When most of us think about mobile devices and apps in healthcare, we tend to think about the ways that doctors and nurses can use tablets or smartphones to improve the care that they provide. One of the first images to come to mind is a doctor checking an electronic health record on an iPad as he enters the exam room, a nurse recording vital signs on a smartphone, or a specialist explaining a procedure or the results of a scan on a tablet in a hospital room -- apps and tools that used by healthcare providers rather than apps used by us. Their patients.
Although healthcare has been undergoing a pretty visible transformation thanks to mobile devices and other provider-facing solutions like electronic health records, the patient or consumer experience of healthcare hasn't really been disrupted by mobile technologies. Most of us still schedule appointments by calling our doctor's office an fill out a paper form when we see a new doctor, and most of the information that we provide to our doctor is done in the exam room and isn't delivered electronically over the Internet.
But the current in-person (or by phone) paradigm of healthcare isn't going to last much longer. Having mastered the core internal technology issues, many doctors, hospitals, and app developers are beginning to turn their eyes towards empowering healthcare consumers with patient-facing apps. Right now, these early adopters of patient-facing technology may be the outliers in the U.S. healthcare market, but that is likely to change -- and to change quickly -- and providers that hang back are likely to find themselves losing patients (and income) faster than they expect.
Convenience and opportunity
Since Apple launched the first mobile app store five years ago, we've downloaded billions of apps. We can pay our bills, research new cars, respond to questions from our bosses, and keep in touch with our friends and families from anywhere at anytime. We integrate new apps for new and longstanding challenges or needs all the time.
We're already using apps for many aspects of our health: Consumer-oriented medical reference apps, health and fitness tracking apps, and apps that connect to consumer health monitoring devices like mobile-enabled blood pressure and glucose monitors, as well as quantified-self solutions like the Fitbit or Nike FuelBand. Many of us are sharing that data with our doctors in one way or another. According to a Manhattan Research survey, 70 percent of doctors have at least one so-called self-tracking patient.
So why haven't we app-ified our medical care? It's not because we're uninterested. It's because most providers don't offer us the tools to do so.
The early adopters and innovators
While the vast majority of doctors, medical groups, and hospitals across the country haven't released patient-facing native or web apps, a few have begun to show the way.
In particular, hospitals, which can be disorienting and even frightening, can use patient-facing apps to help demystify an illness or surgery and the recovery process. Several hospitals have begun to do this with apps that help patients stay connected to their families, check-in with their doctors or other members of their care team, connect with programs for clinical trials, access reference material and hospital services, and use indoor GPS to navigate the often confusing corridors of most hospitals.
Here are some examples of early innovation in this space.
- The Cleveland Clinic offers Android and iOS apps for doctors and patients that helps connect cancer patients with the clinic's clinical cancer trials of new drugs and and other therapies.
- Boston Children's Hospital offers iPhone and Android apps that includes indoor GPS and navigation, lets families management doctor appointments, provides access to lab results and records, a searchable list of doctors and programs, and offers a wealth of information for patients and families including information on hospital food services, parking, support services, and local accommodations.
- Miami Children's Hospital offers an iPhone app with indoor GPS, food service ordering, urgent care wait times, outpatient services and schedules, the option to search for ER and urgent care based on location, and the ability to purchase items from the hospital gift shop.
- The Mayo Clinic offers a comprehensive iOS and Android apps that lets patients schedule appointments, navigation to services and amenities on the Mayo Clinic campus and nearby accommodations and other businesses, access to lab results and records, secure messaging, notifications, and information about the Mayo Clinic and its physicians and services.
- Hello Health offers a web portal and iPhone app for patients that integrates with the company's electronic records and practice management solutions.
- Apps For Doctors is a company that launched in the U.S. and abroad this spring that offers template-driven Android an iOS app development services to doctors, dentists, and other healthcare professionals.
Patient engagement and federal incentives
While market forces will drive a patient-facing app industry, the federal government is also beginning to put pressure on providers to offer mobile apps.
The federal incentive program for electronic records adoption is built around three stages of "meaningful use" -- ways that providers illustrate to the government that they are actively using electronic records and related systems in order to receive incentive payments. The requirements for stage two, which were finalized last year and begin to go into effect in 2014, include an emphasis on patient engagement, meaning providing patients with access to their personal health data like diagnoses, medications, lab results, and so on. Alongside access to their information, providers will be expected to provide secure electronic messaging between patients and their doctors.
The patient engagement requirements for stage two don't have a mobility requirement, and a rather simple web portal could suffice. The challenge, however, is providing evidence that at least some patients are actively using whatever system a provider offers. A mobile app -- or at least a mobile version of a web portal -- is likely to spur use, particularly if it provides helpful and convenient features beyond the absolute basics.
Even without the meaningful use criteria, the Affordable Care Act includes provisions that focus on a quality of care model where doctors and hospitals are encouraged to keep people healthy and to discourage hospital re-admission. Many hospitals have already begun to develop follow-up programs that seek to keep patients who have been discharged healthy and on schedule for doctor visits and tests and to be sure their taking medications properly. A mobile app can be a powerful tool for ensuring medication and treatment compliance.
Today only a handful of doctors, medical groups, or hospitals offer patients a mobile app. Those that do, however, offer a glimpse into the future where we can make appointments, review and even add to our electronic records, and communicate with our doctors and care team from anywhere at anytime -- and once patient-facing apps reach critical mass, doctors and facilities without them will be at a competitive disadvantage.