Bracelet that Measures Your Sun Exposure

June is being worn on this model's wrist.

At the CES 2014, an interesting bracelet made an appearance that purportedly is able to measure sun intensity in real time and monitor total daily sun exposure. Even better, it is able to provide sun protection advice via smartphone app based on your habits and skin type, get notifications when you need to apply SPF, wear a hat, or put on sunglasses…

Made by Netatmo, the bracelet is called "June" and may be beneficial for those individuals who are prone to sunburn,  out in the sun a lot, and/or concerned about skin cancer due to UV exposure.

It comes in three different colors and will soon be available for purchase.

Watch a video about this product.

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iPhone App to Objectively Measure Vocal Quality (f0, shimmer, jitter, etc)

For the inner geek in all singers and other professional voice users, you can now download onto your iPhone an advanced voice analysis program that provides objective measures of vocal quality similar to what is obtained in a professional voice laboratory.

Called OperaVox, preliminary studies have shown good reliability compared to KayPentax Multidimensional Voice Program (f0, shimmer, jitter). Noise to harmonic ratio showed less reliability. Retest reliability was also fairly consistent in all parameters.

Developed by a team of British researchers including an ENT and an audio specialist, there are 3 version of this app including a free "lite" version, a full-featured version meant for one person, and a much more expensive multi-user version meant for professionals.

The free "lite" version provides a recording of pitch f0, jitter, and shimmer as well as a history of your last 3 tests on a graph over time.

The paid full-featured version additionally also records MPT (maximum phonation time), reading measures (pitch range, mean pitch), and singing pitch range. Historical data is presented without any limits.

The multi-user version is really applicable to professionals in order to track more than one patient/student.

For the serious voice user, this app is a worthwhile investment to objectively measure your vocal quality progress (i.e., singers) as well as to provide helpful information to a speech/voice pathologist and physician when things suddenly change or get worse.

Watch video below on how this program works.

References:
Presentation by Dr Marina Mat-Baki et al from University college London and the Royal National Throat Nose and Ear Hospital, London at Cutting Edge Laryngology 2013; “Reliability of OperaVOX as acoustic analysis software: preliminary results”

Presentation by Dr Emily Lin and Jeremy Hornibrook from the University of Canterbury, New Zealand on the suitability of the iPhone microphones for performing acoustic analyses.

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Accurate Hearing Testing Using an iPhone

There is an iPhone app called "EarTrumpet" that apparently can provide accurate hearing testing... almost as good as a professionally administered test (conventional audiometry) and certainly as good (if not better) than medical-quality automated testing machines (ie Otogram).

Created with the assistance of the ENT department at the University of California, Irvine...

According to one study, this iPhone application provided results as good as one administered by an audiologist:

• 96% of the threshold values when obtained in a sound booth
• 94% of the threshold values when testing was done in just a "quiet" room

When accuracy was defined as "within 10 dB of the corresponding threshold value obtained using conventional audiometry."

Given how accurately the iPhone application performs, it may potentially be a very helpful screening tool to evaluate patients with ear/hearing complaints. If the testing comes back normal hearing (between 0-20db at ALL frequencies), than the patient probably hears just fine.

However, if there's any hearing loss detected, it is advised to seek professional opinion because there  are weaknesses to this program and further testing WILL be necessary.

• It ONLY performs air conduction testing. Given the lack of bone conduction testing, pure nerve testing is not possible, especially when hearing loss is detected. For example, the iPhone application will not be able to test hearing loss due to earwax/fluid versus actual nerve hearing loss.
• Speech audiometry is not present. Only pure tone audiometry. Speech audiometry provides information regarding how well spoken words are understood... one can potentially "hear" a beep at a specific frequency just fine, but still mishear a spoken word which is composed of many different sound frequencies.
• As it pertains to this research study, while there was excellent agreement in masked threshold values between the iPhone app and conventional audiometry, the sample size was limited. Masking is especially important when significant asymmetric hearing loss is present.

There may also be potential bias with the research. The developer of the EarTrumpet iPhone app, Allen Foulad, is also the lead researcher of the paper. It would be worthwhile to have other independent labs reproduce and verify the findings.

However, I applaud Dr. Foulad for his work in this area as well as entrepreneurial spirit!

You can download his app here.

As a bonus, this iPhone application can also act as a personal sound amplifier. It can enhance environmental sounds via earphones attached to the iPhone.


Reference:
Automated Audiometry Using Apple iOS-Based Application Technology. Otolaryngol Head Neck Surg. 2013 Aug 20. [Epub ahead of print]

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HIPAA Compliant Text Messaging (for Free)

Let's face it...

Physicians love to text message given it is fast, easy, and convenient. However, regular instant messaging (SMS, MMS) that comes with your smartphone is not secure, saved unencrypted on a server somewhere (forever), and most importantly not HIPAA or HITECH compliant.

Enter the encrypted and HIPAA compliant messaging services.

Though most of these services cost a nominal fee per month, there are a few and growing number of services which offer free and secure instant messaging. Even better, pretty much all these services including the free ones allow sending messages with unlimited characters, pictures, video, and audio along with text.

Regardless of the service, there are two elements that allow for encrypted SMS and MMS.

1) Userid and Password
2) All your secure contacts must also be using the same service (ie, they all have to sign up before using)

The best free HIPAA-compliant messaging services that's out there that I'm aware of are qliqConnect which is geared towards health professionals and Wickr which is geared towards anybody.

There are pros and cons to both.

qliqConnect is available for use on the desktop, iPad, iPhone, and Android. Wickr is available only on the iPhone (Android coming soon).

Wickr offers complete self-destruct of messages after a certain period of time (all metadata with pictures, video and audio files, like your device info, your location, and any personal information captured during the creation of those files). qliqConnect does not.

No email is required with Wickr. qliqConnect does.

Wickr also states that messages are secured using military grade encryption that exceeds HIPAA standards and unencrypted messages are NEVER stored on any server. It is unclear whether qliqConnect offers similar level of security.

Depending on your needs, one of these free services may be more suitable than the other.

Of course, the weakest link for full adoption is that everybody you want to securely message with also needs to sign up for the same service.

In the end, if I'm a betting man... Wickr will probably win out in the end, especially once they have software available for platforms beyond the iPhone.

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Healthcare Mobile Web Presence

It is pretty much a given that healthcare organizations, medical offices, and physicians maintain a web presence given how frequently consumers turn to the internet and google especially for health information.

Given that... I would like to point out that more and more of this web traffic occurs on a smartphone rather than a computer and in an effort to retain consumers who seek healthcare, it behooves that any web presence be also mobile friendly.

According to my own personal web statistics using google analytics (free), in the month of Sept 2012, more than half (59.7%) of all web visits occurred using a smartphone.

Compare this to 53% in July 2012 and 39% in January 2012.

In January 2011, it was a laughably small 12.5%.

Overall, mobile web browsing accounts for 20% of all web traffic in North America. Cisco in February 2012 predicted that:

"global mobile data traffic will increase 18x between 2011 and 2016... By the end of 2012, the number of mobile-connected devices will exceed the number of people on earth, and by 2016 there will be 1.4 mobile devices per capita. There will be over 10 billion mobile-connected devices in 2016, including machine-to-machine (M2M) modules-exceeding the world's population at that time (7.3 billion)."

Also, google's own internal research revealed that half of consumers will use a website less often if it does not work well with a smartphone even if they like a business. In essence, you WILL lose customers at the moments that matter without a website specifically made for mobile devices.

It is based on just such statistics that persuaded me to take the time and money to convert my practice website such that it is now mobile friendly earlier this month.

So what does it mean to have a mobile friendly web presence?

It means that a consumer does not have to enlarge or scroll around horizontally to view a single webpage. Information appears formatted specifically for the smaller smartphone screens automatically.

In the past, there was a call for healthcare to have a web presence. In the future, that may not be good enough... modern IT demands a web presence that is mobile-friendly. Indeed, if one made decisions purely based on statistics, the focus should be on "mobile presence" rather than "web presence".

Food for thought...

Sources:
Mobile-friendly sites turn visitors into customers. Google 9/25/12.

Google Research: No Mobile Site = Lost Customers. Forbes 9/25/12

Mobile is Not a Sideshow. Information Week 9/21/12

Cisco Visual Networking Index: Global Mobile Data Traffic Forecast Update, 2011–2016. Cisco 2/14/12

Mobile Devices Now Make Up About 20 Percent of U.S. Web Traffic. All Things D 5/25/12.

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Smartphone Otoscope for the Masses

The geniuses at UC Berkley (Cellscope) have developed an otoscope that can attach to a smartphone allowing visualization of the eardrum on the phone's screen.

Possible applications include allowing parents to take pictures of their child's ear on the smartphone and emailing to their physician rather than a clinic visit for diagnosis of an ear infection, fluid behind the eardrum, or eardrum perforation.

Not for sale yet... as far as I know...

Here is their original research paper describing this idea which extends not just to eardrum visualization, but any application where magnification is required.

Reference:
Mobile Phone Based Clinical Microscopy for Global Health Applications. PLoS ONE 4(7): e6320. doi:10.1371/journal.pone.0006320

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