many different health apps pop up,” said Joseph Kim, a doctor of internal medicine whose bachelor’s degree is in mechanical engineering. “How do you as a consumer, or as a physician, know which ones are reliable or which are accurate?

“Unfortunately, the technology is moving faster than any regulatory body can keep up,” said Kim, a vice president at Medical Communications Media Inc. in Newtown Township and a specialist in the use of technology in medicine.

“Releasing an app is very easy,” he said, but if it is developed abroad, the standards may be different than they are in the United States. For example, a recommended drug may be approved elsewhere but not in this country.

“There are a lot of questions of liability that have yet to be answered. If a patient uses an app on the iPhone, who, at the end of day, is liable? If someone buys a WebMD Symptom Checker and there’s a problem, is the Apple store liable? Is WebMD liable?”

WebMD provides a disclaimer. “This tool,” it says on its website, “does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.”

Speaking to a gathering of health-care journalists in Philadelphia recently, Kim said the wireless “future is certainly bright, but we have to be very cautious. And given that technology is moving so fast, we have to be very, very cautious.”

It’s easy to be swept away by the possibilities.

Mohit Kaushal, chief strategy officer of West Wireless Health Institute, a nonprofit research and development organization in California, ran through his vision for the future.

“The right care, at the right time, wherever the person may be,” he said, joining Kim on a panel at the Association of Health Care Journalists convention.

That right care, for a forgetful elderly person, could include a pillbox that sends a message to a caregiver, perhaps a son or daughter, if the pillbox isn’t opened for a day or two.

“It could send a message: ‘Your mother isn’t taking her medicine,’ ” Kaushal said.

Skin patches affixed to patients’ chests after they have been admitted to the hospital for problems related to congestive heart failure could monitor them after they are released and send data to a receiving station, with the ability to alert someone when the data show dangerous abnormalities, Kaushal said.

Readmissions for congestive heart failure cost the health system $7 billion a year, he said, adding that physicians would get an “understanding that things are going wrong earlier in the cascade of disease.”

That’s fine, theoretically, countered John Kairys, a surgeon and endocrinologist from Thomas Jefferson University Hospital who also addressed the Association of Health Care Journalists. All of this data-sending assumes that someone qualified is available to read it.

“Who is sitting in the office monitoring all this?” Kairys asked. “No one is being reimbursed for that. If I have to hire someone in my office to do that, where am I going to get the dollars to pay that salary?”

Many physicians, Kairys and Kim agreed, are already familiar with some applications, such as Epocrates, which provides information on drug interactions, pricing, and dosing via BlackBerry, Android, iPhone, or Palm.

But how conversant, Kim asked, are physicians with the many off-the-shelf medical apps for consumers?

Raina Merchandise hopes that her off-the-shelf CPR-coaching app will be ready for consumers soon.

“There’s almost no downside to it,” she said. “If you do nothing, the patient will definitely die.”

And even though she has done CPR many times, Merchandise said she’d still use the CPR app if she found herself in a situation similar to the one on the airplane.

Her research has shown that hand placement and the quality of chest compressions are improved with oral coaching, no matter how much training the rescuer has had.

“There are a lot of mechanics to remember,” she said. “In that moment, when it’s you and that person, it’s quite a task. But we want people to think they can do it.” — AP

Information from: The Philadelphia Inquirer.

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