By Yiftah Ben Aharon, Co-founder and CEO, GlucoMe
Increased patient involvement, greater patient awareness of health issues, and heightened motivation for patients to lead healthier lifestyles; all this and more are among the boons of the digital mobile health revolution. Many physicians have learned to take advantage of — and contend with — the plethora of possibilities health-oriented apps and devices have opened up.
Apps make it possible for physicians to stay on top of patient behavior in a way that was impossible until now. They also enable patients to keep a constant eye on their own conditions, taking a greater role in ensuring they remain healthy or recover faster from a disease.
So what could go wrong?
That depends on what the apps are going to be used for. Take for example apps that enable patients to follow up with physicians after treatment. As demonstrated in a recent University of Toronto study, these tools could reduce the need for follow-up visits, lowering costs and ensuring better recovery for patients who often miss those follow-ups because they are feeling better. Other apps, such as one that purportedly lets users measure their blood pressure using an iPhone, can be downright dangerous, supplying incorrect information and perhaps encouraging bad behavior by patients.
That latter app has since been pulled from the App Store, but its presence there for months is a cautionary lesson for physicians, healthcare professionals, and administrators on the limitations of mobile health technology.
Healthcare professionals run some risks when prescribing apps to patients. On the pro side, patients may be more engaged; however, some may also view such an app as a replacement for their doctor. For instance, if an app says patients are doing well, they may decide they can skip an in-person appointment — a decision that could eventually come back to haunt them. Even worse, apps might undermine long-term doctor-patient relationships as patients begin to rely on apps instead of providers for information. Evidence on whether or not this is true is hard to come by.
The last major study on how information technology impacts the relationship between patients and physicians was conducted in 2008, but there is plenty of anecdotal data online over concerns physicians have about losing touch with their patients.
Other dangers of health apps include the compromising of patient data (hacking is just as big of a problem for developers of health apps as it is for others), as well as the possibility an app that records inaccurate information could upload that bad data to patients’ EHR, spreading problematic information throughout their care cycle. And, of course, there's the bottom line: healthcare facilities could end up losing income if patients begin to replace them with apps.
The bottom line works the other way as well. Government subsidies for increasingly expensive healthcare are falling. Additionally, new regulations are in effect regarding everything from minimal levels of care insurance companies must cover to requiring implementation of electronic records. To adjust, healthcare professionals will have no choice but to work apps into their courses of treatment and work with patients to ensure they are used wisely.
A good example of where using apps is not only wise, but probably necessary, is in the area of EHRs. Under the HITECH (the Health Information Technology for Economic and Clinical Health) Act, healthcare professionals are required to demonstrate they are using EHRs in a “meaningful” manner in that they are keeping up to date records on patients that will contribute to their care. Professionals who comply can receive incentive money from the government, but failure to comply can lead to penalties.
The Act institutes EHR-related requirements for doctors including recording patient demographic information, maintaining an active medication and allergy list, recording smoking status, and others. Unlike some of the other record-keeping requirements (such as the obligation to provide clinical summaries to patients for each office visit), these are essentially recorded by healthcare providers based on patient self-reporting — this data can be reported just as well, if not better, via an app from home instead of in the office.
Devices and apps that can communicate with a healthcare provider's database can go even further. For example, the Act requires doctors to record and chart changes in vital signs, as well as record and report ambulatory quality measures — data that can be recorded and uploaded automatically. The same goes for other requirements, in which the healthcare professional needs to provide data to the patient such as electronic prescriptions or a digital copy of their health information. Under proper medical supervision, this system can be used to help patients maintain a doctor-prescribed ongoing treatment schedule, such as automatically reminding them when to take their meds or scheduling a pulse check at various times throughout the day.
Ensuring doctors remain in the digital loop — and in fact, manage the loop — turns the medical app phenomenon from one that can potentially harm patients and damage their relationships with healthcare professionals to one that aids in all aspects of the doctor-patient relationship. By embracing apps and devices, and supervising how they are used, medical professionals can ensure that technology is used to the benefit of their patients, not to their detriment.
About The Author
Yiftah Ben Aharon is CEO and Co-founder of GlucoMe, a digital diabetes management platform that streamlines and simplifies diabetes care. Prior to founding GlucoMe with Dov Moran in 2013, Ben Aharon was VP R&D of Sentigo Technologies and Software Group Manager at Modu Mobile.