Sunday, March 3, 2013

Social Media Transforming Care for Patients with Rare Diseases

This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care. - See more at:
This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care. - See more at:
This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care.
Several years ago a member of my family was diagnosed with a rare disorder. After numerous doctor visits and a multitude of tests, we finally received a diagnosis and were able to schedule surgery to address the condition.
Among rare disease patients, my family was lucky. A diagnosis was made relatively quickly and a treatment was available.  For many rare disease patients and their families, finding a diagnosis can take years, not months, and few treatments, if any, are available.
Looking back on my experience, I’ve often wondered how social media tools might have hastened the diagnosis and improved access to treatment for my family. In fact, today, we are seeing social media transform care for rare disease patients in several ways.

Facilitating Diagnosis
Though the symptoms of my family member were textbook for a particular rare disorder, our primary care physician never made the connection because he had never seen this condition in his decades of practice. But what if our primary care provider could have shared the details of the case with a large network of physicians, from a wide range of specialties? Would someone have recognized the condition because of professional experience or specialized expertise, helping us find the appropriate specialist more quickly?
Closed social networks such as Sermo and Doximity have helped some physicians crowdsource a diagnosis for difficult cases. Because they are open only to physicians, these social networks can overcome some of the privacy concerns that arise in an open social network. The limited access also ensures greater credibility.

Nonetheless, open social communities, which allow anyone to weigh in, may also be useful in facilitating a diagnosis.  For example, a recent article in Wired magazine describes the case of a mother whose child was accurately diagnosed with a rare genetic disorder by her Facebook network. 
Though information sharing on all social networks has potential to hasten diagnosis, patient privacy issues continue to be an important concern.
Connecting Patients with Treatment, Support, Resources
The pharmaceutical industry has become increasingly interested in developing drugs to treat rare diseases, thanks in part to incentives created by the Orphan Drug Act passed thirty years ago. The incentives extended to firms by the Orphan Drug Act include expedited approval, tax benefits and seven years of market exclusivity. In 2012, the FDA approved 39 products and approximately one-third of those approvals were orphan drugs.
After an orphan drug is approved, the pharmaceutical industry faces a challenge in communicating to patients and physicians about the drug. Using traditional communication channels, such as mainstream media or personal sales calls, is not practical or efficient as patients and specialists are few in number and widely dispersed.
However, the long tail qualities of the internet make it an ideal way for pharmaceutical firms to precisely target communications to rare disease patients and specialists. The National Organization of Rare Disorders (NORD) has links to 180 patient organizations, many of whom have active social communities on a variety of social platforms.
One example of how a firm has leveraged social communities to reach patients is NPS Pharmaceuticals, which has recently received approval for its drug for short bowel syndrome. NPS is working with a patient advocate to help connect with potential patients via his social network of 1,000 patients and caregivers.
Collaborating in Development and Funding of New Treatments
Though there is increased interest in developing treatments for rare diseases within the pharmaceutical industry, only 200 orphan drugs enter development each year according to the FDA.  Yet there are nearly 7000 rare diseases.  Thus, support and funding for many rare diseases may require more than just the support of the pharmaceutical industry. Crowdfunding may offer an option for additional financing of rare disease research. 
According to Mashable, crowdfunding, “describes the collective effort of individuals who network and pool their resources, usually via the Internet, to support efforts initiated by other people or organizations.”  A recent story on National Public Radio, explored how crowdfunding has been successfully used to raise money for a wide range of scientific research. Now, the nonprofit organization, Rare Genomics Institute is using crowdfunding to gather genetic information from rare disease patients that will help lead to the development of new therapies.  
Others are using crowdfunding to promote greater awareness and interest in individual rare diseases.  For example, filmmaker Joey Howell used the crowdfunding platform kickstarter to raise over $30,000 to produce a documentary about the rare degenerative disease MPS II, a lysosomal disorder.
While therapies for many rare diseases have yet to be discovered, new tools for sharing information, such as social media, provide new hope for rare disease patients and their families. To learn more about rare diseases and how you can get involved visit these organizations:

Wednesday, November 21, 2012

Engage with Grace Blog Rally 2012

This year I'm again pleased to participate in the Engage with Grace blog rally. This post was written by Alexandra Drane and the Engage With Grace team. The goal of blog rally is to get people talking about end of life issues with family members while they are still healthy, when it is easier to think through these issues more rationally and carefully. 

As physician author Atul Gawande, MD, MPH noted in a November 2012 lecture at the Harvard Medical School, such discussions are about more than just end of life planning.  They represent, he observed, goals of life--a framework for life planning.  This Thanksgiving let's start planning.  

One of our favorite things we ever heard Steve Jobs say is, "If you live each day as if it was your last, someday you'll most certainly be right." 

We love it for three reasons:
1) It reminds all of us that living with intention is one of the most important things we can do.

2) It reminds all of us that one day will be our last.

3) It’s a great example of how Steve Jobs just made most things (even things about death – even things he was quoting) sound better.

Most of us do pretty well with the living with intention part – but the dying thing? Not so much.

And maybe that doesn’t bother us so much as individuals because heck, we’re not going to die anyway!! That’s one of those things that happens to other people….
Then one day it does – happen to someone else. But it’s someone that we love. And everything about our perspective on end of life changes.

If you haven’t personally had the experience of seeing or helping a loved one navigate the incredible complexities of terminal illness, then just ask someone who has. Chances are nearly 3 out of 4 of those stories will be bad ones – involving actions and decisions that were at odds with that person’s values. And the worst part about it? Most of this mess is unintentional – no one is deliberately trying to make anyone else suffer – it’s just that few of us are taking the time to figure out our own preferences for what we’d like when our time is near, making sure those preferences are known, and appointing someone to advocate on our behalf.

Goodness, you might be wondering, just what are we getting at and why are we keeping you from stretching out on the couch preparing your belly for onslaught?

Thanksgiving is a time for gathering, for communing, and for thinking hard together with friends and family about the things that matter. Here’s the crazy thing - in the wake of one of the most intense political seasons in recent history, one of the safest topics to debate around the table this year might just be that one last taboo: end of life planning. And you know what? It’s also one of the most important.

Here’s one debate nobody wants to have – deciding on behalf of a loved one how to handle tough decisions at the end of their life. And there is no greater gift you can give your loved ones than saving them from that agony. So let’s take that off the table right now, this weekend. Know what you want at the end of your life; know the preferences of your loved ones.

Print out this one slide with just these five questions on it.

theoneslide Have the conversation with your family. Now. Not a year from now, not when you or a loved one are diagnosed with something, not at the bedside of a mother or a father or a sibling or a life-long partner…but NOW. Have it this Thanksgiving when you are gathered together as a family, with your loved ones. Why? Because now is when it matters. This is the conversation to have when you don’t need to have it. And, believe it or not, when it’s a hypothetical conversation – you might even find it fascinating. We find sharing almost everything else about ourselves fascinating – why not this, too? And then, one day, when the real stuff happens? You’ll be ready.

Doing end of life better is important for all of us. And the good news is that for all the squeamishness we think people have around this issue, the tide is changing, and more and more people are realizing that as a country dedicated to living with great intention – we need to apply that same sense of purpose and honor to how we die.

One day, Rosa Parks refused to move her seat on a bus in Montgomery County, Alabama. Others had before. Why was this day different? Because her story tapped into a million other stories that together sparked a revolution that changed the course of history.
Each of us has a story – it has a beginning, a middle, and an end. We work so hard to design a beautiful life – spend the time to design a beautiful end, too. Know the answers to just these five questions for yourself, and for your loved ones. Commit to advocating for each other. Then pass it on. Let’s start a revolution.
Engage with Grace.

To learn more please go to This post was written by Alexandra Drane and the Engage With Grace team.

Wednesday, August 8, 2012

Health Care Social Media Review, 10th Edition: Social Media and Chronic Disease

Welcome to the tenth edition of Health Care Social Media Review.  This week’s theme is the role of social media in addressing, managing and preventing chronic diseases.   According to the World Health Organization (WHO), chronic diseases, also known as noncommunicable diseases (NCD), are a leading cause of death worldwide.  NCDs encompass four main groups: cancer, cardiovascular disease, respiratory disorders and diabetes; these diseases can affect people of any age and socioeconomic group.  As Kenneth Thorpe observed on HealthWorks Collective, “the key to addressing our greatest 21st century health care challenges—controlling costs while achieving improved health outcomes—lies in attacking chronic disease.”  
Beyond patient communities
Social media can be a powerful tool in addressing the challenges created by chronic diseases.  A report produced by NEHI notes that "social media sites engage and educate patients in personal health care, connect patients with their peers, implement evidence-based interventions and change behavior over time."
Writing on the HealthyComms blog for Shift Communications, Amanda Guisbond notes that our view of health care social media is often limited to patient communities that cater to those who have been diagnosed with a particular illness.   However, Amanda continues, the boundaries of health care social media are expanding.  New communities such as MeYouHealth seek to influence people before they become sick by promoting healthy lifestyles.  Amanda writes, "I love the idea that social media influences us to see health in a broader context and not as something we have to attend to once we've been dealt some bad news."  I love the idea too.

The influence of social media is also expanding beyond patient communities organized around those with specific diseases.  The State of Health blog recently profiled a new initiative targeted at youth in the San Francisco Bay area.  The Bigger Picture is a collaboration between Youth Speaks, a spoken word poetry organization, and the University of California San Francisco.  Through the program, twenty poet mentors are turning online peoms into videos to educate high school students on Type 2 diabetes and encourage them to lobby their communities to make neighborhoods healthier.  As one poet stated in the Bigger Picture introductory video, Type 2 diabetes is "no longer our grandparents' disease." 

Improving the quality of health care

There is also a movement to broaden the audiences of patient communities by including health care providers.  WEGO Health invited Kelly Young, founder of the first non-profit advocacy group for rheumatoid arthritis patients in the US, to attend the Annual National Conference of the American Academy of Nurse Practitioners.  Kelly, writing about her experiences on the WEGO Health blog, noted that the experience was valuable in helping build alliances between health activists and health care providers.  Increased participation in patient communities by health care providers can help improve the quality of information found in these communities. 

Participation in social media by health care providers can also provide them with important patient insights.  On the Hive Strategies blog, Jean Kelso Sandlin writes that social communities can provide patients with a sense of belonging and the ability to cope with the challenges of their disease.  However, she continues, the benefits of social communities go beyond patient support.  Interactions in social communities may reveal information that may not be addressed in face to face interactions. 

At the Social Media Healthcare blog, Dr. Mark Ryan also makes the case for participation in social media by primary care physicians.  He writes, "Family medicine's bio-psycho-social approach to care, which enables us to provide capable and effective care for patients with chronic illness, would also be valuable in discussions with engaged and empowered patients who are seeking to improve their own health statuses."

Measuring impact and outcomes

Given the public health priority of addressing chronic diseases, we are beginning to see more interest in measuring the effectiveness of social media's ability to improve health outcomes.  In an interview with Jean Kelso Sandlin, also published on the Hive Strategies blog, Naser Partovi, the founder of Wellaho, noted that his firm has studied the use of the social network in patients with congestive heart failure, obesity and asthma.  In July, 2012, the University of California San Diego announced that it will conduct a clinical trial to determine whether the use of Wellaho improves doctor-patient interactions and health outcomes in diabetic patients. 

Connecting more than patients

Patients aren't the only ones using health care social media.  The Centers for Disease Control and Prevention (CDC) has created several social communities to enable public health professionals to discuss chronic disease prevention and health promotion, including the blog, Preventing Chronic Disease Dialogue

The emergence of crowdfunding means that programs and products addressing chronic diseases may originate outside the research community.  Recently, the found of Medstartr, Alex Fair, spoke with Matthew Holt at the The Health Care Blog.  Medstartr is a way to build support among patients, physicians, and providers for innovative new health care programs or products.  Projects with demonstrated support can draw attention and funding from commercial partners.

Thank you for visiting this week's edition of Health Care Social Media Review.  Our next host is Barbara Ficarra at Health in 30.  Follow the blog carnival on Twitter for the latest news and information, including how to host or participate.  We look forward to hearing from you. 

Tuesday, July 31, 2012

Submit Your Posts: Health Care Social Media Review, 10th edition

After a brief blogging sabbatical, I’m pleased to jump back in by hosting the tenth edition of the Health Care Social Media Review (HCSM Review) on Wednesday, August 8.  HCSM Review is a bi-weekly blog carnival that features posts about the use of social media in health care, including best practices, case studies, resources, social media communities and tools.

The theme of the upcoming edition of HCSM Review will focus on the use of social media by caregivers, providers or health care firms to help patients manage and cope with chronic illnesses. I was inspired by a story which aired on my local public radio station last fall, profiling a woman who tweets on behalf of her mother who suffers from Alzheimer's disease. This example is especially relevant since next week is Alzheimer's Awareness Week. (Please note: submissions may address the use of social media in managing any chronic illness, not just Alzheimer’s disease.)

To submit a post for potential inclusion in the next edition, please send an e-mail to jamierauscher AT with the following information:
  • Email Subject Line: HealthCare SocialMedia Review
  • Blog Title: 
  •  Blog URL: 
  • Post Headline: 
  • Permanent link to post: 
  • Your Name: Name, Username, Nickname, or Pseudonym 
  • Description or brief excerpt 
Submissions are due by 6 pm ET Monday, August 6. I look forward to receiving your posts.

Thursday, March 29, 2012

Six Ways to Promote Your Health Care Blog

This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care.

In March 2012 the Wall Street Journal’s Health Blog marked its fifth anniversary.  With more than 7,300 posts and 118,000 comments to date, the blog’s birthday is significant because it demonstrates that interest in health care blogs continues to grow.   Creating interesting, high quality content is essential in becoming a successful health care blogger;  however, even the best content needs promotional help to gain visibility and readership.  
Here are six strategies to effectively promote your health care blog to build readership and traffic:
Optimize for search.  Search engine optimization techniques work for blogs too.  Selecting relevant keywords and placing them thoughtfully in the titles and body of your blog text are important first steps in optimizing your blog content for search.  And don’t forget to register your blog on Google, Bing and Technorati, a specialized search engine focused on blogs.  
Syndicate to maximize exposure.   Your original content can be published on your blog’s site as well as health care portals that aggregate content from multiple health care blogs.   Each portal has specific directions on submitting posts for publication on their sites.  Choose a portal whose target audience or theme most closely matches your blog.  Some health portals to consider:

Participate in blog carnivals.  A blog carnival is an event in which bloggers submit posts to a host blog for inclusion in a themed blog post which summarizes the work of contributing bloggers.  Bloggers take turns hosting the carnival on their site.  Participation in blog carnivals, as both a host and a contributor, is an excellent way to gain visibility and cultivate relationships with other bloggers.  Well known health care blog carnivals include:

Post responses on influential health care blogs.  Leaving comments on other blogs allows you to establish relationships with influential bloggers and create visibility for your own blog.  However, as David Meerman Scott writes in The New Rules of Marketing and PR, it requires skill and finesse to execute this strategy.  The key, Scott advises, is to focus your response on the issues raised by the blog post, not to write about yourself;  though he notes it is perfectly acceptable to provide a link to your blog’s URL within your response.

To effectively use this strategy you will also want to comment on well-known blogs written by health care thought leaders whose topics are relevant to yours.  To identify influential bloggers you may want to use Technorati, a blog search engine, or consult a service such as Klout which identifies influential people and organizations by topic.  (Note you will need to set up an account to access Klout.)  The health care blog portals and carnivals mentioned above are also excellent sources for identifying influential health care blogs. 

Here is a small sampling of some respected, independent health care bloggers whose blogs you may want to follow:

      Physician Authored Blogs:
           Kenneth Lin (Common Sense Family Doctor)
           Mike Sevilla (Family Medicine Rocks)

      Patient Authored Blogs:
           Jackie Fox (Dispatch from Second Base)

     Policy and General Health Care Issues:
           Paul Levy (Not Running a Hospital)
           David Williams (Health Business Blog)
     Health Care Social Media:
    Pharmaceutical Industry
           Sally Church (Pharma Strategy Blog)
           John Mack (Pharma Marketing Blog)

Host a guest blogger.  Capitalize on the name recognition of thought leaders and other well known bloggers (see above) by asking them to write a guest post for your blog.  
Leverage your social networks.  Posting a link to your blog posts across social networks can increase visibility and search engine ranking.  This includes posting links on your Facebook and Linkedin updates, in relevant Linkedin discussion groups, and sharing on Google+.  Links to blog posts should also be tweeted a couple times a day for several days after publication to ensure that post links don’t get lost in your Twitter stream.  Again, this strategy requires some finesse and judgment to ensure you don’t cross the line from a reasonable level of promotion to spamming.  

Finally, you will want to measure the effectiveness of your blog promotion efforts by using analytics tools to monitor statistics such as number of visits, traffic sources and time spent on your blog.  Several free options such as Google Analytics, Site Meter and Stat Counter are available.  

Creating blog content can require a significant investment of time.  It’s important spend time promoting content as well as creating it to maximize the return on your investment. 
What strategies have you found effective in promoting your health care blog?

Monday, February 20, 2012

The Future of Innovation in Health Care

Is innovation a necessity or a luxury that our financially strained health care system can no longer afford? 
In February 2012, panelists representing a range of organizations debated the role of innovation at the 9th Annual Health Care Conference, hosted by the Healthcare Club of the Harvard Business School.  The consensus among panelists was that innovation will remain an essential element of our health care system but only in the context of the economic and clinical value it brings to patient care.  Key insights are summarized here.
Innovating in the context of rising costs
Keynote presentation by Karen Ignagni, CEO of America’s Health Insurance Plans
  1. Why costs matter.  Ignagni quoted a December 2011 report by McKinsey which found, adjusting for inflation and population growth, that health spending has grown 5 times faster than the gross domestic product since 1960.  Health care costs, she continued, are the primary driver of our national debt.  She questioned how we sustain this growth yet meet the needs of patients.
  2. Shift the conversation to value.  Ignagni suggested we must evaluate whether technological innovation is being used appropriately.  She cited a 2006 study in Health Affairs which considered how to integrate value and technology in making treatment decisions.
  3. Re-engineer payment models.    If prospective payment models like accountable care organizations are to succeed, she noted that hospitals, health plans and physicians must collaborate in goal setting and share responsibility for managing costs.
  4. Re-orient benefit plans.  Ignagni acknowledged that benefit plans need to focus more on prevention and improving care coordination, especially for patients with co-morbidities.
Enabling the development of new treatment paradigms
Discussion moderated by Stan Lapidus, SynapDx with panelists Rick Schatzberg, Generation Health; Wei-Lio Shao, Eli Lilly; Katie Szyman, Medtronic
  1. Balance regulatory rigor with innovation.  While regulation is important to ensure patient safety it can also slow innovation.  Szyman noted that the premarket approval process for Medtronic has increased from 3 to 7 years and costs have increased from $10-20 million to $200 million.
  2. Demonstrate economic value earlier.  In response to concerns about the cost of new treatments, Shao noted that there has been a movement to generate health outcomes and economic data in parallel with the clinical development process. 
  3. Social media can influence regulatory approval.  Szyman recounted the impact of patients and health care organizations on the approval of Medtronic’s Veo insulin pump.  The Veo pump, also known as an artificial pancreas, represents an improvement in management of Type 1 diabetics because it automatically adjusts insulin levels, helping them avoid hypoglycemia.  Despite its use in 70,000 patients worldwide, the FDA had been slow to issue guidance on the clinical approval process for the artificial pancreas.   In response, the Juvenile Diabetes Research Foundation gathered 100,000 signatures online, motivating the FDA to issue draft guidance in December 2011.
Bringing consumer centricity to healthcare
Discussion moderated by Bob Higgins, Highland Capital Partners with panelists Ambar Bhattacharyya, Bessemer Venture Partners;  Jordan Goldberg, stickK; Michael Laskoff, AbilTo
  1. Wellness is a behavior problem, not an information problem.  Panelists noted that we need to use technology in a way that gives individuals the feedback they need to accomplish behavioral change.  Novel new products such as stickK or AbilTo help people remain engaged and compliant.
  2. Employers are target customers for wellness programs.  Both StickK and AbilTo have pivoted their strategies to focus on businesses versus individuals.  However Goldberg and Laskoff cautioned that those marketing wellness programs to businesses need to demonstrate why changing behavior is important and how their programs will save money. For example, since post cardiac-event patients may be vulnerable to experiencing mental health issues that can affect their recovery, AbilTo contracted with Aetna to proactively reach out to plan members who had suffered these events.
Redefining the role of venture capital
Discussion moderated by Terry McGuire, Polaris Ventures with panelists Alexis Borisy, Third Rock Ventures; Chip Clark, Genocea BioSciences; David Schenkein, Agios.
  1. Consider unconventional funding models.  The panel noted that less venture capital is being invested in early stage life science companies because returns have been challenging.  As a result, firms like Genocea are turning to nontraditional sources of funding such as the Gates Foundation.  Schenkein observed that another alternative source of funding is to consider a corporate partnership early in the development process; however he acknowledged that this strategy can mean a loss of management control.    
  2. Opportunities remain.  According to Borisy the contraction in venture capital has focused venture investment on transformative ideas versus lower risk, less novel ones. 
  3. Customers are not looking for marginal changes. As public payers assume greater financial responsibility, Borisy noted that it’s incumbent on firms to create products that produce significant improvements in efficacy or cost effectiveness. 
The future is affordable innovation
Despite the pressures to keep costs in check, panelists were generally positive about the role of innovation in health care, concurring that advances in technology will help firms accelerate product development, demonstrate value and improve decision making by health care providers and patients.

Tuesday, January 10, 2012

3 Factors Fueling Growth in Mobile Health Apps

The market for mobile health apps is forecast to grow 70% over the next five years, to $392 million. Beyond improvements in technology there are several factors fueling this blistering growth.

  • Increased incidence of chronic diseases.  According to the CDC “chronic diseases – such as heart disease, stroke, cancer, diabetes and arthritis – are among the most common, costly and preventable of all health problems in the US.”  Among these, diabetes is particularly significant. According the CDC’s 2011 National Diabetes FactSheet approximately 26 million or 8.3% of Americans have diabetes.  As reported in the January 2012 edition of Health Affairs, an issue devoted entirely to diabetes, an additional 79 million Americans are at high risk of developing the disease over the next 10 years.  The cost to treat and manage these patients is enormous.   Health Affairs notes that  $1 out of every $3 in Medicare  is spent on the disease.  UnitedHealth, one of the nation’s largest health insurers, estimates that treating diabetes in the US will cost $3.4 trillion from 2010 through 2020. 
  • Proven benefits of self-monitoring, communicating & collaborating.  A study at Kaiser Permanente studied nearly 35,000 patients with chronic health conditions, including diabetes over a two month period.  The study found that those patients who used email to communicate with their doctors saw a statistically significant improvement in various health measures.  Mobile health apps are powerful because they facilitate more frequent communication and allow patients to more actively participate in disease management.  
  • Shift in how patients access health information.  A survey conducted by the Pew Internet project found that 9 percent of cell phone owners have apps that they use to manage their health.   The survey also found African Americans and Latinos were more likely to use mobile health apps.  This is significant since, as reported by the CDC, these populations are at increased risk of developing chronic illnesses such as diabetes. 
A sampling of mobile health apps for diabetes
Given the market size and the importance of disease monitoring and management, health apps for diabetics are among the most important being developed.  The popular DiabetesMine blog does a nice job profiling the dozens of options available to patients.  Some apps that have garnered significant attention include the following:  
In 2010 WellDoc received FDA clearance to market  its DiabetesManager.  The software based app includes a medication adherence program and real-time transmission of blood glucose data to physicians.   In a 12-month randomized controlled trial, whose results were published in the September 2011 issue of Diabetes Care, patients using the WellDoc app in addition to their usual care recorded a statistically significant decline in their glycated hemoglobin levels during the study period.  Patients must use this phone-based system in partnership with their healthcare providers.
The Glooko iPhone app introduced late last fall, enables patients to more easily record and report their blood glucose readings.  By connecting their existing blood glucose monitor to an iPhone via a cable patients can use the app to send their readings to physicians by email or fax.  The iBG Star blood glucose monitor from Sanofi-Aventis cuts the cable by plugging directly into a patient’s iPhone.  The monitor also received FDA clearance in December 2011.
Another high tech solution to blood glucose monitoring was reported last week by Walter Mossberg ,  a technology columnist for the Wall Street Journal, who is also a Type 2 diabetic.  Mossberg reviewed the Telcare blood glucose meter which wirelessly transmits readings to a patient’s iPhone and a secure database that can be accessed by a patient’s physician.  The Telcare meter has been also been cleared by the FDA.  
Beyond smartphones
A lot of attention has been focused on using smart phones to manage diseases but not all patients have them.  Text messaging has also been successfully used to send patients important health messages and reminders, as demonstrated by the Text4Baby campaign, a program for expectant mothers.  More recently the Beacon Community health program announced the development of an initiative for diabetes management using text messaging at its sites located in Louisiana and Michigan, areas where the impact of diabetes has been particularly significant.  
What’s next?
We can expect to see continued development of mobile devices to allow patient self-monitoring for chronic conditions.  Increasingly, these devices will facilitate sharing of patient level data with health care providers and communication between patients and providers in response to these data.