As Smartphones Get Smarter, You May Get Healthier: How mHealth Can Bring Cheaper Health Care To All

Smartphones and tablets are transforming the future of health care. Can we really trust them to save lives?

Photo by Dan Saelinger
Photo by Dan Saelinger

The average auto refractor—that clunky-looking device eye doctors use to pinpoint your prescription—weighs about 40 pounds, costs $10,000, and is virtually impossible to find in a rural village in the developing world. As a result, some half a billion people are living with vision problems, which make it tough to read and work.

Ramesh Raskar knew fixing this problem would be tricky. It required a new way of thinking about eye tests—and a new kind of device, one powerful enough to support high-resolution visuals, cheap enough to scale, and simple enough to be used by just about anyone. The MIT professor briefly toyed with stand-alone options, which were complicated and costly. Then he reached into his pocket and pulled out an unexpected savior: his iPhone.

"The displays had gotten so good, thanks to people wanting to watch episodes of Lost in high definition," Raskar recalls. "I was immediately energized."

By creating an app and attachment for the popular smartphone, Raskar could tap into a huge existing user base and skirt millions in distribution and manufacturing costs. The result: a plastic clip-on eyepiece that uses an on-screen visual test to determine a patient's "refractive error" (a number doctors then use to dole out prescriptions). When his startup, EyeNetra, begins market testing later this year in Brazil, India, and Mexico—and eventually in the U.S.—its tech will deliver all the functionality of an optometrist's costly machine for less than $30.

This is the thrilling, disruptive potential of "mHealth," the rapidly growing business of using mobile technology in health care. Leveraging the wonders of a device that's fast becoming ubiquitous—two in three people worldwide own a cell phone—a new generation of startups is building apps and add-ons that make your handheld work like high-end medical equipment. Except it's cheaper, sleeker, and a lot more versatile. "It's like the human body has developed a new organ," says Raja Rajamannar, chief innovation officer at Humana. Smartphones can already track calories burned and miles run, and measure sleep patterns. By 2013, they'll be detecting erratic heartbeats, monitoring tremors from Parkinson's disease, and even alerting you when it's prime time to make a baby.

At stake is the future of health care—and a share of the $273 billion medical-device industry, which is dominated by the likes of GE and Philips. Although today's mHealth market barely tops $2 billion, experts predict that number will skyrocket over the next decade as smartphones get smarter and patients lose, well, patience with the high costs and hassles of health care. "Why prescribe a $1,000 test in the hospital when all you need is a heart rate?" asks Leslie Saxon, a cardiologist who heads the University of Southern California's Center for Body Computing. With inexpensive new technology, she notes, "I could tell a patient to go to the drugstore and buy an ECG [electrocardiogram] sensor for her phone."

But can we really trust our phones to dispense medical data? That's the question facing the FDA, which has spent the past year or so putting pioneering mHealth products through rigorous evaluations. "We had to show that our phone-computing platform and display quality were on par with existing devices," says Sailesh Chutani, CEO of Mobisante, whose ultrasound attachment was sanctioned in January—after about a year of costly back-and-forth. With this first wave of devices approved and a mobile-specific set of guidelines to be finalized later this year, the FDA expects to streamline its approval process, which should juice the mHealth market. "Regulatory clarity almost always drives investment—provided it's not a big, clear no," says Joseph Smith, who helps run the West Wireless Health Institute.

Whether these tools actually make us any healthier, however, will depend on how we use them. Given the ability to record our snacks, thoughts, naps, movements, and more, "we will be overwhelmed with data," warns John Moore, a lead researcher in the New Media Medicine group at the MIT Media Lab. "We need a holistic vision to make it all meaningful and motivating." Among other advances, that vision will require a seamless flow of data across myriad devices and platforms—think how the MP3 format transformed the music industry—and a physicians' movement to adopt electronic medical records. (Right now, only a third of them have.) And even then, there's no guarantee these tools will change behavior. Will we stop eating sugary foods? Or, as Smith wonders, will we just be staring curiously at "phones that show glucose readings in three colors"? Corporate titans are racing to find out. Johnson & Johnson, the world's largest medical-device maker, recently invested in sleep-monitoring technology from Zeo, a Massachusetts-based startup. Best Buy is funding earbuds that can monitor your heart rate. AT&T helped seed an employee-wellness program with WellDoc, whose apps help users manage diabetes, among other conditions. And Qualcomm, the renowned chipmaker, just launched a subsidiary that's helping to develop all kinds of mHealth devices. "Will this nascent technology attract consumers, health-care providers, and health-care payers?" says Don Jones, a VP at Qualcomm. "The entire world is keeping its fingers crossed."

Illustrations by Brown Bird Design

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  • Marelle

    I'm looking forward to reading the article in February. These kind of articles are great as to stimulate ideas on what's possible for healthcare due to mobile revolution & rapidly improving technologies. As an App developer & agency in the Netherlands I notice people starting to get acquainted with the idea of mHealth, yet there's a long way to go before they'll effectively develop such tools themselves. I hope to speed up this process somewhat!

  • catherine costa

    The technology is the enabler that supports and ultimately drives
    human behavior.  How awesome that we can
    now use technology to help people make decisions regarding their health, much
    like technology enables people to mange their money better and more efficiently.  Like the other writers I am an RN and I am
    also a fan of the ‘gizmos’.  The tools
    are here (and more to come) the catch will be to see if people embrace the
    technology and actually change their behavior. Perhaps the next level of Darwinism

  • Mark Megginson

    Excellent glimpse at the possibilities/capabilities of e-medicine for the near future. Like Trish, I'm also an RN with daily patient contact (telephone) and can attest to the need for patients to have a readily available, trusted human interface as they become overwhelmed with complex healthcare financial systems, technological advances (such as the smart phones mentioned here) and clinical data. Physicians, nurses and other health care professionals must become adept at using and explaining the significance of the information these devices generate as well as being able to respond rapidly with follow-up. The current healthcare system is too siloed (created new term-apologies) and ensconced in bureaucratic processes to effectively utilize these wonderful opportunities. A whole new day will need to dawn in the staid practice of healthcare administration before these applications can make a meaningful impact. 

  • Trish Enright

    I believe you may have missed the point, as an RN I can attest to the fact that many individuals would benefit from knowing their daily blood glucose or Blood Pressure levels to better manager their health.  Millions of people suffer long term effects of a single acute episode simply due to the fact that they didn't know they had high blood pressure or are diabetic, approx 6% of the overall population go undiagnosed with diabetes as an example. I believe more people would seek medical attention proactively or talk to their doctor if they had "proof" something was wrong instead of ignoring their symptoms

  • neil michel

    true the author loves gizmos. but let's not forget that 26 percent of the US population is about to flood the federal healthcare system during the next 19 years (yes, we have a federal healthcare system - its for retirees, and its called medicare!). anyone in healthcare will tell you there's no way the current system can deliver quality healthcare to that many more people. so our ability to take care of ourselves and our parents in the coming two decades may well depend on the ability of engineers and health providers to develop innovative new ways of monitoring and treating people remotely. [wire] stone just released a 5-year look into the future of healthcare, and to say disruption is at hand (or, as bluestein points out IN OUR HANDS) is a huge understatement to say the least:

  • Najmul Hasan

    Great article about how good the different appliances can be. Must have been written by someone who is either a great fan of gizmos or is acting on behalf of the manufacturers. The topic of the article suggests that we will become healthier by using the SmartPhones. Really ! I thought we become healthier by changing our life style our eating habits etc. Machines help to find what problems we have and fix the problems. To be healthy means to remove the reasons of the problems.