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mHealth as in the case of eCAALYX is providing a complete solution to improve the quality of life, reduce morbidity

and mortality of elderly people suffering from chronic diseases via monitoring and assessing changes in activity of the patient.
However, using such apps which are data run are risks the customers' privacy to a great extent. Moreso, with the tremendous research done and the various forms of illness discovered it is very likely that the patient may be accidently prescribed incorrectly or ineffectively. Thirdly,following the statistics one may realize that it is mostly the fitness apps that have been doing really good whereas the diagnostic apps have yet not gained as much popularity.
FEASIBLE SOLUTION

These mobile apps should focus on organizing there clouds i.e. should develop a better network connecting that connects the patient to his doctor.

Spreading awareness of the existence of such mobile apps is a must to break the taboo against such apps.

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IMS Health Mobile Health Apps - Making and Prescribing the Best Apps

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For developers and doctors -- making and prescribing the best healthcare apps. Visit the mobile health section: http://imshealth.com/mhealth.

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LIST OF APPLICATION OF mHEALTH

1.Education and Awareness

SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education, health clinics, and a deficit of healthcare workers.

2.Diagnostic and treatment support

While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnosis, other projects provide direct diagnosis to patients themselves

3.Disease surveillance, remote data collection, and epidemic outbreak tracking

Data concerning the location and levels of specific diseases (such as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or organizations identify outbreaks and better target medical resources to areas of greatest need.

4.Treatment support and medication compliance for patients, including chronic disease management

Within environments of limited resources and beds—and subsequently a 'outpatient' culture—remote monitoring allows healthcare workers to better track patient conditions, medication regimen adherence, and follow-up scheduling.

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SURVEY-QUESTIONER

Target Audience-people dependant on apps

1.Do you think animate apps can compete with the hospitality,comfort and an assurance provided by an experienced doctor?

2.Can the use of the advanced technology hinder and complicate this essential medical aid for the old and the backward?

3. In case of an emergency,will you be willing to risk your life depending on these data -run apps to really be your savior?

4.Is this growing app -culture

really an efficient and economic aid in the countries like India where the government has made health care reach the needy and the poor free of cost?

5.Do these mobile apps need bit more public awareness in India?

6.Should new digital policies be created for the new mHealth ecosystem?

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4. BODY AREA NETWORK

BAN devices may be embedded inside the body, implants, may be surface-mounted on the body in a fixed position Wearable technology or may be accompanied devices which humans can carry in different positions, in clothes pockets, by hand or in various bags.

http://www.sciencedirect.com/science/article/pii/S0924424710002657

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3. SMART GARMENT

The garment enabled with different body censors used to observe the several metabolic activities in the body is a smart garment. It is generally paired with the patient's smart phone which in turn with the help of the GPRS is reported to the doctor sitting far away.

http://ieeexplore.ieee.org/xpls/icp.jsp?arnumber=6346374

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2.mHealth

mHealth (also written as m-health) is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices.

https://obssr.od.nih.gov/scientific_areas/methodology/mhealth/

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NEW TERMS

1.CLOUD COMPUTING

the practice of using a network of remote servers hosted on the Internet to store, manage, and process data, rather than a local server or a personal computer.

http://searchcloudcomputing.techtarget.com/definition/cloud-computing

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POST PROOF

a) Author

Name Maged NK Boulos

Qualifications

1.Faculty of Health,

University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK

2.Faculty of Education, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK

3.Information and Communication Systems Unit, INESC PORTO, Campus da FEUP, Rua Dr. Roberto Frias, 378, 4200-465 Porto, Portugal

b) Publication Details

1. Date of publication

Received : 22nd February 2011

Accepted : 5th April 2011

Pubished : 5th April 2011

2. Edition details

name BioMedical Engineering OnLine  2011,  10:24

code doi:10.1186/1475-925X-10-24

c) About the journal

BioMedical Engineering OnLine is an open access, peer-reviewed journal that is dedicated to publishing research in all areas of biomedical engineering.

http://www.biomedical-engineering-online.com/

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THE METHODS FOLLOWED FOR DATA COLLECTION

In the recent past man is not only becoming socially aware of his identity but is also is being made to realize the role health has been playing in his life.There have been several discussions on the social networking sites,seminars,talks that are making man connect to the idea of maintaining his health with the help of the user friendly apps.

1. QUORA

a) https://www.quora.com/The-ever-increasing-speed-of-technological-advances-will-undoubtedly-impact-the-field-of-medicine-and-the-role-physicians-play-in-delivering-healthcare-Within-two-decades-which-medical-specialties-will-be-obsolete-and-which-ones-will-change-the-most-drastically
b)h ttps://www.quora.com/Mobile-Healthcare/What-is-the-future-of-mHealth-and-what-innovations-will-drive-it-forwar d

2.TedTalk

a) https://vimeo.com/26182350

3.Mobile Apps

a)http://www.appstudioz.com/blog/mhealth-a-game-changer-in-health-and-fitness-industry/

4.Recent technology-mhealthhttps://www.youtube.com/watch?v=qkm_7XUDqIY

a)http://www.parangat.com/blog/mhealth-digitization-of-healthcare-industry/

b)http://www.mhealthsummit.org/

c) YouTube

https://www.youtube.com/watch?v=qkm_7XUDqIY

5. eCAALYx

a) http://scholar.google.co.in/scholar?q=ecaalyx+and+its+success&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ved=0CBoQgQMwAGoVChMIq7u_48qvyAIVRSSOCh0ELw7I

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Have you been prescribed apps

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This is the future of the technology development in the smart phones. The most advantageous and compatible forms of technology is going to be incorporated into the smart phones that it may lead to a revolutionary upgrade.

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Standing out in the fiercely competitive smartphone market is becoming ever more difficult.

A specs bump just doesn't cut it anymore when phones that are two years old are still performing admirably and there's only so much bigger that the screens can get before we're forced to stop pretending we're not making calls on tablets.

The fact is it's getting boring too. Phones are becoming the same and we doubt we're alone in saying that we're itching for some innovation. But there's no need to wait because there are already some truly innovative and exciting handsets out there, they're just not the big names.

They might one day be though. The smartphone market of the future is going to be a radically different place, where innovation and value trump power and the current big hitters are going to need to adapt or die.

There's already evidence of this change. With the launch of the OnePlus One we're seeing high end hardware delivered at a fraction of the price we're used to, while brands like Yota Devices and Jolla are thinking outside the box to deliver unique experiences.

But even if the spec wars continue, Apple and Samsung will need to watch their backs, as phones like the Xiaomi Redmi Note and the Meizu MX3 are outdoing them with octo-core processors and 128GB of built in storage respectively, while current big name handsets top out at quad-core processors and 64GB of storage.

In short the old guard are in trouble and if you want to be on the front lines of the revolution the following are the companies you should be looking to.

OnePlus

The OnePlus One is arguably the current poster child for alternative flagships. It had very little build up and is made by a new company which isn't well known, or not yet anyway.

In that sense the odds are definitely stacked against it, but the OnePlus One has a few tricks up its sleeve. Firstly it's tremendously powerful, with a 2.5GHz quad-core Snapdragon 801 processor and 3GB of RAM theoretically giving it more muscle than even the Samsung Galaxy S5 .

It's not just power that it has on its side either. The OnePlus One also runs CyanogenMod 11S, which is a more tweakable and customisable version of Android and something which no other handset currently runs.

The real reason that Samsung and Apple should fear the OnePlus One though is its price, which at just £229 (US$299, around AU$320) for the 16GB model makes it less than half the price of their flagships.

It suddenly makes it very hard to justify spending £500+ on a phone and if OnePlus can get the word out then it should have a very bright future indeed.

Yota Devices

So far Yota Devices has only made one phone, the appropriately named YotaPhone , but that one phone is among the most innovative handsets on the market.

While every other phone is content with one screen, the YotaPhone has two. There's a standard LCD screen on the front and an e-ink display on the back.

The obvious use for that is as a combined phone and e-reader, but the YotaPhone goes beyond that, by also using the e-ink screen for notifications and reminders. It can also save whatever you were last viewing to it if your battery dies, so you'll still be able to access tickets and maps.

Vlad Martynov, CEO of Yota Devices explained to us what makes YotaPhone different: "YotaPhone is the first game changer in smartphones in a very long time. Since the Apple iPhone debut in 2007, there has been very little innovation in the smartphone industry.

"The form factor basically hasn't changed. Instead, the industry has been in a specs race, focusing on bigger screens, better cameras and faster CPUs.

When Yota Devices first introduced the YotaPhone concept, no one had heard of company nor were they embracing the concept of a dual screen, always-on smartphone. Today, YotaPhone is the benchmark by which all similar products are compared.

YotaPhone has also demonstrated that the future of smartphones and mobile devices belongs to always-on displays, which allow users to stay connected without turning off the real world and disrupting the people around you.

Information hidden behind a black screen is of limited use to us. It creates bad habits - like phubbing, the act of snubbing the people around you for your smartphone. And, technology already exists - namely battery saving electronic paper display - that allows you access to information without sapping your phone's battery.

The company has recently announced the next generation of the handset too, complete with a more stylish design and high end specs, so that it's better able to compete with conventional smartphones. The YotaPhone 2 will be launching towards the end of the year.

Jolla

Jolla isn't just rethinking hardware, it's also making big changes to the software we use on it. The company's Sailfish OS is the result of that. It's open source, has a button free and gesture based interface and supports Android apps.

In the words of Juhani Lassila, Head of Communications at Jolla: "With Jolla and Sailfish OS it's all about the user experience." In practice that seems to mean a focus on multitasking and the aforementioned gesture based UI.

The one and only Sailfish phone currently available, the Jolla , is a bit different too, with swappable smart covers which change not just the look of the hardware but can also change the software theme, with new colours, wallpapers and sound effects.

It's available to order now from Jolla's site for 399 (about £327, US$555, AU$593).

Launching a whole new OS is a brave move and convincing users to ditch the tried and true experiences of Android and iOS could be a tough job. But on the other hand it injects a burst of fresh energy into an environment which hasn't changed much in the last few years.

Plus in supporting Android apps it makes the transition for users as painless as possible. Though unsurprisingly there's no access to Google Play, so you'll have to rely on third party app stores.

Jolla believes that usability is key, as Lassila told us that "the heart of Jolla and Sailfish OS is in the user experience, not in the specs. We aim to provide a better, faster, effortless UX. The specs will never be our most important competing factor."

It's an ideology that makes sense. As with most of the world so focused on specs the best way to stand out is surely to take a different approach. Which in this case primarily means an intuitive and fully gesture based interface.

Project Ara

Google itself deserves a mention here as while it's a massive corporation which is already a big part of the smartphone landscape, it's also looking at ways to fundamentally change that environment.

With Project Ara, Google is exploring modular smartphones, where a base handset could cost as little as $50 (about £29, AU$53) and individual components, such as the camera or processor, could be swapped out and upgraded as needed.

So rather than buying a whole new phone every one to two years you could stick with the same one indefinitely and just change the individual parts.

Not only could that work out cheaper for users but it empowers them to create exactly the phone they want. And while its modular nature means that it will inevitably be bigger and blockier than standard smartphones, the size and weight penalty is now at under 25%, so it needn't look like a brick.

If it takes off it could be the biggest disruption yet to the current way of doing things, with new handsets and phone contract renewals becoming rarities.

Project Ara isn't commercially available yet, but the first handset is set to launch in January 2015 for just $50.

Oppo

Oppo might not be a big name in the west, but in China it's a major player, albeit a relatively recent one, and it's likely to start making a dent in the US and Europe over the coming years too.

There's no one thing that Oppo is doing to stand out, but it's a company which isn't afraid to innovate. With the Oppo Find 7 it delivered the first 2K display on a smartphone, while the Oppo N1 has the option to run CyanogenMod and has a swivelling camera, so you can leverage its 13 megapixel lens for selfies and video calls.

Only the latter of those two phones is currently available in the UK though, carrying a price tag of roughly £390 (about US$661, AU$750).

Oppo might never be as big over here as Samsung or Apple but with a few more ideas like that it could certainly make a name for itself.

GeeksPhone

GeeksPhone is perhaps the least well known of all these, but that doesn't make it any less exciting or potentially disruptive.

It's a recent company focussed on building phones for open source operating systems and as part of that it's one of the handful of manufacturers currently supporting Firefox OS .

Its Revolution handset is one of the most powerful Firefox phones around so far in fact, though with a 1.6GHz dual-core Intel Atom processor, 1GB of RAM and a 4.7-inch qHD display it's still distinctly mid-range.

But it's got more than specs and a fledgling OS going for it, as it can also dual-boot Android, so users have a choice of two operating systems at any given time. The Revolution can be ordered now for 164.46 (about £135, US$229, AU$244) excluding taxes.

GeeksPhone is also involved in the making of Blackphone , a handset with top of the line security features.

Ultimately GeeksPhone is unlikely to rise to the top of the ranks, but it's providing some compelling if niche alternatives for people who want something a bit different.

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Unknown but unstoppable: the next-gen smartphone brands you can't ignore

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Standing out in the fiercely competitive smartphone market is becoming ever more difficult. A specs bump just doesn't cut it anymore when phones that are two years old are still performing admirably and there's only so much bigger that the screens can get before we're forced to stop pretending we're not making calls on tablets.

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It can be explained that the facts which are unnecessary to remember but are required, can be got from the smart phone's memory instead of brain's. Some tedious calculations which takes a lot of time can be done in the phone. The basic idea is that, many devices are all collaborated into a single instrument called the smart phone. the devices like alarm, clock, calculator, telephone, PDA, stopwatch, remainder and many m

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As per the video uploaded, it is clear that smart phones are reducing the intelligence of human brain

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This is a misconception. Smart phone is not just meant for talking and making phone calls. That is why it is called a smart phone and not just a phone. Looking through the narrow edge, it kills. But looking through the wider edge, it has numerous advantages that are most compatible with human nature and save precious time. The time can be utilized in doing something else. Now a days improvements are being made to the technology for reducing the radiations from the smart phone devices and making them more user friendly.

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Smart phones tend to have advantages, this is an accepted fact. But, they have disadvantages equally, and this is an agreed argument. Focusing on the disadvantages, major damage is to the health. The radiations from the smart phones are deadly and leads to head ache, and long term diseases like cancer. What is the use of having all these advantages is the person itself dies?

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The answer to your question can be YES, but it always receives mixed reviews from society. Every thing on this earth has both good and evil. It is the choice of the human to choose among them and whether or not the smart phone makes us lazy. The following youtube video depicts the topic in a better way by differentiating the people depending on their thinking ways activities involving their smart phones.

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Cell phones have revolutionized our world, but are they making us lazy? Read More: Reliance on smartphones linked to lazy thinking http://scienceblog.com/77276/reliance-on-smartphones-linked-to-lazy-thinking/#hySJEl2IRGYXzkOd.97 "Our smartphones help us find a phone number quickly, provide us with instant directions and recommend restaurants, but new research indicates that this convenience at our fingertips is making it easy for us to avoid thinking for ourselves."

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It could be said that this makes people lazy, right?

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Considering the initiation of mobile marketing, it has become the back bone of over seas marketing of goods. Many apps have been developed for this purpose. This has brought a hike in recruitments of software. Moreover, this lead to innovation of latest version of smart phones. Gradually, the number of websites and apps offering mobile marketing increased. This can be considered the best way for attracting a huge crowd of consumers as this is most convenient for them to get every thing they wish to their door. As a result of this, the worth of Indian markets shoot up. This lead to good hike in employment as purchasing online involves a lot of people to work for. The value of shares not just from India, but also from other countries raised.

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The eCAALYX Mobile Application is being developed under the scope of the eCAALYX EU-funded project (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012.

The main functionality of the eCAALYX Mobile Platform is to act as a seamless "informed" intermediary between the wearable health sensors (in a 'smart garment') used by the older person and the health professionals' Internet site, by reporting to the latter (but also to the patients) alerts and measurements obtained from sensors and the geographic location (via smartphone GPS) of the user.

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1.eCAALYX -Where has it come from and what does it do

http://www.fraunhofer.pt/en/fraunhofer_aicos/projects/government_contractresearch/ecaalyx.html

2. Key Major Objectives of eCAALYX

http://www.aal-europe.eu/projects/ecaalyx/

3.How to use eCAALYX

https://www.youtube.com/watch?v=iwuP5EeNH4c

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How have mobile marketing apps affected the Indian markets?

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1. The below link provides information about use of smart phones in e-commerce

http://www.ibtimes.com/mobile-devices-are-changing-ecommerce-heres-how-1297265

2.This link provides evidences to the fact that utilisation of internet on smart phones is addicting

http://www.theguardian.com/technology/2015/aug/06/smartphones-most-popular-way-to-browse-internet-ofcom

3.It is a handy method for the teachers to make students use their phones productively in class rooms. This link provides certain ways to use smart phone in class rooms for educational purposes

http://www.nea.org/tools/56274.htm

4.The known fact is smart phones make daily activities of a person easier. This link provides details of the advantages of smart phones in daily activities

http://everydaytechnology2012.blogspot.in

5.The your tube video refers to use of smart phones for commercial purposes

https://www.youtube.com/watch?v=99hjR5vdmRE

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1.http://www.qrcodescanning.com/smartphonehist.html

2.http://www.techhive.com/article/199243/a_brief_history_of_smartphones.html#slide2

3.https://www.youtube.com/watch?v=aimMH-ChUK0

4.https://www.youtube.com/watch?v=RECAvPmQhkc

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Some of the applications that are designed for e-learning purposes are Skill Pill, Design Jot, Udemy, My Moodle, BizMobile, E.Learning Age. Some of them can be accessed freely but some are to be purchased.

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Mention some of the applications that support e-learning

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A personal digital assistant (PDA), also known as a handheld PC, or personal data assistant,[1][2] is a mobile device that functions as a personal information manager. The term evolved from Personal Desktop Assistant, a software term for an application that prompts or prods the user of a computer with suggestions or provides quick reference to contacts and other lists. PDAs were largely discontinued in the early 2010s after the widespread adoption of highly capable, in particular iOS and Android-based, smartphones.[3]

Nearly all PDAs have the ability to connect to the Internet. A PDA has an electronic visual display, enabling it to include a web browser, all models also have audio capabilities enabling use as a portable media player, and also enabling most of them to be used as mobile phones. Most PDAs can access the Internet, intranets or extranets via Wi-Fi or Wireless Wide Area Networks. Most PDAs employ touchscreen technology.

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The sole reason to design smart phones is to make life easy for man-kind by helping them at every step of their activity. Applications in smart phones are the prior uses than making a phone-call. It is not just internet that can be utilised on your smart phone

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Is there nothing to do without internet?

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Availability of internet on smart phones provides retailers an opportunity to expand their business over a wide range of customers mostly multi-national. The utilisation of this is at the door step for the customers who can be exposed to a plethora of goods including the daily grocery. This can be mentioned as the best way of saving time in shopping

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Microsoft Dynamics for Retail eCommerce & Social

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Customers are connected and informed and want shopping choices. They want the option of going to a physical store, browsing on a tablet at home, or shopping on-the-go using a smart phone! eCommerce and Social features in Microsoft Dynamics for Retail provides today's retailers with an opportunity to engage and connect with customers through an omni-channel shopping experience.

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What is Personal Digital Assistant (PDA)

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Moving Question Mark - ClipArt | Clipart Panda - Free Clipart Images

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Can you elaborate about eCAALYX

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Who can now imagine a life without the future life saviors ..the smart phones. At present the world wants to get smarter and smarter.. and smart phones are the key! They are not only binding the international village but also building us up as a community.They are reducing all the differences of caste, creed, race ,poverty, nationality by making all of us approachable so easily and economically via online messaging 'apps' . These apps have rather brought an evolution to our lifestyle and living standards. We as humans who were blindly following the race of co-existance have been made to realize the importance of our being by providing various methods to know ourselves and to pamper ourselves.

One such app is the eCAALYX which is helping our elderly not to give up on life soon.It is a way of tele healthcare to reach all the glimmering eyes which had been unfortunately waiting for a medical help through out there life! This app has been a success so far connecting the exhaustive medical research and the needy.

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The future medicine is in your pocket!! SMART PHONE

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Maged N Kamel Boulos 1 Email author ,

Steve Wheeler 2,

Carlos Tavares 3 and

Ray Jones 1

BioMedical Engineering OnLine 2011 10:24

DOI: 10.1186/1475-925X-10-24

Received: 22 February 2011

Accepted: 5 April 2011

Published: 5 April 2011

Abstract

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

Introduction

More than half of Americans aged 25-29 now live in households with mobile phones but no traditional landline telephones, a December 2010 report on phone use by the US National Center for Health Statistics at the CDC (Centers for Disease Control and Prevention) has found. The same study also found that the younger children are, the likelier they are to live in homes that only have wireless phones, suggesting that younger parents are becoming increasingly reliant on mobile phones even as they adjust from being single to a more settled family lifestyle [ 1]. According to a recent video report by Mobile Future, a Washington, D.C., broad-based coalition of businesses and non-profit organisations, there has been a massive increase in the numbers of consumer smartphone apps (applications) downloaded over the past two years, with figures going up from 300 million apps downloaded in 2009 to five billion in 2010 [ 2, 3] (Figure 1).

Indeed, smartphones have been one of the success stories of the last decade. In a relatively short period of time, smart mobile technology has penetrated significantly into society, capturing an entire age spectrum of subscribers in western industrialised nations, from school children to senior citizens. Such progress has built upon a long history of the use of communication devices, and a rapid adoption of mobile communication devices that began in the latter part of the last century.

On smartphones

Although the mobile phone has been widely used for several decades, smartphones are a more recent advance. They are mobile phones that offer not only the standard facilities such as voice and text communication, but also advanced computing and communication capability, including, for example, Internet access and geo-positioning systems. In comparison to earlier mobile phones, smartphones generally also have larger, higher resolution display screens. Most of the newer generation of smartphones also incorporate other features such as on-board personal management tools, high quality cameras and recording devices.

Some smartphones, such as the Blackberry, also incorporate small internal keyboards in their designs. Recently, Apple's iPhone and Google's Android touch screen devices have increased smartphone ownership. They are popular because of their intuitive and tactile graphical user interfaces and natural gesture control. The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development [ 9]. The potential for the creation of simple and easy to download apps for smartphones has created a vibrant new industry. There is now an app for just about every social, entertainment and educational requirement [ 2].

Smartphones have now achieved such a pervasive presence in society that users find it easy to self-organise themselves across large geographical areas [ 10]. Many have adopted a culture where they are 'always connected' to their peer groups, communities of practice and information [ 11]. The mobile phone provides an essential 'any time, any place' portal into the entire world wide web of knowledge. Such continuous and pervasive social connectivity has important implications for society, and holds a lot of potential in particular for use in education, healthcare and medicine.

Mobile phone applications in healthcare

GPS (Global Positioning System) and location-enabled smartphones offer many additional application opportunities that can further assist the independent living of persons with disabilities and/or multiple chronic conditions [ 22, 23], as well as in epidemiology/public health surveillance and community data collection [ 24].

The eCAALYX example

The eCAALYX Mobile Application is being developed under the scope of the eCAALYX EU-funded project (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012; [ 29, 30]), which aims at building a remote monitoring system targeting older people with multiple chronic diseases. Patients, carers and clinicians' involvement is extensive throughout the prototype design, deployment and testing, and clinical trial phases of the project. The main functionality of the eCAALYX Mobile Platform is to act as a seamless "informed" intermediary between the wearable health sensors (in a 'smart garment') used by the older person and the health professionals' Internet site, by reporting to the latter (but also to the patients) alerts and measurements obtained from sensors and the geographic location (via smartphone GPS) of the user. Additionally, the mobile platform is also able to reason with the raw sensor data to identify higher level information, including easy-to-detect anomalies such as tachycardia and signs of respiratory infections, based on established medical knowledge. A user interface is also provided, which allows the user to evaluate the most recent medical details obtained from sensors, perform new measurements, and communicate with the caretakers.

Major challenges

There are many challenges to the development of the mobile platform. Most importantly, the mobile platform must be seamless and autonomous in its operation (e.g., in raising alerts), in order to provide a usable service to a target group that usually does not have any familiarity with technology and might even be unconscious during times of medical emergency and not able to manually operate any device or software. System and service reliability is also an important issue to take into account, firstly due to the possible negative sensation that the application may give to the user in the case of malfunctioning, and, secondly, due to the physical distance between the technical maintenance teams and the users. From an implementation point of view, the issues regarding the implementation of intelligent mechanisms in a mobile resource-limited device should also be considered. Usability issues are further discussed in the following section.

Usability

Usability is a critical issue for the target group of eCAALYX as, usually, users in this target group do not have any familiarity with technology and this is also often compounded by a range of physical (e.g., poor eyesight) and/or cognitive disabilities (e.g., dementia) that such users might be suffering from that can further limit their use of the technology [ 23]. Due to that fact, the eCAALYX Mobile Platform was designed to be completely transparent to the user, and the necessary interface functionality to be as accessible as possible. The mobile platform and some of eCAALYX software functionalities are depicted in Figure 2 and a video walkthrough available from [ 31]. The usability design for this mobile platform caters for older users' needs in two main areas, namely physical handling and maintenance of the smartphone, and the usage of the phone software itself. Regarding physical handling and maintenance, the following practical solutions were adopted:

Use of dock-stations to simplify the battery charging of the mobile device;

Use of a mobile phone without buttons and with large touch-screens, which allows the building of virtual buttons as large as needed, instead of the small buttons available on commercial mobile phones with conventional keypads and keyboards; and

All maintenance actions are performed either remotely and transparently to the user, or locally, by technicians.

Concerning smartphone software usage, the following practical solutions were adopted:

The phone runs autonomously without the need of any mandatory interaction from the user from the time it is powered on. This includes the supressing of all enquiries of the operating system, such as pin negotiation and the automation of all necessary processes;

Rebooting has to be avoided, because it can be a difficult task to perform by the target users. The phone must therefore support prolonged periods of operation without the need to reboot the system;

All possible navigation has been reduced to two easily accessible screens, to avoid confusion of the user while navigating the software; and

All error pop-ups were supressed, to avoid showing any system errors to the user.

Prototype

The technological platform in the current prototype is the Google Nexus, running the Android 2.1 platform [ 32], with 1 GHz processor and 512 MB RAM memory; however, it can be easily ported to a newer Android version, or even to another Android phone. The software itself is written in the JAVA language for the Android's Dalvik Virtual Machine. From a software point of view, the internal structure follows a black-board architecture, in which several concurrent processes share information using the SQLite database provided in the Android Platform. Access to necessary resources, such as GPS, Bluetooth, and the Internet, is also provided through the Android Platform. The interface with the Caretaker/Clinicians' site is accomplished using the W3C Web Services technology, while the interface with the health sensors (in a 'smart garment' worn by the patient) is realised using Bluetooth wireless technology. This structure is shown in Figure 3.

There are not yet any clinical trials or evaluation results of the eCAALYX Mobile App to report (at the time of writing in January 2011); such details are expected to be available after project completion in July 2012. However, we think that the eCAALYX Mobile App we have briefly described here provides a unique opportunity to have a somewhat detailed 'under-the-hood' look at one current example from a rapidly growing class of smartphone apps for chronic disease management and telehealthcare.

Discussion

eCAALYX builds on the experience gained in a previous and closely related EU-funded project, CAALYX (Complete Ambient Assisted Living Experiment, 2007-2008; [ 23, 30, 33]). The original CAALYX prototype similarly used a smartphone and one of the prototype's commercial exploitation barriers identified at that time was the relatively high cost of acquiring an Internet- and GPS-enabled smartphone with sufficient computing power (and battery life) to run the CAALYX mobile app (plus the subscription costs to a suitable mobile phone data plan), particularly given the generally low income of target users (older pensioners [ 34]). However, recent surveys of mobile phone uptake and penetration in the UK and other developing countries show that this affordability barrier might be gradually improving on the medium to long run, especially for the "younger" older generations (55-70) and as smartphone prices and data plan costs continue to drop.

A closer look at ownership of smartphones

Smartphone ownership in the developed world is rapidly increasing. ChangeWave Research [ 35] report a (presumably US) survey in December 2009 with 42% saying they own a smartphone (rising from 15% in October 2006) (but details of the survey methods are not freely available). Estimates from Ofcom research [ 36] suggest the figure is less, namely that the USA has 36% and the UK has 37% with Internet access via a mobile phone. Ofcom also cites ComScore's MobiLens survey [ 37] estimating only 18% of people with smartphone subscriptions in the UK compared to 26% in Italy and 21% in Spain. Ofcom reports that there is a good deal of consumer confusion over the capabilities of their phone but that 43% claim their phone can be used to access apps, download email, and surf the Web. If 81% have a mobile phone (see below) this would imply a third of the UK population with smartphones. We might estimate therefore that between one fifth and one third of the UK population now has a smartphone.

What are the predictions for smartphone ownership to reach over 90% of the population?

We can perhaps extrapolate from ownership of any mobile phone. UK's National Statistics [ 38] report the growth in mobile phone ownership since 2001/02, increasing from 65% to 81% in 2009. Ownership varies by income group. Only 67% of households in the lowest income decile group reported mobile phone ownership in 2009, compared with 92% in the highest income decile group. (Recent estimates of mobile phone use in the USA are 85% [ 39], so there is no significant difference between UK and USA (given the differences in methods used and error in these estimates).)

Age is probably the major 'digital divide'. The Continuous Household Survey in Northern Ireland [ 40] provides a good indication of how mobile phone ownership is increasing. It puts current ownership at 89% in Northern Ireland. It is not clear whether this higher figure compared to the British 81% from National Statistics is 'real' or due to methodological differences. Nevertheless, the pattern of older consumers lagging behind the rest of the population (Figure 4) is likely also to be the case in England and the rest of the UK. However, if the current trajectory continues, over 95% of the over 60 s will have a mobile phone in five years.

Taking these two trends together we might estimate that 80-90% of the UK population will have a smartphone within 10 years. This might not be quite as rapid as some might suggest, but, in the context of other social changes brought about by the development of technology, is a massive change.

What impact will this have on healthcare?

Jane Sarasohn-Kahn reports "How smartphones are changing healthcare for consumers and providers" [ 41]. Probably the quickest change is in the use of smartphones by professionals. The slightly slower, but possibly bigger, impact may be in the use of smartphones by lay consumers. Producers of apps certainly think there is a market, as by February 2010, some 4000 apps were available within the Apple App Store aimed at patient end-users, and Gartner named mobile health as one of its top ten applications for 2012 [ 42].

Considering that many apps now, especially those intended for chronic disease management, rely on the presence of an active Internet connection on the smartphone in order to function as intended, a question immediately arises about current Internet uptake levels among people with chronic diseases.

Do people with chronic disease go online and can Internet-enabled smartphones make a difference?

Fox and Purcell [ 43] report that in the USA, adults living with chronic disease are disproportionately offline. 81% of adults reporting no chronic diseases go online compared to 62% of adults living with one or more chronic disease. And there is a marked 'dose response', so 68% of adults reporting one chronic disease go online compared to only 52% of adults living with two or more chronic diseases. The difference is even more marked when comparing use of text messages with only 23% of those with two or more chronic conditions compared to 60% of those with no conditions using a mobile to send text messages [ 43].

There are now many health promoting Internet interventions [ 44] but they will, by definition, only be used by those who have already reached a decision to try to change their behaviour. Although many report successful behaviour change in those who continue to use such interventions, attrition is usually very high, and we can assume that those who drop out of using the online intervention have also dropped out of changing their behaviour. It may be that smartphone technology, by its mobility and location awareness, may be able to achieve lower attrition rates, but given the demographics of current users it is likely to be for behaviour change amongst a relatively young and healthy population. Sarasohn-Kahn [ 41] had argued that medication adherence is a problem amongst patients with chronic conditions and suggested that technology can play an important role. However, there is no strong evidence yet on the effectiveness of dispensing devices, and like behaviour change, this is likely only to benefit those willing to use such reminders and who are already smartphone users, unless apps running in specialised devices can be developed.

There are now hundreds of smartphone apps focusing on wellness, fitness, and nutrition. Mobile and home monitoring can be carried out with body-worn and ambient sensors communicating with smartphones (as found, for example, in eCAALYX), including accelerometers measuring motion and gait, infrared detectors measuring body temperature and heart rate, and glucometers measuring blood glucose (some sensors may also be built-into future smartphones). However, Sarasohn-Kahn [ 41] describes how MedApps started as a mobile phone app, but given the low user base amongst chronically ill and older people they re-engineered it as a wireless handheld device, the HealthPal. Users use their 'usual' devices such glucometers, spirometers, pulse oximeters, and scales, and the Bluetooth enabled Healthpal communicates results. Another rather obvious consideration in smartphone use for people who are (chronically) ill, is that most such people are at home, and unlikely to be 'out and about' using their mobile phone. In that circumstance they are more likely, with current device usage, to use a Wi-Fi enabled laptop (or iPad/Android Touch Tablet) from their bed (although the use of 3G mobile Internet connections indoors is also on the rise on different devices ranging from smartphones to notebooks). However, smartphones, especially newer ones with larger (touch) screens, are starting to replace conventional desktop and Wi-Fi access (and some smartphones are both Wi-Fi and 3G mobile Internet enabled). In the UK, 29% of Internet users use their mobile to access the Internet at home, second only to those in Japan at 43% [ 36], and mobiles are rapidly replacing landlines in many homes. In the UK, 13% of all homes used mobiles as their sole form of telephony [ 36], but more than half of Americans aged 25-29 now live in households with mobile phones but no traditional landline telephones [ 1].

At the moment, Sarasohn-Kahn [ 41] cites Eising of Mayo clinic mentioning their research that people use mobiles for 'action-oriented' information, and how they are not going to do in-depth research by mobile. So smartphones will be used by people who are not acutely ill but who maybe want to find some location based information - such as the location and hours of a pharmacist - while on the move. Whereas more detailed information, or communication with others may take place in the home. But as more people get smartphones and use them as their sole means of communication, this may change.

What other barriers to smartphone use in health does Sarasohn-Kahn [ 41] see? She is concerned that too much app development is carried out by technologists without the involvement of patients. She notes the problems of apps recommending particular products and also notes that in the USA if an app includes a sensor then the FDA (US Food and Drug Administration) may monitor it as a medical device. She thinks that the challenges to continued rapid smartphone growth include finding the right business model and privacy issues. (For a brief discussion of the latter privacy issues and some workarounds adopted in CAALYX/eCAALYX, interested readers may refer to [ 23] and [ 45]).

Some limitations of mobile phone applications

Notwithstanding all of the benefits we should be aware that the use of the mobile phone in healthcare and clinical practice is not without its problems and limitations. In comparison to laptop computers, the small internal storage capacity, processing power and screen size of the mobile phone often requires apps that are running to be in reduced format [ 25]. However, the use of cloud computing resources which are external to the mobile device may obviate restrictive processing speeds and memory requirements in the future [ 25]. Never the less, mobile phones are smaller, more portable and less obtrusive than laptops, so it could be argued that this is a reasonable trade off. Although much mobile phone communication is now conducted using text, voice communication still necessitates the securing of space within which vocal communication can be made in private [ 46]. The consideration of such a constraint may be vital to maintain the confidentiality of patient information if used in public spaces. Other factors such as loss or theft of devices may impact upon the security of confidential digital health records or data held on mobile phones. The security of patient data held on mobile phones has been a concern for some time [ 47], while some studies warn of the security risks of using mobile instant messaging in healthcare [ 48].

Patient attitudes and perceptions

When used as a method for monitoring the health status of remote patients, mobile phones should be applied only after due consideration to patient perceptions and feelings. One study in Italy revealed that patients with implantable cardioverter-defibrillators for cardiac resynchronisation therapy welcomed the use of mobile technologies for remote monitoring, but did not want them to replace their personal contact with health workers [ 49]. Other studies using mobile technology for remote monitoring of health conditions found similar results [ 50, 51]. The Canadian study by Seto et al. [ 51] also advised that mobile phone-based remote monitoring will not be suitable for all patients. Those for example who suffer from poor manual dexterity, failing vision or a predisposition to high levels of anxiety may not be able to operate the remote mobile monitoring tools. These results are supported by similar findings from a study of older patients with disabilities in the USA [ 52]. It should also be acknowledged that prosaic issues such as remembering to recharge a device and the simple maintenance of equipment within a patient's home may be problematic.

Kurniawan [ 53], Lorenz and Oppermann [ 54], and Gao and Koronios [ 55] provide detailed discussions of mobile app needs of older people, covering aspects such as ergonomics and user interface issues (e.g., memory aids, visual aids, haptic aids, features to minimise user error, and safety features), as well as the most commonly desired smartphone app functionalities in this age group. However, senior citizens of tomorrow will include the young and middle aged of today, who are more familiar with, and reliant on computers, smartphones and the Internet than previous generations, and are increasingly well-versed in using these technologies on a daily basis for study, work and leisure. This might partially contribute (in the long run) to solving some of the smartphone app usability and learnability issues, which current generations of older people are facing.

Which platform to support? A developer's dilemma

According to a recent MobiHealthNews report published in November 2010 [ 56], from February to September of the same year, Google's Android smartphone saw a 156.6% increase in the number of available health-related apps, compared with a 66.6% increase in Apple's health-related apps. The number of health-related apps in BlackBerry's App World increased by 141.4% over the same period. However, Apple is still leading in terms of the absolute total number of health-related apps available on any platform. As of September 2010, Apple's App Store offered the highest number of health-related apps at 7,136, followed by Google Android at 1,296 and BlackBerry at 338. These figures represent a healthy 78% increase in the number of health-related apps on these three platforms combined since February 2010. The MobiHealthNews report did not cover the latest Microsoft Windows Phone 7 platform as this was only officially launched during October/November 2010; older versions of the Windows platform (Windows Mobile 6.x) had less than a 3% market share of worldwide 2010 Q3 smartphone sales (vs. 25.5% for Android, 16.7% for Apple iOS and 14.8% for Research In Motion--RIM BlackBerry) [ 42], and were probably not considered in the MobiHealthNews report for this reason. However, the emerging Windows Phone 7 platform is rapidly gathering momentum and support by major smartphone providers [ 57], with a growing number of health-related apps already available from Windows Phone 7 Marketplace for the new handsets (Figure 1 - [ 3]). It remains to be seen how the emerging Windows Phone 7 platform will fare against the well-established competitor smartphone players and their planned updates in 2011/2012.

Other constraints

Desk-based health researchers who rely on the telephone to gather their data are faced with a growing problem. Increasingly, respondents are replacing their landlines with mobile telephones, and in so doing, they create a problem for the researcher. Legislation in some countries requires researchers to manually dial mobile phone numbers, thereby incurring significantly more cost in both time spent on calling and in call costs. Further, calling a mobile phone on some tariffs may use up respondents' air time, and there may therefore be an ethical onus on the researcher to reimburse the costs incurred [ 58].

Conclusions

Some commentators [ 27, 41] suggest that the natural progression for healthcare is to go mobile, because it is information intensive and smartphones can offer a convenient solution. Smartphones are useful to keep clinicians up to date with the latest medical techniques, and it is easy and cost effective to communicate updates, advice and guidelines to a distributed community of practice in this way. As has also been demonstrated, mobile phones are useful for monitoring and diagnosing health conditions when clinicians are a distance from their patients. Further, with the Internet playing an increasing role in medical education [ 64], it is likely that for itinerant health workers the most important access portal to this information will be handheld devices such as smartphones. Indeed, Georgetown Medical School in the USA, for example, is now requiring every medical student to have an iPhone [ 65], and surgeons are finding the device (and its apps) very useful in improving their diagnostic skills and education [ 66]. Smartphones are therefore useful to the medical and health related professions because they are agile, handheld, easy to use and can be used on the move [ 41].

Later adopters of new technologies may not use them in the same way as early adopters. Developers of new smartphone health apps need to look 'at the margin', i.e., how the latest group of adopters are using smartphones and how the next group of new users may use it. Although there are hundreds of smartphone apps at the moment, the successful ones are, currently, likely to be for younger and healthier populations. The adoption of smartphones by older people and people with chronic disease will come with time, but also as the relative cost comes down, as apps become easier to use, as there is a greater awareness of what smartphones can do, with the establishment of more 'community knowledge' to deal with the complexity of the new technology [ 67], and perhaps with apps moved to dedicated devices tailored for the specific needs of particular user groups and applications. These changes will almost certainly happen, but probably not as quickly as producers may predict. Producers may need patience and to put more effort into making the technology easier and cheaper to use for all.

Declarations

Acknowledgements

This eCAALYX project is supported in part by the Ambient Assisted Living (AAL) Joint Programme, a joint research and development funding activity by 20 European Member States and 3 Associated States, with the financial support of the European Community (EC) based on article 169 of the EC treaty. The eCAALYX Project Consortium includes 11 member organisations in five European countries.

Authors' original submitted files for images

Competing interests

Authors' contributions

MNKB conceived and drafted the manuscript with contributions from SW, CT and RJ. MNKB and CT (and their institutions) are both involved in the EU-funded eCAALYX project, with MNKB leading the University of Plymouth part of it. All authors read and approved the final version of the paper. (N.B.: All Web links in 'References' below have been last checked working on 16 March 2011.)

The authors declare that they have no competing interests.

Below are the links to the authors' original submitted files for images.

Authors' Affiliations

(1)

Faculty of Health, University of Plymouth

(2)

Faculty of Education, University of Plymouth

(3)

Information and Communication Systems Unit, INESC PORTO

References

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© 2017 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.

# data[].attributes.attachment_link.title
How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

# data[].attributes.attachment_link.description
The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake.

# data[].attributes.body
Mobile marketing is marketing on or with a mobile device, such as a smartphone. Mobile marketing can provide customers with time and location sensitive, personalized information that promotes goods, services and ideas. In a more theoretical manner, academic Andreas Kaplan defines mobile marketing as "any marketing activity conducted through a ubiquitous network to which consumers are constantly connected using a personal mobile device".

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SMARTPHONE FEATURES

A smartphone or smart phone is a mobile phone with an advanced mobile operating system which combines features of a personal computer operating system with other features useful for mobile or handheld use. They typically combine the features of a cell phone with those of other popular mobile devices such as Personal digital assistant (PDA), media player and GPS navigation unit. Most smartphones can access the Internet, have a  touchscreen user interface, can run third-party apps, music players and are camera phones. Most Smartphones produced from 2012 onwards also have high-speed mobile broadband 4G LTE Internet,motion sensors, and mobile payment mechanisms.

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HISTORY OF TELEPHONE

Alexander GrahamBell was the inventor and innovator of who is credited with inventing the first practical telephone in 1876.