Whitney Palmer

Taking the Pulse of Mobile Health

Published in the March 13, 2013 Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

It’s no secret the healthcare industry is going digital. Electronic health records, health information exchanges, and Web-based patient portals are becoming ubiquitous features in nearly all clinical environments. But the fastest, most widely adopted digital push, according to healthcare industry experts, has undoubtedly been in mobile health.

Frequently referred to as mHealth, this phenomenon is the practice of medicine and public health through mobile devices. And, in the great scheme of healthcare developments, mHealth is relatively new. However, it’s already proving to have a large and growing impact.

Consulting firm PricewaterhouseCoopers predicts that by 2017, mHealth will post revenues of $23 billion, with $6.5 billion coming from North America. It’s anticipated that, by that time, nearly two-thirds of the market will be dedicated to remote monitoring of chronic disease.

Although most insurance plans still don’t reimburse physicians for mHealth activities, the healthcare industry is already seeing the cost savings associated with these tools. According to a 2012 Benton Foundation study, mHealth improved medical productivity by $11.2 billion just in 2011. Those gains are expected to reach $305.1 billion by 2022.

The proliferation of mHealth, however, isn’t simply about boosting a health system’s bottom line. Ultimately, it’s about the industry’s end user – the patient.

“One of the big issues facing the healthcare system that isn’t often discussed is the sense of patient empowerment and involvement in their own healthcare,” said Jay Yadav, President and CEO of CardioMEMS, a medical device company specializing in wireless sensing and communication technology. “We all know that if you feel pushed along in an assembly line, your behavior will be quite different than if you’re engaged and have some charge over your care.”

The ultimate goal, he said, is to give patients a sense of ownership over the care they receive, while giving providers effective tools and good data that will enhance the care they provide.

Provider Enthusiasm
Providers aren’t being shy about adopting mobile technologies. According to the 2^nd Annual Health Information and Management Systems Society (HIMSS) Mobile Technology Survey, 93 percent of providers use mobile technology in their daily activities, and more than 60 percent use third-party apps.

But while on-the-go providers are naturally attracted to mHealth technology, the real driving force behind this mobile care trend is patients themselves. In fact, according to a Deloitte study, the number of mobile device users who downloaded at least one mHealth app doubled between 2011 and 2012.

A 2009 Brookings Institution study found that roughly 75 percent of patients nationwide want email appointment reminders, want to schedule appointments online, and want email contact with their doctors. Another 67 percent would prefer to see their diagnostic test results via email, and 57 percent would use a home monitoring device, such as one that transmits blood pressure readings.

Patients are also accessing information on their own. According to the 2012 Pew Research Center Internet & American Life Project, more than 30 percent of patients use their cell phones to research health information. And, GlobalData reports, more than 70 percent of health and wellness mobile apps target patients.

Consequently, according to Jonathan Dreyer, Director of Mobile Solutions at Nuance, the mHealth industry will play into those patient preferences through 2013. For example, more apps and mHealth technologies could use “gamification” – the use of interactive games that teach health information – as a way to reach patients.

“Patients simply want more responsibility over their own health, so we’re likely to see more patient-focused apps, such as health games, fitness and nutrition apps, and wellness tools,” he said. “In all likelihood, 2013 will likely see a great focus on making this technology more accessible and easier for patients to use.”

Payers are already on-board, as well. The Deloitte study reported that many encourage their customers to use mHealth technologies to monitor chronic conditions and share information with their providers. They also support using mHealth as a means to report and share information about facility and provider care quality.

Regulatory Hesitancy
Although mHealth is popular, it isn’t devoid of challenges. Mobile and smartphone technologies can be easy to use, but they have proven difficult to regulate because working with these types of developments is uncharted territory. The Food and Drug Administration (FDA) has grappled with how to ensure mHealth tools are both safe and beneficial.

So far, the agency has ventured timidly into mHealth regulation. In 2011, it published draft guidelines, focusing specifically on how effective mobile devices are in reading diagnostic scans. Its next step came in February 2012, when the agency acknowledged in the Federal Register that patients now have access to medical screening and diagnostic mobile apps. Official regulatory guidelines are still pending, but industry experts anticipate the FDA will claim regulatory authority over these types of apps.

One member of Congress is also trying to help the FDA augment and fine-tune its mHealth capabilities. Michael Honda, D-Calif., introduced the Healthcare Innovation and Marketplace Technologies Act in December 2012. If passed, this legislation would create a wireless health technology office within the agency, launch a support program in the Department of Health and Human Services to help mHealth developers ensure their technologies meet current privacy standards, and establish a tax incentive program for providers to deduct the cost of many health information technology systems. The bill has been referred to the Subcommittee on Health, but, to date, no vote is scheduled.

As of press time, lawmakers on the House of Representatives’ Energy and Commerce committee will conduct a three-day series of hearings in mid-March to better understand how the FDA should regulate mHealth apps on smartphones and tablets. According to the Washington Post, they plan to focus specifically on how regulation may affect patients, providers and developers looking to capitalize on this growing market.

What’s Out There?
The market, however, isn’t waiting for the FDA to craft its rules. Patients and providers alike already have unfettered access to mHealth tools that augment healthcare delivery.

So far, these tools are mostly remote monitoring technologies that help patients keep track of their own chronic conditions, such as congestive heart failure, pulmonary disease or diabetes, and digitally send information to their providers. Their intent is to improve patient outcomes, but a May 2012 Brookings Institution report revealed they could also save the healthcare industry nearly $197 billion in U.S. healthcare spending over the next 25 years.

For example, more than 24 million Americans live with diabetes, and more than 11 million of them use home glucose monitors, such as the GlucoPhone. This device, manufactured by HealthPia, reminds them to test their levels, keeps track of the results, and sends the information directly to caregivers.

Some chronic conditions, however, require a more intensive level of monitoring, said CardioMEMS’ Yadav. To provide that level of data collection and care, CardioMEMS has developed a two-part sensor – a wireless implantable sensor and an external monitor – to keep tabs on a patient’s heart function and eliminate the need for repeat heart catheterizations.

“This technology gives doctors the same kind of cardiac catheter information without actually having to do the procedure,” he said. “It gives doctor’s precise information tied to the patient’s heart disease from inside the body, and they can interpret it.”

In addition, providers have instant, real-time access to this patient data. Through a desktop graphical user interface, doctors and nurses can see how a patient is doing. That information – their blood pressure, heart rate and cardiac output – then feeds directly into the facility’s EHR.

mHealth solutions are also being used to combat substance abuse. Researchers at the University of Massachusetts Medical School developed iHeal, a remote-monitoring device that senses the changes in skin temperature and nervous system activities linked to drug cravings. This data, along with self-reported stress levels, helps providers offer text, video and audio interventions when needed.

These tools are also demonstrating that they can directly impact the day-to-day function of the health system. If a patient near New Hampshire’s Portsmouth Regional Hospital needs medical attention, he or she can text “ER” to a specific number to receive the estimated ED wait time.

Effect on Providers
The benefits of mHealth don’t stop with patients. They extend to healthcare providers of all types, as well, directly impacting the quality of care.

It has been documented that physicians using mobile devices read medical test results more quickly, have better data management and record-keeping skills, and make fewer medication errors at discharge.

These tools also help nurses avoid errors. A 2011 Nurse Educator study reported 16 percent of surveyed nurses said a hand-held device helped them avoid at least one clinical error, and 6 percent credited the tools with helping them to avoid making multiple mistakes.

To meet these provider needs, AT&T launched its mHealth platform, said Geeta Nayyar, MD, the company’s Chief Medical Information Officer.

“At a high level, there are so many connection points in healthcare that are lacking,” she said. “Patients see a primary care doctor, or a specialist, or they go to the emergency room, but there isn’t a streamlined way to communicate between those positions or facilities.”

Consequently, she said, providers often miss out on pertinent data that could impact the care they provide. By using mHealth platforms, physicians can better track their patients with chronic conditions. Patients receive access to an online log where they remotely input information related to their condition, such as diabetes or heart disease, and providers can access and review the data. This way, doctors can contact patients if anything seems amiss.

“This system gives patients just-in-time care when they need it so they don’t end up in the emergency room, or having to see a doctor who doesn’t know them,” Nayyar said. “Basically, it avoids potentially negative patient and quality outcomes.”

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