mHealth allows consumers to actively engage in their own healthcare by simply downloading apps to their smartphones to monitor fitness, seek guidance and alerts and monitor trends for their chronic conditions ... a virtual "pocket brain," if you will.
Apps are evolving in ways like never before, and in some areas supplementing the need for direct physician engagement. They have evolved so much that someone with a prosthesis can make adjustments via a smartphone or app driven device. Now that's a win-win.
Another very interesting development in app development is the research being conducted by the National Stroke Association, SUNY Downstate College of Medicine and School of Public Health and the Arthur Ashe Institute for Urban Health, a collaborative known as Mobile Apps (MAPPS). The aim of this project is as follows: "to explore the needs, attitudes, knowledge and behavior toward mobile technology for health management within the model of stroke, as stroke survivors and their caregivers require continuous health monitoring and informational updates. Usability testing will identify key issues around existing smartphone apps. This aspect of the research will help define user requirements and design solutions for new applications. The study's year 2 goal is to use the data to design and create M-tech applications for stroke survivors and caregivers. Applications will be tailored to address relevant needs of specific populations."
This project is unique because it is diving into the behavioral aspect of patient engagement. OK, we can all admit that even though there are some slick tools out there to use, we may or may not actually use these on a regular basis (weight management, exercise, etc.). This project will get to the heart of what is needed for patients to actually use what we download! (Note: For an additional resource related to apps and usability, check out "Selecting a Mobile App: Evaluating the Usability of Medical Applications" developed by the mHIMSS Task Force.)
The National Institutes of Health (NIH) issued a request for information in mid-September to launch a public-private-partnership (PPP) to engage various stakeholders to embrace research to advance the use of mHealth. Projects such as MAPPS will certainly be a visionary for outcomes of the PPP. Stand by for more information about the importance of research in the development of apps, as MAPPS will be posting a discussion to the mHIMSS blog in the near future.
Not only can consumers benefit from leveraging apps on a daily basis, but providers can also "win" by having information at their fingertips to enhance the care they deliver and the interaction they have with their patients. In fact, apps have come into play even in emergency situations, as articulated by Dr. Eric Topol. Another perspective lies within the New York Times feature Redefining Medicine with Apps and iPads.
So an "app a day to keep the doctor away"?" But what is the reliability of health and medical apps, given the thousands of options that are downloadable in seconds?
The Food and Drug Administration (FDA) is the agency in charge of regulating mobile health apps. However, the process for app evaluation is still evolving. Here's a quick tour:
The mHealth Regulatory Coalition and CDS Coalition in August asked the Department of Health and Human Services to convene a working group "as soon as practicable." "Delaying involvement of the public until, for example, a draft report is published will only limit the consensus building and constrain the report-drafting process," the coalitions said in their August letter. "The issues involved are simply too complicated and dynamic to be solved in isolation, without an opportunity for interested stakeholders to iteratively comment and participate throughout the process." Furthermore, an open and transparent process will increase the "perceived legitimacy" of the new strategy, the coalitions said. The Application Developers Alliance also sent a letter in August calling for the work group to be convened.
A group of House Energy and Commerce Committee Republicans is urging HHS to convene a working group to develop a framework for regulating health information technology, including mobile health applications, as mandated by the recently passed FDA Safety and Innovation Act. The lawmakers' letter follows growing pressure from other stakeholder groups for HHS to start implementing the section of the law by forming an optional working group of external stakeholders. A group of eight committee lawmakers - health subpanel chairman Joe Pitts (R-Pa.), Reps. Marsha Blackburn (Tenn.), Phil Gingrey (Ga.), Brian Billbray (Calif.), Mary Bono Mack (Calif.), Michael Burgess (Texas), Adam Klinzinger (Ill.) and Pete Olson (Texas) - encouraged HHS to seek advice from outside experts as it crafts the HIT regulatory framework required within 18 months of the FDA law's enactment. The department will work with the FDA, Office of the National Coordinator for Health Information Technology and Federal Communications Commission to draft the report.
The Healthcare Innovation and Marketplace Technologies Act (HIMTA), is a bill set to be introduced in the U.S. House of Representatives, which would establish an Office of Mobile Health at the FDA (to provide recommendations on mobile health app issues) and create a mobile health developer support program at HHS (to help app developers make sure they are operating within privacy regulations, including HIPAA). Beginning in January, the 112th Congress will fold, and the 113th Congress will launch; therefore, if HIMTA doesn't get traction in the next 90+ days, it may not move forward.
Beyond the government's involvement, what's happening in the private sector? Happtique is developing a certification process for apps. The company has "developed a set of draft standards that it will use to certify medical, health and fitness apps. The draft standards address operability, privacy, security and content issues; each area consists of multiple standards and associated performance requirements."
If anything, apps should help the healthcare industry focus more of its time and resources on wellness as opposed to caring for the sick. To help keep track of the latest developments, download the mHIMSS app, visit the apps section of mHIMSS.org, connect with mHIMSS on LinkedIn and follow @mHIMSS on Twitter. And to maximize the value you can receive, "Opt In" to mHIMSS.
After all, it is "app" season, isn't it?
David Collins, MHA, CPHQ, CPHIMS, FHIMSS, is the senior director of mHIMSS, the mobile initiative of HIMSS. He has been on more than 30 site visits assessing HIMSS Davies Award candidates and is past liaison to the HIMSS Patient Safety Quality Initiative. He is a 2012 Baldrige Award Examiner.