A pocket full of ODLs

Posted July 27, 2009 by Jason Rothstein and Lygeia Ricciardi 

Easy, anywhere access to tools and health information is a key aspect of many Project HealthDesign projects. Grantees in the first round have explored ways to embed health-related functionality into a wealth of interfaces and devices, including smartphones, which are among the most common devices most patients encounter every day.

The use of smartphones to host health applications is compatible with the platform model Project HealthDesign promotes for PHR applications generally. Blackberry, Symbian, Palm, and Apple devices, among others, support application services, with an increasing number of health applications.

While Project HealthDesign doesn’t endorse smartphones over any other platform—or any particular type of smartphone over others—the Apple iPhone is currently leading the pack when it comes to apps.  There are now more than 60,000 iPhone apps, with the pace of development accelerating. Google’s Android operating system has 5,000 apps, and Nokia and Blackberry have roughly 1,000 each, according to Slate Magazine.

The iPhone may provide certain clues about where we’re headed in the mobile PHR space. And some of these clues may challenge our assumptions about how consumer use of personal health records (PHRs) will grow in the future.

The iPhone App store is full of apps that give users access to sophisticated online services: eBay auctions, Netflix rentals, Paypal transactions, banking, blogging, Facebooking… the list goes on. But curiously, the major PHRs don’t yet have much presence on the iPhone — or on any smartphone platform. Among the most common PHR platforms, only Google Health has a meaningful iPhone presence, through two third-party applications: 1.) Health Cloud, which delivers a view of the account holder’s PHR, somewhat optimized for the iPhone’s screen with limited functionality for users to add new information, and 2.) MotionPHR, which bills itself as a standalone mobile PHR that also integrates and syncs with Google Health.

A quick search through the iPhone app store suggests that most of the 1,500 or so health apps offered focus overwhelmingly on collecting, tracking, analyzing, and even sharing both traditional clinical measures of health and Observations of Daily Living (ODLs) — but not on integrating them with a more robust PHR. (ODLs are consumers’ or patients’ own measures of their health related to factors that they define as relevant. Examples of ODLs include sleep patterns, fluctuations in work-or home-related stress, and exercise/eating patterns.  These observations differ from patient capture of physician directed data, for example, in that they are often uniquely meaningful to the individual.

By far, the most common health and ODL tracking applications in the app store concern weight and nutrition: weight trackers, BMI calculators, calorie counters, and exercise loggers, in almost endless combinations. While some, like the stylish Weight Bot, try to appeal though simplicity, others enhance user experience with added features.

For example, Health Cubby combines weight tracking with exercise goals, simple nutrition records, and the added ability to connect with other people using the same system to provide reinforcement and incentive to stay on a program. Others, like SparkPeople Food & Fitness Tracker, and Livestrong.com’s Calorie Tracker add an iPhone interface to existing social fitness web sites. (It’s tempting to wonder if this social approach to weight loss and exercise goals might have potential for disease management too.)

Just as weight looms large in the imaginations of iPhone app users, so too does one potential consequence of poor weight management: diabetes. One of the more popular programs, Diabetes Pilot, first appeared on the Palm platform many years ago, and also integrates with a Windows-only desktop tool. But the iPhone platform has spurred the development of new applications like Glucose Buddy, an app with a heavy emphasis on combining ODL input (such as exercise and diet) with blood sugar levels to produce easy-to-understand reports for the patient. In the future, smartphones could also link with glucose management hardware to collect data and offer patient feedback, like the system envisioned by the winners of the 2009 DiabetesMine Design Challenge. 

Given the iPhone’s contribution to the explosive growth in smartphone use among women, it only makes sense that reproductive health apps make up another sizeable category. The app store features more than a dozen simple menstruation logs, including the popular iPeriod, and Period Tracker, which incorporate ODL fields to record indicators such as fatigue and mood.  Another several applications, like FemCal, expand on these features to emphasize ovulation timing and fertility, and track pregnancy test results. Still others track pregnancies themselves, like Pregnancy Calendar, which offers fields to record information both about maternal and fetal health indicators. (And then of course, after nine months, Baby Activity Logger helps new parents record ODLs on baby’s behalf. Can Fisher Price’s My First PHR be far behind?)

TheCarrot.com, an app that integrates with a site of the same name somewhat blurs the line between a simple ODL app and what many would consider to be a full-fledged PHR. TheCarrot.com combines a comprehensive set of trackers for clinical health indicators and ODL indicators such as mood, energy level, sleep, and anything else that fits into its journal format. TheCarrot.com also has additional features for disease management, medication management, and some types of lab results. It also incorporates sharing functions both via the web and through simple printable information sheets that patients can take with them to a doctor’s office.

 

Comments

[Gangadhar]

Hello

Thanks for the good review of ODL tracking iPhone apps. We have an application which is missing in this review - hLog. This is similar to thecarrot.com app in that the app helps the users to capture and track their ODLs. The advantage over the thecarrot.com app is that our app does not require internet access to operate. We wanted to keep the app simple so that users can use it on either iPhone or the iPod touch. I hope you will include our app in your next review.

Thanks

[Katie]

I find it fairly narrow minded (?sexist?) to discuss reproductive applications in the same sentence with the growth of women using smart phones. Especially when the article you cite largely deals with women using smart phones to coordinate their families and busy schedules (not their periods!).

If you are going to degrade women's smart phone usage to reproductive applications, then you should equally degrade men's smart phone use - for example there are three iphone applications available to help with pick-up lines, 10 applications to help find a date, and four applications to help stalk dates.

Better yet, maybe more thought should be put into writing...

[Lygeia Ricciardi and Jason Rothstein]

Katie --

Thanks for commenting. If we gave the impression that we thought that women were adopting smart phones because of reproductive health apps, that was not our intention. In fact, we intended to give the opposite impression, namely that as smart phone use rises among women, it's only natural that the offerings in the app store change to meet the demands of these shifting demographics.

You're correct in pointing out that these apps aren't the only examples of 'gendered' applications in the iPhone app store, but at least in the category of health generally, and Observations of Daily Living specifically (the subject of this post), we find no real equivalent category to reproductive health, something we can only hope changes in the future.

As for the discussion of using smart phones to coordinate family schedules and work-life balance (per the article we reference), we'd argue that that's a topic that should, ideally, be of as much interest to men as it is to women.

- Jason & Lygeia

[Jeff Brandt]

motionPHR clarification:

Thank for the mention of motionPHR for the iPhone. We offer a mobile PHR that you can store all of you PHR data securely on the phone itself. We are just compatible with GoggleHealth but we are working on a connection to MS HealthVault. GoogleHealth currently only offers a subset of the CCR data. HealthVault since the release of our product over a year ago has made great strides in the PHR market. It is now our chosen vendor.

I have also written an article on
Smartphones for medical applications that you may enjoy.
http://motionphr.com/blog/

Jeff Brandt
www.motionPHR.com