Thinking about personal health information technology – the wearable devices, remote health monitors, digital weight scales, and Bluetooth-enabled medical equipment scaled for the home – there are two glasses. One is half-full and the other, half-empty.
The half-full glass is the proliferation of consumer-facing devices like Fitbit, Jawbone and Nike, which comprise the lion’s market share in the health wearables segment; the mass adoption of mobile phones and tablets; consumers’ multi-screen media behavior (as tracked by Nielsen); and consumers’ growing share of medical spending, now about 40% of annual spending (or something north of $8,000 for a family of four in the U.S. covered by an employer). (In Chez Kahn, headed by an economist and a banker, the technical term for this is “real money”).
The less sanguine half-empty glass contains the considerations of physician concerns about who will pay for them sifting through bits of patient-generated data from sensor-laden devices used in the home and on-the-go; who’s liable for looking at that data and making health recommendations; and, the lack of evidence for whether using these devices and tools really do change behavior and results in improved health outcomes.
In the recipe for successfully cooking up the adoption of mobile tools for inspiring patient engagement, the magic health outcome will come from the ingredients of design, empathy, respect for workflow/lifeflow, and finally, the right technology.
In our panel “Putting the ‘P’ Ahead of ‘HIT’ – It’s Personal,” Dr. Danny Sands, Dr. Peter Hudson, and I set out the landscape of PHIT – those consumer-facing tools, apps and devices – and how they “PHIT” in the real world. That both Danny and Pete are doctors helped ground our session in reality beyond the Gartner Hype Cycle, showing that wearables are at the top of the peak of inflated expectations – about ready to fall into the trough of disillusionment.
The iTriage app developed by Pete Hudson as an ER doctor is an example of a well-utilized engaging mobile health tool that millions of health citizens use every year. Pete reported utilization data that showed once people have health cost and supply information “in their hands,” people showed a 19-times greater use of in-network health resources than those consumers who did not use the mHealth tool. The point, Pete said, is that if you put useful health information into peoples’ hands at the time they need to make decisions, they feel empowered, competent, and satisfied as consumers.
This enablement – of enhancing peoples’ health literacy and “muscles” as health consumers – then generates trust and sets the stage for health engagement and better health outcomes.
More active health engagement drives costs down, as Dr. Judith Hibbard’s research on the Patient Activation Measure, has shown (see the February 2013 issue of Health Affairs for this paper).
Mobile health tools have a role to play in helping the health ecosystem drive toward The Triple Aim — when the stuff is well-designed from the start, continues to iterate innovation and consumer input on preferences and experiences, and the tool solves a real problem for a real person.
The design aspects cannot be under-estimated: Pete noted that only 2% of iTriage users are over 65, meaning that there is more work to be done to enchant and inspire older people to use health apps that are appropriate and relevant to their own life flow and health values.
The HIMSS 2014 Mobile Health Survey, released today, found that hospitals and ambulatory health providers are calculating ROI for mobile health investments based on improving efficiencies, cost savings, clinician satisfaction, and patient satisfaction. Those are sound parameters, but ROI won’t be very rosy unless health providers have the right incentives facing the CIO and CFO: that is, being compensated on the basis of value and health outcomes, and not for volume. This moving target is morphing toward value, but the pace of that change — coupled with changing the workflow of patient care toward the patient at home, on the care team — will determine the timing of adopting innovations in mobile health.