Many lessons can be learned from the history of successes and failures in relation to mobile health (mHealth) deployment. As an industry, mHealth has the opportunity to learn from other industries and countries that have tread roads that mobile health has not. While the application of mobile technologies in healthcare may lag behind other industries (i.e., the banking industry), the opportunity to gain perspective and avoid “re- inventing the wheel” serves as an opportunity to create a successful mHealth initiative for the future.
Chronic disease management poses as a way to utilize mHealth to help patients better manage their health. For example, remote monitoring devices can help patients record their own health status and instantaneously send images or information to physicians. This keeps patients out of the physician’s office, allows time for the physician with other patients or care-related activities, and ultimately helps reduce costs by keeping patients out of the hospital.
Involving patients with chronic diseases in their healthcare has been difficult and largely unsuccessful both in terms of engagement and retention. Engagement is important since chronic disease drives and remains a significant portion of overall healthcare costs.1 Compared to other countries, the U.S. historically has not managed chronic diseases well, even though the U.S. delivers high-quality acute care. Even with the latest surge in electronic medical record (EMR) deployment and mHealth initiatives, chronic disease management still falls short. Three broad categories can help summarize some reasons: financial incentives, organizational management, and patient engagement.
Case Study: The Future in Hand
mHealth Technologies Hold Promise for Better Managing Chronic Illness
In Sacramento, CA, a mother posts the results of her son’s latest round of treatment for neuroblastoma on a protected social network website. More than 2,500 miles away in North Carolina, a man who has been struggling to control his diabetes receives a text message from a health coach about a recent spike in his blood sugar level and asks what he ate for breakfast. Every day, from every corner of the United States, people are turning to mobile technologies to help them understand, manage and cope with chronic illness. According to the Pew Research Internet Project, 72 percent of Internet users look online for health information and one in three cellphone owners have used their phone to access health information.2,3
A variety of preventable factors—poor diet, alcohol consumption and lack of exercise—have increased the prevalence of chronic diseases, which include diabetes, cancer, heart disease, stroke, obesity and arthritis. Over the past century, chronic disease has eclipsed acute illness as the major cause of death in mankind and is now driving the skyrocketing price of healthcare. Seventy-five cents of every healthcare dollar goes to the treatment of chronic diseases.4
Unlike an ear ache that can be managed by a trip to the doctor and another to the pharmacy, chronic illness can only be managed by reaching patients where they live. Once patients leave the provider setting, they are responsible for the daily management of the disease. It will generally be months before the next doctor visit, by which point their condition may be uncontrolled or complications may have set in. A bridge is needed that helps connect the patient to the care team in order to deliver constant monitoring and appropriate care.
Mobile health (mHealth) technologies are that bridge. These real-time monitoring devices—educational apps and symptom trackers—connect and promote the self-management of a person’s health at a tremendous cost-savings to patients, providers and employers. Innovations in mHealth transform the care of chronic diseases by creating a continuous patient/care team interaction in place of the episodic one that exists today.
New Ways of Connecting Patients to Providers
Empowering individuals with chronic disease to better manage their health is shown to prevent complications, improve outcomes and reduce medical costs. However, traditional disease management approaches have largely failed because they are unable to target those who need focused outreach and take an ineffective and expensive “scattershot” approach to patient engagement. Once patients in need of engagement are identified, traditional, telephonic disease management lacks the tools needed to collect actionable data and drive meaningful health improvement. Because it does not adequately connect caregivers, treating physicians and patients, traditional disease management has largely been abandoned on grounds of high cost and low adherence.
Mobile health tools create a low-cost stream of highly actionable clinical data, using readily available cloud-connected sensors, ranging from glucose meters to heart monitors to asthma tools. The mobile platform offers new ways for patients to stay connected to clinicians and bridge barriers to compliance, such as language, transportation and financial considerations. For patients who may miss their diabetes education appointments or ignore educational materials handed out in the office, mobile health tools can bridge the gap by delivering educational support in the right format, at the right time to patients. Rural patients who must travel many miles to see a physician, often in areas where weather impedes travel for months at a time, have real-time access to their care team. Healthcare providers can send daily or weekly texts or emails, including general educational messages, diet and exercise tips, health reminders, and information about local healthcare providers and resources. While there is considerable focus on the smartphone or internet as an information delivery tool, mHealth technologies can just as readily trigger automated “snail mail” updates for less technologically-focused patients who respond better to that medium.
A Fresh Approach to Engagement
Our ability to manage chronic illness is hampered far more by challenges in gaining patient adherence to existing therapies than by the lack of effective therapies or the need for new ones. In one survey, 75 percent of doctors and nurses interviewed said that patients have difficulty following prescribed diet and lifestyle changes, and two-thirds believe that patients fail to adhere to medication and treatment plans.5
mHealth technologies empower care providers to improve engagement by prioritizing and setting incremental, patient-centered goals that allow patients to build on small successes and turn them into large, sustainable health improvements. Activity and nutrition trackers can chart progress toward exercise and weight loss goals. Medication adherence technologies can help remind patients to take their medications at a prescribed time of day and some can monitor whether the medication was actually taken. Cellular-enabled blood glucose meters can help patients monitor their blood sugar and transmit test results to a secure server. In addition to these benefits, many mHealth technologies enable patients to create online communities and reap the value of peer-to-peer interactions in managing the disease and changing behaviors.
mHealth technologies give the care team something they never had before—access to ongoing, real-time clinical data. This breakthrough technology not only enables them to monitor patients’ health and adherence to treatment plans but represents a new way of delivering on-time care and interventions.
Emerging Technologies Lower Healthcare Costs
Time and human resources are luxuries most providers can’t spare. Traditional disease management programs can be prohibitively expensive and may not precisely pinpoint the individuals in most need of support. They’re founded on unreliable telephonic outreach and lack the data-driven insight to bring about time-sensitive and lasting change. Innovative mHealth solutions are improving the cost efficiency of care in many ways, such as reducing the need for hospital visits and reducing the time required to manage patients’ conditions.
One study shows the use of a mobile healthcare solution for monitoring diabetes can lead to a $3,300 per person annual reduction in employee healthcare costs.6 The overall savings to the employer represents more than five times the cost of the monitoring program, an unprecedented return on investment in the employee health and disease management industry.
mHealth solutions reduce the impact of chronic illness on patients and their families. At a system level, mHealth delivers better care for more people at a lower cost. Most cost saving innovations in healthcare come at the expense of consumer inconvenience and dissatisfaction. In contrast, mHealth offers patients a greater sense of connectedness to care providers, improved sense of well-being and increased satisfaction with the care experience. Twentieth century healthcare was shaped by the development of antibiotics and vaccines that addressed the major causes of death. Twenty-first century healthcare will be shaped by mobile technologies that move healthcare from a location-based (i.e. hospital or doctor’s office), episodic process to an anytime, anywhere, continuous process that is as mobile as we are. In that way, mHealth will fundamentally transform the way healthcare is delivered.