The Executive Suite: Use apps to improve patient outcomes

As the technological landscape evolves, so does the world of health care. Using smartphone apps, doctors can utilize technology to improve their understanding of their patients’ health.

While there are myriad apps available in digital storefronts hosted by Apple, Google and Amazon, it can be difficult to choose an effective app that also keeps patient health data safe.

The intelligence of smartphones in the exam room

Bradley Crotty, M.D., MPH, chief digital engagement officer and internist at Froedtert & Medical College of Wisconsin, sees the use of medical apps as a step along the road to making health care less of a transactional relationship between patient and physician.

“People come into the doctor’s office maybe two times a year, maybe four times a year, but most of the time they are managing their medical conditions along with their lives at home with their family,” he says. “They are left to take that 15 minutes or 30 minutes of time with a doctor and put together a plan, and then follow through with that plan at their home, at work or on the job.”

While these plans often consist of taking medication, they also may include changes in behaviors or routines that are more difficult for patients to engage with when they are not under their physician’s supervision.

Crotty says that smartphone medical apps and other digital tools can be a way for physicians to further patients’ health goals outside of the exam room by addressing behavior such as diet changes and exercise.

Choosing the right app

According to a 2016 study in Health Affairs, there were 165,000 mobile health apps available in Apple and Google digital storefronts. In the four years since that study was conducted, that number has only grown. According to IQVIA, over 200 health apps are added each day.

With a seemingly endless supply of possibilities to choose from, choosing one for patients can be daunting.

Crotty says that when creating a framework for deciding which apps to fold into a practice, keep in mind what goals there are for the app. Some apps are aimed solely at the patient, while some share information directly with the physician without the patient’s involvement. Complicating matters more, Crotty says some apps are a hybrid of the two.

It is also wise to assess whether any research has been done on the app, as many have not been approved by the U.S. Food and Drug Administration, according to Crotty.

The Health Affairs study suggests that clinicians and patients be included in the process of reviewing which apps to use. It found weak correlations between the consumer rating available on digital storefronts, their usability and their clinical utility.

Natasha Fuksina, M.D., practices internal and obesity medicine in Newark, New Jersey. She says that an often-overlooked aspect of choosing an app for patients to use is whether it is compatible with the practice’s EHR system.

An app may be perfect for a patient\. “But how will that actually be implemented and integrated into the EHR?” she asks.

Another facet in deciding which apps is right for patients is cost. Apps that modify behavior and keep the patient in closer contact with their physician can ultimately save health care costs for both the patients and insurers, Crotty says.

Crotty believes that as these apps become more commonly used in a care setting, contracts with insurers likely will be negotiated to make the apps more economically viable as part of value-based care.

Apps may come with initial purchase costs or in-app-purchases, which can be a burden for patients, so that cost should also be taken into account when choosing which app patients should use.

Another facet addressed in the Health Affairs study is the apps’ crisis management. The authors found that the majority of apps they studied at the time were not equipped to properly deal with a situation where the data patients input indicate a health crisis.

Any app that tracks vital health information should be equipped with the ability to alert the doctor if a catastrophic health event is detected.

Privacy concerns

While these apps have many positive aspects, including improved accountability and ease of use, one of the biggest concerns regarding their use in the health care setting is the question of privacy.

The Health Affairs study found that many of the apps reviewed were using unsecure data transfer methods, such as email and text messages, to pass information between the patient and physician.

Crotty says this is an issue that must be addressed as these apps become more prevalent in the health care space. He also is concerned about the lack of transparency by app developers who are known to sell user data.

He says that doctors should have a discussion with their patients, similar to an informal informed consent, about using these apps. Some of the questions that should be addressed include:

What are the expectations for apps?If data are being transferred and reviewed, what are the expectations?
How are the data being stored and how long are the data being kept?
Where are the data being kept?

This conversation may be a patient’s best opportunity to receive direct answers to these questions, Crotty says.

Getting patients to use them

Fuksina finds it quite easy to get her patients to engage with apps due to the prevalence of similar technology in the market.

“Many people now own an [Apple Watch] or Fitbit are able to use their phones to download simple apps,” she says. “And even though we do not have, right now, an app [that] integrates with our particular EHR to be able to scale it … it can ensure some patients’ responsibility and improve [adherence] and, in a way, help them be accountable for their own health goals. I’ve been able to inspire and teach them myself on several apps that I believe are very helpful.”

Crotty says to ask all patients what they are doing on their smartphones. It’s likely that they are already using their phones to search for health information on Google. Once that is known, a physician can look for opportunities to build on the what the patients are already using. To encourage patients to take full advantage of these apps, it’s important to get their families involved in keeping the patient accountable. “The patient and family are the least-utilized resource on a health care team,” Crotty says.