mHealth Appeals to Doctors More Than PatientsMEDICAL APPS AIMED AT MONITORING MEDICAL TREATMENTS AND HEALTH CONDITIONS ARE NOT TAKING OFF, PARTLY BECAUSE THEY ARE NOT CODESIGNED WITH USERS AND ARE EMPLOYED IN A BUREAUCRATIC FASHION
by Rosanna Tarricone, Bocconi Department of Social and Political Sciences
Translated by Alex Foti
We are all connected online. More than 4.5 billion people in the world use a mobile phone and it is estimated that by 2025 the totality of non-toddlers will be covered. In 2017, there were 325,000 health apps available online, a 30% increase compared to 2016. Heartbeats and blood pressure, step count, weight control, calories consumed, consumption of medical drugs, adverse events, psychological moods, and health parameters measured by apps represent an infinitesimal part of the data collected every day in the world that can be used to improve our health, redesign the process of provision of health services while increasing efficiency and reducing inequality. Mobile health (mHealth) means the provision of health services and programs through the use of mobile devices and represents one of the most extraordinary technological innovations in the health sector.
Quality clinical evidence and the huge amount of data collected around the world contribute extraordinarily to the development of new health technologies, improvement of treatment protocols, increase in therapeutic adherence, effective management of chronic diseases, and the empowerment of patients. A randomized clinical trial of patients with metastatic tumors has shown that adding an app for monitoring chemotherapy effects to standard treatment increases survival by 5 months on average.
The ubiquity of connectivity greatly reduces the need for the patient to go to the doctor with savings in health expenditure that can be re-allocated towards maximizing productivity. Access to health services in remote, disadvantaged and/or deprived areas becomes easier with mobile technology. Think of the benefits that would be gained by providing mobile health in Sub-Saharan Africa, where access to basic health provision is limited, life expectancy is among the lowest in the world, but the number of smartphones that can go on the Internet has quadrupled over the last decade, so that now 10% of the world population online lives in Africa.
However, the great hopes for mHealth sometimes remain only that, especially for those medical apps that have the stated objective of monitoring, controlling, and, if necessary, altering health treatments. Most users stop using these apps after a few weeks. What is going wrong?
A survey conducted by Bocconi University on over 1,000 patients and 1,000 doctors in 5 European countries and in the US has investigated the factors that favor or hinder the use of mHealth. The analysis found that there is an important digital divide between doctors and patients: almost 77% of doctors use mHealth while only 28% of patients do and, considering doctors, only a third use apps for monitoring their patients. Administrative uses prevail and they rarely directly involve the patient. This is because apps are not co-developed with end users, with the result that most of them are considered to be of low quality, and doctors do not recommend them to patients.
Most apps are neither supported by empirical evidence nor subject to any evaluation process. Efficient regulation of apps is necessary to increase their quality and effectiveness and thus confidence in their use. In 2017, considering the management of chronic diseases, 860 clinical studies were conducted compared to 126,000 apps launched in the same year. 99.3% of medical apps have gone to market on the basis of no clinical evidence.
mHealth is a disruptive technological innovation that will modify the processes of production and delivery of health services, and exponentially increase the effectiveness of health programs while requiring few additional economic resources. It will contribute to forming a generation of "expert patients", and will replace, at least in part, long and expensive clinical trials with a vastly greater amount of evidence available in a vastly shorter amount of time. But like with all technological innovations in healthcare, it must be governed by appropriate assessment processes and development models consistent with the needs and expectations of a population of patients, which do not necessarily coincide with the population that uses fitness apps. Also, incentives and other nudges can viably encourage their use and dissemination, considering the huge savings that mHealth can bring.