Apple will be officially launching iOS 8 this autumn, and at the same time it will also launch HealthKit. This new health app will provide Apple smartphone/tablet users with a dashboard of their health and fitness data. They have also created a new API tool for developers which will enable other health and fitness apps to work together. HealthKit has already been integrated with Nike’s running apps and the Mayo Clinic app, which will allow blood pressure to be recorded.

Apple are saying that HealthKit is going to revolutionise the healthcare industry so is this all hype or can mHealth solutions in the shape of mobile apps really help to tackle some of the key problems our healthcare system faces?

New levels of patient engagement, as observed in many studies, are proving that patient outcomes are improved and costs reduced when patients are more involved in their own care.  And the advent and continued development of mobile health apps (mHealth) is responsible for driving that patient engagement.

Studies have shown that on average, people check their phones 150 times a day. Healthcare providers have now realised the potential advantage of this “addiction” to engage with people over health issues.

The birth of mHealth could be attributed in large part to Joseph Kvedar, MD, the director of Partners HealthCare’s Centre for Connected Health in Boston.  Since he first began to launch ‘connected health’ through technology some eighteen years ago, the landscape has changed dramatically. Kvedar started with telemedicine as well as dermatological imaging.  The camera he used at that time had less than 1 megapixel resolution, and was the size of the average shoebox.  It cost twelve thousand dollars. In those early days, videoconferencing capabilities cost fifty thousand dollars. Since then, technological changes have been dramatic, with the number of mobiles in use greater in number than landlines.  Other tools like Skype and Facetime make it possible to videoconference anytime and anywhere.

Kvedar’s centre was also the origin of the moniker ‘connected health’ in 2005. This was in response to the lacklustre enthusiasm that there was to the terms telemedicine and telehealth. The mobile revolution was taking off at that time and now, it seems inconceivable to think of developing any program that does not involve the use of mobile technology.

From that point the rise and rise of mHealth has continued.  It is now one of the most exciting prospects for the management and interaction of patients with health care provision that there has ever been. Along with the concept of meaningful use, another important factor that drives the patient engagement trend is the rise of models of accountable care along with payment restructurings. Under these accountable care models, health providers are responsible for the management of an entire population with payments based on results  (keeping the population well and getting them better) rather than a fee based system based on services provided. This makes providers even more keen to find effective ways of engaging their patients in the management of their own health, in between visits to the surgery

Before rushing headlong into digital patient engagement tools, however it is worth mentioning information inheritance and the way in which most providers still currently engage with patients in their care. This includes printed copies of health records, discharge instructions, simple diagrams or descriptions of exercises, medication timetables, and other instructions.  There is still reliance on phone call reminders follow-up phone calls and one to one conversation with healthcare providers.

So, while some of the expanding tools for digital patient engagement aim to be replacements for traditional channels, most aim to be a complementary or offer augmentation to existing channels of communication and contact.  There is no doubt that mHealth has advanced fast since the iPhone came onto the scene just over 7 years ago.  So, it will be interesting to see what impact Apple’s HealthKit is going to have on the healthcare sector and what health and medical apps we’ll have access to in 7 years from now.

Today, a Green Paper on mobile health (mHealth) will be published by the European Commission. mHealth covers all medical and public health practice that is supported by mobile devices. This document will launch a community discussion process that will continue until 2 July 2014.

Covering all practice supported by mobile devices – including tablets, smartphones, and other wireless devices mHealth also includes wellbeing and lifestyle apps that connect to sensors and other medical devices. This is an important and emergent part of eHealth where Information as well as Communication Technology is used to improve services, processes and health products.

The Commission will be looking at several issues surrounding mHealth:

• Data protection
• Patient safety
• Users trust
• Input to the delivery of healthcare of the highest quality
• The level at which this should be applied e.g. – national, regional, or EU wide.

As well as the Green Paper, European Commission direction will also be given through a Staff Working Document, to those involved in app development. This will analyse existing EU legal frameworks currently applicable that are applicable to wellbeing and to lifestyle apps.

There is no doubt that mHealth can help to tackle some of the challenges that our healthcare structure faces. And according to a report by PWC mHealth could potentially deliver €99 billion in care costs by 2017. It is a fast evolving field with the potential to improve healthcare quality and improve efficiency by offering support to professionals in healthcare and in the area of patient treatment. It will also facilitate continuity of care. Some estimates show that as much as 30% of time spent accessing or analysing information could be saved if medical professionals used mHelath-based technology. Remote monitoring facilities could help many more patients live independently supported by technological monitoring systems. Despite this potential, the uptake of mHealth, at present, remains restricted in EU countries and healthcare authorities may look for more confirming evidence before they are prepared to adopt mHealth more comprehensively.

Some criticisms have been:

• Lack of observance and transparency might make users wary of placing their trust in these apps, which may impact on market development.
• Insufficient knowledge among developers with regard to the legalities applicable to lifestyle and well-being apps.

It is hoped that the Staff Working Document being issued with the Green Paper, will raise awareness amongst app developers of the rules being imposed by the EU surrounding issues of data protection, and will assist them in determining whether the legislation is applicable to their app, or not. It will also issue consumer directives.
Some of the areas of concern have been:

1. How mHealth can be aligned with national health care strategies
2. Technology/Interoperability standards
3. Data protection and security
4. Regulation and compliance keeping pace with development
5. Getting patients and HCP involved earlier during solutions
6. Lack of evidence of economic or clinical benefit – (it is worth noting that before email became widespread Intel surveys showed that most people claimed not to want it.)

The era of mHealth has arrived.

Stage 1
At this first stage consumer friendly products link fitness to general wellbeing as seen with Jawbone/Fitbit.

Stage 2
Apps and mobile connected devices permeate the medical field (we have entered this stage)

Stage 3
Mobile, wearables & data-collection devices mesh together to provide the backbone for optimisation & customisation of preventative health, medical treatment & hospital processes.

This is new and exciting technology and the release of the Green Paper is a step to its validation. In years to come will we wonder, as we do now with email technology, how we ever managed without it?

View the Green Paper

If you’d like to respond to the paper visit the EU website where the paper is published

Take Two Pills Twice a Day – and An App

Without our mobile phones we would be lost, appointments would be missed, and our lives would fall apart.  We rely on smartphones to get us up and get us through the day but are we ready to rely on them for medical advice?  An innovative new app is due to launch later this year, as BlueStar’s prescription only app for smartphone becomes a trailblazer in its field.

Could this potentially be the start of something momentous, and poses the question – just how far away are we from being prescribed apps with our medication?

Do we even want to go down that route?  What are the pitfalls and the benefits?  Is introducing this remoteness and prescription by app to be welcomed or feared?  Will GP’s be comfortable prescribing an app with medication and how will a prescription only app be paid for? Furthermore, what restrictions will be placed on marketers with regards to promoting the app, will it fall under the ABPI code of practice as do prescription only medicines (POMs)? So, are we likely to see the buzzword POA (prescription only apps) being added to the pharma jargon dictionary?

WellDoc – a prescription only app

The Blue Star app can be downloaded to tablet, computer or smartphone in the normal way but will only become interactive with a special prescription code issued by a pharmacy. This is the first healthcare app that needs a doctor’s prescription to work and it is being trialled in a small area of the US where it is already causing quite a stir, as several large US corporations have announced plans to incorporate the app into the health cover that they offer their employees.  The precise cost of the app is not yet known but speculation is that it is very likely to be some way over $100 per month.

This medical app has been put through its paces by the FDA in the USA and was approved for use in 2010.  The app has been designed as an aid for people with type 2 diabetes.  It prompts them to check blood sugar levels and gives them useful information about controlling fluctuations in glucose levels along with other advice to help them manage their condition. The prescription only app will offer encouragement and praise for regular blood sugar checking and might also issue helpful reminders to take medication with food, for instance.

Following in the wake of Nike’s FuelBand, an app that is designed to record health related performance, Blue Star’s app does not monitor a patient directly but rather provides a platform for them to use to record the information needed to best manage their condition.  The question is how will doctors receive this innovation?  Not having immediate control of their patient may not sit well, but BlueStar plan to calm any qualms by sending patients statistics to doctors who can then use the data to make adjustments to treatment.  Another potential stumbling block may be the perceived intrusion that might be resented by patients if no immediate improvement or benefit is seen. Only time will tell if the prescription only app is going to become mainstream.