500 Million People to Use Mobile Health Apps by 2015

mHealth Apps Are Hot!

At the recent mHealth Summit (Mobile Health Summit) held last month in Washington, a research report was delivered, indicating that the mobile health application market is about to explode.  It predicts that by the year 2015, 500 million people will be using mobile health applications through their smartphones.

There are currently 17,000 mobile health applications available in the major app stores.  There's an app that will broadcast your heart rate over Twitter.  There are apps that will allow doctors to monitor patients remotely and then advise specialists and nurses regarding treatment.  There are stress test apps, vision and hearing test apps.  WebMD Mobile is now a very popular symptom checker app.  The list is endless as the race is on to get a piece of the anticipated explosion of mHealth market.

Interestingly enough, of the estimated 17,000 mobile applications now available, only 43% are designed for health professionals.  Indeed, many of these are free feature add-ons for enterprise systems.

The real sleeper in the area of mHealth apps are those developed for the patient (aka "the consumer").  

Creation Healthcare reports that "some of the most popular mHealth applications are those that enhance users’ lifestyle, especially when living with disease".  As an example, in a search for the term "diabetes", iPhone's App Store returns 186 possible apps.  The consumer has a voracious appetite for tools that will help in managing disease and chronic conditions, managing diet and nutrition, fitness monitoring, calculating health risk, and so much more.

RSRS understands the appetite the consumer has for information and tools concerning their healthcare.  We are seeing a dramatic increase in patients authorizing the release of copies of their medical records - to themselves.  Moreover, they're telling us that more and more, they are requesting copies of their current lab results, ECGs, x-ray and MRI reports for their own records.  They realize that these are the critical starting points in healthcare management and they want access - for themselves.  As a result, we're transferring these records digitally with encryption, often on mini CDs or secure download, allowing patients to carry their information with them.  We're seeing that patients don't even need to understand everything in the record.  They realize that "access" is more than half the battle - especially at a time when most of the 1st generation EMR's are not integrating patient access in any significant way.

The mHealth app market is here to stay.  The vendors who approach the market strategically, and consider not only healthcare delivery, but consumer experience and access as well, are likely to be more successful.  Creation Healthcare is also seeing an increase in consumer-based mHealth development projects and points out that "tools such as location-based services, touch-screen interfaces, voice controls, and HD video all have the potential to help you achieve your goals in new ways".  However, they also warn that an informed strategy development with a focus on the goals, rather than on the mode of delivery, is critical.

The Bridge to EMR... Document Management

Each week in my work, I either meet or speak with physicians who are just starting to warm up to the idea of electronic medical records.  They're feeling the push from the folks at OntarioMD and Infoway Canada , or they're watching some of their "forward-thinking" colleagues take the leap.  Or perhaps, like so many, they're simply up to the gills in paper and realize that they either have to consider a bigger space to accommodate the accumulated boxes of inactive records they must still retain, or start thinking about the bigger picture of how the records are managed.

Technology has a way of eventually breaking down your front door if you wait too long to graciously invite it in.  It eventually starts to feel like being the only one at the dance without a date.

In the meantime, the latest statistics in Canada indicate that the uptake to EMR is still slower and far lower than expected.   

Unquestionably, the leap to EMR from a paper-based practice is a quantum one. 

But there is an interim step out there that is often overlooked.  This bridge to EMR, not only rids the physician practice of all new paper, it also affords the physician some additional time to better weigh the EMR options out there.  The bridge is called Document Management.

A Document Management System might be
the perfect bridge and interim step to EMR.

In its simplest form, a Document Management System (DMS) is a software application which tracks, stores and allows for immediate retrieval of electronic documents or images.  It is not specific to medical offices, but lends itself beautifully to one.

In the case of a medical practice, the DMS will store each patient record digitally and allow for instantaneous retrieval of that record through its search capabilities.  Once retrieved, the record is similar to the paper record in that you can flip through the record one page at a time by using the arrow button or "next page" button, just as you would use your finger to flip through a paper record.  Any paper coming into the office, be it through fax, mail or even handwritten notes, can be scanned in to the DMS at the end of the day, with each new page appended to the top of the existing digital record for that patient.  Plain and simple.

Document Management Systems vary greatly and usually offer additional functionality such as: annotation tools (highlight, circle, redact, etc.), ability to zoom in and out, rotate an image, print, share, etc.  When set up for it, the DMS can be accessed via any secure internet connection (ie. the home, or hospital).  It can be fully secured, and there's an audit log showing the date and time and username for each activity that takes place within the record.

Compared to its big brother EMR system, the DMS is inexpensive (imagine a $1400 one-time fee per concurrent user license).  It gets rid of all paper going forward.  It prepares everyone for a paperless office environment.  It buys you time to figure out which EMR system is really right for you, while letting the EMR market mature a little more.  And when you do finally make the move to EMR, it will not be quantum leap, but rather a small footstep.

For a solid DMS with a great track record in the medical sector, RSRS recommends Digitech's PaperVision Enterprise, which can accommodate small to very robust requirements.   Here are case studies where PaperVision was implemented in a Single Physician Practice, A Large Clinic, and a Hospital.

EMR is not the only way to do away with paper in a medical environment.  DMS is a very viable option, both as an interim step to EMR and even, dare I say, as an alternative to it.

The EMR Challenge... Collaboration!




Collaboration is key to successful EMR adoption

 I note the words of Richard Alvarez, president and CEO of Canada Health Infoway in today's Globe and Mail newspaper.

When asked why there wasn't faster uptake of Electronic Medical Records by Canadians, Mr. Alvarez replied:  “I would say it's not technology or money that's lacking but a culture of collaboration. Once you have that – ... anything is possible.”

That got me thinking...  He may be on to something there.  While I've always assumed that similar to when any new technology is introduced, the Technology Adoption Curve  applies.  There are going to be the "Early Adopters" followed by the "Early Majority", "Late Majority", and then, "The Laggards" (also referred to by some as "The Skeptics".  And it would appear by the statistics of late, that we're well into the Early Majority stage in Canada.  And the pace of moving from one stage to the next with respect to EMR is not totally unexpected, to me anyway.  We are, after all, a pretty conservative country, and we do like to think a little longer before making wide-sweeping changes.



However, I believe that Mr. Alvarez is really on to something when he suggests that a "culture of collaboration" is missing.




The Technology Adoption Curve & EMR



As a company that works to facilitate medical record storage for retiring, relocating and deceased physicians, RSRS also facilitates the transfer or medical records to the patients and/or to a new doctor.  It never ceases to amaze me how many doctors are still a little reluctant to relinquish copies of the records, to their patients, let alone to new doctors.  There seems to be a tendency to want to safeguard the information, and release it only as an edited summary.  The reason given is often something along the lines of:  "They don't need to see this or that..".  It's only when these physicians are reminded that the patient has a legal right to view the entire record, and in fact, is the legal owner of the information (not the paper though), that the physician reluctantly agrees.



Is it a fear of possible misdiagnosis?  Omission?  Wrong protocol?  I'm not really sure, and admittedly this issue comes up less with the younger doctors who have understood from day one that the records they keep are subject to inspection by a multitude of other authorized parties, not the least of which is their accrediting College of Physicians.

Collaboration is a necessity - certainly when it comes to health.  Physicians learn from other physicians.  They also learn from their patients, who are in the best position to communicate historical issues not immediately available in their medical records.  The patient really needs to have full access to their healthcare picture.  They don't need to understand it all, but they do need to be able to access it, and any good EMR system should have this accommodated.

I believe that the faster that the new breed of EMR's facilitate a safe environment of collaboration for both physician and patient alike, the sooner we move well into the "Late Majority" adoption phase for EMR's.