mHealth transforming health care with apps
Whatever dazzling visions science fiction may offer of the widgets of the future, the long, uphill road of technology inevitably leads to the smaller and the simpler. The horse and carriage gave way to the automobile; vacuum tubes gave way to transistors; and computers that took up entire rooms and required intricate climate-control technologies now fit in one’s pocket.
Technologies used in health care have undergone a similar transition, and much of that has happened in the last few years thanks to the spread of mobile technology.
According to published reports, the number of mobile health apps in the Apple Store increased from nearly 3,000 in early 2010 to more than 13,000 in early 2012. But download rates have not kept up with that growth. According to the Pew Internet and American Life Project, which surveyed 2,260 adults in July and August 2011, the percentage of cell phone owners who downloaded apps to their phones increased from 22% in September 2009 to 38% in August 2011. But in September 2010, only 9% of adult cell phone users had an app for helping track or manage their health. At the same time, young and African-American users seem to be bigger users of health apps. Fifteen percent of users ages 18 years to 29 years had health-related apps, compared with 8% of those ages 30 years to 49 years. Meanwhile, 15% of African-American users had them, compared with 11% of Hispanics and 7% of whites. When the question was asked in August 2011 of those who had downloaded an app to a cell phone or tablet, as opposed to all cell phone users, the numbers were much higher, with 29% of respondents reporting that they had downloaded a health-related app.
Increasingly, everything from keeping track of prescriptions and ordering new ones to management of chronic disease states to health information to medication adherence is migrating to consumer’s pockets and purses. In fact, several major developments in the mobile health, or mHealth, app world have happened within the past couple of months.
In September, Chicago-based Leap of Faith Technologies announced that it had received a grant for more than $1 million from the National Institutes of Health to develop its iPhone and Android platform for improving medication adherence. The platform, known as eMedonline, is described as a software-as-service, mobile health platform that would provide opportunities for drug surveillance and research data mining. According to the company, the platform had demonstrated medication adherence levels of 98% and shown “significant” improvements in patient self-efficacy in clinical trials funded by the NIH and private industry.
Apps tailored to patients taking drugs for chronic disease states have seen development as well. The same month that Leap of Faith Technologies made its announcement, Eli Lilly announced the launch of an app to support patients with Type 1 diabetes taking glucagon. The app was described as a mobile tool designed to teach caregivers how to use glucagon, which treats severe hypoglycemia, or low blood sugar, through simulated practice. It also provides information about severe hypoglycemia and Glucagon; visual and audio emergency instructions; tools to keep track of kit locations and alerts for expiration dates; and safety information. “Lilly Diabetes is committed to developing personalized solutions to help people with diabetes achieve their treatment goals and improve their outcomes,” Lilly Diabetes U.S. product brand director for specialty marketing Matt Caffrey said. “The Lilly Glucagon mobile app leverages the power and reach of mobile technology, providing another opportunity to support people living with Type 1 diabetes. Lilly Diabetes is constantly striving to create new and better tools to support the diabetes community in a variety of ways.”
Other apps that appeared in September include health references that provide information about things like drugs and the human body. Mylan released a mobile version of the reference guide to its drugs. The Generic Brand Reference Guide, or GBR, is designed to allow healthcare professionals, patients and pharmacy students to identify branded and generic drugs. The print edition of the GBR had been released as a pocket-sized reference earlier this year. “We are pleased to offer Mylan’s 2012 GBR to healthcare professionals in the United States, including pharmacists, physicians and nurses, and chain and wholesale buyers,” Mylan North America president Tony Mauro said. “The GBR provides a comprehensive and up-to-date list of the generic and brand names for more than 2,000 separate oral and liquid dosage forms, as well as injectable and transdermal products. Mylan is committed to partnering with healthcare providers to optimize their time and together expand access to high-quality medicine.”
The pace of development in mHealth has been enough to prompt calls in Congress for the Food and Drug Administration to step in and regulate it. Last month, Kaiser Health News reported that Rep. Mike Honda, D-Calif., whose district includes Silicon Valley, was preparing to introduce a bill that would set up an Office of Mobile Health within the FDA. The bill, named the Healthcare Innovation and Marketplace Technologies Act, would also call for the writing of a mobile health developer support program at the Department of Health and Human Services and help prevent violations of the Health Insurance Portability and Accountability Act or other privacy regulations by app developers. “Currently, our healthcare system works against small-to-large startup entrepreneurs with a multitude of barriers of entry,” the Kaiser Health News reported Honda as saying. “Why have the principles of Silicon Valley, which I represent — competition, innovation and entrepreneurship — not fully manifested themselves in the healthcare information technology space? This bill gets us closer to that space.”
Research2guidance predicted that the mHealth market could grow to $1.3 billion by the end of this year, from $718 million in 2011.
‘Building the ACO’ revisited
The ink was barely dry when we received this response to our Oct. 15, 2012, cover story, “Building the ACO.”
Thank you for your excellent article, “Building the ACO.” It is clear that U.S. healthcare policy is moving in the direction of accountability and performance. The objective is to spread primary care responsibility across an integrated healthcare team. As you note, ACOs address the goals of improving healthcare access and outcomes while decreasing cost. I fully agree that this approach is in the best interest of individuals and the healthcare system. It is an example of a policy gone right!
We now have a significant body of research — both government and commercial — demonstrating the value and [return on investment] of integrating community pharmacists into key roles on ACO teams. In my view, the role of the pharmacist in the ACO paradigm is pivotal. As the medical professionals with the broadest knowledge of medicines, and often the most accessible, pharmacists are in a unique position to help impact medication adherence. There is widespread agreement that medication adherence is one of the greatest contributing factors to overall healthcare costs in the United States, … ultimately costing more than $290 billion annually — and growing.
The cost story is clear. The Boehringer Ingelheim data that you cite demonstrate that it is one-third less expensive to visit a retail clinic versus a physician’s office and five times as expensive to go to an emergency room versus a retail clinic. According to the [Centers for Disease Control and Prevention], when pharmacists take a central role in helping to manage medication therapy, the ROI ranges between 3:1 and 5:1, and can be as high as 12:1, based on reduced hospital admissions, use of unnecessary or inappropriate medications, emergency room admissions and overall physicians visits. Other data have supported the role of pharmacists in helping to manage other routine services, such as vaccinations, blood pressure monitoring, and risk factor and lifestyle modification counseling.
Despite the well-documented opportunity at hand with community pharmacies, legislation and private-payer reimbursement models are still lagging in fully recognizing and enabling community pharmacists to fulfill their potential on ACO teams. As a pharmacist and the founder and CEO of RxAlly, I am proud that members of our industry are not waiting for policy and reimbursement models, but have been at the front line advancing the practice of pharmacy forward through innovative research and partnerships. It is this model of pharmacists playing a central role in an ACO on which RxAlly was conceived. With more than 22,000 member pharmacies nationwide, RxAlly has brought together the largest national network of pharmacies to improve health and lower costs. The RxAlly Performance Network of community pharmacies aims to improve health through personalized pharmacist care; reliable, evidence-based clinical practices; proprietary research; and an interoperable technology platform, which many — including you — have identified as central to the success of any ACO.
… I appreciate the role of DSN in tracking and reporting on critical trends and hope you and your readers will continue to focus, in particular, on advocating for legislation and reimbursement policies that further our evolution toward effective ACO models that take full advantage of all that pharmacists and community pharmacies have to offer.
Bruce T. Roberts, R.Ph.
Chairman and CEO, RxAlly
More patients ‘get the point’ of flu shots
While there is still plenty of room for improvement, a growing number of patients have either already received or plan to receive a flu shot this year compared to one year ago. According to an online survey of more than 900 AccentHealth viewers conducted in September, 57% of patients have received or plan to receive a flu shot this year, versus 53% in 2011.
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Focusing solely on patients who did not receive a flu shot in 2011, the recent Accent-Health data indicate a net increase of 11 percentage points in the number who will vaccinate this year. While there appears to be a significantly greater propensity to receive a flu vaccination among patients 45 years and older, “the younger audience segment remains an important area of focus and opportunity of market growth due to the sheer size of the audience,” noted AccentHealth VP market research Natalie Hill. Half of adults younger than 40 years reported they will receive the shot this year.
Importantly, the recent AccentHealth study also confirmed that more patients continue to embrace the community pharmacy as a preferred destination for flu vaccinations, with nearly 1-in-4 having received or planning to receive a flu shot in a retail pharmacy setting this year.
Again, there is a still plenty of room for improvement. The glass-half-empty view focuses on the more than 40% of patients who won’t get a flu shot this year; a recent online survey conducted by CVS Caremark suggested this group could be as high as 51%. However, AccentHealth data suggest some areas where community pharmacy may be able to chip away at the resistance. “Those who do not receive the flu shot most often indicate that it is unnecessary and/or due to side effects or the fear of side effects caused by the vaccine,” Hill explained.
Patient Views is a new, exclusive consumer insights feature that appears in every edition of DSN magazine, as well as the daily e-newsletter DSN A.M. If you could ask 4,000 patients anything at all, what would it be? Send your questions to email@example.com.