Photography by: Tracey Brown
Using Mobile Health for Patient Care
While attending the 2012 mHealth Summit just outside D.C., Maryland Physician explored how providers can select among some 15,000 apps to connect meaningfully with their patients.
Last year, in our March/April 2012 issue, Maryland Physician reviewed the nascent state of mHealth (mobile health) and noted that physicians primarily used it for reference and clinical decision support. While that continues to be the primary use of mHealth today, patient monitoring and compliance tools have exploded, and more insurers, health systems, wireless carriers and entrepreneurs are taking the necessary first steps to use these tools to improve patient health.
In the process, the doctor visit is becoming a smaller piece of the health delivery pie. Using an app, providers can generate automatic reminders to patients to take medications or administer injections, or monitor their cardiac health on a daily basis, rather than waiting for their next doctor’s visit. Even the FCC is optimistic that mHealth can facilitate less costly, more efficient and more frequent care interventions for patients.
Nearly every organization involved in healthcare is looking at mHealth to improve an aspect of care, whether reducing readmission rates, preventing and monitoring chronic diseases, improving medication and therapy compliance, or allowing patients access to mental health care without stigmatization. The approaches range from simple text messages to sophisticated wireless devices that remotely monitor more complex conditions.
The role of mobile devices is growing so rapidly that the FCC’s mHealth Task Force’s goal is to have mHealth technology become a routine medical best practice within five years. By 2020, 160 million Americans will be monitored and treated remotely for at least one chronic condition, according to Nerac, a Connecticut research firm.
With app availability burgeoning, how can physicians determine which apps make sense for their practice and their patients? A partial list of sources physicians can use to find medically validated apps follows.
FDA Cleared Apps (Those involving a “Medical Device”)
To ensure the soundness of apps that involve a medical device to monitor patient health, physicians can turn to the elite group of apps that have received FDA clearance. Such clearance is currently required for apps that entail the remote use of a medical device or that transform a mobile device into a medical device (e.g., electronic stethoscopes or glucose meters), unless they otherwise fall under the exempted Class I devices.
Examples of products that have obtained FDA approval are WellDoc’s Diabetes Manager (discussed in our March/April 2012 issue), Airstrip OB and RPM (remote patient monitoring), Proteus Biomedical’s “Raisin” skin patch and “intelligent pill” sensor, and AliveCor’s and Corventis’ Nuvant wireless heart monitors.
App Certification and Prescription Program
Happtique (www.happtique.com), a subsidiary of GNYHA Ventures, Inc., the business arm of the Greater New York Hospital Association, may be a useful tool for sorting among the thousands of app options. The company allows providers to prescribe health apps via its secure, developer-agnostic platform, and in early 2013, Happtique launched an App Certification Program (note: as of publication, their standards were still in a draft state.) This program can help providers and consumers determine which apps not requiring FDA clearance have reliable content and meet high operability, privacy, and security standards.
Apps Validated by Major Health System Studies
Major health systems such as Johns Hopkins and Geisinger are collaborating with mHealth entrepreneurs to design and test patient applications. Such partnerships can provide evidence-based data about the efficacy of various apps. Johns Hopkins University’s Wilmer Eye Institute worked with MEMOTEXT, a company that developed a proprietary methodology, algorithm and communications platform to improve medication compliance – a huge issue for providers and costly to payers. “The key to positively affecting the kind of behavior change required in patients who are non-compliant are personalized programs that address their individual issues or barriers to adherence.” says Amos Adler M.Sc., founder and president, MEMOTEXT. “We understand that for technology to work in the mHealth space, we have to ask patients what the best means to communicate with them is, and what is important to them about their condition.”
For 60 to 90 days, patients were asked how they were feeling and their complaints were triaged to the appropriate provider. If patients experienced side effects, they were asked if they had reported them. The study found a 31% increase in adherence to daily therapy.
Geisinger Medical Center tested a “medical home” initiative among Medicare patients that uses text messaging and other technology to increase patient adherence to treatment regimens. The program decreased hospital admissions by 8% and overall health costs by 4% in the first year.
Watch Major Insurers
Major insurers also have jumped into the mHealth market with both feet in an effort to improve communication and service to members, as well as to improve health. Take Aetna, which purchased iTriage to help its members initially diagnose their health symptoms and match them to an appropriate provider in their area. It recently launched Carepass, an mHealth technology platform that can connect a wide variety of apps and that encourages entrepreneurs to develop new apps. Carepass encourages subscribers to manage their health by providing easy access to insurance information, an ID card, doctor’s visits, nutritional and health and fitness programs, including over 20 health-related apps such as MapMyFitness or GoodRx.
Kaiser Permanente views mHealth as a new, “fourth site of care” for healthcare delivery that supplements care delivered in hospitals, clinics and the patient’s home. Kaiser launched a mobile-optimized website and created apps for both Android and iPhone users to allow its nearly nine million members 24/7 access to their medical information anywhere in the world from a mobile device. Members can email their providers, check lab test results, order prescription refills, and manage appointments.
A study published in Health Affairs in 2010 found that glycemic, cholesterol and blood pressure measures improved 2% to 6.5% in more than 35,000 Kaiser Permanente patients with diabetes, hypertension, or both by using secure messaging for two months.
The number of studies validating mHealth approaches is growing on all fronts. For example, a winning abstract at the mHealth Summit presented the results of a smartphone-based platform for preventing alcohol relapse. Some 349 patients participated in the randomized clinical study through June 2011; participants had significantly fewer risky drinking days than did the control group.
An online publication for medical professionals, patients, and analysts called imedicalapps (www.imedicalapps.com) offers reviews of apps under the direction of a team of physician editors.
Apple has a list of 80 recommended apps for healthcare professionals that includes every type of app from reference and clinical decision support apps to patient education and personal care apps. However, the rationale for their selection process is not clear, and providers should use other sources to validate the efficacy of apps on this list.
Recognize that Patients want mHealth
Some physicians have not yet realized how ready patients are for mHealth solutions. A recent study found that about three quarters of respondents would like to receive email reminders for doctor’s visits, schedule a doctor’s visit online, and email directly with their doctor.
Another global study, conducted for PwC Global Healthcare by the Economist Intelligence Unit (EIU), found:
- About half of consumers believe mHealth will improve healthcare convenience, quality and cost in the next three years.
- Nearly half expect mHealth to change the way they manage chronic conditions, medication use and overall health.
- 59% of consumers using mHealth services say it has replaced some visits to doctors or nurses.
- The top three reasons consumers want mHealth is to have more convenient access to their provider, reduce out-of-pocket healthcare costs and take greater control over their health.
Even Medicare is contributing to the move to mHealth approaches, as its 30-day readmission rule is making remote monitoring technologies an attractive tool to help keep patients healthy and at home.
The bottom line is that, while providers are right to tread cautiously when recommending, prescribing or using apps for their patients, they should start now to explore the potential for vetted apps to improve their medical practice.
What are your favorite patient care apps or sources for learning about apps? Email us at firstname.lastname@example.org or leave your comments at chesphysician.com.