“It’s awesome” says my daughter about her recently acquired communication device: the Apple iPhone, and at age 14, she is impressively tech savy. She has been showing me amazing applications such as Shazam in which the iPhone “listens” to music you are playing and tells you the name of the song and the artist…amazing applications that seem simple enough once put in motion but…..simple or not, somebody has to conceptualize the application and then put it in motion. And yes we have been doing these things for eons but to have them all at your disposal easy and in the palm of your hand….Its seems that Mr. Jobs was born with this innovation genetic sequence in his DNA.
I remember a particularly critical blog opinion written about the iPhone upon initial launch by one “innovation” consulting firm professing to be experts in implementing innovation within your firm! It is questionable what their portfolio of innovation products or services consisted of. This was your basic market research firm latching on to the flavor of the day. I believe the innovation effort originates from traits inherent in an individual’s personality and thrives in certain environments and innovative people naturally gravitate to innovative industries/firms (and by extension….don’t stay long at firms that stifle free thought and progress). If you want to develop an innovative firm, recruit innovative people. It is all there in the history of their choices and accomplishments. I’m not sure if Mr. Jobs bought the services of these types of here today gone tomorrow consulting firms, but the gadgets his firm launches have encouraged other innovators to come out with revolutionary applications that threaten all sorts of engrained habits in industry especially healthcare delivery which can at times appear to be innovation inertia defined. And these new ways of executing on simple life tasks will definitely help save us all time and $$$.
Take a disease very prevalent in developed countries and growing in prevalence in Asia: diabetes. This can be a very difficult and complicated disease to treat and a very expensive disease to treat. Type 1 diabetes, due to a total lack of insulin production from the pancreas, suspected to be autoimmune in susceptible individuals, requires life long insulin administration. Type II diabetes is what your overweight grandparents have but unfortunately you don’t have to be so old to develop it. It is a consequence of poor diets (fried potatoes) and sedentary lifestyles (couch potatoes) which result in people well above their ideal weights and the resultant insulin resistance. Your pancreas makes the stuff but your cells don’t respond to the degree they should to manage your blood sugar and fats metabolism. Both versions require absolute meticulous monitoring of management (medication dosing, blood sugar, hemoglobin A1C) and attention to potentially severe complications if management is poor. Both also, in presence of other risk factors such as smoking, hypertension, family history of cardiac disease, and others are a recipe for chronic and costly investigations and interventions. The main long term complications involve nerves (diabetic neuropathy) or blood vessels (diabetic retinopathy, diabetic nephropathy, coronary artery disease disease CAD, cerebrovascular disease (TIAs and stroke), and peripheral vascular disease (diabetic foot ulcers/amputations)) and most require chronic interventions including long term pharmaceuticals, repeated specialist visits, aggressive diagnostic investigations, and surgical interventions.
The closer patients maintain normalized blood sugars over a long periods of time the less the incidence and severity of complications, the better the quality of life for the patient, the less interventions required and the less economic burden for patient, family, payor and society. Sounds like a win-win for all involved. However, this is much easier said than done. Patients easily become fatigued by the treatment protocols and compliance drift is inevitable. First, it is difficult enough to engage in lifestyle modification such as regular exercise and diet scrutiny on a sustained long term basis even if you are healthy. Once to twice a day tablets is simple enough though tedious, however, more complex patients require insulin injections which can be of several types (short, medium, and long acting) several times a day. Then, even if you do commit to lifestyle modification and you take your medications as directed, stress, infections, variations in exercise and other factors can still toss off your blood sugar control. And we haven’t begun to discuss the actual monitoring. The most common way to check glucose levels involves pricking a fingertip with a lancing device to obtain a blood sample and then using a glucose meter to measure the blood sample’s glucose level. This must be done at least twice a day and for more complex patients, before each meal and before bed. Sometimes it is even required to do the test mid way through the night. Patients are required to keep records of these levels and visit their physician every 3 months (or sooner) who will calibrate the treatment (adjust insulin types or doses or change medications). Most times monitoring records are incomplete and it is difficult for physicians to make the appropriate adjustments. Physicians then become reliant on long term indicators of sugar control such as hemoglobin A1C. It is even unclear as to how physicians can determine whether patients are taking their medications appropriately and on time.
Well, a company called UTS has attempted to make the process easier and they are utilizing Apple’s iPhone as one of the possible interface technologies.
Features from the product page:
Glucose records are colored according to their value levels. High levels of glucose are highlighted in red and marked with a red alert sign. This allows you to quickly find peak levels.
Adding a new record is simple, as no typing is required for entering a glucose level value.
In addition to blood glucose, you can also track carbohydrates, insulin and medications.
The various different types of charts will help you control all factors affecting your health. The colored background shows whether or not your glucose level is in the dangerous, normal or optimal zone. The iPhone multi-touch technology allows the chart to be easily scaled and scrolled. Also you can compare your glucose level versus your insulin injections, carbohydrates or medication intakes. All data points on charts are touchable and provide detailed hints. All charts are highly customizable.
The UTS Diabetes also provides reports that show your summarized statistics for the specified period of time.
A unique feature of the UTS Diabetes application is the ability to synchronize your data with your online account on UTSHealth.com and optionally to share your data with your doctor, support group members, or any person of your choice.
One could argue that this is simply a high tech way where you still have to input the data. Better off with pen and paper. Well, the benefit is that your pen and paper can’t tell you what song your listening to, and more importantly the ability for real time monitoring and updates is critical. Periodic wireless synchronization would be the next step where the data would be automatically entered into patient e-records and physicians could get flagged or notifications when blood sugar level thresholds are violated. Physicians can identify non-compliance immediately and attempt to deal with it. And as technologies such as continuous glucose monitoring become mainstream the ability to use technology converged in a single multifunctional device will demonstrate clear and apparent value. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the U.S. Food and Drug Administration (FDA) and are available by prescription.
Continuous glucose monitoring (CGM) systems use a tiny sensor inserted under the skin to check glucose levels in tissue fluid. The sensor stays in place for several days to a week and then must be replaced. A transmitter sends information about glucose levels via radio waves from the sensor to a pagerlike wireless monitor. These devices provide real-time measurements of glucose levels, with glucose levels displayed at 5-minute or 1-minute intervals. Users can set alarms to alert them when glucose levels are too low or too high. Special software is available for tracking and analysis of patterns and trends, and the systems can display trend graphs on the monitor screen. This monitor could easily be your iPhone and this process would remove the necessity of the patient to input data at all. And again, synchronization with your physicians e-record system would allow effective oversight and calibration of treatment which will help us achieve the win-win all are seeking.
This is not meant to be a endorsement of iPhone or the related applications and I’m sure there may be equal or better devices but it is compelling not to have a device for music, a device for pictures, a device for phone and another device for medical monitoring. The all-in-one is appealing.
This link shows another example of an incredible potential innovation from Airstrip Technologies…again for iPhone. You would really appreciate these if you have ever been on-call.
Tej Deol, M.D.
