Researchers struggle to evalulate the cost effectiveness of mHealth medication adherence interventions

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In the “Journal of Medical Internet Research mHealth and uHealth” a team of researchers from the Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine have published a paper claiming there is insufficient evidence to support the cost effectiveness of SMS/App based medication adherence in adolescents with chronic conditions.

mHealth Insights

I’m surprised by the findings of this paper because nearly ten years ago I asked a NHS GP friend to poll his Patients about the use of their mobile for medication reminders and he couldn’t find any female Patients who didn’t already use a ZERO COST DIY medication adherence app (a simple alarm/calendar/app set up to remind them to take their pill).

Om Malik I live with a disease and my phone is as much a part of it as my meds

Medication adherence is such a huge and complex problem costing economies like the US hundreds of billions of dollars per year so it should be obvious that a simple one size fits all SMS/App won’t come along and definitively put an end to the issues. Equally if a genius does manage to crack such a manifest problem with a mHealth app you can be sure she will not be prioritising the publication of a research paper that proves the cost effectiveness of this new approach because it’s not very glamorous (eg. while I’ve read about countless dreamers talking up big data, wearables and Virtual Reality etc I’ve  not once seen Urologist Dr Robert Flynn invited to present at a major Healthcare innovation conference or written up in Healthcare journals even though he published in 2011 evidence that conclusively proved the cost effectiveness of SMS appointment reminders – which are related to adherence as Patients with the lowest adherence levels are probably those who also don’t attend their appointments) and if it works there are millions of really smart Carers who will want to adopt it right away regardless of the cost effectiveness because what we’re doing today is clearly not cost effective.

To find results for a paper like this I think the researchers should focus on areas where adherence is being effectively twinned with financial incentives eg. we all know that connected glucometers take the guess work out of diabetes testing and effectively end the billions that are lost/wasted on diabetes test strips.

Why Big Pharma struggles to innovate with mHealth

I would recommend researchers in this area engage with entrepreneurs who are actually working in this business – you can find a great list of them in the mHealth networking group introductions thread – because analysis of published papers is unlikely to yield results as these are only really going to be helpful for rear view market evaluation (eg. analysing evidence for the cost effectiveness of dated adherence interventions that don’t leverage the tools of our time and increasingly make no sense to the next generation).

Another area I would study would be the work of pharma retail giants like Walgreens and McKesson as they have huge financial incentives in getting this right (eg. the Walgreens mHealth app generates +$B’s/year and did more business in it’s first 12 months than had managed online in the previous 10 years). A particularly valuable area I think researchers could learn lots from analysing would be the situation we have here in Ireland where a mHealth medication adherence service developed by the largest pharmacy retail brand (owned by McKesson) produced a model that was so successful the Health Service Executive charged the company with fraud.

Related posts:

NIH funded researchers spend $270 on misleadingly labelled iPhone apps & conclude that apps offered for ‘EDUCATIONAL USE ONLY’ can’t be relied on for ‘PROPER MEDICAL ADVICE’

“Majority of mHealth apps fail to engage patients”

Remote Monitoring in Heart Failure: No additional benefit

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The Medical Tech divide is disappearing thanks to #mHealth


We know that Mobile is the only tech that is more distributed in low income countries than in their affluent counterparts but now mHealth is doing the same for Medical Technologies.

Never before have you been able to find the exact same high quality Medical Technology being used by multi-billionaires (like Mark Cuban – see above), Patients who get it prescribed by their National Health Service


and within the world’s lowest income rural villages…


Click here to order your own Alivecor – the world’s cheapest and most easy to use ECG machine.

Related posts:

The Smartphone Medical

Apple CEO thinks mHealth revenues will dwarf the $Trillion Smartphone market

What unthinkable things will mHealth make possible?

Why we’re more likely to drop the “Health” than the “m” in mHealth


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Why is the #ChoosingWisely campaign ignoring the opportunity to choose if an office visit is needed?


“Doctors are giving too many patients tests and drugs they do not need, senior medics have warned, as they published a list of 40 treatments which should no longer be in routine use.

The unprecedented intervention by the Academy of Medical Royal Colleges (AMRC) follows research which found doctors commonly ordering X-ray, scans and drugs, in cases they believed to be pointless.

More than six in 10 medics said their decisions had been driven by a fear of litigation, with just as many saying they ordered interventions because they felt under pressure from patients”

The ChoosingWisely campaign looks very interesting (helping Patients to choose wisely by letting them share info and consult with independent impartial Doctors is the reason we launched 3G Doctor in 2006) but it seems to be a classic case of Doctors failing to see the wood for the trees.

I personally find it quite hard to take the findings seriously when you read that plaster casts costing a few £’s for children who have injured their wrists are somehow topping the list of wasteful practices, but it’s impossible to overlook the reality that most of these wasteful practices being pointed to are so commonplace because the alternatives aren’t being funded eg. a GP can refer a Patient for a myriad of expensive treatments/tests that have been sold to the NHS/HSE by teams of well funded and persistent sales professionals but most find they can’t even use the tools of our time with their Patients and there isn’t even the capacity to prescribe inexpensive services:


I think it’s also key that campaigns are realistic in their ambitions eg. with most Patients being interrupted within seconds of starting to talk what evidence is there that the suggested list of 5 additional questions for Patients to ask their Doctors will be welcomed by their Doctors?

The vast majority of medical consultations remain undocumented so I think it’s also highly unlikely the quality of the care will be improved if we have Patients focused on asking (and trying to remember the answers they’re told) this extra set of questions (perhaps they should be integrated into the clinically validated Patient History Taking questionnaires that Patients are already using to communicate with their Doctors?):


I think the answer to the “What if I do nothing?” question the campaign wants Doctors to ask of themselves is that all too often it’s not on option for fear of a complaint/solicitors letter. Perhaps the ChoosingWisely campaign would have better results if it focused on educating Patients on the harms caused by the practice of defensive medicine.

Overall I think the campaign is largely a missed opportunity because clearly the biggest opportunity we have to ‘Choose Wisely’ is when we let Doctors choose if this concern is something that will be best served by an office visit.

Related posts: 

Are Patients wasting GPs time OR are undocumented Doctor office visit only models wasting everyone’s time?

Does John need your time or attention?

If you think the product you make is Appointments the NHS makes no sense

Are you better off seeing your GP in the morning?

Flipping the Clinic: Listen to your Patients they’ll tell you how they want you to care for them

Patients need the ATTENTION not the TIME of their GP

The Evidence is in: AskMyGP is helping NHS GPs work at the top of their licence

Why don’t Patients ask Doctors more questions?

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Will Ratings have more impact than Precision Medicine approaches to Clinical Trials?


This interesting JAMA article suggests that a Precision Medicine Approach to Clinical Trials  is an evolutionary not revolutionary step.

I agree. Clearly Patients are desperate to be involved in this industry but in just a few years it’s going to seem such an outdated idea to make an appointment with a specific clinic in the hope of finding a Physician who will be able to match you with a clinical trial that will accept you.

“Five or 6 years ago, only 5% to 10% of patients at David Hong, MD,’s clinic arrived with a mutational profile of their tumor. Today, it’s more like 25% to 30%. They come bearing their tumor profile in the hope that they’ll qualify for one of a growing number of clinical trials targeting specific biomarkers, a strategy called precision medicine. Desperate, some come already knowing that they qualify for a particular trial, thanks to Facebook groups for cancer patients whose tumors share the same genetic abnormality and other online resources”

As I explain in this talk I gave at the Mobile Clinical Congress in Edinburgh the step change happens when we think like the BornMobile generation and let Patients and Clinicians rate Clinical Trials


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What happened to the mHealth Summit?


I’ve drafted a blog post about what I think happened with the mHealth Summit – the world’s biggest mHealth industry meeting – now in it’s 8th year that has merged with Partners Health’s Connected Health Symposium and been renamed by HIMSS as the Personal Connected Health Alliance’s Connected Health Conference.

Before I post it I thought it might be a good idea to post a draft post in case any readers have experiences or thoughts they’d like to contribute (please get in touch via email or the comments thread below).


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Has your clinic/hospital ordered a Tesla yet?

Elon Musk has revealed that all Tesla vehicles in production can now:

> Drive themselves (with no human input at all)

> Travel through urban streets to highway and back to streets before finding a parking spot (by reading street signs)

> Locate you and return whenever you tap the ‘Summon’ button on the Tesla app on your smartphone

> Recharge itself (by driving to a charger station that has the automated solid metal snake charger)

mHealth Insights

When the Royal College of General Practitioners vision for General Practice in 2022 consists of merely of Patients using the internet to make office visit appointments with GPs it’s important we’re all paying attention to how rapidly the world around us is in changing as it’s likely autonomous tech like this will externally transform the need for housecalls, waiting rooms, etc.

Can you imagine a video consulting Doctor deciding that their Patient needs to be seen in person and summoning the clinics specially equipped vehicle to drive to their home to bring them into the clinic?


Can you imagine how quickly a Tesla vehicle could pay for itself if a video consulting Doctor could be productively working from the rear of an autonomous Tesla vehicle seeing Patients while enroute to visit others? The savings on avoided parking tickets would probably pay for the vehicle in a busy city like London!


Related Posts:

mHealth is to ever more sensory Mobile Phones as Public Safety is to Driverless cars

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Kaiser Permanente expect to provide members with 240,000 Mobile Video Consults next year!

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“30,000 secure emails a day between our physicians and our members and we’ve seen (the number) of face to face visits decline exponentially as we’re doing more emails. So we’re already seeing the shift from physical to digital and from digital to centralisation of care. What we’re doing now is we’re deep into creating a Video Dial Tone so that anybody who has a problem that can be better served, and more conveniently served with a Video Visit can do so. We have abou 2,000 video visits a month right now and by this time next year it’s our expectation that we’ll have 20,000 video visits a month. Again it’s providing people with much more accessible and convenient care and what we’re really looking forward to in the future is building the same kind of evidence based system for virtual care that we’ve had for traditional medical care. So in what circumstance is a video visit more effective, more appropriate than a text message? How do we know in what circumstances which type of visit makes the most sense?”

Interesting insights into incredible pace of adoption of Mobile Video Consults at Kaiser are being shared in the brilliant (free) #XMed LiveStream by John Mattison MD, CMIO and Assistant Medical Director, Kaiser Permanente USA (with an annual operating revenue of +$60Billion KP was the world’s first major Healthcare organisation to publicly announce it was going Mobile First).

Related Posts:

Why video consulting with a Doctor isn’t the same as ‘virtual consulting’ (March 2010)

Mobile Video Consulting best practice from nearly 10 years experience with 3G Doctor.

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