This document discusses eHealth and mobile health apps. It begins by noting the explosion of eHealth devices, from fitness trackers to medical apps approved by the FDA. Examples are given of sensor pills and patches that track medication adherence. Challenges around security, privacy, accuracy and costs are discussed. While investments are mostly in fitness, only 12% pay for health apps. Most apps are unrated in stores. Privacy and security are major concerns, as hackers now target medical devices. The document concludes by discussing how to properly evaluate eHealth apps and issues around who has access to personal health data collected by apps.

1. Just Downloading An App Reveals
Information About You!
IEEE Life Members
3/21/2017
Cheryl Tulkoff
ctulkoff@gmail.com

2. eHealth & IOE(The Internet Of
Engagement)
Can eHealth Devices Know Too Much?

3. EHEALTH IS EXPLODING!
▪Fitness devices lead
the way
▪Expanding to broader
health
▪True mobile medical
apps with FDA
approval
▪ Medical devices
Step 3
Medical
Step 2
Health
Step 1
Fitness
http://www.fda.gov/MedicalDevices/DigitalHealth/MobileMedicalApplications/default.htm

4. FDA-APPROVED APPS
Examples of What’s Proven
http://www.fda.gov/MedicalDevices/DigitalHealth/MobileMedicalApplications/ucm368784.htm

5. PROTEUS HEALTH: 3 TIER SOLUTION
Sensor Pill:
medication
adherence
Sensor Patch:
Shares when
pill was
swallowed with
matching
smartphone
app
Device &
App
In use at
Children’s
Health in
Dallas

6. DENTRIX ASCEND DEXIS
▪Fast, cloud-based
image sharing
▪ X-ray image
available to all
authorized devices &
users in < 2 seconds

7. NFANT FEEDING SOLUTION
▪Smart baby bottle sensor
▪Feeding is leading cause
of delay in discharge from
NICU
▪Helps clinicians get to
independent oral feeding
▪Objective feeding metrics
in real time

8. PainKARE: System
for chronic pain
management:
• Patch
• App
• OTC
Transcutaneous
Stimulator

9. EHEALTH CHALLENGES & OPPORTUNITIES
Security
Privacy
Accuracy
Cost
Accessibility
Accountability

10. Privacy BarriersDemographics
Accuracy
To
Medical
Peer
review
Security AdoptionEvidence

11. STATE OF THE EHEALTH INDUSTRY

13. US & China are the
dominant players

14. Mostly fitness

15. Investments in most active subsectors of the digital health industry 2015
Most active digital health subsectors worldwide based on invested
funding in 2015 (in million U.S. dollars)
Source: StartUp Health; ID 388905
Note: United States
1,360
1,260
655
585
498
489
434
211
210
97
0 200 400 600 800 1000 1200 1400 1600
Patient/consumer experience
Wellness/benefits
Workflows
Personalized health/quantified self
Medical device
E-commerce
Big data/analytics
Clinical decision support
Population health
Research
Funding invested in million U.S. dollars
Further information regarding this statistic can be found on page 8.

16. Use of paid digital subscription services in the U.S. 2016, by type
What categories of services do you currently pay subscription services
for?
Source: Vindicia; ID 524521
Note: United States; as of March 2016; 18 years and older; 1,000 Respondents; among respondents with at least one paid online subscription
74%
62%
37%
28%
23%
17%
15%
12%
9%
2% 2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Over the top/
video on
demand
Shopping Audio
services
"Print" media Professional
services
Lifestyle Financial
services
Health and
wellness
Learning
services
Dating
services
Other
Shareofrespondents
Further information regarding this statistic can be found on page 8.
Just 12% paying
for ehealth apps!

17. Leading iOS app categories in the United States 2016
Market reach of the most popular Apple iOS app categories in the United
States as of June 2016
Source: Shared2you; ID 515458
Note: United States; June 2016; data based on a sample device count of 16,983 mobile devices; smartphone, phablets and tablets
99.91%
95.13%
93.65%
81.55%
75%
58.62%
55.77%
55.34%
49.29%
33.65%
31.57%
30.01%
26.59%
23.01%
20.23%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%
Utilities
Social Networking
Entertainment
Productivity
Book
Photo & Video
Music
Games
Lifestyle
News
Shopping
Reference
Travel
Education
Business
Penetration rate among iOS users
Further information regarding this statistic can be found on page 8.
Health & Fitness Only 19.7%!

18. WHAT ABOUT PRIVACY & SECURITY?
Locations of medical facilities targeted in the Independent Security
Evaluators study. Photo by Independent Security Evaluators

19. WHY SHOULD YOU CARE ABOUT EHEALTH SECURITY?
Health records are worth money!
Hospital cybersecurity leaves you
vulnerable
But the biggest flaw in your cybersecurity
might be you
8 out of 10 mobile health apps open to
HIPAA violations, hacking, data theft
http://www.healthcareitnews.com/news/8-out-10-mobile-health-apps-open-hipaa-violations-hacking-data-theft

20. HACKERS NOW TARGET MEDICAL
DEVICES
▪ J&J notified 114,000
diabetic patients that a
hacker could exploit one
of its insulin pumps
▪ The J&J Animas
OneTouch Ping could be
attacked, disabling the
device or altering the
dosage
▪ FDA issued new advice
about how to safeguard
implantable cardiac
devices against hackers.
▪ A wireless transmitter
used to transmit data
from cardiac devices to
medical providers, the
Merlin@home
Transmitter by St. Jude
Medical was found to
be vulnerable to online
hacking
http://www.cnbc.com/2016/10/1
5/as-cyberthreats-multiply-
hackers-now-target-medical-
devices.html
http://abcnews.go.com/Health/fda-issues-safety-advice-cardiac-
device-hacking-threat/story?id=44674842

21. http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-
2015/#523450dd7fd5

22. ALMOST 200 HEALTH BREACHES OF >500
INDIVIDUALS IN 2016
https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

23. HOSPITAL HACKS
▪China & X-Ray
images theft
▪TB-Free X-rays
get you a visa
for travel!
▪DDoS by
Anonymous
https://www.bostonglobe.com/metro/2016/02/25/parents-justina-
pelletier-sue-boston-children-hospital-for-
negligence/jCrlgTQBVikJtokEnlFBmN/story.html

24. Faking out the
Doctors
Downloaders beware
https://www.bostonglobe.com/metro/2016/02
/25/parents-justina-pelletier-sue-boston-
children-hospital-for-
negligence/jCrlgTQBVikJtokEnlFBmN/story.html
Ransomware

25. WHILE SECURITY & PRIVACY ARE
CRITICAL, THERE’S EVEN MORE TO
WORRY ABOUT…….

26. WHAT DO EHEALTH APPS DO &
HOW CAN THEY BE USED?

27. eHealth App Category Example
Casual Tool Brain Fitness Trainer
Common Knowledge Fitness Guides
Treatment Guides First Aid Guide, Medication Guide
Fitness Tools Diet, weight & fitness calculators
Fitness Trackers Smoking cessation, calorie counters
Treatment Support Tools Diabetes calcs, diagnosis tools
Intimate Tools Fertility & pregnancy calcs
State of Health Tests Acuity, color vision, blood alcohol
Intimate Trackers Fertility & pregnancy trackers
Health Monitors Heart rate monitors, disease counseling
Treatment Reminder Medication reminder, patient
interaction
Health Records Your personal health information

28. >38,000 EHEALTH APPS AVAILABLE
ARE THEY ANY GOOD?

29. APP STORE RATINGS – MOST UNRATED

30. HEALTH APP RATINGS – FEW 5 STAR APPS!
Exploring the Far Side of Mobile Health: Information Security and
Privacy of Mobile Health Apps on iOS and Android

31. PEARSON’S LAW

32. HOW WOULD YOU ASSESS AN
EHEALTH APP?
Data Ratings
Users
FDA
Approved

33. No centralized
resource for info
on all ehealth
apps for
effectiveness &
health outcome
1. Searching apps
from app stores
2. Manually
installing each
individual app on
smartphones or
tablets
3. App stores
provide prices &
customer reviews
Researchers want an open mHealth architecture-based platform to aid in scalable &
sustainable health info systems
Evaluation
Process
Today

34. WHO ELSE IS WATCHING?
Hacking
Medicine
Institute
Health
Apps
Review
Program
Effectiveness: Clinical Relevance/
Credibility/ Evidence-based
Functionality: Features, data sharing,
integration with other apps or
HealthKit or electronic medical records
Usability: user interface, user
experience, easy of use, look & feel….
http://hitconsultant.net/2016/05/04/hacking-medicine-institute-launches-health-apps-
review-program/

35. A
P
P
R
E
V
I
E
W
S
Medisafe (Recommended: 81) –
Well designed mobile app intended
for patients who are on multiple
medications for chronic diseases &
who have a hard time complying
with their prescription medications
Mango Health (Acceptable:
74) – A well designed app to engage
users in the daily tracking of their
medications with potential rewards
for adherence
Glucose Buddy (Acceptable:
60) – An “average” electronic blood
glucose logging app with the most
promising feature being the ability
to sync blood glucose readings with
caregivers.
Smart Blood Pressure (
Recommended: 80) – A simple
electronic/ digital diary for blood
pressure and heart rate data
monitoring and tracking
Hello Heart Premium
(Acceptable: 70) – An outstanding
mobile app for people interested in
monitoring and tracking their blood
pressure. However, it lacks high-
quality evidence to backup their
claims of helping people manage/
optimize blood pressure control

36. OTHER INTERESTING EHEALTH APPS &
WHAT YOU CAN DO

37. FIGURE 1:
INSTAGRAM FOR DOCS
▪ >1,000,000 healthcare pros use to:
◦ Recognize rare conditions
◦ Sharpen medical knowledge
◦ Share de-identified teaching cases
globally
◦ Communicate from remote or
isolated locations
◦ Send HIPAA-compliant direct
messages to colleagues
Each image is accompanied by
a description helping build an
index of cases

38. AUSTIN STARTUPS: SELFAWARE ENGINEERING

39. BEFORE USING AN EHEALTH APP…
▪Use security tools for all your devices
▪Mobile, tablet, laptop
▪Use strong passwords
▪Read the specs
▪Review user ratings
▪Discuss with your healthcare professional
▪Beware of data sharing with social
networks!

40. QUESTIONS?
CHERYL TULKOFF
CTULKOFF@GMAIL.COM
512-913-8624

41. SPEAKER BIOGRAPHY
▪ Cheryl has over 20 years of experience in electronics manufacturing focusing on failure
analysis and reliability. She is passionate about applying her unique background to enable
her clients to maximize and accelerate product design and development while saving time,
managing resources, and improving customer satisfaction.
▪ Throughout her career, Cheryl has had extensive training experience and is a published
author and a senior member of both ASQ and IEEE. She views teaching as a two-way
process that enables her to impart her knowledge on to others as well as reinforce her
own understanding and ability to explain complex concepts through student interaction. A
passionate advocate of continued learning, Cheryl has taught electronics workshops that
introduced her to fascinating companies, people, and cultures.
▪ Cheryl earned a Bachelor of Mechanical Engineering degree from Georgia Tech and a
Master of Science in Technology Commercialization (MSTC) program at the University of
Texas at Austin. She was drawn to the MSTC program as an avenue to acquire relevant and
current business skills which, combined with her technical background, serve as a
springboard enabling her clients to succeed in introducing reliable, blockbuster products
tailored to the best market segment.
▪ In her free time, Cheryl loves to run! She’s had the good fortune to run everything from
5k’s to 100 milers including the Boston Marathon, the Tahoe Triple (three marathons in 3
days) and the nonstop Rocky Raccoon 100 miler. She also enjoys travel and has visited 46
US states and over 20 countries around the world. Cheryl combines these two passions in
what she calls “running tourism” which lets her quickly get her bearings and see the sights
in new places.
ctulkoff@gmail.com
512-913-8624

42. FURTHER REFERENCES
• http://www.apple.com/ios/health/
• http://home.isr.umich.edu/releases/great-digital-divide-healthcare-
older-americans-may-left-behind/
• Health Literacy and the Digital Divide Among Older Americans; Helen
Levy, Alexander T. Janke, Kenneth M. Langa
• Dehling T, Gao F, Schneider S, Sunyaev A, Exploring the Far Side of Mobile
Health: Information Security and Privacy of Mobile Health Apps on iOS
and Android JMIR Mhealth Uhealth 2015;3(1):e8
• https://blog.cms.gov/2016/03/02/bridging-the-healthcare-digital-divide-
improving-connectivity-among-medicaid-providers/
• The great promise of technology is to bring information to our
fingertips, connect us to one another, improve our productivity, and
create a platform for the next generation of innovations..
Technology, when widely distributed and available, enables
providers to improve patient care by distributing information and
best practices and leading to better experiences of care for
individuals in the health care system. And technology can make a
significant difference in the rapidly modernizing Medicaid program.

43. FURTHER REFERENCES
▪ Smartphone Applications for Patients’ Health and Fitness; John P. Higgins, MD,
MBA, MPhil; Memorial Hermann Sports Medicine Institute, The University of Texas
Health Science Center at Houston, Houston.
▪ MHEALTH (MOBILE HEALTH)—USING APPS FOR HEALTH AND WELLNESS; Marsha J.
Handel, MLS#
▪ Status and trends of mobile-health applications for iOS devices: A developer’s
perspective. Chang Liua, Qing Zhua,∗, Kenneth A. Holroydb, Elizabeth K. Sengba
School of EECS, Ohio University, United States. b Psychology Department, Ohio
University, United States
▪ Engaging Health: Health Research and Policymaking in the Social Media Sphere. By
Brian G. Smith, Ph.D. and Staci B. Smith, Purdue University
▪ Bridging the Digital Divide in Health Care: The Role of Health Information
Technology in Addressing Racial and Ethnic Disparities, Lenny López, M.D., M.Div.,
M.P.H.; Alexander R. Green, M.D., M.P.H.; Aswita Tan-McGrory, M.S.P.H.,
M.B.A.;Roderick King, M.D., M.P.H.; Joseph R. Betancourt, M.D., M.P.H.
▪ Exploring the Far Side of Mobile Health: Information Security and Privacy of Mobile
Health Apps on iOS and Android, Tobias Dehling, Dipl -Wirt -Inf; Fangjian Gao, MSc;
Stephan Schneider, Dipl -Wirt -Inf; Ali Sunyaev, PhD.
▪ mHealthApps:A Repository and Database of Mobile Health Apps; Wenlong Xu1; Yin
Liu1,2