Rob Carnahan lives in rural Oregon, about 80 miles from the nearest Kaiser Permanente facility. But the 63-year-old checks his personal health records, emails his doctor, receives lab results and makes appointments from out in his fields.
He's even refilled a prescription from atop his tractor.
Carnahan is an avid iPhone user and is on his third generation of the popular smartphone. He accesses the Kaiser Permanente website through the device to keep on top of his health care needs, and he rarely uses a laptop or desktop computer to do so.
"There's 12 hours on the field to go around," he said. "You have a lot of what I call 'brain dead time.'"
Kaiser Permanente, the Oakland, Calif.-based managed care giant, is seeing more and more of its members, like Carnahan, migrate to mobile devices to access the robust services available on its flagship website, kp.org.
On May 8, Kaiser launched its iPhone app. The health care giant launched its application for Android phones and a mobile-optimized kp.org in January.
The Android app has been downloaded about 100,000 times. Since the launch, 3.3 million visits to kp.org, or about 15% of total visits to the site, have come from mobile devices, according to Kaiser officials. About 3.9 million members, or 63% of all eligible members, are using kp.org, according to Kaiser.
Experts call these usage trends impressive and say that integrated health systems are way ahead of the curve in terms of mobile offerings. At the same time, they warn that patients should be aware of the rules and risks of carrying personal health data with them -- especially through apps that, unlike Kaiser and other health providers and plans -- don't have to adhere to strict privacy rules.
"I think Kaiser's numbers are incredibly encouraging," said Deven McGraw, director of the health privacy project at the Center for Democracy and Technology. "Being an integrated system, they are well-positioned to deliver these services to members."
Indeed, other integrated health systems, including Group Health Cooperative in Seattle, also offer personal health information through mobile devices. Group Health last summer launched its iPhone and Android apps, which allow members to make appointments, refill prescriptions, check lab results, email their physicians and check wait times at local clinics. Since July 2011, the mobile app has been installed on 36,700 devices, or 34% of members with smartphones, according to Group Health.
"I think it's pretty clear that more and more computing is moving to the mobile platform," said Gwen O'Keefe, chief informatics medical director at Group Health Cooperative. "It's another aspect of doing business, and it's going to become a core way of running your business."
Nearly half of adults nationwide owned a smartphone as of February, up from 35% from the previous year, according to the Pew Research Center. Some 88% of adult Americans own a mobile phone, and 17% of mobile owners have used their phones to look up health or medical information, according to the Pew Research Center.
Kaiser Permanente spent most of 2011 creating the Android and iPhone apps, pulling from multiple data sources and working on functionality and security, officials said.
"It's a younger technology so there were a lot of issues we needed to work on so we didn't disappoint our members or ourselves," said Christine Paige, senior vice president of marketing and Internet services at Kaiser.
Privacy and Security
For security purposes, Kaiser members must input their user name and password each time they access their health information through mobile devices. The fields don't autofill. "Each session must be authenticated anew," said Paige. The same is true for Group Health's mobile applications.
As both providers and insurers, Kaiser and Group Health Cooperative must adhere to HIPAA, requiring them to keep patient data secure and private.
HIPAA provides safeguards to consumers accessing personal health information through mobile devices as long as that data are stored on servers operated by providers and health plans. However, these privacy standards don't apply to some other personal health offerings from technology companies such as Microsoft and Dossia, McGraw said.
"We're going to need to get to the point where people who aren't members of Kaiser or Group Health can access their personal health information on the go, too," McGraw said. "But we need to have the policies in place."
She said she is encouraged that the data are not stored on the devices themselves and that users must log in at the start of each session. Liability for data breaches falls to the providers if the data are stored on their servers, as is the case for Kaiser and Group Health, while liability for data breaches would fall to patients if the data are stored on the individual phones, McGraw said.
But even Kaiser and Group Health members should take extra precautions when using these apps by password protecting their devices, she said.
"Kaiser doesn't control how patients deal with their own mobile devices," she said. "But it can go a long way in helping people be smart with their smartphones."
The costs or savings of mobile health for providers aren't yet clear, but Kaiser officials said that they think they will see cost savings. "Having people use these online features contributes to cost-effectiveness in care delivery," Paige said. "People are more engaged, more compliant with care regimens, and more aware of preventative screenings and tests."
Looking Beyond Smartphones
What about members of integrated health systems who don't own smartphones? Both Kaiser and Group Health said they are developing text messaging tools.
Paige said Kaiser is "very interested in understanding how to move forward in text messaging." She said, "It seems like most everyone has questions about what kinds of things texts will be appropriate for."
Group Health is working on text messaging capability for appointment reminders, O'Keefe said.
Carnahan said mobile health is part of his day-to-day activities.
"I think you are going to see more and more of this kind of thing," he said of mobile health. "It makes life a whole lot simpler."