However, the vast majority of those downloads will be for health software that tracks a diet, logs cardio workouts or is geared toward reducing stress. Those are all valuable tools, but many health care organizations are aiming their efforts at offering mobile applications that connect consumers (i.e., patients) with the nuts and bolts of health care delivery: appointment scheduling, test results, interaction with chronic disease professionals and online bill pay options.
Consumer interest in mobile health applications indicates a burgeoning demand for health connectivity, but mobile connections between caregivers and patients is evolving much slower than organizations that have invested in that connectivity expected.
Dean Clinic, for example, has been active in the mobile market for more than two years, but hasn't found it to yet be a game changer. The clinic, with 64 locations throughout Wisconsin, since 2005 has offered a patient portal with a personal health record. It currently has 115,000 patients actively using the PHR, meaning they have accessed it during the last 12 rolling months.
Since September 2010, the clinic has made the MyChart portal from Epic Systems Corp. available via an iPhone mobile app developed by the vendor. Dean Clinic was the first Epic client to go live with the mobile app and now has about 6,000 users, says DJ Curran, telehealth program manager. That's around 0.5 percent of the total patient population; the clinic had expected about 10 percent of patients would be using it by now.
An Android app was introduced in the fall of 2011, but didn't result in a big bump in usage, Curran says. On the plus side, Dean Clinic didn't suffer financially; there's virtually no overhead for the clinic except supporting the app on the patient portal, which the clinic hosts.
The low adoption is partly explained by the mobile app's current limitations: The most popular features on the patient portal are self-service functions-scheduling, medication refills, bill payment and access to a medical library that explains test results. But these features are not yet available via the mobile software, though they will be in coming months. Another function that will be added is enabling patients to take and transmit a photo or video, which should increase interest in the mobile offering, Curran says.
Right now, patients can access a basic health summary (problem list, medications, allergies and immunizations), test results, send secure messages to clinicians, and view family records with authorization.
"We were relatively early when we launched the app; it was more of a novelty and now it's becoming more of an expectation," Curran adds. "We had the exact same cycle of adoption on our Web site."
The buzz in this space is around engagement. Many hospitals invested in personal health records years ago and saw those efforts flounder before gaining traction as critical self-service functions came online.
Mobile apps provide a path to leveraging those investments and using PHRs and patient portals to consistently engage patients, not only to potentially improve their health outcomes but to retain and expand the customer base.
Palo Alto Foundation Medical Group, serving northern California, initially saw slow adoption of the personal health records service it launched in 2001. But today, 75 percent of adult patients are enrolled in the PHR service, says Albert Chan, M.D., chief medical information officer for the Sutter Health-affiliated group practice of 1,200 physicians in more than 40 locations.
Palo Alto has phased in services for Apple and Android mobile devices since January 2011, and now provides secure messaging, refill requests, appointment scheduling, lab/radiology results, and immunization information.
Chan says the mobile health era is still very young; the last two years are when smartphones and tablets have really matured and captured market share. "Mobile is here to stay and we want to meet the patient and family where they want in order to provide the services. Frankly, I wish we had offered it sooner."
Going deep
For Palo Alto, the goal is deeper patient engagement in their health care, and mobile devices offer the platform for comprehensive disease management for chronic patients-led by the patients, Chan believes.
The medical group has used smartphones during a three-year clinical trial to determine if using the devices could improve patient outcomes. The PHR service helped Palo Alto set the groundwork for migration to mobile environments by growing an engaged patient base by the time mobile computing began to mature, Chan says. The goal of the clinical trial was to create the new mobile ecosystem that could support those patients.
Four hundred patients with uncontrolled diabetes participated in the trial, funded through the Agency for Healthcare Research and Quality.
Half of the patients were given a smartphone loaded with a personalized care plan for a year, along with access to a diabetes care manager and educational messages; the other patients were in a control group with access to regular clinic care. The trial paid for a data plan for those given a smartphone.
Results published in November 2012 in the Journal of the American Medical Informatics Association found a nurse-led online program can improve patient control of their diabetes. After the first six months patients in the intervention group, using wireless glucometers and mobile applications to transmit glucose levels and other health indicators to physicians, had half the glucose levels of the control patients. The differences narrowed considerably after a year, but then widened again later into the study.
