{"id":338,"date":"2020-07-27T16:30:43","date_gmt":"2020-07-27T16:30:43","guid":{"rendered":"https:\/\/www.socra.org\/blog\/?p=338"},"modified":"2020-08-28T19:19:15","modified_gmt":"2020-08-28T19:19:15","slug":"mobile-medical-devices","status":"publish","type":"post","link":"https:\/\/www.socra.org\/blog\/mobile-medical-devices\/","title":{"rendered":"Mobile Medical Devices"},"content":{"rendered":"\n<figure class=\"wp-block-image is-resized\"><img decoding=\"async\" src=\"https:\/\/www.socra.org\/blog\/wp-content\/uploads\/2020\/07\/MobileMedicalDevices-1024x452.jpg\" alt=\"Mobile Medical Devices\" class=\"wp-image-339\" width=\"850\" srcset=\"https:\/\/www.socra.org\/blog\/wp-content\/uploads\/2020\/07\/MobileMedicalDevices-1024x452.jpg 1024w, https:\/\/www.socra.org\/blog\/wp-content\/uploads\/2020\/07\/MobileMedicalDevices-300x132.jpg 300w, https:\/\/www.socra.org\/blog\/wp-content\/uploads\/2020\/07\/MobileMedicalDevices-768x339.jpg 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h4>By: Jonathan C. Young, PhD, MS, CIP, CCRP Senior Research Regulatory Operations Analyst Rush University Medical Center <\/h4>\n\n\n\n<p><em>Abstract: The use of mobile medical devices in clinical research is increasing significantly. This article provides an overview of regulations and guidance related to mobile medical devices including mobile apps. Possible risks and controversy that may arise from the use of mobile medical devices and how to improve submissions to institutional review boards for research involving mobile medical devices are also discussed. Examples of institutional review board review of real studies involving mobile medical devices at Rush University Medical Center are provided.<\/em><\/p>\n\n\n\n<!--more-->\n\n\n\n<p><em>Disclosure: The author has no professional, personal,\nor financial conflicts of interest with any of the material that is covered in\nthis article. <\/em><\/p>\n\n\n\n<h2>The Future of Mobile Medical Devices<\/h2>\n\n\n\n<p>Worldwide,\nmobile health was expected to grow from $5.1 billion in 2013 to $41.8 billion\nin 2023. This is a huge increase. In 2013, there were more than 97,000 mobile\napps related to health and fitness and 52% of all smartphone users gathered\nhealth-related information on their phones. Both of these statistics have\nincreased significantly in recent years. The most common types of apps in 2013 were:<\/p>\n\n\n\n<ul><li>Weight loss apps: 50 million downloads<\/li><li>Exercise apps: 26.5 million downloads<\/li><li>Women\u2019s health: 10.5 million downloads<\/li><li>Sleep and meditation: 8 million downloads<\/li><li>Pregnancy: 7.5 million downloads<\/li><li>Tools and instruments for tracking health and getting health information from providers: 6 million downloads.<\/li><\/ul>\n\n\n\n<p>The growing market for these\napps and devices will inevitably translate to more novel research. This article\nseeks to help ready clinical research and IRB professionals for the deluge of\nnew studies by discussing current regulations and guidelines as well as\noffering a simple rubric for review of these new app and device studies.<\/p>\n\n\n\n<h2>Definition of Mobile Medical Devices <\/h2>\n\n\n\n<p>Table 1 highlights\ndefinitions related to mobile medical devices. In this article, the terms \u201cmobile\nmedical device\u201d and \u201cmobile medical application\u201d (app) are used\ninterchangeably. <\/p>\n\n\n\n<p>The Federal Food, Drug, and Cosmetic Act 201(h) defines a regulated medical device as: \u201can instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals\u2026\u201d<\/p>\n\n\n\n<p>This definition can be distilled down into a mechanical or electrical object that can diagnose, prevent, make less severe, or cure a disease or condition. Examples of simple medical devices that are regulated by the U.S. Food and Drug Administration (FDA) include stethoscopes, tongue depressors, and anti-snoring devices available off the shelf. Drugs such as aspirin, cough syrup, and nasal sprays are also regulated by the FDA. The generally agreed-upon basic difference between a drug and a device is that drugs are chemical in nature and devices are not.<\/p>\n\n\n\n<p>The FDA\u2019s guidance <em>Mobile Medical Applications: Guidance for Industry and <a href=\"https:\/\/www.fda.gov\/home\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Food and Drug Administration (opens in a new tab)\">Food and Drug Administration<\/a> Staff<\/em> (2015) offers the following definitions related to mobile medical devices. Mobile platforms are \u201ccommercial off-the-shelf computing platforms, with or without wireless connectivity, that are handheld in nature.\u201d Mobile platforms include smartphones, smartwatches, Fitbits, iPads, and other small platform devices.<\/p>\n\n\n\n<p>A mobile app is \u201ca software\napplication that can be executed (run) on a mobile platform, &#8230;or a web-based\nsoftware application that is tailored to a mobile platform but is executed on a\nserver.\u201d Even if the app does not compute or maintain the information and is\nsending it to a cloud server, it can be construed to be a mobile app. Examples\nof mobile apps are Safari, Angry Birds, and Google Drive.<\/p>\n\n\n\n<p>A\nmobile medical app is an app that can be run on a mobile platform and is either\nintended to:<\/p>\n\n\n\n<ul><li>Be used as an accessory to a regulated medical device, or<\/li><li>Transform a mobile platform into a regulated medical device.<\/li><\/ul>\n\n\n\n<p>Thus, there are two tests as\nto whether a mobile app is a mobile <em>medical<\/em>\napp. <\/p>\n\n\n\n<h2>Enforcement of Mobile Medical Devices<\/h2>\n\n\n\n<p><em>Mobile Medical Applications: Guidance for Industry and Food and Drug Administration Staff<\/em> (2015) lists two types of medical apps: enforced and unenforced (Table 2). Mobile medical apps that pose a risk to patient safety are enforced and must go through the normal regulatory process for devices. The first criterion for enforcement is that a mobile medical app is an extension of a medical device and controls that device, monitors the patient, or analyzes medical data. For example, an app that is downloaded to a smartphone to control a pacemaker in some manner would probably be enforced.<\/p>\n\n\n\n<p>Mobile medical apps are also\nenforced if they transform by use of attachments, displays, and sensors or provide\npatient-specific analysis, diagnosis, or treatment recommendations. For\nexample, providing recommendations using data gathered through a device or\nmobile platform means that the app analyzes personal data and provides a way to\ncontrol a condition; thus the device would likely be enforced.<\/p>\n\n\n\n<p>Unenforced mobile medical apps\npose a low risk to patients. Simple tools to organize and track health\ninformation are unenforced. MyFitnessPal, where people can enter the food they\neat and see the calories consumed, is an example. Mobile medical apps that allow\naccess to health records are increasing as more medical centers provide\nelectronic health records via apps or servers with apps for browsing. Secondary\ndisplays to regulated medical devices, such as an app that displays the heart\nrate of a patient with a pacemaker but does not control the pacemaker, are\nanother type of unenforced mobile medical app.<\/p>\n\n\n\n<h3>Other\ntypes of unenforced mobile medical apps:<\/h3>\n\n\n\n<ul><li>Facilitate clinical care by coaching, prompting, or managing <\/li><li>Provide access to condition or treatment information<\/li><li>Help patients document potential medical conditions, such as a      medical diary app<\/li><li>Perform simple calculations used in clinical practice, such as a body mass index calculator.<\/li><\/ul>\n\n\n\n<h2>Benefits and Risks of Mobile Medical Devices<\/h2>\n\n\n\n<p>Mobile medical apps provide easy\naccess to data. For example, they can be used to pull information from\nelectronic health records for a particular subject. Mobile medical apps also\nprovide access to information on more potential subjects and allow researchers\nto consent subjects electronically. Institutional Review Boards (IRBs) can be\nskittish about researchers not meeting the people they consent to participate\nin studies. This reluctance on the part of IRBs is usually due to a perceived\nreduction in the quality of the consent process. Mobile medical apps also\nenable researchers to conduct studies with a larger sample size, which enables\nthem to reach significance more quickly and reduce the cost of a study.<\/p>\n\n\n\n<p>There are many risks and\nthreats to the use of mobile medical apps in clinical research (Table 3).\nResearchers may want to address these risks and threats in the informed consent\nform or the protocol before submission to the IRB. Data security and hacking is\nthe first and most obvious risk. Operating system vulnerabilities can be used\nto hack into the operating system and get information from apps even if the app\ndoes not interface with the operating system of the device that is being used. Control\nof devices is another risk. Using the example of an app to control a pacemaker,\nsomeone can hack into the app and turn the pacemaker off. Many people could die\nif this were to happen, which potentially can be used as a form of terrorism.<\/p>\n\n\n\n<p>Rush University Medical\nCenter has a large orthopedics department, which was using a medical device for\njoints that interfaced with an app in order to collect health information. IRB\ndiscussion at Rush for this particular study focused around hacking into the mobile\nmedical app to steal protected health information. Studies submitted to the IRB\nshould also address this risk of health information theft.<\/p>\n\n\n\n<p>Misuse by subjects and personal\ndevices versus provided devices are other risks and threats of mobile medical\napps. In the examples that will be covered in this article, the study team\nprovided the device containing the app to study participants. Thus, people who\ndid not have an iPhone now had an iPhone and could also use it for other\nactivities. The study team could potentially have some form of liability if\nstudy participants use the provided device for criminal activities.<\/p>\n\n\n\n<p>If the study team is not providing the device and instead asks study participants to download the app to their own device, there is a potential risk that the app could destroy or damage the device if it is not compatible in some way. As an example, Rush University Medical Center recently required employees to download a new app in order to get their email via a mobile device. This app was reportedly destroying or damaging some peoples\u2019 devices. The cost of devices is another risk, so study teams should preemptively build the potential cost of this risk into the study budget.<\/p>\n\n\n\n<p>Coercion and peer pressure are\nalso risks of mobile medical apps. Enrolling in a study that provides participants\nwith an iPad or iPhone with the app loaded confers a sort of prestige onto the\nparticipant. This can create peer pressure to participate. The IRB may interpret\nthis as coercion. <\/p>\n\n\n\n<p>Electronic consent in studies\nusing mobile medical apps is also a risk. Study teams can ask study\nparticipants to come into the clinical research site to consent in person\nbefore downloading the app or they can ask them to download the app and consent\non the app. <\/p>\n\n\n\n<p>If study participants consent\non the app, IRBs recommend follow up.&nbsp;\nFor example, the author is participating in an asthma study. He\ndownloaded the app, which provided the informed consent form. After reading the\ninformed consent form, the author had to take a 10-question quiz to ensure that\nhe understood what he had read. At the end of the quiz, the app provided a name\nand telephone number for any questions. This is a good process; however, it may\nrequire alteration of informed consent from the IRB and must be documented\nappropriately in the IRB application.<\/p>\n\n\n\n<h2>Example: Mobile Device A<\/h2>\n\n\n\n<p>A graduate student developed\nan app to relieve nightmares and post-traumatic stress disorder (PTSD). The app\nwas aimed toward veterans with PTSD who have a history of PTSD-induced nightmares.\nIt was designed to be downloaded to an Android device and used with a\nsmartwatch. The app would know whether the person was having a nightmare and\nsend a vibration through the smartwatch to wake the person up or at least jar\nhim\/her out of the nightmare. <\/p>\n\n\n\n<p>The graduate student wanted\nto conduct a study of the app at Rush University Medical Center. He had not\nthought out the study, however, when he submitted it to the IRB. The IRB had\nmany questions and concerns, including how the study investigators would know\nif the device woke him\/her up during a nightmare and not a normal dream. The\nprotocol did not state this. The IRB was also concerned about privacy because\nthe app interfaced with the electronic health record and downloaded some of\nthat information. The device had some type of artificial intelligence that\nlearned whether a person was having a nightmare. The IRB did not fully\nunderstand, through the documentation provided, how the artificial intelligence\nworked or know whether it was accurate.<\/p>\n\n\n\n<p>The IRB sent the study back\nto the investigator and asked for more information. The author talked to the investigator,\nwho had helped initiate the study. He said that the graduate student decided to\ndo other smaller clinical trials before this clinical trial. The graduate\nstudent was trying to ensure that the machine learning worked before conducting\na larger clinical trial.<\/p>\n\n\n\n<p>There\nis a rubric when reviewing research involving mobile devices:<\/p>\n\n\n\n<ul><li>Intent of the study<\/li><li>Whether the device is a regulated medical device<\/li><li>Whether the device is enforceable<\/li><li>Security of the data.<\/li><\/ul>\n\n\n\n<p>The intent of this study was\nto treat a condition, PTSD. In that case, the mobile device falls under the\ndefinition of a regulated medical device. The next question is whether the mobile\ndevice is an enforceable device. This is not as clear. Since there is a risk\nwith this device of waking the person during a regular dream or normal sleep\nand the person not getting enough sleep and perhaps causing depression, it\nmight be enforceable. This was the author\u2019s thinking when he contacted the FDA,\nwhich said this was probably not an enforceable device.<\/p>\n\n\n\n<p>Data security is an issue.\nDuring the initial IRB review, there was no information about the security of\nthe data or the encryption used. The IRB was also concerned about the efficacy\nof haptic feedback. Another concern is whether the IRB has the necessary\nexpertise to understand data security on mobile apps, such as a staff member\nfrom the technology department. Rush University Medical Center has a staff\nmember from its technology department on the IRB. <\/p>\n\n\n\n<h2>Example: Mobile Device B<\/h2>\n\n\n\n<p>Purple Robot is an app\ndeveloped by Northwestern University that is downloaded to a mobile platform\nand then tracks the person\u2019s location and activities. The app tracks where the\nperson is geographically, what he\/she is typing into the phone or device, and\nhow often the person moves, amongst other things. Purple Robot has been proven\nto effectively determine whether a person is at risk of depression and informs\nresearchers whether the person is at risk for depression. <\/p>\n\n\n\n<p>In this study, researchers\nwanted people in Chicago who are homeless and who were abused as children to\ndownload the app to smartphones, which the study team provided. After the study\nwas completed, participants could keep the smartphones. The first problem was\nthat the study team was providing the smartphones to the study participants.\nThis could create ethical problems and problems controlling the devices, which\ncould easily be stolen. The devices had health information about the study\nparticipants, which would be available to anyone who stole the device. <\/p>\n\n\n\n<p>This was a longitudinal study\nthat would send push notifications to the people in the study so they could\nthen do remote sessions with their psychologist. The intent of this study was\nto treat, mitigate, or perhaps cure this type of psychological distress. Thus,\nthe mobile device falls under the definition of a regulated medical device.<\/p>\n\n\n\n<p>The next question was whether\nthe device was enforceable. If the device stopped working or the person did not\nget the push notifications, it would not put the person at more risk than the\nrisk of daily life. The author believes that the device was unenforceable.<\/p>\n\n\n\n<p>The IRB needs to worry about\nthe security of the data and the provision of the smartphones and data plans.\nWhether the study participants would be comfortable being tracked by the app\nwas a concern, and the IRB needed to determine whether the study required a\ncertificate of confidentiality. If a subject is at risk for criminal harm by\nparticipating in a study, the study should have a certificate of\nconfidentiality, which protects subjects from having their research information\nsubpoenaed. In this case, the researchers had a certificate of confidentiality\nfrom the National Institutes of Health and submitted it with the IRB\nsubmission.<\/p>\n\n\n\n<h2>Example: Mobile Device C<\/h2>\n\n\n\n<p>The third study was also a\npsychological study, in HIV and substance use. Researchers wanted to adapt the\nstandard of care, the Screening &amp; Brief Intervention (SBI), into an electronic\nformat, using an app that sent the information to a server. Researchers wanted\nto see if the electronic version of the SBI plus the standard of care was\nsuperior to the standard of care only. They would provide study participants\nwith smartphones and data plans.<\/p>\n\n\n\n<p>The intent of the study was\nto mitigate a psychological condition in the study participants when compared\nwith the standard of care. Thus, the mobile device falls under the definition\nof a regulated medical device. The next question was whether the device was\nenforceable. If the device broke or the person did not use it, he\/she would still\nget the standard of care, so it would not harm the study participants. The\nauthor believes that the device was unenforceable.<\/p>\n\n\n\n<p>The IRB needs to worry about\nthe security of the data, for example, if the phone was stolen, and the provision\nof smartphones and data plans. This study used electronic informed consent,\nwhich was a concern. The IRB discussed this and did allow the researchers to\nuse electronic informed consent.<\/p>\n\n\n\n<h2>Review of Mobile Medical Devices<\/h2>\n\n\n\n<p>These\nthree examples illustrate the rubric for reviewing mobile medical devices.<\/p>\n\n\n\n<ul><li>Determine the intent of the study<\/li><li>Determine whether the device is a regulated medical device<\/li><li>Determine whether the device is enforceable<\/li><li>Assess provisions for the security of the data.<\/li><\/ul>\n\n\n\n<p>If there is any question\nabout whether a mobile medical device is regulated, it is best to contact the\nFDA. The 21st Century Cures Act Medical Software Provisions modified the\ndefinition of a regulated medical device. Some of the things that are listed as\nunenforceable are no longer defined as regulated medical devices. The FDA\u2019s\nguidance <em>Mobile Medical Applications:\nGuidance for Industry and Food and Drug Administration Staff<\/em> (2015) has not\nbeen updated yet for consistency with the 21st Century Cures Act.<\/p>\n\n\n\n<p>Considerations before\nsubmitting a study involving a mobile medical device for review include whether\nthe IRB has the necessary expertise to review the study. The IRB may not have\nan expert on data confidentiality or data hacking. It is advisable to contact\nthe IRB office to see if staff members want to find a consultant to help with\nthe review.<\/p>\n\n\n\n<p>IRB review of mobile medical\ndevice studies sometimes involves a big brother or creepiness factor. There are\ndiscussions about why people want apps to track them. This attitude is changing\nin the general public. Most people have apps such as Google maps, which track\ntheir location. People are getting used to this and are less concerned about\ngeographic location tracking; however, IRBs will most likely be concerned about\nthis.<\/p>\n\n\n\n<p>It is also necessary to\ndetermine whether the device is compliant with the Health Insurance Portability\nand Accountability Act (HIPAA). The graduate student who developed the app to relieve\nnightmares and PTSD may not have known much about HIPAA, and it is likely that\nthe app was not HIPAA compliant.<\/p>\n\n\n\n<p>The risks related to\nparticipating in a study involving a mobile medical device must be disclosed in\nthe informed consent form. The risks must be explained in simple terms so that study\nparticipants can understand them. If the IRB is having trouble understanding\nthe protocol, participants will have trouble understanding the study too. It\nmay be necessary to provide extra information or to have someone who\nunderstands the app on hand to explain how it works.<\/p>\n\n\n\n<p>Table 4 highlights possible\nissues in IRB review of mobile medical devices. Assessment of the mobile\nmedical device status is an issue. The FDA can help with this.<\/p>\n\n\n\n<p>Confidentiality of\ninformation is a concern. If Rush University Medical Center receives a\nsubmission for a study involving a mobile medical device that does not mention\nencryption, the IRB will send it back to the investigator for more information\nabout data security and encryption. <\/p>\n\n\n\n<p>When preparing to submit a study\ninvolving a mobile medical app to the IRB, researchers should pay careful\nattention to the protocol in general. The IRB is there to help researchers, who\nshould contact their IRB with any questions about review of a mobile medical app\nstudy. <\/p>\n\n\n\n<p>The IRB may not know everything\nabout mobile medical apps, and members may need to learn about the apps and\nregulations pertaining to them. Researchers should inform the IRB in advance\nthat a submission for a mobile medical app study is coming so that the IRB can consider\nwhether the study includes a mobile medical device. <strong> <\/strong><\/p>\n\n\n\n<p><strong>TABLE 1<\/strong><\/p>\n\n\n\n<h2>Definitions Related to Mobile Medical Devices<\/h2>\n\n\n\n<ul><li>Regulated medical device:<ul><li>Mechanical or\nelectrical object that can diagnose, prevent, make less severe, or cure a\ndisease or condition<\/li><\/ul><\/li><li>Mobile platform:<ul><li>A handheld\ncomputing device<\/li><\/ul><\/li><li>Mobile app:<ul><li>Software run on a\nmobile platform<\/li><\/ul><\/li><li>Mobile medical app;<ul><li>Mobile app that\naccessorizes or transforms<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>TABLE 2<\/strong><\/p>\n\n\n\n<h2>FDA Enforcement of Mobile Medical Apps <\/h2>\n\n\n\n<ul><li>Enforced mobile medical apps: <ul><li>Risk to patient\nsafety: <ul><li>Extension of medical device that controls the device,\nmonitors the patient, or analyzes medical data<\/li><\/ul><ul><li>Transforms by use of attachments, displays, and\nsensors<\/li><\/ul><ul><li>Provides patient-specific analysis, diagnosis, or\ntreatment recommendations<\/li><\/ul><\/li><\/ul><\/li><li>Unenforced mobile medical apps:<ul><li>Low risk to\npatient safety:<\/li><\/ul><\/li><\/ul>\n\n\n\n<ul><li>Facilitates clinical care by coaching or prompting, managing<\/li><li>Simple tools to organize and track health information<\/li><li>Provides access to condition or treatment information<\/li><li>Helps patients document potential medical conditions<\/li><li>Performs simple calculations used in clinical practice<\/li><li>Allows access to health records<\/li><li>Secondary displays to regulated medical devices<\/li><\/ul>\n\n\n\n<p><strong>TABLE 3<\/strong><\/p>\n\n\n\n<h2>Risks and Threats of Mobile Medical Apps<\/h2>\n\n\n\n<ul><li>Data security and hacking:<ul><li>Operating system vulnerabilities<\/li><li>Control of devices<\/li><li>Theft of protected health information<\/li><\/ul><\/li><li>Misuse by subjects<\/li><li>Cost of providing devices and data plans<\/li><li>Coercion and peer pressure<\/li><li>Personal device vs. provided device<\/li><li>Consent\/electronic consent<\/li><\/ul>\n\n\n\n<p><strong>TABLE 4<\/strong><\/p>\n\n\n\n<h2>Possible Issues in IRB Review of Mobile Medical Devices<\/h2>\n\n\n\n<ul><li>Assessment of device status<\/li><li>Confidentiality of information<\/li><li>Electronic informed consent and risk disclosure<\/li><li>Provision of devices<\/li><li>Preparing the IRB for review<\/li><li>Composition of the IRB<\/li><\/ul>\n\n\n\n<p>For continued information <a href=\"https:\/\/www.socra.org\/\">visit our website<\/a> to learn more.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By: Jonathan C. Young, PhD, MS, CIP, CCRP Senior Research Regulatory Operations Analyst Rush University Medical Center Abstract: The use of mobile medical devices in clinical research is increasing significantly. This article provides an overview of regulations and guidance related to mobile medical devices including mobile apps. Possible risks and controversy that may arise from &hellip; <\/p>\n<p><a href=\"https:\/\/www.socra.org\/blog\/mobile-medical-devices\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Mobile Medical Devices<\/span> &rarr;<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"categories":[85],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v15.6.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Mobile Medical Devices - SOCRA Blog<\/title>\n<meta name=\"description\" content=\"This article provides an overview of regulations and guidance related to mobile medical devices including mobile apps in clinical research.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.socra.org\/blog\/mobile-medical-devices\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Mobile Medical Devices - 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