As Americans continue to buy smartphones, they are using mobile health more than ever, according to a recent report from the Pew Research Center's Internet and American Life Project.
The Mobile Health 2012 report, released last month after surveying more than 3,000 adults in August and September, found that 45 percent of Americans own smartphones, with those in urban areas, with a college education and an annual income of more than $75,000 most likely to own a smartphone.
In all, 52 percent of smartphone owners use the device to look up medical information, and 19 percent of smartphone users have downloaded a mobile health application. Women are more likely than men (by a narrow margin) to use their smartphone to look up medical information; those under 50, on the other hand, are more than four times as likely to do so than those over 65.
Mobile Health's Potential: Improve Care, Reduce Disparity
The Health Resources and Services Administration within the U.S. Department of Health and Human Services defines mobile health, abbreviated mHealth, as "the use of mobile and wireless devices to improve health outcomes, healthcare services and health research."
Mobile health proponents say mHealth should improve patient engagement and safety, if for no other reason than the fact that patients are more likely to interact with a smartphone app than a stack of discharge papers. Over time, too, smartphone geolocation functionality could be used to reduce Medicare fraud, which costs the United States $60 billion a year, by matching Medicare claims with date, time and location data.
However, mHealth's greatest potential may be helping reduce healthcare disparities in the United States in two ways:
First, minority populations are at a higher risk for infant mortality, cardiovascular disease and diabetes, which is coupled with lower rates of immunization and cancer screening. Pew's findings indicate that Hispanic and African-American smartphone owners are more likely than whites smartphone owners to look up medical information. African-Americans are also more likely than whites to use an mHealth app and receive medical information via text message.
Second, those "underserved" by the healthcare industry—including but not limited to rural residents, senior citizens, the disabled and those below the poverty line—often lack access to care. The vast majority say they would connect with a physician online, though, as it would save them the time, trouble and cost of a doctor's visit. To that end, the Federal Communications Commission's Consumer Advisory Committee wants to make sure the FCC's mHealth Task Force represents underserved Americans as it pursues its goal "that mHealth technology be a routine medical best practice within five years."
Mobile Health's Reality: Slow Adoption
While the Pew Research Center's numbers are encouraging for proponents of mHealth, they miss the larger issue. John Moore, managing partner of healthcare IT analyst firm Chilmark Research, says an uptick in mobile health adoption is simply "not happening yet."
Within healthcare organizations, "mHealth today is still being driven and paid for by marketing," Moore says. "[They] see it as a consumer loyalty play. It's not getting the clinician involved."
Even though nearly all facilities support mobile devices of some kind, whether it's iPads or pagers, almost two-thirds lack a formal, written mobile strategy, according to a recent Amcom Software survey. Roadblocks to creating such a policy include low funding, poor leadership and a lack of awareness of major mobile health issues. Despite supporting mobile device use, 37 percent of organizations without a mobile strategy have no plans to develop one, the survey says.
Moore cites several additional reasons healthcare organizations and patients alike are slow to adopt mobile health:
- Despite the fact that doctors love the iPad and the new iPad mini, incorporating mHealth technology into a physician's encounter with a patient is a substantial change management hurdle.
- Under the United States' prevailing fee-for-service model, there is no incentive for a physician to, as an example, view a photograph of a rash that a patient took with her mobile phone and tell her that she need not schedule an office visit, Moore says.
- While Pew notes that one in five smartphone users has downloaded an mHealth app, Moore says that, according to mHealth application developers, use tends to drop off after only a couple months. Patients want to know that "someone on the other side is looking at this and giving [them] feedback," Moore says, but primary care physicians "just aren't there."
- A lack of interoperability among mHealth applications and the clinical applications that a physician uses keeps information in silos. Until a patient's food app can connect to his diabetes management app, there's no incentive to use either, Moore says.
- Technology infrastructure in hospitals, by and large, is not ready to support mobile health. As one CIO told Moore, "We're just now laying the foundation to digitize our system. What you're talking about now is on the seventh floor."
Analysis: Transforming Healthcare Requires More Than Giving iPads to Doctors (CITE World)
One answer to the infrastructure question, according to John Walls, vice president of public affairs for the Wireless Association CTIA, is improved wireless spectrum planning, especially as more people—and devices—use the network.
"The problem is increasing demand and finite supply," Walls says. "It's in the public's best interest for the FFC to treat growing demand to encourage the market and not deter it." When this happens, he adds, the impact on mobile health could be tremendous, with patients getting information from healthcare providers they can act on immediately and physicians receiving data from patients far more often than a yearly checkup cycle.
FDA Silent on Mobile Health and That May Not Be Bad
The FCC isn't the only federal agency that will play a part in mobile health's future. The Food and Drug Administration is mulling over several guidance documents that will help healthcare organizations, application developers and end users understand the increasingly complex mHealth marketplace.
While the agency may be skeptical of, say, energy drinks, "FDA really likes mHealth," says Bradley Thompson, general counsel for the mHealth Regulatory Commission, an advocacy group that includes vendors, healthcare providers, clinicians and consumers. "From a public health standpoint, they realize this is game changing, and they want to make sure it will thrive."
The challenge, Thompson says, is that the FDA is reluctant to impose guidance on an industry that is changing so rapidly. The agency seems to be taking a "first do no harm" approach, knowing that Congress will keep it accountable if something does happen.
This leaves the FDA "a bit frozen," he says, and mobile health advocates frustrated at times—especially as ethical developers wait for FDA guidance before releasing their applications while "fly-by-night" developers release mHealth apps based on questionable science, only to disappear before action can be taken. "There needs to be a middle ground," Thompson says.
At the moment, the FDA is working on three guidance documents. The one closest to completion, having been held up by the presidential election, concerns what the agency calls mobile medical applications; a second, currently in draft form, looks at clinical decision support software, and a third examines at what point hardware, software and other accessories that connected to an FDA-regulated device such a heart monitor themselves "become" a regulated device. By and large, apps that merely collect data won't be regulated, but those that manipulate data will be.
Thompson says the coalition wants to see FDA guidance on a fourth topic: a distinction between wellness apps and medical apps. It's an important distinction, especially in the context of the Pew Research Center survey, since exercise, diet and weight apps are far and away the most popular mHealth apps for smartphone users.
If you track your heart rate while you exercise, that app is unregulated, Thompson says. But if the app connects to a clinical system that your doctor can see, has the app been transformed? "It's an open question if a doctor's involvement means it's no longer for general wellness," he says.
Mobile Health's Future: Huge Growth Ahead
The right regulatory framework, the mHealth Regulatory Commission wrote in an Oct. 19, 2011 letter to the FDA, is one "that promotes innovation and discovery of new ways to improve the delivery of care; reduces the cost of healthcare; facilitates private investment in the mHealth industry by large and small businesses; and stimulates job creation in the United States."
Walls, for his part, remains optimistic about mHealth's potential for treating diabetes, hypertension and other chronic conditions, which absorb a staggering 75 percent of the United States' annual healthcare expenditures. "It's about having people look for answers rather than create impediments," he says. "All the stakeholders are looking to enabling a positive outcome."
If nothing else, Walls says, people are using their smartphones as health research tools. "They are seeking more information to become even healthier."