I wrote an in-depth response to the “12 barriers” presented in the blog below on the LinkedIn Mobile Health Association group, and am posting my discussion public here.
The title of the blog post is “12 Barriers to Adopting Mobile Technologies in the Healthcare Industry”
This blog presents a nice concise overview of the issues, and I took it as an opportunity to share my knowledge on the subject. As to my qualifications, I designed & patented one of the first mobile health apps in 1997, the DiaCeph Test, a disease management & diagnostic app for the disorder hydrocephalus. It was to run as a stand-alone app on a PDA. I formed my start-up company, DiaCeph, Inc., and for 3 or 4 years I followed all of the developments during those years. Today, mobile data apps are different from the earlier stand-alone & PC applications. However, we can learn a great deal from those early years, and individuals such as myself have experience in working earlier apps. So, it’s just a matter of picking up where we left off. As such, I feel that I have an astute understanding of mHealth app prospects today.
The blog lists 12 distinct barriers that need to be addressed in order for mobile health, or Mhealth apps, to be put into widespread use.
2) Health Devices
3) Remote Places
4) NHS Network – N3
5) Difficulty Understanding the Technology:
6) Difficulty for NHS Staff
8) Lack of Incentives for GPs
9) Mobile Does Not Mean Only Mobile
11) Human Appeal
12) Lack of Support
Let me begin by addressing No. 8: Lack of Incentives for GPs (Physicians). Just as it were proposed 15 years ago, I believe it still holds true today. There needs to be a reimbursement code & fee for physicians to examine patient data from health apps, particularly, disease management apps for chronic illness. If the app provides [invaluable] clinical information that the physician would not otherwise have, the app data must be viewed as clinical testing. Even though the results might only require a quick check or interpretation, there is an interpretation taking place and doing so could/should involve a fee (esp. where there are no other charges for the monitoring). Another way physicians could earn a fee, is thru cost savings and capitation in managed care practices.
In chronic illness, which today accounts for 75% of all health care spending, health apps can make an invaluable contribution to clinical care & outcomes. Digital monitoring has been used in CHF, asthma, diabetes, and a few other disorders with good success. But there’s not yet been the widespread and seamless integration to drive the needed adoption and support.
As to No. 3 Remote Places: I believe “text apps” could be used on standard phones, and operate a bit like my earlier DiaCeph app on a PDA, and the resulting file texted to a care facility.
With most of the other barriers, notwithstanding those of security (which in my view applies to all mobile data), the challenges I believe can be answered by physician and plan reimbursement, which will then drive adoption.
Briefly, my view of apps is in one of three (3) categories: 1) Fitness & light wellness; 2) Disease Management; and 3) PHR or personal health records. The latter category poses the key hurdles with secutity, whereas the 2nd category is for management of chronic illness, which is critical to care outcomes, and is also where much of my experience lies.
If physicians are reimbursed for reviewing or interpreting app data in chronic illness (which I believe can happen), then physicians will lead adoption and tech support – which is how it should be. App recommendations, use, adoption and support will then go thru their office, much in the way prescriptions are written thru their office today. I also envision “app centers” where patients can get support and the latest user information on apps. These app centers could also serve of the types of apps, relieving AT&T, Verizon, and Sprint of this responsibility. Just imagine the marketing efforts that would ensue to physicians, the reimbursement, and the value-cost savings in medicine. We’ve seen leaps and bounds of progress in UIs and adoption of apps in only a few years. So many users are ready for this next wave of technology. It’s the seniors and slow learners next that must be brought on board tech and mobile apps. But just imagine what a coordinated effort could do. There’s so much money & cost savings at stake in mHealth not to do this. Yet, UIs and accessibility must improve.
One of my pet peeves is “cognitive accessibility” of web sites, apps, and product labeling, and store shelves. It is an area that I became involve in, and advocate and write about, as a result of a brain injury and CNS shunt placement in 1992 (I have underwent 12 shunt revisions to date). Times when I am tired or otherwise not feeling well, I have limited patience for misdirection and poorly designed UIs. I have become particularly adept in cognition, artificial intelligence, and learning. In recent years, though, much of my work has been with drumming for the brain. Yet, I am an accomplished neuroscientist & patient advocate, and as mobile technology has progressed, it has attracted my interest. I earlier spent 17 years in nuclear medicine imaging and worked with some of the most poorly designed instrument interfaces you could imagine. Having been adept in technology enabled me to apply it to my needs post brain injury. Plus, 35 years ago, I considered going into instrument design work. All of this affords me a unique perspective with mobile apps & mHealth today. I also provide neurological consults around the world with paper forms based on my DiaCeph design. So I know how mHealth would fit into care.
In closing, I believe we have 90% of the information that is needed to make mobile health succeed today. We must primarily solve the outstanding integration, platform differences, and security issues. Once this is done, the developments will transend the millions of mobile apps coming available, and making them much more integrated, and much more secure. Dare to dream!