Are People Really Self-Tracking?

Even this topic brings out a lot of disagreement. Some think it should be more, others don't think it is growing fast enough, and others feel it should not be increasing. My blog here near the bottom may indicate why as people are encountering insurance problems. This is not addressed in the study and may explain why the growth rate is not growing faster.

In 2012, the Pew research people found that only 11% of adults track their health using mobile apps when only 9% were in 2011. The questions now being asked are relevant and more discussion needs to be sought. Pew is also saying cell phone usage is increasing about 20% a year, but mobile app usage is not.

Since this topic is gaining momentum in the blog world, I thought I would do a little unscientific research on my own. I stopped by a Radio Shack in a town about 30 miles distant and asked the manager of the franchise store about cell phone purchases and he said that mobile phone sales were increasing; however, cell phone app purchases were declining. He said that until recently, he had wondered why. Then one day a regular customer brought by an article showing that medical insurance companies were using data that they could collect from medical apps to help set individual insurance rates. He said this is why he is being requested to deactivate many medical apps and some other applications that could have medical uses. He estimated that for every medical app that he sells, he deactivates seven others.

He went on to state that some cell phones brands are not selling because of an article in an out-of-state Sunday paper showing a list of medical apps that were included on the cell phones and insurance companies were capturing this data.

In talking with another cell service company, they deactivate all medical apps and medical related apps now and only activate the ones that a customer wants. In talking to two different doctor practices, they said they are not equipped to receive medical data from any device currently, so they advise all their patients not to use cell and other mobile devices to collect data when they don't know where the data goes.

So it is rather obvious to me that we need to be cautious about our medical data and who has access to it. While my information is not scientific, it does convince me to be extremely careful if I ever upgrade my cell phone.

What Patients Desire From Mobile Apps

This is a great blog on mobile apps. Please read it at your leisure. There are some additional cautions I would add to what the author says. If you think I am on my own crusade to warn people about mobile apps, you would be right.

#1. Do you know who owns the mobile app? Unless you have carefully researched the app, read the user agreement, and know that you have certain rights only to the app, you may not know who now owns the app. Many of the more popular medical apps are purchased by medical insurance companies so that they may access the data. Also many companies cooperate to make the data available to other companies.

#2. Do you know if the app works with other apps? Why own an app if you have to manually enter everything from another app. This is one time that I can say that I turned down an app from a pharmaceutical company because I would need to enter my blood glucose readings manually and still not be able to upload the information to my computer or to my doctor. I already am able to upload my meter to my computer and print our the data, graphs, and trend analysis for the doctor, but even this is not necessary as the office can do this as well. This app was promoted by the company as being important and a time saver for me. Not. I told the representative that he was blowing smoke and that his company's app was useless for me.

#3. Will the app integrate with others apps and do it seamlessly? With the proprietary apps of today, this is very unlikely and most are developed for a single use only. Until we, as patients, demand that apps work with other apps, it is highly doubtful you will find any app working with other apps.

#4. Will the data be stored only on your mobile device or will it be available to remote apps? This is a question that needs answering. You do not want your medical insurance company to be able to access the information without you knowing it. Who else might have access to the information? This is an important consideration.

#5. Is this an app that your doctor will use for the data or will he/she just toss the data? This is a tough question to answer and even your doctor may not know.

#6. Is there a cheaper method of collecting the data? Sometimes the doctor will suggest just using a pad to write the data on and especially if it is for a short period of time. At times like this, an app may be an unnecessary expense.

#7. How often is the app upgraded or updated? This is a question to be answered. Many apps are frequently updated as the manufacturer seeks to gain market share. With the time taken to become familiar with some apps, do you want to continue to relearn parts of the app after an update. Or if you have a area that you like to have the app open to and this is changed in an update, will you appreciate this.

#8. Will the app bring advertising to you that you don't want? Some apps will flood the purchaser with advertising. If this is something you don't want, avoid the app.

#9. Will the app help reach a medical goal? This could be the most important question. If it will be a help, make sure that #1, #4, #5, and #6 above do not negate the need.

These are a few of the traps in the use of mobile apps and there are many more. I hope these will help you in not getting into the wrong app and encourage you to do your homework before getting caught in their traps.

Who Owns Your Medical App?

I don't mean you, even if you are the one physically in possession of the app. I am talking about the one that owns the rights to the app or where the data it generates is stored. These may be owned by different companies, both with conflict-of-interest issues. Because I do not own any medical apps, I can only tell you what a friend had happen to him. He purchased the app from Amazon, and started using it. About two months later he received a notice that his insurance will not be covering his condition because he is not following his doctor's instructions.

Now he is confused, as he thought he was doing everything correctly, and he contacts his doctor and discovers he is doing everything like he was told. He took the notice to his doctor who wrote a letter explaining that he is following his directions. Approximately a month later he received another letter stating that his monthly premium will be increasing by what amounts to one and one half times what it had been. The reason given is that his results are not in the range they should have been for the medication he is taking.

Because he has an appointment the next day, he took the notice with him. When the doctor completed the appointment, he showed the doctor the notice. The doctor knows immediately what the problem may be. His doctor asks him if he is using (names the app). My friend said he hadn't told anyone and especially not his doctor. This surprised even me, but it turns out that the application was owned by one insurance company and the data storage was owned by another insurance company. Together they had purchased several apps and storage rights to the data generated.

The doctor said he had several patients that were caught in this system. What the outcome will be, I don't know. Even my friend does not know what will happen. He has receive a third letter stating that his premium will not go up, but is waiting for the next bad news letter.

My friend has stopped using the app and says he will not buy another medical app. His doctor says that in the future, he needs to find out who owns a piece of each app before purchasing it. I am relying on my friend for the information that he provided, but this points out problems we need to be conscious of when purchasing and using medical apps.

Trisha Torrey who writes for About dot Com tells a different concern about the use of data by an insurance company. I would urge you to take time to read her information here. This also points out the need to be aware of where the information generated by the app you purchased in good faith, is being used without your knowledge. I agree that none of us would trust an insurance company with our personal medical data although we have to get claims paid, but they don't need every medical detail generated by a medical app.

In my research and reading, I do read several doctor blogs and blogs by people in health information technology (HIT). Many are talking about medical applications, but only as they relate to integrating the information into your electronic health record (EHR). They have not even been concerned about who else had access to this information. The doctors are only concerned about what they may gain from the health app without expending funds.

The next five to ten years will be very interesting with the proliferation of medical applications. I will be watching to see if we see more of what I have described as I can believe with all the greed that many companies have, we will need to be very careful how our personal data is captured and used. The other area of concern needs to be how well future applications are able to work together and if we can avoid the overly proprietary applications available today.

Diabetes Tips and Applications

The previous month, I received an email asking questions that are quite common and important for people recently diagnosed with type 2 diabetes. First, this person wanted to know why he was having such a difficult time managing his diabetes. This reminded me of my blog here. Then he wanted to know if there were any applications that he could use to upload the readings from his blood glucose meter to his doctor. There were several other questions which I have answered in my emails with him and I may do another blog on reasons for using insulin and for avoiding some foods.

In exchanging emails, I discovered he was following the directions of a registered dietitian (RD) and eating the high carbohydrate – low fat meal plan. He also was still attempting to determine what I was talking about in self-monitoring of blood glucose (SMBG). He stated that the certified diabetes educator (CDE) had covered testing and how to do it and then just told him to test one hour after finish eating and moved on to confirm what the dietitian had told him about eating a set number of carbohydrates at each meal and snacks. Sounds like a mandate to do something without really educating him about the why, where, when, and how to use the results.

Is it any wonder I get upset with these “professionals” that cannot do education and live by mandates and mantras. I will not go any further with this, but get back to SMBG. I explained why we test our blood glucose so often at the beginning. This is done to determine how our bodies react to the foods or combination of foods and testing is the only way to determine this. His return email asked why the RD or CDE had not explained this to him. I explained to him that the CDE must tell him about testing and where to test, but generally this is where they stop, as they do not want you to realize the benefits of testing and finding out how the foods affect your blood glucose levels.

Of course, the RD will not explain this, as they want you to just follow their instructions without question. It is using the knowledge you gain from SMBG that tells you how the different foods affect your blood glucose levels and this in turn will let you know that what the RD and CDE issue in their mandates is not the whole truth. Some of the foods will spike your blood glucose readings to a high level. This tells you that you must limit the number of carbohydrates by reducing the quantity of these foods or removing them from your food plan. In addition, you will be looking for different results from different food combinations and also for determining if you are on the correct path to achieving your goals. If you are not moving in the right direction, as was the case for this person, you need to reevaluate the food plan and see what needs to be changed.

For this person, I suggested removing most whole grains and all highly processed foods. He reported back about a week later that his blood glucose levels were greatly improved and he had also reduced the quantity of potatoes he was eating. His fasting blood glucose levels were generally under 100 mg/dl and most of his after meal (post prandial) blood glucose levels were under 140 mg/dl. He was still having some problems with his evening and bedtime testing, but felt that with some additional reductions in food quantities and changing foods this was improving. His final comment was how much better he was feeling and that he was not gaining more weight and actually dropping a few pounds.

He commented that he felt he was gaining more benefits from his exercise and felt this was also translating into better blood glucose readings. Next we covered applications for transferring information from his blood glucose meter to an app and then on to the doctor. I discovered that he travels within a block of his doctor's office to and from work and asked if his doctor could read his meter. He checked and found out that his doctor could and had the software program to download his meter. They talked about how often the doctor wanted to do this and over the six weeks we have been corresponding, the doctor is happy with his readings and now has him doing it only at his appointments.

I had suggested that he purchase the software program and download the meter readings to his computer on a monthly basis. After comparing the two apps he had discovered, plus the cost of a new cell phone to handle the application and needing to manually log his readings to the application, he feels very good about not having purchased any and that the software cost was much cheaper, he wonders why he had not thought of that in the beginning. He now has the software download his meter daily and he is able to compare readings for the preceding week and any period of time.

He admits that he still has trouble maintaining his food log and health log, but as he solves more problems, he says that is getting easier as well. He is comfortable with his daily carbohydrates being in the 120g to 160 gram range and very happy that his weight is nearing the goal he and his doctor wanted. We have discussed his activity (exercise) level and carbohydrate level and he says that he may increase the carbohydrate level to avoid losing excess weight below the goal. He does not want to reduce his exercise level, as he feels good about this now.

He has a job that keeps him fairly active and is not a desk jockey. This helps him and he now feels much better with how he is managing his diabetes. His last A1c was 6.5 which is down from the 8.9 at diagnosis. He is now gaining confidence that he will get to 6.0 or lower in the months ahead. He is asking many good questions now and gaining confidence that he will be able to learn more on his own. He has canceled the next appointments with the RD and CDE, because he feels they would not be a help to him. I said that was up to him, but that maybe he should have kept the CDE appointment to see what was said, but he was determined not to waste any more time with them.