mHealth: Boon or Bane?

What happens to the traveler in a different time zone who needs to communicate with his physician? In the past, it would have been a huge problem trying to deal with morning in one part of the world and evening in the other. Now, we can send our doctor a text or e-mail, and she can respond when the opportunity arises, whether she is at home or in the office. And with modern technology at everyone's fingertips, not only can we quickly communicate with our doctors, they also can access a wealth of medical information, including our medical records. It is a terrific use of technology for everyone. And it is the future.

But all is not sweetness and light. What are the factors that need to be considered when using mHealth devices?

A Growing Force

First, let's define what we mean by mHealth. It is the use of mobile devices such as smart phones and tablets, like the iPad, that enable the transmission of patient information by health care providers at the point of care. Lewis, Nicole, “Mobile Health to Transform Healthcare Delivery,” Information Week, April 7, 2011, www.informationweek.com/news/healthcare/mobile-wireless/229401173.

mHealth is the future of health care communication. Surveys can barely keep up with physicians' use of mobile technologies. With Apple products seemingly the frontrunner, one study found that a full 75% of physicians owned an iPad, iPhone or iPod. Other studies have found that 81% of physicians are using smart phones and 30% are using the iPad tablet (with another 28% expecting to buy one within six months). The general public's use of these technologies is growing too, with 36% of consumers now using smart phones with apps and e-mail at their fingertips. Fewer ' only 5% ' use tablets, but that number has almost doubled in the past year and will surely continue to grow. Whitney, Lance, “Nielsen:
Tablets Are Hot, But Few Actually Own One,” cnet, May 20, 2011, http://news.cnet.com/nielsen-tablets-arehot-but-few-actually-own-one/8301-17938_105-20064626-1.html?tag=mncol;5n.

The market is responding to this interest. The mobile health care market will approach $10 billion in the next five years, according to a report from global management consulting firm Arthur D. Little. “Capturing Value in the mHealth Oasis: An Opportunity for Mobile Network Operators?” Arthur D. Little Consulting, www.adlittle.com/uploads/tx_extthoughtleadership/ADL_mHealth.pdf. The report notes the power mHealth has to transform the health environment from physician-centric to patient-centric and improve quality of care: “mHealth enables critical decision support to be leveraged at the point-of-care, ensuring the accuracy of clinical information and leading to higher quality patient outcomes while reducing medical errors, which are estimated to cost the U.S. $19.5 billion annually.”

Potential and Peril for the Health Care Community

The development of mHealth technologies, paired with the rapid adoption of them by physicians, is like a runaway train ' exciting, yet perilous. The hope and potential of these technologies is their ability to help doctors do their jobs better, enhance communication with patients and make patients happier and healthier. But there are also risks involved, especially as the embrace of these technologies by the medical community outpaces safeguards put in place to protect patient safety and privacy. Providers are exposed to HIPAA violation penalties, and the growing use of mobile devices by the medical community carries a host of new concerns related to malpractice and other lawsuits.

Some of the positive developments in mHealth technologies are:

• With mobile e-mail and texts, technology can increase patient access to physicians.
• Physicians have information at their fingertips. Prime examples of this benefit are applications (apps) that give quick, mobile access to drug information. Epocrates Rx (www.epocrates.com/), for one, lets doctors access up-to-date safety, dosing, and pricing information for over 3,500 brand and generic drugs.
• Some of the most useful apps are teaching tools to help physicians visually explain complicated procedures to patients. Stryker Flipchart (http://www.stryker.com/), for example, was developed for orthopedic surgeons consulting with patients about hip, knee or shoulder replacement. The surgeon can visually walk a patient through these procedures and make marks, notes and other annotations customized for that patient. These visuals can be saved and called up again at later appointments.
• Mobile apps let physicians view scans (like EKG, X-ray, MRI, fetal monitoring) and access medical records to make diagnoses and direct care from wherever they are. Even the FDA has given its first official approval to one example of mobile software for viewing medical images, called Mobile MIM. This is designed for viewing images and making medical diagnoses from MRIs and CT, PET and SPECT scans on several of Apple's mobile devices. Mobile MIM is approved for use only when there is no access to a workstation, but an FDA spokeswoman acknowledged that the agency will have no way of knowing whether doctors use mobile devices all the time for convenience: “We don't know that they won't. The FDA does not regulate the practice of medicine so the physician will have to use their clinical judgment and do what's best to help them treat their patient.” Zajac, Andrew, ” FDA OKs Medical Use of iPhones; Officials Say New Software Is Adequate for Doctors to Make Diagnoses on the Go,” Los Angeles Times, Feb. 5, 2011, http://articles.latimes.com/2011/feb/05/nation/la-na-fda-ipad-20110205.
• Physicians can consult more easily with other doctors and specialists to give better care to patients. Not only can doctors quickly get in touch with colleagues for second opinions and advice, they can access thousands of professionals they've never met who may be specialists in their fields. A new mobile service called Doximity connects medical professionals around the country and even gives them the ability to text or send images to each other over a secure, HIPAA-compliant network. Fear of malpractice exposure may keep some physicians away, but over 7,000 have signed up since its unofficial launch last October. Selyukh, Alina, “Facebook for Doctors; Medical App Gets Venture Capital Support,” Reuters, March 3, 2011.
• Physicians can gauge and tweak their communication skills with patients. For example, an Austin, TX-based malpractice insurance provider, Capson, believes it can improve doctor-patient communication and reduce malpractice lawsuits by simply asking patients to complete a satisfaction survey immediately following a visit with their doctor on an in-office tablet device. The program, called CapsonCare, lets physicians address patient dissatisfaction immediately, and potentially ward off escalating discontent that could result in a lawsuit. Id.
• Mobile devices aid in medical record-keeping, which can be used to defend against malpractice claims. Designed for use with the iPad, Nimble is an example of an electronic medical record (EMR) app that includes access to electronic health records, scheduling, charting, prescribing, voice recording and more. To assuage HIPAA violation fears, patient data isn't stored on the device itself, and is instead stored at a data center. “3M Introduces Mobile Physician Charge Capture with Coding Advice,” Healthcare Finance News, May 5, 2011, www.healthcarefinancenews.com/press-release/3m-introduces-mobile-physician-charge-capture-coding-advicelify.
• Patients using digital tools may be more compliant and remember instructions. The marketplace has become flooded with mobile apps aimed at health care consumers. Even insurers are taking advantage of plan members' hunger for digital tools to help manage their own health. Louisville, KY-based insurer Humana took home top honors in the medical category in the first ever Appy Awards for MyHumana, which lets its members complete administrative tasks with mobile devices as well as receive wellness alerts for things like flu shot or mammogram reminders. Versel, Neil, “Interview: Humana Talks Mobile Strategy,” Mobil Health News, May 4, 2011, http://mobihealthnews.com/10850/interview-humana-talks-mobile-strategy/.

Conclusion

Next month we will look at some of the problems mobile technology can create for medical practitioners ' from causing patient privacy breaches to prompting wrong diagnoses ' and at ways of controlling the risks. We will also discuss how attorneys for medical providers can use information contained in mobile devices to help them prepare for litigation.

Linda S. Crawford, a member of this newsletter's Board of Editors, teaches trial advocacy at Harvard Law School. She has been consulting with defendants on research-based effectiveness at deposition and trial since 1985.

What happens to the traveler in a different time zone who needs to communicate with his physician? In the past, it would have been a huge problem trying to deal with morning in one part of the world and evening in the other. Now, we can send our doctor a text or e-mail, and she can respond when the opportunity arises, whether she is at home or in the office. And with modern technology at everyone's fingertips, not only can we quickly communicate with our doctors, they also can access a wealth of medical information, including our medical records. It is a terrific use of technology for everyone. And it is the future.

But all is not sweetness and light. What are the factors that need to be considered when using mHealth devices?

A Growing Force

First, let's define what we mean by mHealth. It is the use of mobile devices such as smart phones and tablets, like the iPad, that enable the transmission of patient information by health care providers at the point of care. Lewis, Nicole, “Mobile Health to Transform Healthcare Delivery,” Information Week, April 7, 2011, www.informationweek.com/news/healthcare/mobile-wireless/229401173.

mHealth is the future of health care communication. Surveys can barely keep up with physicians' use of mobile technologies. With Apple products seemingly the frontrunner, one study found that a full 75% of physicians owned an iPad, iPhone or iPod. Other studies have found that 81% of physicians are using smart phones and 30% are using the iPad tablet (with another 28% expecting to buy one within six months). The general public's use of these technologies is growing too, with 36% of consumers now using smart phones with apps and e-mail at their fingertips. Fewer ' only 5% ' use tablets, but that number has almost doubled in the past year and will surely continue to grow. Whitney, Lance, “Nielsen:
Tablets Are Hot, But Few Actually Own One,” cnet, May 20, 2011, http://news.cnet.com/nielsen-tablets-arehot-but-few-actually-own-one/8301-17938_105-20064626-1.html?tag=mncol;5n.

The market is responding to this interest. The mobile health care market will approach $10 billion in the next five years, according to a report from global management consulting firm Arthur D. Little. “Capturing Value in the mHealth Oasis: An Opportunity for Mobile Network Operators?” Arthur D. Little Consulting, www.adlittle.com/uploads/tx_extthoughtleadership/ADL_mHealth.pdf. The report notes the power mHealth has to transform the health environment from physician-centric to patient-centric and improve quality of care: “mHealth enables critical decision support to be leveraged at the point-of-care, ensuring the accuracy of clinical information and leading to higher quality patient outcomes while reducing medical errors, which are estimated to cost the U.S. $19.5 billion annually.”

Potential and Peril for the Health Care Community

The development of mHealth technologies, paired with the rapid adoption of them by physicians, is like a runaway train ' exciting, yet perilous. The hope and potential of these technologies is their ability to help doctors do their jobs better, enhance communication with patients and make patients happier and healthier. But there are also risks involved, especially as the embrace of these technologies by the medical community outpaces safeguards put in place to protect patient safety and privacy. Providers are exposed to HIPAA violation penalties, and the growing use of mobile devices by the medical community carries a host of new concerns related to malpractice and other lawsuits.

Some of the positive developments in mHealth technologies are:

• With mobile e-mail and texts, technology can increase patient access to physicians.
• Physicians have information at their fingertips. Prime examples of this benefit are applications (apps) that give quick, mobile access to drug information. Epocrates Rx (www.epocrates.com/), for one, lets doctors access up-to-date safety, dosing, and pricing information for over 3,500 brand and generic drugs.
• Some of the most useful apps are teaching tools to help physicians visually explain complicated procedures to patients. Stryker Flipchart (http://www.stryker.com/), for example, was developed for orthopedic surgeons consulting with patients about hip, knee or shoulder replacement. The surgeon can visually walk a patient through these procedures and make marks, notes and other annotations customized for that patient. These visuals can be saved and called up again at later appointments.
• Mobile apps let physicians view scans (like EKG, X-ray, MRI, fetal monitoring) and access medical records to make diagnoses and direct care from wherever they are. Even the FDA has given its first official approval to one example of mobile software for viewing medical images, called Mobile MIM. This is designed for viewing images and making medical diagnoses from MRIs and CT, PET and SPECT scans on several of Apple's mobile devices. Mobile MIM is approved for use only when there is no access to a workstation, but an FDA spokeswoman acknowledged that the agency will have no way of knowing whether doctors use mobile devices all the time for convenience: “We don't know that they won't. The FDA does not regulate the practice of medicine so the physician will have to use their clinical judgment and do what's best to help them treat their patient.” Zajac, Andrew, ” FDA OKs Medical Use of iPhones; Officials Say New Software Is Adequate for Doctors to Make Diagnoses on the Go,” Los Angeles Times, Feb. 5, 2011, http://articles.latimes.com/2011/feb/05/nation/la-na-fda-ipad-20110205.
• Physicians can consult more easily with other doctors and specialists to give better care to patients. Not only can doctors quickly get in touch with colleagues for second opinions and advice, they can access thousands of professionals they've never met who may be specialists in their fields. A new mobile service called Doximity connects medical professionals around the country and even gives them the ability to text or send images to each other over a secure, HIPAA-compliant network. Fear of malpractice exposure may keep some physicians away, but over 7,000 have signed up since its unofficial launch last October. Selyukh, Alina, “Facebook for Doctors; Medical App Gets Venture Capital Support,” Reuters, March 3, 2011.
• Physicians can gauge and tweak their communication skills with patients. For example, an Austin, TX-based malpractice insurance provider, Capson, believes it can improve doctor-patient communication and reduce malpractice lawsuits by simply asking patients to complete a satisfaction survey immediately following a visit with their doctor on an in-office tablet device. The program, called CapsonCare, lets physicians address patient dissatisfaction immediately, and potentially ward off escalating discontent that could result in a lawsuit. Id.
• Mobile devices aid in medical record-keeping, which can be used to defend against malpractice claims. Designed for use with the iPad, Nimble is an example of an electronic medical record (EMR) app that includes access to electronic health records, scheduling, charting, prescribing, voice recording and more. To assuage HIPAA violation fears, patient data isn't stored on the device itself, and is instead stored at a data center. “3M Introduces Mobile Physician Charge Capture with Coding Advice,” Healthcare Finance News, May 5, 2011, www.healthcarefinancenews.com/press-release/3m-introduces-mobile-physician-charge-capture-coding-advicelify.
• Patients using digital tools may be more compliant and remember instructions. The marketplace has become flooded with mobile apps aimed at health care consumers. Even insurers are taking advantage of plan members' hunger for digital tools to help manage their own health. Louisville, KY-based insurer Humana took home top honors in the medical category in the first ever Appy Awards for MyHumana, which lets its members complete administrative tasks with mobile devices as well as receive wellness alerts for things like flu shot or mammogram reminders. Versel, Neil, “Interview: Humana Talks Mobile Strategy,” Mobil Health News, May 4, 2011, http://mobihealthnews.com/10850/interview-humana-talks-mobile-strategy/.

Conclusion

Next month we will look at some of the problems mobile technology can create for medical practitioners ' from causing patient privacy breaches to prompting wrong diagnoses ' and at ways of controlling the risks. We will also discuss how attorneys for medical providers can use information contained in mobile devices to help them prepare for litigation.

Linda S. Crawford, a member of this newsletter's Board of Editors, teaches trial advocacy at Harvard Law School. She has been consulting with defendants on research-based effectiveness at deposition and trial since 1985.