March 2017

mHealth Update: Digital Health Innovations Spark User Engagement
By David Rhew, MD
For The Record
Vol. 29 No. 3 P. 6

The phrase "medical technology" often evokes images of massive diagnostic equipment such as MRI or X-ray machines. But in a world dominated by mobile devices and services, this conventional view of health care technology obscures the importance of the medical devices small enough to fit in your pocket or on your wrist—the technology you use when you're not in the hospital but at home, at the office, and everywhere in between.

This functionality allows providers to solve an increasingly significant problem in medicine: how to monitor and coordinate care and treatment when a patient is outside of a clinical setting. Of course, providers can offer high-quality care at their offices. However, once patients walk out the door, providers can only hope their patients will adhere to the treatment plan.

The great innovation in modern health care, then, is the ability to leverage digital mobile technology (the very same technology patients are already using every day) to positively impact health outcomes and to ensure that patients are engaging in proper treatment and lifestyle changes.

For example, researchers have shown adherence to the patient treatment plan can have a direct impact on hemoglobin A1c levels in diabetes patients. In a randomized controlled trial, use of WellDoc's FDA-approved mobile application for diabetes management, known as BlueStar, reduced hemoglobin A1c levels by 1.9%. In contrast, according to drug manufacturers, the average reduction in hemoglobin A1c for oral diabetes medications is 1%. These findings suggest that properly timed engagement can be twice as effective as medication.

Targeting Seniors
All too often, however, we assume that consumers and patients adopt and utilize technology in the same way, and that all technology devices are pretty much the same. We now know that is not the case. According to a 2016 study sponsored by Link-age, approximately 80% of seniors aged 85 and older do not own smartphones; the same can be said of tablet ownership. There is a general assumption that seniors in this age group are not interested in technology nor can they properly utilize it. However, current research shows that even the most senior of seniors can readily adopt technology. The key is to change the technology so it adapts to the end user's needs.

Breezie, a software platform provider, has identified that seniors require 43 technology configurations to readily adopt and utilize a tablet. These configurations, which go well beyond implementing larger icons and simplifying the user interface, involve changing the way seniors access and utilize applications, locking down certain apps and configurations, and enabling family and friends to access the device to troubleshoot any problems that may come up.

A study of 225 seniors with little to no experience with mobile technology showed that seniors could significantly increase their adoption and utilization of tablet technology. As part of the study, conducted by Breezie in collaboration with the National Council on Aging (NCOA) and with funding from Verizon Foundation, every participant received a tablet loaded with NCOA's Aging Mastery Program, including activity prompts to promote physical and social interactions. Over the course of the two-year program, users reported an increase in physical activity and social interactions, and improvements in self-esteem, civic engagement, and technology use.

The Importance of Willing Participants
Of course, no matter how much these technologies can increase engagement and improve outcomes, they're effective only if patients are driven to use them on a consistent long-term basis. Time and time again, we've seen how quickly innovative technologies turn into forgotten fads. The question in designing the next generation of mobile medical technology is: How do we make sure people are motivated to use these health care solutions once the novelty wears off?

To address this topic it's necessary to first divide consumers and patients into two general groups. The first consists of those who have a desire to improve their health but for various reasons have not done so. The second consists of individuals who have no interest in improving their health. For this discussion, let's focus on the first group.

Researchers from the University of Wisconsin have shown that mobile applications can help patients with severe alcoholism. Alcoholics who had been hospitalized three or more times in the past 18 months participated in a randomized controlled trial. Those in the intervention arm received a mobile application that provided access to several on-demand support tools to combat alcoholism. These tools included education, access to online support groups, a GPS warning that sounded when participants approached a bar, and an emergency help button to call a support buddy. The results demonstrated that alcoholics in the intervention group had fewer drinking days and a 71% reduction in hospitalization as compared with the control group.

The following factors were key to success:

• Prior commitment: All participants wanted to get better, including those in the control group.

• Personalization: Patients could select which support tools they wanted to use.

• Mobility: These tools were readily accessible on mobile devices and leveraged technology.

• Social support: The alcoholics had support from people whom they already knew and trusted.

Based on the study results, mobile technology enables alcoholic patients to receive the personalized support they need from their caregivers and communities at any time and at any place.

Dawn of a New Age
In each of these examples, mobile innovations create a simplified, personalized, and easy-to-use health care experience. This technology-enabled, patient-centric approach represents a new era of managing patient care—and a path toward more provider, patient, and family engagement in the care process. From preventive care to chronic condition management, mobile technologies are leading the way to better outcomes both inside the hospital and out.

— David Rhew, MD, is chief medical officer and head of health care and fitness for Samsung Electronics America.