TIME TO GET SMART ABOUT PHONES*

I own a smart phone.  I am generally regarded as an un-smart owner, especially by my younger generation. This may be rampant ageism but it is also correct. My iPhone is largely wasted on me, the youngsters say. At least I can phone, send and receive text messages, send and receive email and on rare occasions, when need overtakes concerns about cost, I access Google, Wikipedia and other brain aids for the feeble and dementing. Hey, guys, I am not that bad.

Not so many years ago I recall a debate in The Economist about the future of the mobile phone. If I recall correctly that paper thought (though as usual it hedged its bets) that the search for a phone that would have computer-like features was an aberration. Too much complexity.  People would not fiddle around with tiny keyboards and fiddly screens. Bad investment. Well: welcome to 2012. 

When in India last year, I met with an executive of one of the Scandinavian mobile phone companies that are finding their fortunes in that highly electronically-literate country. Pyramid Research estimated that the addition of 125 million net new phones each year between 2010 and 2015 will ‘bring the total number of mobile subscribers to 1.2 billion in 2015’. 


The Pyramid report on India continues: ‘The exponential mobile subscription rates are driven primarily by the increasing adoption of 3G and mobile services such as music, video and broadband access,’ and mobile data services revenue is predicted to grow [by] 27.3 percent. No wonder the woman from Scandinavia was smiling.


I was in India helping review a program focussed on maternal and child survival a principal component of which was the deployment of may hundreds of thousands of minimally-trained women to assist other women during their pregnancy, encouraging them to give birth near or in a facility that could managed haemorrhage and basic neonatal support. They were paid virtually nothing, but what they were paid came to them through their phone accounts.  They were able to cash in the credit at a store.  No bank was necessary, which was lucky because in remote regions there were none.


The mobile phone put these support women in immediate touch with specialists for advice, transport and help. They were also given bicycles.


It is easy now to imagine or indeed, see, how smart phones could hold personal medical records, monitor basic physiological functions in those say with a cardiac pacemaker, calling for appropriate help automatically in a crisis, and remind owners about medications and clinic appointments. Photos taken with a phone camera can be transmitted to physicians and used diagnostically. Kaiser Permanente in California makes extensive use of mobile telephony among its millions of subscribers and their carers. A pesky rash can be photographed by the patient at home and emailed to the primary care physician who may diagnose directly or seek the advice of a dermatologist.

When I visited, an orthopaedic surgeon asked my group how much we thought it cost to review a patient six months after hip surgery.  We offered a comment based on an x-ray and a consultation – let’s say $500-$800.

“Well,” he asked us, “How much does it cost the patient – half a day’s work to get to the appointment, wait for the consultant, see him or her for five minutes and then probably not go back to work that day. That all adds up – for someone.  And while the consultant is seeing the patient and telling them all is well, they are not doing something else that matters.” 

He then told us what happens at Kaiser. Near the six-month mark, the patient receives an SMS text gently reminding them to get an x-ray.  The radiology services (they have no appointments – just turn up) closest to where they live and work would be identified for them. A questionnaire is emailed to the patient seeking information about pain, mobility and other concerns. 

The x-ray image is emailed to the surgeon who reviews it with the questionnaire responses on line.  If all is well the surgeon texts the patient giving them an encouraging report. No-one has wasted time on things that do not need to be done, especially inefficiently. But notice this: the physician is central to this process and all the electronics do nothing but enhance the importance of his or her role in the care of the patient.

The use of smart phone applications is increasing daily and can be used preventively .  Bruce Neal and colleagues  at the University of Sydney’s George Institute for Global Health have developed a really tricky app with BUPA called FoodSwitch http://www.bupa.com.au/health-and-wellness/tools-and-apps/mobile-apps/foodswitch-app that enables the food-wise purchaser to see exactly what they are buying. By pointing the phone camera at the bar code of a can of beans or whatever, immediate information about fat, salt and sugar content, and alternative choices, shows up on the screen.
Bruce Neal was quoted as saying, "FoodSwitch's three-step approach marries the latest technology with cutting edge research. Australians can now scan barcodes, see what's in a food, and switch to a healthier choice in an instant. The application makes recommendations based on the nutritional value of more than 20,000 packaged food products found in Australian supermarkets.”


My health, and the health of billions, is coming to depend on smart phones. 


*Published in Aus Med