Patient Usage is Exploding, Moving Beyond Fitness
mHealth tools and applications for patients are exploding, and the reality is that many people are or soon will be using one or more mHealth technologies in their lives. One estimate puts the number of health-related mobile apps at more than 17,000. Most apps have been oriented to fitness and weight management, but that’s changing. Emerging applications include:
- Continuous glucose monitoring
- Sleep monitoring
- Checking blood pressure and other vital signs
- Electrocardiograms
- Using saliva and a smartphone to diagnose infectious disease
- Monitoring glaucoma
- Screening for genotypes before administering some medications
The potential for mHealth to extend care beyond the medical office is vast. “The healthcare system really is built to best support subacute and acute care,” Dr. Clough says. “Chronic disease is all about behavior change and giving patients the skills and confidence to self-manage their disease for the long haul. mHealth can enable physicians to support and encourage behavior change ‘virtually’ during those 8700 hours a patient is out on their own, living day to day with their disease.”
One of WellDoc’s products is DiabetesManager, an FDA-approved software-based medical device powered by a proprietary Automated Expert Analytics System™. It provides real-time patient coaching plus clinical decision support to their healthcare providers, extending care beyond traditional office visits.
In a study published in the September, 2011 issue of Diabetes Care, patients using this mHealth device had an average decline in A1C of 1.9% compared to a 0.7% decline seen among patients not using the system. In a second study – a recent demonstration project called DC HealthConnect – Medicaid patients with type 2 diabetes who used WellDoc’s DiabetesManager for one year cut their ER visits and hospitalizations by more than half.
To physicians who believe that patients won’t use this type of device because they currently don’t check their blood glucose levels, Dr. Clough says, “Of course patients aren’t checking them now – they’re just dumb numbers. We need to provide the data in context – tying a blood glucose value to a specific event and then helping the patient learn from the data. This is done via both clinical and behavioral algorithms, because people have a lot more going on in their lives than their disease.”
She continues, “Some programs provide only one-way text messaging. That can be effective for certain health care issues. But complicated chronic diseases need more. We’re using analytic tools geared to the needs of both patients and providers. Effective solutions must employ advanced analytics, user segmentation, behavioral change and just-in-time feedback. Most importantly, solutions must be simple to use and encourage users to engage and stay engaged.”
“Don’t assume patients won’t use mHealth solutions because they’re ‘non-compliant’ now,” Dr. Clough adds. “The biggest wake up call I ‘ve had is how much of patient non-compliance really stems from poor health literacy and/or feeling overwhelmed or frustrated by their disease. You would not believe how powerful something as simple as a positive message about checking their BG can be. At home, patients get only a number on a meter that often is not even looked at by a physician. There will soon be a lot of mHealth options out there. Physicians should ask if it has FDA clearance and demonstrated outcomes, if it can be integrated into your practice work flow and determine the expectations of your involvement with the solution.”
For now, physicians should be aware of what apps their patients are using and what mHealth options are available, so that they can use – and guide patient usage of – these tools as appropriate.
Linda Harder, MBA, serves as editor of Maryland Physician. Ms. Harder is a skilled communications professional with eight years of experience as a healthcare communications consultant and 20 years of experience in healthcare marketing and public relations management including executive leadership at Baltimore’s St. Joseph Medical Center and Carroll County General Hospital.