A Review of the midyear progress of mHealth

A Review of the midyear progress of mHealth focuses on several mHealth IPOs,  specifically Fitbit and Teladoc.

They serve two separate niches, fitbit in the area of mhealth wearables, and Teladoc as a provider-patient centered application allowing remote video patient encounters with physicians.

Several transformative shifts are occuring between mHealth and EHR integration. In some cases mHealth is driving EHR integration.

Our blog today offers a quick centralized source for progress in mHealth application development.

Will mHealth's rise signal the end of the EMR?

One of the hot trends is the integration of patient-facing data into the electronic medical record. 

EPIC , is developing it's own mhealth application in concert with Apple's Healthkit. Epic has begun to offer details about what the platform will look like when the kinks are finally ironed out. 

From Epic's new app store to Validic's partnerships with Cerner and athenahealth (to name just a few), EMR platforms are evolving to accept health and wellness data from devices to better define a patient's profile outside the medical encounter.  "It's not just physician documentation any more," says Girish Navani of eClinicalWorks. "The patient is part of that equation … but there have to be filters."  Consumers, she says, "are more involved in their healthcare, which puts the onus on (clinicians) to work with them, but we haven't seen much good data come out of the FitBits and other consumer-facing devices" that would make a doctor sit up and take notice.

 EHRs and wearables - their time has come?]

The convergence of two industry titans, Apple and Epic portends another swift sea-change fueled by adequate capitalization of IPOs and equity funding. Does this mean the EMR is becoming obsolete? Or is it evolving into an EHR?

Much of the conversation between a doctor and a patient focuses on what the patient is doing outside of the doctor's office – in other words, the doctor is looking for data that today's health and fitness wearables are collecting. This means that all that information in the margins is now being pulled into the record.

Providers say they don't want all that extra information coming into the medical record, but they can't deny the value of health and wellness data in developing a care management plan for their patients. They're worried about validity – is data entered by the patient reliable enough to be included in clinical decision support?

At this point, the answer is no, and mHealth vendors and EMR providers understand this. As Navani points out, the data has to be curated first – collected, sifted and organized into something that a provider can trust and ultimately use. Some EMR companies tackle this issue by shunting consumer-entered data into a PHR or similar silo; the consumer then grants permission to the provider to parse over that data and determine what can be pulled out and ultimately entered into the medical record.

f that's the case, then this truly is a health record, not a medical record.

The proliferation of consumer-facing apps and devices has also given rise to a dichotomy in how mHealth data is collected. On one side stand platforms like Apple's HealthKit and ResearchKit, which gather consumer data for use by healthcare providers. On the other side are platforms like Qualcomm Life's 2net hub, which takes data from reliable devices – not the consumer – and goes to great lengths to ensure that such data is "medical grade."

Can both data streams share space in the same record? That depends on how EMRs and EHRs are defined.

Digital Health May No Longer be a Slow Sell

Though there have been notable exceptions, digital health has often proved a slow sell to the medical establishment. The failures of Google Health and HealthVault to gain traction, for example, underscore the challenges of breaking into the workflow of doctors.

Yet over the past month, three technology giants have, in the form of a series of launches, given an endorsement that digital health will be one of the next important technological trends. From Google has come an API infrastructure called Google Fit. From Samsung,  the data platform SAMI, and from Apple the developer tool HealtlhKit

Healthkit for Sporty Types

Hype or Hip ?

What’s changed to prompt these companies to jump into the digital health all at once? I would argue that the wearables revolution that is currently underway demonstrates that the technology industry has realized that consumers, not the medical establishment, will drive adoption — and that this is fast-tracking the pace of change.

That doesn’t demote the role of the health care establishment in the question of whether this trend proves lasting. Even purpose-build musculoskeletal registries have had difficulty winning the trust of physicians, and it remains to be seen whether the data collected by the current community of health apps and tracking devices is of sufficient quality to create individual-level, real-time health and wellness predictions. To determine this, large-scale validations of insights will be necessary.

It is becoming apparent to all in the industry that data is perhaps the most precious commodity available to digital health and wearable tech firms, and data becomes more valuable when it encompasses multiple perspectives on the same individual. With the explosion of the Internet of Things, users now record their daily activities in several ways, but often in separate locations. Until now there wasn’t any value in sharing these reams of data — not much could be done with them. But with an increased focus on analysis and the provision of insights, this is changing.

Concurrently, with bigger companies offering analytical tools and platforms, a “plumbing system” for the data is becoming a reality. This will provide more exposure to smaller, true data democracy driven startups that are attempting to create a culture of reciprocal data sharing necessary to increase the complexities of  analysis done on wearables data. Indeed, my prediction is that a large number of secondary analysis companies will emerge from the entry of the tech giants and add value to existing devices that have thus far demonstrated poor long-term engagement numbers.

Overall, the latest announcements give me hope that the emergence of wearable tech will become a positive influence on population health and solve some tough problems faced by the medical establishment. The entire world is being faced by a crisis of chronic, non-communicable diseases. Wearables provide one behaviorally-focused tool that may slow or reverse the disease trends and crack the code of wellness for a large segment of society.

Jesse Slade Shantz is an orthopedic surgeon who blogs at The Doctor Blog.