David Kerr: Healthcare apps

David KerrThe latest world record for the most number of tweets being sent on a single topic is now held by the Women’s World Cup football final earlier in July this year. Apparently this particular match generated 7196 tweets per second (TPS) with even Barack Obama joining in. Other recent notable world events on Twitter include the announcement of the death of Osama Bin Laden at more than 5000 TPS and the recent Royal Wedding with 3966 TPS. 

Within social media, the problem with handling billions of “items” each day, is sorting out the wheat from the chaff – making sense of the multitude of symbols, words, and phrases that pass through the different types of media. There is now a burgeoning science devoted to using “semantic analysis” – analysis of the meaning of text and “sentiment analysis” – analysis of whether the text is positive or negative to try to understand the key messages that are somewhere within the social media space. For medicine, social media has the potential to add value to the traditional approach to creating evidence, and also to improve communication and understanding between the professionals and patients especially those living with chronic disease. 

Meanwhile the US Food and Drug Administration has proposed plans to regulate the increasing number of apps that can be used for medical purposes. Thus, software that is intended for the “diagnosis or the cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body of man” will soon be subject to the same regulation as existing medical devices.  Examples of such “apps” that can be used “as an accessory to a regulated medical device” include those that allow the user to view medical images or ones that connect to a home use device such as a blood pressure meter or blood glucose meter. Other apps falling under the watchful gaze of the FDA are those that “transform a mobile platform into a regulated medical device” including ones that collect ECG signals or those that can act as a blood glucose meter, electronic stethoscope, or have a  built-in accelerometer to monitor movement for falls detection. Even apps that calculate equations (such as eGFR, A-a gradient, or Glasgow Coma Scale) will be regulated if the device requires input of patient-specific information to assist in making clinical decisions.

The plans for the FDA to enter the mobile “app” world are tempered by its lack of enthusiasm for taking on social media as an entity, at least for the time being.  In a similar vein, the BMA recently published its guidance on the use of social media suggesting that “medical professionals “should be free to take advantage of the many personal and professional benefits that social media can offer,” but at the same time warning of the need to be “aware of the potential risk involved.” Almost all of the BMA guidance adopts a very prohibitive tone warning members of the damage that baring all can do for the profession. There is no mention of the potential value for better communication between the professionals and patients or an acknowledgement of the sheer number of people who are “social.” I wonder what the TPS score for the discovery of insulin would have been if Twitter had been around in 1922?

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 honoraria 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.