By David Lee Scher, MD
mHealth has been utilized in underdeveloped countries for many years due to inaccessibility to scarce health care resources as well as the widespread use of cell phones. Developments in health care in the Western world have recently spurned interest in mHealth in developed countries too.
1. A present and worsening shortage of primary care physicians, and an even greater shortage of specialists, coupled with health care reform which is aimed at increasing access of health care will make face to face care more difficult. This, in some areas, has spurned the telehealth industry, whereby a physician will literally see you over the Internet. Physician shortages and the cost of this technology (most services charge as an office visit and require insurance) limit the widespread potential success of such endeavors. MHealth initiatives will actually increase contact of the provider and patient via text messaging, email, and communication of sensor-derived physiologic data (see below).
2. Obesity is now the biggest threat to the health of Western countries. It is responsible for the skyrocketing rise of high blood pressure, diabetes, coronary artery disease and even stroke in young people. Most chronic diseases like these are preventable with simple lifestyle changes. MHealth can effect these changes with educational messages, lifestyle reminders, and the transmission of physiologic sensing data (blood pressure, heart rate, blood oxygen levels, EKG tracing, and others).
3. The cost of health care is now literally prohibitive as a percentage of our total national budget. Technological and pharmaceutical development costs due to research, development and regulatory requirements are also at unsustainable levels. Therefore, both the public and private sectors are embracing mHealth as a solution. The government is making significant funding available for mHealth development. Large medical device companies are looking to smaller mHealth companies as a vital future of their business plans.
4. The shift of hospital and provider reimbursement from diagnosis-related fee for service management of diseases to to one of outcomes measured goals necessitates better patient participation. MHealth is a tool that can facilitate better patient care coordination once a patient leaves the hospital. It will hopefully prevent many office clinic visits and hospitalizations as well. Outcomes based care will necessitate close provider-patient contact upon hospital discharge. It may decrease the need for home visits by nurses and others due to transmission of information, both clinical and descriptive by the patient.
5. The advent of more widespread use of electronic health records (EHRs) is ripe for mHealth. Information from mHealth-derived technologies can deliver clinical information directly into EHRs or even cell phones or PDAs to the patient’s provider. Increasing interoperability of EHRs will lend itself to receiving information from MHealth programs. Educational materials in the patient’s EHR can be transmitted to mHealth applications as well. MHealth programs like medication-adherence, lifestyle changing reminders, and programs related to education of medical procedures (improving informed consent) have been developed. These all interact with EHRs. All viable mHealth technologies will be expected to feed into EHRs. This will maximize transparency, increase access, and result in better care coordination.
In summary, mHealth, is pivotal in participatory medicine’s goal of having the patient be the center of healthcare coordination, ultimately preventing and best treating chronic diseases, which utilize the vast majority of health care resources.
About David Lee Scher, MD
Dr. Scher is a medical pioneer (earliest adopter of remote patient monitoring and interoperability with EHR), a lifecycle contributor to development of new technology and regulatory approval as a clinical investigator, and a Medicare Carrier Advisory Committee member. He can be reached by email or through Linkedin.
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