How to Carry Your Doctor in Your Pocket

A combination of research-lab telemedicine and ordinary mobile devices is allowing physicians to keep closer tabs on their patients than ever — even those who may never see the inside of a doctor's office.

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David Jesse can’t afford to get sick. As a truck driver who logs 10,000 to 12,000 miles a month on the road, he’s rarely home long enough to visit a doctor’s office. But if he isn’t healthy, he can’t drive, according to Department of Transportation (DOT) regulations — and if he doesn’t drive, he can’t earn a paycheck.

That’s why the 50-year-old got a scare in 2008, after a physical revealed he had high blood pressure. He had been getting headaches, but thought they were due to stress; he ignored them and continued to drive. But as his doctor discovered, the throbbing in Jesse’s head was a symptom of his vessels straining under the pressure from his surging blood flow, which exceeded the threshold of 160/100 mmHg that the DOT requires of all drivers.

Jesse’s physician at the Cleveland Clinic prescribed medication, but hypertension can’t be treated like an infection, with a set dose of drugs. Each patient reacts differently to the medication, and doctors often need to adjust dosages and switch to different drugs before settling on the most effective one. Jesse, however, didn’t have the luxury of coming in every three to six months to have his blood pressure and other symptoms checked. “If I can’t match the federal government threshold, then I get into a whole new ball game,” he says. “Then I have to have physicals every three months or six months, and it gets to really be a hassle. Eventually, if I can’t get my pressure down, I’ll be denied my livelihood.”

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Fortunately for him, it didn’t come to that. Every night before going to bed, he takes his blood pressure with a digital device that sends the reading via Bluetooth to his cell phone, which then automatically updates his electronic medical record stored at the Cleveland Clinic. His wife Paula, a nurse there, makes sure to alert Jesse’s doctor if the readings spike or drop below the normal range. Thanks to this system, he’s been able to stay on the road despite having to adjust his dosage twice in the last four years. “The remote monitoring has kept me away from the doctor’s office,” he says.

And that’s the idea behind mobile medicine: to extend the borders of the doctor’s office into the home, the truck or wherever the patient may be. It’s the latest expansion of telemedicine, which began as a way to connect remotely located patients to high quality care by allowing doctors to fax and then send digital images across long distances. With smart phones and mobile apps, however, that idea is providing more and more services for patients like Jesse, and giving them ways to connect with physicians via their electronic health records. Jesse’s program is a pilot effort at Cleveland Clinic that is testing the doctors’ reach by relying on the latest technology. Those with chronic diseases like hypertension, diabetes or heart disease are ideal pioneers for such technology, since treating them requires responding to major shifts in regular readings. In fact, such surveillance isn’t just treating them but actually improving the way doctors are able to care for them. And, in some cases, it may even help to reduce the cost of health care by preventing repeated office visits. In Jesse’s case, when his pressure dropped too quickly on a 25mg daily dose of anti-hypertensive drugs, his doctor prescribed a lower dose; now he takes only 5mg a day. “We notice trends, and if we see a few readings running high, we get the sense that something has changed,” says his physician Dr. George Thomas.

Remote medical care is now starting to reach beyond simple monitoring; researchers at Securatrac, a company that develops satellite-based tracking systems, have developed a microsensor patch about the size of a band-aid that can track not only patients’ vital signs such as blood pressure, breathing and heart rate, but also their motion and location. Transmitted via Bluetooth to a mobile phone app, the readings can alert a caregiver or doctor if a Parkinson’s patient has fallen and is in trouble, for example, or whether an Alzheimer’s patient has wandered away from his home.

On the football field, doctors are also using mobile technology to develop a better way to assess players who may have experienced a concussion. They’re taking advantage of the accelerometer in iPads to objectively measure how much someone who has hit his head sways at the hips; the researchers who developed the app can strap an iPad to the player and objectively measure how far he moves. Doctors define anything greater than 30 degrees as the dizziness typical of a concussion. Without the app, they could only make guesses about how dizzy players were, leading not only to false positive but undiagnosed concussions as well.

And that’s just one example of mobile devices that are increasingly bringing the doctors to the patients, rather than the other way around. “For anyone who is on the go, it’s a much needed resource,” says Jesse. And one that could end up saving lives.

MORE: Read TIME’s special report on how your phone is changing the world (and your life) here.

4 comments
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nirav9
nirav9

reposted by mistake, sorry.

nirav9
nirav9

The interesting thing about telehealth and mHealth are that they increase the level of custom treatment for the patient.  This will be evolved even further as we become more attuned to the patient's individual trends, enabled by telehealth.  In the article's example, Jesse's treatment plan was adjusted based on the way his blood pressure readings trended.  What is not mentioned is the fact that most physicians evaluate the patient based on averages.  For example, if the patient's resting heart rate gets above 100, the average rate at which patients start experiencing problems, then the doctor would take action.  But whatif over several years, the patient's resting heart rate increased from 85 to 90 to 95?  Well, if the rate wasn't yet 100, shouldn't the increasing trend be worth acting on before things deteriorate further? With telehealth enabling you to capture information more regularly and electronic health records enabling you to combine them in a single place, these trends could be evaluated more readily.  This is all part of the evolution in personalized medicine.

Nirav Desai, CEO, Hands On Telehealth

eetom
eetom

Would someone please write an advice on "How not to let your doctor empty your pocket".

Thanks.

StephenFerzoco
StephenFerzoco

mHealth is a

testament to the incredible impact mobile technology has on our day-to-day

lives. By being actively engaged in our own health through our mobile devices,

we can begin to change our behavior to ensure we not only get healthy, but we

stay healthy, too.  At Mobiquity we’re excited about the future of

mHealth and look forward to helping our clients further penetrate the market-

Dr. Stephen Ferzoco, Chief Medical Officer, Mobiquity