Mobile health care and patient engagement

The emerging field of mHealth, which is the use of mobile applications to facilitate the delivery of medical care and to enhance patient engagement, continues to expand rapidly, largely out of sight of most primary care physicians. We suspect that it will remain out of sight until, it will seem, mobile health apps are everywhere.

The idea behind mHealth is, given that smartphones have become ubiquitous devices through which people do everything from shopping to making dinner reservations to mobile banking, they are a device that people are ready to use to improve their health. A core component of both the Patient-Centered Medical Home model and Accountable Care Organization is that the patient is at the "center" of care and is an important, if not the most important, member of the health care team.

Mobile apps fall into a number of categories, including those that allow patients to have more effective and efficient interactions with their physicians, track data for things like blood pressure and blood sugars for more effective self-management, and allow patients more direct access to their charts and medical information. We will outline a few of these types of functions below.

One new software platform seeks to improve what patients understand and remember from their physician encounter. It is a common, if not ubiquitous, experience that patients do not fully recall the details of their discussion with the physician during the office visit. It is been estimated that patients recall only about 20% of the information that is shared during an office visit; patients on average miss between 30% and 60% of the medication dosages that are prescribed. It is likely that this lack of understanding and recall interferes with adherence to both the advice and medications. One company has developed a platform with expertly developed educational modules about common diseases with full graphics. What is unique about the platform is that the conversation that the physician has with the patient, as well as annotations to the educational material and graphics, is included in a record of the patient’s visit that the patient can access through a secure portal at any time after the visit. Patients are free to review the material and share it with family members if they choose. By being able to understand their medical condition better, and the specific personalized information that their physician provides to them, patients should feel more engaged and more like they are a part of their health care team. If they are engaged in their own care, they will also be more likely to comply with the recommendation that the physician makes.

Another example of a patient engagement platform operates independently of the physician. If one assumes that information is good, then being aware of what you eat as well as receiving feedback on the number of calories consumed will naturally lead to less food eaten. This type of software has a calorie counter and a database of over 3 million foods. The user enters the type and amount of food eaten, and then the app tracks total calories, using an attractive interface. Most popular brands and restaurant choices are in the database. The mobile app makes it easy to record food that is eaten either through accessing the type of food through the mobile database, or by simply scanning the bar code from purchased foods. If one then enters the amount eaten, the app will calculate the calories consumed and add it to the personal calorie count. In addition, one can record the type and duration of exercise both to track exercise programs and to calculate the number of calories burned from the exercise. The app also has a social function and lets the user compare an exercise program and diet with that of friends or family members (with their permission, of course) to serve as mutual encouragement of each others’ goals.

Finally, electronic health record companies are developing mobile apps that integrate with the electronic health record. These apps have various functions such as allowing patients to access information in their medical record from their mobile device and providing secure two-way communication between physician and patient. Patients are able to view their lab results, request refills and referrals, access educational material, and ask questions. Some of these systems also allow providers to send reminders efficiently to patients, either individually or in bulk. Theoretically, a practice could query its database to find all patients over age 50 who have not had colorectal cancer screening in the last 10 years and then send secure HIPAA-compliant reminders to all patients in the practice who need that screening. The patients would then access the reminder through their mobile app and schedule follow-up. In addition to simply accessing information, that information is presented and collated in a thoughtful manner. For instance, instead of simply accessing a list of blood pressures, the blood pressures can be displayed in graph form over time for easier interpretation.

In summary, we stand on the precipice of a new age of medical information management where, if the dreams of mobile vendors come true, patients will be at the center of a stream of health care, disease management, and wellness information from which they, along with their doctor, with the help of real-time data, can fully participate in their health care and influence their health outcomes.

Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps. Dr. Notte is a family physician and clinical informaticist for Abington Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care.

The emerging field of mHealth, which is the use of mobile applications to facilitate the delivery of medical care and to enhance patient engagement, continues to expand rapidly, largely out of sight of most primary care physicians. We suspect that it will remain out of sight until, it will seem, mobile health apps are everywhere.

The idea behind mHealth is, given that smartphones have become ubiquitous devices through which people do everything from shopping to making dinner reservations to mobile banking, they are a device that people are ready to use to improve their health. A core component of both the Patient-Centered Medical Home model and Accountable Care Organization is that the patient is at the "center" of care and is an important, if not the most important, member of the health care team.

Mobile apps fall into a number of categories, including those that allow patients to have more effective and efficient interactions with their physicians, track data for things like blood pressure and blood sugars for more effective self-management, and allow patients more direct access to their charts and medical information. We will outline a few of these types of functions below.

One new software platform seeks to improve what patients understand and remember from their physician encounter. It is a common, if not ubiquitous, experience that patients do not fully recall the details of their discussion with the physician during the office visit. It is been estimated that patients recall only about 20% of the information that is shared during an office visit; patients on average miss between 30% and 60% of the medication dosages that are prescribed. It is likely that this lack of understanding and recall interferes with adherence to both the advice and medications. One company has developed a platform with expertly developed educational modules about common diseases with full graphics. What is unique about the platform is that the conversation that the physician has with the patient, as well as annotations to the educational material and graphics, is included in a record of the patient’s visit that the patient can access through a secure portal at any time after the visit. Patients are free to review the material and share it with family members if they choose. By being able to understand their medical condition better, and the specific personalized information that their physician provides to them, patients should feel more engaged and more like they are a part of their health care team. If they are engaged in their own care, they will also be more likely to comply with the recommendation that the physician makes.

Another example of a patient engagement platform operates independently of the physician. If one assumes that information is good, then being aware of what you eat as well as receiving feedback on the number of calories consumed will naturally lead to less food eaten. This type of software has a calorie counter and a database of over 3 million foods. The user enters the type and amount of food eaten, and then the app tracks total calories, using an attractive interface. Most popular brands and restaurant choices are in the database. The mobile app makes it easy to record food that is eaten either through accessing the type of food through the mobile database, or by simply scanning the bar code from purchased foods. If one then enters the amount eaten, the app will calculate the calories consumed and add it to the personal calorie count. In addition, one can record the type and duration of exercise both to track exercise programs and to calculate the number of calories burned from the exercise. The app also has a social function and lets the user compare an exercise program and diet with that of friends or family members (with their permission, of course) to serve as mutual encouragement of each others’ goals.

Finally, electronic health record companies are developing mobile apps that integrate with the electronic health record. These apps have various functions such as allowing patients to access information in their medical record from their mobile device and providing secure two-way communication between physician and patient. Patients are able to view their lab results, request refills and referrals, access educational material, and ask questions. Some of these systems also allow providers to send reminders efficiently to patients, either individually or in bulk. Theoretically, a practice could query its database to find all patients over age 50 who have not had colorectal cancer screening in the last 10 years and then send secure HIPAA-compliant reminders to all patients in the practice who need that screening. The patients would then access the reminder through their mobile app and schedule follow-up. In addition to simply accessing information, that information is presented and collated in a thoughtful manner. For instance, instead of simply accessing a list of blood pressures, the blood pressures can be displayed in graph form over time for easier interpretation.

In summary, we stand on the precipice of a new age of medical information management where, if the dreams of mobile vendors come true, patients will be at the center of a stream of health care, disease management, and wellness information from which they, along with their doctor, with the help of real-time data, can fully participate in their health care and influence their health outcomes.

Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps. Dr. Notte is a family physician and clinical informaticist for Abington Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care.

The emerging field of mHealth, which is the use of mobile applications to facilitate the delivery of medical care and to enhance patient engagement, continues to expand rapidly, largely out of sight of most primary care physicians. We suspect that it will remain out of sight until, it will seem, mobile health apps are everywhere.

The idea behind mHealth is, given that smartphones have become ubiquitous devices through which people do everything from shopping to making dinner reservations to mobile banking, they are a device that people are ready to use to improve their health. A core component of both the Patient-Centered Medical Home model and Accountable Care Organization is that the patient is at the "center" of care and is an important, if not the most important, member of the health care team.

Mobile apps fall into a number of categories, including those that allow patients to have more effective and efficient interactions with their physicians, track data for things like blood pressure and blood sugars for more effective self-management, and allow patients more direct access to their charts and medical information. We will outline a few of these types of functions below.

One new software platform seeks to improve what patients understand and remember from their physician encounter. It is a common, if not ubiquitous, experience that patients do not fully recall the details of their discussion with the physician during the office visit. It is been estimated that patients recall only about 20% of the information that is shared during an office visit; patients on average miss between 30% and 60% of the medication dosages that are prescribed. It is likely that this lack of understanding and recall interferes with adherence to both the advice and medications. One company has developed a platform with expertly developed educational modules about common diseases with full graphics. What is unique about the platform is that the conversation that the physician has with the patient, as well as annotations to the educational material and graphics, is included in a record of the patient’s visit that the patient can access through a secure portal at any time after the visit. Patients are free to review the material and share it with family members if they choose. By being able to understand their medical condition better, and the specific personalized information that their physician provides to them, patients should feel more engaged and more like they are a part of their health care team. If they are engaged in their own care, they will also be more likely to comply with the recommendation that the physician makes.

Another example of a patient engagement platform operates independently of the physician. If one assumes that information is good, then being aware of what you eat as well as receiving feedback on the number of calories consumed will naturally lead to less food eaten. This type of software has a calorie counter and a database of over 3 million foods. The user enters the type and amount of food eaten, and then the app tracks total calories, using an attractive interface. Most popular brands and restaurant choices are in the database. The mobile app makes it easy to record food that is eaten either through accessing the type of food through the mobile database, or by simply scanning the bar code from purchased foods. If one then enters the amount eaten, the app will calculate the calories consumed and add it to the personal calorie count. In addition, one can record the type and duration of exercise both to track exercise programs and to calculate the number of calories burned from the exercise. The app also has a social function and lets the user compare an exercise program and diet with that of friends or family members (with their permission, of course) to serve as mutual encouragement of each others’ goals.

Finally, electronic health record companies are developing mobile apps that integrate with the electronic health record. These apps have various functions such as allowing patients to access information in their medical record from their mobile device and providing secure two-way communication between physician and patient. Patients are able to view their lab results, request refills and referrals, access educational material, and ask questions. Some of these systems also allow providers to send reminders efficiently to patients, either individually or in bulk. Theoretically, a practice could query its database to find all patients over age 50 who have not had colorectal cancer screening in the last 10 years and then send secure HIPAA-compliant reminders to all patients in the practice who need that screening. The patients would then access the reminder through their mobile app and schedule follow-up. In addition to simply accessing information, that information is presented and collated in a thoughtful manner. For instance, instead of simply accessing a list of blood pressures, the blood pressures can be displayed in graph form over time for easier interpretation.

In summary, we stand on the precipice of a new age of medical information management where, if the dreams of mobile vendors come true, patients will be at the center of a stream of health care, disease management, and wellness information from which they, along with their doctor, with the help of real-time data, can fully participate in their health care and influence their health outcomes.

Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps. Dr. Notte is a family physician and clinical informaticist for Abington Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care.