mHealth: a caregiver’s perspective
Technology is the future of medicine. mHealth is promoting better healthcare outcomes and empowering patients and care teams.
Eric Quinones, MD | June 17, 2015
I remember my first interaction with email. The year was 1995, and my life was forever changed for the better. I was amazed that I could send a note that didn’t involve postage, paper, or a fax machine. More earthshaking still, I could attach a document and my colleague 250 miles away would have an exact copy in seconds.
Fast forward to 2003. I sat in a Starbucks in Providence, Rhode Island, when I sent my first “Push-to-Talk” message over my Nextel phone to my wife 3,000 miles away in Morro Bay, California. In 2007, I purchased my first smartphone, and I thought nothing would ever top my Blackberry Electron 8700. Wrong. I later graduated to an iPhone, and in 2010 deposited my first check via smartphone using the Chase mobile banking application. What madness!
As technology has become more compact, relevant, and attainable in every industry, healthcare has been outpaced by financial services, telecommunications, energy, transportation, and others. But that won’t be the case for long: a perfect storm of unprecedented size is imminent. Our population is getting older (and sicker), and we have a shortage of primary care doctors, greater regulatory requirements, and a shift in care delivery from volume to value. These looming changes have inspired the healthcare industry to explore how various scalable technologies, such as mHealth, can help it prepare for the inevitable.
8 a.m.: learn; 8 p.m.: obsolete
Computer and information technology has jettisoned us to a new place that seemed impossible relatively few years ago. Moore’s Law states that computer processing power doubles every 18 months. Some theorists say that this law is collapsing to fewer than 18 months. This is actually good news: Buckminster Fuller’s Knowledge Doubling Curve illustrates that in 1900 knowledge doubled about every 100 years—by 1945 knowledge doubled every 25 years. And different types of knowledge have different growth rates: nanotechnology doubles every 24 months and clinical knowledge takes about 18 months. On average, knowledge doubles about every 13 months, but it’s about to get much, much faster. IBM predicts that with the build-out of the Internet of Things, knowledge will double every 12 hours. So what you learn at 8 a.m. will be obsolete by 8 p.m.
One man’s story of technology in healthcare
I learned early in medical school that I had a passion for technology, and I was fortunate to be involved with a progressive institution that believed in electronic health record (EHR) technology. At Dartmouth Hitchcock Medical Center (DHMC), I was part of a team that built DHMC’s ambulatory electronic medical record system, named Clinical Information System (CIS). Though it was largely a data repository, and nothing more, I saw the writing on the wall and the die was cast.
In 2008, I served as Clinical Director for one of the top EHR vendors in the U.S. This was an exciting time for me in healthcare information technology (HIT) because we were focused on the development of a “major version upgrade” with amazing clinical end-user functionality that was going to springboard us past the competition by at least two years. And yet, there was a disconnect: Where was the patient benefit in all this cool technology and information?
The benefits were mostly reactive and provider focused. For example, an EHR could create a pursuit list for patients with a family history of breast cancer and are past due for a routine mammogram. At the time, the most reactive alerting were warnings, such as that the medication I was going to prescribe contradicted another prescription, or that a lab order for hemoglobin A1c had just been done by their endocrinologist, thus eliminating repetitive labs. We need our technology to be preemptive, addressing adverse healthcare events to circumvent poor clinical patient outcomes, in real time.
Another issue is access to healthcare. Thanks to a growing number of aging adults outpacing the bandwidth of our primary care providers and the millions of newly-insured Americans covered by the Affordable Care Act, we are faced with a critical resource issue, and efficiencies are desperately needed.
Fortunately, these challenges come at a time where healthcare information technology, specifically mHealth, can effectively treat these disorders.
mHealth is more than a fad
mHealth, or mobile health, focuses on improving outcomes and reducing cost through patient and provider engagement. According to the mHeath + Telehealth World Conference, mHealth [and telehealth] are critical “in achieving accessibility, interoperability, and sustainability in consumers and accountable care models.” At its core, mHealth is using mobile technologies to promote better healthcare outcomes through education, engagement, communication, and/or patient clinical data. It can be all of these things or just one.
In addition to being a cash register, travel agent, news anchor, shopping mall, music library, wallet, financial advisor, and flashlight, smartphones are now also tools to connect you and your doctor. I find it interesting when people suggest that mHealth is a fad or hype.
First of all, according to the International Telecommunications Union there were 5.98 billion mobile phone users globally in 2011, and adoption continues to soar in undeveloped countries. Now add:
- Our increasing average age and chronic disease demographics, along with 32 million newly-insured under the Affordable Care Act with a slow-growing primary care physician pool
- Healthcare information technology foothold with electronic medical records, telematics, and other data delivery applications that set the stage for mHealth connectivity
- Genomic markers, personal health habits, and clinical data that will drive predictive personalized models and the evidence based actions to be proactive and preventative in circumventing disease
Fad or hype? I think not.
The mHealth market
The mHealth market is exploding exponentially. In January of 2014, the number of mHealth-related applications for iOS and Android reached 100,000—more than double from two and half years earlier, according to mHealth App Developers Economics. The global market revenue was $2.4B in 2013 and is projected to hit $26B in three years.
Today’s mHealth apps target fitness (30.9%), medical reference (16.6%), and wellness (15.5%). Where fitness apps track exercise, medical reference apps share information about medications and diseases, and wellness apps inform you on beauty advice, relaxation methods, and yoga. These applications are saturated because they’re easy to design and share straight-forward data. However, there’s a shift to more sophisticated tools that will focus on remote monitoring, alerting and reminding, clinical compliance, chronic disease management, and overall health and wellness that’s personalized to your clinical resume.
Applications that will link into third-party solutions (EHRs, HIEs, data warehouse, pharmacies, etc.) as well as home monitoring devices, wearable technologies, implanted technologies, and other smartphone applications are on the horizon. Imagine a 24/7/365 genomic personalized healthcare bio surveillance—Siri or Cortana or Google Now—that course corrects you to homeostasis, communicating with you, your designated healthcare family, and your clinical care team when it should. Now imagine this type of application not just being used for chronic disease patients but for all humanity—guiding us early on from childhood to adulthood with up-to-date assistance to maintain a healthy mind and body. This is the type of paradigm shift that can reduce the incidence of diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and some cancers. These chronic diseases account for 75% of the dollars that the U.S. spends on healthcare. These applications require greater connectivity and interoperability from patients, providers, payers, and producers. This requires greater development, collaboration, and financial commitment from both private and public sectors.
In September 2014, Apple released HealthKit: a data aggregator application programming interface (API) that will be able to connect with multiple mHealth and clinically-related applications. Had I had this type of technology in med school, it could have alerted me from 3,000 miles away that my grandmother was fluid overloaded and at risk for a CHF exacerbation. With this preemptive alerting, I could have arranged for her transportation to her primary care physician and avoided an expensive emergency department visit and expected better clinical outcomes.
Our healthcare landscape is changing before our eyes. Risk is being shifted from payer to provider and now to patient. These are the types of mHealth applications that we will see empowering patients and their care teams to avoid a good portion of this risk. Having these tools will promote access, reduce cost, enhance care value, and pave the road toward better clinical results.
Eric Quinones is no longer with Slalom.
Eric Quinones is a Director of Healthcare at Slalom and an innovative senior physician healthcare IT thought leader with more than 13 years of industry experience. He is driven by clinical practice productivity and modernization, surpassing organizational and industry metrics, and superior clinical patient outcomes through the successful influence of IT strategy, tactics, and applications. Follow Dr. Quinones on Twitter: @DrQ4U.