Using mHealth solutions to improve patient engagement

Using mHealth solutions to improve patient engagement

According to Gartner, in 2015, smartphone sales reached 1.4 billion units [1], and in the first quarter of 2016, they represented 78% of total mobile phone sales. [2]

A new report by the IMS Institute for Healthcare Informatics revealed that there are now more than 165,000 mobile health apps on the market. Nearly two-thirds are focused on general wellness issues like fitness, lifestyle, stress, and diet. The remaining third consists of apps focused on specific health conditions (9%), medication info & reminders (6%), and women’s health & pregnancy (7%). Mental health apps led among disease-specific apps, followed by diabetes. [3]

Nevertheless, with telemedicine, mobile health (mHealth) solutions, and wearable devices, the future of better patient engagement is certainly favourable.

During the last few years, the development of wearable devices that can track heart rate, blood pressure, calories and step-counters have experienced an enormous growth. This type of technology is revolutionising the level of patient engagement by proving individuals with an accessible platform to monitor their progress; information that until now was not available.

Nowadays, patients are increasingly looking for health information online, including their medical records. They request access to information and tools to take control of their health. To make this possible, clinics and patients can use a software platform that allows them to share information with each other while keeping the information safe.

Mental health care is not an exception. Now, more than ever, individuals want to be involved in their treatment. Up until a few years ago, patients with a mental illness, had a very passive role in their treatment. They were required to attend weekly consultations, take their medication every day and report their symptoms to the clinician at their next consultation.

The Monsenso mHealth platform empowers patients suffering from mental and behavioural illnesses, to take control over their illness and play an active role in their treatment.

The Monsenso platform helps individuals and clinicians to monitor the illness symptoms and mood patterns continuously. It also helps them handle their medication, as well as to recognise behavioural trends and early warning signs (EWS). [4]

Based on self-reported and automatically collected sensor data, it provides timely feedback to the patient, therefore, increasing illness awareness. By using it on a daily basis, it provides insights into the illness progression. These types of personal health technologies have the potential to apply machine learning techniques that can monitor and learn to recognise a patient’s circumstances and state and supply personalised context-appropriate clinical responses. [5]

Furthermore, clinicians need truthful information to offer better-quality treatment to their patients and assist in their recovery. Traditionally, psychiatrists provide patients with paper-based self-assessments. However, on a clinical study made with bipolar patients ranging from 18 to 65 years old, the raw adherence percentage of paper-based self-assessment is 58%. [6]

Most of the time, patients forgot to complete these assessments, and most people filled them out while sitting in the waiting room. This process generates a problem since most individuals couldn’t remember with certainty how they have felt since their last appointment.

Besides, clinicians may become distracted with paper-based self-assessments during the consultation. At the same time, they are required to interpret the self-assessments and enquire about the patient’s wellbeing. Likewise, once the consultation is over, the self-assessments are probably stored in a patient’s file and seldom retrieved.

On the other hand, recent research shows that the adherence rate of self-assessments when using the Monsenso smartphone app is 88% [7], making it a more reliable source of information.

The Monsenso system is much more than an mHealth platform; it is a personal technology solution that simplifies the continuous monitoring of critical patients, provides a historical overview of a patient’s condition and underlying behaviour. Furthermore, it also offers patients a list of self-help tools facilitating patient engagement and empowering them to become self-aware.

For example, improving illness awareness is vital to the treatment of individuals suffering from bipolar disorder. It is critical that patients monitor their mood and have a good action plan that helps them cope with their risk situations; this helps patients to manage their illness [7].

During the last few years, we have witnessed the development of wearable devices, mHealth solutions, and personalized medicine. Once mental health care providers widely adopt this technology, it will enable them to improve patient engagement. MHealth solutions like the one offered by Monsenso, allow clinicians to provide better-quality treatment based on accurate, real-time data.

The smartphone self-assessments helps patients become more aware of their condition as it helps them identify and learn more about their personal triggers and early warning signs. Furthermore, the information collected by the smartphones facilitates and speeds up the dialog between patients since symptoms and early warning signs can be discussed immediately.


[1] Gartner Says Worldwide Smartphone Sales Grew 9.7 Percent in Fourth Quarter of 2015. Gartner. (2016, February 18)

[2] Gartner Says Worldwide Smartphone Sales Grew 3.9 Percent in First Quarter of 2016. Gartner. (2016, May 19)

[3] New report finds more than 165,000 mobile health apps now available, takes a close look at characteristics & use. Satish Misra, MD. iMedicalapps. (2015, September 17)


[4] The MONARCA a Self-assessment System: A Persuasive Personal Monitoring System for Bipolar Patients. J. E. Bardram, M. Frost, K. Sz´ant´o, G. Marcu, in: Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, IHI ’12, ACM, New York, NY, USA, 2012, pp. 21–30. doi:10.1145/2110363.2110370.

[5] Supporting Disease Insight through Data Analysis: Refinements of the MONARCA Self-assessment System. M. Frost, A. Doryab, M. Faurholt-Jepsen, L. V. Kessing, J. E. Bardram. Proceedings of the 2013 ACM international joint conference on Pervasive and ubiquitous computing, UbiComp ’13, ACM, New York, NY, USA, 2013, pp. 133–142. doi:10.1145/2493432.2493507. URL

[6] Designing Mobile Health Technology for Bipolar Disorder: A Field Trial of the MONARCA System. Bardram, Jakob E., Frost, Mads, Szántó, Károly, Faurholt-Jepsen, Maria, Vinberg, Maj and Kessing, Lars Vedel. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, pages 2627-2636, New York, NY, USA, 2013.


[7] Increasing Awareness,  Insight and Adherence in Treatment of Bipolar Disorder through Personal Health Technology: Pilot Study. Mads Frost, Maria Faurholt-Jepsen, Afsaneh Doryab, Lars Vedel Kessing and Jakob E Bardram. Paper submitted for review to JMIR Mental Health (JMH), 2015.

Empowering patients with digital technology

Empowering patients with digital technology

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.

Figure 1

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].


[1] Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.

[2] Putting patients first. The NHS England business plan for 2013/14 and 2015/16.

[3] Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012.

[4] Medication Adherence: WHO Cares? Mayo Clinic 2011.

[5] Aston Medication Adherence Study, Aston University. See also:

[6] Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also

[7] Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014.