Making Mobile Health Valuable for Patients and Physicians

December 8, 2011

There is little argument that mobile health has value, but getting physicians and patients linked to valuable, engaging applications is a major obstacle for this growing trend.

The number of physicians and patients warming to mobile health solutions to improve care is growing, but with a wide range of platforms and applications and issues of access, getting more people onboard is an ongoing process for those in both the technology and healthcare industries.

At this year's mHealth Summit in Washington, D.C., a great deal of attention was paid to getting buy-in from physicians and their patients to access everything from Skype video-chatting with providers to text message reminders for patients with chronic conditions to telemedicine, linking several members of a care team to the patient via an online platform.

During a keynote speech at the event, John Stratton, executive vice president and COO for Verizon Wireless, noted that what works for other industries, such as banking, can work in healthcare. Banks nationwide have moved away from interaction at their brick-and-mortar branches, increasing access online, via computer or smartphone. This transition has still maintained strong customer service, customer access, and secure interactions, he added.

"Our belief is that most of what we've learned in helping other industries … has strong applicability to healthcare," Stratton said.

And just as online services in other industries have not replaced human interaction and trust, emerging solutions in mobile health will work to preserve interactions, not replace them.

"In no way are we replacing the relationship between physicians and patients … we are helping to facilitate that relationship instead," Stratton said. "…We know that technology will never replace the relationship between doctor and patient … but we can play a valuable role in providing better tools to improve health."

Shifting the role of health responsibility

Stratton used the example of patients with diabetes as an example of how individuals can take control of their health versus relying on constant visits to physicians. He noted that 95 percent of diabetes care is done by the patient, so there is proof that there are ways to encourage people to monitor their own health, set goals, and stay on target.

Joseph C. Kvedar, the founder and director of the Center for Connected Health, put it another way in a separate session: "There is a role for automated coaching and the doctor is not the center of the universe."

Kvedar added that there are two "truths" of mobile health. One, by giving providers "a continuous stream of robust information" direct from a patient's home, providers can keep patients at home and out of the healthcare system via an ER or hospital. The second truth of mobile health, he said, is there is a role consumers/patients can play in taking care of themselves. "When you provide objective information [via mobile health], they can change behaviors," Kvedar said. "That's the biggest resource in moving healthcare forward."

For physicians, mobile health can show how lifestyle issues at home are impacting their patients and can monitor one or several patients remotely. There was little debate on the value of this technology, but great discussion on how to connect physician and patient via mobile health applications.

This discussion included populations that don't have access to smartphones or even a steady Internet connection to make mobile health connections.

Donna Ramos-Johnson, who serves as the chief of technology operations for the District of Columbia's regional extension center, eHealthDC, discussed her area's underserved community. In the District, 30 percent to 50 percent of residents suffer from chronic diseases, ranging from hypertension to HIV/AIDS.

So while mobile health is great at providing text messaging, monitoring, and instant communication for those with chronic disease, the question becomes: How do you reach a population that can benefit the most, but has the least access to technology?

"That is the challenge of mobile health," Ramos-Johnson said. "How do we make these tools relevant and accessible from a cost perspective? The providers want to use them … but we need to make them affordable and culturally sensitive."

Meeting mobile health expectations

In addition to making mobile health accessible to patients in need, another key issue is making these solutions engaging and focused on individuality as possible.

Russell Glasgow, who serves as deputy director for implementation science at the National Cancer Institute, discussed the various stages of cancer patients - from prevention/prediagnosis to survivorship - and how mobile health needs to speak uniquely to patients during their these phases. Whether it is a reminder to seek screening or connecting patients in remission, mobile health needs to gear its use and message to the individual, he noted.

"The greatest opportunity for mobile health is to help in the coordination in a fragmented [system] where you are passed off from provider to provider … to help me [the patient] develop my own survivorship program," Glasgow said, noting his remarks were his own and not on behalf of NCI. "The biggest challenge for mobile health is to make sense of all the different numbers of applications with very little guidance on the data and the science, but to focus it on me as an individual."

He said that there are often other factors cancer patients are dealing with - from financial troubles to depression - so it is important each patient's unique needs are explored, even when using a mobile health solution available to the masses.

So how then, do you create an application that is mass marketed, yet still appeals to individual patients? That was part of the focus of another session at this year's mHealth Summit, where representatives from mobile app companies discussed linking patients to mobile health via smartphones and/or the Internet.

Eric Schultz, chairman and CEO for online resource QuantiaMD, noted the large amount of smartphone applications that are downloaded and either opened once and never used again or never even accessed after download.

"To us, the term 'mobile app' means dead," Schultz said. "We call them 'patient services,' as they need to be alive and not downloaded and forgotten."

To help ensure there is no death after download, Schultz said QuantiaMD looks to the more than 150,000 physicians using their Web-based platform to make sure applications help the patient and the physician as well.

"This is a sacred relationship - the doctor/patient relationship," he said. "We are looking to doctors for advice. Doctors are looking [at mobile health] to save time but also to deliver quality care."

Often, Schultz noted, the most efficient apps accessed via smartphone or online are those that undergo what he called "gamification." As an example, he noted QuantiaMD's popular diabetes application that utilizes quizzes and puzzles to keep patients engaged while also collecting valuable data for physicians.

Making any mobile health application engaging is a must, said John de Souza, CEO of MedHelp International, an online healthcare community and app publisher of tools for everything from mental health to maternity and childcare.

"If [the app] is not engaging, patients won't use it," de Souza said. "And if they don't come back, you won't gather data for doctors."

Since applications come and go, he noted, MedHelp works to give patients an engaging way to take care of their own health, chart data, and provide physicians with that information in an easy-to-view manner, segregating the information physicians need to better provide patient care.

"If you have a bad solution and you make it mobile - you now have a mobile bad solution," deSouza said. "You need to get the solution first, and then go mobile to reach patients. You need to be around [as an app and a company] to make an impact … and you need to deliver real value."