mHealth: There When You Need It

A couple of weeks back, Neil Versal wrote an interesting article for mobihealthnews on mHealth App development and adoption trends. While agreeing with some of the thesis of his argument, that many Apps have little relevance to the broader populace and seem to be more focused on the Quantified Self geeks, there are a couple of points he made that give a false impression of what our research and personal experience have found in this emerging market.

First, there was the argument that those who may be in the greatest need of using an mHealth App to manage a chronic condition may not have the wherewithal to identify and use an App. This is true for pretty much the entire population and not only those with a chronic disease. Our research for the upcoming report, mHealth for Provider-Patient Engagement, found a market where most mHealth App developers struggle to get users, particularly those with chronic illnesses, to continuously use an App.

Where an mHealth App has seen success is when it becomes a critical component of a care management process and a patient receives periodic feedback from a clinician. Such was the case in an urban, predominantly poor neighborhood in Washington D.C. wherein diabetic patients actively engaged in the use of an App to record their glucose readings for they were getting feedback from clinicians. Therefore, our thesis is that the issue is not whether the App has been designed for a given populace but its potential use (success) rests more with how and more importantly who deploys the App. The vast majority of the populace needs that clinician guidance and support in use of an App to manage a chronic condition – it will not work in a vacuum, it must become a part of the care management process.

However, in our conversations with a number of physicians we found a common theme that most are struggling to figure out how enabling their chronic disease patients with such tools and follow-on monitoring will fit into their existing workflow. We see this as code for: “How will I be reimbursed for this effort?”

Good question. The impending changes in reimbursement and subsequent move towards capitation may provide the path forward without the requisite CPT codes. There remains the challenge of how EHRs may accept such patient entered data from an mHealth App as today we do not know of any that can support this capability but that is a topic for another post. The important point we wish to make is that mHealth can play a role an important role in the care process, it just needs a advocate to drive its use, that advocate being a clinician/care management leader to help guide and support he patient.

The other issue we wish to raise is the oft-cited numbers that are thrown about of how people download various mHealth Apps and then rarely, if ever use them.

All of us who have a smartphone likely have a few Apps that we have maybe used once or twice and have forgotten about or tossed them for they did not appeal to us. But that does not necessarily mean lack of use equates to lack of value. Some Apps are not meant to be used frequently, iTriage is one of them, but I sure am glad I have it on my phone.

Now I have been a fan of iTriage from its early founding and was happy to hear that they found a willing suitor in Aetna when they were acquired last year. Their solution, while a little intimidating at times, is one of the better mHealth Apps out there in doing self-diagnosis, which is what I had the opportunity to do last month when visitng my parents.

Late one evening (actually about 3am) I awoke not feeling quite right. Next day I learned that I was not the only one as both my sister-in-law and father where also feeling under the weather. After a couple of days, my sister-in-law and I began to feel better. Such was not the case for my father. After some exploratory questions, came to the conclusion that we all suffered from some form of food poisoning. As my father’s health declined I asked him more specific questions about his symptoms. He was suffering from loose stools, weakness, fever and painful urination (sure sign of UTI). Using the iTriage App I triaged my father eventually settling on the likely culprit: E. Coli poisoning.

Knowing this was a very nasty disease (yes, it kills), you don’t waste time getting treatment. Took father to the local ER where they immediately put him on an intravenous feed of some pretty strong antibiotics and to hydrate him. The attending physician took a culture and stated they would have an answer  in some 36 hrs as to what was at the root of his symptoms. Sure enough, when the physician got back to us he confirmed that it was indeed E. Coli poisoning.

Prior to this event, when was the last time I opened up the iTriage App? Really can’t recall but it was likely to demo it to someone and probably more than six months prior. But this is not an App designed to be opened and used frequently, it is designed to be used when you need it. And that is part of the problem with a lot of these broad pronouncements about the use, or lack thereof, of mHealth Apps: some of these Apps simply aren’t meant to be used frequently but you’re sure glad you have them when you need them. The mHealth App market is far more nuanced and most do not dig deep enough prior to making broad pronouncements instead painting the whole sector with one stroke of the brush which is a disservice to this emerging sector.

As to my father, he has made a full recovery and one of the first things he asked me when he got home from the hospital was: What was that App you used? Can I put it on our iPad? Done. Now if only iTriage would make an iPad version of their App then my father, and maybe others would be even more delighted.