Medical and tech researchers see smartphones as health’s next frontier

Thomas Davis spends a night in September asking people in West Hollywood to participate in a UCLA study about mobile apps and their ability to help improve health and combat disease.
(Michael Robinson Chávez / Los Angeles Times)

The West Hollywood club scene was just picking up as Charles Lea and other UCLA grad students fanned out along Santa Monica Boulevard.

Their goal that evening: Find young black men, gay and bisexual, willing to participate in a study on how smartphone apps can help improve overall health and combat diseases such as AIDS and diabetes.

It wasn’t easy.

Relatively few young black men, a group that has seen rising rates of HIV, congregate at go-to gay hot spots like West Hollywood. This night, most of those approached by Lea and the recruiters begged off on cooperating.


“People don’t want to talk,” Lea said. “They want to party.”

But the research team continued to press ahead, eager to assess how mobile phones can be used to spread information on testing and safe sex among minority men most likely to engage in risky behavior.

The effort reflects both the potential and the challenges facing investors, medical experts and government officials who want to harness the reach and power of mobile phones to revolutionize healthcare.

By some estimates, 90% of adults in the United States have access to cellphones, which makes mobile health, sometimes called m-health, promising terrain for innovation — particularly when it comes to targeting hard-to-reach groups such as young, gay black men.

“History will show that the mobile phone will be one of the most profound influences for improving public health ever invented,” said Dr. Kevin Patrick, director of UC San Diego’s Center for Wireless and Population Health Systems. “The potential is huge.”

But for that promise to pan out, researchers, medical providers and technology companies need to find a sweet spot combining user appeal with tools that deliver valuable information and clear medical benefits.

That’s no simple task, as the West Hollywood HIV study hinted.

Entrepreneurs and researchers are committed to the cause, developing and testing a wide range of apps to monitor and manage conditions that plague millions of Americans and drive up medical costs.


Wireless phones are feeding real-time data to doctors from heart and blood glucose monitors, as well as from Bluetooth-enabled inhalers. Built-in cameras are being used to snap photos and diagnose suspicious growths, and GPS technology and cellphone accelerometers are tracking patients’ physical activity. Text and other messaging systems are reminding and cajoling patients to exercise, watch what they eat, use condoms, check blood sugar or take medications.

Some physicians hope to one day use phone-connected sensors to catch serious conditions, such as asthma and cardiac irregularity, before patients know anything is wrong.

That sort of advancement presents a major opportunity to make medicine more cost-efficient as well as more responsive, said cardiologist Leslie Saxon, founder of the digital-health-focused Center for Body Computing at USC. She said she foresees a future “of everyone being continually diagnosed and continually treated.”

“If you could virtualize the care of many patients, you can save hospital beds for those who really need them,” Saxon said.

The street interviews in West Hollywood are part of a larger trial-and-error effort among Los Angeles AIDS workers trying to figure out how best to use smartphones.

While rates of HIV infection have plateaued nationwide, they have risen among younger men who have sex with men, and most acutely among young men of color, said Ian Holloway, an assistant professor at the Luskin School of Public Affairs at UCLA and lead researcher on the Healthy Selfie project involving the grad students.

Despite some early wariness among members of those groups, as well as app developers, Holloway said mobile technology can offer young, gay black men something they don’t currently have: a centralized spot, at their fingertips, to get authoritative health guidance on HIV.

“The new venues are phone applications, websites, chat rooms and message boards,” he said. “These are the places guys meet each other, for a variety of purposes. Why not bring prevention to those digital spaces?”

Investors have poured about $3 billion into digital health start-ups this year alone, including hundreds of millions into mobile health, according to MobiHealthNews, an online newsletter.

Los Angeles billionaire Dr. Patrick Soon-Shiong, along with Samsung, Qualcomm, Google and Apple, are among those funding m-health research and development.

The attraction of m-health technology, for healthcare experts and investors alike, is the vast reach of smartphones across geographic, ethnic and socioeconomic groups.

But fully realizing the potential of mobile health technology requires protecting the privacy of health information and building user-friendly apps for patients that capture the sort of medical data professionals need.

“A lot of what’s being built is still in the research stage,” said Wendy Nilsen, who tracks developments in the field for the National Institutes of Health. There’s a widespread sense, she said, that of much of what’s being offered isn’t yet delivering proven benefits.

In clinical settings, researchers and technologists are trying to assemble the empirical evidence needed to persuade health systems and insurers to embrace — and pay for — large-scale m-health systems.

“We have all of this cool technology, and all kinds of cool applications,” said Bruce Dobkin, director of the neurologic rehabilitation program at UCLA. “But will anything meaningfully improve healthcare? We need clinical trials to show that.”

Dobkin is using custom, mobile-phone-linked motion sensors to monitor the gait of stroke and hip-replacement patients. Developing the proprietary technology is necessary because fitness trackers commonly available, such as Fitbit, don’t provide the spatial data or level of accuracy he needs, Dobkin said.

Scientists must figure out how to effectively collect and analyze the mountains of data mobile devices could one day stream to health professionals.

And securing personal information is vital to for m-health development and acceptance. One stroke patient who refused to be monitored told Dobkin “the NSA knows enough about me,” the researcher recalled.

Even among those already using cellphones to manage their health, there remains a question of commitment. Surveys have found that half who use mobile fitness trackers to keep tabs on their workouts or diets stop using the programs within six months.

Holloway said the Healthy Selfie project was a departure from earlier health education research efforts that sought to tap into gay social media networks without always working with those networks. Online Buddies — which owns Manhunt and Jack’d and bills itself as the world’s largest gay brand centered on connecting people in search of friendships or lasting relationships — is collaborating on the project.

“We’re going back to the drawing board,” said David Novak, formerly of the Centers for Disease Control and Prevention and now the senior health strategist at Online Buddies. “Let’s ask black men what they think of health messaging. If they want messages, how do they want them? What would be meaningful?”

In West Hollywood the night Lea and his team were recruiting subjects, Markqes Johnson, 24, said it makes sense to use mobile technology to educate people about HIV. But, he added, many could find the information irritating.

“People don’t want to look at that,” he said. “It’s like going to Pandora or YouTube and having to watch an ad.”
Twitter: @LATerynbrown

Times staff writer Eryn Brown reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.