The mobile phone: central station for tele-care, tele-health and communication

The mobile phone is always with us. No matter where we go, most of us have the mobile in the pocket. So it seems a logical next step to integrate functions of tele-care that older and sick people sometimes heavily rely on for their safety. Indeed, some of the tele-care equipment providers exhibiting in November at the TSA Conference in Birmingham do offer feature phones equipped with SOS buttons, that either allow to call the emergency services or pre-assigned contacts in the phone book. And some advocate the extension of tele-care services via smartphone apps. This later aspect however rises a number of questions. 

What is the difference between tele-care apps and health apps? 

There are no established definitions yet, but the US Food and Drug Administration (FDA) has made a first step by issuing a "final guidance for developers of mobile medical applications, or apps, which are software programs that run on mobile communication devices and perform the same functions as traditional medical devices". In this guidance, the FDA specifies that it " intends to focus its regulatory oversight on a subset of mobile medical apps that present a greater risk to patients if they do not work as intended" because "the majority of mobile apps pose minimal risk to consumers".

In practice this means that the FDA will regulate mobile apps that 

• are intended to be used as an accessory to a regulated medical device, or
• transform a mobile platform into a regulated medical device

The FDA will not regulate apps that 

• help manage conditions without providing specific treatment suggestions
• help track the user's health information
• facilitate access to information about certain conditions and general health information
• monitor a patient's medical condition and help communicate this information to the health care provider
• automate simple tasks for health care providers
• enable patients or providers to interact with Personal Health Records (PHR) or Electronic Health Record (EHR) systems

A detailed explanation on which kind of apps will not fall under FDA review can be found on the webpage Examples of Mobile Apps for which the FDA will exercise enforcement discretion.

Barely standards, no regulations 

Still, the world of smartphone apps to date is the wild west. No established authority controls the quality or reliability of health apps. No regulations or internationally accepted guidelines exist on the minimum requirements for apps that can have an impact on the user's health. Apart from the FDA as one of the first government agencies to attempt formalising a regulatory approach to apps, some sort of quality control by peer review emerges in specialised areas. Websites like iMedical Apps (http://www.imedicalapps.com/) for instance offer regular reviews of apps by experts in the field, in this case healthcare professionals; while myhealthapps.net lists apps that have been "selected by 456 distinct patient groups, disability groups or empowered consumers as their favourite apps. The reviews from these groups are supplied for each app, as well as weblinks to the groups themselves."

In this context, one of the participants in the Workshop "Integrating Apps so that they apply to you and me" held during the TSA Conference, asked a very pertinent questions: "When your tele-care app does not work, who are you going to blame? The developer of the app? The mobile phone manufacturer? The operating system? The tele-care equipment manufacturer? Who?" 

The overall tenor of workshop participants who partly came from network operators, partly from tele-care equipment manufacturers and partly from national agencies, was that they are very interested in the idea of employing apps as extension of or help in tele-care but that they are worried about quality control and liability. Guidelines or quality labels would certainly help. 

Exploiting the competitiveness of human nature

In the world of fitness, smartphone apps have been taken up very rapidly. The challenge to sticking to goals, the support via the community of all the people who also use the app to improve their life, are motivating factors. Some workshop participants whose background was in rehabilitation pointed out that it might be worthwhile to think about how to transfer this competitiveness and playfulness witnessed in fitness apps also to tele-care apps in order to help people engage more actively and give them incentives to follow instructions to possibly improve their condition.

Discussing mobile accessibility over lunch in the European Parliament

On 27 November 2013, MEP Dr. Ádám Kósa invited policy makers, industry and representatives of European disability organisations to a lunch event entitled "With GARI and the Real Time Sign Language App to a more accessible European Union". The intention was to discuss openly what industry is already providing in terms of accessibility features of mobile telecommunication devices, how persons with different disabilities are using these features, what from their perspective is still missing and how European policy can contribute to making mobile accessibility a success. 

The Hungarian Member of the European Parliament Dr. Ádám Kósa said: "I have a disability that you can’t see but I have no communication problem." Deaf persons like him have for decades been excluded from telecommunications, but this has changed thanks to the advent of smartphones. "Nowadays, I feel fully included in the communication of society. Thanks to new technologies, thanks to apps, and certain programs which help me. At the same time, we haven't achieved full accessibility yet," he continued. 

Together with his colleague MEP Werner Kuhn, Dr. Kósa proposed last year the project of a real-time sign language application to the European Commission. The idea is to facilitate communication of deaf and hard of hearing persons with the European Institutions by providing a platform independent application offering real-time sign language interpretation as well as captioning. The budget for the realisation of the project has been approved and the European Commission has launched a call for tender, which has already been closed but the winner has not been announced yet. The Commission’s call for tender referred to the design of a total communication system, combining in a coherent and coordinated way voice, real-time text and video in order to be able to have access to sign language at the same time. The platform will in a first time be hosted by the Commission but there will be pilot services with the different institutions. Ideally, the platform would be ready to be tested for the European Parliament elections in May 2014, and if it works well would be taken up also by Member States in order to facilitate access to their institutions. 

Mrs. Inmaculada Placencia-Porrero, Deputy Head of Unit for Rights of Persons with Disabilities within the Directorate General for Justice, spoke about the Commission's plans for the European Accessibility Act and the influence that the UN Convention on the Rights of People with Disabilities has had already in policy discussions.  After the European perspective on accessibility, the Mobile Manufacturers Forum (MMF) took the floor to provide an update on the Global Accessibility Reporting Initiative. Following this Jean-Daniel Ayme, Vice President, European Telecom Operations at Samsung Electronics and Robin Christopherson, Head of Digital Inclusion at AbilityNet both demonstrated what mobile accessibility translates to in real life for users with a disability using either a Samsung or Apple device.

The list of accessibility features that are included in devices is certainly getting longer and longer. Relatively simple features such as the flash light, can give visual alerts for the deaf, while integrated sensors can tell the blind user if the light is switched on. Other features such as adaptive sound, where the user can test their own hearing with the mobile phone and adapt the sound accordingly opens new ways to customise the device for all users, including those with a hearing impairment. As one of the speakers reminded the audience - all of us can be temporarily disabled - whether by injury or an unfavourable environment - and in these moments we all benefit from the mainstreaming of such features. 

Mobile accessibility has certainly advanced quite rapidly in the last decade and work still continues. One can only imagine what the devices of tomorrow will offer.

Read here the press release by MEP Dr. Kósa: http://www.kosaadam.hu/news_display/smartphones_for_people_with_disabilities/