Mobile health has opportunity in addictive nature of smartphones

BOSTON—The Center for Connected Health at Partners Healthcare in Boston is an embedded innovation group dedicated to moving care beyond the hospital, explained director Joseph Kvedar, MD, speaking during a panel discussion on the urgency for connected health at the mHealth +Telehealth World Congress 2013.

Changing reimbursement “portends a big chunk of adoption on the provider side,” said Kvedar.

The average smartphone user checks his or her phone 127 times a day, according to Jeff Bipes, senior IT manager, mobility and mHealth, design & strategy, Medtronic. “We’re looking at a technology that has changed the behavior of individuals and made it okay to do all that looking.” He said patients with diabetes actually prefer to use their smartphone to manage their condition rather than a pump because that keeps them under the radar, doing something everyone else does.

Kvedar said healthcare providers can take advantage of the addictive nature of smartphones. “It’s a whole new tool to engage people. Mobile is transformational is many different ways.”

He also cited studies on telemonitoring for heart failure patients. Patients take their vital signs at home and several nurses watch the population. Managing by exception, the nurses contact patients when there is a concern. The pilot project resulted in a 50 percent drop in readmissions, Kvedar said, along with a “significant and positive impact on mortality.”

“Early on, we had a lot of nervousness that somehow this technology would drive a wedge into the care of patients and they would object,” he said. The result was far from it. “Patients in that setting universally have been quite pleased. They don’t want to leave the program behind when it’s time to graduate.”

That’s because it fills a gap in care, he said. Discharged heart failure patients are usually terrified and the program provided a measure of comfort. Meanwhile, Partners’ teledermatology program with a hospital on Nantucket was not very successful. Patients preferred face-to-face encounters. “When you try to substitute what you do in the office with poorer technology, no matter how good it is, it’s going to fail.” The difference between the results of the two programs provides a clue “about how to utilize this stuff.”

Bipes pointed out that adoption of mobile apps typically falls off dramatically after 14 days, saying that to avoid that, mobile health apps must have clinical value, efficacy and somebody who will, at some point, pay for it.

Kvedar discussed anecdotal results from a trial for Type 2 diabetes patients. Activity tracking that includes location information results in “a feedback loop that can help set goals, improve care and keep their healthcare at top of mind. Uniformly, that’s quite powerful.” Messaging is tailored to each patient’s position on the scale of desire to be active and be engaged in their own health. “We’re finding that it’s working quite well,” he said. “Activity level is going up over time and patients are feeling engaged which is measured by checking and responding to texts.” The lesson learned, he said, is that the feedback loop is good at first but it decays over time. To keep people engaged, healthcare can learn from online shopping which feeds your data back to you with buying suggestions.

Looking to the future, Kvedar said that when he first started telemedicine 18 years ago, the camera was the size of a shoebox. Now, “all that and much more exists in a palm-sized device that’s always on and always connected.” He said the addictive nature of mobile devices “gives us the opportunity to get you addicted to your health.”