Making Mobile Health Personal

The potential of mobile health to improve care delivery and outcomes is beginning to crystallize—given the technology is done right.

Pilots at the University of Wisconsin-Madison (UWM) reveal mobile health’s ability to serve a wide range of patients—from substance abuse addicts to those with lung cancer. Smartphone applications are more than just technology but highly personalized systems that help patients and their families, in partnership with clinicians, proactively monitor and respond to conditions while promoting wellness. 

Getting personal

When it comes to mobile health, “technologies must meet people where they are and respond to who they are,” says David Gustafson, PhD, research professor of industrial and systems engineering and director of UWM’s Center for Health Enhancement Systems Studies, who spoke at the 2014 Healthcare Leadership Forum in Chicago. 

In the late 1980s, Gustafson and other researchers began developing the Comprehensive Health Enhancement Support System (CHESS)—a computer-based health support network. Over the years, the network became a mobile app. He talked about his experience with A-CHESS, a  smartphone app used to support recovery from alcoholism. It provides monitoring, information, communication and support services to patients, including the ability for patient-counselor communication.

A-CHESS’s portal allows input directly into some EHRs, and takes advantage of smartphone features including GPS and the camera. It incorporates predictive modeling to determine imminent relapses that can trigger preventive practices. 

“The system was designed as you’re moving from inpatient care to continual care in the field,” he says. The patient would receive training prior to discharge from a residential treatment program.

Its features include:

• Social support: Discussion group, live chat and text and panic button
• Virtual counseling: Assertive outreach, counselor contact and videoconferencing
• Education and training: Games and relaxation; tailored information and stories; and newsletter
• Location tracking: High-risk locator and meeting locator
• Assessments: Ecological momentary assessments; scheduled assessment; and A-CHESS use
• Alerts: Reminders, risk alerts, and clinician alert

The program motivates individuals to answer app questions by offering a financial incentive if all questions were answered. Answers are reviewed by counselors, who intervene and request a virtual meeting if certain risks are present. Also, if patients are in the proximity of high-risk locations (i.e., bars), the system alerts a counselor.

In a randomized trial with 350 alcoholics, those utilizing A-CHESS had 57 percent fewer heavy drinking days during the eight-month pilot. This success occurred even for participants who also used opioids. At month eight, 60 percent of participants continued to use it.

The impact continued even after the smartphone was taken from the patients, he says. “Over time, even after we removed the technology, the difference between the control group and the intervention group went up. It’s encouraging as it shows the system has an effect.”

As effective as A-CHESS was, Gustafson stresses that it was “just one part of the package.” The intervention was bundled with medication-assisted treatment and behavioral interventions, which contributed to its success, he says.

In this particular pilot, participants had to agree to take Vivitrol, which eliminates the ability to “get high.” Some participants dropped out because of this requirement.

Strengthening Support Systems

A-CHESS not only is effective for patients, but for families of those struggling with addiction. In a small pilot study, he said, when given to adult children of alcoholics, A-CHESS was correlated with an increase in attendance at support meetings.

Prior to A-CHESS, the average attendance at support groups was 37 percent—but after the 10-week pilot it jumped to 83 percent.

Another system was designed specifically for caregivers of lung cancer patients close to death. On a daily basis, it asked the caregiver 10 questions (i.e., “Has the patient had a bowel movement?”) The questions reflected the information preferences of the clinicians.

In a randomized trial, researchers found that patients live 35 percent longer from diagnosis to death when using the app. “With lung cancer, that isn’t a long time but it’s still three-and-a-half months—that could be a graduation or an anniversary.”

In a separate randomized trial, data collected daily through the system was shown to clinicians. This resulted in a dramatic improvement in the status of patient. “This showed us that doctors and nurses were paying attention, they weren’t just ignoring the information,” he says.

The pilot “shows the importance of the relationship between family members and clinicians if we want to make a difference in the life of the patient.”