Mobile healthcare, telemedicine, telehealth, BYOD

Policy News

Multiple Obstacles Hindering Mobile Health Implementation

By Kyle Murphy, PhD

- A lack of evidence, financial obstacles, health data privacy and security concerns, and fears of data overload represent the most significant challenges in the way of mobile health implementation, according to a review of mHealth by the Scripps Translation Science Institute.

Mobile health implementation is hindered by numerous regulatory, financial, and other concerns.

The authors of the review — Steven R. Steinbuhl, MD, Evan D. Muse, MD, PhD, and Eric J. Topol, MD — agree that mHealth technology and applications along with increasing mobile connectivity have the potential to improve the quality of clinical research and healthcare delivery but that a handful of obstacles are preventing mHealth implementation from becoming widespread.

The first obstacle is in the form of a limited evidence base to show meaningful use cases for adopting mHealth solutions. "Indeed, although the number of mHealth-related publications is growing gradually, the majority of the published evidence in support of clinical use is limited to underpowered pilot data," write Steinbuhl et al.

Another evidence-related deficiency results from the focus of this growing body of literature:

Too often, studies of mHealth technology have been designed to answer the question “How can ‘these technologies’ fit into existing systems of care?” Instead, the more appropriate question is “How can systems of care be altered to best take advantage of ‘these technologies’?” Attempting to fit disruptive technologies into existing systems has historically been shown to prevent anticipated gains. Similarly, the implementation of mHealth technologies only as adjuncts to existing systems of care likely will lead to results that fall well short of demonstrating their true impact.

The authors point to volume-base reimbursement as a financial obstacle in the way of increased mHealth use.

"In the United States in particular, current modes of financing health care are the single greatest barrier to mHealth implantation within legacy health care systems," they maintain. "A fee-for-service environment that rewards reactive, sickness-based care is essentially in direct conflict with the capabilities made possible through mHealth tools."

Fee-for-service, the authors contend, is one of the reasons that the use of remote monitoring to prevent the scheduling of unnecessary physician appointments remains underutilized.

As for health data privacy and security concerns, Steinbuhl et al. call for new regulations that properly reflect how health data is collected, secured, and used:

In the era of big data, it is critical that the terms of ownership of personal data, most especially medical data, be unambiguously stated—not buried in the universally unread and then accepted terms of use agreements — with users required to explicitly consent whenever their data are sold or transmitted to others. It is unlikely that this will occur without new laws and regulatory oversight.

What's more, the convenience of mHealth technologies could end up exposing health data to unauthorized access.

"With 4.5 million lost or stolen smartphones last year alone, it is not difficult to imagine the security disaster that would ensue if each of these phones stored sensitive personal health information or, much more concerning, could potentially serve as a portal into an electronic medical record system," Steinbuhl et al. assert.

The fourth and final obstacle in the way of greater mHealth adoption and use concerns data usability and the potential for great volumes of mHealth-generated data to overwhelm both providers and patients.

"This tsunami will create a number of difficult challenges, including the potential requirement for 24/7 oversight, the need to summarize multiparameter, continuously collected data into a usable and clinically meaningful format, and liability challenges," the authors explains. "And this scenario assumes that providers will be willing to embrace patient-generated data by putting as much trust in it as they put into data they collect."

The ability to parse and present patient and provider data will prove increasingly important as the amount of data generated increases.

Ultimately, the authors conclude that addressing these obstacles is necessary for achieving truly patient-centered care.

Read the full review here.

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