Category Archives: mHealth

You are wearing & using health apps but is your care provider using that info?


As you know I follow the mHealth world from the perspective of the patient. Recently I read an article that gave some data on the use of mHealth apps and what the care provider is doing with it. I was genuinely surprised at the statistics. The article  (patient wearable data use) states that while 41% of Americans use the technology only 6% of the care providers were currently using the data from the patient. Working in the healthcare IT field that, as I said, was surprising. While in the field we are starting to use software allowing more patient access to patient’s information it seems we are slow to the start. Another statistic that surprised me was that 29% had no intention of using the data.

A while back, I contributed a blog post that spoke of the use of mHealth data affecting who we choose as care providers – perhaps we want to utilize care providers that are actually using our data and with whom we can see the information from our visits to take more proactive steps in managing our health. Following that train of thought does this mean that the utilization of your data (well, maybe your data) is 94% just not happening?

Another article noted that only 17 percent of consumers perceive health-related industries as being most innovative today. And that “Even in today’s modern world, people think that healthcare innovation will help physicians better treat patients most,” Keith Liu, Klick senior vice president of products and innovation said in a statement. “This suggests that, when it comes to healthcare, people still want a human connection, empathy, and other benefits that can only be obtained through the patient-physician experience.”

So we, as patients, want to see our data, often a constant effort to collect by the patient, and the care providers data and notes but we do still want that care provider to use the information in a face-to-face/human interaction and view that as an optimal care scenario.

Do you use health apps? Does your care provider use your data? And how important are the two factors – use of data and transparency of data and/or human interaction – to you?

 

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An App Here, An App There….


Do you use health apps in your everyday life? Who directed you to the apps you use? Your doctor? Friend? Co-worker? Well, if you got yours from the App Store or Google Play then you are in the majority. That wasn’t the case 5 years ago:

This marks a shift from the firm’s 2010 survey, when more than 65 percent of healthcare practitioners said they’d be the ones to recommend mHealth apps to their patients. Five years later, that percentage has dropped to 48 percent of physicians and 46 percent of hospitals. (link to article)

Back in the late 2000s the apps were mostly driven by the health providers such as physician practices and hospitals. They were also many that were related to specific disease states or information that was gathered from the patient at the specific hospital or physician practice. Now we are seeing a trend, one that has been growing for a couple of years, of apps targeted toward exercise and diet. You may have a Fitbit or an Apple Watch, use My Fitness Pal or other apps to track what you do, what you eat, what your pulse is and how long you exercised.

But a lot of the apps fail to satisfy the users need. They may be too complicated to use, take more effort to input information or just simply don’t do what the app advertises. For instance, I have a Fitbit and originally wanted it to track my sleep. But it is not consistent so I just can’t rely on the information. A lot of the apps that you might have on your phone, iPad or such you have to either read the label and input the information about that chocolate chip cookie or glass of almond milk that you just consumed. Some are sophisticated enough to scan the barcode of the product and take the information from there into the app.

So what has your experience been with apps for your health? Did you healthcare provider point you to helpful ones? Do you use apps that are specific to your disease state – as in the case of diabetic monitors? Or have you just seen others using these apps on Facebook and thought that might work for you?

Tell me about it!


HIMSS mobile IT survey


Take the HIMSS mobile IT survey here!

Completing the survey qualifies you to participate in a drawing, the winner of which will be given the choice of a Samsung Galaxy, Apple iPhone 6 or iPad Mini, and $500 either in the form of a Visa gift card or donation to the charity of your choosing.

And you’ll have the satisfaction of participating and having an impact in the world!


How well will wearables and mHealth apps work with the individual?


Just read an article which discussed the challenges that wearables, or the wearable vendors, face in actually helping the individual. Though very interesting on the discussion I am not sure I completely agree with the expert that the author interviewed. Part of me wonders if the expert really understands what the wearables purpose truly is and has kept up with the expected functions of the wearables – since some of them that they specifically point out have not even hit the market yet and speculation is varied on what they will include. I wrote a blog for my company that talks about wearables in case you want to check that out here.

Wearables are on the market and currently target specific areas such as walking steps and diabetes information. We are anxiously awaiting what the new Apple app is going to do. From what I have read the app has a lot of functions and most are tied to devices that integrate with the app. (That is the short story but if you want more check out the link above.)

The expert interviewed by the author in the first article I pointed out makes some good observations or points on what the mainstream individuals may want from wearables or even mHealth apps. He states that they want some kind of reward or motivation to keep the individual using the wearable or app. One that caught my attention was the use of personal goals. Devising the wearables to produce data or to help the individual achieve goals set by the individual. That is a great idea and one that is currently used in several fitness apps today. Another that made me go “wow!!” is a financial incentive such as insurance discounts. My first question is how are they going to know at the insurance company that I’ve used my wearable to achieve a goal in order to give me the discount? This is going back to the data and Big Brother that I did an earlier blog on. While I would really like to have those monetary incentives I have many concerns on who would have access to my data and be using it specifically for me. I’m really not so concerned with what we in the industry call “scrubbed data” or data that has the personal identifiers removed. There is that big thing called HIPAA act that I kinda like a lot.

What I really disagree with the expert about is that the users will become bored with the wearables or the apps. But I do admit that if an app requires too much daily work for me, as I experienced with the food tracking on MyFitnessPal, I don’t think I would keep up with it – I didn’t on the app I mentioned. If an app or wearable is providing usable information that is easy for the user/wearer to use then I think our culture of individuals that are trying to make their lives more healthy, for whatever reason, will be using it. If it is popular or fashionable with the public then there is even more reason for its use.

What do you think? Would you use a wearable? What would you want from the wearable or app to make it a long-term use?


Apple’s health app


The FDA has been adding some statements about mobile apps since the release of its report back in late March. Specifically, on 6/11/14 it released more clarification on what would fall under enforcement discretion – or those that it will leave up to other entities to enforce. According to mHealth they pretty much described Apple’s health app:

“Mobile apps that allows a user to collect, log, track and trend data such as blood glucose, blood pressure, heart rate, weight or other data from a device to eventually share with a health care provider, or upload it to an online (cloud) database, personal or electronic health record.”

So what does the Apple health app have included? Well, again according to mHealth, they have several diagnostic functions, including number of times fallen, galvanic skin response, and body heat flux. They have weight and activity related metrics – the ability to track body fat percentage, steps taken, calories burned. Then the nifty basal calories burned – those pesky calories burned while you sit and do nothing. And just in case you need it – the blood alcohol content results. Along with the expected medications functions – reminders, alerts to interactions, etc. Nutrition, sleep, and vital signs seem to be included.

What really interests me about the app is that is appears to be designed to work with other products more than as a stand-alone. That makes sense as it really isn’t a medical device and where else could it get most of the medical data if it did not interact? So in my mind this puts the app out there as more of a medical record for me. Then I circle back around to where does the data go?

If you are just waiting on this fall for the release of the app you might want to do some research beforehand and order your extra device for that blood alcohol content monitor, Breathometer (as seen on Shark Tank), or your Nike+ fuel monitors.

 

 


Smartphone Apps & the Healthcare Setting


In a recent blog post for Pivot Point Consulting I share information and thoughts on the use of smartphones in the health setting. We use a lot of health apps as we have become a society that is much more aware of our health over the last 10 years. We use fitness app, those with health/diseases use apps to monitor their disease state and the healthcare providers use apps to provide at the hand information. So what do you use your smartphone for related to your health?

 

smartphone


FDA and mHealth: Upcoming FDASIA report implications


In watching what is going on with the FDA and mHealth, I’ve become a bit more nervous on the topics that are lying “in between the lines” of what the FDA is working with the ONC and FCC to determine where government fits in to the oversight and regulation of the apps. Most of the articles I read keep mentioning the apps that are medically oriented – which there are thousands – and then they slide in the software just once in a while. It’s the software that I am concerned with.

In an article from mobihealth news  March 3rd, Bradley Merrill Thompson talks about current events with the Food and Drug Administration Safety and Innovation Act (FDASIA) and the PROTECT Act. Congress gave specific direction to convene a working group which included the FDA (Food & Drug Administration) , ONC (Office of the National Coordinator for health information technology), and FCC (Federal Communications Commission) to make recommendations for the regulation or lack of regulation for HIT. The report from the group is due at the end of this month and frankly, based on my research, we don’t have a really good idea of what they are going to come out with. I talked about some of the questions that Congress recently sent to the FDA in a letter in this blog.

In the article from Mr. Thompson, he gives us a quick review of the Power Point that the FDA presented (Here and then click on the FDASIA Recommendations) and picks out some very good items that the FDA report needs to answer. He refers to slide 35 and notes that the FDA should be very concise about what software is regulated and what is not. This is one of those points that I cringe at. When you say software to me I am thinking electronic medical records but the overarching “software” really can refer to mobile apps or software that is privately produced by either individuals, organizations, or companies to assist with connecting the patient to medical/disease information, patient information collection or even interaction with clinical providers, among many others. It also specifically calls to software that is directly related to or interacts with a medical device. This is truly the first door that the FDA could reasonably step thru to have more oversight and regulation of medical software – specifically electronic medical records.

The second slide he refers to, 36, speaks to defining requirements. These requirements are from development to deployment and then the post deployment updates for the apps. We, in the industry of healthcare IT, need to know the requirements before we start building these apps. Otherwise, the development is severely impacted financially. You can imagine that you spend, for example, 100 hours creating the app and for each of the hours you paid the developer $60. Then you find out after you’ve finished the app and are ready to deploy it to the public that you don’t meet the FDA requirements. That is a lot of money for any business to absorb. Additionally, if you have already deployed the app and are doing updates then you have the same concerns. And next Mr. Thompson notes that slide 37 truly drives home the fact that these regulations need to be entrepreneur friendly. Again, the regulations and requirements for the software need to be known or communicated as well as reasonable.

Generally, the FDA, ONC and FCC should be looking at which software or apps directly touch the patient and medical devices, create clear, concise and communicated regulations so that the entrepreneurs, established companies and organizations can adhere to the regulations at the very beginning. They should also consider for those apps or software already established what the reasonable regulations and timeline for any changes required should be. The industry is very far along and has complex software that could be adversely affected and the economic impact could be significant.

 

Any thoughts on the upcoming report and it’s potential impact on mHealth?

 


mHealth and the FDA – where is the path leading?


Mention FDA in the healthcare world, especially around us software geeks, and everyone gets quiet and cringes.  I’ve been in healthcare for over 25 years and 15 of those included pharmacy work. So I am very familiar with the FDA. And let me tell you, they have some strong points and some weak points. (And this is my opinion only.)

I am passionate about mHealth and what it can do for the patient and the public. And right now we are at the cusp of an explosion with this. Mobile apps, including Apple’s health app, Healthbook, is getting a lot of attention lately. But this attention, in general, has gotten the attention of the FDA and even Congress.

Now, I’m not a person to tell you which app to use, as I have personally experienced the search to find that app that does what I want it to do, preferably for free, and doesn’t charge me to use more of the good stuff/functions. Taking a look at the Healthbook app courtesy of 9to5mac I like what I see because it is not just a fitness, food, exercise tracker but gives some real tools to help those with chronic conditions. But don’t let me get off track here….

Back to my main point with the FDA and Congress. A few days ago mHealth News shared an article by Erik Wicklund telling us of some of what Congress wants to know from the FDA on their (what I call) control of mobile health apps. And of course, Congress sent the FDA a nice little letter.

“It is important for the FDA to be well-equipped with the proper tools to advance public health while taking care that innovation is not stifled through uncertainty or over-regulation,” the letter stated. “While the FDA’s final guidance has provided clarity on the agency’s approach to regulation of mobile medical applications, we believe more transparency is needed to avoid stakeholder confusion over how a wider range of medical software might be appropriately regulated.”

Then they provided 9 questions to the FDA. When reading thru them I caught note of a few that asked how Congress might help with XYZ. That’s awfully nice of them to ask the FDA. And Congress had some really good technical questions for the FDA. They asked about risk levels, software update tracking, how do they know that the if the app has a function not classified by the FDA, and if they have been coordinating with the Office of the National Coordinator and the FCC. But my favorite question was:

“What approach does the FDA use to regulate complex medical software with multiple and separate functions?”

That made my gut churn. So far the medical software companies have been good at keeping themselves out of the FDA reach. But this question tells me that not only does the FDA have them on their minds but now Congress has caught onto this idea of regulation. I’ve worked in healthcare IT for over 10 years now and mainly with the software implementations and it truly alarms me to think of the FDA stepping in, much less Congress (we’re familiar with their record in other areas lately) and the effect and total chaos that they could bring to the industry.

But I’m going to sit back and pay close attention to this development and I’ll keep sharing my opinion with you. Again, some may not agree with my opinion but maybe you/they will take it as food for thought…
In the meantime look for upcoming posts!


The new “drugs” – smartphone apps or patient engagement? or both?


In a recent post I mentioned a quote from Sherry Reynolds:

 “If  # OpenNotes was a new drug that increased patient engagement by 85%,  every doctor in the country would be prescribing it.”

Now I see an article from American Medical News talking about smartphone apps being the new drug. That really caught my attention – mostly because I am trying to use that concept in my graduate class theory paper. But back to the point…We all have kids that can’t put down the phone – the smartphone because they are texting, Facetiming, gaming, or who knows what else. I’m one of those adults that is almost as bad as my child. I am always checking Facebook, checking my WordPress for comments or likes, looking up the closest cupcake bakery, or texting one of my children or Hubby because I’ve forgotten what I was supposed to have been doing while I was doing all of that. Am I addicted to my smartphone? Nahhhh Could I go a day without it completely? Hmmmm, not so sure…..I’ve gotten close while on two cruises. But when you get to shore you can usually see who’s doing what on Facebook that you might have missed. Or even those wonderful work emails that you are truly afraid that someone messed that project up while you were gone. OOYY!!

So you can see where I am going with the familiarity of those people in the US younger than the age of say 55 – no, don’t go all ballistic on me if you are over 55! My dad only knows how to answer and call on his flip phone and my mom is becoming an iPhone guru so people are different! We rely on those smartphones. Sometimes we rely on them to the point of psychically wrong proportions -but that’s another article.

This is the key point I like about this article:

Discussions are taking place in exam rooms across the country about how a $1 app could be a viable alternative to prescribing a medication and help patients monitor their health. Some even have referred to the act of physicians recommending mobile health as “prescribing an app.”

In the traditional sense of prescribing, the phrase is not accurate, said David Collins, senior director of mHIMSS, a subsidiary of the Health Information and Management Systems Society focused on mobile health initiatives. “But in the digital wave of medicine, when it comes to mobile health, I’d say it does make sense. Patients are used to going to their doctor’s office, getting their problem solved and leaving with a prescription in their hands.”

A few things to think about with this theory, from my point of view.

1) are the patients in that group of users that will know how to get the app, download/install it and then use it? If yes, this can be quick – a business card with the name of the app and whether it is available on the Apple platform or the Android.

2)If they can get to the point of using it then do they know how to get the good stuff out of the app? With calorie counter apps it seems to be easier – you program the number of calories per day, track what you eat, see how you do. With apps that are more complicated and linked – usually via bluetooth – then there is a bit more complexity to the use of the app and the information that you get from it. Then how do you share that information at your next visit? Or even before your next visit?

3) The physician – or designated office person – would need to become a person who helped patients go thru this cycle of us. They are going to have questions when they get home. They are going to have questions when they have a weeks’ worth of data in the app and can’t see what they think they should. They will need help. Can a physician office or clinic charge for that service? (my devil’s advocate at work there.)

Overall, this is a great idea. It is moving on the right path to a nation that has been embracing a healthier lifestyle over the last 15 years. Truly, we have. There are still issues with obesity and such but there is a major trend in our population to develop and maintain healthy lifestyles.

These are some great statistics:

PATIENT MOBILE HEALTH BELIEFS

59% say mobile health has given them solutions that have replaced some doctor visits.

52% say mobile health will lower health care costs within three years.

49% think it will change the way they manage their overall health.

48% say it will improve health care quality within three years.

48% think it will change the way they manage chronic conditions.

48% say it will change the way they manage medication.

46% believe it will make their health care more convenient within three years.

PHYSICIAN MOBILE HEALTH BELIEFS

42% say mobile health will make patients too independent.

27% will encourage patients to use mobile health apps.

13% will discourage patients from using mobile health apps.

Source: “Emerging mHealth: Paths for growth,” PwC, June (pwc.com/en_GX/gx/healthcare/mhealth/assets/pwc-emerging-mhealth-full.pdf)

 

Do you think you would use an app that your physician recommended ? How much “help” would you expect to need to use it? How much interaction would you expect with the physician/office if you were to use it – more or less?

 


MappyHealth – is Twitter telling us the picture of our health today?


I happened upon MappyHealth doing research for my public health class and found that it was extremely interesting. It takes tweets and analyzes them to give us a picture of our health.

For instance, this morning I am still suffering from allergies so I thought I would see what is going on in the world of acute respiratory illness (it was one of the listed tags under conditions.) Here is the graph that I saw telling me the volume of tweets. It looks like we’ve had something brewing in mid-October.

from MappyHealth

 

 

 

 

 

 

 

I even found out what has been going on in Texas over the last week.

MappyHealth

 

 

 

 

 

 

 

Even more interesting is that if you click on a graph from your search you can even get to the tweet level – showing who – by Twitter name – posted and what they posted to put them in that condition group. So here is the one for Texas for STDs! 🙂

 

 

 

 

 

 

Now what do you think of this being out there? Is it helpful or privacy invasive? Were you aware that your Tweets could get you onto MappyHealth?

My first reaction was shock when I saw that it got down to the Twitter name level. But my other voice – who often plays devil’s advocate – said that if I’m going to put something on Twitter that might put me in the category …. well, maybe I should think of that first.

Overall, do I see this as a helpful tool for public health and awareness? Maybe. I’m not too convinced of its validity in the world of true research and statistics. But it is interesting…

What do you think of it? Go try it out and tell me… you have to try it!


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