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The promise and roadblocks of mobile app technology

Monday, August 31, 2015

This guest post by Heather Yeo, M.D., M.H.S., assistant professor of surgery and assistant professor of public health, appeared on the blog of the Association for Academic Surgery.

Photo of Dr. Heather YeoDr. Heather Yeo Well into her 90s my grandma was actively using her cellphone. She was a little slow with it – bothered by the arthritis in her fingers – but she could use it to see pictures we sent of our kids, she could answer calls, and she generally kept it with her.

Now, more than ever, the majority of patients are “connected.” The Pew Research Center recently reported that 91% of adults have access to a cellphone, even those 65+ years of age had a 76% usage rate. And the use is not restricted by socioeconomic status, as even in lower economic groups the numbers are higher than 85%.

The field of mobile health application usage is evolving and expanding rapidly. Much of the previous work in this field has focused on the role of mobile devices to assist clinicians in the care of patients with chronic disease or illness. These devices have in preliminary studies proved useful and have the potential to offer real time data collection for clinicians. Investigators have shown that collecting data from a mobile phone sensor application can be useful in the measurement of individual’s activity patterns. And some medical oncologists are using apps to better track toxicity for chemotherapy, so that they can adjust doses before the chemotherapeutics reach toxic levels. The opportunities are vast.

As a physician in an ever-changing health care environment, there are several areas where mobile technologies have the potential to benefit patients and physicians:

  • Tracking symptoms – several groups are using mobile apps to track symptoms such as chronic pain, bowel habits, or even medication side effects.
  • Keeping health records nearby – using mobile apps, patient data can become mobile and, if integrated properly, can help speed communication between providers.
  • Encouraging healthy behaviors – apps have the ability to remind patients to perform certain tasks, take their medicines, check their blood sugar, or even exercise.
  • Tracking vitals – continuous data is already being monitored with mobile phones, and now new tech can add heart rate, temperature and other indicators.
  • Alerting physicians to abnormal results/quality of life/mobility – once linked to the EMR mobile app, data can be sent directly to physicians alerting them to problems about their patients. Or, abnormal values can be programmed in and alarms triggered to send patients to their physician or to remind them to take medications.

Recent data from the Pew Research Center has shown that in older adults in particular, patients age 65+ fine their smartphones “freeing”, and say they help them feel “connected.” This is actually higher than in younger patients, who more often feel “distracted” or “tied” to their phones.

Challenges that lie ahead

  • Privacy – Recently, several large breaches in data at hospitals and medical centers have led to growing concern from the public about our ability to protect their protected health information. Working with tech companies to secure and encrypt data will be key.
  • Medical legal – In addition to the need to protect patient privacy, the medical legal aspects of having real time data and the capability to follow up on it are two different things. If an app tells the patient he doesn’t need to see the physician and then something bad happens, who is responsible? From a physician’s standpoint, the app, like any other tool, should facilitate, not replace, good clinical judgment. I tell all my patients that if they feel bad or have bad symptoms, they don’t need to wait for an app to tell them to call me.
  • Reliability of data – Several recent studies have questioned the reliability of several health apps.
  • Multitude of devices – Already the number of mobile applications is overwhelming, with over 100,000 “health apps” in the i-Tunes store. Figuring out what apps are accurate and medically useful can be overwhelming for patients.
  • Untested – mHealth apps are occasionally presented as replacements for legitimate medical equipment. In some cases, the apps have drawn government scrutiny. The FDA regulates any devices that try to diagnose, treat or prevent an illness.

Next steps

Now at 101, my grandma is less mobile than she was before, she is more forgetful and her mobile phone sits on the shelf more often than not. But, for someone like her, the promise of wearable mobile technology is the next step. If she had a wristband that would alert her caretaker when she falls, she could be found immediately instead of a few hours later. Or if she had wearable monitor that tracked her HR and temperature, her urinary tract infections could be diagnosed before she became confused and disoriented. The technology is out there; it is up to us as physicians to help innovate it in a scientifically and clinically sound way, to use the technology that works, and to not forget that it is a tool, not a substitute for good clinical judgment.