Archive for the ‘Devices’ Category

The Jetsons Never Predicted Mobile Phones

I was watching an episode of the Jetsons with my five year-old the other day, when it occurred to me that, of all the futuristic inventions the creators imagined, the cell/mobile phone wasn’t among them.

It’s true — even with all the advanced technology that George, Jane, Judy, Elroy, and Astro had at their disposal, like anti-gravity belts, nuclear-powered flying cars that fold into briefcases, robot maids, automated closets, pneumatic tube people-movers, and the awesome Food-a-Rac-a-Cycle, they had no portable communications devices.

In this episode, Jane needed to tell George about something after he had already left for work. And even while he was flying in his plutonium-powered car, Jane had to wait until George was at work before dialing him up on the video phone. Amazing …

It made me wonder if mobile communications technology really is so outside of traditional human experience that its adoption in areas like mHealth is slowed by a basic,  fundamental incompatibility with humans that we’re still working through 27 or so years since the first cellular telephone system was commercially available in the US.

Why Smartphones Are the Wrong mHealth Platform

(At least right now …)

I’ll begin with the iPhone, because it pains me every day that this device is so hyped and has attracted such a cult following in the mainstream media. There is a simple three word reason that the iPhone will never be a useful mHealth device:

Non Replaceable Battery.

Can you imagine the scenario where a patient comes to rely on their mobile device for something like carbohydrate calculations and recording blood sugar readings and insulin use, but then has to send their phone back to Apple for two weeks so the battery can be replaced?

Personally, I find it irresponsible for anyone to try to create any kind of health care application on a piece of hardware with such a glaring flaw. Fine perhaps if you intend to cater only to the boutique client who has enough money to drop $500 every 18 months when their battery starts dying so they simply upgrade to a new phone. But for the average patient — developing on the iPhone is simply unconscionable.

While we’re on the subject of the iPhone, here’s reason number two that the iPhone is a poor development platform: the App Store. Health care is best when decisions are made between a patient and their doctor. And judgments of app effectiveness are best made in the light of day, in public view, with a transparent process. So explain to me how the App Store and Apple’s closed, incomprehensible acceptance process furthers those two goals. It is already painful enough that caregivers and patients have their treatment choices limited by insurance companies; to insert a technology company and an opaque process for making applications available into that system in no way benefits the patient. Now in addition to insurance restrictions, I’m supposed to be happy that my choice of health care technology is limited by a bunch of twenty-somethings sitting in a room at Apple allowing or denying the availability of apps based on their own reasons? Please.

In addition to these two uniquely Apple flaws, smartphones in general suffer from one additional glaring problem: carriers and their plans and contracts. Assuming for a minute that we can get past the different technologies (CDMA/GSM) running on different networks, the basic idea of the discounted phone and lock-in contract is stifling this mHealth industry. Imagine for a moment the day when we have to add the duration of a patient’s cell phone contract into the treatment calculus. “Ms. Jones, I recommend highly this wonderful application which will allow you to share with me in real-time your condition so we can quickly adjust your meds any time day or night.” “Thanks doc, but I’m stuck with my plain old cell phone for another 14 months until my contract expires. Maybe then.”

Don’t get me wrong … I think that in ten or maybe even five years, smartphones will be ubiquitous and critical components of our health care. But right now, the barriers are too great to take them seriously. Perhaps Google can force change upon the carriers with their phone store, but even the Nexus One suffers the same 2-year contract lock-in problem unless you’re willing to shell out $500+ for it. But, what I can do for patients today, or next month, or even this year, isn’t much.