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Practicing Smarter with m-health Technology

The world is growing smaller as the cost of mobile technology plummets and more high-powered smartphones reach the hands of eager new customers. Many observers expect global mobile communications penetration to reach 100 percent within the next five years, and by 2016 there will hardly be a spot on the planet where one can’t place a call using a cell phone.

Although the surge of mobile technologies is good news for telecommunications companies, it’s even better news for those in need of health care when access is a problem. Through m-health, or the rapidly evolving practice of medicine and public health via mobile communications devices, the face of patient care is changing as studies and pilot programs test the efficacy of the handheld devices for use in medicine.

Members of GW’s School of Medicine and Health Sciences (SMHS) are leading the way in these endeavors, exploring m-health technology for use in a variety of areas including critical cardiac diagnoses, medication adherence, and diabetes management.

Smartphones, Smart Heart

One of these studies, led by Brian Choi, M.D., assistant professor of Medicine in the Division of Cardiology, recently confirmed that echocardiogram images taken with mobile cardiac ultrasound devices are as readable and accurate on smartphones and tablet computers as they are on a conventional workstation. These findings mean expert echocardiographers can receive, review, and interpret high-quality images transmitted directly from the field using handheld ultrasound devices, making critical diagnoses more accessible and patient care more efficient.

The study began in August 2010, when Cindy Tracy, M.D., professor of Medicine and director of Cardiac Services at GW Hospital, led a medical mission to Honduras in a particularly inaccessible mountainous region of Central America. Because of the remote location and a limited ability to bring diagnostic equipment, Choi suggested the team use a handheld ultrasound device called a GE Vscan.

“The GE Vscan was perfect for this kind of application because it’s so portable,” Choi recalls. The Cheney Cardiovascular Institute took Choi’s advice and purchased the device for the trip, allowing Tracy’s team to collect diagnostic images. “I was interested in looking at those images to determine if reading them off of a smartphone was as accurate as reading them on a traditional workstation.”

Working with third-party commercial software developer mVisum, which created the HIPAA-compliant smartphone application, Choi sent echocardiographs from 89 patients for analysis by two experts in the United States, who reviewed them on conventional workstations. Afterward, the images were also sent to echocardiographers who reviewed them using a smartphone. Choi then compared the results. The smartphone diagnosis was considered accurate only if an abnormal finding matched at the same level of severity as the interpretation made using the conventional workstation.

“The correlation between the two was very high,” says Choi. “We did a statistical test that showed the diagnoses matched 90 percent of the time. Now that we know reading echoes from a smartphone is nearly as accurate as reading them from a workstation, the key is figuring out how to best incorporate this technology into a standard of care.”

The devices’ implications for medical missions to underserved locations are clear, but, Choi argues, there are practical applications for the United States as well. “Not only can there be a similar interaction between rural sites and tertiary referral care centers,” he says, “but also, these devices could fill an important gap in urgent and off-hours interpretations when experts may not be immediately available.”

Medication Adherence: Phoning it in

GW physicians are also exploring how cell phones might improve medication adherence among patients with hypertension, a disease estimated to affect more than 65 million adults in the United States. Following prescriptions is particularly important for blood pressure patients because poor adherence to medications can result in serious complications, such as kidney disease. What’s more, many patients who suffer from high blood pressure also have other conditions that could result in a drug regimen of up to 10 pills a day.

With a grant from Qualcomm’s Wireless Reach initiative, and contributions from One Economy, Cricket Communications, and VOCEL, GW researchers led a seven-month study to determine whether 3G wireless-enabled cell phones with a mobile medication reminder application could engage patients, improve health outcomes, and reduce health costs. They nicknamed the device the Pill Phone.

“High blood pressure and diabetes are the leading causes of kidney disease, and Washington, D.C., has some of the highest rates of end-stage kidney disease in the nation,” says Richard Katz, M.D., Bloedorn Professor of Medicine and director of the Division of Cardiology. “The Pill Phone Research Study offers a model for disease self-management that can be applied to at-risk communities.”

Patients received 3G wireless handsets preloaded with the Pill Phone application. They received medication dosage reminders, tracked dosage records, images of the pills, and real-time information about potential drug side effects and interactions. Health care providers were able to remotely monitor patient adherence through a secure website.

Mobile Technology and Managing Diabetes

Meanwhile, two teams of GW researchers are focusing their efforts on the impact of mobile technologies on diabetes care and management. The teams received grants from the McKesson Foundation as part of its Mobilizing for Health initiative, a program geared toward improving the health of underserved populations through the use of mobile phones.

One study, led by Joshua Cohen, M.D., professor of Medicine in the Division of Endocrinology, and Neal Sikka, M.D., assistant professor of Emergency Medicine, will examine the effectiveness of text messaging in reducing emergency room (ER) visits by people with diabetes. The team will text diabetes information to subjects, who will report on their disease management. Via text, subjects will also be able to get information about follow-up appointments. The hope is that by improving patient education, people with diabetes can improve their self-care and help prevent the type of health concerns that lead to ER visits.

The other study, led by co-investigators Samir Patel, M.D., associate professor of Medicine in the Division of Renal Diseases and Hypertension, and Katz, will be a randomized, controlled trial of a cell phone application for patients with diabetes and hypertension. Patients will be able to monitor their blood glucose and blood pressure, and share that data with primary care providers. Researchers aim to create a sustainable care model centered on the cell phone application.