Overcoming Barriers in the Adoption of mHealth Mobile Apps

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”
http://www.integratedchange.net/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.

1) Security
2) Health Devices
3) Remote Places
4) NHS Network – N3
5) Difficulty Understanding the Technology:
6) Difficulty for NHS Staff
7) Hacking
8) Lack of Incentives for GPs
9) Mobile Does Not Mean Only Mobile
10) User-Friendly
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!

Stephen

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Availability of Patient Medical Apps in U.S. now under new FDA Regulations

After more than 75 years, medical questionnaires that patients use to share information to physicians, are yet to innovate. Here’s what our FDA is doing now in regards to this innovation. See the accompanying story link.

 

Having spent many years in clinical nuclear medicine, and more recently, the neurosciences, I always viewed myself as an innovator. But, when I’m a patient undergoing any type of medical treatment, I’m less forgiving of an industry’s unwillingness to innovate, and their insistence to hold the marketplace hostage for their failures.

 

Way back in 1997, some 5 years and four failed surgical attempts later to get one of my CNS brain shunts to correctly drain CSF fluid needed for my hydrocephalus condition, I designed a patented a software-based monitoring system & named it the “DiaCeph Test.” It was to be a stand-alone software device. Fourteen years later, the DiaCeph Test still sits on a shelf, while new diagnostics needed for hydrocephalus and many other disorders, are not brought to market. This, and tech monitoring of many other disorders today, could be done via mobile phone apps.

 

Here’s the link to info on my DiaCeph Test, though it’s not been updated in a while: http://www.dollecommunications.com/DiacephPatent.htm

 

Also, visit your Android or Apple store to see what’s available today.

 

My frustration boiled over recently as I was passed between physician specialists and a slew of lab and other diagnostic tests. Truly the medical field is failing to innovate both in the collection of relevant patient information, and in IT systems that should be mining patient tests results for the appropriate steps to follow. Widely today, physicians still use the same patient questionnaires that were introduced over 75 years ago. And no to very few clinical apps have made much of a dent in care in the doctor/patient relationship. And with all the money spent in health care in the U.S., and all of the political wrangling over Obama Care, why is no one talking about these key failures to innovate, and the difference it could make in care today?

 

I’ve enclosed a link to an industry story on the Food & Drug Administration’s new law and guidance regarding health apps. It remains unclear whether these regulations will help or hurt the cause for innovation. But it is certainly a story and topic you should follow, at least if you think there’s chance you might need medical treatment any time soon.

 

Of course, you could seek alternative medical care for what ills you, such as the drum circles and healing (that I do), or chiropractic, meditation, energy work, essential oils, vitamins & herbs, and energy water, to name a few of the alternative options that are available today. These each have some efficacy in bringing about positive outcomes. But, if you have a serious or more chronic illness, you probably want a more proven medical treatment. But, you’ll need supporting technology to make this all work, and you had better stay atop these developments in the industry, and in Washington.

 

Enjoy the reading.

 

http://www.informationweek.com/healthcare/mobile-wireless/new-fda-law-paves-way-for-mhealth-regula/240004268