What is the clinical value of mHealth for patients?

Screenshot 2020-01-23 at 15.38.28

An interesting paper asking “What is the clinical value of mHealth for patients?” has been published in Nature by Simon P. Rowland (Department of Surgery and Cancer, Imperial College London), J. Edward Fitzgerald (KPMG International), Thomas Holme (Department of trauma and orthopaedic surgery, Epsom and St Helier University Hospitals NHS) and Alison McGregor (Nuffield Department of Primary Care Health Sciences, University of Oxford).

mHealth Insights

“Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mobile apps should be utilized to add value to patient care”

We saw a paper similar to this back in 2018 and I think it’s a classic case of not being able to see the wood for the trees.

I think this is because medical educators despite the evidence still aren’t teaching students to use the tools of our time.

If you are a medic who needs to modernise your skills please consider taking the “mHealth for Healthcare Professionals” certified programme that I developed to help educate healthcare workers about the opportunities presented by mobile technology for advancing access to and quality of healthcare.

In 2020 you fail the MRCGP exam automatically by having a mobile phone on your person. Examiners should be testing you on how you use your mobile with Patients because when Patients see you uncomfortable using a mobile they may doubt how current your medical knowledge is.

“We categorize apps according to their functionality (e.g. preventative behavior change,digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematicreviews and meta-analyses and the relevance to patient care”

This is a common misunderstanding that medics have about mHealth. It’s key to understand that basic features of mobile are often the most valuable apps used for mHealth. We don’t have to have Patients download apps to their smartphones before mHealth can totally transform care eg. it’s as easy as saying ‘here’s my number’.

I wrote all about this over at Mobihealthnews 10 years ago: Successful mHealth applications are already here.

“There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes”

This is a classic misunderstanding of the motivations for publishing evidence. 9 years ago a hospital here in Ireland published evidence stating how appointment letters, reminders etc should be replaced by SMS but the HSE ignores it and still wastes millions every year on more expensive and less useful snail mail and missed appointments.

It’s important to appreciate that because mobile first designed care is typically a lot more efficient and less expensive than the services it doesn’t benefit from being published in the same way that a new therapy or drug would (as these innovations come with new growth opportunities for the healthcare businesses eg. increased staffing and/or costs that they can pass onto payers like the government or insurance companies).

If you think mHealth apps aren’t getting adopted without evidence being published in clinical publications study the emergency call business. The entire Irish out of hour Doctor rota is organised using SMS for years. +99% of all calls have been made using mobile phones for 10+ years now in places like UK/USA/Ireland. Very little/anything can be found on pubmed but lots of work has been done behind the scenes by engineers. If they hadn’t figured out things like caller ID, location awareness, mobile phone design etc etc the services we see today would be completely unmanageable.

“The World Health Organization (WHO) Global Observatory for eHealth (GOe) defines mHealth as medical and public healthpractice supported by mobile devices”

When I coined the term mHealth I realised this issue was going to be a problem. It’s incredible that most people still don’t realise that the biggest part of the mobile industry still lies in the $T networks that cover the world… Before you have any hope of appreciating the mHealth opportunity you must understand that the m is for mobile the newest and least understood mass media.

“In total, 2.5 billion peopleworldwide own a mobile phone and there is huge potential for mHealth to facilitate unprecedented access to specialist clinicaldiagnostics and treatment advice. In the US 56% of physicians have discussed mHealth with patients and 26% have been asked about mHealth by a patient (PWC Provider Survey)”

I would doubt the value of a ‘Provider survey’ as most ‘providers’ still use fax machines. The vast majority (+99%) of Patients in the US have used their phone to call someone for medical advice or to look something up. Note: Facebook is very much a mHealth app.

“Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mHealth apps should be utilized to add value to patient care, where value might include improvements in speed and accuracy of diagnosis, personalized treatment regimes, behavioral change advice, patient education or improved access to established therapies such as cognitive behavioral therapy (CBT)”

It’s mostly about training. The Internet and Mobile has totally transformed education but the Universities have for the most part not yet realised:

Please be patient im still learning

“This article discusses the potential valueof mHealth apps for patients and the challenges that cliniciansface in discussing mHealth apps in clinic”

I see this is a major hurdle to the value of this paper. It’s focused on how mHealth apps can support the 2000 year old office visit model but the biggest opportunity is clearly for the newest mass media to take us beyond that model.

The Doctor office visit only model no longer works because we can look it up.

It’s like thinking a paper on how mobile will transform the post office will be interesting whereas the real opportunity lies in how mobile has transformed (and continues to transform) communication.

“Despite the citations of diagnostic mHealth appsthere is huge potential and evidence is starting to emerge todemonstrate clinically significant improvements in morbidity andmortality outcomes in specific scenarios”

I think we’re long past talking about ‘Current limitations’. Check out the Smartphone Medical from 2013. I think it’s clear none of the papers authors have ever seen an experienced medic using a quality mHealth diagnostic app like that developed by Alivecor and unfortunately I think this substantially undermines the value of this paper.

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