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ALHEChapter13_Mobile_Technology.pptxChapter 13: Mobile Technology and mHealth
Robert Hoyt MD
John Sharp
Learning Objectives
After reviewing the presentation, viewers should be able to:
Describe the evolution from personal digital assistants to smartphones and the emergence of mHealth
List the various ways mobile technology is currently being used in healthcare
Compare and contrast mobile technology for clinicians and patients
Identify the limitations of mobile technology
Introduction
Mobile technologies, particularly smartphones, are extremely popular to all members of the healthcare team
Adding to the popularity:
Improved speed, memory, wireless connectivity and shrinking form factor (size and shape)
Affordable
Constantly improving features
Phone capability, email and access to Internet
A myriad of mobile apps for consumers and clinicians
Evolution of Mobile Technology
2G in 1990
3G in 2001
4 G in 2006
5 G ? 2020
Mobile health (mHealth) is the “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and wireless devices”
Global Observatory for e-Health for the WHO (2011)
mHealth
Personal Digital Assistants (PDAs)
1990: Apple Newton $700 and bulky
1996: Palm Pilot
1999 Epocrates, free popular drug program
Later: PDAs with phone capability,
Internet access, WiFi
With huge consumer demand the transition to
smartphones was rapid by any standard
Smartphones
Defined as having an operating systems capable of hosting medical software or it Internet capable
Cloud computing allowed more medical programs of higher complexity to be accessed
Vast majority of adults and physicians carry a smartphone
Many access medical issues on the phone and a minority have at least one medical app and/or receive text messages from a healthcare system
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The iPad was the first tablet to make an impact in healthcare
This very well liked platform has been used in exam rooms and the hospital to provide a light weight means of reaching the Internet and EHR access
The reality is that tablets have shortcomings as well, such that the actual impact of tablets in healthcare is largely unknown
Tablet PCs
m-Health Conceptual framework
Mobile Technology and Patients
Devices: smartphone or tablet PC with apps connected to Internet
Text Messaging or Short Message Service (SMS). Used for:
Appointment reminders
Education
Disease management
Behavior modification
Medication compliance
Laboratory results notification
Public Health – Immunization
SMS messaging more likely to be tried in developing countries
Mobile Technology and Patients (Software categories)
Personal health record
Telemedicine
Medication reminders
Fitness coach
Immunization guides
Disease management
Prevention guides
Diagnostics
Vital sign monitoring
Mental health
Connect with healthcare system
Mobile Technology to Track Health Habits and Physiological Signs
New movement (“wearable HIT” and “quantified self”)
New devices and sensors to monitor diet, exercise, sleep, heart rate, respiratory rate, oxygen level, skin temperature, hydration, etc.
Oriented towards patients
Communicate with smartphone via Bluetooth LE
Smart watches a new platform
It remains to be seen how fitness and home monitoring data can be uploaded, analyzed and archived in an EHR. Who is reimbursing for this?
Should the data be analyzed automatically by machine learning algorithms and posted on a patient dashboard?
Does PGHD change behavior? Probably not
Only a minority of health apps are successful and persist
Patient Generated Health Data (PGHD)
Mobile Technology and Clinicians
Smartphones synchronized with office or hospital. Popular, but raises significant security and storage concerns
Several EHR vendors offer a specific iPad software package for clinicians
Medical Software categories for clinicians: drug information, calculators, databases, immunization guides, medical resources, prevention guides, diagnostics, sensors, image viewers, journal access, Medline searches, monitoring, coding, medical translator, EHR access, telehealth, dictation and remote data collection
Apple
HealthKit: for iOS and Watch OS. Use APIs to integrate app with OS
CareKit: open source SDK for patient monitoring
ResearchKit: iOS app can be used for research
Android
Google Fit: SDK to build apps using APIs
ResearchStack: for research
Research Droid: research using Android smartphones
Software Development Kits (SDKs) for mHealth
Devices and apps which are used for treatment or CDS must have FDA approval
All others do not need FDA approval
Regulatory Requirements
Mobile Technology Challenges
Distraction: at work and everywhere else
Technical: inputting, screen size and interoperability issues
Security: need BYOD policies
Lack of quality control: Mobile App Rating Scale
Lack of evidence (low quality studies)
Will new sensors and devices be reimbursed by payers or will the patient have to pay?
Mobile technology has evolved at a blistering pace
The era of mHealth is here but too early to know what the impact on healthcare system will be
Healthcare-related apps are popular and available for all platforms, but are they used?
Enterprise integration of mobile technology is evolving; smartphones integrating with EHRs
Conclusions
