Prescribing Mobile Apps: What to Consider
hBy K. Terry; http://medicaleconomics.modernmedicine.com; 6/22/15


Over a third of doctors said they prescribe mHealth apps, but half those clinicians had only suggested that patients shop in a app store, Medical Economics reported in fall 2014. A more recent March 2015 survey by Research Now learned that 16% of physicians were prescribing mobile apps. But 46% from the respondents anticipated to integrate this new tool in their practices within 5 years.

Yet don't assume all patients have smartphones, and people who will benefit the most from mHealth apps--older patients with chronic diseases— are least likely to acquire fraxel treatments. Less tech-savvy patients can also have trouble with all the Bluetooth-enabled devices that happen to be necessary to use many mHealth apps.

So if you ever consider prescribing mHealth apps? You may well face numerous uncertainties, including which to prescribe, the way to integrate the data they produce into the workflow, whether and tips on how to integrate patient-generated data inside your EHR, and how you can motivate patients to download and stick with all the apps you prescribe.

Nevertheless, the ubiquity of smartphones as well as the outsized role they play inside lives of the many patients make mHealth apps a compelling tool for patient engagement. What follows a few insights into and recommendations on mHealth prescribing from experts and physicians with already taken the leap.

Lack of evidence

While some physicians have noticed the main advantages of mHealth prescribing, the evidence with their efficacy is within short supply, notes Steven Steinhubl, MD, director of digital medicine on the Scripps Translational Science Institute, in a very recent interview while using Institute for Health Technology Transformation.

Matt Tindall, director of consumer solutions for IMS Health, tells Medical Economics that his firm found only 260 scientific tests of particular apps inside literature.

Moreover, some add-on devices and apps for smartphones produce inaccurate data. Hypertension experts have questioned the robustness of some mobile hypertension devices. Another study learned that three of four years old skin lesion apps misidentified 30 or even more melanoma lesions as benign.

Partly as a result of concern on the validity of commercially accessible apps, some healthcare systems are creating his or her mHealth software, says David Collins, senior director of health information systems for that Health Information Management and Systems Society (HIMSS). But most organizations have found out that it’s too difficult and harmful for develop mobile apps in-house, he adds.

Some healthcare organizations offer external apps that meet their criteria to consumers in their particular app stores. About 10% of healthcare systems recently surveyed by HIMSS, including prominent ones including Ochsner Health plus the Cleveland Clinic, have his or her app stores.

App ratings

Most physicians who prescribe mHealth apps give attention to educational, wellness and fitness apps which might be unlikely to harm patients. But they would still like to learn which apps in those categories are the most effective.

There are a couple of app ratings services, including that regarding IMS, SocialWellth, iMedical Apps, and iGet Better. But the ratings are scattered and quite a few physicians are extremely busy to target them, observes Joseph Kvedar, MD, president from the Center for Connected Health, a unit of Partners Healthcare in Boston.

IMS, which rates all with the health apps from the Apple and Google stores, bases its scores within the responses of medical professionals and patients, assessment from the product functionality, evaluation in the app developer, and proof of clinical efficacy and safety, where it exists.

Over time, IMS hopes that user feedback will increase the accuracy of their scores, Tindall says.

Internist Gregory Weidner, MD, medical director, primary care innovation and proactive health for that Carolinas Healthcare System, notes that IMS’ AppScore strategy is still new plus in demand for crowd sourcing to increase its validity. He knows this well, as the office where he practices part- time is testing IMS’ AppScript prescribing system. AppScript allows physicians to deliver prescriptions straight to their patients’ smartphones and observe the things they're doing with all the apps they download.

Doctors, patients and caregivers must all be included in evaluating apps,Weidner says. “As providers and healthcare teams help people navigate that terrain and evaluate which is best suited, we want that as a continuous learning ecosystem where we realize more today than half a year ago as to what works to get a given patient as well as a given condition.”

Some physicians who prescribe apps please take a more hands-on approach. Medhavi Jogi, MD, an endocrinologist in Houston, may be recommending apps to patients since 2009. He won’t tell a person to utilize an app until he and/or his all of the employees have completed it out, he admits that, “because there are way too many weird apps” that haven’t been vetted by anybody.

Jeffrey Livingston, MD, an ob/gyn in Irving, Tex., recommends some fitness, quitting smoking and anti-anxiety/relaxation apps to his patients. He is also piloting a gestational diabetes app a colleague has developed.

Livingston likes a training app that she provides himself since it is good at calculating calories and enables patients relate their calorie intake to fat reduction goals. He uses a fairly easy, two-part test for deciding if you should prescribe an app: A good app is but one that “makes the life span from the doctor easier, and makes all the care in the patient better,” he explains.

Kenneth Kubitschek, MD, a health care provider practicing in Asheville, North Carolina, along with a member in the Medical Economics editorial advisory board, says he's got tried prescribing fat reduction apps to patients but that adherence has become a problem. “The response continues to be generally disappointing,” he states. “Hopefully even as gain better advice about what encourages patient adherence to those newer apps, I will be utilizing them more routinely.”

Interoperability

It’s one thing to prescribe an app for your patient and be sure he understands or her to put it to use to enhance their. But unless your physician needs a more proactive role, Jogi has discovered, patients are unlikely to stick to the app or make use of it to obtain their own health goals. And in order make use of mHealth apps to assist chronic-disease patients manage their conditions, physicians have to be capable to observe the data generated from the devices.

While patient-generated health data raises quite a few issues, let’s look first at the way the data could be given to other providers.

Currently, The biggest concern is the lac of the place inside the practice to store and analyze your data these apps generate. Most EHRs cannot yet accept this data, of course, if the details went in a separate database, physicians will have to leave their EHR to look at it. Nurse care managers could identify the kind of data and enter it manually or cut and paste it into the EHR, but that could be lots of busywork for very skilled professionals.

“Until these interactive apps that patients are employing on their very own can push out the information into your physician’s electronic record, their utility in decision-making for physicians is likely to remain very limited,” Livingston says. “They continue to have value for patient education and patient engagement. But making that leap from data collection to clinical selection, we’re still not there yet.”

Livingston is proper. But rapid progress has been made on establishing interoperability between mobile apps and EHRs. For example, Carolinas Health System has generated its very own “platform” that may aggregate data from activity trackers, blood pressure levels cuffs, Bluetooth scales, and glucometers. Later in 2010, Weidner says, his organization will link this platform featuring its patient portal as well as EHR.

Some outside vendors are creating similar platforms. The best known of these is Apple HealthKit, which is now being used in a very growing amount of academic medical centers. HealthKit aggregates data from multiple devices, lets the person see the info in a, and will get in touch with EHRs. Epic and Cerner, two with the biggest EHR vendors, have linked their systems with HealthKit. Duke Medicine, an affiliate marketer of Duke University, is already beginning to utilize HealthKit to import monitoring data from patients with heart failure into its Epic EHR.

Data screening

If there have been not a way to screen mobile monitoring data for relevant information and to make use of it for clinical alerts, it may be useless. HealthKit is claimed being able to detecting vital signs values which can be outside normal ranges.

Duke Medicine works on the similar capability to use EHR to alert physicians when the info imported through HealthKit points too a person’s condition may well be a cause for concern.

Nevertheless, observers declare that the actual analytics for screening data are inadequate. At present, those analytic applications are “fairly limited,” says Jay Backstrom, a telehealth consultant plus a partner in Subsidium Healthcare. Mobile data screening, he adds, remains largely a manual process. It will have to be additional automated before it’s ready for everyday use within physician practices.

Kubitschek says she has a chance to download Bluetooth-enabled patient data from patient apps and devices right to his EHR, but won’t utilize it until you'll find better approaches to make certain that the info that arrives is clean and correct.

“I accomplish not need some time to explore all the information in a appropriate fashion to search for the important details, as most in the information is superfluous,” he states. “Unless intelligent screening programs can present the info if you ask me inside an actionable fashion, and only when an action is necessary, I don’t want to become flooded with data I do not need.”

Patient acceptance

According with a recent survey, 96% of customers who use mHealth apps believe they will grow their standard of living. But just as with all the use of patient portals, physicians have found out that not many patients are interested in making the change of these own health whether or not this has a substantial effort.

When Jogi recommends apps to patients for diet or exercise and asks them what they’ve achieved in the next visit, “half any time they’ll say they lost their phone, and I understand what meaning,” he tells.

He estimates that about 15% on the patients to whom he prescribes apps keep with all the app.

“Another 30% say they achieved it, but they're able to’t provide evidence. The rest are extremely lazy to acheive it,” Jogi says. “But if I’m directing it and say, ‘here’s what I would like you to complete,’ and in addition they don’t need any password to log into the app, the interest rate people is around 70%.”

Jogi, who designed his very own wellness app, tells patients who utilize app how much they are able to eat and ways in which much they must exercise, and which he’ll go in the data with these on their own next visit. “I inform them, ‘I are able to see all your details, so don’t try and not take action, because I’ll know you didn’t.’ That works.”

The data on the app goes in a cloud-based database, as well as the system alerts Jogi if someone just isn't while using the app. Then he's a nurse call them to uncover why. He can observe the data within the cloud without leaving his EHR

In Weidner’s practice, two physicians, two health coaches, a medical assistant along with a nutritionist prescribe mobile apps along with other digital content. To date, the care staff have prescribed about 160 apps, which have experienced a download rate which is between 60% and 75%, he states. The retention rates, that also vary by app, cover anything from 25% to 50% from the filled prescriptions, he adds.

Financial considerations

Aside by using an app, patients can share information with Jogi only during visits. “I don’t allow them to transmit me stuff including screen shots or tell me to log in—it takes to much time,” according to him. “But I’ll say at follow-up, let me see what you’re entering to your calories everyday.”

He also doesn’t let patients send him their data “because I don’t receive money that way,” he notes. “I say, ‘bring it in for your visit and we’ll review it.’”

Weidner highlights that, even when the usage of mHealth apps could increase patient engagement significantly, it’s an excessive amount of “to ask every doctor inside the country to complete this with a routine basis over anything else they’ re doing. But when we move into a value-based healthcare ecosystem, where patients experience care differently, and also the reimbursement model supports that, the opportunity of this is definitely unlimited.”

Patient benefits

The physicians we interviewed state that some in their patients have benefitted from mHealth apps. For example, considered one of Jogi’s patients who used his app for four months lost considerable weight, according to him. Weidner says that greater than 100 of his patients experienced “profound shifts into their overall health—losing substantial degrees of weight, improving metrics on blood pressure level and blood glucose levels control, lowering the dependence on medication, and developing self-management and self-efficacy skills which allow these shifts to get sustained.

“Engaged patients have better health outcomes, which’s on the heart of everything we’re doing,” he adds. “We also observe that patients have busy and complex lives, in case we’re going to assist and support them in managing their, we’re planning to have to figure out the way to integrate within their lives, instead of creating solutions that add another layer of complexity.”

Livingston has seen a good impact from mHealth apps also. “Patients are definitely using apps as a possible educational tool. They’re also deploying it as a verification tool,” like finding a second opinion on his or her doctor’s diagnosis or treatment, he admits that.

Where is that this going?

Some experts believe mHealth prescribing, as well as virtual visits along with types of telehealth, eventually will slow up the dependence on office visits. A 2013 commentary within the Journal in the American Medical Association explained the actual way it might happen.

Because consumers will be competent to diagnose some acute symptoms and much better manage their chronic conditions using mHealth apps and devices, prepare yourself for some be fewer unnecessary office and emergency department visits within the future, the authors wrote.

That might sound like science fiction. But if all financial and technical barriers to mHealth prescribing and data integration were removed, Jogi says, he could give the tastes his care remotely. That means he wouldn’t need multiple offices and would've less overhead. “The costs on my end would decrease,” according to him.

However, he’s concerned that a very outcome might degrade the individual- physician relationship and in some cases devalue the experience of physicians. It might also imply fewer doctors could be needed, according to him.

“If the info just put their hands up on my own screen, I could make quick decisions every a few minutes for each patient, and so, you’d need less endocrinologists. You’d offer an army of first responders, of course, if anything is abnormal, health related conditions would handle it.”

Weidner isn’t concerned with that. In fact, he regards mHealth as being a crucial step for the road toward team-based care that's more cost- effective plus much more patient-centered than the actual way of care delivery.

“Mobile app prescribing fundamentally cries out for redesigning how that patients experience care, thus it is a useful adjunct to plus some cases a better for most things we all do today that don’t add as much value,” according to him.

 

 

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