360 Degrees of Health: The Limitations of Mobile Apps
By Jane Sarasohn-Kahn
The market for mobile health is one of the brightest lights of the economy, based on forecasts published during the first half of 2011. In-Stat expects that the market for wireless health will reach $4.5 billion in 2014. Meanwhile, McKinsey gauges the "global mHealth opportunity" at $50 billion.
These are heady numbers driving venture capital dollars into mobile health applications this year, such as the $10 million venture capital investment in Epocrates' Doximity in March and the $48 million investment in Cellnovo's mobile diabetes product. MobiHealthNews tallied over $60 million of venture capital funding for mobile health just in the first quarter of 2011.
Adding to mobile health hope is the view of Kaiser Permanente's chief medical information officer, John Mattison, who calls mobile phones, "the new wellness delivery channel."
But the go-go environment for mobile health deals could exacerbate fragmented health care delivery unless the applications connect with the larger health ecosystem.
Mobile Health Apps: Not Yet Marriage Material
The drivers for mobile health are clear: Mobile phones and tablets are ubiquitous and getting increasingly "smarter," behaving like powerful desktop computers. B.J. Fogg of Stanford's Persuasive Technology Lab has quipped, "We don't merely adopt cell phones. We marry them." The proliferation of smartphone health applications targeting both patients and health care providers has seen hockey-stick growth over the past two years.
However, most consumer-facing mHealth apps are downloaded once and rarely used. While people might love their mobile phones, most don't seem very interested in marrying their health apps.
The Whole Health Ecosystem
Whole health is more complicated than managing one aspect of lifestyle or sickness. Health is co-created in a person's unique health ecosystem, which includes not only their local health care delivery system (typically their primary care doctor, hospital or clinic) but other resources that support their health such as the pharmacy, grocery store, schools, public health department and other personal touchpoints that influence a person's health.
This point was well-articulated by Surgeon General Regina Benjamin, who told the Los Angeles Times that health is, "where we live, we work, we play, we pray."
As they are deployed today, mobile apps are part of the fragmented health system -- largely siloed in the palm of the user. The positive side of that is that mobile apps can provide people with useful health information as simple as the number of steps walked and calories consumed per day, as well as clinical metrics like blood glucose trends and blood pressure over time.
These are, to be sure, helpful statistics in and of themselves for patients to view. People with diabetes can better manage their condition throughout the day if they know this information. But, what about a person with hypertension whose blood pressure tracking app reveals a graph that shows their blood pressure sharply spiking one day?
Holy Grail: Connected Health
That's where the concept of connected health comes into focus. If the patient with hypertension who is self-tracking doesn't contact the doctor after seeing an increasing trend line, then the proverbial tree fell in the forest and no one but the patient heard the sound.
On the other hand, if the mobile health app connected to a health provider, health coach or caregiver, the data could be shared and analyzed, and actionable advice could be communicated back to the patient. This closed-loop approach bolsters patient outcomes.
On that front, it's encouraging to see from Manhattan Research's latest Taking the Pulse survey that physicians are adopting mobile platforms at a fast clip. In 2011, 81% of U.S. physicians own a smartphone. Nearly 1 in 3 U.S. physicians own an iPad, and another 28% plan to purchase one in the next six months.
Furthermore, in the qualitative section of this survey, Manhattan Research found that physicians using electronic health records via mobile platforms have a much more positive experience implementing and using EHRs than doctors using digital records on desktop computers. Physicians expressed strong interest in being able to access EHRs through an iPad.
Physician implementation of EHRs could be the vessel for receiving data from patients' mobile health apps if the EHRs' patient portals offered this capability. That's one expression of interoperability.
As more EHR vendors integrate mobile platforms into their products, physicians might find greater productivity using them on-the-go. Over time, this bodes well for connected health -- where the data generated by a patient's self-tracking -- whether for wellness or disease management -- can seamlessly and easily populate the patient's EHR. That's 360-degrees of health care that could make a big difference in a person's health, 24/7, beyond the app itself.
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