In less than two decades, the Internet and mobile telephony have revolutionized the way we communicate. The health sector has actively embraced these new technologies. As for health professionals, there are more 11,000 professional medical journals available online from Pubmed, the database of the US National Library of Medicine. The computerization of medical data exchange has facilitated telemedicine exchange protocols. The medical use of new technologies is now a field of scientific research in its own right. In this context, engineers, medical informatics experts and clinicians are collaborating to develop a “telemedicine” for the benefit of patients and professionals. For the general public, mobile telephony has democratized access to medical information. More than 100,000 connected health applications for smartphones have been launched.Connected objects are the latest innovation in this ongoing revolution of self-measurement.
The miniaturization of sensors and the growing equipment in smartphones have enabled the development of these new tools. They allow you to better follow yourself on your mobile and share data more easily.
Connected scales, pedometers or sphygmomanometers are now accessible to the greatest number, hence an increasingly important automation of the collection of constants or physical and biological parameters, such as weight, blood pressure, movements, heart rate, oxygen saturation, expiration force, body temperature, blood sugar, walking, sleep…
The term “connected health” has emerged to designate a break that is not only technological, but also societal. A follow-up formerly reserved for the medical world becomes accessible to the general public.
The uses are multiplying: coaching, medical prevention, screening, diagnostic approach, surveillance, therapeutic education, adaptation of treatments, orientation of the use of care … For medicine, the relevance of data collection varies greatly depending on the profile of the user and context. Weight data does not have the same meaning depending on whether it is a child, an adult
overweight or underweight. Beyond medical judgment, automating data collection has socio-professional repercussions. She opens new perspectives and ask new questions:
- How does it impact medical practice?
- Does it improve the health of users?
- Should the organization of the healthcare system be adapted to these changes?
In a classic organization, the patient calls the doctor if a symptom appears, then follows the answers given by the health professionals with a view to the cessation of the health problem. Good management of chronic diseases is a game-changer. For asthma or diabetes for example, the patient is on the contrary invited to participate in prevention actions. He must anticipate complications or even act if they occur. The patient must learn to judge his own situation to decide whether to call the doctor.
This empowerment process requires good therapeutic education.
Connected health offers new possibilities for perfecting self-measurement gestures and self-management programs.
Connected health is emerging at a time when demographic aging and the explosion of chronic diseases make it necessary to optimize the organization of care.
The medical community should not fear that consumers of care will take connected objects. On the contrary, we must work for a constructive dialogue
between them and health professionals. To do this, we encourage a rigorous evaluation of the impact of these tools and of new practices.
Self-measurement, a well-established medical interest
Self-measurement, long practiced, is defined as the measurement of health parameters by the patient himself. At the start of the 20th century, scales and thermometers began to equip households, particularly since the fight against tuberculosis required monitoring changes in weight and temperature. The rise of self-measurement in the management of chronic diseases dates back to the 1980s thanks to the availability of devices for patients to easily measure
– and at home (home monitoring) – blood sugar (first using urine strips to measure glycosuria or acetonuria, then with devices for measuring capillary blood sugar), breath (with a peak flow meter ) or blood pressure (with an electronic blood pressure monitor).
Through numerous expert reports, these different devices have demonstrated their usefulness in the quantification of medical semiology: the difficulty in breathing is assessed precisely with spirometry; the increase in the number of blood pressure measurements made possible by self-measurement has improved the precision of the definition of the blood pressure level compared to the only measurement made in a medical consultation. These devices have also proven their usefulness in the regular monitoring of chronic diseases. Using data from epidemiological studies and therapeutic trials, it was possible to demonstrate the existence of statistical links between the results of the measurements and the occurrence of health events. It was possible to define threshold values of the self-measured parameters from which a health risk becomes significant and therefore medical intervention is justified.
This is why in current medical practice, doctors invite their diabetic, asthmatic or hypertensive patients to keep notebooks recording the history of their self-measurement results over time. Memorizing these values leads to the possibility of proposing action plans: we move from the concept of self-measurement to that of self-monitoring, then to the purpose of self-management or self-management. These approaches giving more room to the patient’s decision have a strong scientific rationale. Computerization paves the way for writing intelligent algorithms. With them, the classic self-measurement approach benefits from interpretation and the action that flows from it thanks to computerized medical programs.
|Capillary blood sugar||Glucometer||Type I (insulin dependent) and Type II (non insulin dependent) diabetes||Implementation since the 80s. Now recommended by learned societies and patient associations subject to therapeutic education with the implementation of an action plan. It is most useful in type I diabetes.|
– Eating disorders (bulimia / anorexia)
– Heart failure
– Renal failure
– Pediatric disorders
|Home weight measurement dates back to the early 20th century. Measurement protocols and interpretation
results differ markedly from one pathology to another. The weight put in equation with the size allows the calculation of the body mass index (BMI). The scale is quantitatively the most widely used self-measuring device.
|Arterial pressure||Oscillometric electronic sphygmomanometer||– High blood pressure Implemented since the 80s||Recommended since the 2000s subject to compliance with a measurement protocol. More precise than the measurement in the office, self-measurement is indicated in screening and monitoring.|
|Cardiac frequency||– Watch
-Oscillometric electronic sphygmomanometers
– Heart rate monitor
-Heart rhythm disturbances
– Heart failure
|The heart rate is monitored in certain physical activities (jogging, cycling, etc.) and cardiovascular situations (symptoms, myocardial infarction, taking medication, etc.). But monitoring from home is not common practice on a large scale.|
|Expiration force||Peak flow meter||Asthma||Implementation since the 80s. Recommended since the 2000s subject to the respect of an education because this self-measurement is of delicate realization.|
|SpO2 (oxygen saturation rate)||Pulse oximeter (or saturometer)||Chronic obstructive pulmonary disease (COPD)||Saturometers are available to the general public, but the interpretation of the measurement results is difficult. There are negative studies regarding the usefulness of PaO2 self-measurement at home in preventing COPD exacerbations.|
(electronic and test strips. Mercury thermometers are no longer sold because of their environmental toxicity)
especially in children
|Used since the beginning of the 20th century, the thermometer is very widely used in homes. Self-temperature measurement guides people in their use of care (call
doctor) and in infectious disease surveillance.
|Number of steps & movements||– Pedometers
|– Public health campaign against
– Help with motivation to walk in case of diabetes, asthma, obesity, arteritis
lower limbs, cardiovascular rehabilitation
|Although inexpensive and easy to use, pedometers are still little recommended and used in everyday medical practice. They help improve glycated hemoglobin, weight, cholesterol levels by increasing physical activity. The persistence of their long-term impact is unknown.|
Home telemonitoring and diabetes
Telemonitoring solutions for diabetic patients from their homes have shown their ability to significantly reduce glycated hemoglobin levels. A meta-analysis of 7 randomized studies of type II diabetic patients comparing usual care to management using new communication technologies including a remote transmission of blood glucose revealed an average decrease in glycated hemoglobin of 0.5 %. Study with mobile phone coaching reduced glycated hemoglobin by 1.2% at the end of 12 months – remember that according to the data from the UKPDS study, a reduction of 1% in the glycated hemoglobin level allows a reduction of 14% in the relative risk of all-cause mortality, by 14% in the risk of infarction myocardium and 37% of microvascular complications. Beyond the transmission of biological data, mobile solutions can incorporate educational programs that comply with the recommendations. In addition, initiatives for direct connection to medical records are being tested.