Walking the fine line on mHealth for patients

Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo
Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo

Wearable health devices and mHealth applications are becoming ubiquitous – or so it seems. At first blush they appear to be everywhere you look and increasing daily. In fact, there are tens of thousands of online health apps. The Robert Wood Johnson Foundation says this number will grow by 25 percent a year, and that by 2018 1.7 billion people worldwide will download a health app.

This seems like good news as the United States tries to bring down healthcare costs by requiring payers and providers to focus more on preventive care, chronic care management and patient engagement. Unfortunately, recent studies show that people who most need these mHealth apps and devices probably aren’t using them.

A study from Technology Advice found that nearly 75 percent of adults do not track their weight, diet or exercise using a fitness tracking device or app, and the most cited reason was general lack of interest.

With steadily increasing rates of diabetes, obesity and heart disease, there is certainly a need whether patients are “interested” or not. Nearly 10 percent of the US population has diabetes. Over 600,000 people die of heart disease each year (one in four deaths annually) and nearly half the United States population has at least one risk factor for heart disease. These two diseases alone cost the United States hundreds of billions of dollars a year.

Any tool that can enable providers to help these patients reduce their risk, minimize complications and live healthier lives is beneficial. And clearly, mHealth apps and devices have the potential to help achieve this goal and bring down costs across the industry.

Even otherwise disinterested patients see this. Many say that they do have an interest if there is some incentive according to the Technology Advice survey. More than half of those surveyed said they would be more likely to use a health tracking app or device if there was a possibility of lowering their insurance premiums. Just over 40 percent said better advice from their healthcare provider would be a possible incentive to use a fitness tracker.

This is good news, but there are challenges that need to be addressed. The issues that physicians face are really two fold when it comes to mHealth. First, how do you get patients to use an app or device to track and improve health and outcomes? Second, how do you avoid data overload as wearable devices bring in an increased influx of data? There is really no point if the tools and data don’t have meaningful value.

This is where physicians need to walk a fine a line. No provider wants to log into each patients app through a HIPAA-compliant portal (where there is one). For providers who are already stretched thin, this approach isn’t realistic. And, emailing providers isn’t HIPAA complaint so that isn’t an option either. In some cases, it might make sense to have patients send summaries through a secure messaging option in a portal, but this can become more work than providers can handle too. Since most mHealth apps and wearables are not currently able to integrate with electronic health records (EHRs), it makes sense for providers who are interested in “prescribing” apps to start with a simpler wellness approach.The goal being to get some benefits from these devices for the patient without creating an undue burden on providers.

“Prescribing” apps for diet and exercise that are supported by a clear set of goals agreed upon by both the provider and patient is a good place to start. For example, the patient and provider decide on a healthy goal weight or body mass index (BMI) target. Other goals might be blood pressure or target heart rate. Patients then report back data at follow up appointments with no need for EHR integration.

Down the road as vendors find ways to transmit data, physicians can take that next step, but not until the raw wearable data can be transformed into actionable intelligence. For example, there are efforts to look at long-term heart rate variability as a predictor of serious cardiovascular events. In this scenario, the provider gets a single alert based on 100 gigabytes of raw wearable data.

While there is a lot of buzz around wearables and mHealth apps, the truth is that this is just the beginning and providers should treat it that way. Start slow and watch what happens in the market. Use them as one tool in a larger effort to help a patient improve wellness. You may increase their use or expand the types of devices and apps as they become more integrated by vendors into the EHR and are able to provide data in a useful way. Watch this market closely as there is surely much more to come in the next few years.



EHR, electronic health record, Kareo, mHealth, Robert Wood Johnson Foundation, wearables


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