This article was originally published in the Journal of mHealth; you can access the full issue here.
Despite their potential, until recently, many reports pointed out that Mobile Health solutions are still lacking scientific evidence supporting their effectiveness; however, this is fortunately slowly changing now.
There is growing evidence that mHealth solutions are moving from fitness trackers and quantified self to more impactful tools that truly empower healthcare professionals and patients. Such tools have the potential of revolutionizing Healthcare.
In April 2017, the remarkable results of a randomized trial comparing a mobile health follow-up with regular examination in Lung Cancer patients showed that the median survival was 19 months for patients who used the app, compared to only 12 months for those who received routine checkups1. The study also reported a better quality of life among the app users. “Through personalized follow-up using this convenient and simple online application, we can detect complications and signs of relapse and offer appropriate care earlier,” said lead study author Dr. Fabrice Denis, MD, Ph.D., a researcher at the Institut Inter-regional de Cancérologie Jean-Bernard in Le Mans, France. “This approach introduces a new era of follow-up in which patients can give and receive continuous feedback between visits to their oncologist.” Which makes this solution one of the first Evidence-Based Medicine Applications showing significant overall survival improvement in a clinical trial, paving the way for more evidence-based mobile solutions to come.
Mobile health solutions also proved to be a noteworthy tool in enabling health researchers to recruit big numbers of patients and monitor them in real time. A research published in “Nature Biotechnology” showed how an app to study asthma triggers enabled the research team to recruit about 9,000 participants with asthma, who used a mobile health app daily to register their symptoms and triggers. The research team wanted to investigate the impact of the wildfires in the area on asthma patients, and thanks to the real-time data reported through the app, they concluded that when fires flared up, so did asthma symptoms2. “In the past, stuff like this was just logistically impossible to do,” says Chan, director of digital health at the Icahn Institute for Genomics and Multiscale Biology at Mount Sinai in New York City. “It opens up a brand-new area of research.” Such contribution in rigorous research shows the undeniable value of real-time monitoring and reporting enabled by mobile health solutions.
The instrumental role of healthcare professionals
The growing evidence around the effectiveness and impact of mobile health is, however, not enough for its success; healthcare providers’ adoption is key in making mobile health solutions a standard of care in healthcare when it makes sense.
Notably, healthcare professionals have a tendency to be late in adopting new technologies in general; this could be due to their critical nature and their professional concern about any risk or uncertainty that could be related to novel technologies, which pushes them to adopt such solutions relatively late when they have proven to be more mature and safe to use3.
Another noteworthy observation in the specific case of mobile health solutions compared to other healthcare technologies is that they are mostly patient-centered and patient-driven.
A survey conducted by MedPanel about the crucial role that healthcare professionals can play in the success of mobile health solutions points that physicians can play a much more effective role in such tools’ adoption if they are involved more actively. “As long as tech companies view wearables and apps as consumer-driven markets, these products will remain a fad,” says MedPanel President Jason LaBonte, “But if they engage physicians to recommend these products, wearables and apps will be viewed as part of healthcare and become permanent fixtures.” This shows the critical role that Healthcare Professionals (HCPs) can play and the importance of involving renowned physicians and scientists in the development as well as the endorsement of the apps in order to make them a success.
Factors impacting HCP adoption
Knowing that a successful integration of mobile health solutions in the healthcare system is largely relying on HCPs and whether they would choose to adopt such solutions, many researchers investigated the topic, including systematic reviews that analyzed and condensed much of what has been published about the topic, for example the work by Gagnon et al 4. These studies showed that there are emerging themes pointing to the main factors impacting the decision of healthcare professionals when they are considering whether or not to integrate a mobile health solution into their daily practice.
The usefulness and ease of use of the mobile health solution in question, as well as its impact on clinical outcomes, are the top factors mentioned by healthcare practitioners when asked about elements impacting their decision to adopt an mHealth solution.
Legal compliance issues, such as privacy and security matters, are generally perceived as a major barrier to adoption as the use of mobile health tools could generate risks to patients’ data privacy.
Training and access to support came up in various discussions, with HCPs stating that the availability of training material and easy access to support are key, and many mentioned that they stopped using some mHealth solutions due to the lack of these elements.
Interoperability and system reliability also emerged repeatedly, and mHealth is still sometimes perceived as an additional workload when it is not integrated with other technologies used such as Electronic Health Records (EHRs).
Other factors such as cost issues are still perceived as a barrier, especially in the absence of a clear reimbursement scheme for such solutions. On the other hand, HCPs confirmed that mHealth undoubtedly empowers patients and positively impacts their relationship with them.
Ensuring a successful adoption and integration of mHealth in healthcare practice requires app developers and providers to take into account the different factors impacting this adoption, and the fact that these factors go far beyond technology and the app itself to include other important social factors such as training, support and legal compliance aspects. These are elements that should not be underestimated.
References:
1. Denis F, Lethrosne C, Pourel N, et al. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst. 2017;109(9). doi:10.1093/jnci/djx029.
2. Chan Y-FY, Wang P, Rogers L, et al. The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit. Nat Biotechnol. 2017;35(4):354-362. doi:10.1038/nbt.3826.
3. Wu I-L, Li J-Y, Fu C-Y. The adoption of mobile healthcare by hospital’s professionals: An integrative perspective. Decision Support Systems. 2011;51(3):587-596. doi:10.1016/j.dss.2011.03.003.
4. Gagnon M-P, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc. 2016;23(1):212-220. doi:10.1093/jamia/ocv052.