High times: the promise and reality of health apps
The mHealth party bus has pulled out of the station with overinflated tires and a standing-room only crowd of Baby Boomers, investors and techies waving from the windows and singing along to the Grateful Dead.
As healthcare industry seeks to reduce costs, mobile health apps — which monitor our health with the admirable goal of preventing medical crises, hospital readmissions or unmanaged disease states — are becoming more prevalent. Some 40,000 health-related mobile apps have flooded the market and found a very welcoming audience among older Americans and their caregivers, as well as patients with chronic conditions. According to the Association of American Medical Colleges, at least one research firm estimated 44 million downloads of health care apps in 2012 — a figure that’s projected to rise to 142 million by 2016. Small wonder, then, that Mobile Health Market News reported venture capital firms invested more than $900 million in mHealth last year.
Nothing puts the starch in one’s shorts like a clinical trial. Two recent studies from prestigious journals have called into question the effectiveness of mobile health apps.
In January, Scientific American reported on early trials using mobile technology, such as text messaging and downloadable apps, to manage a disease or adopt healthier behaviors, concluding that health apps lack rigor and show mixed results. Of the 75 clinical trials in which patients used technology to change health behaviors, only three showed reliable positive results: text messages help smokers quit, improve diabetes control and boost adherence to antiretroviral therapy. Mobile interventions, with a few small exceptions, did not help with the vast majority of issues, such as disease management, diet, exercise, psychological intervention, reduced alcohol consumption, safer sexual behavior or weight loss. Here’s the full article on the PLoS clinical trials.
Similarly, the Journal of the American Medical Informatics Association found we tend to crash after the initial high of intervention. In a year-long trial to evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes, researchers compared the progress of patients receiving usual care with those who received an extensive online intervention, including such features as texts, videos, nutrition and exercise logs, and uploaded glucometer readings with graphical feedback. The online intervention group showed significant improvement in reducing A1C levels by six months, but those results were not sustained after 12 months. In other words, it was a wash.
No Escape from The Man
Despite the promise of medical app makeovers, there are some solid reasons why they fail to deliver, starting with our own unrealistic expectations. For example, I want to get more sleep. I’ve tried Ambien, Benedryl, ZzzQuil and Jack Daniels. Short of finding a tool that produces a hammer at 11 o’clock and knocks me over the head, I will probably have to make some serious, long-term behavioral changes. And that’s no fun.
Most of these apps collect data, which is not the same as analyzing it and then coming up with a game plan to fix the problem. Seeing on a graph how many times I wake up during the night is not going to help me sleep. It’s going to make it worse. Besides, most of us are well aware of our issues. What we need are solutions. I can already tell you that I am awake at 1:30, 3:30 and 5:30. What else have you got?
Reducing readmissions and trips to the doctor are not the same as doing without clinicians. What’s missing from many apps is a clinician’s input and direction not only in the design of the technology but also in the interpretation of data.
And who better to lead the way than the company that transformed the way we search for medical information?
WebMD and its physician-facing company, Medscape, recently partnered with Qualcomm Life to create tools and apps that will collect data from the health devices that connect to Qualcomm Life’s 2net platform. WebMD’s VP and CTO Bill Spence said it will package wireless health services under its brand, interpret data and enable physician recommendations or prescriptions of mobile apps and wireless health devices, layering in additional insights and actionable information alongside data.
Viva Las Vegas
Sick happens. But the longer we can stay out of doctors’ offices and hospitals, the longer we get to keep our homes and retirement savings. Healthcare apps can help us on that path as a low-cost intervention that is highly customizable and engaging, but it has to have the right clinical workflow to make a connection, to empower change.
In the meantime, the mHealth party bus passengers have descended on The Flamingo, lured by a swell of bells and buzzers, flashing lights and the heaving bosom of longevity. They drop their coins into the slots and wait for the big payoff.