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mHealth Meets Population Health

phone_steth134749508[1]Two seismic shifts in the how we communicate and how we deliver health care are coming together in what is being called mHealth: mobile healthcare.

The driver is the need to control health care costs. As hospitals and insurance companies are under pressure to bring costs down, they must look for ways to keep people healthier and reduce costly readmissions. The fee-for-service model is transitioning to accountable care, a model in which a healthcare provider or insurance company (or a partnership between them) takes responsibility for improving the health of population they serve.

In practice, this means that a hospital is not only responsible for treating a patient’s condition when they present to the hospital, they must also take responsibility for what they do once they leave. Simply giving a patient instructions and prescriptions is not enough. If a patient leaves, doesn’t take medications as prescribed, doesn’t follow up with a physician, or experiences complications that aren’t identified soon enough, they quickly can be back in the hospital. Too many readmissions and the hospital faces government-imposed penalties.

Some innovative programs are using mobile technology to help establish regular connections with participants that help them both monitor and control their health. The results, so far, appear promising.

Here are some of the ways mHealth is being used:

Wellness and Motivation

Sometimes, it seems, the nagging voice in your head isn’t enough to motivate you quit smoking, eat better or exercise more. But, apparently, a little nagging through your cell phone can be effective. Researchers in the UK conducted a study in which they found text messages that offered encouragement and reminders to pass up that cigarette doubled the likelihood a smoker would quit.

Developers at the University of Wisconsin created an app to help alcoholics who had completed a rehabilitation program stay on course.  Participants received daily messages of support and answered questions once a week.  Counselors would analyze the responses and could identify those who might be susceptible to drinking and need more support. Participants could also activate a “panic button” to receive an immediate response and offer of help.  The results? Those who took part in the program were 65 percent more likely to avoid alcohol in the year after their release from a treatment center than those who didn’t take part.

Increase Medication Adherence

The World Health Organization reports about 50% of people in developed countries do not take prescriptions as directed. This has serious consequences for those with chronic conditions like diabetes, asthma, HIV/AIDS, hypertension and cancer. To bolster prescription adherence, some organization are turning to text messaging. Patients are sent reminders to take their medications based on their prescribed schedule. It’s a non-invasive message that goes straight to their phone.

Howard Brown Health Center conducted a study in which HIV/AIDs patients, between the ages of 14 and 29 and with poor histories of following their prescription schedule, were sent a daily personalized text reminder to take their medications. One hour later, they received a follow-up message asking them whether they had taken the medication. The study found that the text reminders significantly improved adherence and 95% of the participants said the text messages helped them “very much.”

Reduce Missed Appointments

Missing medical appointments costs medical providers time and money and can have a negative impact on a patient’s long-term health. Simple and effective, text messages are being used to remind patients of appointments. One study found that it reduced the number of appointment no-shows by 30%. This was slightly less effective than staff phone call reminders (34%), but more cost-effective.

Monitor Health

According to a survey by Booz & Company, 88% of physicians want patients to monitor their health at home, including weight, blood sugar and vital signs.

Linking monitors to apps that can help patients monitor their heart rate or manage their diabetes can send early warnings of issues and provide information on what can be done to lower risk and when to call the doctor. The most advanced systems will automatically alert the doctor.

The monitoring and integration with apps and physicians will continue to evolve to be more automatic. Google is developing a contact lens that has a tiny wireless chip that measures and transmits the glucose levels in a diabetic patient’s tears.

What’s Next

As we move forward with mHealth, the Food & Drug Administration has announced it will have a role to play in monitoring any app or technology used as a medical device.

This oversight, while it has to potential to slow the speed of development and launch of new medical apps, will help provide a framework that can assure what is launched will be safe and effective, encouraging physicians to prescribe and insurers to cover, the use of mobile technology to improve patient care and control costs.

Mobile Health: Just What the Doctor Ordered

Mobile Health: Just What the Doctor Ordered