Apps And Health Care, How Do They Fit Together?

Jun 6, 2016

Nancy Furbee, of Wexford, has her smartphone loaded with apps, like many people. But she has strategically placed two health related apps right where her thumb hovers each time she unlocks her iPhone.

“Because it really keeps me focused," she said. "And every time I look at my phone, they’re a little smack in the face to remind me to not eat too many things and to really keep honest with my fitness goals."

Furbee said her friends greatly impact her app choices.

“We often pull up our phones and go through our apps," she said. "We share what we have. Sometimes we go through food logs, we talk about how to best use it, when we actually use it, how honest we are when we use it. It actually really has become part of our lives.”

Recommendations from friends might be a good place to start, especially when talking about counting calories or tracking a cardio regiment. But as the complexity of the health issues increase, so should the questions one asks about the apps, according to clinical psychologist Ellen Beckjord.

“Unfortunately … there’s really not a lot that makes use of the evidence base that behavioral medicine has built over the last 50 years,” Beckjord said.

Beckjord became interested in health-related apps 10 years ago while on a fellowship with the National Cancer Institute. Her focus was on smoking cessation apps. She said she found that many of them did little more than provide soothing music or distractions.

As mobile devices become an increasing part of our lives, apps should be able to better support someone trying to make health-related behavioral changes, Beckjord said.

Smoking cessation could be ripe for support through cell phone apps.
Credit Henrik Jensen

“Something that we think is very important is using mobile devices to collect data that let us provide information and intervention to individuals in a context-appropriate, context-aware way,” Beckjord said. “So if we are trying to help someone quit smoking, we know that the probability of you having a cigarette is not equal across the day. It’s highly dependent on the time of day or where you are, or your own smoking patterns.”

A mobile device can help to detect those factors and infer when a person needs help or deliver intervention when a person needs it most. 

Beckjord is now working with UPMC Health Plan, which plans to provide several behavioral modification apps early next year, including one aimed at smoking.

Until then, Beckjord said it's hard to tell which apps are best, but she suggests using ratings as a guide. 

App makers focus on pregnancy and early childcare 

It seems like there isn't a phase of life into which app developers haven't ventured. There is something on iTunes or the Google Play store dealing with life from cradle to grave. And in the case of an app developed by Magee Hospital, there's one for before the cradle. 

Beckjord said knowing that the app is backed by the Magee name has given women across the country a certain level of trust in it.

“When you look at the generation we have in their 20s and 30s, of child bearing years, they are very oriented to computers and systems,” said Patty Genday, executive director of women's services at Magee Hospital. “We utilize this to help women understand their pregnancy and make it fun at the same time.”

The app offers information on the size of the fetus and the changes occurring in the mother and child, but it also deals with issues like nutrition and the signs of pre-term labor.

“So, if you have any of these signs and symptoms you can contact your physician immediately and we can intervene," Genday said. "Because we know the baby has the best outcomes with early intervention if something doesn’t go as we expected it to go during pregnancy."

There are also apps aimed at parents looking to care for their newborns and toddlers. Among them are Today's Parent's My Family app, Baby Medbasics, WebMD Baby for infants. For toddlers, there's Potty Training with the AnimalsAwesome Eats and Kurbo Health Coaching & Tracking.

As they get older, there are apps that help with those troubling teen years, including THRIVE, HealthYI and MindShift and, of course, menstruation.

As teens spend more time on their phones apps looking tom help them make healthy choice are also increasing.
Credit Ed Yourdon

Apps to track menstruation   

Period trackers abound in the app world. The Hormone Horoscope puts an additional spin on the idea. It was developed by freelance women’s issues writer Gabrielle Lichterman. She said it all started when she came across a study showing that women prefer more masculine looking men during certain portions of their cycle. 

“If there was this one study out there that was this interesting, there had to be a lot more like it," Lichterman said. "So I went digging and sure enough there are just hundreds and hundreds of studies that show how women’s hormones impact us in virtually everyway, in a different way every single day of our cycle."

From that research, a book was born. But Lichterman said carrying around a book is cumbersome and they're not easily updated with the latest information. That's why she created an app that adds what she calls a hormone horoscope for every day of a woman’s cycle.

“Including their mood, their energy, memory, their libido, their sleep habits, food cravings and even what they are going to shop for,” Lichterman said. 

Lichterman said she realizes there are hundreds of other factors that impact a woman’s day. And though she isn't a doctor, she said she's spent a lot of time doing research. 

Tracking fitness and health goals 

Individuals with years of practical experience, but who maybe aren't doctors, tend to delve into the fitness app sector. 

Josh Proch and Tammy Zubasic are co-owners of Pittsburgh North Fitness in Warrendale and have each spent more than 20 years in the fitness and training industry. They developed an app that helps their members with scheduling sessions and offers announcements about events. But Proch said, for everything else, their clients turn to other apps. Despite seeing common ones like Endomodo, Fitbit and My Fitness Pal, Proch said he has a hard time making recommendations.

“If somebody is using one app and they’re not liking it, just try something (else),” Proch said. “Just do a search and there’s plenty other ones out there. I will say usually the ones that you have to pay something for are probably going to be a little bit better than a freebee, or something like that. I think that’s standard with most apps.”

Why it matters which app you use

Just going with which app you prefer isn't always the best option. The American Diabetes Association has seen the rise of apps intended to help people manage their condition. Jane Chiang, ADA senior vice president for medical technology, estimates there are 1,200 diabetes-related apps out there, making it nearly impossible for her organization track them all.

Controlling diabetes could be supported through the use of apps.
Credit Ms Hellyer

“If you have diabetes and there is a diabetes app that recommends certain medical stuff ... check with your doctor to make sure that it is a legitimate app," Chiang said. 

Chiang said the ADA is also in the process of trying to figure out the best way to help improve the quality of the apps available on the open market and has plans to make an announcement later this year. 

Chaing said a patient will see a doctor for about seven minutes and then spend the next 2,000 to 5,000 hours managing their condition on their own, so apps could be a huge help. But what about those who can't easily access and use smart phone apps?

An app program for those without smartphones or mobile devices 

Pittsburgh-based Wellbridge Health has created an app and entire system aimed at helping low income individuals dealing with chronic conditions like diabetes and heart disease. The company contracts with insurance companies that provide policies to Medicaid customers.

Wellbridge sets up an in-home meeting, provides an iPhone 6 plus loaded with its app, and a few others that could be beneficial in dealing with the client’s condition, and any appropriate bluetooth-enabled devices such as a scale, glucometer or fitness bracelet.

“You weigh yourself and (the app) asks, 'Are you dizzy?' And there are pictures,” said Cynthia Zydel, Wellbridge CEO, as she uses a heart disease patient as an example. 

The app goes on to ask, “How did you sleep? Are you short of breath? Are your ankles swollen?” For each question it offers icons as choices rather than words or numbers. 

It then asks, “What was your mood yesterday?” 

“We added the depression question because we had such a predominance of depression in this population,” Zydel said. “And then it says, ‘Thanks. You’re all done.’”

From there, it takes a few reading from the fitness bracelet and sends it all back to a social worker for review. A nurse is brought in to consult on any medical red flags and once a week the social worker checks in with a live video chat. 

In a six-month pilot, Wellbridge was able to get 93 percent compliance. 

Zydel said since the clients are all living at or below the poverty line, the company decided it would be best to give each of them a free phone and data plan. Zydel said not only did it make it possible for the system to work, it also came with the added benefit of helping clients connect to loved ones, doctors and other service providers.

Mental health patients could find help through cell phone apps between visits to their doctors.
Credit mattwalker69

Zydel said mental health issues can be a big problem among those with chronic conditions. Highmark Health has recently partnered with the technology company Quartet to help look through patient records to connect medical doctors and psychologists when it comes to caring for patients with one foot in each world. Psychiatrist Duke Ruktanonchai said the goal is break down those silos and help improve overall patient care. 

Part of the partnership also includes building an app aimed at helping behavioral health patients deal with their conditions between visits with their therapists. 

“So that they are working on something every day of the week,” Ruktanonchai said.

Ruktanonchai said the hope is that the activity provided by the app is tailored to the individual’s needs in real time based on a few simple questions. 

End-of-life care

Hospice and end-of-life planning has also become an ever more popular subject of discussion, especially among baby boomers. The Jewish Healthcare Foundation, which is a sponsor of WESA’s Bridges to Health series, is spending a lot of time researching end-of-life issues. 

Chief Program Officer Nancy Zionts said it's never too early to start talking about advance care planning and some apps can help.

“It helps them understand that they have choice regarding comfort care measures or for people to understand what code status is for example or what hydration is,” said Zionts.

She said apps also help individuals think about what information to include in advance care planning documents and how to store them. Some apps even hold the documents allowing first responders to find them in the case of an emergency. 

Zionts said there is no one perfect end-of-life planning app, but she said the best usually come from well-known names like the American Bar Association. She also recommended Cake, Stanford Letters and Best Endings.

Though she said no app should replace talking to a doctor or loved ones. 

Health care coverage on 90.5 WESA is made possible in part by a grant from the Jewish Healthcare Foundation.