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Medicine Software

The First Prescription-Only App 84

TWToxicity writes "Most prescriptions would say something like 'take two pills nightly with meal' on the bottle. Now, we may be adding a new method. Baltimore-based company WellDoc is making a national push in 2014 for doctors to prescribe their app, BlueStar, after a regional launch last Fall. BlueStar helps patients with Type II Diabetes by suggesting in real-time when to test and how to regulate their blood-sugar levels by, for example, altering their medication or food intake. Prescription apps may revolutionize mobile medicine and allow for more effective treatments because the patients get real time feedback and the data collected by the app is sent to their physicians. WellDoc is currently working on apps to monitor and coach patients with other diseases. The success of this product will rely on how many doctors prescribe it."
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The First Prescription-Only App

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  • Lovely... (Score:2, Insightful)

    by the_skywise ( 189793 )

    The doctors are prescribing minders...

    • by Penguinisto ( 415985 ) on Friday January 03, 2014 @06:46PM (#45861297) Journal

      They do prescribe some electronic devices and programming (e.g. CPAP machines) to individuals, but in all honesty, this is one step too effing far.

      Mind you, my missus is diabetic, but she can control her blood sugar levels just fine w/o being forced to buy/use a smartphone app to do it. Instead she uses a combination of common sense and a meter. So far, it's stayed happily between 98-130, and that's in spite of juggling two different types of insulin to keep it under control (Novolog and Lantus).

      Last bloody thing I need is for some doc getting a kickback to push an app onto her phone that the insurance company gets billed $12,000 for :(

  • by bob_super ( 3391281 ) on Friday January 03, 2014 @03:52PM (#45859707)

    "The success of this product will rely on how many doctors prescribe it"

    I'm too cynical to read stuff like this.

    • Agreed.

      Damn I'm getting old. I remember when companies would strive to get customers to do the purchasing. :/

      • i kind of.. don't like the idea of pharma getting customers (end users) to purchase ANYTHING. even as something as inane and pointless as this.
  • Certification Request in 3...2...1...
  • This looks great, and I could see products like them being used in the future to great benefit, but they'd better be sure the security is bulletproof inside and out. The line "data collected by the app is sent to their physicians" instantly sets off the "this could end badly" red flags in my head.
    • by sunderland56 ( 621843 ) on Friday January 03, 2014 @04:00PM (#45859801)

      Never mind security - who is going to be the first patient who died, because their cellphone battery died?

      • Re:Security? (Score:4, Insightful)

        by ColdWetDog ( 752185 ) on Friday January 03, 2014 @04:20PM (#45859941) Homepage

        I just love this meme on Slashdot. Instant Worse Case Scenario. In fact, instant OMG! Meteor-Strike-Worst-Case-Ever scenario. First off, it's not a ventilator - nobody dies instantly if the app doesn't work. Second, I'm rather sure that security was built in to the system (how effective it is remains to be seen). Third, it's been reviewed at the FDA level - some considerable thought has gone into the product.

        The numbers they are describing - a nearly 2 point drop in Hemoglobin A1c (which measures a running 90 day average of blood sugar levels and is sort of well correlated with long term risks of complications from diabetes) are impressive. That level is typically better than a lot of drugs (manufacturers would be tickled pink to get a whole 1 point drop on a consistent basis). Experience tells us that efficacy in the field is typically less than in controlled trials, but even a 1 point consistent decrease in HbA1c for something as benign as a iPhone app is significant.

        The real test is going to be how well these folks do 3, 4, 5 and 10 years down the line. That's the problem with chronic diseases like diabetes - you have to study interventions for long periods of time to determine if they really are helpful and to gauge any harms. Who knows what an iPhone will be like in 10 years - it may well be directly wired into your brain (and VISA card).

        • I just love this meme on Slashdot. Instant Worse Case Scenario. In fact, instant OMG! Meteor-Strike-Worst-Case-Ever scenario. First off, it's not a ventilator - nobody dies instantly if the app doesn't work.

          If I were this company I'd be more concerned with people claiming to have followed the app's advice and become worse because of it. Our litigation-crazed society makes it inevitable.

    • by Altus ( 1034 )

      In America, HIPPA would apply to an application like this so they would be required by law to follow best practices for securing patient data. Sadly that is not as secure as you might like it to be, but there are liability rules in place for things like this.

  • No thanks (Score:5, Insightful)

    by dreamchaser ( 49529 ) on Friday January 03, 2014 @03:58PM (#45859763) Homepage Journal

    I guess I could see this being useful for some, but I am a diabetic and I have no need for this app. Most people who would need it just don't practice tight control with enough discipline. I know when to test, can tell by how I feel when things are off, and know how to adjust my diet and insulin as needed. I also don't think I like the potential for abuse with an app like this. Yes, I know there is HIPPA to protect privacy. For some reason that still doesn't make me feel warm and fuzzy about tracking my health or disorder with an app.

    • Re:No thanks (Score:5, Insightful)

      by wcrowe ( 94389 ) on Friday January 03, 2014 @04:08PM (#45859855)

      I am also diabetic, and I agree with you. Adjusting your diet and dosages is not that difficult to achieve good control. After a while it almost becomes second nature. Anyone who is too lazy to do it on their own is going to be too lazy to input data into an app which tells them what to do. And, as you say, the tracking component is highly undesireable. I don't need some faceless company nagging me about what I should or shouldn't be doing. Life's hard enough when you have to be your own pancreas.

      I could see a future where insurance companies will require this sort of app, though. I hope they find a cure, or that I'm dead, by then.

      • Re: (Score:3, Informative)

        by snoig ( 535665 )
        I have also recently been diagnosed as a type II diabetic. While I'm sure that eventually I will easily be able to manage my diet by how I feel without an app like this, there is a learning curve and something like this could be very helpful to me at this stage. I've found some online resources that are very helpful when it comes to meal planning that could be even more useful if they could be integrated with my blood glucose meter and a smartphone. Imagine the day when there will be an implantable blood g
        • It took me all of a month to get the hang of it, but if it helps you then by all means that's great. It's NOT at all hard to practice tight control.

      • They can pull most of the data from my glucose meter already, no wait they all speak different electronic dialects. Glucose meter mfgs have tried similar approaches, but they charge for the software/service and data cables are proprietary. I can't afford diabetes meds like insulin already, supporting more medicine for profit is not on my to do list.

        Best healthcare in the world my ass. You want the data? Pay Me

    • Re:No thanks (Score:4, Informative)

      by techno-vampire ( 666512 ) on Friday January 03, 2014 @04:31PM (#45860041) Homepage
      Me too neither. However, on the other side, I'm part of a clinical study of a new fast-acting insulin, and I have to keep a diary including when I take my basal insulin (Glargine/Lantus) in 24-hour time. As I'm ex-Navy, that's easy for me, but from what the clerks at the clinic tell me, most people find it very hard to keep straight. I'd guess that for people who can't manage 24-hour time, an app like this might be worth while, assuming that they actually use it properly.
      • by wcrowe ( 94389 )

        That's interesting. On a side note, I've always wondered how they do a control group in such a study. Do they fill the pens (or vials) of the new insulin with a known, working, bolus insulin (like the Novolog that I use)? They sure as hell can't let you inject a placebo. That's not gonna work.

        • In this case, the trial version is Novolog with a new enzyme added that will, it's hoped, make it work even faster; the control group gets Novolog without the addition. Of course, it's all double-blind.
    • Not to be a dick, but isn't type 2 diabetes due to lack of self control as it is? So you say that it's not hard to remember to control your diet etc, but if you had the ability to keep yourself to a tight schedule and stay mindful of what you're doing its likely you wouldn't have type 2 to begin with (not you specifically). Yes some people make the proper changes, but many of my dietician friends say it's much more common that their patients ignore a majority of what the say. So an app will be helpful movin
      • by wcrowe ( 94389 )

        Well, it's not quite that simple (I'm a type 1 who was erroneously diagnosed as a type 2 for years), but you're on the right track. I know a lot of type 2s and some are very good at controlling their disease, while some take a very cavalier attitude towards it. One of my acquaintenances didn't start to take things seriously until he lost a toe. So, yes, some type 2s can be really bad about this sort of thing, and I don't think an app is going to help one bit.

      • Depends - sometimes Type II diabetes comes along for the ride when other conditions arise or get worse, and will diminish as the underlying disease relents (my missus has a fairly rare disease where this happens - it also does fun stuff like dump a ton of magnesium into her muscles, causing partial paralytic episodes. Even though her A1Cs are just on the good side of diagnosis, she's stuck with taking insulin anyway because the blood sugar count would go nuts otherwise.)

        Sometimes it comes about after dousin

      • Not at all. In some cases it is, in others there's a strong genetic component. I was 46 when I was diagnosed and I was quite fit, with a healthy diet.

    • Like you, I am a Type 2 diabetic. While an app to assist in tracking my intake and blood glucose levels can be helpful, it really comes down to discipline.

      There are apps that are great for tracking your calories and blood sugar levels. And, they are useful when you can see trends such as increases in your blood sugar level due to stress or illness or lack of sleep. And, they could be helpful in detecting when they things such as your medication aren't being as effective. Interestingly, the best thing I

    • It may not be for those who have been living with the condition 10 years or more. It may be intended as a teaching tool for those newly diagnosed, or those who have not exhibited good control of their disease (non-brittle, A1c>8)

    • Great. You've been dealing with it for how many years to acquire that "know when to test" and "feel when things are off"?

      This app is for newly-diagnosed people so they don't have to go through that "learning experience" and the likely damage that builds up while they're figuring things out.

  • by Anonymous Coward

    To forestall the inevitable sarcastic comments which the denizens of /. seem so fond of, may I direct your attention to the Wikpedia entry on medical compliance [wikipedia.org], which includes medication compliance. Patients failing to adhere to their prescribed course of treatment properly is a huge problem and only adds to medical costs when relapses and complications occur.

    Regardless of whether or not this particular application is helpful, it is a small step in the process dealing with the problem and that deserves re

  • Who are already overloaded in information, paperwork, journals, and hypochondriacs asking for penicillin for their colds. And/or the physician is 60, 5 years from retirement, and never bothered learning how to use a PC because they're wealthy enough not to.

    This seems like a great idea from some mid-20s hipster marketing drone, but there's no real benefit. Real-time data to your doctor? Like he's going to call you immediately (or text you, bro) and tell you to put down the candy bar?

  • by nani popoki ( 594111 ) on Friday January 03, 2014 @04:09PM (#45859871) Homepage
    I work in the medical products field as a software developer. You would not believe the amount of red tape involved in making a piece of software that is used to advise treatment. Such software is classified by the FDA as equivalent risk to an implanted defibrillator!
    • Rob, I think it would be more productive to talk about Clara.
    • by Anonymous Coward

      You're probably right. As I understand it, there's a difference between "an app that makes suggestions about treatment" and "an app that helps patients manage their own treatment." An app that reminds a patient to take a pill on their prescribed schedule is probably not giving "treatment advice," since it's basically just allowing the patient to set a reminder for themselves. Also, allowing someone to simply record their nutritional information (and sharing it with a doctor, who would be the one making t

    • I will make my usual chime in and suggest, shockingly, that the FDA costs more lives than it saves by delaying for years treatments, which could kill, by inaction, hundreds of thousands in the case of a cancer or heart treatment. Set against the downside of stuff getting to market too soon, and then pulled after a few hundred or thousand incidents.

      But those few hundred are much more camera-ready for grandstanding politicians than millions who would die anyway. "I stand here next to the bodies of 100,000 h

    • by tlhIngan ( 30335 )

      I work in the medical products field as a software developer. You would not believe the amount of red tape involved in making a piece of software that is used to advise treatment. Such software is classified by the FDA as equivalent risk to an implanted defibrillator!

      Which is why the FDA has been cracking down on medical apps - there are established guidelines on the research involved. One of the first casualties were "color" apps that basically said "Run the app, shine on your acne and it'll go away in a w

  • how much good is this? If my doctor prescribes an app, then will my insurance company pay for the cell phone required to run it?

    Something tells me they will not.

    There are still three of us in the world who refuse to own a cell phone.


    • I'm Type II, and I do have a cell phone, but all it can do is make calls and simple texting. I have no use for a smartphone and no desire to shell out the cash to get one just for one app that I don't have any use for. Yes, there are people out there who really need something like this because they don't know how to manage their condition, but most of them probably wouldn't use this properly if they had it.
      • But those same people probably also don't know how to manage their money and certainly have a smart phone.

      • I'm in a roughly similar position; I have an iphone for work. I find the idea that people actually spend ~$1000 (NZ) on these things mind-boggling, but since I have one for free I've found that some of the 'glucose monitoring' apps to be very useful for managing my diabetes.

        I've got no idea why there is so much snobbery on here by people claiming that you only need to monitor and record if you're some kind of moron who can barely tie their shoelaces together. I know how to manage my glucose, I understand th

  • Why can't I install it myself, send the data to me, and share that data with any doctor I see fit?

    That's how it should be. Now, if it's making medication change suggestions the doctor should at least know about it.

    But when it's your information and your device you should certainly have access to it.

    I didn't read the article, so I may be whining about nothing...
    • Now, if it's making medication change suggestions the doctor should at least know about it.

      Some diabetics need to adjust their dosage on a day-to-day basis, depending on their blood sugar reading. If so, they need to understand the process well enough to calculate how much insulin to take based on their reading. Not all of them are comfortable with math, and find it either frightening or confusing, if not both. An app like this would simply do the calculation for them, so that they would know how much
      • Absolutely right. Despite finding some current apps really useful (currently using Glucose Buddy [glucosebuddy.com]), they do tend to just focus on retrospective monitoring of glucose levels and insulin.

        I'm finding this useful currently just because my phone is the only thing that goes everywhere with me, so it's easy to always record wherever I am. I would love to have them go the extra mile, though, and tell me:

        1. what my ideal insulin/carb ratio is
        2. suggest dosages for certain meals
        3. track injection times, and monitor the half-
  • Now we just need an app that will prescribe this app.
  • Do they get a cut of the insurance companies price? the full non insurance price? do they get a cut of the mo fees? Will apple / some other say under the rules we must get a cut of the full insurance plan price?

    • Hmm...the app is free, but it only works with the prescribed device? Just like most other services that require a device. Then again, if it has monthly fees, Apple wants 30% from any in-app purchase. So it's probably a one-time purchase. But then the device probably "expires" after x years and has to be repurchased.

      • but I think app may also have rules about going around a in app monthly fee buy to get out of the cut?

        • Right - there's no easy way out of the cut if you have monthly fees. Unless you put no reference to a subscription in the app itself. If the only way to subscribe is to go to a web site and figure out that address without referencing the app, I think you can get by without allowing an in-app purchase.

          So the easiest option is to build the monthly fee into the cost of the hardware and give it a limited life span.

  • by peter303 ( 12292 ) on Friday January 03, 2014 @04:29PM (#45860025)
    Could the App be considered in a small sense an A.I. practicing medicine if it makes decisions and gives advice? Who gets the blame if something suddenly goes wrong or there is a gradual worsening? Plenty of other computer programs give advice, but are not as consequencial as a medical decision. Does the programmer or medical expert adviser share some of the blame? Where do you draw the line between looking up something in a manual versus actually having a decision made for you?
    • I'd say it's the same as any electronic medical device. It's not even an AI in a small sense. It's following predefined rules. If the person who prescribed it was aware of issues (or should have been aware) before prescribing it, then they'd share some liability. Otherwise, the liability is with the maker of the product. Not really any different than trusting a cheap electronic glucose meter.

  • I don't have a smart phone.
    Does this mean if I get perscribed an app my insurance will pay for the smart phone so I can get the perscription filled?

    • by OhPlz ( 168413 )

      Yes, but your insurance premium will increase an amount equal to several times the cost of a smart phone. That means it's free.

      Either that or Obama will pass an executive order demanding that we all buy smartphones or else be penalized/taxed by the IRS. They could already be working on the app portal and cafeteria plans for cell coverage. If you thought healthcare.gov was great, just wait until you see smartphone.gov!

    • will they cover roaming and data overages?

      Let's say you need this all the time will they pay for ALL data use even fringe roaming as well when you take a trip out side of the usa?

  • if it can be prescribed then it can be medically necessary then it can billed to insurance/medicare/medicaid. this is a goldmine.
  • My kid has asthma so need a nebulizer. This is just a oiless air pump with a cup to hold the medicine. You can get them online for $50-$100.

    I got a prescription for one and I called my insurance company to see how to get it filled. They used some medical device company which I called an ordered it. I had to pay a $20 or $30 copay. Then next month I got a bill for another $20. I didn't realize it at the time but this was a rental. My fault I should have read the documents better. The insurance company was pa

  • If people over rely on these apps, and their smartphone runs out of battery, what then?

%DCL-MEM-BAD, bad memory VMS-F-PDGERS, pudding between the ears