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How mHealth Technology Supports Patient Engagement Strategies

mHealth technology helps providers reach their patients between office visits, helping to drive robust patient engagement.

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mHealth is an important tool for improving patient engagement because so much of the technology is already consumer-facing. From fitness trackers and patient portals to smartphone apps and home monitoring equipment, mHealth permeates patients’ everyday lives.

When these tools are easily available through a smartphone or a wearable sensor on a wrist, they can ideally lead patients to monitor  their health and even interact with their providers every day.

mHealth can also be used for remote patient monitoring and telemedicine, which help patients access care in a way that is convenient for them, opening doors to care encounters that may have been more difficult to reach.

Below, PatientEngagementHIT.com breaks down the role of mHealth technology in patient engagement, reviewing different kinds of tools and how they enhance the patient experience.

Fitness trackers and patient-facing smartphone apps

Patient-facing mHealth apps for smartphones and tablets can include nutrition and fitness tracking apps, calorie counters, and other general wellness apps. Wearable devices such as Fitbits or Apple Watches that keep track of physical activity, may provide the data to fuel basic analytics available through interface apps.

These tools can help patients, regardless of health status, manage their overall wellness.

Patients can also tap into apps that manage other aspects of healthcare. Some apps help manage medication adherence by sending text message reminders to chronically ill patients to follow their treatments. Others aid in mental and behavioral healthcare by helping these patients manage their unique symptoms.

Patient-facing apps also serve providers by helping them gauge patient wellness between visits. Providers can track weight loss patient progress through a nutrition app or a fitness tracker, for example. While this may be helpful, patients and providers do face some data sharing barriers.

Limited health IT interoperability can keep willing patients and providers from sharing patient-generated health data (PGHD)  with one another.

Additionally, a study published in the Journal of the American Medical Informatics Association showed that providers may be reluctant to collect and discuss patient-generated health data because they do not believe it is relevant to acute care.

“Providers described concern that systematically collecting [PGHD] information, in particular psychological data on depression and anxiety, could open ‘Pandora’s Box’ during visits,” the researchers reported.

“For example, some said discussing these issues could harm care quality by diverting their attention away from acute problems that they judged to be more relevant at a given visit or more aligned with their clinical expertise.”

In response, researchers suggested organizations adopt a right place at the right time mentality. Providers and other hospital staff reported wanting a system that could analyze patient conditions and deliver PGHD results to providers based on current patient needs.

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Remote patient monitoring devices

According to the Center for Connected Health Policy, remote patient monitoring is the use of “digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.”

These tools hold a lot of potential for improving chronic disease management. In a 2016 study conducted by Capital Blue Cross, researchers found that when heart failure patients used remote patient monitoring devices, it cut hospitalizations by nearly one-third. The technology also helped cut more than $8,000 per patient.

According to Capital Blue Cross executives, these tools can also help improve patient satisfaction and quality of life.

“Not only is chronic disease expensive, difficult to manage and a drain on our healthcare system, but it also takes a toll on patients and families, decreasing their quality of life and often leading to an accelerated transition out of the home and into facility-based care,” said Jennifer Chambers, MD, Chief Medical Officer at Capital Blue Cross.

Additionally, these tools help improve follow-up care.

Providers can collect key patient data through remote patient monitoring tools, saving patients the trip back into the hospital while they still recover properly.

However, they can also suffer a similar fate as fitness trackers and smartphone apps. With limited interoperability, it may be difficult for providers to integrate this patient-generated health data into their own EHRs.

However, through patient-generated health data requirements under meaningful use and MACRA, as well as technology requirements under the ONC Nationwide Interoperability Roadmap, providers and IT developers alike may respond to the mounting pressure to make PGHD a reality.

Providers can adopt application programming interfaces that enable disparate technologies to seamlessly exchange data, or look into other interoperability solutions in order to meet these requirements.

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Telemedicine and patient healthcare access

Telemedicine, a major healthcare talking point, allows patients and providers to conduct doctor’s appointments via videoconference. Providers in need of specialty knowledge can also consult with each other via telemedicine, potentially boosting care quality.

According to a 2015 study published by the American College of Allergy, Asthma and Immunology, telemedicine is just as effective in treating pediatric asthma patients as in-person visits. The benefit, the study suggests, is telemedicine’s convenience.

"All of those seen -- whether in the clinic or by telemedicine -- showed an improvement in asthma control over the six months," Chitra Dinakar, MD, an ACAAI Fellow and study author, told Science Daily.

"We were encouraged because sometimes those with the greatest need for an asthma specialist live in underserved areas such as rural or inner-city communities where allergists aren't always available. The study shows these kids can get effective care from a specialist, even if they don't happen to live close to where an allergist practices."

Telemedicine opens several doors with regard to patient healthcare access. The technology allows patients in rural areas to connect with physicians who they otherwise would have to travel extraordinary distances to visit.

Telemedicine also allows offers significant flexibility. Patients can consult their physicians using their smartphones on their lunch breaks or receive answers about a child’s minor ailment before sending them off to school.

Increased convenience boosts patient satisfaction and ensures patients get the help they need when they otherwise might go without.

According to Reena Pande, MD, Chief Medical Officer at Abilto and cardiologist at Brigham and Women’s Hospital, this flexibility is at the core of patient engagement and patient-centered care.

“I do strongly believe that making it simple for a patient and a provider to engage with one another remotely – by telephone or video – and removing the barriers is a key factor to improving patient engagement,” Pande said in an interview with mHealthIntelligence.com. “It is beneficial to simplify access to that type of care and reach a provider at a time that patients need to.”

Telemedicine does not come without its challenges and critics, however. Broadband access is a significant barrier for patients located in rural areas.

At Lakewood Health System Hospital in Staples, Minnesota, healthcare professionals face challenges in delivering care to patients located in remote areas of the state.

"We do some on cellular, but it's not very good," Bonnie Johnson, the hospital’s director of home-based services, told Minnesota Congressman Collin Peterson.

According to Peterson, the potential for telemedicine in rural regions is high, but in order for healthcare organizations to achieve it, they need better broadband.

Additionally, some providers are wary of telemedicine because of its convenience. At a 2016 meeting of the Medicare Payment Advisory Committee, experts pondered whether patients unnecessarily use the technology because it is so convenient. Patients may rely too heavily on the technology for ailments that may otherwise work themselves out.

Other committee members argued against that point, stating that the overall cost savings in emergency and other departments may outweigh any cost increases.

"If telehealth suppresses some of those costs, the incremental increase in telemedicine may be good," Craig Samitt, MD, MBA, told the committee. "I think we are being overly conservative. We should be embracing the use of technology faster in the industry. Our payment system should not suppress progress."

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Does mHealth work to improve patient engagement?

With regard to the effectiveness of mHealth, different research points to different answers.

One data brief from the CommonWealth Fund found that not all mHealth apps are created equal. The research team assessed all healthcare apps available in the iOS and Android app stores based upon an extensive set of key quality indicators.

The researchers found that although some apps met some criteria, very few met all criteria. For example, some apps were good for recording and tracking health data but did not provide feedback, coaching, or educational information. Other apps were geared toward starting the patient engagement process but did little to sustain that engagement.

Although some mHealth apps may be missing the mark,  telemedicine may be doing its job by offering convenient healthcare access to patients.

A survey by the American Telemedicine Association and WEGO Health shows that convenience is a driving force behind telemedicine uptake.

The poll of 424 individuals shows that 22 percent of participants had used video conferencing to consult a physician. Half of those individuals said they had actively sought out telemedicine because of its convenience.

The 78 percent of patients who had not used telemedicine said it would be a more convenient method to access treatment if it were offered to them.

So long as providers continue to offer quality care via telemedicine platforms, it may prove an effective measure to get patients access to care when they may otherwise go without.

At Nemours Children’s Health, the convenience of telemedicine is improving patient satisfaction. When patients can more easily access healthcare, it boosts the patient experience.

“The patient would show up at the clinic two hours away from the hospital, the doctor would have their visit with the patient via telehealth, and it was great,” said Bernie Rice, Chief Information Officer at Nemours Children’s Health.

“Mom loved it because she didn’t have to pack up all the kids and drive two hours north for an appointment and then two hours back home. So it was much more convenient for the patient and the family.”

Telemedicine also holds promise for improving follow-up care and chronic disease management. According to Dennis McWilliams, President of Apollo Endosurgery, telemedicine options help his practice manage patients recovering from weight loss surgery.

In an interview with PatientEngagementHIT.com, McWilliams said telemedicine was successful at improving patient experience and care outcomes.

“What we’ve found is patients are much more willing to, from the convenience of their home or sitting at their desk during their lunch hour, do a virtual consultation over the internet with a trained nutritionist, or tell their physician how they’re feeling or get a message from their physician in terms of how they’re doing with their new therapy,” McWilliams said.

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Patients are showing interest in mHealth

According to data released by communications firm Ketchum, patients are showing interest in mHealth tools to keep track of their health and message their providers.

A survey of 2,000 patients found that 58 percent of patients like to message their providers using smartphone apps. Forty-seven percent use mHealth apps to track their health, and 87 percent of them use those apps at least weekly.

“This study points to a shift in people’s attitudes and readiness to use technology to manage their health,” said Ketchum’s Executive Vice President Lisa Sullivan.

A 2015 survey from Markovsky/Kelton shows that 66 percent of patients are ready to adopt mHealth and want to incorporate the technology into their treatment. Patients were reportedly most interested in wellness apps, fitness trackers, nutrition apps, and medication reminder apps.

Interest in mHealth crosses age barriers, as well. A Salesforce survey shows that 60 percent of millennial patients prefer telemedicine sessions than in-person office visits. Another survey conducted by Welltok shows that 80 percent of senior patients already use mHealth, and 56 percent are willing to use it as a part of their treatment plans.

Although mHealth may have piqued patient interest, it’s still a low priority for them. A 2016 Deloitte survey shows that patients ranked digital technology and mHealth last out of a set of healthcare characteristics. The survey suggests that there aren’t many options for the tools that patients want to use, and little education on how these tools may improve patient health.

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Do providers approve of mHealth technology?

Although patients may be eager to adopt mHealth, providers have mixed reviews of mHealth technology.

Steve Willey, MD, created the YouPlus Health app to help doctors reach all kinds of patients outside of the office. In an interview with mHealthIntelligence.com, Willey explained that mHealth apps have the power to reach patients and coach them through all of their health needs.

“Getting people to understand they need to make changes in their lifestyle (to live healthier lives) is the easy part,” he says.

“The hardest part is getting them to actually do it. Obviously, what we’re doing now isn’t working.”

Other providers have more reservations, stating that mHealth has not yet undergone enough testing. According to a 2015 Quantia survey, only one in five physicians suggest mHealth apps as a part of treatment because they are not certain of their effects.

“When a prescription drug goes generic, it has at least 7 years of data about its effectiveness and safety, which gives physicians assurance that patients can use it for self-care. Medical apps have no history of either effectiveness or safety,” said Quantia’s Editor-in-chief Mike Paskavitz.

mHealth is in fact in its earliest stages with room left to mature. Going forward, industry experts will need to continue to test and regulate these models to ensure their safety and effectiveness. Additionally, they may consider patient preferences in mHealth, ensuring that they are tools that patients want to use, ideally driving adherence.

mHealth developers may consider a systematic review process, pilot testing apps or devices on diverse patient populations to collect patient feedback. According to a study published in JMIR mHealth and uHealth, an iterative approach is more effective for patient-centered mHealth development.

“Future mHealth research should combine several design and usability testing methods in health technology development, as well as document this design process,” said research leader Courtney R. Lyles, PhD.

“This can not only improve the technology and its ultimate impact but also disseminate key lessons learned that other developers and investigators can build on.”

A recent Deloitte patient poll says that providers should consult patient satisfaction and preference data and target their digital health adoption toward those preferences.

“Focus digital investments on the health care interactions that matter most to consumers: provider experience and affordability,” the report offered. “By focusing on what’s most important to consumers, plans can drive better and broader digital adoption and earn the permission space to digitally engage consumers for other reasons.”

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