The yin and yang of mobile healthcare

My “swag bag” from the unSUMMIT contained an issue of Specialty Pharmacy Continuum, a throw-away pharmacy journal focused on specialty pharmacy practice. Like most throw-away pharmacy journals I read these days, I found the content timely and interesting.

One of the articles – Get Appy! New Tech a Bridge to Patient Care – discusses how Avella Specialty Pharmacy is using mobile technology to connect with their patients. Apparently Avella is pretty forward thinking.

“Avella launched an app in January, available on the iPhone, Android and Web; so far, it has about 4,000 active accounts….The app’s functions include a prescription tracker and refill option, label scanning, physician appointment tool and the ability to manage “family accounts”….“Prior to launching the mobile app, we had a bidirectional text-messaging program in our specialty population, focused on our less adherent patients,” she said. “It included daily reminders to take medication, reminders for lab work, and educational tips about blood pressure monitoring, motivational messaging, surveys, etc. Any indication of nonadherence triggered real-time pharmacist intervention on the phone.” The text-messaging program improved adherence by 29% in the nonadherent cohort, Ms. Shanahan noted. (Patients who already were adherent remained at the same high adherence levels, whereas new patients had an adherence rate of 94.5 %.) But others are skeptical of just how much mobile apps and similar technology can really affect adherence.”

Emphasis on the last sentence is mine. That skepticism fits in well with a recent article at The cHealth Blog – Challenges Evaluating mHealth’s Success.  Will mobile technology really have a lasting positive impact on healthcare? It’s a reasonable questions. The author of the cHealth Blog article takes an interesting look at the differences between evaluating mobile technology for a consumer versus a “patient”. Things like small sample size, limited length of study time and “novelty effect” bring into question the validity of the current mobile healthcare craze, and thus the long-term value of mobile technology in healthcare.

Here are my personal observations regarding mobile technology in healthcare:

• It’s too soon to tell. The endpoint will likely be different than people think. Healthcare can learn a lot from the world of consumers, but not everything translates perfectly.
• Healthy people tend to tout the use of mobile healthcare software and hardware more so than unhealthy people. Let’s face it, people that are seriously ill care about little more than making it through another day. I’ve witnessed this firsthand via family members and close friends that have battled through some pretty serious illnesses. Ask someone that’s puking their guts out if they care about receiving a text message reminding them to take their medication. The idea reminds me of my days as a night pharmacist at Salinas Valley Memorial Hospital. The fax machine would make a “beeping” sound just prior to printing. Initially it didn’t have any effect on me, but after a year of getting my butt kicked at night the sound started to elicit some pretty negative feelings. On busy nights when I couldn’t keep up, that sound literally made my stomach churn. I imagine a text message stating “take your medicine, now!” would have a similar effect on some.
• Sometimes personal contact is better. A call, a visit, etc. can go a long way in improving medication adherence. Calling my mom on the phone a few times a week has proven very helpful in managing her medication compliance.
• Not everyone is tech-savvy. Seriously, some people still have an aversion to using technology. Does that mean we leave them behind? In some cases that’s exactly what we’re doing. Everyone wants to focus on making mobile health better by collecting more data, improving monitoring, etc. All very good things, but how about we work on improving overall patient care first.
• It’s a money grab. Yep, a lot of the software and hardware hitting the market is nothing more than that. Companies can see an opportunity to turn a quick buck.
• How valuable is mobile health data, really? Heart rate, blood pressure, steps. Are these things we need to improve healthcare? Possibly, in some instances, but definitely not for the masses. One could argue the value, but does every person need to have 24/7 feedback on their heart rate?