mHealth: Closing the Gap Between Promise and Adoption

by Kate Ackerman, iHealthBeat Managing Editor

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FORT WASHINGTON, Md. -- Stakeholders at this week's third annual mHealth Summit in the Washington, D.C., area touted the potential of mobile health technology to improve health care quality, increase patient centeredness and reduce costs. However, they also acknowledged that while mobile tools have helped revolutionize nearly every other industry in the U.S., the health care field has lagged behind.

The mHealth Summit -- which was presented by the Foundation for the National Institutes of Health in partnership with the mHealth Alliance, the Healthcare Information and Management Systems Society and NIH -- attracted nearly 3,600 attendees from 46 states and 48 countries, up from 2,400 attendees last year.

HHS Secretary Kathleen Sebelius -- one of the summit's keynote speakers -- said, "Virtually every American today has a cellphone. ... And every year, our phones have more features and computing power." She added, "As our phones get more powerful, they are becoming our primary tools for doing everything from getting directions to deciding where to eat. And, increasingly, that includes using our phones to track, manage and improve our health."

The promise of mobile health is not new. Health care leaders for several years have advocated for increasing use of mobile tools to help improve preventive health care, reduce unnecessary physician visits, curb rising health care costs and empower patients. Yet, widespread mobile health adoption has remained elusive.

Sebelius said, "Over the last few decades, we've seen information technology improve the consumer experience in almost every area of our lives. We've gone from waiting until a bank opened to make a deposit to 24-hour ATMs and paying bills online," adding, "But health care has stubbornly held onto its cabinets and hanging files."

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Entrepreneurs and technology vendors see health care as a market ripe with potential.

Noting that the iTunes store boasts nearly 12,000 health-related applications, Sebelius highlighted several promising apps on the market, such as iTriage, which "makes finding a local care facility as easy as finding a local lunch spot," and Pillbox, which can help individuals identify unlabeled medicine.

Eric Topol -- vice chair of the West Wireless Health Institute and a practicing cardiologist at Scripps Memorial Hospital in La Jolla, Calif. -- demonstrated how mobile tools can aid health care providers.

Topol, who said he "once diagnosed a patient who was having a heart attack on a plane," used an iPhone to give himself an echocardiogram. Later, he used a mobile device and some hotel room lotion to give himself an ultrasound. Topol said that because of mobile ultrasound technology, he hasn't used a stethoscope in two years.

Rick Cnossen -- director of worldwide health information technology at Intel -- said he believes in the next 10 years 50% of health care could provided through the "brickless clinic," be it the home, community, workplace or even car. Cnossen said the technology -- such as mobile tools, telehealth, personal health records and social networking -- already exists to make this possible. He said, "We have the technology. ... It's time to move out on it."

Cnossen said, "At the end of the day, mHealth is not about smartphones, gadgets or even apps. It's about holistically driving transformation," adding, "mHealth is about distributing care beyond clinics and hospitals and enabling new information-rich relationships between patients, clinicians and caregivers to drive better decisions and behaviors."

Addressing mHealth Barriers

So if the technology already exists and leaders from both the public and private sectors see the need, why has progress in mobile health been slow?

Cnossen said, "The challenge is not a technology problem, it's a business and a workflow problem."

He said health care clinicians can be resistant to change, adding, "We need to introduce technology into the way to do their business, not the other way around."

Cnossen also said that payment reform is essential for "mHealth to survive and thrive." He said, "We should not be fighting for reimbursement codes for each health device and app. That is ultimately a losing proposition. Instead, we must fight for payment reform to pay for value over volume, regardless of whether the care was provided in a bricks and mortar facility or was it at the home or virtually through electronic means."

Krishnan Ganapathy, president of the Apollo Telemedicine Networking Foundation in India, said patients will not widely adopt mobile health unless their health care providers also are using the tools. However, primary care providers don't have any incentive to use mobile health under a fee-for-service model, he said. In fact, the use of mobile health technology could hurt physicians' bottom line if chronic diseases are better managed and patient visits are prevented.

Joseph Kvedar -- founder and director of the Center for Connected Health at Partners HealthCare -- took a different stance, saying that "maybe, the doctor isn't the center of the universe." He noted that patients could help drive mobile health care. Kvedar said mobile health "can really empower patients and consumers to take care of themselves," adding, "Patients are our biggest untapped resource."

Kvedar said, "Other industries have done it. Health care needs to jump on board."  

Donna Ramos-Johnson -- chief of technology operations at the District of Columbia Primary Care Association -- said the challenge is to make mobile health tools relevant, affordable and culturally sensitive to the patients who stand to benefit the most from the technology. She said doctors need to be incentivized to monitor patients' health remotely and patients need to be incentivized to monitor their own health.

Stephen Ondra -- senior policy adviser for health affairs at the Department of Veterans Affairs -- said the health care reform law is starting to address the payment barrier. He noted that accountable care organizations will receive incentives for reducing costs and that CMS in 2015 will use a value-based payment model to pay physicians based on the quality of care they provide, rather than the cost of care they provide. He added that this health care system disruption "is great for entrepreneurs."

Officials from federal agencies such as CMS, FDA, the Office of the National Coordinator for Health IT, the Health Resources and Services Administration and the Federal Communications Commission said they are working collaboratively to advance mobile health technology, while ensuring patient safety.

Yael Harris -- director of the Office of Health IT and Quality at HRSA -- acknowledged that the federal government often doesn't "move as fast as we'd like" but said that HHS entities and other federal agencies are working to "leverage collective knowledge and really advance the field."

Sebelius said that "there is no more powerful force for innovation than American entrepreneurs" but that the "government can play a limited but crucial role as a catalyst." She said, "That starts with taking the vast amounts of public health, medical and other data our department collects and making it available to innovators," adding, "So what we did is unlock the data, put it in a central clearinghouse called healthdata.gov and then told developers: 'Have at it.'" She said HHS data already are being used in dozens of health care apps for consumers and health care providers.

Sebelius also noted that the federal government is working directly on several mobile health projects such as Text4Baby and SmokeFreeTXT. In addition, the government, along with private-sector groups, has launched contests challenging developers to create innovative apps that address some of the country's health care needs.

Sebelius said, "When we talk about mobile health, we are talking about taking the biggest technology breakthrough of our time and using it to take on one of the greatest challenges of our time." She added, "And, while we have a way to go, we can already imagine a remarkable future in which control over your health is always within hand's reach."

George Margelis
MHealth appears to be a surrogate for the need for healthcare reform. We develop techology models to try to make healthcare more efficient when the real issue is the need to reform the system to reward quality and efficiency.
Michael Millenson
It's time to apply some common sense here. Reporters use iPhones. Ever had a battery problem with an iPhone? Ever had a problem getting consistent WiFi reception or had a call dropped or had a problem with the 3G network? Wanna bet your life on Dr. Topol's iPhone reception in, say, Manhattan versus his stethoscope? Pioneers and advocates are great, and mHealth is exciting. But when asking why the future hasn't arrived yet, the answer "Because they're not paying me enough money" -- favored by vendors -- may not be the only reason.

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