organized curiosity

Improving health care through research


Mobile Health Apps – A Cautious Boon?

Mobile Health (mHealth) Applications for your smartphone, tablets, phablets, etc. are the next best thing in healthcare. We have moved from a recent push on enormous amounts of $$ being spent on Electronic Health/Medical Records (EHR/EMR) to a new trend in the building of mHealth applications that are easily accessible to the consumer. In the US alone, a report  in 2011 indicated that spending was to surge to a massive $40B in Healthcare IT and at the time were focused solely on EHR/EMR’s.

Consider the attractiveness of lightweight Mobile Apps that are inexpensive, albeit less comprehensive but a lot more consumer friendly. The last Apple Worldwide Developers Conference was also indicative that Big Business believes there to be big money in mHealth. This isn’t news, as Microsoft, Google and others have been in this space for some time now.

With all the competitors in the mHealth space, how can you stand out from the crowd? Is there a strategic way to do so? mHealth Apps if done correctly can set the stage for a consumers to take ownership and control of their healthcare. This revolution has been a long time coming.

We need to first understand the landscape of mHealth Apps. The Institute for Healthcare Informatics, in Patient Apps for Improved Healthcare noted that there were close to 43,000 mHealth Apps available on iTunes in mid-2013.  Most provide only information and 16,275 deal with health and treatment. This number has since grown and with Apple’s recent announcement, is bound to grow further with their strategic partnerships with the Mayo Clinic, IBM and Epic Systems. Detailed statistics on Mobile Apps are available at Statistic Brain.

A few strategic steps to consider are:

1 – Evidence (Data) – Use evidence to drive the development of a mobile app, as the platform is only a delivery mechanism. Consider the recent article in The New England Journal of Medicine by Nathan Cortez that asks if apps need to be regulated by the FDA to ensure they are safe and effective to use. In addition, Eric Topol also warns us of apps not having any validated data compared to accepted reference standards.

iphone apps

2 – Partner up – If you are a healthcare professional looking to develop an mHealth app, get the right development as well as design partner to help you. Conversely, if you are a designer or a developer and are looking to develop a novel mHealth App, get a health professional to partner up. To be clear it does not have to be a partnership of equity, just a partner that can help with the expertise of their subject matter be it through an equity position or through term contracts.

3 – Design for the Consumer – Healthcare professionals are tireless champions for health and I have the utmost respect for them. Designers know how to design for the consumer and their visual needs. The healthcare professional knows their consumers health needs. A group of potential users to help you through the design process will bring rigour to the final product.

4 – Marketing – If you build it, they may not come. If mHealth Apps need to reach the masses, they need to be marketed appropriately to the targeted audiences. This could take the form of partnerships with other healthcare professionals for their patients to media coverage through industry specific publications, mass media, newspapers, social media influencers, etc. to ensure a wider access and distribution medium.  Marketing takes resources and funding partners need to understand that without marketing, the app may not be used.

In the Maritimes we have seen the mobile space develop quite quickly in healthcare, with Dr. Dunbar, an Orthopedic Surgeon at Capital District Health Authority currently developing a Gait Monitoring System, hoping to reduce wait times for in-hospital appointments garnering the same information via the App, along with exercise videos, diets, etc. Dr. Kutcher, the Sun Life Financial Chair in Adolescent Mental Health and a Psychiatrist with the IWK Health Centre had the Transitions app ( developed for youth transitioning from the school system to post-secondary education providing for a free resource that has been widely used across Canada. You will also find Apps from all the major pharmacies and some from private first responders within the market. That said, there are a lot more in the pipeline that will be available soon.

-Ashwin Kutty

Full disclosure: I am the President & CEO of WeUsThem Inc. and we are in the business of designing & developing mobile applications including mHealth Apps. I will be at the Medicine 2.0 World Congress in Spain & Maui this year talking about Business in Healthcare if you would like to join me.


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A Good but not Perfect Solution for a Killer Disease

The Public Health Agency of Canada reports on diseases affecting Canadians, including the flu. As you can see in the graph below there are thousands of hospitalizations each year in Canada for influenza. In fact the data from the Public Health Agency is an underestimate because some provinces don’t report and some infections may be undetected.


As well, hundreds of Canadians die each year from influenza, as can be seen in the second graph. It is important to note that this year’s data includes up to January 10th.  It is hard to predict what this year’s final numbers will be but there is potential it could be a bad year.

Several systematic reviews have shown that flu shots are effective. That does not mean that getting a flu shot is any sort of guarantee that you won’t get the flu. It does lower your chances, however, and may make flu a bit milder if you do catch it.   In truth many medical treatments are much less than 100% effective but we still use them.

There can be slight negative reactions to flu shots, such as arm soreness or a bit of a funky feeling.  What flu shots don’t do is give you the flu because the vaccine is made from a dead virus that cannot cause the flu.


Recent reports in the media tell us that this year’s flu shot is not a great match for the virus that is currently making the rounds.  That means that it will not be quite as effective as if it were a good match. It does not mean that it is totally ineffective.

Let’s be clear on one thing. I am a psychologist, not an infectious disease specialist. So what is a psychologist doing writing about the flu?  Because behavior can be an important way to prevent the flu.

Flu spreads via droplets from coughing, sneezing or talking. It also spreads from the flu virus being on a surface and then being transferred on the hands to the mouth or nose.

People who have weak immune systems because of very advanced age or because of a disease or treatment of a disease, such as cancer, are particularly vulnerable. You never know if your co worker has a child or partner or aged parent at home who is immunocompromised.

Here are the behaviors that you can do to reduce the flu in yourself and others around you.

  1. Get the flu shot. It helps prevent the flu. If you don’t have the flu, you won’t spread it.
  2. If you are sick. Stay at home. Don’t spread the flu (or a cold).
  3. Cough and sneeze into your sleeve. Throw out tissues when you use them.
  4. Clean your hands every chance you can by washing with soap and water or using alcohol based hand sanitizers.

Don’t be responsible for infecting someone else.

~Dr. Patrick McGrath

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When I Am Ill Put Me in a Clinical Trial

Fortunately, I am now in excellent health. I try to keep it that way by moderation in everything (except I guess I work too much; this blog is being written at 7am on Sunday).  I keep moving in spite of my sedentary job, I eat well, I watch my weight, I don’t drink too much and I am happy most of the time. At my age, it is a bit unusual that I have no chronic health problems.  I did have a heart arrhythmia but it was cured at the QEII heart rhythm unit.

But I will develop some health problems and when I do, I will try to find a clinical trial to participate in.  Moreover, I will always encourage my family to find and participate in clinical trials. I even tried to sign up for the Ebola trial at the IWK but was too old for it. I sign up for as many studies as I can even if I am not sick.

Why do I want to participate in clinical trials?Research

  1. Clinical trials are a way to get new treatments before they are widely available. In addition, all study drugs are provided free of charge.
  2. Care in clinical trials is even more carefully monitored than in regular care. There are extra staff. Often times a special nurse is assigned to clinical trial participants. That means your condition is even more closely monitored.
  3. I always learn something and meet new people. This may not be a motivation for others but I think participating in research is fun and interesting. I meet the research staff and I have learned about things such as vaccines for shingles, new ways of measuring visual acuity and the benefits of blueberries.
  4. All clinical trials are voluntary. No one is ever required to be in a clinical trial and I can drop out any time without affecting future care.
  5. There is no cost to being in a clinical trials except time. In some trials where a lot of time is involved, there may be payment for participation.
  6. Clinical trials are safe. Before any clinical trial is done, many studies are completed on safety. Participants are monitored for any negative events. All trials are scrutinized by our Research Ethics Board which is made up of scientists, clinicians, ethicists and lawyers who have nothing to do with the trial.
  7. Clinical trials make a contribution to science and improve others treatments. Even if I don’t benefit from a new drug or process, I have the satisfaction of contributing important information to what we know.
  8. I never feel I am a “guinea pig” or am being denied care. In all cases, I am told exactly what will be done. In cases of important illnesses, most trials compare standard care with a new treatment that might be better. Sometimes the comparison is standard care plus a placebo versus standard care and another active drug.

~Dr. Patrick McGrath