The mHealth Revolution: An Alternative to Traditional Healthcare

BEFORE COVID-19, few could have imagined the immeasurable effects a pandemic could wreak on the world’s health. Due to quarantines and the resulting lack of healthcare availability for many, it is now more important than ever for patients and healthcare providers to have technology to provide access to healthcare information and guidance. Fortunately, mHealth (an abbreviation for mobile health) has been a growing industry for some time, but it is now coming of age and is increasingly more significant. As a MedTech Boston blog notes, “With the reach of mHealth technologies spreading further, it is expected to become one of the most game-changing aspects in the current healthcare scenario.”¹

For those less familiar with mHealth, the World Health Organization’s Global Observatory for eHealth defines it as a “medical and public health practice supported by mobile devices such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices.”² mHealth is often utilized to educate consumers about preventive healthcare services, and it is also used for disease surveillance, treatment support, epidemic outbreak tracking and chronic disease management.³

The Data

The statistics alone indicate mHealth is and will continue to be a key component for physicians and other healthcare providers. For example:⁴

• More than 318,000 mHealth apps are currently available — nearly double the number in 2015. The wealth of possibilities for health guidance becomes clearer considering more than 80 percent of American adults today have a smartphone, and 95 percent of teens have access to a smartphone, which they report using “almost constantly.”
• More than 60 percent of Americans have downloaded an mHealth app within the past six years.
• At least 62 percent of Americans have used their smart devices to gather health-related information, which means mHealth use is more common than online banking, job searches and accessing educational content.
• Two-thirds of the largest U.S. hospitals offer mobile health apps, indicating there is increasing openness to mHealth as apps and technology continue to improve.
• 74 percent of patients say using mobile apps, wearables and other mHealth tools helps them cope with and manage their conditions.
• 85 percent of health insurance companies think mHealth creates value.
• The biggest cost-saving benefit from mHealth apps will be reduced hospital costs by decreasing readmission rates and length of stay, and by assisting with patient compliance to medication plans, according to the majority of respondents (60 percent) in a Research2Guidance report.
• The global mHealth app market is expected to reach $111 billion by 2025. Fitness apps account for the largest portion of the U.S. mHealth app market, which is expected to grow to $50 billion by 2025.

Benefits of mHealth

Judging from the statistics, it seems mHealth is here to stay. Following are some of its advantages:

Real-time communication with remote patients. While an in-person visit is often best — or at least most satisfying for providers and patients in many cases — the perks of telehealth cannot be denied, even when we are not in the midst of a pandemic. mHealth apps and equipment such as TytoHome/TytoCare, KardiaMobile EKG and many other technologies enable healthcare professionals and patients to work together remotely, allowing patients to stay within the safety, comfort and convenience of their own homes while healthcare providers can converse while checking vitals and other important data in real-time.⁵ “The new reality is that patients want to seek care in their own environment and on their own schedule online, as opposed to going to the office and waiting for a provider,” says Mark Greenwood, MD, a family medicine specialist in Richfield, Utah, who is working with a Humana Medicare Advantage pilot mHealth program.⁶

Readily accessible and efficient paperless health documentation. Thanks to mHealth, many of the reports, prescriptions and other documentation that healthcare providers must complete can now be done electronically and then digitized through mHealth apps. And patients can now access their healthcare documentation and providers’ instructions via smart devices. More accessibility means fewer documents lost and less confusion for both parties. Even healthcare expense report management companies such as Expensify are now digital, using Cloud storage instead of paper filing.^7,8

High patient receptivity and better treatment compliance. mHealth can make life less stressful for patients who like to be involved in their care, and conversely, it can motivate those who are not typically as diligent. By enabling patients to track and record their prescriptions and set up reminder notifications to help them avoid missing a dosage, for example, mHealth can help patients feel in control and organized. It also allows prescribers and others to answer treatment questions and provide clear, easily accessible information to patients to ensure better treatment compliance. With some apps, providers can also watch as patients track their compliance if patients desire.^{5,6 7,9}

In addition to medication management, other types of treatment progress can be monitored by patients, which often helps them achieve a sense of success and empowerment. Whether it is a workout or physical therapy regimen, a dietary plan, insulin dosage and blood sugar level tracking, heart rhythms or blood pressure, there are mHealth apps for those and more — and they can keep patients involved and providers connected.^6,7,9 A 2018 Accenture Consumer Survey revealed “healthcare consumers continue to show strong use of digital technology for self-service care — and the numbers are rising each year. In 2018, 75 percent of U.S. consumers surveyed said technology is important to managing their health. Patients are increasingly open to intelligent technologies taking on elements of their care such as medical consultations and monitoring. And they are using self-service digital health tools that go beyond websites.… Nearly half (48 percent) of healthcare consumers are using mobile/tablet apps compared to just 16 percent in 2014.”⁹

Patient coaching. With more and more mHealth apps being developed by hospitals and other agencies, health coaching is also becoming more available for patients. One online program provided by San Francisco-based Omada Health for patients at risk for diabetes is having positive results. In the year-long pilot, patients were assigned a health coach, as well as private online support and moderated discussions that provided social support and personalization. “You can’t just send someone a scale and a step tracker and pray for results,” says Omada Chief Executive Sean Duffy. “You have to combine these instruments with high-touch intervention.”⁶ As clinicians and software developers find increasingly efficient and helpful ways to engage and guide patients in their own healthcare, it is expected there will be more of these hospital programs. Health coaching is already available in less clinical settings through fitness, weight loss and mindfulness apps, among others.^7,8

Cost savings. Healthcare is expensive and can be a burden for individuals who have inadequate health coverage, including very high insurance deductibles. Because mHealth apps are improving continuously, some predict they will eventually be able to work as de facto healthcare providers as long as they are used in conjunction with primary care physicians or other providers, ensuring people’s health needs are regularly met — especially in areas suffering from healthcare shortages.⁷

Treating chronic disorders. Apps that help patients manage specific chronic conditions such as asthma, diabetes, high blood pressure and heart disease already exist. These apps seek to improve quality of life by connecting users to others who have the same health challenges, as well as by offering helpful articles, recording/tracking tools and additional resources. Chronic diseases need continuous evaluation, and in addition to tracking their conditions, individuals can schedule appointment reminders and other notifications.⁷

mHealth Drawbacks

Clearly, mHealth has its benefits. Yet, while the technology is already helpful and increasingly promising, it is definitely not without shortcomings:

Quantity does not ensure quality, and there is little federal regulation. Although there are an ever-increasing number of apps available, many of them are subpar as evidenced by poor functionality, poor follow-through by providers and/or poor user reviews. According to Amir Lerman, MD, a cardiologist at the Mayo Clinic whose interests involve digital health, “You can’t just build an app in your garage and think it is going to change medical care. You need to have a treatment plan behind it and a health system to care for the patient.”⁶

At this point in mHealth’s development, it remains the Wild West on some levels. While healthcare providers can do their own research about selecting the most effective apps to recommend to patients, it can be time-consuming and frustrating. And as Dr. Richard Larson, MD, PhD, at the University of New Mexico Health Sciences Center School of Medicine who conducts research on mHealth said, “The rapid growth of mobile health apps has resulted in confusion among healthcare providers and the public about which products rely on evidence-based medicine. Only a small subset of mHealth apps are regulated by the [U.S. Food and Drug Administration] FDA.”¹⁰ In fact, FDA has issued few regulatory restrictions for mHealth. According to a recent article in The Lancet, “In most countries, medical device regulation applies only to a subset of high-risk health apps that have welldefined medical purposes. However, most health apps available on the market target a wide range of health-related issues, including diet and exercise, pregnancy and mental health, while still being considered nonmedical devices.”¹¹

On top of this, many apps lack privacy and security. A Business Insider report states, “A recent analysis of mobile health apps found their data-sharing practices to be excessive, which creates privacy risks that should make providers wary about prescribing mHealth apps to their patients.”⁹

Users could become too reliant. Despite the lack of federal regulation and privacy/ security issues, the majority of people in the United States — and perhaps the world — use mHealth apps today in some form. And experts fear people — whether patients or providers — will become too reliant. Some consumers, for example, are choosing mHealth apps and devices over professional help, which is certainly not the safest option. In fact, a 2015 Harvard Medical School study on symptom-checking websites and apps found “of the top 23 symptom checkers, correct diagnoses were listed first in only 34 percent of standardized patient evaluations.” The study also showed the “correct diagnoses were listed by symptom-checking tools within the top 20 possible diagnoses in less than 60 percent of the evaluations.”⁸ In other words, many people are misusing apps and taking their health into their own hands inappropriately. And, clearly, an inaccurate diagnosis or lack of diagnosis is dangerous. For providers who recommend apps to patients, it is absolutely crucial to stress that proper medical care via a qualified provider, not merely an app, is a key component of good health.

Future of mHealth

In some ways, healthcare is easier than ever for patients and providers because of mHealth, including its wearables, apps and other devices that allow patients to manage their well-being in groundbreaking new ways. But the technology faces challenges even beyond developing and enforcing regulatory standards. As James Michiel, MPH, previously senior mHealth and informatics analyst at Emory University’s Rollins School of Public Health in Atlanta, Ga., and now director of product strategy and innovation at Aetna, states, “The future of mHealth is open — open access, open source, open data and open innovation.” And come what may in the future, Michiel adds, “It is imperative … these tools and technologies are used deliberately and efficiently, with an eye toward the end user in a way that ensures long-term sustainability and development.”

Simply put, mHealth must find ways to continue to serve its users better by protecting, guiding and serving them through clearer guidelines and increasingly improved functionality for providers and patients.

Only Time Will Tell

As with all things, only time will tell how current trends will progress. But mHealth’s prognosticators foresee increasingly higher standards and better efficacy in the market. And as more hospitals and healthcare organizations partner together with software developers such as Omada, mHealth’s quality and efficiency will surely improve, especially with helpful regulation as FDA recognizes the market’s need for increased safety and standards.

The future of mHealth looks bright — at a time when many providers and patients need a bright spot on the horizon.