Mobile Health Presents Challenges, Opportunities

If you thought transitioning physician practices to electronic health records systems has been daunting and slow-going, imagine what it will be like to create a mobile-friendly health environment, with patients receiving remote physician consults using cell phone cameras, physicians doing rounds remotely, and doctors using tablet computers to input patient data to “the cloud.”

Impossible?

Actually, all of that and much more is happening right now, and the 3,600 attendees of the mHealth Summit this week in Washington, D.C. - the largest such gathering ever, organizers said - think healthcare is on the cusp of a consumer-driven revolution that will render almost moot the physical locations of doctors and patients while vastly expanding the opportunities for each to interact.

"It's really about mobilizing the point of care," said consultant James Brehm of Compass Intelligence.

The opportunities for improving health outcomes and access are clear. Public health researchers in Kenya, for example, found that they could significantly increase HIV patients’ adherence to medication protocols simply by sending the patients a weekly text message reminder, then following up with patients who didn’t respond to the text. The sample size in the study was small, but researchers concluded that they reduce downstream treatment costs by tens of millions of dollars, while improving patient outcomes, if the protocols in the study were followed for all of Kenya’s HIV-positive patients, according to Bella Hwang, a business analyst with mobile health consultant Wel Tel, who detailed the study results at the mHealth Summit. In the United States, meanwhile, Andrew Watson, a colorectal surgeon and director of the Center for Connected Medicine in Pittsburgh, says he delights patients with technologies such as video calls and remote telerounding.

Patients are demanding mobilized healthcare and have shown a willingness to pay something for it, speakers and organizers of the event said. That has enticed everyone from large healthcare systems to insurance companies to small mobile-device application developers to focus their efforts on building mobile-health software that both patients and doctors enjoy using. Adoption of electronic records systems, by contrast, has moved at a glacial pace precisely because patients have not seen a direct benefit and therefore have not demanded them.

Yet business-model obstacles within the healthcare delivery system remain. For one, payers are experimenting with reimbursement methods for remote care but haven’t yet widely adopted them. “Payers and providers are really testing this space,” said Julie Kling, mobile executive business lead for national insurer Humana. Reimbursement for remote care “often occurs in limited-access areas, like rural areas, where there may not be the access to specialists” available in more populated locations, she said, adding, “I think there’s still some work to be done before it moves out of the testing space.”

Provider groups, meanwhile, are struggling to provide technical support for all of the different devices that their doctors want to use, in order to protect the security of their data systems. That’s not just a healthcare-industry problem, explained Steve Heilman, an emergency physician and the chief medical officer at Norton Healthcare, a five-hospital health system in Kentucky. “It’s Bring Your Own Device Day at work,” Heilman said. Some doctors in Norton’s system are also frustrated with the implied promise of mobile healthcare that patients will be able to gain access to providers virtually around the clock. Some physicians raised in a system where patients arranged their schedule around the doctor’s are struggling to adapt to a model where patients want access to an answer whenever they have the question, he said.

Finally, mobile healthcare may be opening a new area of friction among younger and older physicians and between larger and smaller practices, according to Brehm. “Smaller practices tend to have physicians who are older, less comfortable with new technology, and less-well capitalized. Larger practices tend to employ younger docs. They’ve grown up with mobile technology, they’ve always uses it in their personalize lives, they’re social networkers, and they’re just more comfortable with this stuff.”