Texting again at 3 a.m.? Your phone could tell your doctor. The habits and symptoms your smartphone can know about you are fast becoming part of a powerful medical toolkit. Mobile software applications collectively known as mHealth have the potential to extend the reach of health interventions far beyond that of traditional care, especially for chronic diseases. After all, treatments for diabetes, asthma, or obesity require everyday vigilance, not just occasional clinic visits.
New and valuable mHealth apps are coming out all the time. But for each one, the developer has to reinvent all the basic components, creating from scratch the data path from phone to caregiver. “The rate of innovation and the spread of this technology are held back because everything is coming out one siloed product or project at a time,” says Deborah Estrin, professor of computer science at the University of California, Los Angeles.
Instead, Estrin suggests, the field could develop an open architecture in which mHealth applications share common building blocks. Such an infrastructure could spark innovation in much the same way that the Internet’s standard protocols revolutionized many sectors of the economy. Creating an mHealth app would enable the patient to report drugs and dosages, symptoms and side effects at any time, so the doctor could respond quickly and with more accurate data. “If you’re doing teens and asthma, or you’re doing overweight teens who are at risk of diabetes, or you’re doing new moms who have not lost their pregnancy weight and are at risk of cardiovascular disease—all of these completely different diseases and demographics need basically the same components, but with very different skins and flavors to them,” says Estrin.
Specifically, every app needs a way to prompt the user for information—How much does it hurt? What time did you take your meds? How high is your blood sugar?—to collect data and feed information back to the patient and the health care provider. The data also could come from smartphone sensors that capture how much the patient moves around or talks on the phone.
At the Department of Veterans Affairs’ (VA) National Center for PTSD in Palo Alto, Calif., psychologist Julia Hoffman agrees. “The problems are so complicated that it doesn’t make sense to struggle with them over and over again, and then to let other health care providers” do the same, she says. “Building this common infrastructure that we can tie into allows us to solve the most difficult problems just once.”
One of those problems is privacy. On current versions of mHealth applications for the VA, self-assessments are maintained by the user on the phone, “and the only way to share the data is to actually bring the device to the providers, hold it up, and show it to them,” says Hoffman. Estrin’s alternative is a “personal data vault” that could securely capture and share information. “Let it go someplace where it’s encrypted in the cloud in its full detail, and it’s available only to you” and the parties you choose, says Estrin.
The mHealth revolution will make the most difference in underserved populations. “If you are wealthy and can afford to see a therapist twice a week and have a personal trainer, probably nothing can beat that,” says Estrin. “So how can we start to bring that level of personalization to people for whom seeing a human being that often is just not in the cards?”
Deborah Estrin and Ida Sim, “Open mHealth Architecture: An Engine for Health Care Innovation,” Science, 330, 2010.
Read more stories by Jessica Ruvinsky.