COMMENTARY

The Big Problem With Mobile Health Apps

David Lee Scher, MD

Disclosures

March 04, 2015

In This Article

Security and Privacy Issues

Although security and privacy are always of paramount concern to users of any type of app, their importance is magnified in healthcare. We are required to protect patient information when downloading and using an app. We are not security experts, and we are justified in expecting the apps we use to be free of viruses and malware.

Health Insurance Portability and Accountability Act (HIPAA) protection comes from both how information is handled by the app itself (which is the responsibility of app developers), as well as security measures, such as using strong passwords for our devices (which is the responsibility of hospitals and physicians).

Until security and privacy can be assured, the use of apps by physicians will continue to be limited. In response to requests from mobile medical app developers, the federal government has said that it will better define HIPAA standards to ensure app compliance.[9]

The Problem of Data Overload

Apps will collect lots of data. Our worst nightmare would be receiving a deluge of useless information at all times of the day or night. The transmission of only data that would cause us to change a treatment plan is what would make technology beneficial to us, and what we must demand.

This remains a challenge. Most technology developers—who have neither a clinical background nor solicit advice from clinicians—don't seem to understand that unfiltered data merely create information overload. This isn't useful in patient monitoring.

Do we really care how many steps a patient takes or what the patient's average heart rate is every day? Built-in tools called "analytics," which can filter out the useful information from the noise, are what is missing from most apps today.

Reimbursement Issues

If remote technologies are to serve as patient management tools, then the review of information provided to us and the counseling of patients on the basis of these data are tasks we should be paid to perform. Payment for monitoring noninvasive as well as implantable cardiac rhythm-monitoring devices has existed for decades.

The federal government realizes the potential benefits of remote patient management for chronic conditions. The Centers for Medicare & Medicaid Services recently decided to allow monthly payments for monitoring of chronic disease states with remote technology.[8] This will involve the use of app/device combinations, with many apps residing on smartphones and many devices functioning as smartphone attachments.

Commercial insurers will need to follow suit if app adoption is to become more widespread among physicians. This is already starting to happen. For example, WellDoc in Baltimore, Maryland, a company that uses mobile technology to improve disease management outcomes, has developed a product called Bluestar®. It's the first app-based disease therapy to be cleared by the FDA for adults with diabetes—and doctors who use it to monitor their diabetic patients are being reimbursed by commercial health plans.[10]

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