The Mobile Health Tech That Could Combat COVID-19

THE INSTITUTE In April more than 60 digital health experts from around the world set out to determine whether today's mobile-health technologies can help in the fight against COVID-19 and future pandemics. The Task Force on mHealth Technology assessed 90 wearable sensors, contact-tracing apps, and electronic patient-reported outcome systems. The latter compile medical information recorded by individuals, such as their vital signs.

The task force's members represented hospitals, universities, and government agencies as well as consumer electronic, technology, and pharmaceutical companies.

The group reported its findings in Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?" The 70-page report, recently published in the IEEE Open Journal of Engineering in Medicine and Biology, is organized into nine sections, corresponding to the technologies the experts reviewed.

The lead author is Paolo Bonato, former vice president of publications for the IEEE Engineering in Medicine and Biology Society (EMBS), which sponsors the journal. Bonato, an IEEE senior member, heads the Motion Analysis Lab at the Spaulding Research Institute, in Boston. He is also an associate professor at Harvard Medical School.

What's unique about this project is that it involved a large number of individuals from around the world who contributed their thoughts on how we could use these technologies for medical effect," Bonato says. I thought IEEE EMBS should [publish the report] because it is the largest society that deals with these types of issues, so it's something that we are uniquely positioned to do, and we have a professional obligation to do."

Here are some key takeaways from the report.

CONTACTLESS MONITORING

Many researchers and companies have pitched wearables as a way to monitor vital signs remotely, reducing how often medical professionals and patients need to come into close contact. The task force reviewed 27 biosensing systems including wrist-based health trackers, skin patches, and sensors embedded in clothing. The wearables can measure heart rate, skin temperature, blood oxygenation, and other vital signs.

The group found that bio patches-adhesive sensors that stick to the skin-are generally more suitable than smart watches and other wrist-worn sensors, particularly when clinicians are interested in assessing cardiovascular function. The patches can be used for continuous monitoring. Some can even record coughing and sneezing characteristics.

Skin-interfaced sensors could be used to assess lung function of patients with respiratory symptoms. Flexible biosensors could be incorporated into cuffless blood-pressure monitoring devices to identify changes, possibly associated with the coronavirus.

While promising, such wearables have limitations, the report says. They can't capture information about all the body's functions, because they are designed to be placed on just a few areas of the body.

Other concerns the experts raised include data security and privacy issues. Ethical concerns need to be considered, they said, to ensure that COVID-19 monitoring does not lead to unintended uses.

Tracing CONTACTs

Contact tracing is one approach being used to stop the spread of the virus. In many areas, the task is done by people, who ask those with the virus for the names and telephone numbers of those with whom they spent time during the previous 14 days. The process can be problematic because the patient might not have that information, might not remember, or might be too sick to provide any details.

To address those issues, many companies are developing contact-tracing technology to gather the data. The task force reviewed about 50 such products. Of those, they determined that 43 had potential: 26 smartphone apps, six online surveys, and 11 data aggregators.

The apps use GPS, Bluetooth, gyroscopes, and other smartphone features to determine when people are close to one another and for how long. Online surveys require a participant to supply information about symptoms, location, age, gender, medical condition, and contact with COVID-positive individuals.

Data aggregators collect location information from smartphones to provide insights such as COVID-19 cases by location. Other apps use datasets maintained by academic institutions, governments, and open-source projects. Most provide risk assessments and offer data-visualization features to dig into the data and interpret trends.

According to the report, online surveys and data aggregators do provide information about trends in symptoms and where infected people are located. Such information can help officials allocate resources to affected areas and decide, for example, whether to close area schools and restaurants.

The authors said that for contact-tracing solutions to be effective, there needs to be broad adoption, as well as timely reporting of confirmed diagnoses and encouragement to share data.

They also cautioned that because of the sensitive nature of the information being collected, strong privacy and ethical safeguards should be incorporated into the products.

SELF-REPORTING SYSTEMS

Electronic patient-reported outcome (ePRO) platforms are used for a variety of purposes including tracking patients' symptoms, monitoring their condition, checking vital signs, gathering health information, managing prescriptions, and making appointments. According to the report, the systems have evolved from simple computer- and telephone-based systems to mostly app-based platforms often combined with wearable devices.

The task force reviewed 13 ePRO systems, all with COVID-19 modules. Some incorporate questionnaires that doctors can use to determine whether a patient likely has the condition from the symptoms he or she reported.

The experts also checked whether the platforms could perform contact tracing to help prevent the spread of the virus, and found four that did.

One of the advantages that all platforms offer is the ability to massively implement their solution across large cities or countries. Most platforms can be deployed immediately or in a couple of weeks," the authors wrote. Even if some challenges exist, the relevance and impact that ePRO solutions can have in scenarios like the one presented during COVID-19 are apparent, as they allow clinicians to effectively identify, classify, monitor, and manage noncritical patients remotely to prevent saturation of the health care system."

CAUTIOUS APPROACH

In their summary, the authors wrote that the mHealth technologies they reviewed have truly revolutionary potential" but that companies need to proceed with caution.

Some of the largest issues in the adoption of mHealth technologies are related to preserving privacy, establishing data sharing, maintaining accessibility, and ensuring data security and safety," the experts said. While the technology rises to meet this challenge, regulations and policies will need to be enacted to ensure their safe use and smooth implementation into routine clinical care."

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