Recently, our office’s longstanding software provider excitedly released a mobile application that connects users with our comprehensive EMR system. But despite their touting the ability to “securely view real-time data from your EMR on your mobile device” my colleagues and I still can’t build a business case for us to use mobile health, or “mHealth”, in our work.
That will strike some readers as strange. After all, isn’t mHealth one of the most promising and fastest growth areas in eHealth?
It is if you believe the vendor hype about how new applications will benefit patients and providers.
But consider: The fundamental role of technology in healthcare is to be a tool, an implement that makes the job of delivering care more efficient and safe. It’s a means to a better end.
In contrast, technology in our society often plays the role of toy. That is, it’s an amusement that isn’t a means to an end, it’s the end in itself. It doesn’t do things better than alternatives. Or if it’s promoted as a “solution”, it’s a solution in search of a problem.
Which leads to the obvious question: Is mHealth a tool or a toy?
My answer is that it depends on who’s using it and what they’re using it for.
We’ll start with the healthcare provider.
The reason that my colleagues and I can’t see the benefit of mHealth as a clinical tool is because we provide patient care in an environment optimized for using our EMR system. There are workstations with large screens everywhere and we have remote VPN access to our personal desktop computers from anywhere. Any healthcare organization that wants to work effectively with an EMR should be doing the same.
In that light, it’s difficult to see why one would use a mobile device and application to interact with an EMR. The device’s small screen prevents the user from seeing the “big picture”, which is a patient safety risk; we need interfaces that allow us to integrate patient data, not fragment it onto separate screens. Furthermore, data entry is much more difficult on mobile devices.
True, remote access to the EMR might be beneficial when the provider is in transit between points of care. But not if you’re operating a vehicle or are in a place that’s public enough to jeopardize the privacy of screen contents.
Nevertheless, there are two aspects of mHealth solutions that can be helpful to a clinician: messaging and data capture. For messaging, a portable device serves as a smart two-way pager capable of delivering rich messages that can include text, graphics and images. Data capture occurs through the device’s camera, microphone or a dedicated sensor for upload into the EMR. But note that neither of these capabilities requires a functional client for the EMR on the phone or tablet, just messaging and data transfer.
Beyond the clinical uses of a mHealth EMR connection, vendors also advertise the ability for a user to see the patient schedule and to capture billing charges when away from the system. The billing part is valuable in a small minority of situations. As to viewing the patient schedule, that seems like a hollow feature: does it really affect how professionals deliver care or is it just an obsessive detail with no real effect on provider or patient?
To summarize, while mHealth isn’t purely a toy for providers it’s only a tool for very limited circumstances. And it’s certainly a second-class interface for working with an EMR.
In contrast, mHealth in the hands of a patient meets more of the user’s needs. That’s because patients use mHealth tools primarily for data capture and messaging, the two areas where mHealth excels.
With respect to data capture, the majority of use has been in gathering fitness information with wearable products that monitor movement and pulse. However, we don’t yet have any evidence that such monitoring leads to better health outcomes or even improvements in exercise motivation.
Where mHealth monitoring may yet show benefit is with measures of common conditions, particularly blood pressure and blood sugar. But to optimize the value of that data collection the solution must also be able to send the results to the patient’s electronic record.
That brings us to messaging, which constitutes the lion’s share of what serves patients’ wants and needs, including:
• Asking a health question to their provider, which may include data captured with a monitoring device, camera or microphone
• Booking an appointment either for an office visit or for a virtual online encounter
• Requesting authorization for prescription initiation or renewal
• Receiving test results
Note that while this can be accomplished by a mHealth application linked to the provider’s EMR, the patient will often find it more useful to interact through a web-based portal that provides the greater usability of large screens and true keyboards.
Still, it’s clear that mHealth is more a tool than a toy when serving a patient, even if patients might be wrongly sold on mHealth data capture capabilities that have no evidence of benefit.
The bottom line is that the present flurry of mHealth device and application releases is more a fad than a breakthrough. While mHealth offers valuable nuggets in data collection and transfer, the form factor of portable devices is simply too limited to make a difference in how providers deliver care. That means that we need to distinguish mHealth tool from toy so we can focus on innovations that will truly improve health outcomes and efficiency.