Kimberly Churchill learned the hard way to be proactive about her own health. The 38-year-old mother from Portugal Cove – St. Philip's, NL, has had type 1 diabetes for 23 years. One day in 2003, she rushed out to work without having had breakfast and might have died as a consequence.

On that day, she was a passenger in a car with some co-workers; when she stepped out of the car, she suffered a grand mal seizure. "I fell down an embankment and split my head open," says Churchill. She learned the hard way that she has hypoglycemia unawareness, a condition in which her blood sugar can drop dangerously low without any warning signs. Churchill says she knew then that she needed to do a better job of managing her disease.

Today, in addition to wearing an insulin pump and a sensor that measures her glucose (blood sugar) levels every five minutes, a key component of her self-management is an app she has on both her iPhone and iPad, called Diabetes Buddy.

For $4.99, Diabetes Buddy helps diabetics track the factors that influence their blood sugar levels. Users input data such as the food and water they've consumed, how much exercise they've had, and their blood pressure and glucose readings. Users can set targets and Diabetes Buddy will notify  them when they've undershot or exceeded their targets.

"It's been a great tool for me. I had huge difficulty getting control of my diabetes after my second baby. My sugars were high," says Churchill. Today, she has a two-year-old son and a baby with special needs. "Taking care of myself is a challenge.... There are days, honestly, when I can't remember the last time I changed the needle on my insulin pump or my sensor. This app will tell me."

Medical smartphone applications are just part of a wide variety of new technologies that are empowering patients to manage their own care from home. Dr. Raymond LeBlanc, vice president of learning, research and innovation at Capital Health, supports giving patients tools to track and manage their chronic disease, and to communicate their concerns and symptoms to their health care teams. "Anything that gives a patient accountability, responsibility and engagement can be empowering and can add quality to the management of that patient's medical challenges," Dr. LeBlanc says.

Cutting-edge technologies

In Halifax, Kanayo Software is developing Healthgraph Connect, a technology designed to facilitate remote patient management. This tool will transmit data from a device such as a blood pressure cuff or oximeter (which measures the oxygen saturation of a person's blood) to that person's health care providers. Patients will also answer questions posed electronically by the device and their responses will be made available for analysis.

Kanayo is also working with the director of research for orthopaedics at Capital Health, Dr. Michael Dunbar, on an app that will analyze patients' manner of walking, otherwise known as their gait, to help determine the long-term health of their knees and hips. The app will allow medical professionals to follow these patients without requiring them to visit the hospital. Those now testing the app simply mount their smartphones on their belts, turn on the app and go for a walk. The smartphone accelerometer (an electromechanical device that measures acceleration forces) evaluates their gait and sends the results electronically to Dr. Dunbar's lab, where they are analyzed. If necessary, patients will be scheduled for a follow-up appointment based on the app's readings, just as they would have been had they been tested at the hospital's gait lab.
 
Dr. Dunbar says that by separating the patients who need further medical intervention, like hip and knee replacements, from those who don't, this particular innovation could save millions of dollars, as well as many hours of patients' time. In the near future, a post-surgical patient may be sent home from the hospital with a $200 cellphone loaded with an app that prompts the patient to correct his or her posture, reducing the need to make numerous visits to a physiotherapist.

He also imagines further developments such as having patients do prescribed exercise programs using treadmills or gaming systems such as Wii or Xbox Kinect in their homes. These systems would have built-in alerts that signal patients when they are exercising outside of their optimal zone. The force plate currently used in the Wii system (which retails for about $150) is almost as good as equipment in the gait lab that costs $150,000, says Dr. Dunbar.

He sees mobile health as a terrific option for reducing the current burdens plaguing our health-care system. In his own practice, wait times for hip and knee replacements are currently about 18 months, and Atlantic Canada overall has longer-than-average wait times for orthopaedic surgeries.

Dr. Dunbar also sees Atlantic Canada as having huge business development opportunities in the field of mobile health technologies. "We should not be humble about this. We can't afford more of the same. The solution must be disruptive. It must be cheaper. We have the design expertise…. We could be world leaders in this."

Matt Clark at Kanayo Software also hopes the potential for innovation of medical technologies right here at home is realized. "In Atlantic Canada we're working hard to save as many health care dollars as we can. There is low hanging fruit in this industry. We only need the wherewithal and investment to go out and pick it."

A new kind of health care

Both Drs. LeBlanc and Dunbar acknowledge the potential criticism patients may wage - that these technologies will mean less face time between patients and their doctors. That may be true, but as Dr. Dunbar points out, more efficient models are needed.

"I'd rather see patients who need to see me rather than those who don't. We need better ways of teasing those out. Rather than 100 patients waiting a year to see me, let me see the six that need to see me right away, and support the other 94 with the successful models of allied health professionals," such as nurses, physiotherapists and occupational therapists.

"The strength of this approach is in using widely available transformative technology - for example, smartphones - but using them in a different manner to deliver health care," says Dr. LeBlanc.

Kimberly Churchill is a convert. And although she notes that there's no substitute for a doctor or health care team, she says she'd recommend medical apps, not just for diabetics like herself, but for anyone with a chronic disease.

"It's absolutely essential to be proactive and to learn to be the manager of your own health," she says. "This technology can help you do that."

There's an app for that

Smartphones and tablets aren't just for email or Angry Birds anymore - they're becoming health platforms. Here are some medical apps that are currently available for smartphones and tablets:

• EndoGoddess: Hit your glucose targets and earn points that can eventually be used for iTunes purchases; $0.99
• Bant: Record, analyze and share blood glucose readings; free
• Cancer.net (American Society of Clinical Oncology): Store your questions, medications and symptoms, and browse articles, videos and podcasts on living with and treating various types of cancer; free
• Proloquo2go: For people who have difficulty speaking; tap one of 8,000 symbols and it speaks for you; $189.99
• Hello Baby (pregnancy monitoring): Learn about each stage of your baby's prenatal development from four to 40 weeks; free
• Pill Finder (and Pill Identifier): Identify unknown tablets/capsules based on physical characteristics including characters or number printed on a medication, shape, color, size, and scoring; free/$0.99
• PocketCPR: Instructions on how to administer CPR; free
  
• Can't Wait (Crohn's and Colitis Foundation of Canada): Locate bathrooms on a map or in a list, find the nearest bathroom and review the features of each bathroom; free
  

Choosing the app for you

If you're trying to evaluate the usefulness of an app before you download it, first check out online user reviews and ratings. Also, according to software developer Matt Clark, the apps that charge a small download fee (often ranging from $0.99 to $4.99) are typically better than the free ones. You may also want an app that's been developed by, or in consultation with, a medical association, and if it replaces a medical device, says Clark, choose an app that was created by the medical device developer.