Health Care and Mobile Devices

When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.

- Billy Graham

Regardless of where you come down on the Health Care Debate, there is no debating that the advancement in mobile networks and devices will have a significant impact on the Health Care Industry.

Sprint Nextel CEO Dan Hesse made the case at the annual conference of the Healthcare Information and Management Systems Society on March 1.

Today, on a planet of 6.8 billion people, there are more than 4 billion active cell phones—more mobile phones in the world than TVs, PCs and cars combined. The cell phone is the most rapidly adopted technology in the history of this planet... High mobile phone penetration provides an incredible opportunity for us to work together to improve health care and health care access, regardless of location, age, gender or disability.

Mobile devices may be on their way to replacing the characteristic stethscope hanging from every doctors neck or pocket. Today 64% of U.S Physicians use smartphones and is expected to reach 81% by 2012 according to the health care consulting firm Manhattan Research. With the introduction of iPhone 3.0 OS just over a year ago Apple set the stage for increased penetration of the iPhone into the Healthcare industry. Features included in that release made this possible, such as the External Accessories API, allowing external accessories to interface to the iPhone via the dock connector or wirelessly over Bluetooth. Apple used a blood pressure cuff as an example so I guess the stethoscope analogy isn't that far off.

In fact, Apple seems to have always had it's eye on the Healthcare market, partnering with Dr. Geoffrey Rutledge, chief medical officer for Epocrates Inc., to reformat a huge medical database into a downloadable app known as Epocrates RX, before the iPhone was even launched. Today, Rutledge claims Epocrates RX is used by one in five U.S. doctors as a drug reference and to prevent interaction problems between a patient’s multiple medications.

In India, the iPhone is being used to cure a disease called Retinopathy of Prematurity (RoP), an eye disease that affects thousands of prematurely born infants and can cause blindness if not swiftly treated. This type of disease is especially a problem in countries where there is a lack of adequate facilities, long distances to travel, illiteracy and low accessibility to quality healthcare. Laboratory assistants take pictures of the retinas of prematurely born babies and transmit them via broadband to pediatric eye surgeons, many times hundreds or thousands of miles away. The surgeons, use the iPhones high resolution graphics and pinch-and-drag capabilities combined with special software to diagnose and then determine treatment.

Currently there are hundreds of mobile applications in the AppStore's "Healthcare and Fitness" category available to businesses and consumers. Many more applications will be needed by the growing Healthcare Industry. Device manufacturers are improving their operating systems and SDKs to appeal to application developers designing tomorrows Healthcare Solutions.

A few application areas that apply to Healthcare include:

• Medical Spanish or Medical translation capabilities so doctors can communicate with Foreign language-speaking patients
• Fast medication facts, alternative medications, multiple drug interaction data, health plan insurance guidelines on medications.
• Remote diagnostic and treatment recommendations, bringing Healthcare to the patient.
• Receive and analyze laboratory test results.

Waiting for Moore's Law to Work

Reading the "Mobile Web Application Best Practices" a W3C Recommendation from 14 December 2010, I was struck by the similarity of the resource management challenges faced by early Personal Computer developers and those faced by mobile device developers today.


Here are some of the best practices for early PC Development that are arguably non-existent today.

Keep programs small (especially true for the Basic Interpreter, and then compiled programs that had to be shipped and installed on Floppy Diskettes. Smaller programs loaded and ran faster. Later with overlay managers it was important to optimize overlay segments for application start-up time.

Use memory very, very efficiently. First there wasn't much of it, and later when there was more, memory management and disk swapping caused performance issues, especially when multiple applications were running.

Keep your code footprint small. Early on this even meant keeping your variable names very terse (x,y,z were good candidates), there were even utilities that would convert your code before compile and reduce your nice long readable variables to terse variants.

Optimize the User Interface to be responsive or at least appear to be responsive to the user. This meant coming up with strategies to improve performance or at least hide slow running tasks, and when all else fails put up the hour glass and appear responsive.

Here are some of the best practices for mobile development from the W3C, "Mobile Web Application Best Practices".

Use Cookies Sparingly - information stored in cookies is sent to the server for every request and so using them for excessive amounts of data can negatively impact performance on a mobile network.

Use Transfer Compression - compression like HTTP 1.1 compression, which uses the gzip and DEFLATE algorithms which are widely supported, reduces bandwidth of each payload and increases transport efficiency. But...decompressing and compressing use up time and battery so this is a balancing act/ Alternative compression formats (such as EXI [EXI]) may be worth looking into.

Minimize Application Data and Size - obviously the smaller the better, faster downloads and execution time.

Minimize Perceived Latency - device limitations can lead to latency in page views, page reloads can frustrate even the most patient user.

As you can see we seem to be faced with similar resource management challenges as those faced by developers of the early PC. But why is this? Are we waiting for Moore's Law to raise all ships in Mobile Bay. Remember Moore’s Law?, named for Intel co-founder Gordon Moore, states that the number of transistors incorporated in a chip will approximately double every 24 months. That rate of progress means that the semiconductor industry will far surpass that of nearly all other industries over time, or from the flip side, other industries can't keep up. So the mobile device as a system, with components from several industries, batteries, network towers, displays, is going have resource management challenges and limits to growth directly related to the slowest advancing component.

We saw this with the PC, the integrated circuit was only one component of the overall system. And until recently we had some really, really fast computers with some really, really big monitors, that took up most of a normal size desk, now we have smaller, flatter monitors, we even have entire PC's the size of the old monitors.

The mobile device is more than the integrated circuit and it is experiencing the same disproportionate growth of it's individual components. Although if you look at the first "smartphones" you would have to agree that the iPhone in totality shows an amazing evolution in a short period of time. But you would also have to agree that certain components and sub systems are not as impressive in their rate of advancement and this can be seen in the familiar resource management issues mobile programmers are faced with today.

Looking Back...BP Oil Spill and Mobile Devices

The BP Oil Spill is a disaster of epic proportions. Responding to the disaster has required innovative minds to use all available technology to craft quick and effective solutions. It's interesting to note some of the solutions that have been crafted using mobile technology.


Oil Spill Crisis Map

The Oil Spill Crisis Map was created using the Ushahidi, a free open-source software created specifically to enable people with cell phones to contribute during a crisis. Ushahidi, which means "testimony" in Swahili, was initially developed to map reports of violence in Kenya after the post-election fallout in 2008. Students at Tulane University in conjunction with the Louisiana Bucket Brigade have used Ushahidi to give the citizens of the Gulf Coast a voice to give testimony on the how the Gulf oil spill is impacting their lives and environment.

Reports can be made in four ways:
1. Send a text message or call (504) 27 27 OIL (7645),
2. Send an email to bpoilspill@gmail.com
3. Via Twitter with the hashtag #BPspillmap
4. Filling out this form (http://oilspill.labucketbrigade.org/reports/submit/ )

iPhone Applications


These applications were built taking advantage of the iPhone SDK features enabling the creation of forms, back end web data storage, GPS and RSS feeds. As I write this there are over 20 apps in the app store about the oil spill. There are apps in several categories, heres a sample:

News - keeping users up to date on all the news available across the many internet resources including community sites like Twitter and RSS Feeds
Utilities - enabling users to report location, size and severity of oil contamination
Travel - tracking all world oil spills so you know if there is oil where you plan to vacation
Games - of course there are games like "Fight the Pipe" where you compete with others around the globe to plug the hole with your finger for the highest score.

QR Codes

QR Codes or Quick Response Codes are 2d bar codes designed to be decoded at high speed. A QR Code can handle many times the amount of information of a conventional bar code, 7,089 characters can be encoded in one symbol containing, URL's, web service calls with parameters, text etc.

QR Codes are most commonly used in "mobile tagging" sometimes referred to as physical world connections or "object hyperlinking", basically connecting the internet and it's resources to the physical world.
QR Codes, popular in Asia, have are becoming more popular here and have made their way into Sports Illustrated magazines, Pepsi Bottles and Times Square to name a few.

ScanLife the world wide leader in barcode scanning applications, has partnered with the celebrity backed "Be The One" campaign to get signatures for their petition, which states: “I demand that a plan to restore America’s Gulf be fully funded and implemented for me and future generations." Using QR Codes, the campaign enables mobile users to scan the code which automatically takes the users to restorethegulf.com where they can watch the Be the One video and sign the petition. The "Be The One" QR Codes have shown up in Times Square and availble on T-Shirts.

Text Messaging

Several organizations have launched campaigns to make it easy for mobile users to donate money to aid in the cleanup of the Gulf.
Examples include Mad Mobile, a mobile marketing company, has launched the “Oil Spill Relief” campaign, users can text the keyword GULF to the short code 50555 to donate $10 and the National Wildlife Federation has established a "Gulf Oil Spill Restoration Fund" which users can donate $10 to by texting "WILDLIFE" to 20222.

Text messaging is also used to sign up for alerts from the Deepwater Horizon Unified Command

Mobile Technology...A Bridge Too Far?

“We are told never to cross a bridge until we come to it, but this world is owned by men who have 'crossed bridges' in their imagination far ahead of the crowd.”
Author Unknown

The Digital Divide splits the world in half, those people who 'have', and those people who 'do not have' access to digital information technology. Or put it another way, the 'haves' are those people around the world who have the:

1. Wealth - to afford devices to access the Internet
2. Education - to operate those devices effectively
3. Opportunity - to live near or be able to commute to an area that has access to the Internet.

In his paper "Wireless and Mobility Defined", Adam Kornak defines mobility this way: " The application of mobile devices and wireless technology to enable communication, information access, and business transactions from any device, from anyone, from anywhere, at anytime." So how does mobile technology offer a bridge for the Digital Divide, a bridge for the 'have nots' to access the infinite resources of the Internet.

1. Wealth - Mobile devices are less expensive than personal computers and so are much more affordable and available for subsidized mass distribution.
2. Education - Mobile devices, in part because of their low cost, can be tailored for specific functions, take the Fed Ex driver and his mobile package scanner as an example. This enables them to deliver high quality functionality with intuitive and simple to operate user interfaces.
   
   Physical World Connections (see my ddj blog 'RingTones') enable realworld objects to be connected to information about them on the internet. 2D barcode tags can easily hold enough information for a url and parameters to a web service. This empowers people that may not understand an operating system or desktop to simply point their camera phone at an object, take a picture and have the device connect them to the world of information. An aid worker in the plains of Africa can point their camera at a medical supply bag dropped from an airplane and get information on how to distribute, apply and help the villagers with the medicine. The tag may even connect them to a live online physician.
   
   The education deficit is all but eliminated.
3. Opportunity - Mobile coverage will extend to more than 90% of the global population by 2010. In the GSM Association's white paper "Universal Access" the paper states "There will remain, however, some areas that will never be economically feasible to serve. In most countries this will be the last 2–5% of the population, which corresponds to 20–30% of the geographic area."

Mobility has the promise to bridge the digital divide in even more meaningful ways. Try this, launch iTunes, go to Podcast's, select Education from the Categories menu, than select Higher Education from the More Education Menu below. Now look at the list at the right "Today's Top Podcast's", as I write this there are entries from lectures given at Yale, Harvard, Standford, Chicago School of Law and the list goes on. When I was growing up the only way you could listen to a lecture from one of these professors was to be there. This is liberating stuff for the 'have nots', now armed with an iPod for less than $200 they can learn Spanish, Math, Reading or enter into the world of higher education and be taught by the best.

In fact the only thing the iPod lacks that keeps it from being a real Digital Divide bridge is wireless connectivity. If the iPod could access the iTunes store on it's own and sync the iPod with any updated content or subscription feeds it would be a digital divide killer. Than you could really have students in an impoverished area of Africa downloading the latest lecture from Harvard Business School and sitting down to listen to it as they watch the sun go down over the plains.

Of course mobility has many other touch points in business and consumer life but its capacity to bridge the digital divide is very real and happening now.