Health Care Apps Offer Patients an Active Role

Posted: Apr 24, 2014

Source and photo creditThe New York Times
by Ann Carrns

If you have young children, you’ve most likely endured caring for an ear infection or two. Or perhaps you’ve experienced a mysterious rash. Those situations generally mean a trip to the doctor’s office and time away from your job, if you work outside the home.

But what if you could snap a photo of your rash, or your child’s ear canal, and send it to your doctor? That’s the idea behind a new breed of apps and devices that increasingly put medical tools in the hands of consumers.
CellScope Oto, for instance, combines an app with an attachment that lets you turn your iPhone into an otoscope — the tool physicians often use to examine the inside of your ear. Various apps and online services now let you communicate with your dermatologist by snapping a photo of a rash or mole and transmitting it electronically. And with an app-and-attachment combination called AliveCor, you can turn your smartphone into a heart monitor, record an electrocardiogram and send it to your doctor.

The trend of do-it-yourself examinations and tests is part of a shift in health care toward consumer participation that began with online health information sites and is accelerating with advances in mobile technology. Consumers are increasingly comfortable using walk-in medical clinics for minor ailments, and they see at-home digital tools as yet another level of convenience, said Ceci Connolly, managing director of the Health Research Institute, an arm of the consulting firm PricewaterhouseCoopers.

"We know from our research that consumers are very interested in these conveniences, as opposed to going to sit in a doctor’s office,” she said.

Erik Douglas, co-founder and chief executive of CellScope, said ear infections were a top reason for visits to pediatricians, so the Oto device might help eliminate unnecessary trips.

Robert L. Quillin, a pediatrician in Webster, Tex., has used CellScope’s Oto for several months during the device’s testing period. Shaped like a traditional otoscope, it fits over the phone’s camera, has a plastic tip that is inserted in the patient’s ear, and uses the phone’s camera to take photos or video of the ear canal and eardrum. Dr. Quillin can show the image on the phone directly to the patient — or to medical students, to educate them about ear infections. Ultimately, he said, a physician or nurse practitioner must interpret the image, make a diagnosis and prescribe any necessary treatment. “It’s a great tool for teaching parents and young doctors,” he said.

Joseph C. Kvedar, founder of the Center for Connected Health, part of the Partners HealthCare system in Boston, said that in these relatively early stages of mobile health tools, doctors might be most comfortable using them to expedite follow-up care, or to treat conditions with a relatively low level of risk. For instance, a patient who is doing well under a treatment plan for acne may be able to send photos and answer a few questions for the dermatologist to feel comfortable advising the patient to continue a treatment plan without an in-person examination. “For something like acne,” he said, “probably the time has come.”

Right now, he said, these new digital tools help expedite evaluation and diagnosis by a doctor. But in the long term, he said, they may become more disruptive and controversial as they begin to use algorithms and large databases to diagnose conditions and recommend treatment, without a doctor being directly involved.

Here are some questions about do-it-yourself health tests and apps:

Can I buy these tools now, for use at home?
Some are available now, while others are expected to become available shortly. AliveCor is sold online for $199 (it used to require a prescription, but does not anymore, according to the monitor’s website). There are several available online dermatology services, like DermatologistOnCall, currently available in a half-dozen states, that connect you to dermatologists you may not know; various mobile apps connect you with your own doctor. Typically, you’ll pay a fee of $60 to $70 to submit an image for review. CellScope Oto is expected to become available to consumers by the end of the year, Mr. Douglas said.

Does insurance cover consumer use of these tools?
In general, you can expect to pay out of pocket for using such services. (The reimbursement policies followed by Medicare and other health plans were cited as one barrier to further adoption of telemedicine options, in a study released this week from the RAND Corporation.)

“Right now, reimbursement is still a hurdle in our health care system,” said Ms. Connolly of PricewaterhouseCooper’s Health Research Institute, so “many entrepreneurs and new entrants are thinking about devices that consumers are willing to pay for out of pocket.”

The tools may, however, be covered by your flexible spending or health savings account, which lets you cover health expenses using pretax dollars.

Are there any caveats?
It can take a little practice to learn to use the tools properly. And patients should understand that while becoming more involved in their health care is a good thing, they are in effect shouldering more responsibility by using do-it-yourself tools, Dr. Kvedar said. Sending an image of one mole to your doctor electronically, for instance, means the physician isn’t examining the rest of your body for other, potentially more serious, moles. “You, as the patient, own more of the execution,” he said.

Category: Mobile Usage