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February 13, 2012

App Overload
By Lindsey Getz
For The Record
Vol. 24 No. 3 P. 10

As smartphone adoption rates soar, an accompanying deluge of mobile health apps gives healthcare professionals plenty of choices.

Medical professionals have begun to seriously embrace their mobile devices. From iPhones and iPads to other tablets and devices, mobile technology is being utilized more frequently in a healthcare setting. In fact, in 2011 Manhattan Research predicted that 81% of physicians would be using smartphones by this year. The group also reported that nearly one-third of physicians already use mobile tablets—primarily iPads—and another 28% plan to buy one.

“We’re already in a world where so much is done via smartphones or tablets, so it only makes sense that the medical community is part of that trend,” says Lynette Ferrara, partner in the Health Informatics Practice of CSC’s Global Health Care Sector. “I believe within five years it will be the preferred method [of accessing data] and you won’t see a lot of PCs. Currently we’re seeing that with smartphone and tablet adoption, the medical industry is among the top rated. A third of the population as a whole in the US owns smartphones compared to at least two-thirds of doctors who own them.”

With figures such as these, it’s no surprise the industry is also experiencing growing interest in health-related apps that can be downloaded onto these mobile devices.

Apps Everywhere
There is certainly no shortage of choices for healthcare professionals who want to download apps to their mobile devices. Approximately 3,660 medical apps are available to iPhone users, according to a 2011 MobiHealthNews Report. But that’s not to say all of them are necessarily helpful.

“Based on our projections of the rate at which medical apps are being added, we predict there will be close to 5,500 medical apps available by July 2012,” says Brian Dolan, editor-in-chief and cofounder of MobiHealthNews. “That makes app overload a real problem. Only a small percentage of those apps available will actually be used by medical professionals. Sifting through them all can be time consuming. I equate it to the early days of the Internet and websites—doctors didn’t know which websites they could rely on for good info. Variety is important, but the question with all these apps is how do [users] find the right one? Finding the right filters can be a challenge, and it’s a huge opportunity that’s being worked on by folks trying to capitalize on that opportunity.”

Recently the Apple store launched a new section featuring apps recommended specifically for healthcare professionals. Interested parties can access it through the main site by following the “iPad in Business” header, but it’s not particularly easy to find, says Dolan. “It wasn’t really promoted that well, and I would suspect many medical professionals don’t realize it exists,” he notes. “It only has about 50 apps out of the close to 4,000 apps that are currently designated as ‘for professionals,’ but it is a way to filter them down and see what Apple recommends.”

Dolan believes most medical professionals are filtering apps the old-fashioned way—by word of mouth. “With more than 80% of physicians using smartphones, you have to imagine they’re talking to each other about which apps they do and don’t like,” he says. “It’s not a formal process; it’s just happening—casual social networks are forming. Still, I believe there’s an opportunity for a group or a person to come out with a better filter for finding good, useful medical apps so that medical professionals can filter them even better. That’s just not something we’ve seen yet, but there are groups out there like Happtique that are working on new possibilities.”

For Peggy Stilley, CPC, CPMA, CPC-I, COBGC, director of audit services at AAPC Physician Services, it’s been a trial-and-error process when it comes to app selection, noting that there is definitely such a phenomenon as “app overload” and that it’s easy to get bogged down by too many choices. To combat overload, Stilley frequently opts for free “lite” versions to get a better idea of whether she wants to wants to purchase an entire app.

“It’s a method of letting you try it without actually purchasing the full version,” she explains. “Sometimes the lite version won’t show you much, but it’s usually enough to make sure the app is doing what it claims. You want to make sure it comes from a reputable publisher and that you’re familiar with how it works before you purchase it.”

Instead of “carting books all over the place,” Stilley uses apps that condense key information onto her tablet or smartphone for easier access. One of her favorites is Stat E&M (by Austin Physician Productivity, LLC), an auditing tool that gives her the ability to print, save, or e-mail information for later use.

“I like the fact that I may not always have my coding books with me, but I know I’ll have my phone,” she says. “When I worked in OB/GYN I could never find my pregnancy wheel for reference, so I got it on my phone and I always had it right there. I also use the WebMD app and the Stedman’s Medical Dictionary app. There are just so many options, and I feel it’s the future of the industry. There will always be some books I still want because I know where stuff is and how to find it quickly, but there’s no question I’m moving more toward leaning on computers for help. I think everyone is.”

“These apps are basically easier-to-use versions of the things doctors have used for the last 30 or 40 years,” adds Ferrara. “Think of looking up a word in the dictionary.  You just type it in and get a list to choose from and pick the one you need. It’s all right there at your fingertips, and it’s fast and easy.”

Potential Concerns
While the advent of healthcare apps has been a boon for information access, there are concerns that need to be addressed and more fine-tuning that needs to be done. Stilley supports the use of apps but says at this point they can’t completely replace textbooks and manuals, noting that it’s important for users to be careful that the data in their apps match what’s in the books.

“The app doesn’t always have everything,” she points out. “If you’re looking for a refresher, apps are great, but sometimes if you need to do some hardcore work, you really do need your books or your full computer system. I was on site once and somebody asked me a question about E/M codes and the guidelines were not on the app, so you do still need the software.”

There’s still much to figure out for healthcare organizations that decide to adopt mobile technology throughout their system. “Once you decide to include mobile devices, you have a lot of questions to answer—questions that could severely impact the complexity and cost of the infrastructure you need to support,” says Ferrara. “If you’re a hospital, do the physicians pick up a tablet when they come in for their shift or do they use their own? If they use their own, how do you maintain privacy and security? If they’re getting information on their own device 24/7, is there really any such thing as being on call and off call anymore? Will physicians get reimbursed for time they spend looking at their iPad at home? And once you decide to go mobile, are you also going to provide devices for coders like you would a PC? There’s a lot to figure out, and it’s not necessarily simple.”

In some cases, apps may actually offer a solution to privacy concerns. In general, texting between physicians has been a privacy issue since the advent of smartphones. The Joint Commission recently issued a ban on texting because it is not a secure HIPAA-compliant form of communication. But it did acknowledge that mobile apps can become HIPAA compliant and may even be preferable to texting by offering additional user options such as video.

“Physician texting is definitely an issue, as sharing personal identifiable information via text is a violation of HIPAA,” says Dolan. “Still, surveys seem to indicate it’s still being done, and that’s probably because it’s such an easy form of communication. That efficiency is trumping privacy in some cases. But a lot of work is being done to create secure messaging applications that may take the form of an app. It may not be as easy to use as text messaging, but it will meet the security requirements and still be convenient and fast.”

Another area of concern surrounds the disconnection between apps and the health system as a whole. That’s changing, albeit somewhat slowly, Ferrara notes. “For instance, there are a number of e-prescribing solutions available which will replace a prescription pad with a mobile app that taps into a pharmacy network. That’s something we’re starting to see a lot more frequently and is an example of how it can all come together,” she says.

Dolan agrees, noting that in terms of functionality, access to EMR information via mobile app technology resides at the top of physician wish lists. While apps are currently being utilized more for medical reference purposes, Dolan sees the future being tied to electronic records. “It dovetails with the EMR adoption trend,” he says. “They feed one another. Once more EMR systems are in place, those apps that were once very disconnected from each other are suddenly connected back into the hospital system as a whole. And getting mobile access to that platform will be incredibly useful for physicians.”

In the coding world, Ferrara believes traditional workstations may remain. Apps will help provide quick references and other useful tools but will work in conjunction with existing software and systems. “I do believe that workstations in some form will still exist as we move into the future, particularly for coding,” says Ferrara. “You want to set up a work environment that’s easiest to operate and for someone that is keying in a lot of information, the standard keyboard really is typically most helpful. But for the average physician or nurse, being able to access information quickly or dictate information quickly is huge. A tablet is a lot less formidable barrier between medical professionals and patients. It’s a friendlier device all around.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.


Supporting a PHR
When Google Health dissolved, it seemed to deal a significant blow to the idea of PHRs becoming an accepted form of health record keeping. But MedAdherence, a company that aims to lower healthcare costs by enabling providers to manage patient care with mobile phones and automated care management tools, believes PHRs must be redefined. Specifically, PHRs must become “actionable information with supporting tools,” says CEO Jonathan D. Katz. In other words, the technology needs to engage the patient—and that’s where mobile technology steps in, says Katz.

“It’s always been my view that healthcare has never really used technology as effectively as other industries,” he says. “We have great drugs and devices, but at the end of the day, your doctor is your doctor and they are the ones that have your information. Everyone has their own systems and their own information. So I started thinking about how we can use technology to deliver better services. As mobile phones became so popular, it made sense to start looking at how they could be utilized for better healthcare delivery.”

In looking at where healthcare dollars were going, it was obvious to Katz that chronic disease conditions such as diabetes and asthma would serve as ideal platforms. “Only about half of the people with chronic conditions do what the doctor tells them,” he says. “If we could just get a few more people to do what they’re supposed to by combining mobile phone technology with low-cost, back-end, cloud-based technology, we could make a dramatic impact on healthcare.”

TransCareManager was established for transition care, while the CarePlanManager is purposed for ongoing chronic care. “Once the patient leaves the doctor’s office, the physician has no clue what happens,” says Katz. “We thought if we could extend the doctor’s viewing to what’s going on outside of the practice while also engaging the patient, we might be able to drive behavioral changes. Our solution is positioned as an extension of the provider service—we extend what they already do by extending the patient’s care. This will be positioned as Dr Smith’s Diabetes Management Program, not a MedAdherence app. Our plan is to be in the background.”

William Rudman, PhD, RHIA, executive director of the AHIMA Foundation, which has partnered with MedAdherence on grants providing education and training while MedAdherence provides the mHealth platform, says that if the PHR is ever to be accepted as part of our healthcare culture, it’s going to be accomplished via smartphones. “The way the PHR can be developed now, offering a direct link into our health records, develops that continuity of care that we’ve missed in the past,” he says.

Rudman believes the combination of PHRs, mobile phones, and health apps will lower emergency department visits and ultimately produce better overall health. “One of those reasons is better education. We can now put out educational messages via phone applications so the patient is much more engaged,” he explains. “But it’s also better connectivity with the physician. When patients get their glucose results, they can plug that into the mobile app and it automatically sends it to the patient’s electronic health record. If the care provider sees a pattern over time, such as abnormal responses, it can trigger an alert and they can call that person and get them into the office. In truly furthering the concept of continuity of care, I believe mobile applications are going to be critical.”

— LG