MHealth provides vital tools to support the goals of health care reform to increase health care access, improve care delivery systems, engage in culturally competent outreach and education with technology that is easy to use, affordable and scalable, and is already adopted by patients of all ages and socioeconomic status.
Mobile health technology (mHealth) is changing the way the world approaches health care access and delivery. Text messaging is used to support patient adherence with chronic disease management and mobile health applications (Apps) engage patients in preventive care and connect them to community and educational health resources. According to Research2Guidance, 500 million smartphone users worldwide will be using a health care application by 2015. (Mikalajunaite, 2010) In 2012, the number of mHealth application users who downloaded a smartphone mHealth application at least once will reach 247 million. (Jahns & Gair, 2012)
Mobile technology provides outreach and access to people irrespective of their socioeconomic status, race, ethnicity, or geographical location. As of December 2010, there were more than 302 million wireless subscribers in the US and an estimated 5 billion mobile cellular subscriptions worldwide. Currently, 85% of US adults own mobile phones, with 17% of them accessing health information using their mobile phones. Ethnic minority groups are more likely to own a mobile phone and use mobile phones to access health information. (Taskforce) A Pew study documenting mobile phone access for minority and lower socioeconomic populations reported 79% of Medicaid recipients, 83% of African-American adults, 79% of Hispanics and 68% of whites use text messaging. (Fox, 2010)
MHealth can be defined as using mobile technology in conjunction with social media and the internet for medical care. MHealth creates new ways to activate and engage patients with disease education and management applications like Txt4Health diabetes initiative and SmokeFreeTXT, a smoking cessation program targeted for teens that delivers tips, motivation, encouragement and fact based information via unidirectional and interactive bidirectional message formats; and participatory applications like Fitbit, a wireless pedometer that transmits data to the cloud for access from any internet connected device. Clinician focused applications can support access and efficiency of care management with Apps for downloading patient data like Sanofi’s iBGStar, an iphone glucometer that can wirelessly transmit blood glucose data. Aging-in-place technologies, like Comfort Zone, a web based location management service can aid persons with early dementia to remain at home, improving patient satisfaction and decreasing health system costs. Untethered Personal Health Records (PHRs) are a means for patients to capture and track their personal health data electronically. Pocket Health Mobile by Cognovant, is an App for Apple IOS and Android platforms that enables patients to manage their health data and connect electronically with providers following the Continuity of Care Standard (CCD). Stage 1 Meaningful Use requires providers to give patients electronic copies of their own records, in CCD format. In future stages of Meaningful Use, providers likely will have to be able to import CCD data. (Center for Medicare and Medicaid Services, 2012)
Managing complex health needs especially in vulnerable populations is a labor-intensive endeavor for patients, clinicians, and health systems. Many such patients require a multiple medication regimen; frequent monitoring of vitals and laboratory studies; lifestyle changes in diet, exercise, stress management, smoking cessation; and encouragement to schedule and adhere to medical appointments and diagnostic tests. Patients who are informed, active participants in their own care have better outcomes, and their health care is apt to cost less. (Blair, 1974) MHealth provides vital tools to support the goals of health care reform to increase health care access, improve care delivery systems, engage in culturally competent outreach and education with technology that is easy to use, affordable and scalable, and is already adopted by patients of all ages and socioeconomic status. Effective mHealth can empower patients with knowledge by providing information and education about medications and disease diagnoses; connect patients to communities and resources; and provide patient advocacy through engagement.
The FDA recently released guidelines on mHealth technologies in an effort to balance the potential for innovation with patient safety in the rapidly changing mobile space. Jeff Shuren, director for the FDA’s Center for Devices and Radiological Health said the rapid change pace has prompted the agency to take a more flexible approach in its reviews of products. For example, some software manufacturers could prove their product is accurate based on its design rather than trials in a clinical setting. The guidelines suggest three types of applications should require FDA oversight: a mobile application that acts as an accessory to a regulated medical device, turns a mobile gadget into such a device, or makes suggestions regarding a patient’s diagnosis or treatment. (FDA: Food and Drug Administration, 2011) Additionally, FDA oversight will address licensing, credentialing and security issues.
Safeguarding a patient’s privacy is crucial as more sensitive information is accessed via the internet. For example, What’sMyM3 is an App used to assess depression, anxiety and PTSD symptoms. Although the App does not indicate a definitive diagnosis, it will prompt recommendation to seek professional consultation based on symptom scale. Patient safety issues are being carefully considered, to address the challenges and safety risks of using medical devices in the community by lay users. Issues and specific recommendations raised by the mHealth Regulatory Commission will be an important framework of responsible regulation of a rapidly growing important mHealth sector.
There is early evidence that certain mHealth applications can improve care and reduce certain unnecessary costs, but more research is needed to learn how to integrate mHealth with traditional care delivery, reduce barriers to adoption, assure privacy and security of health information, and how to implement mHealth on a community scale. The key to longevity of mHealth technology is the ability to integrate into the core clinical information system.
The HITECH Beacon Community Grant Program supports communities with high levels of electronic health record adoption to develop and test new models of mHealth technologies that demonstrate measurable improvements in chronic health conditions, unnecessary hospitalizations, patient experience, and health disparities. Innovative uses of mHealth technology for improving care for rural areas, stationary populations (e.g., home-bound patients and patients in correctional institutions and long term care facilities), and regions with a shortage of health professionals are a national priority. (ONC, 2011)
New payment approaches are recommended such as accountable care organizations, bundled payments, and value-based purchasing to support appropriate and effective care in patients’ homes and communities facilitated by mHealth technologies. Without payment reform, widespread adoption of mHealth will not be viable, and patients and providers in safety net communities will be left behind the fast moving mHealth train.
Future stages of Meaningful Use will provide a critical opportunity to advance effective mHealth as a way to increase patient engagement, improve chronic care outcomes and reduce unnecessary costs including avoidable hospital readmissions and emergency room use. Increased attention must be focused on technology that incorporates low literacy and multilanguage access and marketing and promotion of mHealth to these communities who have traditionally had lower e-health use to avoid promotion of a digital divide and widening health disparities. (Sarkar, 2010)
Anna M. Gard, FNP-BC is a certified family nurse practitioner at the VNA Community Health Services Children’s Clinic, a nurse managed health center in Abington, Pennsylvania. She is a Health Disparities Consultant for the Association of Clinicians for the Underserved. Her key areas of focus are the intersection of health disparities, quality improvement performance, patient centered medical home, chronic care management, and health IT in safety net populations.