Mobile health technologies will become a part of the health care landscape for all stakeholders at some point. Other sectors of society currently cannot function without mobile; for example, retail and financial services consider mobile a vital component of their business models.
There are many reasons for lag in adoption of mobile technologies by health care. Regulatory issues, the need for a digital cultural shift, lack of business models, and lack of proof of efficacy are certainly barriers.
Dr. David Lee Scher
But what is underappreciated by app developers and industry analysts is the fact that physicians will be key players in the future of mobile health. Physicians are the most trusted stakeholder by patients with regard to care planning. Issues that are important to consider from a clinician’s standpoint are reimbursement for coordinating digital care; the fresh, negative experience of poorly performing electronic health records (which should not be the face of other digital tech); the present lack of commitment to the philosophy of participatory medicine and that most health apps are consumer (not patient) oriented, with little proof of efficacy via clinical studies.
That said, there remain fundamental reasons that mobile health app prescribing will occur:
• Patients are mobile. According to the Pew Research Center’s Internet and American Life Project, 91% of adults in the United States own a cell phone. Few older adults use smart phones (18% in 2013), but effective mobile health can take the form of text messages, as has been proven with prenatal care and smoking cessation, as well as more sophisticated disease management apps such as WellDoc. Even though older patients might not be smart phone users now, a baby boomer turns 65 every 8 seconds. Many in the sandwich generation today and all in the future will be mobile health tech ready.
• There is a perfect storm of necessity and opportunity. The number of patients participating in health care has increased because of the Affordable Care Act. There is a well-recognized physician shortage, especially in primary care. Americans today do not want to live out their last years in an institutional setting as 70% of them do today. Digital technology will be required for this aging at home. Sensor technology, whether environmental or wearable, will be fundamental. Mobile technology not only will facilitate new care models, but will create them.
• Useful information and data will be at patients’ fingertips. New technologies – such as IBM’s Watson and Apple’s HealthKit – will hopefully serve as frameworks for many disease-specific apps. EHRs are repositories of huge amounts of data. The key to better health care lies in applying analytics to harness the power of this data and make it useful for better care on both population and individualized patient levels. Analytics will improve patient safety, proscribe therapy based on individual and population data, and increase efficiency.
• It is how patient content will be delivered. Physicians and health policy experts recognize the need for better patient education with regard to their diagnoses and medications. A research2guidance report on the disappointing diabetes app market illustrates the pharmaceutical industry’s heretofore slow uptake of mobile health. In general, the pharmaceutical and medical device industries (with 250 of the approximately 100,000 health and fitness apps) have so far concentrated on disease-specific content. The challenge remains to design apps that center on the clinician-patient interaction, not just the disease state. Interoperability with EHRs via more robust patient portals will help close this loop.
• It will create the engaged patient. "Patient engagement" is as overused as "innovation" when discussing technology in health care today. However, the concept is paramount to improving health and promoting wellness. I like a definition of patient engagement from the Center for Advanced Health: "Actions individuals must take to obtain the greatest benefit from the health care services available to them."
I believe that the basis of patient engagement is the combination of an informed patient (and caregiver) and shared decision making. It is not surprising that a significant percentage of patients leave the hospital or physician’s office not knowing their diagnosis or why a medication was prescribed. Mobile health is the potential holy grail of patient engagement. Behavioral change by both patients and providers in the broad sense (which includes payers, clinicians, and institutions) is imperative to affect patient engagement.
Health care must, for the first time, be approached as a rightful partnership between the patient and physician. I believe that mobile technology can utilize trending patient-derived data, transforming it into a useful actionable tool, and create a multidirectional (patient, provider, caregiver) platform of communication leading to better shared decision making.