Electronic Health Records

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Healthcare Foursquare? Geomedicine tracks disease triggers

By Jennifer Bresnick

An asthma inhaler with a GPS sensor to report where asthma is the worst.  An app that pinpoints environmental toxins within three miles of where a patient lives.  A website that lets doctors see how a moldy apartment complex can spark migraines and sinus infections.  Tools of the future?  Not anymore.  Patients are “checking in” before their checkups thanks to a variety of new devices and services that integrate location data with traditional medical information in order to provide a comprehensive treatment plan for patients who suffer from environmentally sensitive diseases.

Geomedicine is an offshoot of the mHealth explosion, using GPS devices in smartphones and other devices to let patients and physicians add a new dimension to their healthcare.  The Washington Post reports that population health management is benefiting from these new endeavors, giving physicians and researchers more data to work with.

Epidemiologist David Van Sickle began to work on a GPS rescue inhaler in 2006 after being frustrated during his attempts to pinpoint the reason for individual asthma attacks.  “The first prototypes were very ugly — like a coffee machine alongside of an inhaler,” Dr. Van Sickle says.  But the latest version transmits data with a tiny Bluetooth device straight to a webpage that maps where and when patients take a puff.  This information can help patients identify what causes their asthma attacks, and what locations or activities to avoid. “It’s these kinds of insights that we think will help us understand the origins of disease,” he asserts.

Geomedicine is not just a device maker’s fad.  Loma Linda Medical Center in California is planning to integrate de-identified location data into their treatment protocols by early March.  The software will map the health status and environments of more than one million patients, displaying the data on its website as disease hot spots on a map.  Patients looking to avoid the flu might steer clear of a mall at the center of an outbreak, for example, or keep their kids home from school if pink eye is going around.

Some experts even believe that location data should be integrated into EHRs.  “Place should be a vital sign,” says Dr. Ethan Berke of Dartmouth Medical School.  “I would love it if I could bring up [a] map and see the grocery stores, parks right there while you are checking their blood pressure,” he says.  Such information would allow him to tailor his advice to a patient’s individual lifestyle.

The focus on individualized care is in line with accountable care objectives laid out by CMS and other governing agencies in order to provide a highly satisfactory healthcare experience for patients.  But privacy concerns may slow the adoption of such tools, since unregulated apps could sell patient information to third parties without their consent, and hospital data breaches will take on an entirely new meaning if hackers know every detail of their victims’ daily routines.  And according to Kate Black, a health privacy attorney with the ONC, such data could be used against individuals on a corporate level. If health insurance companies “learn that you’ve lived in these fourteen neighborhoods, exposed to these fourteen different risks, that might be the basis for denying you coverage,” she warns.

While location-based medicine is still in its infancy, the potential is huge.  Millions of patients already use their smartphones or other mobile devices to engage in healthcare, and millions more are comfortable using such features on social networks like Facebook and Twitter, for relatively insignificant events like going to a concert or a new restaurant.  If tagging oneself in a location can help improve or save a life, will users jump on board?





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