Understanding the potential and promise of mobile health
Right in your pocket is one of the most powerful and exciting tools that is currently being used to improve healthcare. Mobile technology, which includes your smart phone, tablet and wearable, has become an unavoidable force that is changing how you can monitor and support your patients- both in and out of the doctor’s office.
In numbers, the sheer impact and potential of mobile health is staggering. With an estimated seven million cell phone users worldwide, over half a million health and medical apps listed in the Apple App store and nearly daily innovations happening with wearables and smart watches, the adoption of this technology into the lives of clinicians is becoming a necessity.
So how can we effectively use healthcare apps and mobile health (mHealth) to help patients?
The first step, says Duane Bender, is not to think about how you can include and adopt mobile health, but instead consider how you are already using it. Bender is the director of Mohawk College’s mHealth and eHealth Development and Innovation Centre (MEDIC) in Hamilton, Ontario and one of Canada’s leading experts on mobile health. He is a professional software engineer who researches the application of systems engineering, software engineering, information technology and mobile technology to healthcare.
Even if you aren’t actively using clinical healthcare apps on your phone, suggests Bender, there is a good chance that your patients have already embraced consumer wearables or apps, such as Fitbits, MyFitnessPal and the Apple Health Kit, or looked up healthcare information on their smart phones.
“If your patients are using it, then you are using it,” says Bender. “In fact, most clinicians would be surprised by the level of consumer demand for mHealth. We know now that consumers and patients are extremely interested in these technologies and I think some providers would be surprised to learn how many of their patients are experimenting at home with Fitbits and Fuel bands.”
That ease of consumer adoption is important for the integration of mHealth into patient care but this ease of use also comes with some risk. While it allows for easy integration, it also means that clinicians may have to be more vigilant about how patients use the technology.
“These devices and applications provide a degree of self-empowerment that patients have never had in the past. This is great opportunity to lead to more meaningful clinician-patient interactions,” explains Bender, who advocates that clinicians and consumers alike use a good “dose of common sense” when adopting healthcare apps. “While I highly doubt that counting your steps and estimating your caloric burn in a day will hurt you, there have been cases where apps have been provided directly to consumers which claim to be able to diagnose complex medical conditions such as melanoma. This is obviously a highly risky practice and I suspect that people could be seriously harmed by a delay in seeking appropriate medical attention.”
It’s also important to remember that mHealth isn’t pure science, it is a confluence of forces, including healthcare, technology, consumer demand and public policy. In a sense, it is a contradiction: easy to use but hard to understand. Understanding the types and features of healthcare apps that are currently available for clinicians and for consumers is the first step to evaluating the best way to integrate them into practice.
“There is a clear distinction in the industry between apps and devices that are used by patients to collect and record data about their conditions and devices and apps that are used by clinicians for diagnostic purposes,” says Bender. “The first type are not currently regulated by Health Canada or the FDA and their clinical effectiveness is not really known. Devices and apps that are used by clinicians for diagnostic purposes, like diagnosing a disease or condition, are regulated by Health Canada or the USA FDA. This is a much more complex and expensive process which requires proof of clinical effectiveness.”
The exacting process that is involved in the development of clinical grade mHealth products and solutions is an area that Bender and the MEDIC team are very familiar with. While MEDIC doesn’t provide end-user apps directly to consumers, it does assist organizations in developing their apps in the research centre. It’s Bender’s own personal knowledge, gained from working on over 20 different mobile health apps, that allows him to articulate the complexity of developing a mHealth app.
“Healthcare technology development has aspects unique to the health industry – such as specialized privacy and security requirements and detailed specifications for the structured exchange of health information,” says Bender.
There is more to mobile health than just the actual app and there continues to be a desire and need to integrate apps and devices together, he adds. “Most people don’t realize the tremendous amount of infrastructure that is behind modern smartphone apps. Have you ever tried to use an app without the network connected? You generally don’t get too far. Companies such as WebMD and Epocrates have been collecting and developing medical content for many years and have tremendous platforms. Public agencies such as Canada Health Infoway and eHealth Ontario have also been building sophisticated infrastructure in recent years that will enable the next generation of highly integrated medical apps for Canadians.”
Bender is optimistic that the pace of mHealth adaptation and development will increase thanks to these infrastructure investments. He points out that Mohawk’s Apps for Health Conference continues to grow with upwards of 400 attendees attending last April to hear from startups, small and medium enterprises, government agencies and hospital systems that are developing and using mobile health technologies. Bender suggests that Canada is still in a “wait and see” mode while most of the commercial activity in healthcare apps is happening in the USA and abroad.
“Canada has a world-class health system with both some of the best clinicians in the world, as well as some of the best engineering and innovation talent in the world,” says Bender. “I hope to see a change in our mHealth focus in the next few years.”
Innovation and adoption- those are the two paths that Bender sees for the future of mHealth in Canada.
“I see massive potential in mHealth for alleviating some of the pressure from the healthcare system through virtualized care and patient self-management,” says Bender. “The only way that we can sustain the current level of care without raising costs is to become more efficient through the use of technology.”