Healthcare Information Technology
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HADM 5431 Healthcare Information Technology
The Revolution of Mobile Healthcare Applications
Group 1: Christina Barsamian, Tanya Barsamian, Zaryan Hamidani, and Chioma Winifred
Ihunwo
University of Houston - Clear Lake
Table of Contents
Introduction
Benefits
Patients
Providers
Payers
Drawbacks
Patients
Providers
Payers
Applications Types
Results
Conclusion
Works Cited
Based on the feedback that we received last week. Tanya and I will be adjusting the
sections into Provider, Patient, and Payer for Benefits and Drawbacks. Winnie for the
RESULTS you need to include that there are more benefits and elaborate. Winnie for the
CONCLUSION you need to write how to fix/improve drawbacks and conclude. Winnie the
RESULTS and CONCLUSIONS was too repetitive. Zaryan for the APPLICATIONS
TYPES you need to write how the app ties in the Provider, Patient, and Payer with each
app. Also Zaryan you need to cite the rest of your sources with subscripts and Winnie
finish up the introduction so we can put the subscripts in order of appearance.
Look for websites you want to use these are some that we found. http://www.pcmag.com/article2/0,2817,2476623,00.asp http://www.digitaltrends.com/mobile/best-medical-apps/ Intro/Conc/Results http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/ INTRODUCTION
The use of mobile devices by healthcare professionals (HCPs) has transformed many aspects of clinical practice.1,2 Mobile devices have become commonplace in healthcare settings, leading to rapid growth in the development of medical software applications (apps) for these platforms.1,2 Numerous apps are now available to assist HCPs with many important tasks, such as: information and time management; health record maintenance and access; communications and consulting; reference and information gathering; patient management and monitoring; clinical decision-making; and medical education and training.1–8
Mobile devices and apps provide many benefits for HCPs, perhaps most significantly increased access to point-of-care tools, which has been shown to support better clinical decision-making and improved patient outcomes.2,8–10 However, some HCPs remain reluctant to adopt their use.1,4 Despite the benefits they offer, better standards and validation practices regarding mobile medical apps need to be established to ensure the proper use and integration of these increasingly
sophisticated tools into medical practice.4,8,10,11 These measures will raise the barrier for entry into the medical app market, increasing the quality and safety of the apps currently available for use by HCPs.11
Mobile healthcare can be traced back to the beginning of the twenty first century when smartphones were introduced to the market. Just like most technologies, mobile health applications started slow and small back in 2003 when the penetration of smartphones with the capability of running such applications but has since increased in a rate we would call exponential. For instance, in the year 2009 when a partnership between the Foundation for the National Institutes of Health, the National Institutes of Health and the mHealth Alliance held a mobile health inaugural summit only a little less than 1000 people were in attendance.18 Fast forward to 12 months later, in 2010, 2400 people were in attendance in the conference which was about 300% the attendance of the previous year. This could be attributed to the increase in the penetration of smartphones globally, where in some countries the penetration of wireless devices is way above 100%. The third world has also not been left behind as more and more people are having access to smartphones capable of running mobile health applications.
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USE OF MOBILE DEVICES BY HEALTHCARE PROFESSIONALS
Types and Prevalence of Devices Used
The introduction of mobile computing devices (personal digital assistants [PDAs], followed by smartphones and tablet computers) has greatly impacted many fields, including medicine. Health care professionals now use smartphone or tablet computers for functions they used to need a pager, cell phone, and PDA to accomplish.7 Smartphones and tablets combine both computing and communication features in a single device that can be held in a hand or stored in a pocket, allowing easy access and use at the point of care.7 In addition to voice and text, new mobile device models offer more advanced features, such as web searching, global positioning systems (GPS), high-quality cameras, and sound recorders.12 With these features, as well as powerful processors and operating systems, large memories, and high-resolution screens, mobile devices have essentially become handheld computers.12
The first mobile device that incorporated both communication and computing features was the Blackberry, which was introduced in 2002.5 After the Blackberry was brought to market, other handheld mobile devices were introduced. Perhaps most notably, in January 2007, Apple launched the first-generation iPhone.5 Subsequently, smartphones that run the Google Android operating system were introduced in October 2008.5 Because of the intuitive touch-screen user
interfaces and advanced features and capabilities that the iPhone and Android smartphones offer, ownership of mobile devices has increased rapidly.12 In April 2010, Apple introduced a new innovation, the iPad tablet computer, which because of ease of use, portability, and a comparatively large screen was yet another transformative computing tool.5 The iPad ignited the tablet computer market.9 Tablets that run the Google Android operating system (Samsung Galaxy and others) were launched later that year, making the use of these mobile devices even more widespread.5
Without a doubt, medicine is one of the disciplines that has been profoundly affected by the availability of mobile devices.4 This is evident in many surveys of HCPs that reveal a high ownership rate of these tools, which HCPs use in both clinical practice and education.2 Smartphones and tablets have even replaced desktop systems as the preferred computing devices for HCPs who need fast access to information at the point of care.9
The June 2012 Manhattan Research/Physician Channel Adoption Study found that doctors’ ownership and use of mobile devices is pervasive, with 87% using a smartphone or tablet device in their workplace, compared to 99% who use a computer.13 Surveys have shown that around 80% of physicians use an iPhone, while most of the remainder opt for Android smartphones.1,14 An estimated 66% of doctors own a tablet computer, which 54% use in their practices.13 Interestingly, the popularity of mobile devices does not correspond with age, since 80% of physicians ages 55 and older own a smartphone.13 Similar results reflecting the pervasive use of mobile devices by HCPs were reported in a survey of medical school faculty, residents, and students.1 The results of this study found that 85%, 90%, and 85% of respondents, respectively, use mobile devices in a wide variety of clinical settings ranging from classrooms to hospitals.1
Need for Mobile Devices at the Point of Care
One major motivation driving the widespread adoption of mobile devices by HCPs has been the need for better communication and information resources at the point of care.7,14 Ideally, HCPs require access to many types of resources in a clinical setting, including:
● Communication capabilities—voice calling, video conferencing, text, and e-mail 7 ● Hospital information systems (HISs)—electronic health records (EHRs), electronic
medical records (EMRs), clinical decision support systems (CDSSs), picture archiving and communication systems (PACSs), and laboratory information systems (LISs)7
● Informational resources—textbooks, guidelines, medical literature, drug references7 ● Clinical software applications—disease diagnosis aids, medical calculators7
Prior to the development of mobile devices, these resources were mainly provided by stationary computers, which do not support the need for mobility in health care settings.7 In an attempt to address this need, some health care environments set up portable, wireless mobile information
stations such as Computers on Wheels (COWs) or Workstations on Wheels (WOWs).7 With the availability of mobile devices, however, clinicians now have access to a wellspring of information at their fingertips, through their smartphones and tablets.10
The results of the 2012 Manhattan Research/Physician Channel Adoption Study also identified the purposes for which HCPs rely on mobile devices.13 Searching was the most popular activity among HCPs, with 98% using their desktops/laptops to search, 63% using their tablets, and 56% using their smartphones.13 Focusing on smartphone use for doctors alone, searching is again the most common activity, occupying 48% of phone time, with professional apps consuming an additional 38%.13 Physicians were also found to spend an average of three hours per week watching web videos for professional purposes on desktops/laptops (67%), tablets (29%), and smartphones (13%); the most frequently viewed content (55%) was continuing medical education (CME) activities.13 A frequent reliance on mobile devices was also reported in the survey of medical school HCPs and students, with 85% reporting the use of a mobile device at least once daily for clinical purposes, often for information and time management or communication relating to education and patient care.1
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MOBILE APPS FOR HEALTH CARE PROFESSIONALS
What Are “Apps”?
The rapid integration of mobile devices into clinical practice has, in part, been driven by the rising availability and quality of medical software applications, or “apps.” 2 Apps are software programs that have been developed to run on a computer or mobile device to accomplish a specific purpose.1 Faster processors, improved memory, smaller batteries, and highly efficient open-source operating systems that perform complex functions have paved the way for the development of a flood of medical mobile device apps for both professional and personal use.4
The ability to download medical apps on mobile devices has made a wealth of mobile clinical resources available to HCPs.15 Medical apps for many purposes are available, including ones for electronic prescribing, diagnosis and treatment, practice management, coding and billing, and CME or e-learning.9,10A broad choice of apps that assist with answering clinical practice and other questions at the point of care exist, such as: drug reference guides, medical calculators, clinical guidelines and other decision support aids, textbooks, and literature search portals.7,13,15 There are even mobile apps that simulate surgical procedures or that can conduct simple medical exams, such as hearing or vision tests.6,7 Many mobile apps are not intended to replace desktop applications, but are meant to complement them in order to provide a resource that has the potential to improve outcomes at the point of care.7 The use of medical apps has
become frequent and widespread; 70% of medical school HCPs and students reported using at least one medical app regularly, with 50% using their favorite app daily.1,9
In July 2008, access to apps was further revolutionized by the launch of the Apple iTunes App Store, which gave iPad, iPhone, and iPod Touch (iTouch) users the ability to shop for and download apps from an online marketplace.9,15 As of January 2014, Apple reported that a staggering 1 million apps were available through the iTunes Appstore.16 In 2011, Apple created the “Apps for Healthcare Professionals” section within the medical category of the iTunes Appstore, a unique feature among mobile app marketplaces.17 In 2013, this section was further divided into subcategories including: reference, medical education, EMR and patient monitoring, nursing, imaging, patient education, and personal care.18 Google similarly launched a “Google Play” shop that provides a wide variety of apps, including some for HCPs, for mobile devices that use the Android operating system.15 To reach more users, some mobile apps have been made available for use on either Apple or Android platforms.9
The primary criteria for choice of app is often cost; users may prefer to download a free app but will replace or upgrade it later, if necessary, with one that requires payment.9 Some free apps are fully functional, while others are nonfunctional or partially functional unless a subscription is purchased.9 Many well-known medical journals and medical textbooks can be purchased as mobile apps after payment of a subscription fee.9 Although some medical apps may initially be costly, they can ultimately be cost-effective if updates are included.9,15 For example, medical textbook apps are often updated annually, eliminating the need to buy newer editions.9
How HCPs Use Mobile Devices and Apps
Health care professionals use medical devices and apps for many purposes, most of which can be grouped under five broad categories: administration, health record maintenance and access, communications and consulting, reference and information gathering, and medical education. The many uses for mobile devices and types of medical apps that fall under these categories are discussed in the following section, and are also listed in Tables 1 and and22.
Table 1
Uses for Mobile Devices and Apps by Health Care Professionals
Table 2
Medical apps for health care professionals2,4
Information and Time Management
One of HCPs’ most frequent uses for mobile devices is information and time management.1 Popular information management apps, such as Evernote and Notability, enable users to write or dictate notes, record audio, store photographs, and organize material into categories within a searchable electronic database.6 E-book reader apps, such as GoodReader and iAnnotate, allow users to view, underline, highlight, enlarge, and annotate text in PDF files.2,5
Cloud-based storage and file-sharing services that can be accessed using a mobile device are also useful for information management, since they allow users to store, update, and share documents or photographs with others without exchanging a flash drive or CD.2,5,6 Most cloud-based storage systems provide users with a few gigabytes of memory for free; additional space often requires payment of an annual subscription.2Cloud-based information storage provides the additional advantage of permitting information to be accessed instantaneously from multiple devices, which allows people who are collaborating together to share materials quickly.2,5,6
Dropbox is a popular cloud-based storage service that can be used with multiple devices.2,5 Google Drive also allows file uploading, sharing, and management through Google Docs.2,5 SkyDrive, a cloud-based storage service that is compatible with mobile devices, uses the Windows 8 operating system.5 Box is a cloud-based storage service that is reportedly compliant with both the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.19 However, it should be noted that some cloud-based storage services are not compliant, and therefore may not be suitable for storing or exchanging patient information.2 Access to cloud-based storage services
requires an Internet connection, but files can be saved to the mobile device’s internal memory for offline use.5
An additional advantage provided by information management apps is that they can be used in combination. For example, GoodReader can be connected to a cloud service, allowing PDF files to be downloaded from the cloud into the reader app.5 Evernote, as well as some other information management apps, can be used in conjunction with a cloud service and reader.5 This enables a PDF downloaded from the cloud to be viewed with a reader, then sections of the document can be cut and pasted into the information management app.5
HCPs frequently use mobile device apps for time management. This doesn’t require a special app; native apps that come installed on mobile devices are often sufficient to organize and track appointments, meetings, call schedules, and other clinical obligations.1,3 Mobile apps such as ZocDoc, which allow patients to view information about and make appointments with participating doctors, are also available for the iPhone, Android, and Blackberry devices.4
Health Record Maintenance and Access
Apps are also available that aid in data collection and retrieval, such as entering information into a patient’s EHR or EMR.3,7 Hospital information systems often include features that allow HCP management of EHRs and PACSs, permitting secure access to patient information (medical history, vitals, prescriptions, lab results, x-rays, scans, consultations, and discharge notes) either on site or remotely.3,7
One health care software company, Epic Systems, has partnered with Apple and released versions of the Epic scheduling, billing, and clinical support app for the iPhone and iPad.4 PatientKeeper Mobile Clinical Results provides physicians with access to patient clinical data via either Apple or Android mobile devices.7 Teamviewer is a general-purpose record maintenance and access app that can be installed on mobile devices, allowing remote access to desktop PCs.5 In the absence of such apps, a virtual private network (VPN) log-in can often be obtained from the hospital to allow remote secure access into the in-house network through the Internet to view records for emergency consultations.5
Specialized apps are also available for remote viewing of medical imaging scans.10 Mobile MIM is a free app for the iPad and iPhone, approved by the Food and Drug Administration, that allows remote viewing of x-rays and imaging scans when users cannot access imaging workstations.6 This software works with a paid subscription or pay-per-use plan using MIMCloud, a HIPAA-compliant server that allows users to store and share medical images.6 Images can be downloaded from the cloud and viewed with the MIMViewer paid app in any setting, whether during discussions with team members or patients.6
In some instances remote evaluation of image scans via a medical device has been proven to be just as effective as viewing them at a standard workstation.4 In fact, one group demonstrated that its members could use their iPhones to diagnose acute stroke on CT brain scans just as accurately as when a workstation was used.4 Mobile devices’ cameras are also useful for documenting images to aid in diagnoses, such as taking pictures of gross or microscopic pathology specimens to get a colleague’s opinion or for personal reference.3
Communication and Consulting
Health care systems are often highly dispersed, encompassing multiple locations such as clinics, inpatient wards, outpatient services, emergency departments, operating theaters, intensive care units, and labs.7Consequently, HCPs not only need to be mobile themselves, they also need to be able to communicate and collaborate with people in different locations.7 Mobile devices satisfy this need by offering multiple means of communication, including: voice and video calling; text, e-mail, and multimedia messaging; and video conferencing.3,7 Clinical communication apps are available for mobile devices that are specifically designed to simplify communication among clinicians.7
Mobile devices have been proven to improve contact between HCPs and their colleagues.1,4 In one study, mobile devices were shown to improve communication between doctors and nurses on inpatient wards.4 In a survey of medical school HCPs and students, more than 80% of respondents described using mobile devices to communicate with colleagues about patient care via e-mail, telephone, and text messages.1 They described texting as a more efficient means of communication than telephone conversations or in-person meetings.1 Mobile devices also allow rapid response to e-mail, allowing users to keep up with communication.1 Texting or calling colleagues directly on their mobile devices, rather than paging them, has also been shown to save critical time in emergency cases.3,7 Mobile devices can also be used by HCPs to aid long-distance patients by allowing them to text or send pictures regarding problems or questions.3
Social networking apps are useful tools for enabling discussion, consultations, and collaboration among HCPs.5 Doximity is a HIPAA-compliant social networking site that has been described as a “Facebook for doctors.”4 Registration on Doximity requires validation of a potential user’s credentials through verification against a medical license database.4 Once registered, physicians can network with colleagues from medical school, residency, or elsewhere, and exchange patient-related information via text messages.4Facebook itself has also reportedly been used to establish a “nondisclosed” forum for consultations, discussions, and mini-lectures among infectious disease specialists who are registered university professors.5 Such forums can provide a convenient and efficient means for medical specialists to rapidly and efficiently share opinions.5 Chatting apps that allow text messaging and image exchange can be used to trade
detailed information during consultations.5 It should be noted that Facebook, as well as many other social media and chatting apps, is not HIPAA compliant.5
Reference and Information Gathering
Literature Research and Review
Mobile devices are invaluable tools for HCPs to use to search or access medical literature, as well as other information sources.1 The survey of medical school HCPs and students found that mobile devices were often used to access medical journal websites (60%) or medical news online (74%).1 Several medical journals, such as the New England Journal of Medicine , The Lancet , and BMJ (formerly the British Medical Journal ), provide apps that allow articles to be viewed on mobile devices.5 However, journals rarely provide free access to articles without the purchase of a subscription.5
Search applications for HCPs, such as PubMed/MEDLINE, also facilitate searches of medical literature databases to identify published medical information.7 Mobile medical literature search apps used by HCPs include: PubSearch, PubMed on Tap, Medscape, MEDLINE Database on Tap (MD on Tap or MDoT), Docphin, Docwise, Read by QxMD, askMEDLINE, PICO, and Disease Associations.7 PubSearch is available for free, while PubMed on Tap is available for several dollars.2,7 Both apps work with the iOS platform to facilitate PubMed/MEDLINE searches using the iPhone, iTouch, and iPad.7 The free app MD on Tap is provided by the National Library of Medicine to help HCPs using PDAs access medical information at the point of care through three search engines: PubMed, Essie, and Google.7
Drug References
Drug reference applications are generally used to access information including: drug names, indications, dosages, pharmacology, interactions, contraindications, cost, formulary status, identification guides, and dose by weight calculators.3,7 The most frequently used mobile drug reference apps include: Epocrates, Skyscape RxDrugs/Omnio, Micromedex, FDA Drugs, and DrugDoses.net.2,4,7Epocrates, Skyscape RxDrugs/Omnio, and FDA Drugs allow users to check multiple drug– drug interactions at the same time.7 FDA Drugs, which includes official FDA labeling for prescription and over-the-counter drugs, permits searching by active ingredients.7 The authors of Epocrates, the most commonly used drug reference app, found that 90% of physicians use mobile device apps to access drug information.7,14
News Acquisition
MedPage Today is one of the most popular apps among HCPs for accessing breaking medical news, organizing news by interest, and earning CME credits.4 The MedPage Today app provides
information about drugs, diseases, and medical procedures, as well as daily podcasts, videos, and news updates.2,3 It encompasses 30 medical specialties and provides annual coverage of more than 60 meetings and symposia.2
Other medical news apps are available.5 For example, the “Outbreaks Near Me” app for users of either Apple or Android mobile devices provides real-time information regarding disease outbreaks according to geography.4 This information is gathered from multiple resources, including online news, eyewitness accounts, and official reports.4 The Outbreaks Near Me app was funded by Google and developed in collaboration with the Centers for Disease Control and Prevention, as well as other organizations.4
Patient Management
Clinical Decision-Making
Mobile devices provide HCPs with convenient and rapid access to evidence-based information, supporting clinical decision-making at the point of care.8 HCPs’ increased reliance on electronic resources for this purpose was identified in the Manhattan Research/Physician Channel Adoption Study, which reported that physicians spend the majority (64%) of their online time looking for information to make or support clinical decisions, double the time spent reviewing print resources.13
Many evidence-based software apps serve as useful bedside clinical decision-making tools.7 Printed medical references often used in disease diagnosis are now available as mobile device apps that provide information on diagnosis, treatment, differential diagnosis, infectious diseases, pathogens, and other topics.7 Such apps include: Johns Hopkins Antibiotic Guide (JHABx), Dynamed, UpToDate, 5-Minute Clinical Consult (5MCC), 5-Minute Infectious Diseases Consult (5MIDC), Sanford Guide to Antimicrobial Therapy (SG), ePocrates ID, Infectious Disease Notes (ID Notes), Pocket Medicine Infectious Diseases (PMID), and IDdx.2,7
Diagnosaurus, a popular, low-cost mobile differential diagnosis app for the iPhone, iPad, and iTouch, can help ensure that alternative diagnoses are not overlooked.4 Flowcharts to help physicians identify diagnostic possibilities are included in the apps 5MCC and Pocket Guide to Diagnostic Tests.7 Other diagnostic mobile apps apply clinical algorithms to aid physicians in determining a disease diagnosis.7Mobile devices can also be used to access CDSSs installed on desktop computers in clinical settings to aid in diagnosis and treatment decisions.8
Mobile apps can also help clinicians identify the appropriate scans or tests to order, decreasing unnecessary procedures and reducing cost of care.7 Lab test apps provide information such as: reference values and interpretation, causes for abnormal values, and laboratory unit conversions.7 They include: Pocket Lab Values, Lab Pro Values, Palm LabDX, Normal Lab
Values, Lab Unit Converter, Labs 360, Davis’s Laboratory and Diagnostic Tests, and Pocket Guide to Diagnostic Tests.2,7
Mobile apps can also be used directly to conduct simple examinations for visual acuity or color blindness, as well as blood pressure or glucose level.3,5,7 The iPhone iSeismometer app, which is used to measure tremor frequency, has been reported to match more sophisticated and expensive devices used for electromyogram analysis.3 The iMurmur app provides recordings of 20 types of heart murmurs, allowing a physician to match and identify what she or he hears.3 Many apps are available to determine pregnancy due dates by using a patient’s sonogram and date of last period, such as “Perfect OB Wheel.” 3 These apps have been said to predict pregnancy due dates more accurately than the paper wheels that had previously been the standard.3
Current treatment guidelines available at the point of care via mobile apps also provide a valuable resource for HCPs.6 Several guidelines are accessible on mobile platforms, including the National Comprehensive Cancer Network guidelines for cancer care available through the Epocrates app, and the American College of Chest Physicians antithrombotic therapy guidelines available via the CHEST app.6 The Johns Hopkins ABX Guide app provides an impressive compilation of antimicrobial recommendations and guidelines, including some for surgical prophylaxis and surgical site infection treatment.6
Other mobile apps, such as medical calculators, use standard formulas to make calculations to determine risk scores and other measures, such as body mass index (BMI), body surface area (BSA), and proper drug doses.4,7 Calculation of clinical scores or indices typically involves utilizing complex formulas that require several input parameters.7 Even if a HCP knows the formula, performing even simple clinical score calculations manually can be surprisingly time consuming and error prone in a fast-paced clinical environment.7 In contrast, HCPs who use medical calculators do not necessarily need to know the formula for calculating a clinical score or index; they only need to enter the parameters to quickly produce a reliable result.7
Popular medical calculators include: Epocrates MedMath, MedCalc, Mediquations, Calculate, Medical Calculator, Archimedes, uBurn Lite, Softforce’s Antibiotic Dosage Calculator, and Paeds ED.2,6 Others that are available are: Vancomycin ClinCalc Full, Softforces’s Antibiotic Dosage Calculator, and MedCalc 3000 Pharmacology.5 Calculate by QxMD is a free app that calculates heart disease and stroke risk based on various patient variables.3 Since the results are visual, this app can be very effective in communicating risks to patients during discussions about potential behavior change.3 Another free medical calculator called Archimedes is available through Skyscape.4
The Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, provides the free Electronic Preventive Services Selector (AHRQ
ePSS) app.3,4 This app is designed to assist primary care physicians in screening, counseling, and identifying preventive measures, based on a patient’s age, gender, sexual activity, tobacco use, and other risk factors.3,4 Surgical risk calculators are also available, such as the euroSCORE calculator, which uses recommendations from the Society of Thoracic Surgeons to calculate operative risk at the point of care.6 The American Cancer Society National Surgical Quality Improvement Program is also developing a surgical risk calculator.6
Patient Monitoring
The use of mobile devices to remotely monitor the health or location of patients with chronic diseases or conditions has already become a viable option.7 Mobile device apps can provide public health surveillance, aid in community data collection, or assist disabled persons with independent living.12In one study, a single-lead electrocardiograph (ECG) was connected to a smartphone to diagnose and follow treatment of patients with sleep apnea, providing a possible alternative to costly and labor-intensive polysomnography.4 Sensors attached to garments that communicate with mobile devices have also been used to remotely monitor and collect medical data regarding chronically ill elderly patients.4
A clinical monitoring system was developed to monitor an entire unit or one bed in intensive care via smartphone; it displays an alarm, color-coded according to severity, based on patient vital signs.7 The app iWander for Android was developed to monitor and track patients with early Alzheimer’s disease who are prone to wandering by using the mobile device GPS.4 HanDBase, a HIPAA-compliant relational database software program, can be used on mobile devices to track hospitalized patients according to their locations, diagnosis, tests, treatments, and billing information.3 Smartphone apps have also been used to monitor patients during rehabilitation.4 For example, a smartphone connected via Bluetooth to a single-lead ECG device enabled the monitoring of patients in their own neighborhoods when they were unable to reach traditional hospital-based rehabilitation.4 Although potentially useful, patient monitoring apps can be limited by factors such as Internet and GPS reliability, as well as the patient’s ability to use the device.4
Mobile apps that supplement medical devices are being developed.5 One example is iStethoscope, which uses the microphone function of the iPhone to auscultate and record.5 While this app isn’t officially intended for use as a medical device, it is significant in that its existence suggests that mobile devices can eventually replace medical devices.5 Mobile devices have also been used to accurately track heart rate and heart-rate variability.4 In January 2011, MobiSante became the first company to receive FDA approval for a smartphone-based medical diagnostic tool that uses an ultrasound probe for echocardiography.4 Work has also already been initiated to develop ECG recording devices that work with smartphones.4
Medical Education and Training
Mobile devices play an increasingly important role in medical education as students and schools use more technology during training.4 Mobile devices are used by health care students in a variety of ways: to log their experiences, to access information about medical conditions and drug treatment, to perform calculations, and to make basic notes.1
Mobile devices have become ubiquitous in educational settings, particularly because they are a “learn anywhere” resource for accessing information or double-checking knowledge.1,15 Health care students are increasingly relying on mobile devices as a “pocket brain” for quick, easy access to information they need in order to succeed in their programs and careers.9 Resources frequently used by health care students include: online textbooks and lectures, medical podcasts, medical calculators, and search engines to look up unfamiliar terms.1 In addition, many mobile apps for health care students can be used for knowledge assessment, such as case study quizzes or tests to help prepare for board examinations.6,7 The ability to access all of these resources has been shown to enhance student learning in the clinical environment and to increase student knowledge scores.1
Mobile devices are also used by practicing HCPs for educational purposes, especially for CME activities that keep them informed about the most current evidence-based information and medical practices.3,4,7QuantiaMD has a mobile CME app that provides well-scripted interactive case studies that can be shared with colleagues.4 In a survey of medical school faculty, residents, and students, 75%, 95%, and 55%, respectively, agreed that using a mobile device for rapid access to educational resources while on the go had a positive educational effect.1
Mobile devices have been shown to be important tools for teaching medical curricula. In one example, doctors who used a mobile device app during advanced life-support training had significantly improved scores during cardiac arrest simulation testing.4 Mobile apps such as Touch Surgery or vCath are available for simulated surgery training.6 In addition, Northwestern University’s Feinberg School of Medicine faculty uses an iPhone app to assess residents’ autonomy and skill level in the operating room based on self-assessment and the attending surgeon’s evaluation.6
INTRODUCTION
Mobile phones and portable personal computers are increasingly becoming an integral
part of us today for their ever increasing ways they make the accomplishment of various tasks in
the day to day life easy. This is made possible by mobile applications available for smartphones
today that have been designed in such a way as to be used by healthcare providers, patients and
by extension researchers in the field of health and care provision. At the beginning of this
century when the concept of m-health was being introduced it was defined to be the wireless
telemedicine involving the use of mobile telecommunications and multimedia technologies and
their integration with mobile healthcare delivery systems 18. M-health has broadened ever since
and can be defined today to include fitness tracking applications, prescription monitors, research
applications and such like. It is imperative to understand the fact that these applications are
diverse in their operability and are available on the many different mobile operating system
platforms like Android, Linux, Symbian, iOS among others. Again, they are dependent on the
main technologies including 3G, 4G-LTE, GPRS and GSM mobile telephone networks,
computer-based technologies like WiFi and WiMAX, and Bluetooth connectivity for relaying the
health information.20
Mobile healthcare can be traced back to the beginning of the twenty first century when
smartphones were introduced to the market. Just like most technologies, mobile health
applications started slow and small back in 2003 when the penetration of smartphones with the
capability of running such applications but has since increased in a rate we would call
exponential. For instance, in the year 2009 when a partnership between the Foundation for the
National Institutes of Health, the National Institutes of Health and the mHealth Alliance held a
mobile health inaugural summit only a little less than 1000 people were in attendance.19 Fast
forward to 12 months later, in 2010, 2400 people were in attendance in the conference which was
about 300% the attendance of the previous year. This could be attributed to the increase in the
penetration of smartphones globally, where in some countries the penetration of wireless devices
is way above 100%. The third world has also not been left behind as more and more people are
having access to smartphones capable of running mobile health applications.
BENEFITS
Patients
There are many benefits that come with mobile apps and devices for patients. The first
benefit is that apps improve access to care. Apps allow patients and doctors to not be in the same
place in order to receive care. This is beneficial for patients that have chronic diseases, those who
live in rural areas, those who are elderly, those with conditions that make it difficult to see their
doctors, and those who have to travel a great distance. Instead of going to another city or across
the globe, patients can be treated at home more and more often. Many patients cannot afford to
go to the extremes needed to go to a doctor’s visit, with apps patients can still be treated by their
doctors. This makes it easy to get the care that patients want and need.2 The second benefit is that
apps improve patient engagement. By using mobile technology, it improves the provider-patient
interaction. Mobile technology can be used to harness information regarding a patient’s
physiologic factors as well as their environment and lifestyle factors. This information can then
be organized to help with a patient's lifestyle and health choices. Patients can use certain apps to
see where they need to adjust their choices, and they can ask their physicians to help them
navigate the information gathered from the apps.3 Additionally, apps can remove complexity to
help patients engage more in their health. For example, an medication reminder app that tells the
user what pills to take, at what time, and how many.2
The third benefit is apps improve patient safety. Digital apps allow patients to have the
tools to manage their own health. When patients get discharged, they can leave with a lot of
paperwork and instructions. They do not always remember what they are supposed to do once
they get home. Apps can help with such things as monitoring side effects, reminding patients to
take their pills, and giving information to their providers. Apps can also tell patients when their
doctors are not going to be on time, schedule doctor’s appointments, and help follow the
patient’s care plan. This is all important to patient safety, and can help with recovery.2 The fourth
benefit is that apps connect patients to peer and support communities, and helps caregivers help
patients. Some apps can provide education, support, decrease anxiety, and connect patients with
one another. This is especially rewarding when questions and concerns can be exchanged with
those with similar conditions and symptoms. Apps can also help caregivers help patients. This
can be done by apps transferring data and share patient-derived information to a caregiver, which
is critical to the patient’s health. Doctors do not always acknowledge caregivers, even though
they are sometimes the only people that can insure the patient knows the instructions and follows
the medication schedule that is prescribed. Some apps can assist caregivers by helping them cope
with their patients chronic illnesses. This can give caregivers a sense of knowledge and
understanding that can benefit their patient.4 The fifth benefit is improved accuracy and increased
efficiency/productivity. Patients have more complete records, and more accurate records with the
improved accuracy that apps provide. This is beneficial, because a patient’s medical records will
be updated with the most recent information that their doctors can use to treat them.
Additionally, increased efficiency/productivity allows patients to be seen quicker by their
doctors, because apps can streamline physician workflows. Patients do not have to wait for their
doctors to dig for information, it will all be readily available. This means less time spent at a
doctor’s office or hospital and more time recovering.
Providers
There are many benefits that come with mobile apps and devices for healthcare
professionals as well. Access to care can benefit physicians as well, because physicians will be
able to see more patients that cannot be seen in a normal face-to-face settings with telehealth
apps. Physicians can be at home or at the office, and help as many patients as possible. They can
potentially make money more this way, because of the convenience of practicing anywhere and
anytime they want. Patient engagement can be beneficial for physicians, because it increases the
information exchange between the patient and provider.3 Having information exchange between
patients and physicians is the driving force to effective patient care.4 This improves the physician
and patient relationship making it more of a personal one rather than a formal one, which can
allow the patient to open up. Opening up allows the physician to start a conversation about the
information collected from the apps.3
Additionally, apps can improve accuracy and increase efficiency/productivity for
physicians. Mobile devices/apps have improved both accuracy of patient documentation as well
as completeness compared to paper records. Some reports have shown more accurate diagnostic
coding, increases in medication safety, more frequent documentation of side effects, reduced
prescription error rates, reduced discharge order list errors, and fewer discrepancies in recording
neonatal patient weights in hospitals.1 Mobile devices/apps have also increased
efficiency/productivity. Some reports have shown decreased time spent accessing, retrieving, and
recording data during patient rounds, which allows doctors to see more patients and streamlines
their workflow.1 A specific example is electronic prescribing, which has increased pharmacists
productivity by easily allowing important drug information and quicker prescription orders. In
general, physicians will be able to make faster decisions with less errors, increase accessibility
and quality of data management, and improve practice knowledge and efficiency. This will
reflect positively on patient care outcomes, such as reducing adverse events and shortening
hospital stay.1 The sixth benefit is that apps help physicians improve treatment processes/clinical
decision-making for their patients. When information from clinical issues are hard to follow or
document, physicians can get the most out of their patients using data-tracking/diary-type apps to
track their patient’s conditions in real time. The huge quantity of data collected will be of quality
and usefulness to display what is really going on with the patient’s condition. By knowing all the
information, physicians can pick the best treatments, which will lead to better clinical decision
making.4 This is especially important when practicing evidence-based medicine.1
Payers
There are many benefits that come with mobile apps and devices for payers. The benefit
regarding improved treatment process/clinical decision-making, leads physicians to better
diagnoses. Payers can spend less money on inaccurate treatment plans, and on potential lawsuits
for wrongful hospitalization/death. The benefit regarding improved accuracy, leads physicians to
less errors due to more accurate reports. This means less mistakes that insurance companies have
to pay for whether it be minor or very serious. The benefit regarding increase
efficiency/productivity allows physicians to see more patients, which means more money for the
insurance companies. The seventh benefit is that apps help reduce Medicare fraud. Some may
think that the opposite would occur, but that is not the case. With the help of digital apps,
insurance companies and the government can track people and their transactions, as well as give
a timestamp with their location. This can be useful when there is an investigation involving
fraudulent behaviors to connect claims data with location, and time data to search for the
criminal. Everything can be researched and investigated in real-time, instead of many months
later with the money already long gone. This will help save payers tons of money and time.2
DRAWBACKS
Patients
Mobile applications have many benefits, but they have drawbacks as well. The first
drawback is that mobile apps are being chosen over physicians. Patients trust in medical apps are
on the rise, while their trust in physicians are the lowest it has been in a long time. This might be
problematic if something is truly wrong with patients, and they are not seeking the medical
attention that they need.5 Patients can make their conditions worse if they do not physically go to
the doctor and get treated. The second drawback is mobile health devices and apps can
encourage hypochondria (or iPochondria). If a patient sees one wrong or negative reading, they
will rush over to their physician. This can cause more harm than good, because they can get
obsessed with using the mobile devices/apps and continue to think and stress about having more
things wrong with them when they do not. Being a hypochondriac could also hurt the patient if
they go to the extreme measures to “cure” themselves of a disease that they do not have.6
The third drawback is trust and quality issues with apps. Mobile applications claim that
they only educate patients, are for medication adherence, are to track vital signs, and many other
patient derived data. However, this is not true. Apps that make these claims can be pointless on
one spectrum and dangerous on the other for patients. The US Food and Drug Administration
(FDA) acts as the authority of the accuracy and safety of mobile healthcare apps. The FDA only
regulate apps that function as medical devices, change a device to a medical device, or provide
analyses, diagnoses, or treatments.7 The fact that not every app on the market is approved or
regulated by the FDA along with liability risks involved, makes this even more troublesome.8
The fourth drawback is security and privacy issues with apps. Apps can hold important
information as well as control many healthcare devices, and placed in the wrong hands can be
disastrous. Hackers can go into a patient’s mobile device and to the apps and change a patient’s
pill schedule, shut off their pacemaker, or even falsify their heart rate or glucose levels. These
security breaches can be life-threatening. Hackers can also leak private information that patients
would not want their bosses or other people to find out about.7
Providers
With patients choose mobile apps over seeing their physicians can cause physicians to
not see as many patients anymore. The basis of a physician's career is aimed towards helping and
treating patients. Due to the lack of patients, providers will be losing money to mobile apps as
well. With patients who have encouraged hypochondria from apps, physicians will be wasting
their time and energy seeing those patients and trying to convince them that they do not have the
condition that they think they do. Physicians should see patients who actually need to be seen,
and not use their valuable time with patients who do not. With apps having security and privacy
issues physicians expect the application to be safe by having no viruses or malware, but this is
not the case. Physicians do not want to be held liable if they have suggested an app, and a
patient's becomes hacked. The only way physicians will prescribe more apps is if security and
privacy can be guaranteed.7 Physicians have a duty to protect their patients, and apps should not
hinder that protection.
A fifth drawback is the problem and potential of data overload. Since apps have a lot of
data, there could potentially be a lot of unnecessary information at times. Alternatively, there can
be useful information that is missed because of the overload. The only data that is useful is data
that can change a treatment plan, and everything else is just noise. The technology developers
behind apps do not understand that giving tons of data with no filtration creates data overload.
This is especially true if app developers do not have clinical knowledge. Apps need “analytics”
to separate the useful data from the noise in order to stop data overload.7 Physicians do not know
what to do with this influx of data, because they do not have the IT capabilities or foundation to
effectively utilize mobile data. If the foundation is not created so that physicians can collect,
analyze, and share mobile data, than physicians will end up continuing to treat their patients with
data from one area while patients diagnose/manage their health with different data.5
Payers
With the appeal of mobile apps and wearable devices, many people would rather choose
this cheaper and more convenient alternative than going to the doctor.5 When patients start to use
mobile apps more, they will rely less on medical professionals. This is an issue, because app
developers will be receiving the money that payers could have received. With mobile health apps
encouraging hypochondria, physicians workloads will be even more than they already are.
Physicians will need to take vacations more frequently, and payers will lose money. Insurers may
also need to consider this an issue, because this will continue the rise of health care costs.6
APPLICATIONS TYPES
We will now talk about some of the applications that help patients keep in track their
health and overall help them live a better and more organized life. We will be talking about
applications that help patients remind them to take their pills or help them to see how healthy
they are eating and even when they have to go see their doctors for scheduled appointments.
These applications are very helpful to patients and we feel like in a way to doctors also because it
makes the patients take their medicine on time and get to their appointments on time so the
doctors do not have to worry about reminding their patients constantly about taking their pills or
to come to the appointments. One of the biggest aspects of these applications has to be the
security and privacy that it brings to the patients files to make sure they are protected from any
outsiders harm. So let's take a look at how these application work, what they can improve and
also the qualities that make them so useful and helpful to patients and also healthcare providers.
The first application that we were intrigued by is called Chartspan which is a desktop and
mobile application. Its functions allow you to manage all of your health records from just one
single account so that saves a lot of time. 9 The best thing we like about this application has to be
that you can take a picture of your paper records and turn it into digital copies which is very
useful specially with all this new technology in the world. Lastly, this application can manage
just not your medical records but your whole families, so no matter which doctor you are seeing
and for which family member everything will be just one click away. 9 The team at chartspan
prioritizes privacy and security to the highest level because they realize how important that is
and makes sure each patient's file is encrypted and safe from any unwanted activities.
The second application that intrigued us would definitely have to be the fitbit application
which is an overall great application that can help you live a long and healthy life. Also it is the
world's leading application for tracking your workouts, all-day activity and even sleep. 10 It also
lets you log your food faster and measure your hydration which is a very important aspect of
working out. You always have to be hydrated in order to get a good workout in and as they say
abs are made in the kitchen so logging your food in is definitely a plus and something you need
to get in shape. Some of the things that are not so great about the fitbit and things that they can
improve on are that it breaks a lot, does not track everything and lastly some people get obsessed
with reaching their steps and will check repeatedly each day until it is done. Overall we feel like
this is a good application that can improve in some ways but we would still recommend it to our
friends and family.
Another application that we want to take a look at is Medisafe Pill Reminder for Meds
and Prescriptions. It has a 4-star rating on the App Store and is also free and has many customers
that use it on the a daily basis. However, there are some things that people are not big fans about
when it come to this application. Some of those things are that the price to go premium is way
too high and people think it should be lower so they can afford it. Also people have complained
that the application sometimes will crash and there is no in-app support to send feedback to
which does not help to improve or resolve their problems. There are also a lot of good things
mentioned about this application which consist of it allowing you to input your medications,
including dosage, and even what the pill looks like. It also sets reminders for any pill that you
take regularly and also notifies if you miss a dose so you can make it up as soon as possible. As
people get older that comes into use and actually even for younger people sometimes it's hard to
remember to take your pills because you are so busy with your other activities that the last thing
you remember is to go to the cabinet and take some pills specially if you are taking a lot of them
at different timings. So we feel like this application is very helpful in keeping your life simple
and organized.
Another healthcare provider except doctors are pharmacists, they are the people who
supply the medication and answer any questions that patients have on how to take the pill and in
how many hours they have to take it. One of the applications that help that patients for pharmacy
related things is GoodRX. GoodRX makes comparing prescription prices very easy and also
provides a lot of coupons which always helps. It has a 4.7 rating on the App Store so you can tell
just by that rating that is it is very useful and patients love it. However, there are some cons
about this application too that we will discuss as well as many pros. One of the cons for this
application is that consumers think that the estimated price does not exactly match the prices at
the pharmacy store which is a big problem. Some of the pros for this application are that it was
the winner of the 2012 Webby award and it offers different estimated prices from different
pharmacies in your area so you do not have to go too far. Also the application provides coupons
so you can get some extra cost off and lastly you can browse any medication you want either by
condition or name which is very useful.
One of the last applications that we would like to discuss that we believe is helpful and
the most useful we feel like for many patients in the healthcare field is Doctor on Demand.
Doctor on Demand is an application that is also covered by health insurance or employers. It is
also rated a 5-star on the app store which many applications do not have. We feel like the people
who it helps the most is new moms because most of them are really new to this and want to make
sure that their baby is growing in a healthy way. They can quickly contact specialists for their
kids no matter what the reason is and they will get treated with care and respect. The reason this
application was created was because if you know anything about healthcare, you know the
biggest problem is the lack of time the doctors have to spend with their patients because they
usually have so many that they have to take care of. This application provides doctors that have
been carefully screened and are qualified to resolve any problems you are facing. The patients
can video call them on their smartphone or computers any time of the day because unlike the
physicians in clinics and hospitals, they are there all day to help you. The costs also for this
application is actually the same as a typical copay but much less than the cost at urgent care but
with quicker service and more quality of time with your physician. So why are we not using this
application already? Maybe you did not know something amazing like this existed, well now you
know so go download it right away.
You might be wondering why we chose these specific applications, well let me answer
that question by explaining some of our reasons behind choosing these applications. One of the
reasons we chose these applications is because we feel like these applications are the most
helpful and organized in the healthcare world. These applications do not just help the patients,
but it helps the physicians too which is one of the biggest reasons why we chose these specific
applications. They also cover many of the problems that patients and physicians always complain
about like patients forgetting to take their medicine at the specific time or missing their
appointments. Another complaint that is reoccurring from patients is that they cannot see their
doctor when they want to and that they have to wait approximately 2 weeks just to get a free
appointment with their doctors and even when they finally do get to the clinic or hospital they
have to wait another 2-3 hours just to see the doctor. After all that waiting, they barely get any
time with their physician because he has so many patients to see that he has to hurry and that is
where this application Doctor on Demand comes in and solves all these problems. People also
have a hard time tracking their sleep and logging in their food to see how many calories they
burn and how much they ate to see if they are following their diet or meal plan. Fitbit is the
application that helps with that and another thing consumers have a problem with is the cost of
these medicines. The application you can use to help with that is GoodRX which helps you find
alternative pharmacies and cheaper prices for those medicines in locations that are near you so
you don't have to go too far or out of your way. So as you can see we covered these applications
because we thought these are the most useful and helpful applications in the healthcare field to
the physicians and also the patients.
RESULTS
It is clear healthcare professionals continue to use mobile healthcare technology available
in the market today to accomplish various different tasks in the day to day provision of health
and care to patients globally, from administration purposes and health record maintenance to
providing consultation services, collecting information and even medical education.
Reminders and notes are important in the medical field both for the healthcare professional and
the patient; a surgeon has to remember when they are scheduled to undertake an operation while
a patient has to remember when they should take their medication or when they are due for
appointment with the doctor and so forth. This and much more is made possible by some among
many of the mobile health applications.21 Communication and consulting is made easier by these
applications as most of them have actually made consultation visits to the doctor not mandatory
as the patient can get the same service from the comfort of their seats. Besides, consultation
between professionals is made possible by the mobile health applications designed for such.
Access to medical history records by the patients and the health professional has been made
simple by these applications as seen earlier in the document. Apple Inc. is one of the leaders in
this regard with its “Health” application that incorporates Apple Watch in health data collection,
recording and storage. Imagine being able to track health progress over time with only your
smartphone and some variant of a wrist watch; it is a leap into the future of healthcare provision.
Again, medical literature, reviews and drug references are accessible everywhere one goes by the
applications in mobile devices. Applications talked about above such as MEDLINE for searching
databases for medical information and Micromedex for drug reference are examples of the ever
increasing importance of mobile health technology. When it comes to health, news reaching the
intended destination in the shortest time and most convenient way is as important as the news
itself, and this cannot be reiterated enough. HCPs, therefore, need such convenient technology as
mobile healthcare support devices to facilitate news acquisition and transmission together with
rightful clinical decision-making supported by evidence-based information available today in
health databases and made possible by mobile health devices and applications.
CONCLUSION
Mobile devices continue to form an integral part of today’s generation not just because of
communication purposes but also for other purposes that devices of the previous generations did
not provide. One such purpose is monitoring and continuous improvement of healthcare
provision through use of the thousands of different mobile applications available in the internet.
These mobile health apps are designed to provide support to HCPs at different points of health
service delivery from data collection to consultation after during and treatment. Mobile health
applications have made it easy for both the health service providers and the patients to provide
and get best health services respectively. However, the fact that this technological innovation
comes with its drawbacks cannot be disregarded though in the long run they are overshadowed
by the good. The future of mobile healthcare provision looks brighter now more than ever,
especially with the always increasing penetration of smartphones and other mobile devices in
developing countries. 22 The growing number of mobile application developers should also boost
this frontier of healthcare provision.
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