Incorporating mobile health applications into the primary care practice

Technology has transformed almost every area of daily life, including the healthcare industry. That growth is mirrored in the number of healthcare organizations now offering telehealth services for their patient populations: According to the Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey, 76% of hospitals and health systems currently offer telehealth services or plan to implement them by the end of 2018.

Mobile health (mHealth) applications, one type of telehealth utilization, are a fast-growing market. The FDA defines mHealth apps as those intended to either be used “as an accessory to a regulated medical device” or “to transform a mobile platform into a regulated medical device.” In 2017, the number of available mHealth apps was estimated at 318,000, with more than 200 being added each day. An estimated 3.7 billion mHealth app downloads occurred worldwide in 2017. The mHealth market is expected to reach $46.2 billion in global revenue by 2021, up from $13.2 billion in 2016 (compound annual growth rate of 28.6%).

Providers and patients appear to have an interest in this growing market. A survey done by Quantia Inc. found that 37% of physicians had prescribed an mHealth app to their patients. In a survey of more than 900 patients, 70% of smartphone owners reported use of mHealth apps.1 A separate survey of 2,000 mHealth users found that many were using mHealth apps to monitor workouts (60%), motivate themselves to exercise (53%), record calorie intake (49%) or monitor weight loss (42%). Thirty-two percent said they share their app information with their physicians. Overall, 96% agreed that mHealth apps help improve their overall quality of life.

Types of mHealth apps

mHealth apps can be categorized by the different services they offer.

• Wellness apps: Apps that encourage users to self-monitor lifestyle choices. This could include diet apps (MyFitnessPal, Lose It! – Calorie Counter), workout apps (FitBit, Nike + Run Club), smoking cessation apps (Smoke Free, Pivot, SmartQuit), meditation/mindfulness apps (Calm, Headspace) and sleep tracking apps (Sleep Tracker, Pillow).
• Monitoring apps: Monitoring apps allow patients to track medical and biometric data, some of which use special equipment to connect to the app: blood pressure monitors, blood sugar monitors, body scales, wearable ECG monitors and pulse oximeters. Examples include vital sign monitoring apps (iHealth MyVitals), cardiac monitoring apps (Qardio Herat Health), diabetes monitoring apps (mySugr, One Drop, iHealth Gluco-Smart, Glucose Buddy, Tensio), GI symptom monitoring apps (mySymptoms), vascular monitoring apps (VasTrac), ovulation and menstrual tracking apps (Glow Ovulation & Period Tracker, Flo Period & Ovulation Tracker), and maternity and newborn care tracking apps (Pregnancy & Baby Tracker, The Bump, Sprout Baby, Feed Baby).
• Management apps: Management apps can help patients monitor adherence to treatment plans. This could include adherence to behavioral home treatments (Kegel Nation App, Daily Water Tracker Reminder) or medication compliance tracking (Medisafe).
• Patient education apps: Patient education apps are available to inform patients about their medical situation. There is a wide range of information available, from pharmaceutical information (Iodine, Drugs.com Medication Guide) to general medical information (Mayo Clinic).
• Physician-patient communication apps: Communication apps typically allow for physician-patient messaging, while incorporating electronic health record access (MyChart, FollowMyHealth, Healow).

Benefits of mHealth apps

For healthcare providers, mHealth apps can increase efficiency in reviewing patient data. Rather than reviewing patients’ written logs of blood pressure or blood sugar readings taken at home, physicians can utilize technology to quickly view data trends. 

App usage also can improve patient-physician relationships. Patient-physician communication may be directly built into some apps. In addition to direct communication, some apps offer indirect communication by alerting physicians when the app detects out-of-range values.

For patients, mHealth app use can empower them to be active in their health management. By actively self-monitoring health data and having access to trends and analysis, patients may be more motivated to meet their health goals. They may also see tangible evidence of improvement, helping make them more adherent to their healthcare plans.

Disadvantages of mHealth apps

A common concern about mHealth apps is regulatory oversight. A Quantia, Inc. survey of 250 physicians found that 42% of physicians are hesitant to recommend apps because of the lack of oversight. App effectiveness and a general lack of knowledge of currently available apps are also cited as physician concerns.

To ease these concerns, app curating resources such as iMedicalApps.com and iPrescribeApps.com can help physicians find apps with strong, evidence-based methodology relevant to their needs.

Finally, the amount of data available to physicians may be overwhelming. In searching for mHealth apps to recommend, physicians should identify apps that will condense necessary data to allow for more efficient viewing.

Steps for incorporating mHealth apps

1. Identify your patients’ needs. Determine if there is a need to help with medication management, tracking biometric data, diet and exercise plans, patient-physician communication or something else.
2. Identify apps to recommend to patients. iMedicalApps.com is a physician-edited website that provides reviews, research and commentary on mHealth apps. The website is also responsible for iPrescribeApps.com, a new service for physicians that identifies a short list of pathology-specific applications that have met “strict selection criteria based on evidence-based methodology and expert opinion.”
3. Recommend apps to patients who may benefit from them.
4. Ask for patient feedback.
5. Continue to identify and recommend new apps that may benefit your patient population.

API and patient data exchange

The 2015 Edition Health IT Certification Criteria issued by the Office of the National Coordinator for Health Information Technology (ONC) supports patient access to their health information, including patient-directed transmission of their health information. The 2015 Edition included application access criteria that requires health IT to demonstrate it can provide apps access to the EHR through an application programming interface (API). APIs will help to address the multiple apps and portals patients access by allowing individual patients to aggregate their data from multiple data sources into a web or mHealth app of their choice. This capability will allow patients to connect their primary care provider with their multiple mHealth apps and also other patient portals they may utilize. Combining these multiple data sources will enable providers to have a longitudinal view of patients and their medical history.

Conclusion

mHealth apps are a growing area of medicine, spanning many different uses and designs. Beyond the benefits associated with mHealth app use, there is a need for services that will provide oversight and help physicians identify the best apps to recommend to patients, as well as a need for further research on the effectiveness of these apps in improving health outcomes. 
 

Note:

1. Bauer AM, Rue T, Keppel GA, Cole AM, Baldwin L-M, Katon W. “Use of mobile health (mHealth) tools by primary care patients in the WWAMI Region Practice and Research Network (WPRN).” J Am Board Fam Med. 2014;27(6):780-788. doi:10.1007/s10439-011-0452-9.Engineering.