Thank you for coming. This is Session 326, Mobile Medical Applications. I'm Constantine Jean, and really, let's get started. This disclaimer says, I know nothing, and if you take any offense, it's not my fault, nor is it the fault of Liberty Mutual or anyone else. Okay, so have a couple of, oh great, okay, have a couple of quotes here. One is from Andy Grove, well probably the most famous one is from Bill Gates, who said a few years ago 250 kilobytes should be about enough memory for anybody. Everybody remember that, right? And then we had Andy Grove who said, the dream of a pocket-sized communicator, telephone, internet access, it's just a pipe dream. Okay, so here's another prominent speaker who has a quote about mobile medical apps, and tell me if you guys know who this is. There's several exciting things happening in mobile medical apps, artificial intelligence, wearable devices, telemedicine apps, mental health, patient engagement, overall, apps are going to have the potential to transform medicine. So who said this? ChatGPT. ChatGPT stands for generative pre-trained transformer, and this is the actual printout there of what it does, and it's going to transform a lot of things. It's very useful. I found it incredibly helpful when I want to come up with a joke, or say, you know, I have an 80-year-old uncle, I said, hey, what kind of present should I get for an 80-year-old, etc. It really was very, very helpful. Unfortunately, as you can see in the lower hand, it's also something that's being used by our children, who hopefully won't be too impacted by it. The problem with the whole, remember, artificial intelligence now are really just neural networks. There's just huge quantities of data, and they have the ability to access it at lightning speed, to pull up things, and this one's trained in terms of text and diction and English. The problem is the only way to get them to work is to make a, get a large database, and what's the largest database out there? The internet, of course, and it's filled with a lot of wonders and amazing knowledge and things we can access, and it's filled also with a lot of bias and crap and other stuff. So you kind of, and the notion is, well, why don't we just, you know, give it the good data? Well, if you're going to curate the database, what's the point? So that's one of the big problems with the pre-trained generative things. By the way, chat GPT-4 is out. Also, Google has a version called BARD. There are many, many others. Anyway, just, it kind of brings up a dilemma because things are changing so rapidly that as we get older, we find ourselves at the peak of our abilities. Unfortunately, we're masters of world that no longer exists. Here's an example, a really interesting thing. In the 1930s, GE had the home electric motor. You could buy this, bolt it to your kitchen table, hook up belts on it, and it would run, run your fans, it would run your dishwasher, anything that needed, well, your washing machine, anything that needed mechanical things. It was like a big deal. They had bigger versions of this that were as big as washing machines. And, of course, a few years later, about 90 years later, I mean, there must be 500 electric motors in this room. I can't see one of them. You know, they're in a lot of watches, et cetera. Things have changed. And so just in the past eight years, things have changed enormously with apps. In 2015, I gave a very similar lecture at AOHC, and it was, all the apps were kind of standalone, really interesting functionality, a lot of neat things going on. I'm going to show you some of those. They're still neat. And, of course, you know, it was, what, 16 years ago that Steve Jobs invented, or I should say brought to market the iPhone. In that time, the app has now become a front end. This is, this is, it's now the front end for huge databases. And now you have self-diagnosis. I, well, let me see. How many of you have used a portal to access your personal physician's stuff? He sends you labs, texts, et cetera. Let's see. Like 90% of the room. Right. And, and there's an app on your phone that they, that you've downloaded, likely, or a website. There's telemedicine portals, of course, which is becoming a huge thing in mental health. We'll talk about in a bit. Medical diagnoses. There's a lot of home monitoring. This is from a 2019 article. We'll, we'll talk about that too. And, of course, medical devices. And we'll show you some of this. A lot of it's really neat. Really fun. But what's happening is the individual app can be analogized now to the automobile hand crank in 2015. Remember, you needed it. You had the four-cylinder engines. You had to crank it to get them started, especially in cold weather. Now you have automatic starters. You have rotary engines like the Winkle engine. You've got electric cars. You don't need a hand crank anymore. And so you'll see the app will take on a different character as, as this decade goes forward. So what I'm going to do is talk a little bit about mHealth apps and where they fit. And then we're going to talk about apps for occupational docs and occupational health professionals. And then apps for clinical professionals. And some of the interesting stuff. And some of the weird stuff. And some of the stuff you really want to watch out for. So apps are happening. They're big. And it's going to impact your patients, if it hasn't already. Right now, there are 3.2 billion smartphones in the world, 25% of which are in China. There's 325,000, roughly, mobile health applications in 2020. And there's been a 65% increase in mobile health apps since the pandemic. If you're an industry, 65% is a big number. And more than half of U.S. adults have at least one digital app they're using. And so what is a medical app? And are they any good? And you'll understand this as we go through. It's iterative. It's reference. But where are we? You'll understand that in a minute. So a definition of a medical health app is basically something that is software application that runs on a mobile platform. And it has something to do to manage health and wellness. And we're into that, right? We're a branch of the boards of preventive medicine. We're into that, right? And then there's kind of an interesting distinction is the FDA makes a difference between apps that are a medical device and apps that are just a software utility. And if it cures, mitigates, or treats, it's a device requiring all of the pre-marketing and other things. Or if it attaches to a device that cures, mitigates, or treats, it becomes an app. And here's how they've kind of broken it out. Simple stuff that coaches, captures images, educates, routine calculations. The FDA will exercise enforcement discretion. If it cures, mitigates, treats, or transforms a device, it is a regulatory medical device requiring regulatory oversight and pre-marketing and post-market notification, all those things. And all this changed, why, just seven months ago. The FDA is updating this constantly. They've been criticized. The FDA was criticized for this because the quality of evidence for apps is low. We'll talk about that. And the regulatory framework focuses on apps with medical purposes only, but as we will see, there's a ton of overlap. And the apps interact with patients. Has anybody heard of orthosomnia? One person? Okay. Orthosomnia is the obsession with your sleep app and the fact that you, it came out of Rush University, the fact that you, in essence, it's not an official designation yet, but the notion is it's coming into common parlance where people become obsessed at getting a good night's sleep to the point that they've got insomnia. You can't make this stuff up. And so there was a, Nature has a, Nature Digital Medicine, you know, one of their many magazines, I guess by using the word magazine, I'm dating myself, right? That's it. That they looked at 69 randomized controlled studies on medical apps and only one third, 33%, had a healthcare professional involved. Remember, these apps come from engineers, you know, corporate offices, you know, all kinds of places. We'll show you a few of those that really aren't necessarily medical and medical advice, you know, probably costs a lot of money. And so 66% do not have a medical professional. So, and all of the studies had short follow-ups, small sample sizes, high risk of bias in the randomized controlled studies, and they couldn't really do a decent meta-analysis. And some of the changes were patients interact with the apps and they become very, they use them in different ways. Also, an app, you know, you do a study on one app, you know, six months later, there's version 2.0. And 12 months later, there's version 5.0. And so it's a moving target. And so what was studied is no longer what that app does, that you can't genericize it, as the FDA said. You know, do they, and they have diagnostic potential, even if they're quote unquote, just a reminder. And it was just really, really fascinating that it can't be studied. And don't count on privacy. The British Medical Journal looked at 20,000 mHealth apps, of which 8,000 were medical apps, pure medical apps. And 88% had real problems with access to the information. 28% had no privacy policies. And 23% had, you know, they communicated over insecure ports. And so it's a challenge if we're going to be, you know, our patients are involved with them, we get involved with our patients, it's a challenge. Now, that being said, there's some really neat stuff too. So, what is in your iWallet? Okay, anybody, anybody here ever see the movie Bananas with Woody Allen? Okay, all right. In this, for you younger people, in this movie, Woody Allen played, went to a South American country and played El Presidente, and he had this, you know, obviously phony beard. And the, the FBI, or CIA, I guess, was on to him. They're looking at pictures of him. And, and the guy goes, all right, let's go pick him up. And then he looks up and says, we're going to make an example of this hip cat. In the day, it brought a great laugh. It basically, hip cat was what we, you know, kind of like a hippie from the 50s, if, anyway. At the time the movie was made, it was hopelessly out of date, and it's, and it's tough to keep up. And so, but for occupational, environmental health professionals, like, I assume most of us in this room, there's a, there's a zillion of them. Many of you know Hippocrates, we'll talk about that in a minute, Medscape, Up to Date, you're all familiar with that, I presume. Two that I really like, and would commend to you, are Skyscape Medical Library, and I apologize, I thought the app was on your, on your, on your app. I thought this was there, and you could, but you can look, you can just type in those names. And the, and so, Skyscape has books, a lot of the five-minute consultant books, a lot of emergency care stuff. Really useful, high-quality stuff. And then the U.S. Preventative Task Force, the U.S. Preventative Services Task Force, great. I mean, I don't know about you, but I have trouble keeping up with, you know, what are the latest guidelines for cancer screening, and, you know, when do you do the, how often, and where do you go for that? U.S. Preventative Services Task, U.S. Preventative Services Task Force app is great. You can just pull it up, and there it is, right on your, right on your wall. It's a wonderful thing. The, the other app that I use all the time, well, these two I use all the time. Essential Anatomy 5, it's from the company, 3D, and then number 4, medical, 3D for medical, is amazing. It's incredibly detailed. You can, you can spin it any which way. You can remove layers at any time you touch something, it'll give you the name. If it's a muscle, it'll give you the insertions. It's incredibly useful. I think it's 20 bucks. I mean, you can't, you can't, I, man, every time I see a patient, I show them that, and, and they feel they understand, and it's a way to communicate with your patients much more effectively. The other, let's see, the other app that I use all the time is Medibabble. Anybody here use Medibabble, that specific app? Okay, all right, good. Well, then we're, we're making progress here. What it is, is it has questions. You notice chief complaint, past medical history, et cetera, and you touch it, and it, and it gives you the translation. So, this is, is the problem something you can point to, such as pain, discomfort, or other concern related to a specific location? And I don't speak Spanish. El problema es algo que puede señalar como dolor, malestar, o otra molestia relacionada con un lugar específico del cuerpo? And the beauty of it is, it's got, it's very detailed expert medical questions, and the beauty of it is, there's only five answers. Yes, no, point to the body part, and then if it's, it's, you know, what drugs are you taking, do you know the names, how many times a day do you take it, a lot more detailed questions. It's amazing, and, you know, and it's got like 50 languages, you know, it's just incredibly useful. So, these are the kind of things, as an OCDOC, you can use, you can go into a plant, and I, I don't know if Ukrainian is in there, if anybody's going to Ukraine, but a lot of good stuff. Another thing useful for occupational physicians is, this is also from 3D for Medical, I, I don't have any stock in them, though I probably should, they're really good. This is kind of an amazing thing. In addition to, on the far right there, in addition to sort of, you know, if you have like a hamstring pull, you can touch the part of the body, it'll give you diagnosis information on the condition. But then it'll have recommended therapies for this, for early, middle, and late. You can sort the therapies by equipment available, you know, if you're home and you only have some weights and a couple rubber bands, or if you're in a gym and you got a whole thing, you can do that. For each exercise, they give you a short video, they're about maybe, you know, 30 seconds that show you how to do it correctly. And you can then pick the videos, print out a prescription, and hand it to people, you know, hand it to your patients. I mean, to me, it's pretty amazing. And I've used it, and it's very helpful. Even if people don't have, if they have the app, they can then watch the videos, if not, there's like, you know, 10 frames of the video to kind of show you how to do it. Just standard stuff, you know, many of you are probably aware of these, of course, you know, the NIOSH mobile pocket app, very useful for what we do. And something I found really neat is the OSHA NIOSH heat safety tool. I heard about this from Paul Papenak, a occupational medicine physician out in California. And this one is really great. It'll give you the wet globe temperature. It'll give you, you know, when the humidity, et cetera, is getting to the point that it's in a danger zone, it has recommendations, has definitions easily, with easy to look at pictures showing you when it's heat illness, it gives recommendations, et cetera, lets you know if it's an emergency, and you can find weather by zip code, pretty darn amazing. Also for occupational health professionals, has anybody, you, okay, another show of hands, sorry. Who has used the decibel meters on your iPhones or, okay, okay, yeah, a good half of you. These are really amazing. NIOSH even has one. They have a sound level meter, but nothing is yet ANSI certified, but it can sure give you a very close idea about what's going on. And for your kids that go to concerts and get their ears blown out, dB meter pro and decibel X are, you know, you can begin to educate them and give them a tool to work with. They're really, really, really very helpful. They use the microphone on your iPhone or on your Android phone and they're really great. So that is occupational medicine, kind of some of the really neat things happening in apps there. But if I recall correctly, more than 50% of ACOM membership is clinical, and so some of you probably see patients on occasion, right, okay. This is really neat, all this stuff happening here, the Internet of Things. Going back to Hippocrates, I was kind of blown away by this. Hippocrates has a new feature, bugs and drugs. You put in a zip code and it gives you all the sensitivities for 50 or more organisms in that zip code. So you're in the hospital and, you know, gee, is this thing still sensitive to clindamycin or not? It's awesome. I mean, you know, it's like I, like ChatGPT said, this could transform medicine. It's pretty amazing. And then the other one I like from this list is ResolutionMD that allows, in addition to kind of communicating with your doctor, it has the software to take images, actual images, MRIs, et cetera, and display them. So if you're adept at reading MRIs or whatnot, you can do it on your iPhone. Pretty cool. This is the article that came out in the New England Journal of Medicine 2019 that talked about, and, you know, right, I guess it really presaged the pandemic, but it talked about how that seniors, it was focused on seniors, could use medical devices to assess themselves. They called it the Ecologic Movement Assessments. In other words, you'd have something that would monitor. It sounds a little creepy, but for medical purposes, it's really useful. Monitor movement. The doctors would know what's going on with them, less subject to recall bias. There would be a sort of a connection between the doctor. They would know things that were going on, and, you know, a lot of it's just passive sensor collection, kind of like, you know, your, if you guys have iPhones and an iWatch, you can go to your phone, and it'll tell you how many steps you've taken over the past month, and it's like, wow, I guess it's been listening. Really and truly, this is, they were basically presaging a thing. Another kind of, now we start getting into, so this is all sort of the official, you know, great clinical stuff, you know, this is, you know, a lot of these are sold by major companies that have done the research, et cetera. Now you start getting into some of the more interesting features. This is a program called Rash ID, and it, you take a picture of the, I've used it, it's pretty good. You take a picture of the rash, you then, it gives you a series of pictures, and you can kind of help it identify your skin condition, and it generates a differential diagnosis. Pretty cool. And then, once you've, you know, settled on the primary diagnosis, it'll give you information what to do, whether it's serious, et cetera, et cetera. So that's really cool. I mean, it's like, hey, that's neat. You know, how many times have you, like, you know, had a rash on one of your children or a neighbor or whatever, and it's like, you know, gee, it looks like a rash to me, you know. So you know, unfortunately, this was, if you go to the About Us, you notice that, I think it's Tim Barrett, I've forgotten his name now, but it begins with a B. He, you know, proudly says that he recently graduated with a B.S. in biology, and, but don't worry, he's a long-time medical researcher. Okay. Okay. All right. So, I'm wondering if he's one of the 66 percent that did not consult a medical specialist when he made his app. Anyway, that's, so here's something that, this is sort of part of the problem. This is really neat technology. Clearly we all know that at this point in time, you know, the ability to recognize a rash has error bars like that big, right? And so it may be right much of the time, but not all of the time, and of course, it's that cancer that you miss, that melanoma that really looks like a mole or whatever that you really worry about. So this is kind of, you know, part of this is cautionary for us as occupational medicine health professionals that we're, not everything is rosy. Now there are big companies in this. This is the Claris Ultrasound app, pocket ultrasound, put the ultrasound in one pocket, the iPhone in the other, and there you are, you know, in the field doing ultrasound. I mean, what an age. I mean, this is pretty amazing. Again, limitations of mobile stuff. I don't do ultrasound, but my understanding is every device requires a different head, you know, like a long head, look at the shoulder, and you see some nods in the, okay. And requires training. You know, in other words, each joint requires, you got to know about that joint and how the ultrasound shows and what it all means, et cetera. So this isn't quite as cool as it seems, but it's still pretty cool. But that's going to change medical practice, I think. Another thing that I ran across, in fact, I think Warner Hudson told me about this one. This is the Littman Digital Stethoscope. Yeah, yeah, no, okay, a few nods, okay, all right, yeah, okay, Denise has one, okay. This, in addition to, you know, helping out your aged ears, if you're, as John Howard said, chronologically gifted, this will record to your iPhone the sound waves, the actual cardiac sounds, and you can analyze them, and of course, you know, with all the tools available, you can clarify the sounds, and you can expand them, and you, so you're in essence increasing the ability to diagnose and send it to a cardiologist, and it can be coupled with an actual rhythm strip, so pretty cool. And this is available, this is technology now, but it involves an app, so I thought it was legit for here. This brings, this is, the Panoptic's been around for 30 years now, I think. This is, for those of you that don't use them, you know, when you use a regular ophthalmoscope, you've got that little light, and you're trying to go, did I see that, you know, is that Drusen, gee, I don't know, you're trying to figure all this stuff out, and it's hard, but Panoptic looks at a third, a third of the retina, it's really cool, and you can, it now has a device to attach an iPhone to it that now transmits a picture, and you can actually look at that picture instead of having it sort of, you know, crane your neck and everything else. This, though, turns the iPhone into a medical device, remember, because the Panoptic is an app that is to use to treat and diagnose, now, if the color is off on that screen, if the software doesn't faithfully transmit the image, et cetera, that patient could be misdiagnosed and have something severe happen that could have been diagnosed if the thing was working properly, so it is now a medical device requiring all the FDA kind of things that go on with that. So again, deep water sometimes, but really kind of cool. Speaking of orthosomnia, you can, you know, the, an article just came out in the New York Times about, I guess, a week ago in the business section that basically said that your mobile medical apps don't give you great fidelity of data, you really need to follow the trends more than any specific day, and so this would apply to the Apple Sleep, Apple Watch Sleep app, et cetera, but the American Society of Sleep, American Academy, excuse me, of Sleep Medicine has come out and formally endorsed the Nite Owl, it's a little device that goes on and you have other wires that attach to you for home sleep studies. I wasn't aware of this, apparently there's a lot of people doing this, I was just out of the loop, but that was 2017, so basically you could have developed orthosomnia all through the pandemic, it would have been cool, right? So that's kind of what, that's for us, health professionals, things we can use, there's a ton of apps for your patients that you really want to be aware of, if nothing else. There's a couple, you know, there's a bunch of simple things like Pillboxy, Reminder, you know, oh, time for my statin, I better, you know, better get my statin, and it's very elaborate, and they, you know, Pill, colors, pictures, reminders, alarms, all that stuff, that's pretty cool. There's ergonomic stuff that I found helpful, a stand-up reminder, get up and stretch, you've been sitting at the computer for two hours now, it's time to move around, that's pretty cool. And mobility and stretch reminders, you know, same thing, you know, uh-oh, let's do our anti-carpal tunnel syndrome exercises, et cetera, also pretty cool. There's some other, most of you, I assume, know about GoodRx, you know, you can be in your doctor's office and put in the pill, it'll show you a map with all the pharmacies around and the prices, they have that pill at that prescription, at that size of a dosage, you know, what each one's selling it for, who has coupons, who doesn't, pretty cool. The other, another thing I found, Buff Muff, now we're all health professionals here, right, you know, that postpartum incontinence and uterine prolapse is a real thing, you know, but this, I thought, despite its name, really exemplifies the promise of mobile medical apps, you know, for our patients. So this is basically, it's got, this has educational videos, it's got workouts, you know, for basically pelvic floor tightening and Kegel exercises and whatnot. It's got experts that come on and talk, et cetera, they're interviewed, and it's something, it fills a real medical need. And to me, this is like, wow, this is a lot of promise. This is like a promise fulfilled for people that have uterine prolapse, that have incontinence postpartum, et cetera. So that's pretty cool. The flip side of the coin is some worrisome stuff. This is called Reflex IO, and the IO designation is from the Chagos Archipelago. So somebody in the Chagos Archipelago came up with this. Why does it worry me? If you've had a concussion, you take out your camera and flash, it flashes in the eye and watches your pupil, takes a little movie of the pupil going back and forth, and comes up with a concussion index score. Is this bad or not? Is this normal response or not? And there are people doing this in, like, research settings, you know, so I'm not, it's not like this is a crazy idea. But it gives kind of, you know, gee, is there meiosis, midriasis, how is it working? But it was very difficult to find out anything about this. You know, I checked the web, I checked the app, you know, the information. And so, and it's 400 bucks a year. So I'm wondering, you know, have they done the homework? Is the research there? And you know, given the things I said earlier, you can probably suspect my thoughts that it really isn't that good. Something as critical as assessment of a concussion, you know, shouldn't be left to something this unknown. It's a cool, it's cool. And if it actually is validated and peer reviewed and all that stuff, be very useful to have doctor and every emergency room pull out their phone and be able to get a quick assessment. But is it there yet? Don't know, don't know. So finally, a huge area. Mental health apps. Let me ask, does anybody here have a patient who's using a mental health app that you know of? Okay, all right. That's about 10, 20% of you, okay. There are 10,000 mental health apps in 2018 available, and about only 3.4% had any research to justify their pronouncements, their recommendations, et cetera. 20% had government affiliations. I'm going to show you some from the VA that I think are probably really useful and really they're pretty neat, but you really want to kind of be aware that in general, you really have to be careful. And what's happening now is Talkspace is a $1.4 billion enterprise being sponsored by Optum and Cigna to do online psychological therapy. And in fact, if you look at the far one there, you can even get medication management from a psychiatrist, presumably, though they probably cost more than general practitioners. And so the whole issue of who's minding the store, who's giving the recommendations becomes a big one, particularly since, you know, many mental health conditions are fatal. You know, so it's, again, I know I sound like somebody saying, you know, that internal combustion engine, it'll never catch on, you know. But you really have to kind of, you know, think about what this all means and where it's all going to be thoughtful as you advise and talk to your patients. And so that being said, there are some people who do have the resources, such as the Veterans Administration. They're big into PTSD, as we all might imagine, you know, for obvious reasons. And they have a PTSD coach. They have a PTSD family coach. They have all kinds of apps. You should take a look at the website. It's actually quite wonderful. You know, they have the resources to make all of these potentially legitimate, well-funded, and evidence-based. So I would commend this to you as something that you want to, you really want to kind of be aware of, be thoughtful about. Who was it? Was it Benjamin Franklin? Never be the first to adopt the new, nor the last to abandon the old. Okay. So this is another really kind of interesting development. This is an EMDR app for post-traumatic stress, where you basically follow the light with your eyes, and it makes pronouncements, et cetera. Is it really the treatment that you want? You know, again, I was not able to find out what research had been done for this particular app, but again, people may be using it. The VA, again, has an insomnia app, which is, you know, which is, you know, can be very helpful, and I presume the advice has been well-vetted. There is a, there is one device. I've looked at the board that's on this, and shift aside depression, I don't know if it's come out yet. Let's see. Is there anything I've seen? Is Kurt here? Yeah, Kurt. Anyway, this is one that has a board of preeminent people that are with it. It's been researched and evidence-based. Again, I have no affiliation with it, just, you know, just heard about it, but it looked really good. Wobot, probably one of the more famous apps. This is from a psychologist from Stanford University. It's been well-accepted, and it's pretty cool. You know, it's free, and, you know, you talk to it, and you go, gee, I'm kind of feeling blue today, and it'll give you a text right back, well, tell me about that. Well, you know, my dog died, and there's not, you know, it sounds like you've had a lot of problems going on with that. You know, what, have you sat down and just wanted to take in a vacation day? It's pretty amazing. I was, and it was written up in the New York Times as My Therapist, the Robot. As we round a third and head towards home, finally, we have mind-expanding apps. There's a ton of these. This is from UC San Francisco. Two I'm familiar with are Insight Timer and 10% Happier. 10% Happier was written by, it was a book written by somebody who was sort of a major anchor for one of the big, or he's, basically, he's affiliated with one of the big news outlets, and he was getting depressed and stressed out, and he started meditating, and he basically said it made him 10% happier. And so, now they have an app. Again, it teaches you how to do meditation, that sort of thing. Kind of neat. And UCLA has an app, which is down there, the Mindful app, Mindfulness Coach, et cetera. A ton of these. Some of them can be really helpful, and you don't have to worry that, you know, you don't have to worry too much about them. Insight Timer is kind of cool. It's a meditation app that basically has videos, and you can, you know, you can pick your guru or your leader or your whatever. And so, I just find, you know, in terms of if you become familiar with any of these, these are things, you know, that have sort of a low potential for harm and a high potential to do some good if you find they're useful for you, you may want to consider talking to your patients about them, because they can be very, very helpful. Final thoughts. Kind of my personal opinions is that, for all you HEPCATs out there, is that we're basically entering another era, I think, of empirical medicine, only mediated through apps. We saw some of the really cool things, some of the ones of great promise, and some of the ones that, you know, you'd be really scared to prescribe for your patients. But I think, ultimately, we'll be doing that. And I draw the analogy to Chinese herbal medicine, where, you know, Chinese, you know, have a 4,000-year history or longer, and a lot of their herbal remedies are actually quite effective. You know, I was living in Asia for a while, and we did Kung Fu a lot, and these guys put Chinese medicine on their knuckles, you know, because they were, you know, when they get hurt punching and stuff, and it really seemed to work. I mean, it was really quite amazing to me, and I, so I came to respect it as something that's potentially useful. And I think the same thing is happening with digital health. We're kind of sifting through, over time, the different apps, aware of their downsides, but really realizing a lot of them have promise, making personal judgments about it. And I think we'll want to kind of do that. And if you want to find apps, iMedical Apps is a website that has less new stuff all the time now, but they used to have a ton of stuff. In fact, I was so impressed with them, I offered to work for them for free, and they told me I was overcharging them. So I said, well, okay. MedCity News and Healthcare IT Today are two other sites where you go and kind of just see what's up, what's happening, what apps have come out. Again, it's a waterfall of apps. There's thousands of them, but, and then this, I'm going to find out if I can't get this posted. I put all the things I talked about, I had links here, and I had checked off the box saying, yeah, put my presentation on your app so you can kind of, you know, get to these. So I do apologize. I was told that this isn't available on your, what's the conference app called? Yeah, Swapcard. So it should be. It's too big to email, so, but if somebody wants, I'll be happy to send them a Dropbox link if you just email me. Really that's it. These are all just the links, and with that, I think I have a few minutes here, we'll take questions. Thank you. Hi, Dean Denise Clement, just an update on your Reflex. IO? Yes, so it's actually a product out of Purdue University. Of Purdue, really, is it? Yes. How can they use the IO designation? Well, it's IO, a lot of tech apps are using the designation IO. So it has nothing to do with who, the country that sort of owns the extension. So you'll find a lot of tech companies are something dot IO. Thank you. Thank you. So that's out of Purdue, you said? Out of Purdue University. Okay. We've got a peer-reviewed study. All right. I take back 50% of the things I said about it, so okay, that's good, all right. So this one is a valid product. Thank you. The app I wanted to mention, especially for people doing anything with chemicals, is called Wiser, W-I-S-E-R. It's an app for the phone, and it's tremendous because it gives you medical treatment, signs and symptoms, and it's just a phenomenal app. I used it all the time. Thank you. Where is it out of? W-I-S-S-E-R is the name of the app. Like Wiser today than yesterday kind of thing. Yeah. But it's a legitimate app, well-researched, and very helpful. All right. Thank you. Thanks, Denise. That's really neat. Yes, sure. Good afternoon. I'm President of Portuguese Society of Occupational Medicine in Lisbon, and last year I presented here our study about alcohol, tobacco, obesity, and sleep. And the reason my question is, what's your opinion? Because I don't know if I was distracted, but you didn't mention anyone about tobacco. And tobacco, I think, could be interesting to use the apps. What's your opinion? How do you spell that? Tobacco. Tobacco. Oh, tobacco like smoking. Oh, tobacco apps. Yeah, sorry. Helping patients to not smoke. Oh, okay. All right. No, thank you. I'll add it to it. Should anybody ask me to give this again? Go ahead, please. Thank you for the excellent talk. Two quick questions. Number one is Apple versus Android. Are you just seeing in terms of the Android platform or other platforms an explosion also of apps in general? I know we talk about Apple, but I know different populations I deal with, and some of them, they all have the Apple interface. I do know globally for all medical and non-medical apps, the Android world has almost as many. For medical apps, I don't know. Some of the ones, such as the 3D for medical ones that require more video processing, and this goes back three or four years. I didn't check that question. The iPhone is more suited to that, and iOS is more suited, but I suspect it's such a huge market that anything that's only on one platform eventually will move to the other, but I don't know the answer to your question. That's okay. Thank you so much. All right. Thanks. Just the definition on the WISER app. It stands for Wireless Information System for Emergency Responders, and it's from the National Library of Medicine. Thank you very much. Yes. Also very helpful, since we're under PrEP-Med, is USPTF, US Preventative Medicine Task Force. You put in a patient or employee's demographics, and it has the A recommendation, B recommendation, C, et cetera. You mean now demographics as in their personal demographics or where they live? Like, say you put in a 51-year-old male who smokes or whatever, and say, okay, they need colonoscopy, recommendation A, et cetera. Oh, great. Thank you. Appreciate that. Hi. Hi. My name is Chidima. I'm a physician from Nigeria. We're currently in Hopkins. I have a question about the apps, and do you have anything to say about using these apps and their legal implications or ethical considerations? Are there any problems or any issues with that, using the app and doctors? I'm sorry. Issue with what specifically? Any connection with using the apps and legal implications or ethical considerations while using the apps with treating patients? I'm just not getting the question. I'm sorry. I'm talking too fast. It's me. I've got ancient ears, and my apologies. I'm probably talking too fast. Sorry. My question is about using the apps and using them with patients or patients using them. I'm wondering what you have to say with the apps and legal implications or ethical considerations. That's a great question. What do I have to say about the legal implications of using the apps or prescribing apps for patients? I'd say the legal implications are the same. Maybe if you're in the military, you have a shield, but for any non-military physician or nurse practitioner or PA, you have liability. If it doesn't work, particularly, I think, with mental health apps because of the danger of suicide, et cetera. I think you have huge liability. You're better off, if you are going to recommend something, recommending something from a, if not unimpeachable source, a very good source, VA just comes to mind, though I haven't looked at each one of their apps to see how many have evidence-based research. I think you're just as liable as you would be for a drug or for a device that didn't work or caused harm. Hey, Andy. Are you aware of any, like for sustainability, there are organizations that certify this product as whatnot. Are you aware of any organizations that are providing a kind of seal or certification or just kind of a stamp of approval for these apps saying, hey, this one is actually based on evidence or this comes from a good source or anything like that? I think, no, I'm not, is the direct answer to your question. I think the problems that they had doing the randomized control trial and the meta-analysis that these apps are constantly morphing, they're used in different ways, it's hard to pin them down. I think that probably prevents somebody. I don't, you're kind of like a gold seal program or something like that. No, I'm not aware of it. I suspect there is, but I just have not seen any. We could poll the room. Anybody know of any certification programs or apps? I imagine it would be a thankless job because the apps change all the time, but I don't know. Great question, Andy. Okay, I think we're pretty close to time here. I just want to thank you all for coming. Oh, we had a, oh, hold on. Dr. Peterson, yes, please. Well, the question about tobacco really raises a whole other book. Ten years ago, I gave presentations on e-wellness, and there were hundreds of programs and systems. Today, there are thousands, and you could give a whole presentation on really self-care, behavioral management, weight management, exercise, sleep, fitness, diet, et cetera. I think that's a whole other area that borders on your subject. I totally agree. I would not encourage you to try to boil the ocean. I think what you focused on was very good. This had medical in the title for a reason. The whole wellness world is like a 500% greater mushroom cloud over those medical apps that we were talking about, but yeah, it's a big deal. Thank you. I really appreciate you coming. Thank you. Thank you.

mobile medical applications

medicine

transformative potential

GPTs

healthcare

self-diagnosis

occupational health professionals

mental health apps

certification