A recent poll
by QuantiaMD,
which touts itself as the largest social learning network for physicians, found
that 37% of physicians have prescribed a mobile health app for their
patients. On the other hand, another 37%
still have no idea what apps are out there, so we’ve not quite fully entered
the mHealth (or ehealth/digital health) world.
That lack of knowledge about the app universe may
not last long. In addition to patients
bringing their favorite apps to their physician’s attention, physicians now also
have AppScript,
introduced last December by IMS Health,
to help them understand the health app universe. AppScript
classifies and evaluates over 40,000 health-related apps, and allows them to
organize them into custom formularies based on patient needs and practice
preferences.
We talk about physicians “prescribing” health apps
when we really mean them only suggesting ones that might be useful, but there
is actually at least one health app that requires
an actual prescription.
BlueStar,
developed by WellDoc,
helps patients with Type 2 diabetes manage their condition. WellDoc even secured FDA approval – back in
2010 – and is working on getting health plans to cover the app.
The main reason cited in the QuantiaMD poll for not
prescribing apps, named by 42% of respondents, was the lack of regulatory
oversight, with 21% also noting the lack of longitudinal data on their
effectiveness. Still another 21% feared
the apps would generate an overwhelming amount of patient data.
Regulation of mobile apps is a somewhat contentious
issue. The FDA is slated to release a long-awaited
report to Congress on health IT regulation, including
mobile health apps, later this month, and it has already said it will only be a
draft report open for public comment.
The health IT industry is already
gearing up to fight regulation, citing concerns about the
impact it could have on innovation, and some in Congress are jumping the gun by
introducing
legislation that would limit FDA oversight to
medical devices, not what they see as lower risk digital health technologies.
I find myself somewhat torn about the possibility of
regulation. On the one hand, no one
wants to stifle innovation in this hyper-fast developing field, yet as apps
serve more clinical functions – e.g., the American College of Cardiologists and
the American Heart Association just announced
an app to estimate the risk of heart attacks/strokes – one wants reassurance
that they work as advertised. And then
there is the issue with security,
which is scary enough on computers and even riskier on mobile devices. So some kind of regulatory framework seems
advisable.
In the meantime, mobile is quickly becoming more
important in health care. HIMSS just
released their Third
Annual HIMSS Analytics Mobile Survey. While more representative of healthcare
systems than independent practitioners, it found that three-quarters of
respondents claimed mobile was a high priority for their organization. Eighty-three percent said physicians were
using mobile technology for some kind of patient care, with 69% viewing patient
information using mobile technology.
Uses fall off rapidly after that – e.g., only 33% used e-prescribing,
25% telehealth, and 20% remote patient monitoring.
Only 35% reported offering a patient app of their
own, but 62% claim having some type of patient tool, with app-enabled patient
portal the most common (55%). These patient
portals are the source of the most planned activity, with 70% intending to do
something. On the device side, laptops have been the leading
type of mobile device (87%), but tablets are seen as the device of the future –
63% healthcare-specific tablets, 49% general tablets.
Although 45% of respondents have seen only a minimal
impact from mobile on how care is delivered, 34% think it has had a significant
impact, and 4% claimed a “dramatic” impact. I have to wonder what the 10% who reported no
impact were doing with it; playing Angry Birds?
The Ohio State University Medical Center is testing
apps, patient portals, and tablets.
Their EPIC-based patient portal, OSUMyChart, has 65,000 registered
users, with 20% of last year’s inpatients signing up. They are also testing another Epic app called
MyChart Bedside, aimed for use during hospital stays. OSUMC gives patients an iPad for use during
their stay, with the new app focuses on the information directly related to
that stay. They apparently can shop with
it too.
Texting successes have been found by several
organizations as well, such as for diabetes
and inflammatory
bowel disease, to name two Actually, texting is being used for a host of
conditions, as evidenced by the HHS
Text4Health projects.
Frost & Sullivan also predicted
that mHealth is going to be one of the three biggest areas of growth in global
healthcare, particularly citing various patient monitoring tools that can help
provide innovation solutions in a variety of areas. Another mHealth
survey, this one from Grand View Research, shares this optimism, predicting
a compounded annual growth rate of 48% from 2014 to 2020.
We’re just starting to scratch the surface of mobile
health, much less the vast amounts of data all these tracking devices will
generate. It will take some time to
figure out what we really want to do. All
this nifty technology – apps, texts, portals, wearable monitors, even
nanotechnology – are, like any technology, just tools. Clinicians and patients are going to have to figure out how to use them to get
the best health outcomes.
It’s won’t be easy.
PWC’s 2014
U.S. CEO survey found that 86% of healthcare CEOs think technological
advances will transform their businesses in the next 5 years – and 57% are
worried about the speed of technological change. Most fear their teams (both R&D and IT)
are not well-prepared to make the necessary changes.
According to Statista,
the average smartphone user has installed 26 apps, with the U.S. somewhat above
that at 33. I like to think I’m
conservative about adding apps, but I probably have double that – none of which
are health-related. Way back in 2012 –
an eon ago in app time – the Pew Foundation reported
that 1-in-5 smartphone users had at least one health app, so I suspect more
than a few of those 33 apps are health-related.
Any way you look at it, though, most smartphone or tablet users are
walking with a heck of a lot of apps.
Personally, I’ve always thought apps are sort of a
transition stage, as are the distinctions between types of devices. It feels like old technology to make the user
figure out which app is best for their given task, much less which device to
use. In a cloud world with Siri-like
agents, people should be able to focus on what they want to know or find out,
and let their various devices figure out the best way to meet that need and how
to present the corresponding information.
Experts now talk about “the
Internet of Things” or “the Internet of Everything,”
in which most everything is connected to the internet and to each other. In such a world, almost anything can be your
“computer,” at any time. Cisco estimates
this revolution will create $19 trillion in economic benefit and value over the
next decade, which is serious money even by health care standards. If you want to try to imagine such a future,
check out a recent
op-ed by Robin Cook and Eric Topol, which describes a
smart, connected, ubiquitous and personalized world of digital medicine, to use
their term. It’s pretty cool.
Providers’ challenge isn’t in coming up with their
own app – especially just to have an app -- but rather in developing their
strategy of how to best take advantage of all these new options, in an
integrated manner. Different patients
will want different technologies, and even the same patient will want different
options at different times in different places.
Sounds hard.
Sounds fun!
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