ONC12: mHealth driving patient engagement

The creation of the ONC’s new Office of Consumer Health is “exciting because it signals a real commitment on the part of ONC to engage consumers,” said acting director Lygeia Riccardi. While the office works closely with other ONC programs, the “walls are permeable,” Riccardi said, because the office also works with other agencies and the private sector. “We view our role as being conveners and catalysts. We are fueled by a combination of policy, changes in healthcare and the way technology has become a big part of our everyday existence.”

The office’s goals are organized around three “As:” access, attitude and action. Access is about giving people easy electronic access to their information in a way that they can use it and reuse it however they see fit, Riccardi said. Action involves building an ecosystem of tools and devices such that, once we have liberated data, we can take action with it. Attitude is the “recognition that consumer engagement isn’t just about a technology or policy challenge but about mindsets and changing the traditional roles of consumers and providers to think about building more of a partnership.”

“Medicine is still very siloed and departmentalized,” said Daniel Kraft, MD, physician-scientist, inventor, entrepreneur and innovator and current executive director of FutureMed. “We have the opportunity to rethink healthcare. We’re not just a bucket of body parts. We are being connected in new ways.”

We’re starting to see reinvention in all things, such as how we read books and how we take and share photos, Kraft said. He cited a $35 tablet made in India—there are “huge implications for healthcare and education when you can give away a tablet for less than the price of many prescriptions.” Gamification is changing how we act with our wellness and medications, such as making physical therapy more interactive, fun, engaging and compliance-driven. “We’re clearly in the era of digital healthcare,” he said.

The smartphone applications becoming available include the ability to analyze skin lesions and diagnosis ear infections. One in three Americans have hypertension but half of those are uncontrolled, Kraft pointed out. So, the proliferation of devices designed to measure activity are primed to meet patients’ needs. And, “when we merge apps with telemedicine, we open up huge opportunities.”

The challenge now is using all the available tools effectively. We could be introducing too many sensors and too much information. Kraft compared the situation to that of all the sensors available in most vehicles now when all we really want to know if when the engine check light comes on.

“Our behavior is more responsible for our problems than our genetics,” Kraft said. “Using augmented reality can change our minds in certain ways. Smart tools can leverage behavior change because we know it’s really hard. All these technologies are great but unless we reinvent how we pay for things it’s a challenge.”

We can change our healthcare system to one that is episodic and reactive to one that is continuous and proactive. “Ideally, we can shift our thinking from being organ donors to being data donors and enable fields like personalized oncology. We need to look for exponential technologies, recognize where disruptions happen and use those to start to fly higher and faster as we reinvent both patient engagement and human healthcare.”

Meanignful Use Stage 2's requirement that patients are enabled to access their data and be able to download and transmit their record is "a big deal," said Riccardi. "The point is, it's yours. What's important is not just liberating these data but the opportunity to mash it up with tools. That's where it gets really cool."

The question of who is going to pay for these apps is a major concern, Kraft said. The first trials are showing dramatic results with tools that are almost free. "Still, someone has to pay and encourage innovators to build the platforms." There also is uncertainty about apps regarding who is going to regulate them and how. Regulations sometimes drive innovation offshore."

While older Americans may not be comfortable with online tools and smartphone apps, Riccardi said it doesn't take much to get them started. "You don’t need anything complex to begin that mindset of being more engaged." Patients can become a health information exchange of one, she said, and coordinate their various providers to make sure they are all on the same page."

Meanwhile, many physicians are feeling either empowered or disempowered by this shift in healthcare, Kraft said. Once physicians can bill for diagnosing an ear infection via smartphone, "they will start to use it." Once physicians start to get rewarded for keeping their patient panel healthier, "they are going to start prescribing these tools and using that to connect in smarter ways to provide better prevention and follow-up care."