mHealth for All

Monday, January 18, 2010  | Rob Havasy

About the Author:  Rob Havasy is a business analyst at the Center for Connected Health.

As we begin 2010, the signs of a mobile health (mHealth) revolution are all around us. New smartphones, netbooks, tablets, and services reach the market every day. The promise of giving every individual a constant high-speed connection to friends, colleagues, and to the wealth of information available across the planet has entrepreneurs salivating at the possibilities.

The Center for Connected Health believes in the power of mobile technology to transform the lives of patients and to improve the quality of care that we provide. We are currently exploring several areas of mHealth, from smartphone applications to wireless data transfer systems that can give patients a closer relationship with their providers, without increasing the burden on primary care staff.

That I work to integrate such cutting-edge mobile communications into healthcare and people’s lives, while sitting barely 250 yards from the very spot where Alexander Graham Bell made the first telephone call is a contrast not lost on me. Walking past the plaque erected to honor that event twice each day helps me remember people’s true desire for communication: To use whichever technology enables the most efficient way to convey the information they need to convey. For a large population of our patients, that technology is still Mr. Bell’s telephone, even if only to initiate a face-to-face conversation with their healthcare provider. A recent survey conducted by the Center for Connected Health confirms that people looking for a “connected device” most want it to facilitate better dialog with their providers. (Pena, Watson, Kvedar, & Grant, 2009)

Those of us driving this revolution must ensure that the mHealth ball doesn’t quickly roll beyond reach of the people who can most benefit from its help. For, although I may enjoy writing much of this article on my tiny MacBook while tethered via Bluetooth to my 3G cell phone, diabetic patients with whom I interact every day would rather forego uploading their blood sugar readings to a shared website than learn how to use a new computer or a smartphone.

Susannah Fox, Associate Director of the Pew Foundation’s Internet and American Life Project wrote on the e-Patients.net blog in late December:

               No matter which way we slice the population, though, I can tell you that internet access is
               still low among people challenged by health problems. Not much has changed in two years.
               (Fox, 2009)

In the actual survey summary, she goes on to say:

               … just 16% of U.S. adults age 65 and older go online wirelessly, via a laptop or handheld
               device. By contrast, 55% of all adults connect to the internet wirelessly. (Fox, Four in Ten
               Seniors go Online, 2010)

This is where I believe the state of the mHealth market is right now. Devices are available and services are coming. But the technology isn’t yet simple enough to truly impact the majority of people’s lives. Smartphones and apps and the accompanying buzz have created awareness among the public, but cannot yet deliver lasting effect. Pinch Media recently analyzed 30,000,000 iPhone app downloads in which their technology is embedded and determined that only 1% of users downloading an app become long-term users, and a stunning 98% of downloaded apps are never opened again 30 days after download. (Yardley, 2009)  (And for all the iPhone buzz, iPhone users remain less than 3% of the total 276.6 million US cellular subscribers.)  This is a clear call to action: we can do better, for all segments of the healthcare population.

Now we must craft mobile components into solutions, which are meaningful and available to all of our patients. The true potential for mobile will be realized not by ever more complex iPhone apps, but rather by embedded data connections creating a new class of purpose-built, always connected devices, which reduce the complexity presented to the user. Think of the Amazon Kindle as the new paradigm for this type of device. Kindle users needn’t know that their book purchases are enabled by the Sprint EVDO data network – they needn’t even know that Sprint is involved. They simply turn on their Kindle, key the serial number into a web page (or have someone do it for them), and then download books anywhere and anytime with a touch of a few buttons. When physiologic data and provider coaching flows just as simply, even for patients whose primary means of communication is a traditional telephone, the true promise of mHealth will be realized.

Works Cited:

CTIA. (2009). Wireless Quick Facts. Retrieved December 30, 2009 from CTIA, The Wireless Association: http://www.ctia.org/media/industry_info/index.cfm/AID/10323

Fox, S. (2009, December 22). Access is (almost) everything. Retrieved December 27, 2009 from e-Patients.net: http://e-patients.net/archives/2009/12/access-is-almost-everything.html

Fox, S. (2010, January 13). Four in Ten Seniors go Online. Retrieved January 14, 2010, from Pew Research Center's Internet and American Life Project: http://www.pewinternet.org/Commentary/2010/January/38-of-adults-age-65-go-online.aspx

Pena, V., Watson, A. J., Kvedar, J. C., & Grant, R. W. (2009). Mobile Phone Technology for Children with Type 1 and Type 2 Diabetes: A Parent Survey. Journal of Diabetes Science and Technoogy , 3 (6), 1481-1489.

Yardley, G. (2009, February 18). AppStore Secrets. Retrieved December 29, 2009 from Pinch Media Blog: http://www.pinchmedia.com/appstore-secrets/

Member Comments

One thing to keep in mind is that it may not be the patient/healthcare consumer who is connecting to the "clouded resources" but rather their home healthcare worker. Incidentally, those workers may use the very same wireless devices to launch an effective nationwide hhc union. Africa and Asia are already making strides is mHealth and attending mPayments platforms. May you live interesting times. Ed Dodds, blogging at moblie healthcare watch, MBlog - the Medical Banking blog and conmergence.com

Ed Dodds

Comm Strategist, Web Dev, Writer
Conmergence

 

Posted by: Ed Dodds
1/19/2010

 

Technology's Success Depends On Informed Caregivers.

The goal is better care, not just be better technology.

When technology comes into play with an elder and their family, and the data starts to flow, it is often quickly apparent that the family is sorely lacking in basic knowledge about their elder’s health status. To assure that the technology is effective it is imperative that prior to its use, the elder’s basic health information be collected, stored and easily accessible to the family caregivers, in a secure repository and with the ability to communicate it to others who also provide care to the elder.

The most advanced indicators and gages on the dashboard of a car need to be read, and the implications understood, by the driver, to be of any value. It is same in the case of TeleHealth. Is the detection of a blood pressure spike being caused by a physiological change or is it due to non-compliance with the medication regimen. The primary caregiver, most often a family member, must know what the medication regimen is before they can make an effective decision about whether to call the doctor or see that the elder complies with the medication plan to correct the issue. This is just one small example of an elder's information that must be part of any caregiver’s knowledge base if the technology is to be effective. The strongest and most advanced building cannot be built on a weak foundation and be expected to stand the test of time. It is also true that the best caregiving technology will only succeed when it is providing data to those with a foundation of knowledge and understanding of the patient.

What is being done to help to see that the users of technology have the solid foundation needed to assure that the systems will stand the test and become the great long term benefit they are capable of being? Not much I am afraid. A lot of attention is being paid to the process of collecting and sending data with too little attention being paid to seeing that the information can be used effectively by the recipients.

Let us not have TeleHealth and the other caregiving technologies become the clocks on VCRs blinking 12:00 AM until the best solution is to put black tape over it and pay no attention at all to what it is trying to tell us.

John Boden
ElderIssues, LifeLedger

John Boden

Founder
ElderIssues, LLC

 

Posted by: John Boden
1/20/2010

 

Rob's comments are incisive and on point. Some supplemental thoughts. In the community practice that is most actively using our diabetes connect solution, 40% of the patients are not familiar with or comfortable with a web browser (let alone a mobile browser). Our program is set up to gather blood glucose readings from the patient, share that information with them through the browser, and allow for a provider to intervene, coach, etc. via the same browser interface. So some patients only upload their glucose readings (because of lack of browser familiarity). Any insights they get from their readings are garnered when the diabetic nurse educator in the practice reaches out via the telephone to engage them around their data. The effect is remarkable on several levels. In a recent analysis, it was noted that web users upload significantly more readings than non-web users and they continue to upload more consistently over time than non-web users. Uploading is linked to outcomes; uploaders had an average drop in HbA1c of 2.1, whereas those who do not upload showed no drop in A1c over time.

Two lessons emerge from this that are complimentary to the wisdom in Rob's post: one is that we can track real clinical outcomes to patient engagement - it matters. the second is that even if we set the bar at basic Internet use (forgetting mobile Internet use for a moment), the overlap between our sickest patients and those who actively use the Internet is smaller than we'd like. This is consistent with the Pew data quoted by Rob in the post above.

Joseph Kvedar

Director
Center for Connected Health

Joseph C. Kvedar, M.D., is the Founder and Director of the Center for Connected Health, applying communications technology and online resources to increase access and improve the delivery of quality medical services and patient care. Dr. Kvedar is also a board-certified dermatologist and Vice-Chair of Dermatology at Harvard Medical School. In his role with the Center for Connected Health, Dr. Kvedar launched the first physician-to-physician online consultation service in an academic setting. He is also leading important research into novel approaches for connected health in a variety of medical specialties, including post-operative care in the home, wound care, and remote monitoring of patients with chronic diseases. Dr. Kvedar is a past President and member of the governing Board of the American Telemedicine Association (ATA). Dr. Kvedar is also Chair of the American Academy of Dermatology (AAD) Task Force on Telemedicine. Dr. Kvedar is internationally recognized for his leadership and vision in the field of connected health and the application of communications technologies to improve healthcare to patients. Dr. Kvedar is co-editor of a new book, Home Telehealth, which was published in May 2006. He is a frequent lecturer and has authored over 60 publications on telemedicine and connected health. In 2003, Dr. Kvedar was honored by the New England Business and Technology Association for his extraordinary leadership in the field.

 

Posted by: Joseph Kvedar
1/22/2010

 

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