SG IM FO RUM 2016; 39 (6 ) SHARE NEW PERSPECTIVES: PART I Mobile Technologies to Facilitate Self-Management of Chronic Conditions: Current Favorite Apps from Medical Students McKenna Longacre, Alexander Kazberouk, Luccie Wo, and Leigh Simmons, MD

Ms. Longacre, Mr. Kazberouk, and Ms. Wo are third-year medical students at Harvard Medical School. Dr. Simmons is a primary care internist and clerkship director at Massachusetts General Hospital in Boston, MA.

met Mr. R on my ambulatory keted toward a relatively young, ing to Pew Research Center data, Imedicine clerkship. He is in his tech-savvy, and affluent crowd. We “[s]ome 13% of Americans with an late 70s and has multiple illnesses, contend that smartphones have a annual household income of less including poorly controlled diabetes tremendous potential to help older than $30,000...are smartphone-de - and depression. He lives alone and adults live happier and healthier pendent [versus] just 1% of Ameri - continues to actively participate in lives as well. cans from households earning more community activities. We started A common misconception is that than $75,000.” 1 Furthermore, “12% discussing the challenges he faced technology is beyond the reach of of African Americans and 13% of in managing his diabetes with diet many of our elderly patients. We Latinos are smartphone-dependent, and exercise. In the winter, he felt have observed that older patients compared with 4% of whites.” 1 uneasy walking or driving on ice, are increasingly engaged with tech - Finally, the smartphone’s ubiqui - making it difficult to go to the gro - nology—they show us pictures of tous presence in the pockets and cery to buy healthy food. He thus their grandchildren on smartphones, purses of most Americans means ordered takeout several times a they use pill-tracking apps to keep that emergency personnel have a re - week. While he was talking, I track of medication use, and some liable means of obtaining essential started imagining how I would solve spend many hours on social media information: Comprehensive medical some of these problems. The an - applications such as Facebook. In information can be stored on all swer in almost every case was to fact, many apps are not only acces - iPhone and Android smartphones, pull out my smartphone and get to sible but also easier to use than tra - providing ready access to emer - work. This patient had a smart - ditional means of interacting with gency contacts and important med - phone with him, so I asked him if the environment. For example, it is ical details. (No phone passcode is he had ever tried to use an applica - arguably easier to press three but - required to access this medical ID.) tion on his phone to order grocery tons on a phone to request an Uber Even simpler is instructing patients 1 delivery during inclement weather. than to find a phone book, look up to place a label on their phone with He looked at me and said, “You can the number of a cab company, and their name and emergency contact do that?!” correctly identify your address to a information; this is a practical low- Most Americans are becoming dispatcher. Challenges with mobile tech identification method that can accustomed to using smartphones applications for older adults include be used regardless of phone type. to pay for purchases, track finances, risk of privacy violation, potential for During the visit, our patient call cabs, buy goods, read news, excessive spending with a “virtual” downloaded the Peapod ® app, and connect with others. Nearly shopping cart, and rapidly changing which he now uses to have gro - two thirds of Americans own a application interfaces, but none are ceries delivered to his home during smartphone, and nearly 20% rely on insurmountable with effective sup - the winter. As our visit ended, I felt smartphones for accessing online port and teaching. gratified knowing that even as a ju - services. Not surprisingly, this has Another misconception about nior member of the team, I had this fueled runaway development of ap - smartphone use is that it is limited unique knowledge to share with my plications that allow users to easily to those who have significant finan - colleagues and patients. I was able access the Internet to coordinate cial resources. In fact, recent stud - to help my patient at the point of activities of daily living. Smartphone ies have shown that smartphones care with something that would pro - technology is also successfully are most readily—and consistently— vide him healthy food, peace of moving into the health care sector: used by those with the least finan - mind, and a bit more independence. “Already 62% of smartphone own - cial resources. In fact, vulnerable Table 1 lists applications that clin - ers have used their phone in the populations are more likely to be en - icians can share with their patients past year to look up information tirely smartphone dependent as and their caregivers to assist in about a health condition.” 1 Today, they have no other reliable Internet streamlining their activities of daily these applications are largely mar - connection or online access. Accord - continued on page 2 SHARE

NEW PERSPECTIVES: PART I continued from page 1

living and socialization with the addi - be geographic variation in availability Reference tional aim of facilitating chronic dis - of each of these services, and cer - 1. Smith A. US Smartphone use in ease self-management. This is a tainly this is a list that should be up - 2015. Pew Research Center, snapshot view of applications that dated frequently as new ones are April 1, 2015. are currently in wide use. There will developed. SGIM

Table 1. Applications Facilitating Disease Self-Management

Issue Application Examples Use Case Considerations

Transportation Lyft, Uber, Sidecar, • Frequent short trips during a • Surge pricing can lead to unexpected Boston Cab (many time of disability (e.g. to physical expenses. local cab companies therapy) can be easily managed. • Name and address are made known to now using ride- • Receiving specific pick-up times drivers, perhaps raising safety concerns. hailing apps) in inclement weather may be more feasible than with traditional cab services. Food delivery Instacart, GrubHub, • People with mobility impairment or • It is not possible to examine food prior Peapod, Foodler who stay in because of inclement to purchase. weather can still have access to • Social benefits of shopping or dining healthy food (i.e. prepared or out are reduced. grocery delivery). Housing AirBnB, HomeStay • A patient traveling to the city for • This choice may not meet the expectations an extended course of outpatient of patients who are used to overnight treatment (e.g. radiation therapy) accommodations in motels or hotels. may find home stays less expensive • Accessibility of the unit must be assured than hotel lodging. prior to the stay. 2 Communication Skype, Facebook, • In times of serious illness or infirmity, • Sharing private data (i.e. location, financial WhatsApp people can stay in touch with family data) online may raise safety concerns. and reconnect with friends via social • Video calls can lead to data overcharges media and free video calls. on typical phone plans. Medical Amazon • A patient who is managing wound • Flexible spending accounts can help MyHealthCare care at home can order most with online medical purchases. Wishes App needed supplies from Amazon or • Documents can be faxed or e-mailed from (American Bar other online suppliers. a smartphone to a health care provider; all Association) • Important health care documents documents are stored on the phone, are always with the patient, avoiding not on a cloud or server. the need to search a file cabinet or access a safety deposit box.

SG IM FO RUM 2016; 39 (6 )