Monday, August 27, 2018

The Medical Reformation

Sebastian Romero
PhD Student
College of Nursing
University of Utah


“What is it?” My patient asks nervously.
“114.” I reply.
“That’s great! That’ll my fifth level in normal range, right?”
“Yeah, I think you’re right. I’ll check.” I reply, now back at my computer looking at her previous four blood glucose levels.
Not surprisingly, my patient is right, her blood sugar levels have been below 120 since yesterday morning. She thanks me as I start walking out of the room. I promptly respond but she doesn’t hear me, by then she is too busy manually inputting her blood sugar level into one of the many glucose monitoring applications (apps) one can download to their phone.

The growth of health apps
This is the age we live in. The age of the e-patient. The “E” stands for both electronic and empowered. Long gone is the day that the doctor or nurse is the source of all health knowledge. The invention of smart phones and mobile health applications has done for patients today what the translation of the bible did for common people during the Reformation. This is the medical reformation, the age when the patient is empowered with access to seemingly endless information at their fingertips. Over 320,000 health applications like the one my patient was using are available on app stores today. Like the religious boom that was seen during the Reformation, in today’s medical reformation, companies are scrambling to throw their hat in the ring and get a slice of this expanding tech market estimated to be worth more than 27 billion dollars. The annual growth rate is estimated to be in the 32nd percentile translating to an average of 200 health apps being added each day to the app store. This means more options for my patient with diabetes and any other person looking to improve their health and health literacy, but it can also create a source of potential danger.

Regulation is crucial
Despite information becoming more accessible, questions remain on the quality of information patients are gaining access to. Meaning that the information and claims stated by some of these applications may be erroneous, misleading and even potentially harmful. The Federal Trade Commission (FTC) warns about this and estimates that only about half of all health sites and apps are doctor reviewed. This can be especially dangerous if people are relying on the information they are receiving from their apps and not seeking a second opinion from a trained health professional. Unfortunately, a second opinion is not always obtained and now app companies are going to great lengths to protect themselves from potential lawsuits, with many apps incorporating multiple layers of consenting before the downloader can finally use the applications settings. Along with the FTC, the Food and Drug Administration (FDA) oversees the regulation of these mobile health applications. These regulations can be found in the Mobile Medical Applications Guidance for Industry and Food and Drug Administration Staff, a 45 pages document written to reduce the negative consequences of this medical reformation. Consequences that although very real, may still be outweighed by the positives.

Positive may be too big
A staggering 96% of health app users report improved health when using an app, according to a 2015 study done by Research Now. Not only are patients benefiting from mobile health apps, health care providers are too. In the same study, 86% of health professionals agreed that health apps will improve their own knowledge of their patients condition as well as increase their patients sense of responsibility for their health. This excitement is being shared by hospitals, many of which are now seeing the adoption of such apps as a necessity. Dr. Shafiq Rab, Senior Vice President and Chief Information Officer at Hackensack University Medical Center, said:
The delivery of healthcare is moving from large buildings and big offices into patients’ homes and mobile devices… The new model means that we as healthcare providers must step up our game and… provide the convenience, access, quality and transparency required to acquire and retain patients (n.d. para. 1)
Other primary care providers (PCP) are also aware of this shift and are already seeking ways to “step up [their] game”, 46% of all PCPs state plans of incorporating apps into their practice within the next five years. Additionally, different from many priests during the Reformation, doctors seem to be open to the shifting distribution of knowledge as job satisfaction levels and patient-doctor relationships are being left unstrained during this shift.

Conclusion
In conclusion, the age of mobile health apps has led to a medical reformation that distributes knowledge and responsibility back to the patient. With this shift in knowledge, regulatory measures must be used to protect patients from inaccurate and misleading information. With protective measures in place, apps have the potential to not only improve the patients’ health but also improve health care system as we now know them. As doctors work to incorporate such technologies in their practice, patients’ will increase in health literacy and become more significant role players in their own care.

References
Conn, Joseph. (2015). Easy of those apps: Mobile medical apps gain support, but lack clinical evidence. Modern Healthcare. Retrieved from http://www.modernhealthcare.com/article/20151128/MAGAZINE/311289981/easy-on-those-apps-mobile-medical-apps-gain-support-but-many-lack
Health information on internet is often unreliable. (2000). BMJ : British Medical Journal321(7254), 136.
Rab, S. (n.d.). The paradigm shift in medicine and how it affects technology. CIO Review. Retrieved from https://healthcare.cioreview.com/cioviewpoint/the-paradigm-shift-in-medicine-and-how-it-affects-technology-nid-3823-cid-31.html
Research Now. (2015). Are mobile medical devices good for our health? A new study by research now reveal that doctors and patients say yes. Retrieved from https://www.researchnow.com/newsroom/mobile-medical-apps-good-health-new-study-research-now-reveals-doctors-patients-say-yes-infographic/
The Growing Value of Digital Health: Evidence and impact on human health and the healthcare system (2017). IQVIA Institute Report. Retrieved from https://www.iqvia.com/institute/reports/the-growing-value-of-digital-health
U.S. Department of Health and Human Services Food and Drug Administration. (2015). Mobile medical applications guidance for industry and Food and Drug Administration staff. Retrieved from https://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf


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