[strawhatdev]

Medical devices, e.g. (some) insulin pumps like the Tandem Mobi, are managed via smartphone apps only. It's an unfortunate fact of life that life supporting technology can increasingly only be interfaced via smartphones.

From my perspective, that's an unfortunate but ultimately good reason for some kids to have smartphones.

[bsder]

> It's an unfortunate fact of life that life supporting technology can increasingly only be interfaced via smartphones.

Things like "insulin pump control" had separate, non-phone devices for a long time. Consumers flocked to the ones on the phone even when they sucked and had 1/10 the features.

I'm no defender of medical companies, but the blame for your complaint falls squarely on the consumers, themselves.

[strawhatdev]

I think this strikes me as a revealed preference story. Would you rather carry around an additional device, remember to charge it, etc. else be locked out of lifesaving care? I see the appeal of reducing the number of devices you have to carry around.

I also think for many smaller medical device manufacturers it can be advantageous to build on an existing platform like android/iphone. You're already solving one challenging hardware problem, why add another when you can take advantage of a mature development ecosystem that consumers 1) seem to have a preference for and 2) have already paid for, thus lowering the cost of treatment delivery.

[stackskipton]

Sure, and law can be written in a manner that those with medical device reason can keep their phone with them.

[slothtrop]

A case at the extreme margins. Exceptions are trivial to deal with.

[beanjuiceII]

my kid's phone is used for managing and monitoring t1d, and they will always have their smart phone at hand i don't care what law people think they are putting in place

[jkaplowitz]

Valid, yes. But the law could still require that the medical monitoring device have other functions disabled or (depending on what the legislators consider easy enough) not in use while in class except for the t1d monitor + SMS + voice, right? And they could still apply discipline if the student's phone has other functions enabled or (depending on the legislative wording) in use while in class?

The law could also use indirect leverage to gradually separate students' medical monitoring from the smartphone over the medium to long term. For example, they could begin a multi-year transition period after which NY-regulated health insurance plans would have to cover a non-smartphone version of these monitoring devices with at least equivalent functionality to any smartphone version they cover, at no greater out-of-pocket cost to the patient, unless no comparable non-smartphone product is on the market from any manufacturer. Then they could eventually require the non-smartphone version in class once it exists, with a fully insurance-paid (no cost-sharing) transition available at that time to children who use the existing smartphone monitoring system.

To avoid a gap in insurance coverage, NY could continue to mandate that some version of these devices be covered, so nobody would go without affordable medical monitoring. But as soon as one company decides to make a non-smartphone version, their competitors would have to do the same or else lose market share in NY, so they all would. (Why would that first company take the leap? They'd get a lot of insurance-paid device purchases for the transition for children's existing devices.) And then teachers would have an ADA-compliant way to remove the distractions of smartphones in class even for kids with medical monitoring needs, without causing harm to anyone.

[strawhatdev]

> The law could also use indirect leverage to gradually separate students' medical monitoring from the smartphone. For example, they could begin a multi-year transition period after which NY-regulated health insurance plans could only cover these types of smartphone-linked medical monitoring devices if they also cover a version with equivalent functionality in a non-smartphone version (at no greater out-of-pocket cost to the patient) unless no comparable non-smartphone product is on the market from any manufacturer. Then they could eventually require the non-smartphone version in class once it exists, with a fully insurance-paid (no cost-sharing) transition available to existing users of the smartphone monitoring system.

I think there are a few issues here.

T1D is already incredibly intrusive in the daily lives of children. Continuous glucose monitors (device 1, on body with bluetooth connection to a smartphone, device 2) track one's blood sugar every 5 minutes or so and gives the child, the parent, and the school nurse the information they need to jointly replace the functionality of the child's pancreas. This might be dosing with insulin through a pump (device 3, sometimes managed via smartphone) to lower blood glucose or cover carbohydrate consumption. Or it might be eating to raise blood glucose.

If the student's blood glucose gets either too high or too low (which can happen in a matter of minutes) the consequences can be fatal or lead to lifelong complications like nerve damage in the extremities or eyes. High stakes stuff.

If I understand correctly, your proposal would introduce a fourth device to separately monitor blood glucose and, I assume, manage the process of uploading this data and sharing it with all parties. This fourth device would mean a few things:

- Yet another piece of expensive, and durable medical equipment you are required to pay for, that insurance rarely fully covers.

- The child would have to tote around now four devices daily to manage a chronic condition.

- Another device to manage and maintain (batteries need to be charged, etc).

- Paying for another 5g plan to ensure that the monitoring device can share information with parents etc.

Despite some of the cons to these systems being integrated into your smartphone, there are considerable advantages to using the networked compute you always have in your pocket. Not to mention that these devices suffer from painfully slow development and approval cycles. Durable medical goods often have to go through federal approval and even small changes to firmware can take years.

Also, just some quick figures. The school age population in NY state as of 2021 was 2,622,879. About 1/400 children ages 0-18 have type 1. So around 6.5k students. This is neither the extreme edge case that others have described (and just one of many chronic diseases that are managed via smartphones) nor is it likely a large enough segment to change product development at these large health tech companies.

I don't think the solution is to try to engineer incentives and overhaul the entire health insurance coverage of durable medical goods. Nor do I think the solution is to require children with T1D to carry around and pay for yet another expensive device.

I think we just need to be careful in the design of legislation like this, as you suggest, especially when it comes to ubiquitous devices that have been integrated into so many facets of people's lives. There is no such thing as a 'trivial exception' to a state law (responding to a commenter further down).

[jkaplowitz]

Then maybe the easier solution is for the states to work with Apple and Google to make a “classroom mode” that disables everything except SMS, voice calls, and medical apps, and the presence of which can somehow easily be detected by the teacher in a privacy-preserving way (e.g. checking only the aggregate number of nearby classroom mode phones broadcasting that status over Bluetooth LE).

In the world where that is common, smartphones can still be banned in the classroom except for people with a medical accommodation, and those people would need to set their phones to classroom mode. The teacher would then have an app to alert them if the number of classroom mode broadcasts deviates from what is expected.

If that number of broadcasts is too low, that’s cause for investigation either because someone with an accommodation is using nonmedical apps in class or because someone’s medical monitoring is impaired due to a depleted phone battery. The former case would lead to discipline for using nonmedical apps in class outside the scope of their medical accommodation; the latter case would lead to whatever medical assistance is appropriate.

There would of course be plenty of other considerations to balance anti-abuse measures, convenience, and privacy. But the basic idea would work.

[ryandrake]

What is your plan as a parent for when the kid loses the smartphone by accident? Or if it runs out of battery?Whatever that plan is, why can’t that be the procedure while in school?

Making one’s child’s health utterly dependent on a smartphone sounds like... not a well thought out idea. What did people use to manage t1d prior to smartphones? Does that no longer work?

[strawhatdev]

Before Continuous Glucose Monitors (CGMs), diabetics would need to draw blood from a finger prick and use that with a glucometer to measure blood glucose levels or pee on a test strip.

These ways are still widely used but they still require a secondary device (a glucometer, or test strips) and also lead to much less frequent readings. This means that high and low blood sugars were more difficult to detect and correct.

Because you get far fewer readings (unless you're pricking your fingers every 5 minutes) there are very real health consequences. Having a high blood sugar for too long (oops, that apple had more carbohydrates in it than expected) can lead to nerve damage and blindness in the long term and potentially fatal diabetic ketoacidosis (DKA) in the immediate term. There are similar negative outcomes for low blood glucose levels.

Before CGMs people managed T1D but the short and long term health outcomes were/are much worse and the risk of death due to undiagnosed hyper/hypoglycemia was also much higher. Of course, we still carry glucometers and urine test strips (very inaccurate + coarse measurement) everywhere we go and the school has these as well.

[strawhatdev]

Same. The ADA act is our friend.

[ThrowawayTestr]

Does that phone need a sim card?

[kube-system]

What are you suggesting?

[ThrowawayTestr]

Take out the sim card

[kube-system]

Every day before school? What if they have a new phone or plan that uses eSIM?

Maybe alternatively, they could just teach their kid to be responsible?

[ThrowawayTestr]

They definitely could do that.