It’s rare that I see a patient in my office who doesn’t have a smart phone. At least once a day, one of them shows me something on it relating to their health. My last patient, new to me, scheduled a visit to go over her MyFitnessPal.com data as she’s still not able to lose weight. Other patients show me pictures of rashes or wounds.
Increasingly, like the patient above, it’s self-entered data (blood sugar, blood pressure, weight or daily caloric intake) that they want to share. Two days ago, we spent time reconciling a patient’s multiple medications based on three sources:
- His Pill Reminder application
- Our records
- eRx’s external history available through the EMR we use
His app — serving as his personal medication record — was invaluable to help us resolve a conflict, as he had several OTC meds that were not in our system nor in the external history coming through Surescripts.
According to Research2Guidance, an international market research firm, there are over 40,000 mobile health apps downloaded and used by 247 million people.Over 80% of Internet users have looked for online health information but only 10% of adult cell phone users have signed up for a health app according to Susannah Fox, associate director of digital strategy at the Pew center.
While the overwhelming majority of these applications require the user to manually enter data and return specific information or log and chart their own progress, a growing number are leveraging mobile device hardware or wireless communication to eliminate human data entry. These applications actually measure pulse, weights, blood pressures and other physiologic parameters. Examples include Azumio’s Instant Heart Rate and Stress Check apps that use the iPhone’s flash to detect pulse and calculate stress; Withings Body Scale and Blood Pressure Monitor that uses wi-fi to transmit weights to iOS devices and then on to Personal Health Records like Microsoft’s HealthVault or to other apps like iBP.
There’s also a growing number of much more sophisticated devices designed primarily for clinicians that fit onto a smart phone to record ECGs (Alivecor’s AliveECG) for diagnosis of heart tracings and reports that similar sleeves with transducers may enable clinicians to use their smart phones for either medical ultrasonography education but eventually converting their phones to diagnostic devices. Qualcomm’s $10M Tricorder X Prize contest is adding fuel to the innovation fire that will probably overshadow the dampening effect of the FDA’s decision wade into application regulation.
In the meantime what’s a physician to do?
I’m pretty convinced that mobile apps are going to be a cornerstone for improving individual health and managing chronic conditions in order to reduce the cost of providing health — or should I say disease ’ care in the US. Already we have deployed Voalt to improve secure communications internally. We have committed to participating in at least two ACO’s and will be trying to leverage mobile applications to help us. But already there’s no way our HIT staff can even attempt to create and maintain interfaces with even a small number of the many apps my patients are using.
Just as it’s not remotely possible for me to download and use all of the apps my patients are using, there are too many apps for me to dictate which ones my patients should use. I have made suggestions including Loseit, Myfitnesspal.com, and The Eatery for those wanting to manage weight but am finding they are not going to switch from one app to another, and there’s only a limited number they are going to use. Many of them tell me that while the cost of the apps is usually free or miniscule the time invested in them is significant. They are reluctant to switch until their history can migrate with them.
I have seen at least 20 apps patients are using now for weight management alone. They want me to participate and share in their activity and to see their data reflected in my EMR.
Therein lies the problem with apps.
Yes, I’m convinced that all disease at some level is social, and unless our information systems are aligned with social structures as well as bacteria and viruses we’ll never be able to get out in front of diseases. I’m also convinced that unless the patient is the primary user of the EMR/EHR, we’ll never be able to reduce the overhead, accuracy and integrity of the systems we do use.
Mobile healthcare apps dangle the tantalizing solution to both of these issues but all of them are isolated islands and don’t communicate with each other or with me. But at the same time, they are little prisons ensnaring all of their users. A person isn’t free once they start using an app to jump to another one and carry their history with them or easily export their data in a meaningful way to others.
A lot of them will export information and progress to Facebook, but most of us providing healthcare don’t have the time to leverage the timelines of our patients in a meaningful way or without feeling somewhat creepy.
When thinking about mobile health and it’s current direction, I hear Samuel Coleridge’s “Rime of the Ancient Mariner” ringing in my head:
’Water, water everywhere,
And all the boards did shrink
Water, water everywhere
Nor any drop to drink.’
The problem with the apps are they are everywhere but it’s almost impossible to use them as a group effectively.
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