Electronic Health Records

Adoption & Implementation News

What obstacles might undermine the promise of mHealth?

By Kyle Murphy, PhD

- Given the rise in smartphone users and proliferation of mobile applications, what is preventing mobile health (mHealth) technology from having a greater impact in the years to come? According to Harry Greenspun, MD, the answer to that question comes down to being able to measure the effectiveness of mHealth use in a specific context.

“We need to take a serious look at understanding what the outcomes are that we’re really trying to achieve,” says the Senior Advisor of Health Care Transformation & Technology at the Deloitte Center for Health Solution. “Simply deploying it is not an outcome. Are we actually making an impact on the quality, on the cost of care, on access to care? That requires a bigger investment, a more thoughtful planning approach, and it’s just harder.”

The challenge for developers and adopters of mHealth apps is to translate an individual’s use of that technology into actionable information in the context of her care.

“We need to figure out where these things really work,” explains Greenspun. “Just because I have a fitness app on my phone, it doesn’t make me an athlete, and just because I have a diabetes app on my phone doesn’t necessarily mean hemoglobin A1c went down and it’s been effective. That’s where we have to start sort of tying these things together to understand what’s effective, what works, what doesn’t work, and really track what’s been successful.”

On the provider side, the healthcare CIO is tasked with ensuring that these mHealth apps do not themselves become silos cut off from other pieces of patient data. These healthcare leaders will need to be able to answer an important question: How do you reign in all of these siloed efforts and do something and do something well?




According to Greenspun, for any mHealth app to be successful it must address for key items: demographics, infrastructure, reimbursement, and disease dynamics.

Demographics: In theory, an mHealth app has an intended user and intended use. However, the reality may turn out differently. “Very often people thought an mHealth app was going to be great, but they didn’t realize either the type of usage or the type of individuals using it,” observes Greenspun.

Infrastructure: Despite the increased use of smartphone and mHealth apps, connectivity is not the same everywhere. “There are a lot of people who think that broadband is ubiquitous and we have the ability to do all this stuff all over the place. But if you look at many parts of the country and many parts of the globe, there’s either no or very little broadband access,” he adds.

Along with variations in connectivity are variations in the devices individuals are using and their level of use. “That also varies in terms of different areas using different types of technology, and it goes a little bit along with the demographic aspect where you might have certain populations using very sophisticated apps, other people such as teenagers using primarily texting,” says Greenspun.

Reimbursement: Are there financial benefits to making mHealth a part of a healthcare organization’s care delivery? According to Greenspun, issues around reimbursement and payment will need to be addressed in order for mHealth to prove a valuable tool, a lesson that telemedicine has taught members of the healthcare industry:

The fact that we’re moving toward value-based, outcome-based medicine or reimbursement has really opened the door to a lot of innovation. But in the past, what we’ve seen repeatedly is that we have technology people solving a very narrow problem and usually the technology problem is not the big problem. Telehealth has been around since the 1920s, but it hasn’t caught on broadly, not because of the lack of good technology; it’s really been related to a lack of aligned incentives and proper reimbursement.

Disease dynamics: One size does fit not fit all. What is true of EHR and health IT systems is also true of mHealth apps. “There’s been tremendous enthusiasm in a lot of diseases about sharing information on Facebook and everyone getting social support and doing gamification, and that’s great, but there are many healthcare issues which have big privacy concerns or just don’t necessarily lend themselves to the kind of support and gamification that others will,” says Greenspun.

Health IT in the form of mHealth apps has great potential to impact the quality of healthcare. Whether that impact is positive or negative will come down to how all the data is brought together and used to inform better decision-making.




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