Mobile medicine: using phones to improve health
26 Jan 2015
93 per cent of the UK population now own and use a mobile phone. MRC Science Writer Sarah Harrop finds out how researchers and doctors are taking advantage of these pocket-sized companions to improve our health.
Smokers will tell you that the hardest part of giving up is breaking the habits and routines associated with the addiction. But imagine having a friend with you who knows all about your smoking habits and offers you advice and support whenever you’re tempted to light up. That’s the idea behind a new mobile phone app called Q Sense being developed by MRC-funded researchers at Cambridge University.
One of the lead investigators developing Q Sense, Dr Neal Lathia from the Cambridge University Computer Lab, explains: "The app will send you tailored support messages depending on what it learns about your smoking triggers. For example it might deliver advice about relieving stress for people who report high stress levels at work. Or if you regularly report smoking at work with colleagues, the app will tell you ways to cope with colleagues who aren’t quitting."
By learning the smoker’s behaviour and using GPS to track their movements the app is able to provide personalised support to deal with the cravings after they give up. It even sends messages which are triggered when a user enters a place where they have habitually smoked.
Mobile phones offer opportunities to change our behaviour because they are almost always with us.
“Some researchers ran an experiment where they measured how often a mobile phone was within close proximity of a person, and they found that the phone was within arm’s length of its owner nearly 80 per cent of the day,” says Neal. “Just that fact makes access to people, access to patients so direct - and that’s one of the largest opportunities for M-health.”
M-health is the name for medicine and public health supported by mobile phones; now a burgeoning field. And with the appearance of smartphones in recent years, it has both the potential to save the NHS time and money and transform how we receive healthcare.
For example it may soon be possible for people to test themselves discretely for sexually transmitted infections (STIs) using an app and gene chip being developed by Dr Tariq Sadiq from St George’s, University of London in collaboration with experts from other universities and industry.
The UK Clinical Research Collaboration-funded team, called the eSTI2 consortium, has also built an online ‘e-care pathway’ that will eventually allow people to receive their results and collect their treatment from a pharmacy without having to make an embarrassing trip to the clinic (although patients would still be able to contact a health professional if necessary). The hope is that this will encourage more people to get tested and treated; currently one in five people infected with Chlamydia never seek medical treatment.
Dr Sadiq explains: “The vision is that people would simply buy an STI test from pharmacy in the form of a gene chip, load a urine sample onto it and have it read by the phone, all within half an hour. The phone app then interprets the data to produce the result, and sends it off electronically to a pharmacy where the patient could collect their medication.”
Testing of the e-care pathway has already begun and early trials of the phone and gene chip technologies are due to start shortly with results expected towards the end of next year.
Pocket-sized tools for doctors
Contrary to what you might believe from a journey on the average commuter train, smartphones aren’t just for apps, playing angry birds or checking Facebook. Increasingly they’re also used professionally - and that includes in hospitals.
“Most doctors use smartphones pretty much every day, for looking information up, occasionally for tests, and for various medical calculations,” says Professor Alasdair MacLullich, a doctor and researcher at the University of Edinburgh. He’s taken advantage of this opportunity to develop a simple smartphone app to help doctors to detect delirium.
While it might sound like a Victorian malady, delirium is actually a common modern-day problem which causes great distress and is linked with dementia and even death in the elderly. But it often goes undiagnosed, because it’s hard to distinguish patients with delirium from those with dementia. With MRC funding, Alasdair has designed a smartphone app for doctors that tests patients for their ability to count slowly presented flashes of a white disc on the screen. Delirium sufferers can’t focus their attention for more than a few seconds, whereas a dementia patient usually can, even if their memory is severely impaired.
“Early detection improves patient outcomes, including the duration of the delirium and the distress associated with it, and there are knock-on effects on length of stay and other outcomes. So if we can help to increase early detection of delirium by providing a simple tool that doesn’t require a great deal of skill to use and the score means something, then I think this kit has potential for quite a lot of impact in the NHS,” says Alasdair.
His team is now working with a company called Cambridge Cognition to modify and improve the app, known as DelApp. The plan is then to test in several hundred patients with a view to licensing it to a company who will launch and sell it - hopefully in around four years’ time.
Part of the allure of mobile phone technology for researchers and doctors is that it offers a simple and low cost way to empower patients to take responsibility for their own health – something that’s particularly effective in mental health.
At the University of Manchester, the MRC is funding Professor Shon Lewis and colleagues to develop an app for psychosis patients called Clintouch. By asking users a series of personalised questions about how they feel, the app gathers information on how a patient’s symptoms have changed over time which is then beamed off to their care coordinator. The idea is to detect when a patient is at risk of relapsing and head it off before it happens.
Clintouch Project Manager Dr Matt Machin explains: “One of the big costs to the NHS of a patient with schizophrenia is when they relapse and end up as an in-patient. Psychosis patients face the challenge that treatment is only successful in the short term, so over time their symptoms come back again. Often this happens too quickly for their medical team to intervene and prevent it from happening.”
Clintouch’s developers estimate that even a five per cent reduction in re-admission rates would save an average of almost £500,000 - £1m for each NHS mental health trust.
So far, feedback from users has been promising. Matt says: “One of the things they like about it is that it empowers them to manage their condition. Besides the results of questions being uploaded for clinicians to see, patients can also see simple graphs on their own handset, and they can also privately record their own feelings and moods in a daily diary which is in the app.”
The popularity of mobile phones isn’t confined to developed countries. Their widespread use, even in the most remote locations, could help people get faster and easier access to healthcare.
At the London School of Hygiene and Tropical Medicine, MRC Population Science Fellow Dr Chris Smith is leading a trial of MOTIF, a mobile phone voice messaging service which provides contraception support to women in far-flung villages of Cambodia. Globally there are 47,000 deaths each year from unsafe abortions, and abortion rates are lowest where contraception use is highest – so for these women, contraception can be a matter of life or death.
But in rural Cambodia, many women are anxious about the side-effects of contraception and myths - such as the fear that condoms cause cancer, or burns - abound. Trial results are currently being gathered but early indications about how well MOTIF works are promising, showing that getting a voice message, for example asking if they would like to speak to a counsellor, reassures women and encourages them to stick with their birth control.
“One woman said that when she listened to the messages she felt like someone was next to her, supporting her,” Chris says.
Hopping continents to Africa, MRC Research Fellow Dr Andrew Bastawrous has led the development of the Portable Eye Examination Kit (Peek) which uses ordinary Android smartphones to test for a range of common eye problems even in difficult-to-reach places. Ordinarily, testing such a large group of people would involve taking a team of doctors and £100,000 worth of heavy and fragile equipment to remote villages, many of which have no road access or electricity supply. In contrast, Peek is small, light and costs one fiftieth of the price - and it only needs one specialist to do the test rather than a whole team. Andrew is now leading a trial of Peek on 5,000 people scattered across the Rift Valley in Kenya.
So will phones play a big role in the future of healthcare? Neal Lathia thinks so: “M-health’s role is going to be very important, especially for people who are looking to manage their own health. Maybe not for the people who are so critically down the road in certain conditions that they need a lot of care, let’s say, for the bulk of the population who are looking to be empowered to take positive steps themselves in different health conditions these mobile solutions will be ideal.”
“The principle that people use smartphones and tablets is established and I see doctors using smartphones for cognitive testing and other medical testing so that it’ll become normal in five to ten years or maybe sooner,” agrees Alasdair MacLullich.
And even the older generation concur. When asked whether she minded her test being done on a phone rather than using a test kit with flashing buttons, one of Alasdair’s elderly patients told him: “It’s better that it’s on the phone because that’s the future, isn’t it?”
Hear more from the scientists interviewed in this piece in our podcast.
Some other MRC-funded M-health developments
Dr Will Whiteley at the University of Edinburgh has made the ‘FAST’ test for stroke available directly to patients by creating a free app which asks users to check someone for three main symptoms of stroke: inability to smile, difficulty lifting both arms and slurred speech. If all symptoms of stroke are present, the user is told to call 999.
At the University of Leeds, a team led by Dr Janet Cade has created an app for promoting weight loss called My meal mate. The app allows people to self-monitor their daily calorie intake - using a food composition database of over 30,000 items - and set weight-loss goals. Unlike other apps, the team have scientific evidence that it can help people to lose weight; in a pilot trial, average weight loss of users of the app was 4.6kg (10 pounds) by 6 months. To date, the app has been downloaded over 10,000 times.