How Mobile Devices Reshape Patient Care

Will a glorified pedometer change the way America does healthcare? And what is "mHealth," anyway? Five experts speak.

"There's a focus on health data, but so much is dependent on a lot of other factors," Greenspun said. "It's where you go, what you buy, and who you hang out with. Mobile allows you to collect that type of information."

This is valuable in mental health patients, for example.

"Patterns that develop can be real signs of changes in mental health status," Greenspun said. "As patients get more depressed, the geodynamics of where they go shrink. They post less on Facebook. They talk less on the phone. There are interesting things you can pull from people's device usage that can be leading indicators of other issues."

The biggest question about mHealth is what to do with all the data providers now have access to. There are devices to track everything from patients' heartbeats to bowel movements, but not all of those data points are important. In fact, most of them aren't.

"The data that's available isn't necessarily valuable in and of itself," Greenspun said. "There needs to be analytics applied to look at the patterns. Right now there's little ability to see how one piece of information correlates and impacts another."

Making the data actionable will be the next win for mHealth and will help its adoption by physicians.

"There's a universal acceptance that the data has a value to be collected," Ackerman said. "Where it's put and how it's visualized and acted upon by providers is a different matter."

There's also the issue of standardization. For example, Fitbit and Nike Fuel both track activity level, but measure it in different ways.

"Those differences matter," Ackerman said. "It's too early to know exactly how it can be leveraged, but the desire to collect it is there."

Another kink to work out is the business model, which is complicated because of the way the entire healthcare system works in America.

"The facts are that mHealth works really well," Valencia said. "The reality is that today it's still like any other industry. It's messy and there's a lot we still have to figure out."

Figuring out how to get mobile apps and technologies to market in a reasonable amount of time will be a big piece to the mHealth puzzle. Right now it can take five to 10 years for mobile technologies or apps to hit the market, depending on the circumstances, said Shivani Goyal, a PhD candidate in biomedical engineering at the University of Toronto. Goyal helped develop an app at the Center for Global eHealth Innovation in Toronto.

"The question is if this model of clinical trial is an appropriate one," she said. "Clinical trials are typically developed for pharmaceuticals, not mHealth apps. It takes so long to conduct the studies that, by the time the results are there, the technology has already moved on."

An alternative could be creating a retrospective cohort study. This would also help generalize the results because participants wouldn't be actively watched, Goyal said.

Mobile health's bottom line is engagement.

"It's easy to engage people where they are, and they're on their phones," Ackerman said. "That's why everyone's chasing this space."

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)

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