Tuesday, March 4, 2014

Take One App and Text Me in the Morning

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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