The Sexual mHealth Revolution

The relative anonymity of mHealth is boosting its uptake among patients with STDs. Hans Klis takes a look at the longer-term implications for the tech in the private areas of sexual and personal health as well as beyond…

When Bryan Stacey felt a pain in his left testicle in 2012 he didn’t get it checked out immediately. He was scared and did what a lot of men do when confronted with an intimate health issue; he ignored it hoping it would go away. It didn’t and when he eventually saw a doctor he was diagnosed with chlamydia and testicular cancer.

The experience profoundly changed Stacey. Last year he founded Biem (pronounced ‘beam’), a mobile app for Android and iOS platforms that makes it easier for users to get their sexual health tested.

“We’ve found that people are often too scared, nervous or embarrassed to talk to their partners or even their doctors about sexual health,” Stacey says. “They put off getting tested, asking questions and having important conversations until it’s too late.” The free app soft-launched in New York City this summer.

Biem users get a chance to talk one-on-one with sex health care providers about their problems through video chat ($45) and can set up testing appointments at home with a qualified health technician ($45) or in a health care facility through the app.

So there’s no self-testing, but FDA and CLEA certified diagnostics. STD-results get sent to your phone within two to three days, avoiding embarrassing phone calls with receptionists, and users can show concerned sexual partners verified health results. Biem also sends anonymous notifications to bed partners if one of them tests positive for an STD within a specific time frame.

According to CEO Stacey, Biem might have a real impact: “STD rates are at an all-time high in the United States, and I would argue that sexual health anxiety is also rampant and is partly to blame for rising STD rates.”

Last year the STD surveillance reportof the Centers for Disease Control and Prevention (CDC) found that sexually transmitted diseases are on the rise in the United States. Between 2014 and 2015 reported cases of syphilis rose by 19 percent, gonorrhea by 12.8 percent and chlamydia by 5.9 percent--mostly because infections were not treated, patients did not see a doctor, or they went much too late, like Stacey. “The first step towards sexual health is always the hardest because it’s easy to make an excuse for why not to go to the clinic.”

Biem is at the vanguard of a new wave of mobile health applications flooding into the app stores. Of the more than a quarter million health related services available right now most are fitness trackers or concerned with mindfulness. A study in 2015 found that a meager 4 percentof apps in the last category actually educated users on their mental and physical well being.

But behind the scenes a lot is happening. There’s an mHealth revolution brewing. Venture capital funding into this emerging market is growing steadily according to research by Mercom Capital Group. It saw funding for digital health companies in 2016 rise by almost 10 percent to $5 billion compared to the year before. Most of the money, $1.3 billion, went into the mobile apps market.

And that is showing. Apple for example is working hard to make the iPhone into a mobile doctor. With its HealthKitAPI, it wants to help programmers to better integrate health and activity data into their apps. And their ResearchKithelps health services better gather data for research purposes. Hosting clinical data will make Apple a health care powerhouse.

API’s such as ResearchKit are helping developers like psychiatrist Alex Leow and computer scientist Peter Nelson at the University of Illinois at Chicago develop apps that address more than getting your daily exercise.

With BiAffect the researchers hope to better monitor patients with a bipolar disorder, including Nelson’s son. The men’s’ research revealed that the way bipolar patients type on their phones correlates with the mood they are in. In some subjects they have studied, manic episodes show faster typing and more spelling errors in communicating, while slower typing may likely be correlated with a depressive episode.

In this way BiAffect can function as a real-time alarm device, Leow says, adding, “Tracing data points correlated with manic and depressive episodes makes it easier to intervene and make sure the rights steps are taken by health professionals.”

The app is installed once and works in the background, tracking keystrokes meta-features but not the content of the communications. It gives health professionals a better insight into how a patient is doing. The real-time monitoring provides big data that is normally unavailable during outpatient checkups or sessions that can only provide a snapshot of a person’s mental health. 

BiAffect is not only beneficial for health professionals monitoring patients but also potentially for patients themselves to gain more self-knowledge, Leow stresses: “People with bipolar disorder, or many other severe forms of mental illness for that matter, don’t have insight into their affliction.”

In fact, Leow and colleagues have also studied the lack of insight in subjects with Anorexia, and they believe that if someone can’t perceive reality (i.e., thinks of self as normal even when evidence suggests severe weight-loss) providing them with data they can relate to – like an on-screen interpretation on a mobile device – “might help develop that insight.” And hopefully result in a more effective treatment for the patient.

The mHealth market will see more apps and devices in the near future focusing on mental health and illnesses, analyst Dr. Cheryl Lee Barton of market research company BCC Research predicts. “With an aging population mental illnesses will become more prevalent. We’re seeing more developments to monitor depression for example. You didn’t see that ten years ago.”

In the app space there’ll be more apps providing cognitive tests to examine mental fitness. A rise coupled with a growing number of pharmaceutical innovations and products focusing on mental health. Innovations in mHealth and the pharmaceutical industry go hand in hand.

In her report Mobile Health Technologies and Global MarketsBarton forecasts that the global mHealth market will grow from $13.2 billion dollars in 2016 to $46.3 billion dollar in 2021. The forces driving this growth are the potential to help health services allocate resources more effectively, she explains. “An app that helps people adhere to their medicine could reduce the long-term cost associated with not taking their medicine.”

Just like the health industry, national governments see benefits in mHealth. Dr. Scott Gottlieb, the Trump appointed U.S. Food and Drugs Administration (FDA) commissioner, signaled in June that the regulatory organization wants to stimulate mHealth development. “For these digital technologies to take hold and reach their fullest potential, it is critical that FDA be forward-leaning in making sure that we have implemented the right policies and regulatory tools, and communicated them clearly, to encourage safe and effective innovation”, he writes in a blog post.

Gottlieb, an mHealth advocate, has advocated for a new vetting procedure to lower the threshold of innovators to enter the market.

Innovation in health services will most assuredly improve resource allocation and increase effectiveness. The jury, however, is still out on whether more investments in mHealth will significantly lower costs of health care, according to Barton.

Health insurance and pharmaceutical companies welcome mHealth initiatives. They provide a trove of data that can be used to tailor care to the customer and streamline services. When integrated properly information from mHealth applications could potentially detect diseases early, which would benefit everyone involved in the health care process.

“There’s a lot of discussion about implementing artificial intelligence and algorithms that can collate vast amounts of data that could provide a number of diagnostic outcomes quicker than a single doctor,” Barton says.

It could help uncover illnesses that go undiagnosed otherwise. But using AI would require tight regulation by health authorities. The ramifications of a misdiagnosis could be colossal for all parties involved. That’s why health professionals will always be a part of medical treatment even in an mHealth utopia.

Video chatting with a sexual health care professional is compulsory for Biem users, for example. In most American states, a face-to-face meeting is required to establish a patient-doctor relationship, explains Biem’s CEO Stacey. “Without it we would not be able to answer medical questions, order prescriptions or order tests. Also, prior to being tested, diagnosed, or treated, patients must prove their identity over video chat by showing a Biem health care provider their government-issued ID.”

The most important hurdle for a successful mHealth service, after regulatory issues, is cybersecurity. Biem is both HIPPA and HITRUST compliant, ensuring safe handling of digital information. However recent ransomware attacks that crippled the NHS, among other organizations and companies worldwide, have shown that cybersecurity will be one of the most looked at requirements for this emerging market.

“For Millennials sharing personal information with digital services is the norm,” Barton warns. “They’re more used to interacting with a web interface than picking up the phone.  But Millennials might think twice about sharing sensitive information if they fall victim to cyber attacks or medical identity theft.”

The success of innovative services like Biem or BiAffect is dependent on protecting personal data while improving health services. But even breaches are unlikely to stem the rising tide of mHealth.