The practice of medicine and healthcare in general has become an electronic and increasingly mobile interaction. Patients are better informed, more engaged, more connected and have a much greater virtual presence. In fact, according to Pew Research data, the fastest growing demographic on Twitter are those who are in the 45-65 age bracket. Nearly 50% of all seniors engage online on a daily basis through at least one social media platform and many of these interactions and online engagements occur via mobile devices. Almost 75% of all adults go online within hours of attending a visit with their physician in order to gather more information about their particular medical problem. For healthcare providers—and for patients—the internet and mobile technology presents us all with wonderful opportunities to interact, engage, support and ultimately improve outcomes.
New connected devices and medical applications for mobile devices are on growing exponentially. The world responded favorably to the latest release of the iPhone 6 and the iOS8 operating system recently released by Apple. The new device has many interesting features but one in particular caught my eye early on. Apple has created a standard package for all iOS 8 devices that is called the Health Kit. This particular application allows a user to track calories, steps taken (similar to a pedometer), flights of stairs climbed and other customizable health related data points. These data can be organized into graphs and charts that allow users to track progress and adjust activity levels to achieve particular goals. More impressively, the device will allow other health related applications to organize data in the Health Kit as well. One of the biggest problems with medial applications in the past is that there has never been an easy place to organize, store, collect and view all of the data together. Moreover, this data is not easily shared with healthcare providers. The Health Kit and Apple may revolutionize this entire process of data collection, retrieval and sharing—Apple has partnered with a major electronic medical record service known as EPIC. Work is underway to allow the Health Kit data and applications to easily interact with the EPIC medical record. This would allow for easy downloads of health data during a face-to-face encounter with healthcare providers. Currently, most major hospitals and healthcare systems are moving to the EPIC platform. The data collected and downloaded at one location would subsequently be available to all providers in the system—portability of data allows for better care and less duplication of effort.
Much has been written about patient engagement and improved outcomes in the medical literature. I can think of no better way to improve engagement than through the use of real time health applications –these allow patients to receive real time feedback—both good and bad—and respond quickly in order to improve their overall health status. I think that this type of technology will only continue to grow. Apple plans to release the Apple Watch in early 2015. I expect that this will also be integrated with Health Kit and allow for the measurement of respiratory rate, heart rate, body temperature and other biologic measurements. As these tools continue to develop and applications grow, healthcare providers as well as patients must be receptive to their use. These technologies have the potential to allow clinicians to better assess patients between office visits and provide more directed and timely changes in therapy. Ultimately I believe these technologies will transform healthcare. As we continue to struggle with healthcare cost containment in the era of healthcare reform, the ability to shift care and routine interaction to mobile platforms may very well prove to be a critical piece of the puzzle.
This is an exciting time in medicine as well as in healthcare technology. Moving forward, I look to a day where biologic sensors collect data, relay data to mobile devices and then transmit information seamlessly to healthcare systems. The healthcare providers are alerted to any abnormalities and electronic responses are generated—those patients requiring timely in person visits can be identified and scheduled, while those that can be handled virtually can be managed quickly and effectively as well. Ultimately, our goal is to better manage disease and improve outcomes. I think that technologies such as the Health Kit and the Apple Watch are giant leaps forward and are just the beginning of a new age of virtual healthcare.
Posted in Doctor Patient Relationships, Healthcare Reform, Optimizing Patient Care, Outcomes
Tagged apple, Engagement, EPIC, healhcare, healthcare applications, medicine, patient care, technology
Smartphones, tablets such as the iPad and other mobile technologies are becoming commonplace in the US today. These devices are nimble, efficient and able to process large amounts of data while conveniently sized. In a recent survey in 2012, it was found that nearly 95% of all Americans have mobile phones and 60% have smartphone devices. The numbers are a bit higher in the younger age groups but the devices are prevalent even in the over 65 set. Tablet computer sales are expected to overtake laptops in 2013–one estimate predicts that 240 million tablets and 204 million laptops will be purchased this year. With technology at everyone’s fingertips, it is not surprising that more and more patients are using technology to track their medical conditions.
The New York Times recently reported on a survey published by the Pew Research Center on American’s health tracking behaviors. Fortunately, as a society, it appears that we are becoming much more health conscious. In the survey, Pew researchers found that 70% of all adults track some health indicator for themselves or a loved one. However, much of the tracking is classified as informal and 49% say that they track “in [their] head”. Of those who track health indicators, 35% use a paper journal and now 21% use technology such as a smartphone or tablet application. As mentioned in the Pew report, this is the first survey conducted to examine health tracking behaviors in the US–Importantly, the survey found that 46% of those with tracking behaviors changed their approach to healthcare and have become much more engaged. Specifically, the engagement prompted them to ask more questions of their physician and to often seek more that one opinion.
Mobile technology is a powerful tool. Last year alone over 500 companies made healthcare related applications and there are now almost 15,000 applications for health indicator tracking on the market. By tracking health indicators such as blood pressure, heart rate, daily weights and blood sugars (among others) patients can see the impact of interventions such as diet, exercise and drug therapy. Seeing results in real time can be very motivating. The ill effects of chronic diseases such as hypertension and obesity are not always readily apparent to patients until end organ damage occurs. With tracking applications, the patient is able to see the day to day variation and is engaged in the control of his or her health indicators. As I have mentioned in a previous blog, I believe that the time is near when physicians will begin prescribing mobile health tracking applications for their patients during routine office visits. Healthcare in the US has to change in order to be successful. No longer can patients passively sit back and accept the fact that physicians will be able to take care of all of their healthcare needs. Now, more than ever, patient engagement and participation is key to success. Under the new healthcare system, physicians will face increased pressure to see more patients in less time. Documentation challenges with electronic medical records (EMR) and other paperwork will further diminish the time spent with patients. Patient participation in health maintenance through health indicator tracking via mobile applications will prove to be a critically important part of our healthcare system. I foresee a doctor’s visit where a patient can download their smartphone data directly into their EMR file in their physicians office. This ability to sync data will not only save time but will improve accuracy of the record. Ultimately, I expect that mobile applications will be able to transmit data messages to physician offices when certain health indicators have risen to dangerous levels.
Technology to improve the health of Americans is here. How and when we incorporate these technologies into the healthcare system is still developing. As with most things in medicine in the US, the FDA will most likely begin to play a larger role in the evaluation of health tracking applications. Ultimately, I expect the same level of regulation that we see with new prescription drugs or medical devices. (However, that could be subject of a blog all its own). For now, I encourage patients and physicians to consider using medical applications in their practices. Certainly, tracking indicators can benefit patient outcomes–patient access to data increases awareness, increases engagement and will ultimately save healthcare dollars.