Background: Advancements in technology have always had major impacts in medicine. The smartphone is one of the most ubiquitous and dynamic trends in communication, in which one’s mobile phone can also be used for communicating via email, performing Internet searches, and using specific applications. The smartphone is one of the fastest growing sectors in the technology industry, and its impact in medicine has already been significant. Objective: To provide a comprehensive and up-to-date summary of the role of the smartphone in medicine by highlighting the ways in which it can enhance continuing medical education, patient care, and communication. We also examine the evidence base for this technology. Methods: We conducted a review of all published uses of the smartphone that could be applicable to the field of medicine and medical education with the exclusion of only surgical-related uses. Results: In the 60 studies that were identified, we found many uses for the smartphone in medicine; however, we also found that very few high-quality studies exist to help us understand how best to use this technology. Conclusions: While the smartphone’s role in medicine and education appears promising and exciting, more high-quality studies are needed to better understand the role it will have in this field. We recommend popular smartphone applications for physicians that are lacking in evidence and discuss future studies to support their use. [J Med Internet Res 2012;14(5):e128]

The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students

Ambient Intelligence (AmI) is a new paradigm in information technology aimed at empowering people's capabilities by means of digital environments that are sensitive, adaptive, and responsive to human needs, habits, gestures, and emotions. This futuristic vision of daily environment will enable innovative human-machine interactions characterized by pervasive, unobtrusive, and anticipatory communications. Such innovative interaction paradigms make AmI technology a suitable candidate for developing various real life solutions, including in the healthcare domain. This survey will discuss the emergence of AmI techniques in the healthcare domain, in order to provide the research community with the necessary background. We will examine the infrastructure and technology required for achieving the vision of AmI, such as smart environments and wearable medical devices. We will summarize the state-of-the-art artificial intelligence (AI) methodologies used for developing AmI system in the healthcare domain, including various learning techniques (for learning from user interaction), reasoning techniques (for reasoning about users' goals and intensions), and planning techniques (for planning activities and interactions). We will also discuss how AmI technology might support people affected by various physical or mental disabilities or chronic disease. Finally, we will point to some of the successful case studies in the area and we will look at the current and future challenges to draw upon the possible future research paths.

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A Survey on Ambient Intelligence in Healthcare

Background: Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. Objective: The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. Methods: We conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. Results: The 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. Conclusions: The lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices. [JMIR Mhealth Uhealth 2015;3(1):e20]

Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature

Photoplethysmography (PPG) is a noninvasive optical technique for detecting microvascular blood volume changes in tissues. Its ease of use, low cost and convenience make it an attractive area of research in the biomedical and clinical communities. Nevertheless, its single spot monitoring and the need to apply a PPG sensor directly to the skin limit its practicality in situations such as perfusion mapping and healing assessments or when free movement is required. The introduction of fast digital cameras into clinical imaging monitoring and diagnosis systems, the desire to reduce the physical restrictions, and the possible new insights that might come from perfusion imaging and mapping inspired the evolution of the conventional PPG technology to imaging PPG (IPPG). IPPG is a noncontact method that can detect heart-generated pulse waves by means of peripheral blood perfusion measurements. Since its inception, IPPG has attracted significant public interest and provided opportunities to improve personal healthcare. This study presents an overview of the wide range of IPPG systems currently being introduced along with examples of their application in various physiological assessments. We believe that the widespread acceptance of IPPG is happening, and it will dramatically accelerate the promotion of this healthcare model in the near future.

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Photoplethysmography Revisited: From Contact to Noncontact, From Point to Imaging

https://www.heartrhythmjournal.com/article/S1547-5271(12)01435-X/pdf

A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation

Objective. Current generation smartphones' video camera technologies enable photoplethysmographic (PPG) acquisition and heart rate (HR) measurement. The study objective was to develop an Android application and compare HRs derived from a Motorola Droid to electrocardiograph (ECG) and Nonin 9560BT pulse oximeter readings during various movement-free tasks. Materials and Methods. HRs were collected simultaneously from 14 subjects, ages 20 to 58, healthy or with clinical conditions, using the 3 devices during 5-minute periods while at rest, reading aloud under observation, and playing a video game. Correlation between the 3 devices was determined, and Bland-Altman plots for all possible pairs of devices across all conditions assessed agreement. Results. Across conditions, all device pairs showed high correlations. Bland-Altman plots further revealed the Droid as a valid measure for HR acquisition. Across all conditions, the Droid compared to ECG, 95% of the data points (differences between devices) fell within the limits of agreement. Conclusion. The Android application provides valid HRs at varying levels of movement free mentalperceptual motor exertion. Lack of electrode patches or wireless sensor telemetric straps make it advantageous for use in mobile-cell-phone-delivered health promotion and wellness programs. Further validation is needed to determine its applicability while engaging in physical movement-related activities.

/pdf/development-and-validation-of-a-smartphone-heart-rate-3xoqez2hpy.pdf

Development and validation of a smartphone heart rate acquisition application for health promotion and wellness telehealth applications

Background: Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities. Objective: To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude. Methods: After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale. Results: Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P =.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P =.02). Conclusions: The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility. [J Med Internet Res 2013;15(1):e6]

Ronja Maximiliane Frenzel

Papers

Development and validation of a smartphone heart rate acquisition application for health promotion and wellness telehealth applications

Patient Attitudes Toward Mobile Phone-Based Health Monitoring: Questionnaire Study Among Kidney Transplant Recipients