There are literally hundreds of apps out there promising to keep you on a healthy diet, have you exercise regularly, and make sure you are a happy person every day of the year. I walk the exhibit hall of the mHealth Summit meeting in Washington DC and mostly that’s what I see. Most, if not all, will disappear without a trace. The underlying problem is that the field attracted a bunch of young tech geniuses who know everything about software but have little or no understanding of the needs of health care.
In the midst of all these pessimistic musings I happen to walk into a demonstration of a mobile health application and violá: An app with a real contribution to the practice of medicine.
TB treating app
Any physician who has ever treated the aged or the immigrants who are poor or suspicious of Western Medicine knows the frustration of nonadherence; the patient who doesn’t take his meds as prescribed and ends up in the emergency department. Case-in-point: TB in the Vietnamese immigrant population; poor, suspicious of western medicine, and totally confused about the multiple drugs they are supposed to take. The only way to ensure that meds are taken correctly, or taken at all, is to have the patient show up daily at the clinic, or send a nurse to the home.
Studies have shown that Direct Observed Therapy (DOT) indeed increases adherence from the low 60’s to the 80% plus. But the cost is enormous; this approach is simply not scalable. On the other hand, failure to adhere to the daily intensive regimen can result in the generation of resistant organisms, treatment failure and death.
Richard Garfein Ph.D MPH and his clinical colleague Kathleen Moser MD MPH—both of the Division of Global Health at the University of California, San Diego—with grants from NIH and the Verizon Foundation, developed a Video Cell Phone Direct Observed Therapy (VCP-DOT) to treat 48 Latino patients in the San Diego area on therapy for TB. Some of the patients live on both sides of the border—in Tijuana and San Diego—or cross the border frequently. Obviously, a difficult population to rigorously follow their medication adherence.
The patient uses the smartphone’s camera to show the nurse his daily intake of drugs. He reads each drug’s name off the label, describes its color, swallows the pill and opens his mouth to demonstrate that the drug was swallowed. This was to reduce the chance that patients “share” drugs with family members (as many are wont to do) or sells it on the black market.
The whole procedure takes about 2 minutes. The patient also gets text messages to remind him if he forgets to take his pills or fails to check in, or if he needs to contact the clinic. If he is out of range (in Tijuana), his session is stored in memory and transmitted when he is back in range. Simple, cheap and extremely useful. Adherence rate was 99%, and 100% of participants expressed high satisfaction and would recommend it to others. Where else do you get such results?
Why was TB selected as a model disease for the app? Because it is the leading cause of death among people with HIV and the second leading cause of infectious disease deaths worldwide. It claims 1.4 million lives each and every year. It is a chronic and fatal disease, but is treatable, as long as the daily, intensive regimen is adhered to strictly.
Take home lesson
Is it going to gain traction? My prediction is that it is going to become the standard way health care professionals manage patients remotely. Already, health departments from Mumbai to the U.K are using it. New York City and San Francisco are gearing up. Many other health departments are in line.
This ought not to be limited to TB or to public health departments. People on HIV medication can be followed this way, so can people in methadone treatments. Hospitals and nursing homes can make medication administration, a major time-consuming task for the floor nurse, much more efficient.
The road to the mobile health revolution will be paved with the carcasses of hundreds of stillborn companies but the ones who offer useful solutions to real problems will survive and indeed change the way medicine is practiced.