Smartphone As a Personal, Pervasive Health Informatics Services Platform: Literature Review

83 © 2012 IMIA and Schattauer GmbH Smartphone as a Personal, Pervasive Health Informatics Services Platform: Literature Review K. Wac University of Geneva, Institute of Services Science, Quality of Life Group, Geneva, Switzerland 1 Introduction 2010 and 12 billion in 2011 [5]. Be- Summary sides the dedicated smartphone apps, Objectives: The article provides an overview of current trends in per- A ubiquitous availability of personal users can access web-based content on sonal sensor, signal and imaging informatics, that are based on mobile devices and high-capacity wire- their smartphone, i.e., websites with emerging mobile computing and communications technologies less networks enable innovative appli- information, gaming applications or enclosed in a smartphone and enabling the provision of personal, cations in different aspects of our daily positioning and navigation services. pervasive health informatics services. life, e.g., communication, education or Furthermore, as we have investigated Methods: The article reviews examples of these trends from the entertainment. Over the past decade, in one of our large population studies, PubMed and Google scholar literature search engines, which, by no particularly smartphones become more people carry their smartphones around means claim to be complete, as the field is evolving and some recent prevalent, e.g., 50% of U.S. mobile almost all the time with them [6]. advances may not be documented yet. phone users had a smartphone at the In parallel, an increasing availabil- Results: There exist critical technological advances in the surveyed end of 2011 [1] and 300 million ity of smartphone built-in (e.g., mag- smartphone technologies, employed in provision and improvement smartphones were being sold world- netometer, accelerometer, air pressure), of diagnosis, acute and chronic treatment and rehabilitation health wide in 2010 [2] and 500 million are as well as external sensors, capturing services, as well as in education and training of healthcare practi- predicted for 2012 [3]. At the end of different phenomena (e.g., electric, tioners. However, the most emerging trend relates to a routine appli- the 2011, there were more smartphones magnetic, electrochemical, mechani- cation of these technologies in a prevention/wellness sector, helping sold in the US, than PCs [3]. A cal, thermal and optical), enable a de- its users in self-care to stay healthy. smartphone is different from (low-end) velopment of new sensor systems for Conclusions: Smartphone-based personal health informatics services feature phone, as the former has larger measurements of a state of a phone user exist, but still have a long way to go to become an everyday, person- computing power and storage capabili- and his/her surrounding environment. alized healthcare-provisioning tool in the medical field and in a ties, as well as a set of advanced fea- Particularly there exist sensor systems clinical practice. Key main challenge for their widespread adoption tures (camera, touch-screen) and ad- worn on the body or around the body involve lack of user acceptance striving from variable credibility vanced application programming forming a Body Area Network (BAN), and reliability of applications and solutions as they a) lack evi- interfaces (APIs) for running third- for which a smart-phone is a central dence-based approach; b) have low levels of medical professional party data-based applications (apps), processing unit. These BANs can involvement in their design and content; c) are provided in an while the latter is mainly designed for measure user’s psychophysiology and unreliable way, influencing negatively its usability; and, in some voice and text-based interactions and environmental conditions, integrating cases, d) being industry-driven, hence exposing bias in informa- come with a pre-installed set of fixed for example heart rate, respiration rate, tion provided, for example towards particular types of treatment or applications and limited features. and body and, as well as ambient tem- intervention procedures. The smartphone market leaders in- perature sensors. These BANs and as- clude Apple’s iPhone, RIM’s Black- sociated mobile applications can be Keywords berry, Google’s Android and Microsoft used as a tool for gathering quality data Smartphone, mobile phone, cell phone, personal health Windows Mobile platforms, each hav- for medical research, or regular informatics, wearable technologies ing own unique set of features [4] and healthcare practice, as data can be gath- applications distribution channel, such ered from the subjects unobtrusively Yearb Med Inform 2012:83-93 as app-store (Apple) or an app-market for long periods of time, in a labora- (Google). There has been a large in- tory, as well as in a subject’s natural crease in the number of apps environments. downloaded on smartphones over the This article reviews some examples past years, with 300 million applica- of trends in personal sensor, signal and tions downloaded in 2009, 5 billion in imaging informatics from the PubMed IMIA Yearbook of Medical Informatics 2012 84 Wac and Google scholar literature search prove or promote health or health serv- ing or conducting other daily life ac- engines, without claiming complete- ice use and quality. These include ap- tivities, were not considered. For the ness, as the field is continuously en- plications designed to improve primary purpose of presenting the recent ad- riched with new developments. We re- or secondary prevention, diagnosis, vances and developments documented call that, according to definitions by acute or chronic treatment, rehabilita- in prevention/wellness sector, we have Lehmann, Aach and Witte [7], sen- tion or practitioners’ training. We run a query in the Google search en- sor informatics refers to an acquisi- therefore include applications provided gine [11]; as majority of these advances tion process of data from physical on smartphones owned or directly used are not yet documented scientifically. sensors, signal informatics – to data by a patient, practitioner or a lay-per- The search was not exhaustive, but management, visualization, and sim- son. Furthermore, we include studies rather informative, where the main ple data analysis, while imaging that have a controlled design to evalu- goal was to get an overview of current informatics refers to processing data ate the application as a primary com- trends in personal sensor, signal and in two or more dimensions. Personal ponent under evaluation, including imaging informatics and map them on health infor-matics refers to usage of both randomized controlled trials and current developments in mobile com- such processed data in the health(care) non-random group allocations, em- puting and communications technolo- processes that are designed to meet bracing also numerous feasibility gies enclosed in a smartphone. The the particular needs and situation of studies. We do not impose a limit on selection of the references cited in this the care receiver [7]. We expand this study participants in terms of age, article is based on their novelty and definition twofold. Firstly, we ex- gender, ethnicity and morbidities possible contribution into the field of pand it by including care provider, (for patients) and staff role and oc- the personal pervasive health infor- e.g., clinician, using such processed cupation (for practitioners, e.g., sur- matics services. In total, 772 articles data for own training or in the geon, psychologist). Also, we are in- were found and around 100 are selected health(care) processes that are designed cluding all outcome measures, both for this article, given the inclusion cri- to making the decisions upon care re- objective (e.g., performance) and teria described above and the fact that ceiver’s diagnosis, interventions, self-reported, with the emphasis on for some objectives, e.g., telemoni- treatments, or rehabilitation. Moreo- user-acceptability factors (e.g., us- toring of vital signs there were many ver, we expand this definition to- ability, usefulness). examples of similar studies, and to wards receiver’s self-care and wellness The results presented in this article avoid repetition, only the most recent and prevention processes. are based on the relevant literature studies have been selected to be in- This article is structured as follows. search using PubMed [8] search engine cluded in this overview. Section 2 presents details of the method for scientific, peer-reviewed literature, employed in our research, while Sec- enclosing majority of relevant for us tion 3 presents its results. Section 4 articles from the Association for Com- summarizes the findings and discusses puting Machinery (ACM) [9] and In- 3 Towards Smartphone- their limitations, while Section 5 con- stitute of Electrical and Electronics cludes this article. Engineers (IEEE) [10] digital librar- Based Personal, Pervasive ies and their search engines. Additional Health Informatics Services results available in the latter search engines are omitted from our study as This section presents the results of the 2 Methods these relate to results of simulations literature search. First, we present ad- and/or small feasibility prototypes, in vances in the surveyed technologies, as For the purpose of this overview, we most cases without an involvement of employed in provision of diagnosis scope our research as follows. We con- real (health)care practitioners or pa- (Section 3.1), treatment (Section 3.2) sider smartphones as portable mobile tients. The search

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