Every day clinicians incorporate clinical knowledge, skill, and experienced practice to provide care for their patients. Another valuable tool has the potential to dramatically change patient diagnosis, treatment, education, and follow-up, and it is already in the hands of patients.
The use of mobile technology with a cell phone, specifically the “smartphone,” has empowered patients to become more active in their care. This technology, which has been called “disruptive innovation in health care,” can be useful to gain patient participation but can present new difficulties for the already hard-working clinician who is not adequately prepared.1
The use of mobile technology has seen rapid growth in the United States. Ninety percent of American adults have a cell phone, and 58% of American adults have a smartphone as of January 2014.2 A key feature of the smartphone is the ability to install the “mobile app.” Mobile applications (or apps) are software that can be run on mobile devices and distributed or downloaded via services such as the iTunes store for Apple devices or through Google Play for Android devices.3
The demographic makeup of mobile phone users is similar to the typical practice makeup for clinicians across the country; mobile phone owners are equally distributed across gender, ethnicity, age, educational level, household income, and community setting. Smartphone owners skew slightly younger, with a higher educational level and household income in urban settings.2
These mobile technology users are increasingly using their devices to access and track health information. A 2012 survey conducted by Pew Research found that 52% of smartphone owners have used their mobile phone to look up medical or health information, and 19% have downloaded a mobile app to specifically manage or track their health.4
In addition, Pew Research found that 19% of mobile and smartphone users had used their phones in the last 30 days to get help in an emergency situation.2 Caregivers, now 39% of U.S. adults, use mobile phones to gather health information at significantly higher rates than noncaregivers, going online to find resources to help them provide care and cope with stress.5
Market research confirms that health care providers are increasingly using smartphones for patient care.6,7 The use of smartphones by clinicians can improve clinical communication, integrate the practice of evidenced-based medicine, and allow access to information systems and tools at the point of care.6
The NIH has recognized the potential of the mobile phone and states that this technology could “make a significant difference to public health and health care delivery.”8 With the increasing use of mobile phones in American society, patients will begin to expect their health care providers to be familiar with and use this technology in their care.
Types of applications
For this article, healthcare apps are divided into two main categories−apps for clinician use and apps for consumer use. Mobile apps designed for clinicians can be used for disease diagnosis, drug references, medical calculators, literature searches, clinical communication, hospital information system client applications, chronic disease management, and clinician education.6 The benefits of mobile technology for clinicians include the ability to make decisions more quickly with fewer errors, the ability to improve the quality of care, and better data management.3,1
Consumer health care apps used by patients may focus on many different types of health promotion topics. Mobile apps geared toward consumer patient populations looking to quit smoking include checklists, “quit date” countdown trackers, and financial savings calculators.
There are a plethora of dietary and physical activity mobile apps to help patients eat healthier, record physical activity, and even assist with marathon training. Mobile apps are also being used by consumers to assist them with health monitoring for weight management, reproductive health, and personal chronic disease management. Smoking cessation, physical activity, weight management, and diabetes control are a few areas that have demonstrated improved health outcomes through the use of real-time mobile technology interventions.9
The use of technology provides an opportunity for patients to become more engaged in their care. Making information more accessible to patients or allowing for self-management of chronic diseases with remote monitoring is beginning to make an impact. Patient-centered chronic disease management mobile apps have assisted patients to better control asthma, chronic obstructive pulmonary disease, and diabetes, and to address sleeping problems, hearing issues, and fall risk.6,10
Although most health care mobile apps are unregulated, the FDA issued a guidance document entitled “Mobile Medical Applications” in September 2013. This document provides regulation for medical apps that diagnose or treat disease and function as medical devices, when improper functioning poses a risk to the patient.11
The FDA provided further guidance and discretionary enforcement for apps that help patients self-manage their disease or treatment, such as tools to track their health information, communicate with their clinician, perform simple calculations (e.g., BMI, APGAR score, NIH Stroke Scale score, pregnancy due date calculator), and interact with electronic health record systems. With the sheer number of health apps falling outside FDA jurisdiction and the rapid pace of their development, it is highly unlikely that mobile app certification will be available in the immediate future.12
This regulation only applies to apps that serve as medical devices; the FDA does not regulate wellness or educational apps. Because only a small proportion of the current mobile app market will have any oversight, a great majority of health care apps are still unregulated, which leaves patients potentially vulnerable to misinformation, technology malfunctions, and security breaches.