Rama Mwenesi sits at his desk, Post-it notes with scrawled writing spread haphazardly around him. This is how he plans his day.
Mwenesi, 24, of Ann Arbor, Michigan, suffered a traumatic brain injury six years ago after several severe concussions from boxing. These injuries have permanently affected his short-term memory and ability to organize. Each Post-it note contains a task he needs to get done that day, which usually include work meetings and appointments with his neurologist. “This is how I cope; this is how I keep track of my life for myself and for my doctors,” said Mwenesi.
Rama Mwenesi writes a memo on a Post-it note to help him remember his tasks for the day.
Mwenesi uses a smartphone with access to assistive health apps. However, he has yet to find one that completely addresses his needs.
A December 2016 study by University of Michigan Medical School assistant professor Karandeep Singh reported that many mobile health apps used by patients to monitor chronic illnesses fall short of their desired effectiveness. Despite the recent push towards mobile health, these apps leave much room for improvement.
Mobile health apps, or MHealth apps, allow users to better monitor their health and send data on their conditions to their clinicians. These apps can save patients money and time by decreasing the frequency of their office visits, increasing their independence, and helping them build better relationships with their physicians. A survey conducted by New York University found that more than half of Americans with smartphones had downloaded mobile health applications in 2015.
However, 85% of the 137 top-rated MHealth apps for chronic illnesses tested by Singh’s team did not respond adequately, if at all, when a patient entered a dangerous or abnormal value that may indicate they are at risk. This is a significant obstacle in mobile health dependence, especially for the underserved population of patients who could benefit most from use of these apps.
“There is literature that says tracking your diet on paper has a real health benefit,” Singh said. . “If we can make our apps one step more powerful than paper, that is when we will have success. Right now, most apps mimic paper, only allowing you to track. We need them to respond.”
TwineHealth, an app for patients with high blood pressure, is one of the few programs that provides immediate feedback to users from their physicians and healthcare advocates. Healthcare advocates are hired by clinics to monitor and educate patients on treatments. TwineHealth allows patients and care providers to develop fitness goals and medication schedules. The records entered by patients appear in real time on their care provider’s dashboard. This app, however, is limited because patients must be linked to one of the few participating clinics in the country.
“It changed my life,” said Tim Samuels, 57, of Charlotte, North Carolina, one of the first patients to test TwineHealth three years ago. When Samuels began using the app, he was entering his blood pressure every day due to consistently high cholesterol levels. For the following six months, Samuels’ healthcare advocate carefully tracked his daily records, sending encouraging reminders and tweaking his care with his physician.
“Now, I only check in once a week,” said Samuels, who has lost weight and maintains much healthier cholesterol levels. “They still keep me accountable, still send me messages, and I can ask questions. When I was entering my blood pressure every day, it really put my focus on good health and it became more of a routine.”
Samuels said the ease of communication with his clinic was the most beneficial. With physicians in high demand, giving each patient personal attention is often a difficult task.
“Every physician would love to spend more time with their patients, but in a healthcare system that is largely driven by profit, spending more time with patients every day means seeing fewer altogether,” said Dr. Lorraine Buis of Family Medicine at the University of Michigan Medical School. Despite the fact that Samuels’ physician intermittently checks in on his records, the healthcare advocate at his clinic is still his primary tracker and responder within the app.
Buis is working to develop a similar blood pressure monitoring app, BPTrack. BPTrack focuses on building a stronger relationship between patients and pharmacists, who are equally as qualified as physicians to prescribe medication and alter treatments, unlike healthcare advocates.
“In reality, doctors aren’t going to look at all of your health records before meeting with you every time,” Buis said. “We could be using other resources, other medical professionals, who are often more available.” BPTrack targets pharmacists to work with patients on balancing their cholesterol levels, and this instant feedback from trusted healthcare providers will become the standard for all mobile health apps.
Both Singh and Buis say there are still several obstacles to overcome before responsive applications like TwineHealth and BPTrack can become large-scale successes. For instance, majority of underserved patients with Android devices cannot use BPTrack due to incompatibility issues stemming from varying phone versions.
Additionally, self-management of health requires self-control. There is no guarantee that patients will have their phones on them to receive necessary reminders. “Some patients will do everything their physicians tell them, and some patients have no desire to listen to anything their physicians say. This method of treatment is only effective for a specific group of people,” said Buis.
Another obstacle is data security. About 60% of the apps that Singh’s team tested used insecure methods of data sharing from patient to physician, such as through text messaging or email, making health records more vulnerable to theft. Only one app in the app store allows users to enter data directly into electronic health records, which is the most secure and ideal way to transfer information.
According to a report by the National Science Foundation, the transition to more secure data sharing will be difficult because it requires a much higher level of privacy expertise from developers and more complex platforms to handle necessary computational compatibility.
Despite these hurdles, mobile health apps have the potential to make a real impact in the lives of patients globally.
“I’ll say it once, and I’ll say it again. It saved my life,” said Samuels about TwineHealth. “The only improvement I could ask for is that it start doing the work for me,” he chuckles.