by Thomas Lethenborg | Jan 10, 2017 | Blog, mHealth
According to an article published on Harvard Business Review, digital health tools have the potential to provide effective, low-cost ways to prevent and treat chronic illnesses. The article states that these technology-based solutions that have a clinical impact on disease are comparable to the effectiveness of a drug, and they use consumer-grade technology such as mobile devices and big data analytics that can be deployed in real-time and at scale, which is critical for the management of chronic diseases.
From the chronic diseases, mental illnesses account for five of the ten leading causes of disability worldwide [1]. Therefore, prevention as well as the the early identification and treatment of mental illness represents a high priority since it promotes recovery, independence, self-sufficiency, as well as facilitating social activities and employment opportunities [2].
In fact, in the UK alone, depression and anxiety accounted for 11.7 million lost working days last year [3]. Moreover, according to the American Medical Association, stress accounts for 60% of all human illness and disease [4], which means that clinically-tested health apps can help government authorities, corporations and insurance companies reduce their costs by monitoring individuals remotely and intervening at an early stage.
Nowadays, the majority of large employers that offer health benefits also offer a wellness programme in an effort to promote employee health and productivity as well as to reduce health-related costs.
We live in an era where certified and clinically-tested health apps, or mobile health solutions (as they are widely known), are readily available, or are being developed for most chronic diseases.
Most of these digital tools are extremely easy to use, and can be obtained by downloading an application from iOS or Google Play, signing-up, and sharing your information with a coach. The clear advantages of this technology are scalability and low-cost, since an effective health app bundled up with a telehealth can provide affordable support to either 50 or 5 million users.
The Monsenso mHealth solution can be used by insurance companies and large corporations to reduce costs by offering a preventive mental wellness programme. Individuals can use the Monsenso smartphone app to enter their daily levels of stress, anxiety, irritability, physical activity and number of hours they slept. This information is gathered and stored electronically so it can be accessed by a healthcare professional anytime, anywhere. However, the coach only needs to take action when the web portal indicates that certain individuals present any triggers or warning signs. For example, the coach will be notified when anyone in the system indicates a high level of stress, anxiety and irritability for more than five consecutive days or when someone sleeps less than six hours for more than three consecutive days. These two actions would be considered indicators that the individual needs to be contacted for a “wellness check” and implement the necessary measures to prevent the person from going on stress-leave or from becoming affected by other physical conditions such as heart disease.
References:
[1] Prevention of Mental Disorders. Effective Interventions and policy options. World Health Organisation in collaboration with the Prevention Research Centre of the Universities of Nimegen and Maastricht. http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
[2] Early intervention and recovery for young people with early psychosis: consensus statement. J. Bertolote and P. McGorry. British Journal of Psychiatry (2005). http://bjp.rcpsych.org/content/bjprcpsych/187/48/s116.full.pdf
[3] Stress in the City: ‘At first, I thought my depression was a heart attack’. The Telegraph. Peter Stanford. (2017, January 7)
http://www.telegraph.co.uk/men/health/stress-city-first-thought-depression-heart-attack/
[4] How Stress Affects the Body (INFOGRAPHIC). Huffington Post. (2013, January 10)
http://www.huffingtonpost.com/heartmath-llc/how-stress-affects-the-body_b_2422522.html
Simple Digital Technologies Can Reduce Health Care Costs. Harvard Business Review. Alexander L. Fogel, Joseph C. Kvedar. (2016, November 14).
https://hbr.org/2016/11/simple-digital-technologies-can-reduce-health-care-costs
by Thomas Lethenborg | Dec 6, 2016 | Blog
Digital self-monitoring tools enables individuals to track meaningful data about themselves. This capability has encouraged healthcare providers to use these tools to personalise and scale treatment in a more cost-efficient way.
A recently published research paper titled “Self-monitoring utilisation patterns among individuals in an incentivized programme for healthy behaviours,” suggest that the use of digital self-monitoring tools could significantly improve a patient’s long-term health engagement.
According to the research paper, the 69% of Americans track regularly at least one indicator of health, including their weight, diet, exercise routine, or symptoms related to chronic disease. Since there is a wide range of mHealth devices, there is a growing trend among the general population to measure, track, and make changes related to their health based on quantifiable data collected by oneself. Projections show that the number of everyday wearables, devices, and sensors will increase 5-fold by 2019 [1].
Although the effectiveness of these tools varies depending on the manufacturer, it is well-established that effective, digital self-monitoring tools can have profound health benefits. For example, among diabetics, blood glucose monitoring is a major component of disease management and provides individuals the ability to assess glycaemic targets and evaluate response to therapy. Additionally, blood pressure monitoring has been associated with improved short-term blood pressure control and medication adherence, and self-monitoring has also been shown to improve weight loss and short-term activity levels Importantly, monitoring programs, wearable devices, and other non-traditional healthcare resources can potentially facilitate healthy behaviour changes [1].
As non-traditional healthcare channels such as virtual care become more popular, there is a shift to value-based treatment. Together, these aspects have led to an interest in incorporating digital self-monitoring tools into chronic condition management, and the diagnosis of acute episodes. All these are important steps in incorporating digital technologies into routine patient care.
According to the research, after 20 weeks, 28.36% of registered users were still actively engaged in the program. Meanwhile, combined with the duration of program participation, the frequency of program participation over the first 20 weeks demonstrated some interesting trends. First, the average number of activities logged by users was 4.28 during the first week in the program. However, after excluding the roughly one-third of users who ceased recording activities after one week, the average number of activities logged by participating users increased to 7.53 by the second week. After four weeks, this number was 8.01 and remained relatively steady throughout the 20-week period examined [1].
Overall, the study demonstrated that while a large proportion of users stopped participating in the programme early on those that did continue to log activities did so at a fairly consistent level throughout their participation period [1].
Primary findings
Monitoring physiologic parameters, health activities, and health behaviours in a non-medical setting has the potential to enable alternative systems of health management that can be both more individualised and convenient for health consumers.
An understanding of home-based, self-tracking parameters can provide insights into optimising such programs in future health care models.
The results of the study suggest that incentives might work for connected and active participants in achieving healthy activities. The study showed consistent, extended results of how incentivised consumers track health behaviours and health data in a real-world setting with a large population.
Long-term adherence to healthy behaviour programme and automated self-monitoring tool
According to the study 57% of all users that remained on the study after one month continued to participate for at least twenty weeks. However, it should be taken into consideration that engaging consumers initially and for prolonged lengths are important components of success.
There is still much to learn about long-term participation. However, the digital tools used, should be easy to use and they should incorporate proven behaviour change theories through the use of rewards or incentives. For example, useful tools to improve long-term, self-monitoring are mobile health-tracking technologies since they can collect, transmit, and aggregate health data.
In fact, a study looking for adherence to the protocol through mobile phone apps which compared website or paper diaries for weight loss also proved the advantage of mobile phone apps even when it was not a fully automated process [1].
Web-based and mobile health self-monitoring is popular in the general population, and could play a critical role in the future of health management and wellness. Self-monitoring has been shown to improve health and management of chronic conditions. [1].
The Monsenso mHealth solution can be used as a digital self-monitoring tool by individuals with a mental illness. With the smartphone app, individuals can track their health and behavioural data, as well as their symptoms and medication compliance. Besides, all this information is also synchronised with the clinical web portal enabling healthcare professionals to offer a more personalised treatment.
Reference:
Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviours. JMIR Publications. Ju Young Kim, MD, PhD; Nathan E Wineinger, PhD; Michael Taitel, PhD; Jennifer M Radin, MPH, PhD; Osayi Akinbosoye, PhD; Jenny Jiang, MS; Nima Nikzad, PhD; Gregory Orr, MBA; Eric Topol, MD; Steve Steinhubl, MD. 2016. http://www.jmir.org/2016/11/e292#Body
by Thomas Lethenborg | Jan 19, 2016 | Patient Engagement
A new survey by Accenture revealed that 54% of consumers would like to use their smartphones more to interact with healthcare providers. Unfortunately, most healthcare providers have failed to adapt to their patients’ needs. Consumers complain that most apps offer a poor user experience, and they fail to meet their needs.
As digital patient engagement becomes the norm and consumers become unhappy with their care providers’ lack of mobile services, they may look for alternatives. Care providers need to meet consumer expectations by adopting mobile technology and improving the overall user experience.
The Accenture survey identified that although 66% of the largest 100 US hospitals have mobile apps for consumers, less than 40% of that subset have developed their own.
Unfortunately, merely having a mobile app is not enough. Often, healthcare providers fail to engage consumers with these apps due to poor functionality and poor user experience. The survey revealed that hospitals are engaging successfully with just 2% of patients!
Patient-centred apps published by disruptive innovators are gaining traction in the market by fulfilling the users’ demand. These disruptor apps are focusing on functionality and user experience in line with the patients’ needs.
Technology slackers pay the price
The Accenture shows that around 7% percent of patients have switched healthcare providers due to poor customer experience. This is the same level of customer dissatisfaction as seen with hotels and telephone service providers, and according to Accenture, these losses represent over $100 million in annual revenue per hospital.
As consumers bring their service expectations from other industries into healthcare, care providers are likely to see higher switching rates, on par with the mobile phone industry, cable TV providers, or even retail.
Nevertheless, the rewards are clear for those who get it right. According to a survey by RBC Capital Markets, between 55% and 69% of users who use online health tools reported increased satisfaction.
Today’s consumers expect to interact with their care providers digitally, and most of them are being let down. As a result, in the increasingly competitive healthcare market, providers that ignore mHealth technology today could lose valuable customers to the competitors who adopt this technology.
Partnering up with technology innovators
Inpatient experience and mobile engagement are both part of the holistic patient experience that can lead to customer retention or switching.
MHealth technology can help care providers succeed in an era of individualized healthcare, where patients are empowered to help manage their own care. To improve customer satisfaction, care providers should create a better user experience tailored to the functionality demanded by patients. Care providers should partner with technology companies presenting innovative solutions to create a mobile platform that is tailored to their specific patient needs. For example, partner with ZocDoc for appointment scheduling, InstaMed Go for bill payments or Monsenso to support the treatment of mental illnesses.
Reference:
Losing patience: Why hospitals must revive their digital health strategies.
https://www.accenture.com/us-en/insight-health-losing-patience.aspx
by Thomas Lethenborg | Jan 5, 2016 | mHealth, Patient Engagement
On the previous blog post, “Transforming health and social care with digital technology” connected health or technology-enabled care (TEC) was defined as the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. This type of technology can empower patients and carers by giving them more control over their health and social care needs. It can also help individuals to obtain more information regarding their health.
In broad terms, TEC can:
- Improve self-management through remote monitoring, education, and treatment adherence
- Tackle areas of unmet needs that traditional treatment struggles to address, such as mental health
- Supports the development of online patient portals and patient communities
- Transforms the relationship between patients, carers and healthcare providers to focus on co-creation
Enables self-management
Nowadays, patients and their carers use technology to research information online, identify treatment options, rate providers, and share their experiences. Healthcare needs to acknowledge that emerging technologies offer a tremendous opportunity to transform the way people engage with their health.
Besides connecting patients and providers, digital technology leads to better outcomes and a more personalised service by educating patients in regards to their health-related issues, enabling remote monitoring, and supporting treatment adherence.
Informs and educates patients and carers
It is estimated that 75% of the UK population goes online for health information. Websites, apps, videos, texts and free online courses are being used to educate and provide information to patients and their family caregivers [1].
Figure 1 displays the most common category of mobile apps: fitness, medical reference and wellness apps, which provide information with other very limited functionalities.
Figure 1. Digital health app category, percentage share in 2014.
The use of digital technology to educate patients and carers is a crucial driver of patient engagement. Surveys suggest that patients are more likely to make better choices and be engaged in their health if they can access information quickly.
Digital technology connects patients and providers, leading to better health outcomes and a more convenient and personalised service, through informing/educating, two-way remote monitoring, and supporting treatment adherence [2].
TEC can help carers understand and support those they care for by:
- Providing psychological reassurance
- Enabling carers to co-ordinate their work-life-care balance through supporting flexible hours and remote working patterns (approximately 2.3 million people have had to give up work to become carers and three million have reduced their hours)
- Delivering peer-to-peer support
Facilitates remote patient monitoring (RPM)
Remote monitoring uses technology to monitor changes in patients’ health status outside conventional clinical settings.
Historically, it allows a patient to use a device to perform a routine test and send the test data to a healthcare provider. Initially, it depended on a healthcare provider recommending its use to patients. However, digital technology has increased the potential for remote monitoring and, with the advent of apps and wearables, patients are increasingly bringing the innovation to doctors [3].
New advances in the development of biosensing wearables are spreading their capability beyond simply tracking activity. New devices can monitor a broad range of physiology (from posture to brain activity) and convert this information into outputs, through advanced connectivity and computing power.
Biosensing wearables can support people with chronic conditions, automating monitoring and detecting real time changes in an individual’s health status. Data from biosensing wearables can be uploaded to an Electronic Patient Record (EPR) and this information can be used to display an overview of a patient’s medical history in real-time, supporting early diagnoses and early intervention.
If a negative change occurs, patients, family caregivers and healthcare providers can be alerted quickly, preventing emergency admissions.
Increases treatment adherence
In bad cases, failure to follow treatment can cause a patient’s condition to deteriorate, leading to an increased likelihood of hospital admission, permanent disability, or death. Electronic reminders and alerts, via text SMS or apps, can remind patients to follow their treatment regimens, thus improving health outcomes.
The World Health Organisation has calculated that adherence to long-term therapies in developed countries is around 50%, and is even lower in developing countries [4].
In the UK, between one-third and half of all medicines prescribed for long-term conditions are not taken as recommended. It is estimated that the cost of unused or unwanted medicine is around 100 million GBP per annum [5].
Improved adherence allows healthcare providers and pharmaceutical companies to obtain a better understanding of the impact of drugs, including any complications or drug interactions, providing useful data for research. An increasing number of pharmaceutical companies are investing in digital TEC projects to increase patient adherence to the drugs they produce. Likewise, patients and carers are increasingly using digital health software to register and monitor medication intake [6].
References:
[1] Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.
http://circle.leeds.ac.uk/files/2012/08/110512-circle-carers-uk-valuing-carers.pdf
[2] Putting patients first. The NHS England business plan for 2013/14 and 2015/16. https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf
[3] Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012. http://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-telehealth-telecare.pdf
[4] Medication Adherence: WHO Cares? Mayo Clinic 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/
[5] Aston Medication Adherence Study, Aston University. See also: http://www.aston.ac.uk/lhs/research/health/pharmacy/adherence/
[6] Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also http://www.mobilehealthglobal.com/in-the-news/news/109/mobile-apps-fighting-for-patient-adherence
[7] Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014. http://www.hscic.gov.uk/catalogue/PUB14899/psyc-ther-ann-rep-2013-14.pdf
by Thomas Lethenborg | Dec 15, 2015 | mHealth, Patient Engagement
Earlier this year, Deloitte published a report titled “Connected Health: How Digital technology is transforming health and social care.” The information on this blog post has been obtained from this report.
Connected health or technology-enabled care (TEC) is the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. TEC is now seen as a fundamental part of the solution to solve many healthcare challenges. TEC helps people self-manage their health and well-being, alert healthcare professionals in case of any changes in an individual’s condition and support medication adherence. It also helps clinicians and care providers deliver more efficient and cost-effective care.
Digital technology is advancing exponentially, and its cost is becoming more and more affordable. At the same time, the demand for more cost-effective healthcare is rising. Now more than ever, healthcare authorities need to adopt new technologies to help meet these challenges.
An aging population
In the UK, as in other parts of the world, the population is increasing, and people are living longer. These two factors, in addition to a rise in chronic conditions, present new healthcare challenges.
Over 25% of the population in the UK are affected by a chronic condition, and an increasing number have multiple conditions. It has been appraised that people with long-term conditions use up to 50% of all GP appointments and 70% of days spent in hospital beds. It has also been estimated that their care absorbs 70% of hospital and primary care budgets in England.
Use of mobile devices is increasing amongst all age groups
Although ownership of smartphones and tablets is growing rapidly, the older population, who are the largest users of health and social care services, hadn’t adopted this technology until now. However, in 2014, baby boomers generated the fastest year-on-year growth in smartphone penetration.
Additionally, smartphone owners are encouraged to exercise, lose weight and improve their health, with the help of numerous mobile health apps.
Other market drivers
The demand for apps and wearable devices is also being driven by an increased focus on personalised care. Large pharmaceutical companies are now using apps and wearables to gather valuable health-related patient data, support their research, and provide an holistic service to patients.
In 2014, the leading pharmaceutical companies had an increase of 63 % in unique apps compared to 2013. In just one year, the total number of downloads of pharmaceutical apps increased by 197% as shown in Figure 1. These apps deliver education and training, can titrate medication and monitor compliance.
Figure 1. The number of apps published by leading pharmaceutical companies, 2013 and 2014.
There has also been an increase in on-line patient communities, using social media as a platform to exchange experiences with patients and carers.
Increasing patient trust in health apps
There is strong evidence that patients are now more than ever concerned about self-care, and they are interested in boosting their health and well-being. In addition to this, health technology companies are working to improve the quality of apps, increase user confidence and trust, and launch informed decision-making in app selection for health professionals, patients and the public.
Agencies like the US Food and Drug Administration (FDA), or NHS Choices and its NHS Health Apps Library have developed criteria that judge apps for safety and technical proficiency. For example, for apps to be included on the NHS Choices search website, which in early 2015 lists around 150 apps, they must be reviewed by a technical team (testing relevance, legal compliance and data protection), then by a clinical team (to test scientific rigour).
PatientView is an independent organisation that has developed a systematic method of appraising health apps. Until April 2015, there were 363 apps recommended for the Apple platform and 236 for Android, with smaller numbers recommended for use on other platforms.
In 2014, PatientView undertook a survey of 1,130 patient group members to identify what people want from health apps as shown in Figure 2.
Figure 2. What do patients and carers want from health apps?
Reference:
Connected Health: How Digital technology is transforming health and social care. Deloitte Health. http://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health.pdf
