Color me skeptical about mHealth

When I was a medical student, my then-girlfriend (now wife) bought me this amazing device called a Palm Pilot. The thing was amazing. When I was a resident, I taught myself to program for the things. I even helped to start a small software company making medical programs for handheld devices. I thought these things would change the way we practiced medicine.

I was so convinced, I dedicated my fellowship to studying their use in the NICU. I created an EMR that was Palm OS based and conducted a randomized controlled trial to see if if could reduce documentation errors. It pretty much didn’t work.

Later, I did a number of studies looking at mobile technology to improve adolescent diabetes management. I’m talking over the course of years. Again, modest results, but nothing to set the world on fire.

I bring this up to say that I’m a huge supporter and believer in mobile technology. But I’m realistic about how far we’ve got to go to make it work well.

There’s a Viewpoint in JAMA this week on the topic that starts a bit too optimistic for my taste:

There is substantial enthusiasm for the concept of mobile health (mHealth), a broad term typically used to describe the use of mobile telecommunication technologies for the delivery of health care and in support of wellness. In 2011, US Secretary of Health and Human Services Kathleen Sebelius referred to mHealth as “the biggest technology breakthrough of our time” and maintained that its use would “address our greatest national challenge.” This level of exuberance for mHealth is driven by the convergence of 3 powerful forces. First is the unsustainability of current health care spending and the recognition of the need for disruptive solutions. Second is the rapid and ongoing growth in wireless connectivity—there now are more than 3.2 billion unique mobile users worldwide—and the remarkable capability this brings for the bidirectional instantaneous transfer of information. Third is the need for more precise and individualized medicine; a refinement in phenotypes that mandates novel, personal data streams well beyond the occasional vital sign or laboratory data available through intermittent clinic visits.

Towards the end, they have a little more equipoise:

mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike.

Worth reading in full, but I leave you with this. For decades, people have been promising us that health information technology would revolutionize the health care system. I’m still waiting.


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