I have been looking at mobile apps for several years, even pre i-Phone. The initial focus was on Obesity control and Type 2 Diabetes management. It just never seemed to have gotten where it can truly work, and oftentimes this is proven by the explosion of such apps which purport to do something but don't quite. (Note: Image from Dermoscopy by Soyer et al, Elsevier Ltd, 2012)
In JAMA Dermatology there was a recent analysis of a few apps applied to identifying melanomas, a highly aggressive malignancy of the skin. Now back in the early 1960s when I first was introduced to this as a student one all too often saw a patient with a Stage IV melanoma, large, bleeding, and most likely terminal. Also most physicians would be conservative and not do a referral until till often too late. I saw patients whose legs were amputated in attempts to stop the ravages of the disease.
Patients and general physicians, even dermatologists, were not attuned to treating any suspicious pigmented lesion carefully and quickly.This has changed for the better and dermoscopes have helped, magnifying devices which allow for better examination of the pigmented lesions. From my perspective, if one had even a hint, better to carefully excise and biopsy by a highly competent dermatopathologist.
Now there are quite a few apps which use a smart phone to take a picture of a lesion and analyze it. However the results were far from positive. They state:
The performance of smartphone applications in assessing melanoma risk is highly variable, and 3 of 4 smartphone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation can delay the diagnosis of melanoma and harm users. As smartphones use increases, these devices are applied to functions beyond communication and entertainment and often become tools that are involved intimately in many aspects of daily life through the use of specialized applications. Several applications in the field of health care, marketed directly to the public, are readily available. Some examples include applications that are intended to aid users in learning about adverse effects of medications, to track their caloric intake and expenditure to manage weight loss, and to log their menstrual cycles to monitor fertility. Although such applications have the potential to improve patient awareness and physician-patient communication, applications that provide any type of medical advice might result in harm to the patient if that advice is incorrect or misleading.
Patient self-diagnosis is always a double edged sword. On the one hand one gets the hypochondriac patient who has some strange and rare disorder and needs extensive treatment. I often think of the Lyme Disease culture who ascribe every human ache and pain to some prior infection, not that there are no such cases, but most likely not as many as are presented.
The article concludes:
Technologies that improve the rate of melanoma self-detection have potential to improve mortality due to melanoma and would be welcome additions to our efforts to decrease mortality through early detection. However, extreme care must be taken to avoid harming patients in the process. Despite disclaimers presented by each of these applications that they were designed for educational purposes rather than actual diagnosis and that they should not substitute for standard medical care, releasing a tool to the public requires some thought as to how it could be misused. This potential is of particular concern in times of economic hardship, when uninsured and even insured patients, deterred by the cost of copayments for medical visits, may turn to these applications as alternatives to physician evaluation. Physicians must be aware of these applications because the use of medical applications seems to be increasing over time; whether such applications may be subject to regulatory oversight, whether oversight is appropriate, and when oversight might be applied remain unclear. However, given the recent media and legislative interest in such applications, the dermatologist should be aware of those relevant to our field to aid us in protecting and educating our patients.
The highlighted portion is of special concern. In a piece from the Wall Street Journal on the JAMA article the writer indicates that reimbursement for reading a smart phone image is $5 per image. From what I also know that is the benchmark for teleradiology readings of chest X Rays. On the one hand we have explosive Health Care costs and on the other we have a pittance for what is a life saving procedure. It will be interesting to see if this field evolves.
Technologies that improve the rate of melanoma self-detection have potential to improve mortality due to melanoma and would be welcome additions to our efforts to decrease mortality through early detection. However, extreme care must be taken to avoid harming patients in the process. Despite disclaimers presented by each of these applications that they were designed for educational purposes rather than actual diagnosis and that they should not substitute for standard medical care, releasing a tool to the public requires some thought as to how it could be misused. This potential is of particular concern in times of economic hardship, when uninsured and even insured patients, deterred by the cost of copayments for medical visits, may turn to these applications as alternatives to physician evaluation. Physicians must be aware of these applications because the use of medical applications seems to be increasing over time; whether such applications may be subject to regulatory oversight, whether oversight is appropriate, and when oversight might be applied remain unclear. However, given the recent media and legislative interest in such applications, the dermatologist should be aware of those relevant to our field to aid us in protecting and educating our patients.
The highlighted portion is of special concern. In a piece from the Wall Street Journal on the JAMA article the writer indicates that reimbursement for reading a smart phone image is $5 per image. From what I also know that is the benchmark for teleradiology readings of chest X Rays. On the one hand we have explosive Health Care costs and on the other we have a pittance for what is a life saving procedure. It will be interesting to see if this field evolves.
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