- It’s hard not to be attracted to the glittering promises of mHealth. Reviewing the day’s charts on your iPhone as you pick up your morning coffee can be a great way to get a jump on your schedule, until you see that Mrs. Smith’s chief complaint is that her FitBit is malfunctioning and she wants you to do a full sleep study because she can’t stand not knowing how much REM she’s getting. You’ve already looked at all the data she’s uploaded to her PHR and she’s sleeping fine, so you shoot off a message through your patient portal hinting that there’s nothing to worry about. She texts back instantly, unconvinced because she doesn’t have enough of her own data to trust you, and you turn that grande latte into a venti, because it’s going to be a long day.
mHealth does a fantastic job of making connections between patients, providers, and a wealth of new quantifiable information, but with those new connections comes a new way of interacting with patients, with the office, and with technology. Providers who aren’t prepared for what it means to have a smartphone in every pocket and a tablet by every bedside can start to feel like über-connected patients are speaking an entirely different language – and in many ways, they are. The healthcare expectations of the iPhone generation vary widely from those of their parents, and providers can either embrace the revolution or hold on to the wire-bound ways of the past.
Recent surveys have shown just how popular mHealth is becoming, although anyone stepping into a waiting room full of people with their heads down and their fingers gliding across a touchscreen can see that at least half of US adults own a smartphone. At least half of those smartphone owners use them to track their health in some way, whether it’s calorie counting or doing research online.
And physicians are bigger smartphone users than their patients. Ninety-three percent believe that EHR-connected mHealth apps can benefit patient care, and the same number want to see patient-provided data from devices like Mrs. Smith’s Fitbit, integrated into their EHR. Smartphones make it easy to schedule appointments, communicate with physicians and staff, and monitor diabetes, weight loss, smoking habits, and exercise. They also make it simple for physicians to access research, reference materials, and EHR data, as well as exchange information with other providers and facilities.
But commercial mHealth apps are nearly entirely unregulated, developed by software engineers looking to make a quick 99 cents on the next big iTunes Store hit, whether or not the app has any real clinical value. Patients are trusting these apps as much as they trust their own doctor, and that means physicians are losing the authority they used to have before Dr. Google was given equal weight with an MD. Do physicians want to be reduced to spending half their appointments discrediting false information their patients found online? Do they want to spend time parsing through uploaded heartbeat and sweat output data in hopes of finding something worthwhile to report to their eager technophile patient?
Finding a workable balance is critical in a world increasingly monopolized by cool gadgets and the quantified self. mHealth is most effective when used in the context of monitored clinical care to achieve specific objectives, and not when it becomes a wedge driven between a patient and a physician. Patients don’t like to be told that their hours of research are inaccurate or aren’t medically relevant: it introduces an element of skepticism and wounded pride that can erode trust. At the same time, when a patient can text a nurse and send a picture of a worrisome rash, getting an immediate advice to try an over-the-counter cream instead of making an appointment and taking up valuable time and resources, mHealth can save the day.
Deciding just how much you want to embrace mHealth in your practice is a personal decision, and should be based on the available technology and your staff’s comfort with patient-provided data, smartphones, tablets, and the internet. While mHealth isn’t going away any time soon, there is still doubt about how effective it will be for clinicians, and how well the smartphone world can integrate with medicine. As expectations and workflows shift with the introduction of mobile devices in the consult room, providers need to be able to look ahead and come to their own conclusions about the mHealth buzz as technology marches on.