Why doctors aren’t prescribing health apps to patients

The BBC had a story recently about general practitioners (GPs) in the UK prescribing health apps to patients. The idea is that prescribed apps would be free to patients, even if they had a cost associated with them, so I’m assuming that the NHS would pick of the tab for such apps.

The story has gotten a lot of attention, and I think with good reason. I’ve written before and believe that physicians need to prescribe health apps, whether they be mobile or web, in order for patients to signup and use them on an ongoing basis.

There are several huge benefits that exist from this approach:

Enhancing, not replacing, the doctor-patient relationship. As eroded as it has become, the doctor-patient relationship is a powerful thing capable of very positive things for our health system. In my utopia, health apps are used to enhance that relationship, providing constant touch points between provider and patient, even if some of the content from the provider is somewhat generic and/or canned. I think that constant contact and accountability for the patient, whether real or perceived, will be a huge driver of ongoing usage. Also, collecting additional data and summarizing it for the provider, potentially with clinical decision support built in, makes the time spent face-to-face that much more valuable.

Minimizing disruption. If the provider can have select apps for each condition or cohort of patients then it makes disruption of clinical flow less for them as they only have to learn to view and act on results from a small subset of apps. Also, if these targeted apps are then integrated into the EMR, even as attached reports, that is less disruption. Or maybe more app developers start making physician apps for viewing patient data. Again, the number of apps has to be limited. If all app makers agree to push data to one platform, such as MS HealthVault or Dossia or whatever, then this problem is solved, but I don’t see the convergence of one storage platform to be very realistic in the near future.

Reducing silos. This relates to disruption above. Reducing the number of apps used by patients reduces the number of silos of data from different app makers. It also filters the huge number of potential apps out there.

Virtually linking patients and providers. If a doc prescribes an app, ideally they could do it with an invite code or QR code or someway for the patient to choose them as part of the app registration process. I realize very few apps do this today but we’re going to be seeing more and more of this coming. Instead of walking out with directions memorized or on printed documents, prescribed apps can pull data into the app and present it a more meaningful way, or maybe automatically add events to a calendar, or create a specific health calendar. This is definitely future-state but has a ton of potential. Linking the two makes access to data easier and also enables messaging between parties, once both patients and providers are ready to message.

Lowering the cost of care. Regardless of provider involvement, I think engaged patients that use health apps on an ongoing basis will be healthier. I think patients feel more accountable if something is prescribed to them and can be tracked. Accountability leads to more active engagement which then leads to better outcomes and lower costs.

With so many benefits, why aren’t physicians prescribing apps? Unfortunately, I believe we are a long ways off from seeing most docs prescribe health apps to patients. The UK has a bit of an advantage because it is a more centralized health system. Systems that are similar in the US, like Mayo, Kaiser, Intermountain, and Geisinger, I could see being some of the first to start having providers prescribe institutionally approved apps.

But, for the vast majority of providers and, by extension, patients, several very large obstacles remain:

The vast majority of providers don’t know anything about health apps. If you’re a provider reading this post, I’m not talking about you. Most practicing physicians don’t have any idea what apps are out there for their patients. Heck, most providers don’t have much of an idea of what apps are out there for themselves (Epocrates and UpToDate excluded, although my wife only knows UpToDate has a mobile app because I installed it on her phone).

Assuming providers knew about apps, they need guidance on what apps are safe. I believe docs are never going to prescribe an app unless a trusted organization confirms its value and accuracy or a trusted colleague tells them about how great it is. Maybe that is where the FDA comes in? But, even with FDA approval, apps don’t fit into nice categories like drugs do (it’s easier to compare two statins than it is to compare two diabetes apps). I’m not sure how this will work exactly but I know there needs to be some higher authority validating, and in essence taking some of the responsibility, from providers. This is what Happtique is trying to do; we’ll just have to see how well it works from a clinical buy-in perspective.

Providers don’t know how it fits into practice. Providers are going to want to know how the apps fit into their practice. Right now I think that’s still unclear. Obviously more data on mood trends as somebody is starting new meds for depression is great, as long as it is presented to the provider in a digestible way. But, what if the patient is suicidal according to the app and there is no feedback mechanism to trigger an alert. If providers are now prescribing patients to enter this additional information, are providers on the hook to assure they know when an immediate response is warranted and then to respond to it?

Lack of payment. Unfortunately this might be the biggest obstacle. In the NHS story references above, the apps were going to be free to patients. In the US, that is not the case, at least it isn’t today. Prescribing patients to spend additional money is likely going to prevent widespread uptake. Or maybe different payers will have different “app formularies” so providers will have to wade through lists to see what approved apps are free based on payer. That would be great. Also, if providers aren’t paid for responding to app messages or alerts it’s likely not going to happen.

I’m curious to see where this goes in the UK and also within some larger health systems in the US. I think prescribing apps is crucial so we’re going to see organizations start to address some of the obstacles I listed above. I’m sure I’m missing some benefits and obstacles. What others can you think of?

Travis Good is a physician involved in health IT startups.  He blogs at HIStalk Mobile.

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