5 ways to improve the adoption of medical apps

Before the adoption of new technologies which will undoubtedly improve health care (as it has the retail and finance sectors), it must be introduced in ways which are digestible, scalable, and subject to rapid iteration.

Is mobile technology different from the adoption of any other change in health care delivery? I think not. The culture of care certainly requires change as care models are changing. The point of care is shifting to the home, professionals other than physicians are delivering most of the care, and digital technology is becoming a fact of daily life.

With this care shift is the shift of daily tasks to mobile technology. Most mobile tools utilized today by physicians is related to reference or other resources geared towards them, not the patient or care. I suggest a few ways in which the introduction of mobile health care tools to physicians will itself lead to adoption. Baby steps are needed in this process contrary to what I see as industry’s “build it and they will come” philosophy, with its predictable disappointment.

The following suggestions are predicated on good medical app development practices.

1. Involve physicians in clinical pilots.  This accomplishes three things. It introduces physicians to mobile health tools and processes involved in using them. It serves an avenue for user experience feedback from both clinicians and patients, and might provide some outcomes data.

2. Establish a network of key opinion leaders (KOLs). Peer to peer education has a successful track record in both the pharma and medical device sectors. The “in the trenches” experience provided by these KOLs is invaluable in conveying information and addressing concerns of physicians.  It speaks to pain points, benefit to patients, and health care and business models.  These KOLs using digital tools themselves via closed professional social networks is a model I would look forward to being useful.  KOLs have impact via presenting data at professional society meetings, discussing new technologies via traditional media outlets as well as social media.

3. Payers incentivizing physicians to use good tools (portal, diabetes tools).  The use of mobile health apps and other tools (communications, delivery of educational content, and interoperability of data with EHR) might promote or even necessitate the use of robust patient portals. This therefore accomplishes two things which will benefit patients. Payers are in the unique position to incentivize both patients and providers to take advantage of these mobile tools. In what way can payers incentivize physicians? How about having a physician directory which spotlights those who utilize mobile health technologies?  Like-minded patients who desire to become more participatory in their care will gravitate towards these providers, thereby potentially fostering good relationships even before they meet.

4. Patients introducing technology. Changing behavior in the doctor-patient relationship can be a bidirectional process. Just as physicians can change patient behavior, patients can exert influence as consumers on physicians by asking questions about the use of digital technologies by their physicians. These inquiries might get physicians thinking. Patients who suggest medications based on DTC marketing ads often receive them. Patients who are proactive are better patients.

5. Medical school courses for students. Digital natives (or close to them) are now medical students. There is much enthusiasm by students for the use of mobile technologies in health care.  Many are designing apps or anxious for others to do so. There are many reasons why medical schools are at the forefront of mobile medical apps. A “bottom up” approach seems logical  in this arena because of the slow pace of the change in health care culture by the establishment. Mentors in medical school might not be champions of mobile health tools for many reasons. As often is the case in politics of many sectors of society, the new generation is the source of execution of the dreams of others.

Though none of these points are revolutionary, they should provide sources of consideration for starting points of those interested in this sector. There needs to be a distinction made between introduction and adoption of technology, as I believe they are considerably different. Thinking about the process this way might result in less frustration by the industry, investors, and create a different model for implementation and sales.

David Lee Scher is a cardiac electrophysiologist and a consultant, DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.

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  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Are there any clinical trials showing clinical benefits (to patients) of mobile apps? And while we’re at it, are there any studies showing the benefits of mobile apps to consumers in either retail or financial industries? Do mobile apps improve consumer finances? Do mobile apps increase the value consumers derive from retail? Or are those mobile apps deployed by financiers and retailers to get more money out of consumers pockets in a more convenient way?

    • southerndoc1

      9 out of 10 KOLs say . . .

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Yes, with a “successful track record in both the pharma and medical device sectors”….

    • dlschermd

      Margalit,
      While I agree with you about clinical outcome data needed for health apps (and anyone who knows me in the sector will attest to my dedication to efforts in this nedeavor), there are ways other than RCTs which might provide evidence of utility. The benefits of EHRs are first surfacing not out of clinical trials but by testimony of clinicians who are seeing things like medication discrepancies. It will take time. But does the absence of hard outcomes data mean we go back to illegible paper charts? As a clinician I cringe at the thought of wading through a chart the size of a Manhattan phone book looking for a test result ordered by another physician. With regards to your question as to whether people benefit from apps used in commerce and finance, I would simply ask if you know anyone who uses apps to shop, locate a business, bank online or make a reservation at a hotel, restaurant or for transportation. Do companies like Uber thrive because they have no business? People use these apps to save time, energy and and this adds up to savings. Yes, convenience is an important metric in daily life that people love about technology everyday to an extent that they take it for granted.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Hi Dr. Scher, let me first say that I am not railing against the machine, so to speak. I absolutely love computers, and also the idea of EMRs. EMRs could have been an enormous source of joy and relief for doctors, instead of the scourge they turned out to be, precisely because of this headlong rush to get them into every practice, without proper research, without proper supervision (FDA), and for reasons other than better patient care.

        Now, we are turning our attention to pushing apps; third party apps, mostly to “consumers”; free apps. Who are these people? What are they selling? And to whom?
        If someone wants to peddle a free app to manage diabetes (a medical device?), I want to know three things: does it improve management of diabetes in a significant way? how does the app developer make money? what happens if a user is harmed by the app?
        Right now, the answer to the first question is “we hope so”. The answer to the second question is “none of your business”. And the answer to the third question is “not our problem”.
        On a side note, since you mentioned Uber, I guess we’ll find out about the third question now that the service which requires its workers to constantly use apps while driving, finally caused a horrible accident that I guess nobody in Silicon Valley could have foreseen.

        As to apps in other sectors, yes convenience and energy savings are probably the only advertised benefits to consumers. Of course, spending a few more calories per task could significantly reduce the need for diabetes management apps, so I doubt that this is truly a benefit. And making shopping for stuff we don’t need a bit more difficult than one-click on a whim (after being served “personalized” ads that exploit every bit of our weaknesses), is really not quite the benefit we think it is.
        Not to go into the whole macro level argument that these things are displacing workers, which is making us poorer, hence we need even cheaper stuff, which requires more automation, which gets rid of even more workers… etc. etc. etc.
        Health care is one fifth of the “economy”, and employs almost as many people as the retail/food industry directly, plus a whole bunch more indirectly. What happens to these people once the techie notion of cutting health care costs in half (or whatever the latest numbers are now in Palo Alto) becomes reality? Half of them will be on the street, with no income and no ability to pay for even that half of the price. So we need to cut even more, and more people will lose their jobs…. etc. etc. etc.
        And I didn’t even mention “quality”. Or doctors’ incomes. What do you think will happen to those? And at this point in my (too) long rant, why should doctors voluntarily embrace this self-devaluating solution? Why should any of us?

        • dlschermd

          Regarding EHRs, I agree with your assessment of the initial aim and lack of clinical involvement in development. They were initially developed as billing tools. As an aside, the FDA does not have jurisdiction over EHRs, the ONC does. This is more than “we hope so” for some apps. There are over 100 apps which are FDA approved and which have been through clinical testing. A few of them are diabetes apps which are not only used in practice (Glooko is being used by the Joslin Clinic) but approved for payer reimbursement (Welldoc, Glooko). Developers have different business models. Some like iBGStar by Sanofi make money by selling lancets to patients used for the mobile tool attachment to the smartphone. Others are being sold as pt management tools (cloud-based data and analytics) as well as live coaching. :I would urge you, if you’d like to learn more about digital health tech to look at the Linkedin group Digital Health. The discussions and resources there will answer all your well-founded queries and much more.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Thank you, I will.
            As an aside, ONC is a politically appointed body with no experience or ability to regulate medical devices. The job belongs to the FDA.

          • dlschermd

            I resprctfully disagree. It doesn’tThe FDA has no expertise in the area.

          • southerndoc1

            The FDA can regulate apps but not EHRs?

          • dlschermd

            Correct

  • guest

    I was, at the age of 46, the first physician at my hospital to carry a smartphone which ran Epocrates, so I am certainly not anti-app. Having said that, I think we all should keep in mind that the main point of apps is to make money for the people who design and sell them; it’s important not to get caught up in the “if it’s digital it must be better” hysteria.

    • dlschermd

      I appreciate this comment. Sure apps are businesses. It is the hope that THESE businesses supplant more expensive ones with dinosaur hardware and software. There’s nothing wrong with a business model aimed at improving healthcare. It’s development shouldn’t be given away. That said, skepticism about companies feeding off the dying carcass of the broken healthcare system is certainly welcome. I twill drive the best developments.

      • guest

        I would argue that there are a few things wrong with a business model aimed at improving healthcare, the chief one being that the primary aim of the business model is always going to be to make money; that’s what business models are, by definition. Patient care is always going to be a subordinate factor to profit in the model, otherwise it wouldn’t be a good business model.

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