As exciting, disruptive and transformative as mobile health or mHealth is to the entire healthcare ecosystem, no one should underestimate the challenges that it still needs to contend with.
That was one of the topics of discussion at an event hosted by the Brookings Institution Tuesday. The event, which was webcast is part of the Mobile Economy Project, centered on a discussion of how mobile technologies and monitoring devices was modernizing healthcare on Tuesday.
The discussion touched on wide-ranging issues - how to determine quality of medical apps, the FDA's role in regulating mobile apps and how these enabling technologies will play a crucial role in the healthcare industry's shift from treating the sick and getting paid for it to being rewarded for keeping people healthy and managing chronic diseases less expensively. The panelists were Iltifat Husain, an emergency medicine resident at Wake Forest University, and founder and editor-in-chief of iMedicalApps.com; Asif Khan, founder and CEO of Caremerge, which provides an integrated set of mobile and web solutions to improve the care management of seniors; Erik Auguston, Program Director, Tobacco Control Research Branch (TCRB) at the National Cancer Institute. His responsibilities include finding ways to improve population-based tobacco control. He also manages NCI's smoking cessation websites and directs development and evaluation of smokefree.gov and women.smokefree.gov.
Although one other panelist took on the issue of risk associated with mHealth, Auguston tackled the issue of challenges more broadly and under four buckets:
How Do we Boost Health Literacy?
Technology has enabled us to gather astonishing amounts of data in real time that are housed in these massive databases. But getting meaningful information out of that and conveying that to the average end user is a big challenge.
“It’s very easy to get enamored by our ability to collect data, but ultimately we have to be able to crunch that data down to something that is meaningful, whether that data is going to a medical team, which are sophisticated” or whether it’s going to end users, Auguston said.
Are Target Populations Being Addressed?
Sometimes mhealth apps are downloaded by millions of people but are those apps reaching the correct population groups. For instance, a person may be a fitness enthusiast and may have downloaded an app that tracks movement, calorie intake and may offer diet suggestions. But that app would be most useful to prompt behavior change only if it reached an obese person with a chronic weight problem.
“Again it’s very easy to become enamored with ‘Oh 5 million people have downloaded this particular piece of technology’ but how many people actually needed a health behavior intervention?”
How does mHealth Sustain Behavior Change?
Auguston remarked that people are very good at kicking off a change in behavior over short period of time, but not very good at sustaining it over the longer term. mHealth technologies have the potential to change this dynamic but so far it hasn’t been done well, he said.
These technologies, specifically the functionality they posses, have to be used in conjunction with psychological interventions and psychological literature that is available to push the needle on sustained behavior change.
How do we know mHealth technologies work?
Randomized clinical trials typically take several years to answer the question of whether an intervention is having the desired effect. That is an eternity in today’s world especially with how quickly technologies become irrelevant,
“There is a real tension that is going on between the conservatism of standard research approaches and the very entrepreneurial and dynamic nature of the space that we are in using mhealth and ehealth kinds of interventions. we have not yet effectively found a way to blend those two to come to a middle space where we can both be doing solid methodologically rigorous evaluations while also recognizing the dynamicness of the rapidly-changing field that we are in.”