Has mobile health monitoring hit a wall?
■ The percentage of patients using technology to track their health hasn't budged in three years despite the explosion of apps that let them do so.
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The number of technical tools available to help patients live healthy lifestyles or control chronic health conditions has grown considerably during the past few years. But the percentage of patients who use some form of technology, such as mobile apps, to track health indicators has remained virtually unchanged for three years.
The Pew Internet & American Life Project published a report Jan. 28 that found 69% of U.S. adults track at least one health indicator such as diet, exercise or weight. The survey of 3,014 adults conducted between Aug. 7 and Sept. 6, 2012, found that 49% monitor their progress in their heads, 34% track the information on paper, and 21% utilize some form of technology, including mobile apps, which 7% use. The results mirror findings from a Pew survey in 2010.
“As a tech industry thought leader, I'm disappointed when I see a survey like that,” said Bill Crounse, MD, senior director of worldwide health at Microsoft Corp. “But as somebody who has served as a physician and was involved in patient care for 20 years … I'm not particularly surprised.”
Dr. Crounse said most people have an idea of what they weigh because they occasionally step on a scale. But a much smaller population would write that number down, enter it into a patient portal or document it through a mobile app.
For years physicians have asked patients to track some aspect of their health, whether it be weight, diet, headache frequency or blood pressure, said Aaron Michelfelder, MD, vice chair and professor in the Dept. of Family Medicine at the Loyola University Chicago Stritch School of Medicine. “And, honestly, it's only about one in five patients that will do that anyway,” he said. “So even before apps were available, we got a low return rate on asking patients to track their data.”
But many remain optimistic that mobile health monitoring will be an important aspect of health care.
“I don't see this as a plateau, but the very beginning,” said Michael Esquivel, a health information technology attorney and partner at Fenwick & West in Mountain View, Calif.
Dr. Crounse said “the triple aim” of health care reform — raising the quality of care, improving access to care and lowering the cost of care — will play a significant role in the growth of mobile health.
Changes in technology
Many early adopters of mobile health technology were patients with a chronic disease and patients who were attracted to the novelty of it, Esquivel said.
“People are buying these things, and they are using them. But unless that data is actionable and meaningful and it actually helps improve your health in some manner … then the mere collection of data is a novelty that will wear off,” he said. There's growing recognition among developers that the apps must do more to keep patients engaged, and the apps are starting to evolve as a result, he added.
Jose Andrade, technology director at Publicis Life Brands Medicus, said many patients mistrust the apps. “While there's no shortage of these kinds of apps, and it is a big opportunity for health care in general, unlike drugs, whether prescription or over-the-counter, they don't have the kind of credibility or authentic resources that are governed typically by the FDA,” he said.
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Only 7% of patients use mobile technology to monitor their health.
Andrade said until the Food and Drug Administration catches up, organized medicine could offer some oversight, which app developers would welcome so their apps could gain more credibility. The American Medical Association does not have a third-party approval or endorsement process for mobile apps, but it has developed its own branded apps.
But it's not as simple as the medical establishment building or approving apps, said David Harlan, MD, chief of the Diabetes Division and co-director of the Diabetes Center of Excellence at the University of Massachusetts School of Medicine and UMass Memorial Health Care. Patients also must have an incentive to use them. And a promise of better health isn't enough for many to get started, he said.
Change in mindset
As physicians figure out how the move from the fee-for-service payment model to one based on outcomes will change how they do their jobs, patients will have to re-examine their responsibilities.
“If we ask people to do something that's hard, there's no way they are going to do it, so we have to make it easy, No. 1,” Dr. Harlan said. “Then, we humans are funny creatures, so we have to think of incentives — silly things — that will pull people in.”
He said he has seen patients do things for small incentives. A month later, they feel better and realize the benefits of changing their behaviors.
Dr. Harlan helped develop a monitoring system for diabetics at UMass that launched a year ago. Today, he said, 5,000 patients load information into the system, but only 50 do so from home. This year's goal is to bring that number to 2,000. They plan to use incentives, such as rewards for each time patients check their blood sugar, to encourage wider use.
But Dr. Crounse does not foresee an immediate boost in the number of people using technology to track their health. Until physicians are given incentives to encourage use of mobile tools, he said, adoption will continue as it has thus far. It will be isolated among those who are either genuinely excited by the technology, or those chronic disease sufferers who have a real need to use it.