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August 2015

How Millennials Are Reshaping mHealth
By Amanda Griffith
For The Record
Vol. 27 No. 8 P. 8

More wired, consumer-oriented, and innovative than ever before, the $2.8 trillion US health care industry is undergoing profound transformation. Studies have shown that 90% of Americans own a mobile device and spend an average of 43 hours per month on those devices, compared with just 22 minutes at an average doctor's visit.

To take that a step further, as a society, we spend more time on social media than we do exercising. On Facebook's second quarter earnings call, CEO Mark Zuckerberg stated, "People on Facebook in the US spend around 40 minutes each day using our service." Meanwhile, the Centers for Disease Control and Prevention recommends 21 minutes per day of exercise, a feat only 20% of Americans accomplish. Zuckerberg also said the 40 minutes spent each day on Facebook account for one-fifth of the total time spent on mobile devices in the United States.

It should come as no surprise, then, that a February 2015 Salesforce.com report, "State of the Connected Patient," found that many millennials (defined as currently aged 18-34) would prefer to engage with their providers through digital health technology. Such trends have led Farris Timimi, MD, medical director of the Mayo Clinic Center for Social Media, to stress the importance of providers "seeing" patients where they spend the most time—online. To do so, physicians will need to reshape their care strategies, he notes.

"The challenge lies in providers being professional, being strategic on a social platform, and understanding what content needs to be redirected to patient portals on mobile devices, which is where millennials want to be," Timimi explains. "Many clinicians can accomplish this well, but it requires the ability to engage effectively, efficiently, and appropriately."

Heeding the Call
Ron Remy, CEO of Mobile Heartbeat, a clinical communications vendor, says younger clinicians are driving the push for a deeper dive into digital health. He relates an anecdote from a prospective customer in which a young provider came to the practice to interview for a position. "She held up her smartphone and said, 'I can order a pizza on this, so why can't I communicate with my patients on it? What's the hold-up?'"

As Evan Williams, cofounder of Twitter, told Wired magazine, "People will be people. The Internet wants to give them exactly what they're looking for. And people who understand how to channel that tendency will be disproportionately powerful."

In this regard, it's likely that millennial physicians will work with patients to drive mobile health (mHealth) adoption. For their part, older clinicians are willing to adopt digital health offerings, but only once it's been proven that the technology enables them to do their jobs faster, better, and with increased value.

"There's a 'show-me' aspect with older providers," Remy notes. "They won't accept this technology at face value so the onus is on vendors and developers to show how a new app or platform enables improved patient care in a way that's more effective and efficient than traditional methods."

Harnessing Provider Power
Timimi likens health care providers to human bandwidth for patient engagement, noting, "If I could get all 60,000 members of the American Academy of Pediatrics willing to weigh in on social media about the vaccination debate, we'd be the moral authority on vaccinating, not [actress] Jenny McCarthy."

Janet Munro, MD, CEO and cofounder of software developer Optimal Medicine, agrees. "I'm hoping surveys like Salesforce.com's provide clinicians with the comfort level they need to understand how much mobile health initiatives can improve patient lives—and their own," she says. "I spent years practicing as a clinician and am continuously amazed at how the new digital world can solve so many of the problems I faced."

It's no longer even a matter of training to help these clinicians embrace millennial patients' preferences for interaction. "Seven to 10 years ago, it was necessary to train users to use their fingerpad and not their fingernail when using the smartphone," Remy says. "Now, 99% of users have experience with smartphones so training is easier and more streamlined."

Cost is less of a barrier, too: Most digital health tools are either inexpensive or free. Even analytic tools usually offer free platform tools that don't require a heavy time investment.

"A health care provider can form a significant presence on Twitter with as few as five tweets each day, two of which are retweets," Timimi says. "That's three 140-character comments on a daily basis, something that's easily accomplished over the course of the day."

The challenge is to design a process that encourages openness and collaboration. Take Facebook, which has 1.5 billion people sharing everything from prom photos to political opinions. Ironically, it was founded in 2004 around the same time as Patientslikeme, a patient-powered research network. Yet, Patientslikeme has a following of only 350,000. Why the disparity?

"When you put too many structural constraints on the way people share health information and suggest that it's dangerous to do so, they'll be less likely to participate," says Matt Tindall, general manager of consumer solutions for IMS Health. "On the flip side, when you give them an open forum in which to talk and share, they join and share more often, making their own choices about what information they feel comfortable offering and to which audience. They do it because they want support, and in many cases they feel the reward outweighs the risk. In the end, they want their disease or condition cured or prevented in their lifetime and they know that answers sometimes come from unknown or unlikely places. While data privacy and security is critically important, it's still the patient's decision."

Findings from the 2015 HIMSS Mobile Technology Survey support a push toward mobile technologies creating communities of personalized, real-time support and feedback. Respondents reported leveraging various mobile tools, including app-enabled patient portals (73%), telehealth services (62%), and text communications (57%). Of these technologies, 36% of respondents believed app-enabled patient portals to be the most effective patient engagement tool.

"The good thing about millennials is they are incredibly tech savvy so they will push parents, loved ones, friends, and their physicians to formally change the way they think about engaging technology," Tindall says. "The bigger challenge is to help app developers, connected device manufacturers, and big technology companies come together to design solutions that physicians can put in their virtual toolbelt."

To that end, Optimal Medicine offers a comprehensive mHealth suite of clinical decision support solutions to improve efficacy and outcomes, and assist physicians deliver consistent, high-quality care. Such platforms integrate Web-based and mobile technologies for clinicians and patients, allowing care to be initiated and adapted according to the consumer's unique profile and evolving needs.

As the development and use of mobile consumer health apps grows, patients—and their physicians—face a dizzying array of choices with no easy way to sort through more than 40,000 options to ascertain which one best fits their needs. However, as part of wellness, prevention, and treatment regimens, physicians can organize these apps into formularies based on their specific patient population and practice preferences.

"If we physicians and health care providers don't take on the task of providing feedback to technologists, we won't get it right and we'll perpetuate the problem so many digital health systems face, in that the doctor and patient sides aren't lined up," Munro says. "There's enormous potential for physicians to ride this wave that the millennials are surfing—or drown."

— Amanda Griffith is a freelance writer in southeastern Massachusetts.