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Clinicians who want to implement and use mobile health care technology to treat chronic conditions and engage patients more deeply are still leaping hurdles to get there.
Mobile health, or mHealth, could have major implications for treatment and patient engagement, said panelists during the mHealth World Congress in Boston in July. The demand for remote interaction with health care providers will continue to grow. The potential benefits of mobile health care in treating patients with chronic diseases include improved doctor-patient communication and higher rates of medication compliance. Additionally, the proposed Stage 2 meaningful use rules require physicians to make electronic copies of records available to their patients. Therefore, it's imperative that health care providers find ways to overcome the hurdles that could stand in the way of using mobile technology, the experts said.
Technology and engagement hurdles to mobile health
Dr. David Judge, medical director of the Ambulatory Practice of the Future primary care clinic at Partners Healthcare System Inc., listed a few of those obstacles. Integrating mobile device platforms into existing systems, engaging physicians in using the technology, and making sure doctors don't get inundated with information from remote monitoring devices are three of the main challenges that threaten to hold back the implementation mHealth practices.
Aside from these concerns, providers also need to figure out ways to engage patients in using mHealth systems. Patients want to interact with their physicians more, and mobile devices can facilitate this, Judge said. But implementing a system that utilizes mobile devices doesn't guarantee engagement. "Patients want to know that they're doing this in partnership with their care team," he said. "That's a powerful thing."
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One way to ensure that patients engage with mobile health care initiatives is to use the technology to give them a greater role in the decision-making process. This can be accomplished in simple ways, said Andy Steele, director of medical informatics at Denver Health and Hospital Authority. For example, his organization operates a text messaging program that supports the treatment of patients with chronic diseases. It sends text message reminders to help patients manage their condition and solicits some information, such as blood sugar readings from diabetics.
This kind of system is relatively easy for patients to participate in, Steele said. It also helps individuals feel they are playing a larger role in their care; that's something patients increasingly are looking for. "People are ready to get the data, but they also want to start having decision-making capabilities," he said. Low-cost text messaging and phone follow-up programs can help patients play a more central role in their own care, he added.
Done this way, patient engagement is not simply a matter of making patients happier. It can lead to improvements in quality of care, as well, Steele pointed out. For example, from a clinical standpoint, he would rather see hemoglobin A1c test scores every three months from diabetic patients than have access to five blood-glucose readings per day from them, he said. Text message reminders to test blood-sugar levels can also incorporate smoking cessation or weight management counseling, however. In this way, physicians can use mobile technology to reach their patients with a chronic disease on a broad spectrum of health issues.
Payment and reimbursement hurdles
Payment reform for mobile health services remains one of the greatest barriers, the mHealth panel agreed. Currently, few payers have policies in place that reimburse physicians for providing follow-up phone calls to patients with chronic diseases or enrolling patients in text messaging programs.
Payment models will have to change in order to establish a larger role for mobile devices in the delivery of care, said Dr. Mohit Koushal, executive vice president of business development and chief strategy officer for the research organization West Wireless Health Institute. This is already happening to some degree, as the growing adoption of accountable care organizations is making it easier for physicians to choose how to care for their patients. With costs continuing to rise, Koushal expects adoption of these systems to continue, which will support growth in the mobile health industry, he said.
"We're all going to be paying more for health care out of our pocket, and I think that's the main trend for patients to be more engaged in their health care," Koushal said. "Now we're seeing a bunch of tools around helping patients navigate cost transparency, helping with chronic disease management. I think that's the way it will continue, and we are going to have more engaged consumers because of that."
Partners Healthcare's Judge has already seen this trend play out, he said. Partners recently launched a primary care program for the employees of self-insured member organizations. Because Partners acts as the payer and provider in this scenario, it is able to determine what types of care to fund, then deliver those services. As this system has developed, the use of mobile tools has grown.
"When you can bend the rules of what you want to pay for, what does care look like, how much becomes virtual or mobile?" Judge said. "Not surprisingly, a lot of it does."
There is plenty of demand for mobile health care services, Denver Health's Steele said. People already can complete many bank transactions from their smartphone and make dinner reservations through mobile applications, he pointed out, and they wonder why they can't interact with their doctors in similar ways. This demand could push providers to solve the hurdles that prevent the widespread adoption of mobile health tools and implement systems.
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