There are now two groups of people living with chronic disease, those that are connected and those who are not. In days gone by, “being connected” meant having personal and professional contacts in all of the right places to further an idea, career, or relationship. Being connected nowadays, however, means something completely different – owning and using a “smart” mobile telephone or any electronic gadget. For those who are connected there is a mindboggling array of applications (apps) that can be used to take self-management of a chronic disease to the next level. In addition, payers of healthcare are now demanding decentralised methods for delivering patient care compared to the existing expensive traditional models.

For example, the US start-up company, “Massive Health” has just launched a mobile app in the diet and nutrition space that moves away from the traditional approach of simply counting calories. The eatery app lets the user take photographs of their food and rate how healthy each snack and meal is on a scale from “fit” to “fat.” The app also lets the user share their meal data with others through social media and encourages everyone to rate and comment on how healthy an individual’s eating habits are. Within the first 2 days more than 200,000 meals had been uploaded. As the eatery app is only available at present for the iPhone 4, most early users have, unsurprisingly, been from San Francisco and New York, probably reflecting their interest in technology and health.

Therefore for a medical app to be of value it needs to be connected to users and healthcare providers rather than just a vehicle for data collection. It also needs to be cost-reductive. In areas of chronic disease such as diabetes, for connected individuals the future approach will no longer be routine clinic visits and in-between clinic visit measurements of fingerstick blood glucose levels performed in a random and chaotic manner. Connected people living with diabetes will have access to apps covering important “moments” such as travel, intercurrent illness, admission to hospital, moving to University etc where approaches to monitoring and treatment will be algorithm (and evidence) based with the data messaged to central tele-health centres for immediate support and advice. Blood glucose testing will be more structured and gaming techniques will be applied to encourage people to test more often. The advantage will be rapid access to high level expertise with much less need for “routine” visits to traditional clinics. Add the potential for enhancing communication between people with diabetes and their clinicians using social media – this will create “disruptive diabetes care” so that the future will be one of integration of patients with mobile technologies, care teams, continuous monitoring, feedback loops, and analytic based system progression based on the huge amount of real-time data collected.

However, what about people who are disconnected? The digital divide between those who can afford, understand, and use the technology and those who cannot, will create a defined group who will still need an alternative to this technology based approach to delivering health care, at least until the younger generation who have grown up with devices reach the age of risk for developing chronic disease. If the barrier to disruptive diabetes care is one of affordability then perhaps providing resources to increase access to smart phones would be a cost-effective approach to “connecting for health.” The focus would be using readily available consumer electronic devices to connect people to their clinicians and to each other rather than chasing the Holy Grail of connecting healthcare providers with each other. 

Companies such as Apple have become successful and popular because they saw the need to communicate with their target population and to make their products easy to understand and use. More effective connectivity and engagement must also be possible in any healthcare system provided this does not result in exclusion.

David Kerr wears many hats, sometimes at the same time – Diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes. He has received consultancy fees and honorariums for participating in advisory boards for Medtronic, Roche, Lifescan, and Abbott Diabetes Care. He also holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.