There can be little doubt that the introduction of the smart phone has revolutionized medicine. In 2014, twenty percent of smartphone users had one or more health related apps on their device, and physicians had well over one hundred thousand applications available to them. The diversity of these applications is simply remarkable. What began with weight and fitness trackers has burgeoned into a twenty billion dollar market covering areas as diverse as mental health, chronic conditions, and patient education.

The companies that have managed to succeed in this space are remarkable. They have taken an idea about how to improve care and developed it into a solution that can run on a handheld device. They have swum in a sea of uncertainty as regulatory bodies such as the FDA have attempted to cradle this new spark of innovation into a burning flame. Above all, they have had to make a market; to define a new approach to Healthcare.

Some of the most successful entrepreneurs in mobile healthcare have had a medical background or a call to action through a family member or friend who has been afflicted by disease. Consider Amy Gleason at CareSync who started her career as a nurse before moving into high tech. In June 2010 Amy’s daughter Morgan was diagnosed with a rare autoimmune disorder. Her exeperience in Electronic Medical Record and Practice Management systems were challenged by her subsequent experiences arriving at medical appointments where providers had no history of her daughter’s condition and were not prepared to furnish treatment. This drove her to a new view of patient’s right to keep copies of their own data, and together with her cofounder Travis Bond, to the formation of CareSync.

Other apps serve useful functions in the area of telemedicine. The First Derm app allows a user to take photos using their smart phone camera that can be sent to board certified dermatologists. While the application was first launched to diagnose sexually transmitted disease, the Swedish company has recently extended above the waist. In testing First Derm I noticed a red patch on my face. Forty eight hours later the company contacted me to let me know that I had a pre-cancerous lesion that needed treatment. While I had known it ws likely I had skin damage from my youth in Australia, getting an official diagnosis prompted me to visit the dermatologist. Their diagnosis concurred with First Derm but also found a basal cell carcinoma in another site. After some minor surgery and cryo-treatment the problem was resolved.

Telemedicine is not restricted to dermatology. Doctor On Demand provides access to medical doctors, psychologists and lactation consultants from your home and accepts insurance for select plans. While prescriptions cannot be written for controlled substances, the service is perfect for many typical medical complaints, and at the current pricing on $40 for fifteen minute intervals it’s a no-brainer for a large slice of the medical population. With an allstar cast of executives and the backing on healthcare luminaries such as Dr Phil and Jonathan Bush from Athena Health, Doctor On Demand is a very promising entrant into the Telemedicine market.

These companies and others like them are representative of a seismic movement in healthcare. In his book, “The Patient Will See you Now”, Eric Topol speaks of a reversal of the patient-provider relationship. No longer content with turning up passively at a Doctor’s office, the patient now researches their condition and is an active participant in their care, seeking services from doctors as needed.

Eric’s approach assumes a well educated, and motivated patient. Patients with chronic conditions may not fall into either category. Complex diseases such as rental insufficiency or late stage cancer can cause problems with processing information and brain fog. Yet, even in these situations apps can help, providing they are designed and implemented appropriately.

I recently had the opportunity to see a new product from Joel Benzel of TouchStream solutions aimed at patients who need to manage complex health conditions who are required to work with medications, weight management, blood sugar, blood pressure, and self care. The app runs on an iPad and is carefully designed for users who may not be computer savvy. Sporting large buttons, readable text, voice prompts and simple workflow, it’s a functional solution for elderly or infirm patients who may be having problems with self care.

Touchstream’s use of multi-modality interface design is one of it’s best features. The tablet is extended into physical space through the use of hardware addons such as connected scales, blood pressure cuff, glucometers, and RFID chips in pill boxes. Voice prompts and large, easy to read, text are are integral part of the experience, making it use easy for the patient with low visual accuity. If a reading is taken that is out of range, or a patient forgets to take medication the physician or other caregivers can be notified.

When we speak of patient participation in the context of elderly or infirm patients it’s crucial to remember that family and other caregivers are critical members of the care cycle. The Touchstream app connects this community of care to the patient in realtime by allowing other caregivers to receive alerts and reminders of scheduled appointments and important events directly to their cell phones. This allows the patient autonomy and self direction while providing appropriate assurances and ability to intervene if there is a problem.

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