Smartphones as doctors

Want to learn how to interpret an electrocardiogram? Track your calories and exercise? Monitor your blood pressure? Find the nearest emergency room?
Say it with me: There's an app for that.
As of May, Apple's iTunes store featured more than 5,900 mobile medical software applications, with the list expanding every day, according to Dr. Thuc Huynh, CEO of ScrubdIN, a medical apps shopping site. Android, BlackBerry, Windows and other smartphones account for even more.
The apps are pretty popular, too: Three fitness products recently broke iTunes' top 75 apps list. And about 9 percent of adults who own a cellphone use an app to track or manage their health, according to a recent Pew Research Center study.
Some health professionals are hesitant to dive into the trend, however.
"A lot of physicians, unfortunately, don't know much about the apps that are out there," said Dr. Joseph Kim, president of Medical Communications Media Inc. "There are so many apps and so many different disease areas, that it's hard for that doctor to be able to give any kind of real helpful advice to their patient unless they're a lover of technology and this is something that they really enjoy learning about."
That holds true among some of South Hampton Roads' major health and medical organizations. Queries to Bon Secours Hampton Roads Health System, Sentara Healthcare, Eastern Virginia Medical School and Children's Hospital of The King's Daughters yielded no recommendations for medical apps from outside developers.
"At this time, because we haven't evaluated and approved any, we have a policy against endorsing anything," said Greg Raver-Lampman, a CHKD spokesman.
CHKD's caution is well-taken.
Kim listed several potential pitfalls and precautions for users of mobile medical apps.
Though more and more hospitals, academic institutions and health-related companies are developing software, so are people with more questionable backgrounds, he said.
That means some apps could be dispensing bad advice. Consider that one of iTunes' most popular free apps listed in the medical category claims to give users a detailed description of their past lives.
Earlier this month, the U.S. Food and Drug Administration proposed guidelines for mobile medical apps. However, they would only be for apps that are used as an accessory to an FDA-regulated medical device or to transform a mobile platform into such a device. Only a small number would be covered.
"Microsoft, Google, Apple: None of them have any kind of stringent criteria or way to really check to see whether or not this information is credible," Kim said.
On the other hand, complicated information in some apps is completely reliable, but meant for health professionals and could be misinterpreted by the man on the street with a cellphone.
For example, "Pocket Eye Exam," a smartphone app developed by University of Virginia physicians and biomedical engineering students, was designed to help health care providers diagnose vision problems.
Some of its features - such as a test for colorblindness and a standard eye chart - are easy for the average person to understand, said Dr. Ivan S. Login, a U.Va. professor of neurology who worked on the project. Another of the app's tests, which diagnoses a particular brain dysfunction based on eye motion, would be difficult to use correctly without the proper training.
"Although it could be a great icebreaker for a party, and sort of fun to use, the interpretation of it would generally be beyond the average person," Login said.
Smartphone users also should beware of anonymous developers.
Scammers can rig apps to harvest and steal personal information from cellphones, Kim said. Software to detect and protect against such problems is not yet common for smartphones, as it is for PCs.
"The danger that people don't realize is that unknown app that's on your device could be doing something that you don't want it to be doing. You may not actually know it," Kim said.
Apple will remove an app from iTunes if users report a serious problem, he said. But there's no recall message for people who already have downloaded the app.
Consumers can avoid such traps by researching an app's developer and steering clear if they can't find reliable information. They also should delete apps from their phones if they no longer use the software, Kim said.
"I don't want to suggest that everyone ought to be paranoid," he said. "I'm saying you need to be cautious."
The same goes for protecting personal medical information.
Because regular texts and emails generally aren't encrypted, their content is vulnerable if someone hijacks a message, Kim said. That makes it unwise to discuss private medical matters with doctors or anyone else using those means.
The best apps for storing health records and communicating with providers are tethered to a hospital's or health plan's electronic systems - unlike the Google Health product which will be discontinued next year, Kim said. With a health provider's system, a mobile user must access the software through a portal that adds a level of security.
Earlier this month, Express Scripts Inc. and Tricare, the government health insurance for active-duty military, their dependents and retirees, launched such a product. The Tricare Express Rx app allows beneficiaries to manage home-delivery prescriptions and find the nearest retail pharmacies in their network.
Locally, Sentara offers a mobile medical records application. Bon Secours Richmond has one, and there's one in the works for Bon Secours Hampton Roads patients.
About 1,500 people have downloaded and logged into the free Sentara MyChart iPhone app since it was introduced in March.
Dr. Meredith Rose wrote in an email that it allows him to communicate more directly with patients when they're not in his office.
"When he leaves my office, he can see an 'after visit' summary which includes the details of our visit," wrote Rose, who is affiliated with Sentara Family Medicine Physicians in Virginia Beach. "He can also confirm his medication list, allergy list, changes in medication. It's very, very helpful to patients."
The most useful medical apps help people form or continue healthy habits, particularly by tracking calories and exercise, Kim said. Often, the software extends to social media, such as Facebook, creating a community of support and accountability.
Nathalie Vandenheiligenberg has seen it work.
People trying to lose weight are more likely to keep up with a food diary on their phones than if they must write out entries and calculate calories by hand, said Vandenheiligenberg, a nurse practitioner with Chesapeake Regional Medical Center.
"It increases the chance for success," she said.