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international mHealth initiatives include telemedicine, mobile health apps, SMS appointment reminders, public-health messaging, treatment compliance measuring and patient monitoring. However, cutting-edge sensor technology is expanding the capabilities of mobile devices into a whole new realm. Later this year, Sano Intelligence, an American technology start-up, is set to release a wireless transdermal patch that can monitor your bloodstream, transmitting blood chemistry data to your mobile device and notifying you of problems. Its prototype could measure glucose and potassium levels but the aim is to eventually monitor all components of a basic metabolic panel. In China, technology company Qualcomm has been working with rural community health clinics to remotely monitor patients with cardiovascular disease. Patients are given smartphones with built-in electrocardiogram sensors, which they hold for 30 seconds. The phone then collects and sends the data to a cardiac specialist in a Beijing Life Care call centre, who can respond within three minutes of receiving data and send feedback to the patient and clinic via SMS or phone. Qualcomm is taking an even bigger step into the future with its X Prize Foundation collaboration. Together, they have launched a $10 million prize competition, tagged science reality, which is looking for someone to develop a Tricorder, the handheld device used in the cult TV series Star Trek, to diagnose anybody at the drop of a scan. But back on the planet as we know it, at least for now, smartphones and tablets can monitor and manage a wide range of health and medical issues with the aid of mobile health apps. According to Research2Guidance, an international market research company, there are over 40,000 mobile health apps currently available. Last year, an estimated 247 million people downloaded a health app and that number is set to rise to about 500 million by 2015. However, the rapid growth of this largely unregulated industry has raised some concerns among clinicians, researchers and regulatory bodies about their e cacy, safety and oversight. Last month, a research paper, published in JAMA Dermatology, found three out of four apps designed to diagnose skin lesions incorrectly classi ed 30% or more of melanomas as unconcerning. In 2011 the FDA also began exing its regulatory muscle over mobile apps, with the drafting of guidelines and the identication of apps that come under its purview. The desire for regulation is matched by attempts at integration. In the UK, the NHS Commissioning Board has built an manage yourself. For this reason, mHealth innovations, such as sensor technology, have the potential to transform Australias healthcare, says Robert Steele, professor of Health Informatics at Sydney University and vicechair of ACM Sigmobile. data to be an item of consultation between the clinician and their patient. The Royal Australian College of General Practitioners has no formal position on mHealth. Dr John Bennett, the chair of the colleges National Standing Committee on eHealth, says it is keeping a watching brief on such technological innovations and their implications for general practice. Like with any new medication or treatment, we would encourage doctors to use some scienti c principles when they decide whether they want to use those sorts of devices with their patients, he says. And while he welcomes the information access and patient empowerment that mobile technology will bring, not all GPs will be as comfortable. You will probably get some push back from people who are extremely doctor-centric: theyre the experts, youve got to come see them and nothing else

will ever be as good. And they will still have a cadre of patients who will want that model, Dr Bennett says. But for Professor Coiera the writing is on the wall and education is key: Its well past time that all doctors, both in medical schools and as part of specialist training, are taught informatics. He argues in a middle out approach, where no one stakeholder can build an electronic health system, GPs need to play their part. These technologies will become part of the standard of care and they should not wait to be told what to do by someone else but become rst-class actors in the story, he says. They need to realise the world is changing rapidly and will continue to do so, and that sitting on sidelines is a guarantee of irrelevance. Its a call Dr Seidler has heeded: My patients dragged me kicking and screaming into the 21st century.

All doctors, both in medical schools and as part of specialist training, [should be] taught informatics. PROFESSOR ENRICO COIERA
online directory of apps after a Department of Health campaign asking patients and healthcare professionals to identify their favourite ones. Professor Enrico Coiera, director of the Australian Institute of Health Innovation, says Australias healthcare has been one of the last sectors to bene t from technology. Its so clear technology and information have touched every part of our lives, except for our healthcare. Its no longer possible to ignore it, Professor Coiera says. He says the impact of mobile technologies on healthcare is as much about the people as it is the platforms. Consumers need for engagement and information on their terms, as opposed to the medical professionals terms, has long been ignored. The power of the consumer platforms, like smartphones, is that they now are so pervasive they are forced to put people into the space, he says. According to the Cisco Visual Network Index, by the end of this year the number of mobileconnected devices will exceed the number of people on earth, and by 2017 there will be nearly 1.4 mobile devices per capita. Mobile data tra c will also grow 13-fold. Professor Coiera says healthcare will bene t from such a triumph of scale. So much of telemedicine in the last 20 years failed, for example, not because it wasnt a good idea, but because commercially it doesnt make sense to purpose-build technologies to measure your blood pressure or measure your blood sugar at home. But now I can do it via these cheap platforms and that just changes everything, he says. And change we must. With an ageing population, high health demands and a lower tax base, the health system is unsustainable and we need to reimagine it, he says. If you want to be healthy and to have good care in 2020, you are going to have to Emergency detection, preventative healthcare, chronic health management and detailed self-knowledge about health - we are talking about capabilities substantially beyond what we have at the moment, he says. And the idea of gathering information via sensors doesnt mean its just available for the patients. They could choose to make it available to their eHealth record and that would allow


There is now an app for everything from breastfeeding to blood pressure.

WHEN patients send pictures to Dr Raymond Seidler, theyre less of the smiling-baby variety than the leaking-wound kind. I get all sorts of stu sent to me: [smartphone] photographs of injuries, photographs of wounds, photographs of lesions theyre concerned about, says Dr Seidler. Ive got patients who send me videos of their dressings and hospitals, saying, What do you think about this?

The Kings Cross GP, a fan of using YouTube to explain things to patients and an early adopter of electronic medical records, also sees mobile health apps making their mark amongst his patients. In the old days women used safety pins attached to their bras to tell them which side was empty. Now there is an app for breastfeeding. Its just astounding; theres an app for

everything, he says. Dr Seidler believes innovative mobile technology will become part of the future of healthcare. A report last year by US thinktank the Brookings Institution said mobile technology was set to transform healthcare by altering how it was delivered, decreasing its cost and improving the quality of the patients experience. It said international mHealth initiatives are already

improving chronic disease management and medication compliance, empowering the elderly, extending services to underserved areas and improving medical system e ciency. With the rapid advance, widespread use and innovative health application of mobile and wireless technology, mHealth has emerged as a subspecialty of eHealth. The most common examples of current

29 MARCH 2013