The Era of mHealth: A Global Perspective
HTA QUARTERLY | SUMMER 2020
The Era of mHealth: A Global Perspective
Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable, and digitally enabled care environments that strategically leverage digital tools, technologies, and services to transform care delivery.
Digital Health Consumer Adoption
An annual survey of 4,000 US adults conducted by Rock Health, a venture fund that invests in digital health companies, and Stanford Center for Digital Health reported that adoption of digital health tools like telemedicine, wearables, and health apps has steadily climbed upwards over the past five years. In 2019, 44% of respondents tracked some aspect of their health digitally, and those who used digital tools shared health tracking information with their physician or other medical professional more frequently than those who used other tracking methods (Figure 1). Additionally, one in three respondents owned a wearable, and one in four wearable owners used it to manage a diagnosis.
Figure. 1. Tracking at Least One Health Metric/Indicator (2017–2019)
Source: RockHealth 2019.
Survey question: Do you currently keep track of any of the following? Responses: Weight, Heart rate, Blood pressure, Medications, Physical activity (steps, exercise, etc), Food/diet, Sleep, Blood sugar, Other
Survey question (asked for each metric that respondents track): How do you currently record the following: Weight, Heart rate, Blood pressure, Medications, Physical activity (steps, exercise, etc), Food/diet, Sleep, Blood sugar, Other? Responses: In a paper journal or log, In your head
Survey question (asked for each metric that respondents track): How do you currently record the following: Weight, Heart rate, Blood pressure, Medications, Physical activity (steps, exercise, etc), Food/diet, Sleep, Blood sugar, Other? Responses: With a wearable, Connective device (eg, smart scale, glucometer), or in an app that doesn’t connect to a wearable, In a digital journal or log
Survey question (if tracking any metric): With whom have you shared or discussed this data in the past year? Responses: Your physician, Another medical professional
Encompassed within the extensive rise of DHTs, mobile health (mHealth) plays an essential role in monitoring and sharing information via mobile technology (eg, mobile apps for diagnostic and treatment support). mHealth allows patients to keep track of their own health data in real time and inform healthcare providers in a single push of a button. With the drastic increase in utilization and integration of mHealth (and the data that can be obtained), the global mHealth market value is expected to surge rapidly (Figure 2).
Moreover, the increase in mHealth provides healthcare professionals and patients with increased access to data which allows all stakeholders (patients, providers, researchers, and pharmaceutical manufacturers) to obtain a more holistic view of patient health. This positions mHealth to enhance treatment pathways and diagnostic capabilities which can ultimately improve health outcomes and lower costs. This article will provide a global perspective of mHealth, describe opportunities to leverage mHealth, and contextualize mobile technology in terms of current health technology assessment (HTA) processes.
Opportunities for mHealth
Electronic Patient-Reported Outcome
Patient-reported outcomes (PROs) have traditionally been collected using paper questionnaires as a systematic way of measuring patients’ subjective views about their own health. In trials, PROs provide additional patient-centric data which are unique in capturing the patient’s own opinion on the impact of their disease, and its treatment, on their life. In our work with clients, we have seen that the increased use and accessibility of mobile devices has created substantial opportunity for mHealth to facilitate advancement in the integration of electronic PROs (ePROs) within clinical trials and electronic health records. Development and incorporation of validated ePROs (via mHealth) will allow all members of the provider team to communicate with patients to optimize care delivery, while collecting a plethora of data in the context of clinical trials.
Increase Medication Adherence
Medication adherence is a critical factor that impacts healthcare outcomes and costs, particularly for chronic conditions. In the US, it is estimated that at least half of the nation’s medication users are not taking their medication as prescribed, resulting in approximately $300 billion a year in avoidable healthcare expenses. mHealth represents a means of enhancing medication adherence, through features such as automated alerts to take medications, tracking doses, and supporting medication instructions. A study of 77 patients with tuberculosis compared adherence via wirelessly observed therapy, using a novel patient self-management system consisting of an edible ingestion sensor, vs directly observed therapy. Findings from this study revealed that wirelessly observed therapy using a mobile device to detect medication ingestion resulted in higher adherence compared to directly observed therapy by clinicians. This is an example of how using mHealth has the opportunity to increase medication adherence. In the future we expect to see mHealth play a vital role across many therapeutic areas as a means to increase medication adherence and allow clinicians to intervene more quickly.
Improve Patient-Provider Communication
Effective patient-provider communication is a key predictor of not only health outcomes, but also healthcare resource utilization and expenditures. According to a study using the Medical Expenditure Panel Survey, optimal patient-provider communication was associated with higher quality of care and cost savings. mHealth provides a platform for patients to stay connected with healthcare providers through secure messaging platforms, online scheduling capabilities, and remote access to personal clinical data. A study conducted at Kaiser Permanente Northern California, an integrated delivery network, assessed patient portal usage for over 165,000 patients with diabetes. The study found that use of mobile patient portals offering these services had led to higher patient engagement and fewer emergency department visits and preventable hospitalizations.
Spotlight on mHealth:
COVID 19 + Microsoft
The power of mHealth has been demonstrated recently by a collaboration between Microsoft and Swedish Health Services to build an app that helps hospital staff monitor resources for COVID-19-related care.
Swedish Health Services, the largest nonprofit health provider in the Seattle area, unveiled the COVID-19 Emergency Response (CERA) app to allow frontline hospital workers to use mobile devices to keep track of COVID-19 patients, protective gear, ventilator use, and other coronavirus-related information. The app syncs with hospital dashboards to help Swedish leaders gauge activity at its five care facilities, two emergency departments, and units in critical areas.
The CERA app has already helped clinicians convert a post-anesthesia room into an additional Intensive Care Unit and more than 400 Swedish clinicians are using the app. This is one example that demonstrates the clear utility of mobile technology and the opportunity to impact healthcare globally.
Kevin Brooks, Chief Operating Officer at Swedish First Hill
“This near real-time view of quickly changing data is empowering Swedish to better prepare for a COVID-19 surge and better manage the needs of our patients and caregivers.”
Payer and HTA Agency Perspectives
Challenges for mHealth
The article should be referenced as follows:
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