Just call me Pinocchio because I lied. Last week I said I would review the Sleep Cycle app for this week’s mobile health review, but over the holiday weekend I came across an app that I am so excited about I just have to tell you about it first. But don’t worry, the Sleep Cycle app is already downloaded on my iPhone and I promise to tell you all about it next week.
For Crohn’s disease or ulcerative colitis patients like me, GIMonitor by WellApps is a must-have mobile app. If I didn’t already own a smartphone I would buy one just for this app alone. I would highly recommend this app to anybody with any type of GI issue or IBD - and best of all, it’s free. I downloaded GIMonitor primarily for the purpose of tracking everything I eat, along with my six-plus daily bowel movements, in order to gain a better understanding of which foods cause problems for me and which foods (if any) are truly safe. This app is a fantastic way to do this.
GIMonitor allows users to track the exact time, consistency and urgency of every bowel movement (BM), every meal, and every symptom that may be directly or indirectly related to their digestive issues. Then it charts the information over a particular time period so the patient and their doctor can look for patterns. Additionally, the app automatically calculates the user’s quality of life on a scale of 1 to 10 based on the frequency and urgency of their BMs, along with any pain or blood associated with it.
Perhaps the best feature GIMonitor offers is a social forum where users are able to share their thoughts and support each other in the battle against Crohn’s, colitis, etc. It’s actually a lot like Facebook for IBD patients and is affectionately referred to among frequent users as Buttbook.
I can’t stress enough how important the social feature of the app is. People who suffer from IBD and related disorders - or any chronic illness for that matter – are often uncomfortable talking about their symptoms with friends and family. After all, describing the frequency and consistency of one’s poop isn’t exactly good dinner conversation. It is incredibly refreshing to be able to connect with real people who truly understand what I go through each day. Just being able to have candid discussions about what goes on in the bathroom is surprisingly rewarding.
I know there are similar mobile apps available for people with other chronic diseases, like diabetes. If those apps even come close to doing for those patients what GIMonitor does for people like me, the developers of such apps should be commended. I only wish I had discovered this app sooner.
It’s that time of year again when millions of us in the U.S. make New Year’s resolutions to improve ourselves in some grand way – often by means of getting in shape and/or leading an overall healthier lifestyle. And this year we’re sticking to it – right? Well, at least until mid-February.
Fortunately this year there are dozens of free mobile health apps that can help us with our resolutions - or at least make it more fun trying. There’s literally an app for everything from helping you lose weight to tracking your menstrual cycle, monitoring your heart rate, and evaluating your sleep patterns.
As a proud new owner of the latest iPhone, I am always looking for an excuse to download new apps. And what better excuse could there be than to make using mobile apps part of my job by writing a weekly blog review of a new mHealth app?
This week I compared three relatively simple apps designed to monitor your heart rate using the camera feature on your phone.
I began by installing the free Heart Fitness app by Senscare. As directed, I measured my heart rate with the app after I had been in a sitting position for at least 5 minutes. In less than a minute the app determined my average heart rate to be 91.8 beats per minute, indicating my fitness level is somewhere between average and poor. According to Heart Fitness, anywhere between 60 and 100 would be considered normal for an adult while a well-trained athlete should fall between 40 and 60 beats per minute. Other features of this app allow you to enter body information to boost the accuracy of the results; and for 99 cents you can get additional information, including a cardiovascular risk estimation.
Next I installed the free version of Instant Heart Rate by Modula. Like the Heart Fitness app, Heart Rate also has a 99-cent version with added features, but the basic fingertip measurement component is free. Again, my heart rate was 91 BPM, and according to this app, that puts me in the poor range by 1 BPM (60 to 90 is considered normal by Modula’s Heart Rate app).
The third heart rate app I tried was simply called Heart Rate by Chris Greening, CMG Research. This one was a little less exciting than the first two and it did not tell me when to stop taking the measurement. I got the impression that it would just continue to measure my heart rate until I removed my finger tip from the phone's camera lens. I liked the first two heart rate apps better because they both measured my BPM for a set time, which was about a minute or less.
Next week I’ll review an app called Sleep Cycle designed to monitor your movement during sleep and wakes you up while you are in your lightest sleep phase so that you feel rested and relaxed.
[caption id="attachment_1187" align="alignleft" width="300" caption="Dude, this is the coolest!!!!"][/caption]
Ah, modern medical imaging. You can bet your car payment that I get a lot of mileage out of medical imaging as the Washington editor for Medical Device Daily. All those cuts under the Deficit Reduction Act of 2005 have just littered the Washington roundup practically since the day I took this job. What's not to like?
Still, imaging is not just another pretty face or another bunch of pretty pictures, as the doctors like to say. There's some real substance to modern imaging technology beyond providing the occasional nutcase at the Transportation Security Administration with a cheap thrill. So read on for my top five reasons to love modern medical imaging.
Number five: What other branch of science gives you a PET that can help you get well without dumping a lot of veterinarian bills in your lap (as you can tell, I deliberately started with the weakest of the five)?
Number four: Speaking of pets, aren't we glad they removed the A from CAT scan? I got more than a bit weary of hearing those jokes about felines and canines testing your health. “Your CAT scans and your labs came back okay!” Groan. That joke wore me out the first time I heard it.
Number three: In this line of work you have to know acronyms, which allows you to say things that make you seem really smart. For example, you may find yourself explaining to a rapt audience that SPECT stands for single photon emission computed tomography. One little caveat: This works on the neighbor kids in second grade, but don't expect the middle school kids to be impressed.
Number two: In this one, I'm thankful for the cut-and-paste feature in word processing because my fingers start to spasm every time I have to spell out fluoroscopy and fluorodeoxyglucose all by myself. On the other hand, I do like the fact that fluorodeoxyglucose is also known as F-18 because I use that as an excuse to look at YouTube videos of the F-18 Super Hornet blowing things up.
And the number one and very best reason to love modern imaging is: It's probably the one thing in life other than sheer luck that can keep your proctologist's equipment at a safe distance.
Donald Berwick's tenure at the Center for Medicare & Medicaid Services was brief, but should come as no shock to anyone who knows how the former physician came to the job. What's stunning is how many believe the Obama administration and House and Senate Democrats bear no responsibility for the brevity of his stint at CMS.
Let's take things in chronological order. First, President Obama and Democrats in Congress drafted what is probably the largest piece of legislation ever to pass without any input from the legislative minority. They then rammed the vote through Congress with only feeble support from a handful of Republicans with large constituencies among “blue” voters. That apparently was sufficient to call it bipartisan legislation.
When Obama nominated Berwick to the CMS post early last year, the White House recognized that getting Berwick in at CMS would be close to insurmountable (assuming they believed it could be done at all) given the way the Affordable Care Act (ACA) was handled. So rather than have Berwick appear on Capitol Hill in any capacity – let alone for a confirmation vote – the administration appointed Berwick to the job during the 2010 summer recess.
Anyone with any common sense knows you don't use recess appointment for a job like that at a time like that unless you're willing to jettison any prospect for bipartisanship. Berwick waited 'til last November to appear before the Senate – he had been on the job for a third of a year by then – and according to an article in the Washington Post, Sen. John Kyl told Berwick “I haven't seen a single thing you've written or said I agree with,” to which Berwick is said to have replied “that's not a framework for a conversation.”
If Berwick was worried about frameworks for conversations, he should have shown up before November 2010. To be nice about it, his riposte to Kyl was hypocritical given the way the ACA was handled, not to mention his recess appointment.
One line of thinking about all this is that the administration hoped Republicans would roll over and play dead for Berwick despite the tone set by Democrats in getting the ACA through, but another line of thinking is that the President figured a year and a half of Berwick was better than no Berwick. After all, we've had a stretch of acting administrators at CMS in the post-Tom Scully world, so a brief tenure for Berwick would be no shock to anyone in this town.
I'm not here to proclaim the GOP the Party of All Things Good and Democrats the Root of All Evil. After all, the GOP stupidly used budget reconciliation to ram through the tax cuts passed during George W. Bush's time in the White House, and this is a town with a lot of sharp elbows on both sides of the aisle, not to mention long memories.
All the same, I find it naive to think this appointment could be handled this way. Whether you believe the ACA was both appropriate and constitutionally sound is irrelevant because of the ham-fisted approach taken by Democrats in the White House and on the Hill. Hence, this Berwick business can't be interpreted as anything more than one of two things; a case of towering political arrogance on Obama's part, or a belief that a year and a half of Dr. Berwick is better than no Dr. Berwick at all.
“Okay, hon. I’m headed over to MammothMart. Need to grab some beer and munchies for the Monday night game, a replacement shower head for the bathroom and maybe that new Michael Connelly book."
“I might as well get the oil change and lube done on your SUV while I’m there. And while I’m there, I’ll get that loose pair of glasses tightened at the optical shop. Oh yeah, and I guess I’ll have them check out that stomach pain I’ve been having off and on.”
If any of the above seems to border on crossing the line between imagination and reality, you haven’t been paying much attention when you have visited, say, your local outpost of global retail colossus Walmart.
There, alongside a bank branch, beauty salon, nail emporium (or whatever they call such places) and whatever chain sub shop is that particular store’s choice for providing sustenance to the shopping hordes, you’ll find an in-store medical clinic that is aiming at doing nothing short of changing the face of individual healthcare in the U.S.
Whether it’s within one of the sprawling Walmart outposts or part of a decidedly less frenetic shopping site such as CVS or Walgreens, the retail healthcare clinic now looks like it’s here to stay.
The fact that the mere existence of such care has brought out the usual bleating from those who look down their nose at such things is proof enough that, after some less-than-smooth stops and starts, retail medical care may truly be ready to build on what is an admittedly small footprint. As a concept whose time has come – and gone – on more than one previous occasion, retail care now seems to be trending upward.
While there are other players dabbling in the retail care concept, the aforementioned trio of retailers seem most serious about it at this point. CVS operates somewhere around 550 of its MinuteClinic units within stores, while Walgreens total about 335 Take Care units. Walmart at present is lagging behind with clinics in less than 150 of its stores, but think about it, folks, when have you seen the executive team in Bentonville, Arkansas, settle for being last in a retail category?
Last month, the leaking of a confidential document sent by Walmart to potential healthcare service partners indicated the world’s largest retailer’s clear interest in becoming a considerably bigger player in that sector. The document involved a request for information from organizations that could, for example, help monitor patients with diabetes, asthma, high blood pressure, heart disease, obesity and other conditions.
While Walmart gave the public appearance of backing away from parts of its own document, saying it did not intend to build a “nationally integrated” primary care platform, that’s really just a bit of posturing. That’s more a result of the widely fractured state laws governing the way healthcare services are provided than it is an acknowledgement that Walmart doesn’t intend to be Numero Uno in this space.
So what’s behind apparent growth in both the numbers of and usage of retail-based clinics? Convenience, for one. As in the example I used back at the beginning of this piece, if you’re going to be shopping at either a megastore or retail pharmacy anyway, why not take the opportunity to have some health problem looked at?
Another, and one that is cited by both providers and patients, is the certainty of costs up-front, with rates for various services clearly posted, as opposed to the crapshoot of charges that results from visits to more traditional outposts for care.
Part of the latter point is that costs for those services at these store-based clinics generally are considerably lower – 30% to 40% lower in many cases, and as much as 80% lower than at that other popular option for care, the closest hospital’s emergency room – than at those more traditional points of care.
More and more employers, especially the smaller companies that are going to be even more financially challenged when new federal requirements for health insurance coverage take effect in 2014, are seeing such clinics as offering cost-effective opportunities for screening and wellness programs. Hiring a company to come in and conduct wellness programs would be costly, but partnering with a retail-centered clinic to provide blood tests, conduct nutrition counseling or organize diabetes management programs could sharply bring such costs down.
Then there’s the impending shortfall of primary care doctors, estimated by one study to total 21,000 physicians by 2015. Use of the nurse practitioner model in retail clinics will help lessen the effects of that shortfall.
As for the “look down their nose” crowd, that kind of mystifies me. I have recently asked several friends what they think about “Walmart healthcare,” and the near-universal response has been “Oh no, I’d never go there for healthcare.”
In the Atlanta area, where I live, the estimable Emory Healthcare organization has teamed up with CVS Caremark to provide services at 31 MinuteClinic locations around the metro area. Somehow I can’t see Emory cutting any corners in providing care through those clinics.
Maybe my friends would have a different outlook if they were uninsured or had had enough bad experiences with overscheduled, understaffed and vastly overpriced traditional primary care providers. My feeling is that it’s an idea whose time is coming, if not totally here yet.
Truth be known, I haven’t used such a clinic myself. But with the vast majority of my healthcare encounters being of the every-six-months “wellness visit” variety, I’m pretty open to the idea. My wife and I do get annual flu shots from our friendly local CVS pharmacist in lieu of the much longer treks we previously made to our respective primary care physicians, so a more convenient wellness visit may be a very logical next step.
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)
[caption id="attachment_1144" align="alignleft" width="300" caption="When patients can see you, but can't hear you"][/caption]
As mentioned in a posting earlier this week, my wife and I were out for dinner recently and made the acquaintance of some opinions about FDA and the industries it regulates. Opinions about FDA ranged from awful to terrible, and doctors and industry fared no better. It seems a lot of people think user fees conscript FDA, and some see the agency, industry and physicians as some sort of malevolent troika that would have made the Kremlin of Leonid Brezhnev proud.
Maybe I'm too close to it all to appreciate the nefariousness, but I wonder how anyone comes to see things that way, not to mention how many see it that way. Here's the question, though: If those perceptions are widespread, why are such things allowed to fester? One can easily understand why FDA and device makers might dismiss this kind of prattle from a member of the trade press, but it's not just me who thinks this ought not go unaddressed.
I recently interviewed Bray Patrick-Lake, President/CEO of the PFO Research Foundation (Boulder, Colorado), who appeared at Transcatheter Cardiovascular Therapeutics. One of her remarks at TCT 2011 was some patients “actually believe that when [a drug or device] is FDA approved, the risks are zero.” As covered in the Nov. 30 edition of Medical Device Daily, Patrick-Lake also told the audience at TCT, “if we don't do a better job of educating patients … we will continue to see lawsuits and backlash” against agency and industry alike.
During our interview, Patrick-Lake said that some patients are “asleep at the wheel” where the risks and benefits of a drug, device or procedure are concerned. She indicated that a failure to appreciate the risks can leave a patient with one of those unintended consequences that seems a bad trade-off, even if their life was saved in the process. A better appreciation for those risks might change a few minds about which treatment to select, Patrick-Lake suggested, but at the very least would avoid the kind of psychological whiplash that goes along with finding out the ride wasn't free of risk after all.
All the same, Patrick-Lake was not inclined to let FDA, docs and industry off the hook. “What gets advertised or what ends up on 20-20 … is never what happens to the average patient,” she said of DTC ads and sensationalistic media coverage, making the argument that the gap between the two is where device makers and FDA need to put forth some effort.
Patrick-Lake acknowledged that all the data on patient sub-populations means that a lot of work will go into the production of disease-specific patient education material (not to mention updating that material as new data emerge), but she also said that a more general public information campaign might work wonders for those who are not yet patients, giving them the heads-up on what to look for once they end up under a doctor's care.
Patrick-Lake said a public service campaign intended to make the audience aware of risks “would be very simple to do, and I don't think it would be that expensive.” She also remarked, “I can't imagine industry would have anything to lose over patients being better informed,” stating that both industry and FDA bear some responsibility to do something along these lines.
“It can be done and it should be done,” she said.