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Live from iHT2-San Francisco: What Are the True Barriers to Optimal Healthcare Mobile App Use?

April 5, 2016
by Mark Hagland
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Industry experts share a broad range of perspectives on the impact and opportunities around mobile health apps

A lively and incisive conversation about the introduction of consumer-facing mobile health apps dominated the first panel discussion on Monday morning at the Health IT Summit in San Francisco, being held at the Park Central Hotel here, and sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics, under the Vendome Group LLC corporate umbrella).

Shadaab Kanwal, executive director, corporate services and digital technologies, at the Oakland-based Kaiser Permanente, led the panel discussion, titled “Mobility & Medicine.” He was joined by David Kagan, M.D., a practicing primary care physician and the co-founder and CMO of Circle Medical; Tim Needham, executive director, healthcare solutions delivery practice, for Burwood Group Inc.; and Spencer Hamons, the regional chief information officer for the western U.S., at NetApp Healthcare.

Near to the start of the discussion, Kanwal asked the audience if anyone had a statistic on how many mobile apps related to healthcare are in use now? Jukka Valkonen, R.N., P.H.N., director of health innovations strategies and solutions at Blue Shield of California Health Innovations and Technologies, and a speaker at the conference, answered that there are 170,000 mobile health apps now in use.

“A lot of the focus has been on health and fitness,” Kanwal said, regarding the consumer-facing apps that make up the vast bulk of the mobile health apps currently in use. “But now, those apps are starting to turn into workflows for our physician community. And when they become disruptive, and sometimes, physicians start creating those workflows. How do physicians cope with that?” he asked his fellow panelists. “And how are providers consuming those healthcare applications?”

“I had no idea about 170,000,” Dr. Kagan replied. “I use three to five. My patients use apps that help keep them motivated,” he reported. “MyFitnessPal is an example. And I can talk with my patients about what they’re actually eating. The data itself isn’t necessarily helpful on a static basis, but when I talk with them about what they’re doing and their activity level, it keeps them motivated.”

(l. to r.) panel: Kanwal, Hamons, Needham, Kagan

“Spencer, you have the opportunity to speak to CIOs,” Kanwal said. “How many things have been put in place?”

“From the CIO’s perspective, patient engagement is an important aspect, but not the most important,” Hamons replied. “I would much rather see us have 1,000 clinical projects that have IT components than 1,000 IT projects with clinical components. Over time, we can make the technology more meaningful.”

Needham noted that a number of patient care organizations are doing self-development around some mobile apps. “Providence [Health] is a good example” of that, he said. “There’s a lot of developer talent in Seattle, and they’re bringing it forward” in this area. Still, he conceded, the U.S. healthcare industry is early in its journey in this area of activity.

“Can you enlighten us on the apps that you’re using in your medical practice, David?’ Kanwal asked. “Are they outside your regular workflow?”

“I don’t think they’re disruptive, I think they’re helpful,” Kagan said. “What I would like to figure out, though, is how I can get the data from these apps in real time. If patients bring us information about their weight loss, etc.—‘I notice that you haven’t been exercising,’ ‘Your diet is off,’ etc., I’d like the technology to talk to us, rather than having to have the patient bring it to us.”

“There are close to 500 million smartphone users worldwide,” Kanwal noted, contexting mobility in a global framework. “And in the intervening years, we think the use of healthcare applications will increase, and probably more than 3.4 billion smartphone users will use an app in some way. So when I go in to see my physician and show him my watch, he says, that’s good! But it’s not part of my EMR. Everybody has a different device. I have both Apple and Android. How is this BYOD aspect affecting workflow? Do you think we’ll see ‘bring your own applications,’ also? Will the group of apps narrow down?”

“I think this is one of those areas where we’ll see an evolution,” Hamons said. “Meaningful use has actually stifled innovation, because everyone had to focus getting to a baseline” of implementation of clinical information systems, he contended. “As meaningful use wraps up, we’ll see more innovation, with an emphasis on integration. And I think we’ll see an evolution… with everything coming forward in a meaningful way.”

“I was visiting a 15-hospital health system very recently,” Needham said, “and the CIO said, ‘I know my physicians are going to have to care for twice as many patients as before, but with no time in their way.’ So any patient-provided data has to at least come into a dashboard of some kind. And not every type of data has to come into an EMR. In the next 12-18 months, we’ll see some significant innovations,” he predicted. “But in terms of more granular patient data getting into the EMR, we’re still somewhat at the mercy of interoperability. So I think I would focus attention on creating dashboards that can [ingest] patient-provided data.”

An audience member told the panel, “I’m very interested in the idea that there needs to be a physician dashboard, but I don’t see that happening. I see a lot of end-user dashboards. But not physician dashboards. Is that happening?” she asked.