Physicians aren’t taking mobile health seriously

I just returned home from mHealth Summit Meeting in DC which, in my opinion, is still one of the biggest and best mobile health conferences of the year. On the first day of the conference, I discussed the EndoGoddess App as a use case example of mobile health from the practicioner point of view.

Sadly, the numbers of physicians in the mobile health entrepreneural space at mHealth Summit were still few and essentially unchanged from last year by my counts.

Although I realize that many actively practicing physicians cannot attend all technology meetings, I would consider mHealth Summit to be that one meeting a year that an ambitious physician mobile health entrepreneur would take the time to attend. Therefore, I am assuming that this correlates with a low number of physician entrepreneurs in the marketplace. Although large numbers of physicians are certainly using smartphones, there is still a notable lag in the incorporation of mobile health within the traditional medical practice.

For example, case examples of physicians recommending health apps to their patients and then measuring changes in medication adherence or health outcomes are not common. Additionally, mobile phone sensors as a dominant outpatient diagnostic tool is also uncommon although cardiologist Dr. Eric Topol mentioned that his mobile phone vscan ultrasonic sensor has now replaced his stethoscope in his outpatient clinic. Exchanges on twitter such as the one listed below may mirror the fact that perhaps physicians aren’t taking mobile health seriously:

Physicians arent taking mobile health seriously

I hope more of my fellow physicians take the opportunity to use their voices (as new entrepreneurs) to shape the future of medicine into the one that they would like to see. Physician voices are important and a critical part of making mobile health and other technologies successful in improving patients’ lives.

Jennifer Shine Dyer, a pediatric endrocrinologist, is Founder, EndoGoddess LLC and Chief Medical Advisor, Eproximiti DuetHealth.com. She blogs at EndoGoddess Musings.

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  • http://expatdoctormom.com/ Expat Doctor Mom

    Dear EndoGoddess

    Thanks for highlighting this summit.  Here is the link for the others:  http://www.mhealthsummit.org/ Will look out for it next year.

    I think for whatever reason many docs are just not entrpreneurial and why the generalization has been made that they don’t make good business men/women.  (Not my generalization).

    I think the possibilities for the future in medicine are endless :)

    Best.
    Rajka

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      Thanks for the comment Rajka! I’m not exactly sure why there aren’t many other physician entrepreneurs beyond the general idea that physicians are part of a risk averse culture. However, I like to say that it is possible to be a dreamer and doer if you take out one important word: impossible.

      • Anonymous

        I think it goes beyond being a financial risk averse culture, Jen.  I think it goes to the issue of physicians treading water with new things being thrown and thrust upon them. EHRs, ICD-10, hospital regs for newly-employed physicians.  It goes on and on. Between that stuff and having to study/take recertification exams and fulfilling CME requirements, they are innovation-fatigued in my opinion. The average doc would love to appreciate new technologies, but cannot incorporate them easily because of reimbursement issues, connectivity issues with the existing EHR, among other things.  I’m not making excuses, but reflecting what I think are legitimate concerns.  I don’t believe that physicians aren’t taking mHealth seriously as your title suggests as much as a combination of adoption barriers in play, some of which involve awareness. I know you know all of this, but I would differentiate the entrepreneurs from the practicing docs that would be customers/facilitators of worthy mHealth technologies.  The entire healthcare system paradigm needs shifted from provider-centric to patient-centric to bring this technology to the adoption phase, in my opinion. No small feat.  Physicians are sensitive to patient desires and concerns, and if mHealth’s pressures to become adopted come from the outside in, there will be a better chance of success.

  • Anonymous

    I agree, and am glad to be entrenched in mHealth. This is not a passing fad, nor a David vs Goliath small companies vs big situation. Large companies are partnering with smaller ones and realize the value and game changing propositions of patient-centered technologies. I’m proud to be working with people and companies dedicated to disrupting healthcare, transforming it to a cost-effective patient engaging world. Thanks for your contributions as well, Jen.

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      Love that you mention a cost-effective patient engaging world for the future…it WILL happen!! :)

  • http://twitter.com/jojoben59 JoAnn

    although mobile apps are and will be the way to “assist with diagnosing,” (…and I use them everyday), let us not forget one of  the best ways to still obtain objective data in examining our patients is with our eyes, ears, fingertips, & nose…. & our brains We can’t dumb ourselves down & think that mobile technology will be the end all. What would happen if the mobile app crashed? Would we remember how to use a stethoscope, & interpret the sounds we hear with our ears?

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      I agree with you, mobile technologies are just tools and not replacements for the history and physical exam by a healthcare professional. And, just like I learned in my ICU medical training, one should always have constant quality checks and an old-fashioned, dependable human backup plan in the forefront of the mind to reference if any life-threatening technologies were to fail (ie, bag-mask-valve ventilation by a healthcare professional when ventilator alarms go off on an intubated/sedated patient).

      Thanks for your comment! :)

  • http://twitter.com/rchirvasuta Radu Chirvasuta

    Dr Dyer,

    I agree with your post and also hope that physicians become more involved in the creation of new technologies and apps. Simply making use of the ones available would also be good.You wrote:”Additionally, mobile phone sensors as a dominant outpatient diagnostic tool is also uncommon although cardiologist Dr. Eric Topol mentioned that his mobile phone vscan ultrasonic sensor has now replaced his stethoscope in his outpatient clinic.”The article you indicated says that “Technically the GE Vscan is not a mobile phone, but it certainly resembles any old clamshell on the market today.” which is why I wouldn’t call the GE Vscan a mobile phone.

    Could you provide a reference for Dr. Topol’s bold use of this new technology? I’d like to share this remarkable detail.

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      You are correct that the GE Vscan is not technically a mobile phone but rather looks like one.

      Dr. Eric Topol mentioned it in his keynote at mHealth Summit that he now uses this technology on all of his physical exams rather than the stethoscope as a better way to diagnose cardiac pathology (ie, visualizing aortic stenosis rather than auditory description of aortic stenosis). It should be noted that as a cardiac specialist, he is already trained in reading ultrasound so the new technology did not require any additional training for him to use it…rather it just became a more accessible and convenient option for superior diagnostic function over the stethoscope as a tool for his physical exam. It was implied in the discussion that the rise of mobile phone sensors and technologies such as the GE Vscan (upon integration into a true mobile platform) may one day be a dominant tool in the outpatient clinic.

      Thank you for your comment! :)

  • margaret.coles

    I couldn’t agree more with the article on health and the
    social media. I am vitally interested in telehealth in all its forms. My part in
    it as a physiotherapist, is to give what some call telecoaching. I’ve put 40 years of experience into reader-friendly
    format and put it on the web at no cost. It’s main thrust is supported self-care
    tackling management of Long Term Conditions in particular. As
    a leader in technological health commented, we have to reach people where they are. Many are at
    the other side of information technology. This is where trained health
    professionals can use their expertise, also supporting generic workers in the
    community who will be face to face with health service users. A good use of
    Twitter.

    In this way inequity of health provision can be reduced and
    cost effective services designed. There is evidence to show use of technology is
    just as effective as face to face health care. Let’s hope health professionals
    correctly guage the impact this could have.

    Margaret Coles

  • http://twitter.com/alshar alshar

    mHealth can be powerful but there still is too much hype and not enough demonstrated value. There was an NIH session on evidence at the summit and one on value that was sponsored by RWJF Pioneer. I begin to discuss this at http://rwjfblogs.typepad.com/pioneer/2011/12/reflections-from-mhealth-summit-2011.html and will be adding to that.

  • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

    Evidence is important, I agree. However, mhealth also just makes sense…ie, meeting people (patients) where they are. In my opinion, need more real-world action and implementation beyond just evidence.

    Thanks for your comment! :)

  • Rajesh Harrykissoon

    App burnout, apps with limited relevance, apps with glitchy functionality.  In my opinion these are the reasons why mHealth has not achieved greater utilization by clinical practitioners.

    For example, I balk at having a dozen or more apps to open to convey the scope of what I do with each patient visit.  I’m not aware of very good to excellent comprehensive apps that offers patient education for diabetes, heart disease, emphysema, chronic kidney failure, sleep apnea and anatomic imaging to show that bulging vertebral disc all in one.  Certainly I can find AN app for patient intake, AN app for diabetes and AN app for vascular disease…but who wants to open an app for every little thing? 

    Unless you’re super specialized like a diabetic educator or podiatrist, an app has little relevance to comprehensive patient care.  Furthermore, of the apps available it’s difficult to find one that performs at the level of very good to excellent and does so with fidelity.  Many are introduced without seeming beta testing and, thereafter, remain unimproved and unupdated.

    I admire the desire to better utilize mHealth and I share this desire.  However, we don’t need 76 piece meal apps when a half dozen or so well designed apps would better fit the needs of most practitioners. Hopefully some entrepreneurial type will see this need and come to the rescue.

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      ABSOLUTELY true about the lack of good basic patient education apps. In fact, that is what I am working on with Duet Health. But, need more entrepreneur healthcare types to join me!! You in?

      Thanks for the comment!:)

  • Chris OhMD

    Jen, I am an internist who loves EMR, mobile devices. I do home visits, my own blood draws, EKG and plan on purchasing the GE Vscan next yr. I think mobile devices and mHealth help me tremendously in delivering better care to patients while cutting costs – a goal which everyone should strive towards.

    I have been pondering the same question you raise for many years: why is it that something so straightforward is presented with great benefits but very few take it seriously? I think that the answer actually lies in understanding the psychological makeup of a physician. Docs are in general smart people but the rigorous medical education requires them to follow rules, guidelines and make it difficult to think of concepts that are outside the box. In a nutshell physicians find it intimidating to incorporate new technology into his/her practice especially when there are so many choices out there.

    However I’m quite certain that slowly but surely healthcare will move in that direction and we will be at the front of the trend.

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      I definitely agree with you about the psychology of a physician. Perhaps the changes in the healthcare landscape will drive more physicians to become entrepreneurs when the risk of doing nothing to improve the healthcare system is higher than the risk of becoming an entrepreneur who changes the system. That is my story anyway. :)

  • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

    IMO the biggest reason that Mhealth usage hasn’t taken off by physicians is that they are providing a divergent solution.  What we busy physicians need is the opposite– convergence.  We spend increasingly amount of time finding our way through cumbersome new EHRs. We need Mhealth to automatically share data bilaterally with our new electronic health universe.  If we are jumping around devices and databases, this is not good for our efficiency and most of us will balk.  Once we have convergence and using mobile is easier than not using mobile, you will see a rapid uptake.  Until then we can talk talk and physicians will say ‘talk to the hand’.

  • http://twitter.com/science4care Children’s Hospital

    We are completely enamored with mobile health and agree that it’s a very useful tool especially when physicians are strecthed for time. It may take a while to catch on but the benefits to physicians and patients are clear. We recently wrote about Vgo, a robot that goes home with patients after surgeries and the robot’s “face” is actually a screen so physicians can talk to their patients and monitor their health during recovery. I think these technologies will become more common and thus less expensive making them more widely available. Great post Dr. Dyer, we’re looking forward to the next one!

    -Lindsey
    Vectorblog.org 

  • http://twitter.com/LastCardiology TheCardiologist

    For anyone interested I’ve just posted a detailed hands on review of the VScan from my last weekend on call on my blog at http://wp.me/p25FwE-1O and part 2 at http://wp.me/p25FwE-2n

    TheLastGeneralCardiologist

    • http://twitter.com/EndoGoddess Jen Dyer MD, MPH

      Very cool!