Clinicians’ Role in the Adoption of mHealth and Its Implications for Organizational Practices

This original research paper was published in the Journal of Medical Internet Research (JMIR) mHealth and uHealth; the full text can be accessed in this link

Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians’ adoption is the most influential factor in such solutions’ success.

Objective: The aim of this study was to focus on understanding clinicians’ roles in the adoption of an oncology decision support app, the factors impacting this adoption, and its implications for organizational and social practices.

Methods: A qualitative case study of a decision support app in oncology, called ONCOassist, was conducted. The data were collected through 17 in-depth interviews with clinicians and nurses in the United Kingdom, Ireland, France, Italy, Spain, and Portugal.

Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, its implications for the organization of work, and clinicians’ role in its constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption decision; however, other social factors such as endorsement, neutrality of the content, attitude toward technology, existing workload, and internal organizational politics are also reported as key determinants of clinicians’ adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages, whereas higher efficiency and performance, sharpened practice, and location flexibility are the main workflow advantages.

Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies and the creation of new digital roles for clinicians both on the hospitals or clinics and on the development sides but also more collaboration between health care organizations and digital health providers to enable electronic medical record integration and solving of any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi’s methodological guidance that accounts for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process.

Please cite as:

Jacob C, Sanchez-Vazquez A, Ivory C

Clinicians’ Role in the Adoption of an Oncology Decision Support App in Europe and Its Implications for Organizational Practices: Qualitative Case Study

JMIR Mhealth Uhealth 2019;7(5):e13555

DOI: 10.2196/13555

Would your doctor prescribe a mobile health solution?

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.


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.

Digital Health Solutions From Hype To Impact

This article was originally published on the Huffington Post

In a world where digital and genomic revolutions meet to transform the healthcare sector, digital health is developing at unprecedented speed. Every day, we hear about new solutions holding promises to empower patients, reduce healthcare costs, increase physicians’ efficiency, and improve accessibility, safety, and personalisation.

The use of health apps doubled between 2014 and 2016, jumping from 16% to 33%, with more than 165,000 mobile health apps available to consumers. The use of health wearables doubled as well, growing from 9% in 2014 to 21% in 2016, with consumers and doctors confirming that wearables help patient engagement. Moreover, the use of social media for healthcare has increased from 14% to 21%. Meanwhile, 65% of patients knew more about the data they could access through their electronic health records (EHR) in 2016 compared to 39% in 2014. These are just a few examples from one report; there is much more, and the digital health market keeps growing.

Despite the buzz around the possibilities that digital health presents, the clinical proof supporting its effectiveness is still rather scarce. For example, a report from IMS Institute for Healthcare Informatics finds that even though the number and adoption of mHealth apps are increasing, over 50% of those apps still have limited functionality. Also, while healthcare providers are interested in using such apps to improve patient engagement and care delivery, adoption is limited due to barriers like a shortage of scientific evidence, limited integration in the healthcare system, and a lack of clarity around regulatory and privacy issues.

Hype or hope?

The barriers slowing the adoption of digital health show it has a long way to go both in technology and how it fits into the healthcare ecosystem. This caused some wide-ranging criticism, such as when the American Medical Association CEO, Dr. James Madara, called digital health “the digital snake oil of the early 21st century“.

Published research indicated that seniors are less likely to use digital health tools, despite being one group that needs it the most. The researchers suggested that the reason isn’t a lack of willingness to use it from the seniors’ side, but rather a lack of user-friendliness of the tools themselves.

Another study implied that low-income households are less likely to benefit from digital health. Considering 70% of the participants had low health literacy, they had difficulties with manual data entry and could not easily retrieve data from the apps. Based on those findings, the researchers’ recommendation was to design apps with larger buttons, simpler interfaces, and add function explanations to help users understand the purpose of each task, for example, explaining to diabetic patients why it is beneficial to keep a diary of their meals. Simple and intuitive recommendations that are still overlooked in some health apps, leading in many cases to poor adoption rates.

These studies are rightfully raising concerns about Digital Health and its ability to improve healthcare, while there are many other studies that show the value of digital health solutions and how they can positively affect healthcare. Could it be that the real question to ask is not whether digital health is effective, but what are the factors that make a specific digital health solution effective?


A promising potential

Considering more digital health solutions, we can find examples of inspiring success stories. A remarkable case of medication adherence app involved coronary heart disease patients with a mean age of 73.8, an age group that, according to other studies, is less likely to benefit from digital health. The study concluded that nearly all patients favoured the app over the pen and paper journal, and wanted to continue using it. The key to success, per the researchers, is that they focused not only on developing a winning app, but rather went beyond technology and made sure that an investigator personally coached each patient on how to use the tablet and the app. As they explained, “Although this requires initial offline training, it can reduce complications and clinical overload because of non-adherence.”

A study evaluating the efficacy of using digital health for diabetes management in India – known as a lower-middle income economy – revealed that it significantly improved patients’ quality of life and their knowledge about Diabetes. The study recognised a great potential in using digital health for reaching people in remote areas.

A Mayo clinic meta-analysis found that digital health solutions reduced relative risk of cardiovascular disease by 40%, which is a better result than what one could get with statins, aspirin, or anti-hypertension drugs alone.


Going beyond technology

Evidently, not all digital health solutions perform the same, but the failure of some cannot deny the valuable impact of others.

The real value of digital health goes beyond technology and embraces the user engagement processes, without which even the most brilliant solution would not deliver its promises. It’s important to develop workflows that ensure a seamless integration of such solutions into patients and practitioners’ daily routines, while fitting in the healthcare ecosystem as a whole.

One thing is clear: digital health presents a real opportunity to improve healthcare if done properly, balancing technological and sociological aspects to reach effectiveness.