Sophisticated mobile health apps empowering patients

SINGAPORE — Want to know if your asthma inhaler is positioned correctly or how that slice of chocolate cake might affect your blood sugar level?

These days, such medical information is just a swipe away on your smartphone, thanks to the wide availability of mobile health applications.

According to healthcare research firm IMS Institute for Healthcare Informatics, there are now more than 165,000 health and medical apps on the market. Reports also suggest that about one in five smartphone users have one or more health-related apps on their mobile devices, said Dr Winston Ho, medical director of Parkway Shenton.

Besides apps that offer everyday wellness advice on diet, lifestyle, weight and sleep patterns, a growing number are venturing into medical care. They measure and monitor the user’s disease symptoms and treatment, and some even allow users to access their doctors remotely, said Dr Ho.

About one in 10 apps allows users to connect to a device, such as a heart rate monitor, which can provide feedback to health professionals, according to a 2015 study by IMS.

This year, at least three such sophisticated mobile health apps have been launched in Singapore. Breatherite, for instance, is an app that uses augmented-reality technology to address errors in asthma inhaler use, which Adjunct Associate Professor Augustine Tee, vice-president of the Asthma and Allergy Association, said remains one of the greatest challenges for people suffering from the chronic disease.

Studies show that incorrect inhaler technique is linked to poor asthma control and can exacerbate symptoms.

The app, developed by Mundipharma, engages the smartphone’s front-facing camera and sensors to track the user’s head alignment, inhaler preparation, inhalation and exhalation.

The other apps include Zero Bleeds, which helps people with the bleeding disorder haemophilia manage their condition, as well as Nutritionist Buddy (nBuddy), a nutrition app conceptualised by a National University Hospital (NUH) dietitian. NBuddy is tailored to help Singaporeans who are overweight or obese to manage their meals, calorie intake and activity levels. A similar nutrition app for those with prediabetes or Type 2 diabetes called nBuddy Diabetes is now available on the Google Play Store and will be on the Apple App Store next week.

ENGAGING AND EMPOWERING PATIENTS

Amid rising rates of chronic disease, experts said mobile health apps can motivate patients to take charge of their health and medical conditions.

Chronic diseases are expected to make up almost two thirds of the global healthcare cost burden by 2020, said Dr Ho.

While community health screenings have helped identify at-risk groups, there remains a significant gap in post-screening intervention programmes, said NUH’s chief dietitian Lim Su Lin, who conceptualised nBuddy and nBuddy Diabetes.

The reality is that there will never be enough doctors or dietitians to provide the intensive follow-up diet and lifestyle advice that these patients need, she added.

“For instance, every diabetic needs advice for his diet and lifestyle on a day-to-day or even meal-to-meal basis. Sending individuals with abnormal health screening results to general practitioners and starting them on medication is inadequate, as the root cause (of many chronic diseases) is usually related to lifestyle, and requires changes in habits,” said Dr Lim.

This is where mobile health apps come in. They allow patients timely access to information, help them to monitor parameters such as blood sugar and blood pressure, and allow them to make small but continued adjustments in their lifestyle and treatment with the help of their doctors, said Dr Ho.

“These apps also help overcome traditional barriers like accessibility for wheelchair users and may even allow them to contact their healthcare team outside regular clinic hours. All these will result in better compliance to medical care and allow timely intervention during adverse events,” he said.

Haemophilia sufferer Tan Kai Ern, 18, whose blood-clotting disorder causes him to bruise easily and bleed internally, is among those who have benefited from the new apps.

At least twice a week, Mr Tan accesses the Zero Bleeds app, developed by biotechnology company Shire, to record his condition, treatment dosages and doctor’s visits. Such information is essential, as a missed or incorrect treatment dose could spell danger.

Mr Tan, who used to experience up to two bleeding episodes every month during his childhood, has not experienced any bleeds since he started using the app four months ago. It is currently available to haemophilia patients seen at KK Women’s and Children’s Hospital, and also allows users to share their records with their healthcare team.

“Previously, my mother would manually record everything in her diary, but there was no way to sort the dates and details properly. The pen ink would also fade over time. Now, having all the information available in my phone allows me to monitor my condition and adjust my treatment dosage when necessary,” said Mr Tan.

Logging regularly into the nBuddy app has improved 62-year-old Ahsathiamal Subramanian’s blood sugar level and helped her lose weight.

Found to be prediabetic following a health screening last year, the retired vice-principal has lost 6kg after using the app, which also allows premium users to get direct advice from a dietitian via a support chat channel.

“It made me realise why I was not losing weight previously, although I dieted. My food choices and portions were not correct. I could not believe it when the doctor told me my blood sugar level was back to the normal range after using the app for about a month. It has changed my diet and lifestyle in so many ways and I feel more energetic now,” said the first-time health app user.

NUH currently runs a three-month weight-management programme, in which participants are supported by dietitians using the app. A pilot trial conducted by the hospital found that almost all of its 40 participants lost 3kg to 5kg within three months of starting the programme.

USE MEDICAL APPS WISELY

Some researchers, however, warn that medical apps could pose risks when used incorrectly or without support from healthcare professionals.

An overseas study published last December in the journal Health Affairs reviewed 137 of the most highly rated apps targeting people with substantial medical needs.

While nearly all the apps allow people to record their health status such as blood pressure, only about a fifth reacted appropriately when reviewers entered a “red flag” symptom, such as a dangerously high blood-pressure or blood-glucose level.

“If a pedometer inaccurately measures the number of steps taken, the impact is harmless. But that cannot be said for an app that uses an algorithm to diagnose skin cancer by way of photos taken with a smartphone,” said Dr Ho.

In Singapore, mobile applications intended for medical purposes such as the investigation, detection, diagnosis or treatment of diseases or medical conditions are presently regulated as medical devices. They are subjected to regulatory controls by the Health Sciences Authority (HSA), but not those intended for general purposes such as well-being or digital log books. The new apps such as nBuddy come under the latter category.

Users should always consult the healthcare professionals for medical advice and management of their medical conditions, said an HSA spokesperson. The experts emphasised that even the most sophisticated apps cannot provide an accurate diagnosis. Regular follow-ups are also important for patients with multiple conditions or complicated diseases, and they must pair their app use with very accurate sensor devices, not just an app-store downloadable app, said Dr Lim.