Health technology has gained considerable attention in the recent years with new innovations being touted every year at major health tech conferences. With the dearth of attendance from end users of these technologies (i.e. Clinicians and Patients), companies showcase expensive technologies to the audience often comprised of healthcare executives, administrators, and other tech companies. In the midst of hype and showcasing new technology, the voice of the physician and patient is often forgotten. Entrepreneurs and vendors would do best if they listen to the needs of their end-users to build a solution that solve real problems. In that regards, both building and offering solutions should utilize human-centered design approach where the user is considered first, even during the sales cycle. That is key to winning over physician.
In the midst of the rapid growth of health technology, physicians can often find themselves lost and overwhelmed with the number of technologies pushed on them. A physician at a practice will be inundated with marketing material and vendors whereas physicians within larger systems will be compelled to use technology as deemed appropriate by senior executives. In both cases, the physician is under pressure to deal with the technology. Having stated the above, there are numerous benefits of using health technology in healthcare. When we look past the hype and inspect further, we discover that there are numerous benefits of integrating technology for clinicians and patients.
A good example is telehealth technologies being adopted by small and large healthcare organizations. The definition of telehealth varies but there are considerable overlaps amongst most of the definitions. The American Telemedicine Association defines telehealth as ‘…the remote delivery of health care services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite and telephone media.’ On a similar note, The Mayo Clinic defines it as ‘..the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services.’ In our technology-dominated society, smart phones are ubiquitous part of our lives and telehealth has incorporated smart phones as part of care delivery. We spend most of our time outside of healthcare facilities, so it only seems natural that care should be accessible and administered outside of a healthcare facility. As mobile health, or mHealth, is gaining traction within healthcare, it is worth understanding it’s value, especially considering that mHealth will become more common form of interaction between clinicians and patients.
While doing a ‘virtual visit’ with your doctor right from your homes does offer benefits such as convenience and lower costs, the real benefits are for individuals with complex health problems – chronic care and post-surgery recovery. In that regards, both research and actual use of telehealth technology points to benefits of improving outcomes.
mHealth in post-op care
Post-surgical care remains a focal point for deployment of telehealth technologies, specifically mobile health, or mHealth, systems to manage individuals recovery process. In a realm where telehealth technology is oversold and inundates the market, physicians may find it difficult to understand what sort of telehealth technologies are beneficial to them. However, there are more and more studies being undertaken to test the efficacy of telehealth and mHealth technologies. A 2011 study in Canada tested the efficacy of using mHealth app with patients recovering from breast reduction and orthopedic arthroscopic anterior cruciate ligament repair surgery. Patients reported overall satisfaction of 3.9 (Breast reduction) and 3.7 (ACL repair) out of 4.0. Additionally, surgeons indicated that based on the responses by patient via mHealth app, they would feel comfortable cancelling follow-up visits if the patient was progressing well and would communicate with the patients electronically. A more recent 2017 study in Australia is studying the effectiveness of using mHealth applications to monitor the progress and clinical outcomes of total knee replacement (TKR) patients after the surgery. While the findings have yet to be published, the researchers feel that ‘the TKR platform is designed to provide flexibility in care delivery and increased engagement with rehabilitation services.’
A study in Sweden launched in 2017 is trying to determine if mHealth platforms can improve the recovery, communication, and management of cancer patients. The study incorporates evidence-based self-reported outcomes measures into mobile application for patients to report their condition, symptoms, side effects, etc. to the clinical team. The clinical team in turn can assess and contextualize the patient-reported information to form a meaningful picture. Kathleen Armstrong, MD the lead author of the study noted:
Patients using the mobile app require approximately 2 minutes to input the quality of recovery, pain visual analog scale, and photographs of the surgical site. This ease of use allows patients to submit data frequently (i.e., daily or weekly), providing a continuous, richer inflow of information than could ever be achieved by telephone or in-person follow-up care.
Another recent study in 2017 by researchers at the Weill Cornell Medicine at New York-Presbyterian Hospital conducted survey with 800 individuals to determine their interest and willingness to use mHealth technology for monitoring their progress after surgery. The result indicated high willingness to wear a wrist tracker (80.6%), fill out a daily survey (74.3%), send pictures (66.3%), and share updates (59.1%). The largely positive feedback paves a path for hospitals and transitional care teams to seriously consider the use of mHealth technologies for post-operative care, especially within the context of 30-day readmission reduction and improving surgery outcomes.
mHealth in chronic care
A study published in 2018 conducted a meta-analysis of 12 studies between 2005 and 2016 to gauge the efficacy of mHealth apps for chronic disease management. Ten of the 12 studies were found to have statistically significant impact on patient health and outcomes. Interventions via mHealth had favorable health outcomes for patients with chronic diseases including asthma, cancer, cardiovascular diseases, chronic pain, spina bifida, or Parkinson’s disease. The study subsequently concluded:
The findings from the majority of reviewed studies that used mHealth interventions showed some health out- come improvement in patients with chronic disease conditions. Favorable factors in mHealth approaches are automated text reminders, frequent and accurate symptom monitoring (often in real time), and improved communication between patients and healthcare providers resulting in enhanced self-management in patients with chronic conditions. Thus, the future of mHealth is presumably optimistic. The relationship between engagement of users on mHealth tools and outcome improvement should be further studied. The studies reviewed in this paper showed disease-specific mHealth interventions that might be different from commercial mobile health apps available to the public. Rigorously tested mHealth apps developed through research should be further considered to be made available to the general population.
A multi-institutional study comprised of New York University, Harbin Institute of Technology, and Carnegie Mellon University conducted an mHealth study with over 1,000 patients with diabetes over a 15-month period. The study found improvements in patient self-management, improved outcomes, and cost reduction. The study specifically concluded:
More specifically, first, we find the adoption of the mHealth platform indeed has a significant impact on improving diabetes patient health outcomes as well as reducing medical costs. This insight is the most critical one from this research, demonstrating the great potential of mHealth in empowering diabetes patients for efficient and effective health management. Second, between web-based and mobile-based platforms, we find a strong device effect: the mobile interventions led to a significantly higher impact than the web-based intervention. Third, in conjunction with patient self-management through the mHealth platform, we also find heterogeneous effects between personalized and non-personalized messages.
Considering the annual cost of diabetes is $327 billion, according to American Diabetes Association, population-wide impact of mHealth-driven care and intervention holds great promise for patients, providers, and insurers.
As evidenced by the growing volume of research in the telehealth domain, there are immense benefits to all parties involved. However, challenges remain that impact the proliferation of mHealth apps amongst patients and providers; most notably, building adequate traction amongst users and having a robust financial/reimbursement model. The most effective way for mHealth to reach patients will be via healthcare systems and physician practices. Such strategy requires better alignment of an mHealth app that can fit well within organizational workflows, their payment models, and easily usable by patients and clinicians. While clinical validity of mHealth apps is gaining momentum, ensuring sustained growth will require maneuvering past organizational barriers and layers to reach patients.
DocToDoor is a custom branded Telehealth solution designed to empower physicians to manage care through the entire care continuum for post-visit, chronic care, and post-op recovery. We are empowering physicians with user-centric remote patient monitoring & engagement and telemedicine platform to manage and care for patients through the entire breadth of patient-provider relationship.