Getting Doctors in Sync with Patients and mHealth02.20.14 by Eric Topol, M.D.
In his inaugural H&HN Daily blog, Eric Topol, M.D., implores doctors to jump on the mHealth train.
Editor's note: H&HN Daily is pleased to introduce its newest monthly blogger, Eric Topol, M.D. A passionate advocate for advancing health IT, Topol's blog will appear as part of H&HN's Connecting the Continuum series, which, in 2014, focuses on the growing trend of mHealth.
As many of you know, I have long been a passionate advocate for mobile health (mHealth) applications, which I believe can transform health care when properly designed and used. Consumers will drive this change, because they're the ones who have the strongest motivation to use the technology. That's why, in addition to my role at Scripps, I'm excited to join AT&T as chief medical adviser. I see AT&T as a company that is uniquely positioned to become a major force in enabling and facilitating how health care information will be rendered and received by consumers through connected devices.
Physicians also have a critical role to play in helping their patients use mHealth tools to improve their health. Until now, however, doctors have not been enthusiastic or incentivized to prescribe mobile apps. This has been especially disappointing to patients with chronic conditions who have tried mHealth apps and add-on devices with their smartphones and tablets. When their physicians don't view the mobile device data or factor it into their care plans, these patients tend to stop using these apps after a few months.
What a big missed opportunity! For the first time, patients have the mobile tools to store, track and share data about their chronic conditions; and for the first time, physicians are able to monitor how their patients are doing day to day — even minute to minute. Patients now can capture data on their smartphones that previously were unattainable — like blood pressure, heart rhythm, oxygen saturation in the blood, and many other important metrics. And this is "in the wild" during real life rather than one-off measurements in a doctor's office.
I have been "prescribing" (recommending) medical apps and their hardware adds to my patients for the past few years. My experience with blood pressure, for example, has shown that patients take considerably more frequent measurements and are able to contextualize the information to diagnose whether their BP is properly managed. If it isn't, they know when and often why. The same holds true for heart rhythm. Today, patients can get their rhythm electrocardiogram done via a smartphone and get an automatic computer interpretation. For diabetics, glucose fits this same template. Now patients are getting their data, having it graphed on their smartphone or tablet screenshot and it is being continually updated. Patients also are looking at their devices on average more than 100 times per day, and getting far more engaged in their own medical care. In my experience, consumers want to use this technology now, but there is a general lack of support by physicians that is holding back progress.
There are a number of reasons why doctors haven't adapted to the medical app movement. It's a conservative profession, which innately is resistant to change. Moreover, if hundreds of patients start sending screenshots of their data, there is a legitimate concern that a physician would be inundated. Like emails, there is no reimbursement for reviewing the data and getting back to the patient. There is also concern about potential medicolegal liability. And since this whole area is new, there is a general lack of peer-reviewed publications on the technology to assure the medical community of accuracy.
But this mHealth train has indeed left the station and we need to find ways for getting consumers and doctors in sync. Some physicians are concerned about the loss of control, the flow of data directly to the patient and a potential weakening of the doctor-patient relationship. But studies on the impact of emailing between doctors and patients have shown that online communication between visits actually strengthens, rather than weakens, these relationships. If doctors and patients used mHealth apps together, their relationships likely will grow stronger.
While the increased workload for physicians is a thorny issue not yet worked out, the use of cloud computing and validated algorithms eventually will take hold and defuse this concern. It will be vital for appropriate filtering and signal processing to be in place to ensure that physicians only get alerts on their patients and when appropriate. Certainly doctors should and will have a role in setting those thresholds.
I hope that my physician colleagues will start to recommend mobile apps for their patients to gain direct experience on how excited and motivated patients become when they get their own medical data. This represents a step forward in medicine's future that is both individualized and democratized. While the young digital native doctors get it, and patients want it, it's time for us older docs (digital immigrants) to embrace the potential of mHealth. We'll all become digital doctors in the future, one way or another.
Eric Topol, M.D., is chief academic officer at Scripps Health and a practicing cardiologist with Scripps Clinic. He is also chief medical adviser to AT&T. Follow him on Twitter at @erictopol.