Why The Smartphone Physical Isn’t Ready for Prime Time

A couple of weeks ago, I had the privilege to attend TedMed 2013 in Washington DC. One of the highlights of the conference was a technology showcase area, staffed by a number of start-ups and healthcare innovators looking to show off their wares. One booth, sponsored by Steelcase and Medgadget, offered to provide a ‘smartphone physical’ utilizing 10 of the latest generation medical diagnostic devices built to work with the iPhone. The experience left me wanting.

Nice Socks.

Nice Socks.

For starters, a majority of these devices were iPhone-enabled variations of diagnostic tools that already exist, albeit with a much higher price tag. A Pulse Oximeter? $30-$50 on Amazon.com. Want the iPhone-enabled version? $249. Same exact features, except one plugs into an iPhone and the other does not. Similarly, the Withings blood pressure monitor, which does everything your top-end Omicron cuff does, costs $129 to the Omicron’s $65. You decide for yourself if the time saved by not having to manually enter the diagnostic data into an app or spreadsheet is worth the cost difference. I have stand-alone, non-iPhone versions of all these tools (including a thermometer, HR monitor, BMI calculator, scale and otoscope) and they work just fine, with no iPhone required. What’s more, your cost increase doesn’t give you any insight or information about whether these readings are good or bad.

For tools that are being touted as ‘smartphone enabled’ they certainly behave like dumb objects.

The collection and monitoring of health data is growing rapidly, and users should do a bit of research to understand what the data, say the numbers for your blood pressure or O2 saturation, means and what it may positively or negatively indicate. After all, the more data you have about your health, the more active you are likely to be in maintaining your overall wellness.

There were 3 tools demo’d during my physical that did show some promise. First, because there currently isn’t an analogue version at a lower cost, and second, because they could in many ways reduce false positives in the diagnostic continuum. They were the Welch Allyn iExaminer, the AliveCor EKG Monitor, and the MobiSante Ultrasound. You can read more about these devices here, but for me, these at least begin to show what’s possible with mobile diagnostics. These technologies were once supremely expensive and exclusively the domain of hospitals and are now available to the (medically validated) public. Most of these require a medical license to purchase, but I suspect that barrier will fall in a year or so. Even still, these devices, as wondrous as they are, are still missing the key ingredient, which when launched upon the marketplace, will accelerate the digital healthcare revolution exponentially.

20 years ago, landing a fighter jet on an aircraft carrier was a highly specialized skill. It took years of training, and thousands of hours to perfect. Now, pilots push a button. Automated landing systems have replaced manual pilot engagement on almost every fighter jet landing on an aircraft carrier. The computer is more reliable, can react faster to variables, and has far less errors than it’s human counterparts. Now think about diagnostic medicine. 20 years ago, it was a highly specialized skill. It took years of training and countless hours of experience to master. Now, with the advent of data collection and cloud-based systems, most of it could be automated at the touch of a button.

Think about it. Is reading an irregular EKG really so difficult? The irregularities in heart rhythms are already easily accessible online, yet the tools to record the actual heart rates are still physician-only. AliveCor requires a doctor write a prescription to receive the device as a patient and will only send the results to a doctor, keeping the patients themselves from seeing their data. Why? This closed-garden approach to health monitoring is exactly what’s wrong with the current system. Now think about ear infections. A smart piece of software should be able to quickly identify the most common infections (especially among children) and provide a diagnosis. The Allyn iExaminer will take a photo for you to email to a doctor, why not have the software to simply diagnose the infection?

I have 3 children. Each of them has had their fair share of infections. Our pediatrician gave us a chart and we bought an Otoscope and now I can tell swimmers ear from mild inflammation. I’m guessing we live in an age where software can do the same. Couple that with the fact that through out my life I have had the ‘privilege’ of seeing some horrendous doctors. While the quality of care I receive now is much better, it took years to find a good primary and the group of specialists I now have access to. Is it just about protecting the business model? Currently the only way to be ‘truly’ diagnosed is to pay your co-pay and see a doctor, but for a large majority of common conditions, that can’t be sustainable.

For all the hype about the coming digital revolution, the tools are far from being as smart as they say they are. And until the data is freed up to be used by the patients themselves, the promise of more control over our own healthcare will have to wait.

4 Responses to “Why The Smartphone Physical Isn’t Ready for Prime Time”

  1. David Albert, MD May 13, 2013 at 4:47 pm #

    Actually, any patient with a prescribed AliveCor ECG can see their ECG as they are recording it and review all recorded rhythm strips on the phone or our secure web site, both of which allow printing. The patient sees the same info as the doctor.

    • Bill Evans May 16, 2013 at 8:57 am #

      Good to know. I’ll make a note of that in the article. Is it possible to get a demo unit for a few days to do a full review?

  2. CS June 6, 2013 at 8:51 am #

    In my opinion merging medical diagnostic devices with smartphones can only go in so little direction, either people become more aware with their health or they either become too reliant on self diagnosis, because who isn’t guilty of looking up their own symptoms.

    In terms of the revamp of tools, I personally think that if it’s not broken don’t fix it, but then again if new improvements can be introduced why not, the more the merrier right?

    Also there are times and places in which such devices could be of use.

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