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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mHealth will Revolutionize Modern HealthCare

We are on the verge of revolutionary change in health care delivery in the U.S., of the likes we have not seen in the last 50-75 years. And I believe physicians, the corresponding medical organizations, and the U.S. government are scared to death of these changes – because THEY will lose CONTROL! In fact, I think the U.S. government is more fearful than even of drug trafficking. And this revolution will come via new mHealth technologies & mobile apps.

Clearly, the U.S. government & industry have resisted changes to health care delivery. But mHealth apps will transition control of health care from the clinical setting/utilization review over to the patient as a consumer, and armed with many new customizable apps and combined with the power and offerings of the Internet. These new technologies and capabilities will enable Americans to be healthier, stronger, wealthier, happier, and more independent – and that just scares the crap out of you-know-who! These new technologies would also help make health care spending more transparent, and likely reveal huge amounts of spending wastes. And that too scares the crap out of you-know-who!

FDA and Congress would have us believe that they have been protecting our privacy through legislation such as HIPAA all along. But, I believe this has ever been about protecting our privacy. It’s been about stalling the capabilities and independence that mHealth would bring, and it’s transitioning control from the current clinical setting and utilization review, to a more transparent system that would give patient’s far more control and say so in their care.

With ObamaCare now coming into the fold in 2014, it will be interesting to see how these new features & coverages play into the new mHealth-concentric care model.

ABOUT ME: Began my career in 1976 as a nuclear imaging technologist, founded my own imaging company, and dev’d skills as a medical intuitive in 1981. Today I put on drum circles for the brain, and provide neurological monitoring & consults for the disorder hydrocephalus via my DiaCeph monitoring method I developed back in 1997.

I had also suffered a brain injury and CNS shunt placement in 1992, and have undergone 12 surgeries to date, with 7 of the devices that were used, and failed, not having been reported to FDA! In 1996, I had successfully petitioned FDA on several problem CNS shunt devices, then in 1997 designed & patented the DiaCeph Test, an early mHealth PDA app for hydrocephalus. Since then, I created many different AI methods for cognition & memory, and cognitive accessibility. I am also a writer & speaker. Based out of Newport Beach, California.

FDA’s Proposed Reclassification of Hydrocodone a Dangerous Precedent for Patient Care

In an effort to apparently combat “misuse and abuse” of pain-killing drugs, the Food and Drug Administration has proposed new restrictions that would change regulations for some of the most commonly prescribed narcotic painkillers on the market, specifically, hydrocodone combination pills also known as opioids, which combine hydrocodone with less potent painkillers such as acetaminophen. One widely-used drug is Vicodin, or hydrocodone APAP with Tylenol.

Currently labeled as Schedule III drugs, hydrocodone combination drugs would, if the reclassification proposal is accepted, be labeled as Schedule II. This means patients would have to have a written prescription from a doctor, instead of a prescription submitted over the phone, to obtain the drugs. And refills would be prohibited. Instead, patients would have to check in with the doctor to get a new prescription for each refill. A Schedule II classification would also put manufacturing quotas in place for these hydrocodone products. Pure hydrocodone is already a Schedule II substance.

These new restrictions would no doubt make it much more difficult for sick patients with legitimate medical concerns to obtain access to these medications that they’ve used safely for years. These new restrictions, if passed, would no doubt put patients under unnecessary risks and stresses, delaying treatment and posing considerable additional costs to patients in time and more costly alternatives. Some patients may also turn to “street” forms of Vicoden, as well as those available over the internet, which can often not be the same drug. The federal government’s DEA agency also led a campaign on these proposed changes, as was the original bill drafted by Sen. Joe Manchin (D-WV).

However, as a patient advocate, neuroscientist, and long-time hydrocodone user for complications relating to hydrocephalus, I view this proposal as a dangerous new precedent and example of government, as an outside 3rd party, over-extending its authority in interfering in patient care in a matter where there is no clear product safety issue. The same could be said for guns or gasoline, where a consenting adult lawfully chooses to shoot him or herself, or drink gasoline. Do you ban the guns and gasoline? They will merely find another alternative, and very likely one that is more problematic.

And it gets even worse. Dr. Sidney Wolfe, long time medical director of the group, Public Citizen, spoke out in favor of the proposed changes saying he thinks it will curtail drug overdoses and mis-use. But, we know that such reasoning has not worked in the past where there is a rational need, no clear risk, and the alternatives, street and internet drugs, then become the new problem. Dr. Wolf’s comments can be found via this link:

http://www.aboutlawsuits.com/public-citizen-vicodin-restrictions-40746/

The reality is that there is a true medical need in a vast number of the prescriptions amid an aging population, with arguably limited care & alternative options available to the millions of users, and with a pretty widespread lack of understanding of pain management practices by prescribing physicians. Plus, in countries with fewer pain medication problems, they have far more alternative & Eastern medicine modalities at their disposal. In the U.S., such “alternative” therapies like acupressure, massage, energy healing are not covered by insurance. So in these regards, it would appear the U.S. has created many of its own problems.

Most recently, Janet Woodcock, M.D., Director, Drug Evaluation and Research at the Food & Drug Administration, authored a “statement” in support of this hydrocodone reclassification. She takes more the position of the DEA than that of a treating physician on safety and efficacy, and she offers no alternate solution. Her views are unprecedented in patient safety and access to care, where government can see a problem and take action without there being an issue of product safety. Here statement can be found via this link:

http://www.fda.gov/Drugs/DrugSafety/ucm372089.htm

As you can see, I do not support the government’s position in restricting access to a medical drug or device where there is no safety issue in the drug or device or medical treatment when used according to the labeling. In my view, the problems are more a misunderstanding of pain management practices, poor & failed care, and a lack of available funded alternatives. Pain management is in fact a medical specialty, where there are specific courses to follow, too few physicians follow these, and where patient and physician widely use drugs like hydrocodone because of economic reasons….. which may amount to one more reason for ObamaCare.

There are many medical products that are safe when used as directed. But, casting a restrictive blanket policy over a class of safe products because of physician expertise or available care dollars, or because “the nation” is suffering a health & mental health crisis, is ludicrous!

Further, these new restrictions will compromise the care of user patients. Some will seek illegal street and cross border drugs, and drugs thru the internet, which pose much higher risks & costs, while others such as myself, will face compromises and a deterioration of their care, and for no other reason than the DEA wants to curtail illegal drug use. This is a failed policy used in the 1930s!

As for the group, Public Citizen, I earlier worked on a shunt device safety issue with them in 1996, and upon their urging, I petitioned FDA on widespread safety issues with CNS anti-siphon shunts. The petition was considerable and took me 9 months to complete. FDA sided with me, and then held the 1999 STAMP Conference on High Risk CNS Shunt Devices in Washington, D.C. But as I had criticized a medical device company (Medtronic Inc.), someone saw to it that I was never placed on the STAMP advisory panel. And in the years since, CNS shunt safety issues have been atrocious, and despite my repeated inquiries to FDA on these safety problems, including, a request in 2003 for new Postmarket Surveillance of CNS shunt technology used in the treatment of hydrocephalus, no new safety initiatives were ever undertaken, and there were clear device safety issues. I find it odd that FDA could not act on CNS shunt safety where there were clear product safety issues, yet, was happy to over-step its authority in this hydrocodone matter where there is no product safety issue. In the latter, the issue is more one of physician oversight and a lack of health care dollars. I do not see how restricting the product solves this!

My latest CNS shunt which was implanted last November 2012 has already been recalled. Oddly, my earlier model like this in 2007 that kept loosing its setting and had to be surgically replaced, never faced any recall, and that issue was much more substantial that the most current model. I cannot wrap my head around the safety views adopted by FDA today. It really is shocking!

As for Public Citizen, I no longer have any relationship with them, in part because they never took any interest in my revelations of widespread failures of CNS shunt devices in the field, some of them involving criminal misconduct. And I felt they’d become too political. Their misguided activism in this recent hydrocodone bill only solidifies my concerns.

But I think my bigger concern now is WHAT’S NEXT? I mean, we already have massive authorization and reimbursement problems with drugs, devices, and many medical tests. And hydrocodone is very cheap in price compared to the alternatives. So how will this new government philosophy concerning medical care more forward, where a 3rd party group with no connection or standing in the care of a patient, is allowed to champion restrictions in patient care merely because they fear the a particular product poses a secondary social issue?

The reality is that this new bill is much bigger than hydrocodone use or misuse. It’s about the government’s prerogative to interfere in one’s access to medical care and treatment, not to mention one’s civil rights pertaining to health & happiness as protected under the Constitution! No doubt this proposed new legislation is a shocking invasion by government into one’s private life and medical matters, and represents a dangerous precedent over matters of patient care.

Stephen Dolle
Dolle Neurosciences
Newport Beach, CA