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AMA Approves List Of Best Principles For Mobile Health App Design

Posted on November 29, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The American Medical Association has effectively thrown her weight behind the use of mobile health applications, at least if those apps meet the criteria members agreed on at a recent AMA meeting. That being said, the group also argues that the industry needs to expand the evidence base demonstrating that apps are accurate, effective, safe and secure. The principles, which were approved at its recent Interim Meeting, are intended to guide coverage and payment policies supporting the use of mHealth apps.

The AMA attendees agreed on the following principles, which are intended to guide the use of not only mobile health apps but also associated devices, trackers and sensors by patients, physicians and others. They require that mobile apps and devices meet the following somewhat predictable criteria:

  • Supporting the establishment or continuation of a valid patient-physician relationship
  • Having a clinical evidence base to support their use in order to ensure mHealth apps safety and effectiveness
  • Following evidence-based practice guidelines, to the degree they are available, to ensure patient safety, quality of care and positive health outcomes
  • Supporting data portability and interoperability in order to promote care coordination through medical home and accountable care models
  • Abiding by state licensure laws and state medical practice laws and requirements in the state in which the patient receives services facilitated by the app
  • Requiring that physicians and other health practitioners delivering services through the app be licensed in the state where the patient receives services, or will be providing these services is otherwise authorized by that state’s medical board
  • Ensuring that the delivery of any service via the app is consistent with the state scope of practice laws

In addition to laying out these principles, the AMA also looked at legal issues physicians might face in using mHealth apps. And that’s where things got interesting.

For one thing, the AMA argues that it’s at least partially on a physician’s head to school patients on how secure and private a given app may be (or fail to be). That implies that your average physician will probably have to become more aware of how well a range of apps handle such issues, something I doubt most have studied to date.

The AMA also charges physicians to become aware of whether mHealth apps and associated devices, trackers and sensors are abiding by all applicable privacy and security laws. In fact, according to the new policy, doctors are supposed to consult with an attorney if they don’t know whether mobile health apps meet federal or state privacy and security laws. That warning, while doubtless prudent, must not be helping members sleep at night.

Finally, the AMA notes that there are still questions remaining as to what risks physicians face who use, recommend or prescribe mobile apps. I have little doubt that they are right about this.

Just think of the malpractice lawsuit possibilities. Is the doctor liable because they relied on inaccurate app results collected by the patient? If the app they recommended presented inaccurate results? How about if the app was created by the practice or health system for which they work? What about if the physician relied on inaccurate data generated by a sensor or wearable — is a physician liable or the device manufacturer? If I can come up with these questions, you know a plaintiff’s attorney can do a lot better.

E-Patient Update: Time To Share EMR Data With Apps

Posted on November 18, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Like most Americans, I’ve used many a health-related app, in categories including vitals tracking, weight control, sleep management, medication management and exercise tracking. While I’ve continued to use a few, I’ve dropped most after a few uses because they didn’t contribute anything to my life.

Now, those of you who are reading this might assume that I lost interest in the apps because they were poorly designed. I admit that this was true in some cases. But in others, I’ve ceased to use the apps because the data they collect and display hasn’t been terribly useful, as most of it lives in a vacuum. Sure, I might be able to create line graph of my heart rate or pulse ox level, but that’s mildly interesting at best. (I doubt physicians would find it terribly interesting either.)

That being said, I believe there is a way healthcare organizations can make the app experience more useful. I’d argue that hospitals and clinics, as well as other organizations caring for patients, need to connect with major app developers and synch their data with those platforms. If done right, the addition of outside data would enrich the patient experience dramatically, and hopefully, provide more targeted feedback that would help shape their health behaviors.

How it would work

How would this work? Here’s an example from my own life, as an e-patient who digitally manages a handful of chronic, sometimes-complex conditions.

I have tested a handful of medication management apps, whose interfaces were quite different but whose goals seem to be quite similar — the primary one being to track the date and time each medicine on my regimen was taken. In each case, I could access my med compliance history rather easily, but had no information on what results my level of compliance might have accomplished.

However, if I could have overlaid those compliance results with changes in my med regimen, changes in my vital signs and changes in my lab values, I have a better picture of how all of my health efforts fit together. Such a picture would be far more likely to prompt changes in my health behavior than uncontextualized data points based on my self-report alone.

I should mention that I know of at least one medication management app developer (the inspiration for this essay) which hopes to accomplish just this result already, and is hard at work enriching its platform to make such integration possible. In other words, developers may not need much convincing to come on board.

The benefits of added data

“Yes,” I hear you saying, “but why should I share my proprietary data?” The answer is fairly simple; in the world of value-based reimbursement, you need patients to get and stay well, and helping them better manage their health fits this goal.

Admittedly, achieving this level of synchronization between apps and provider data won’t be simple. However, my guess is that it would be easier for app developers to import, say, pharmacy or EMR data than the other way around. After all, app platforms aren’t at the center of nearly as many overlapping data systems as a health organization or even a clinic. While they might not be starting from zero, they have less bridges to build.

And once providers have synchronized key data with app developers, they might be able to forge long-term partnerships in which each side learned from the exchange. After all, I’d submit that few app developers would turn up the chance to make their data more valuable — at least if they have bigger goals than displaying a few dots on a smartphone screen.

I realize that for many providers, doing this might be a tall order, as they can’t lose their focus on cultivating their own data. But as a patient, I’d welcome working with any provider that wanted to give this a try. I think it would be a real win-win.

mHealth App-makers Must Develop Privacy, Security Standards

Posted on November 30, 2015 I Written By

The following is a guest blog post by Jon Michaeli, Executive Vice President of Medisafe

In recent times, consumers have developed a rapidly-growing interest in mobile health apps. In fact, more than half of the 1,600 mobile phone users surveyed recently by a New York University research team had downloaded at least one such app. And signs suggest that user uptake of mHealth apps could grow dramatically over the next few years.

But consumers’ adoption of mobile health apps is being held back by concerns that their health data isn’t safe.  Nearly half of consumers surveyed told Healthline that they’re afraid hackers may try to steal their personal health data from a wearable, and one-quarter of respondents said that they don’t believe app or health tracking data is secure.

We believe that it’s time for mHealth app developers and vendors to take a stand on mobile health data privacy and security. Consumers have the right to exchange private health data securely, and to be sure that data is never stolen or shared with unauthorized parties.

But until we develop industry-wide standards for protecting mobile health data, it’s unlikely that we’ll be able to do so. To make that happen, we welcome the creation of a broad industry coalition to create these standards.

Security fears justified

Concerns over the security and privacy of mHealth data are well-founded. Less than one-third of the 600 most commonly-used mHealth apps have privacy policies in place, according to recent research published in the Journal of the American Medical Informatics Association. Another study, by HIMSS, suggests that health IT leaders are just beginning to scope out their mobile health security strategies.

Worse, some practices engaged in by app developers pose a clear risk to users’ health data. For example, some health apps use a Social Security number as a “secure” user method of validating user identity. Unfortunately, Social Security numbers are often stolen during hacking exploits, and they’re fairly easy to buy online. Thieves have a powerful incentive to steal SSNs, as health data now sells for 10 times the prices of credit card numbers.

Once SSNs are obtained by the wrong party, the results can be catastrophic. If I obtain a user’s SSN and download their claims data, I might find out that they, for example, take meds used to treat psychiatric conditions or HIV. Malicious parties could conceivably use this information to blackmail someone, expose them at work or in the community, outflank them during a divorce or worse. There’s a reason that SSNs sell for 10 times the price of a stolen credit card number on the black market.

Not only that, even among those who post privacy policies, few app developers make it clear how they address privacy issues. Developers often fill their policy write-ups with jargon and deceptive language. And few consumers are informed enough to demand plain, straightforward disclosures in areas that may affect them. For example, they may not be aware that their privacy could be compromised if the app pulls data from outside sources without requiring an additional login and password.

Those opaque privacy policies may also conceal questionable data-sharing practices, such as the sale of personal data. If individually-identifiable data gets shared with the insurance industry, insurers might use this data to reject applications for coverage. Pharmaceutical companies could leverage this data to market meds to such consumers. Employers could even buy such data to screen out sick applicants. The possibilities for harm are great.

Time for mHealth security standards

Fortunately, mHealth vendors that want to boost security and privacy protections don’t have to start from scratch. Practices and standards already in place in healthcare IT departments provide a good foundation for mHealth app developers. Certainly, consumers need to play a role in protecting their own health information, by taking a responsible and smart approach to app use, but we have obligations too.

First, we should assume that any mHealth app must meet HIPAA standards for protecting patient health information (PHI). Requirements include making sure users are who they claim to be (authentication), seeing that PHI isn’t altered prior to reaching its destination, and assuring that data is encrypted at rest, in transit and when stored on independently-managed servers.

Also, if PHI is being exchanged, mHealth developers must be sure that any third-party apps integrated into our health app also meets HIPAA requirements. And we need to verify that compliance. If connected third parties are compromised, the app isn’t secure either.

But above all, our industry needs to establish privacy and security standards that meet the unique needs of mobile health environment, standards which evolve as mHealth changes. I believe it’s high time that the mobile health industry leaders collaborate and create these standards. Otherwise, we may fail in our ethical obligations and do lasting damage to consumer trust. We invite other mHealth app vendors and their partners to join us in collaborating to protect consumers.

Jon Michaeli is Executive Vice President of Medisafe (www.medisafe.com), a cloud-synched platform which helps consumers manage their medications.

All I Got for Christmas was a New Digital Health App

Posted on December 26, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Last week, I wrote that “All I Want for Christmas is a Doctor’s Appointment.” Turns out what I got – a flu-like cold – put that need into perspective. As luck would have it, I had recently read an article by fellow Healthcarescene.com blogger Neil Versel about AskMD, a new app from the folks at Sharecare. Being a mother of two children who are both in school, and thus exposed to their fair share of colds, I thought I’d get good use out of the symptom checker, which Versel explains, enables users to “choose which symptoms they are feeling and then see which potential health issues they might have. The app then walks the user through a “consultation” in which the app will ask the user a series of questions to identify more specifically what the symptom feels like, when it started, and if there are any other symptoms accompanying it. After the “consultation,” the user can enter in any information about medications that they are taking. When users have finished entering information, AskMD generates a list of potential problems the user might have ordered by the commonality of the potential problems.”

Before rushing to try and make an appointment with my local primary care physician during Christmas break, I decided to give AskMD a whirl. Anything that could potentially save me a co-pay, crowding into a waiting room with other sick folks, and then ultimately being told by my kindly nurse practitioner that the only treatment is rest and fluids, would be beneficial. After entering in an initial main symptom, the app took me through a series of 19 questions, resulting in a list of 11 possible causes, plus a link to find physicians and prepare for my visit. The list of physicians was helpful, and I was surprised to see that Cartersville Medical Center, where I had surgery over the summer, sponsored the results. It’s promising to see small, community hospitals are recognizing the importance of digital health tools.

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While a nasty cold wasn’t something I had bargained for over the holiday, it’s nice to know that a digital health app can bring me some peace of mind as I decide whether to treat my symptoms at home, or ultimately go into the doctor’s office. What digital health app did this Christmas bring your way? Or perhaps a new EMR was on your wish list? Let me know what health IT tools you’ll be ringing in the new year with in the comments below.

Prescribing Health Apps

Posted on July 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was really intrigued by an article in Forbes by David Shaywitz that takes an interesting look at Digital Health and why “pills still matter.” This paragraph sums up the article quite well and provides some interesting points of caution for those in Digital Health.

I read a tweet recently asserting that physicians may soon prescribe health apps as an alternative to medications; my initial reaction: good luck with that one. It’s certainly easy enough to envision how magical thinking about the power of health apps will soon be replaced by disappointment as app developers realize something drug makers have known for years: it’s hard to improve health, and it can be very difficult to get patients to stick with a treatment long enough to make a difference.

I’ve been watching the idea of prescribing an app for quite a while. In fact, we’ve written about the “virtual pharmacy” on Smart Phone Healthcare a few times. Plus, I’ve talked a number of times with John Moore about his new company Prescribable Apps. Isn’t that the perfect name for an mHealth company?

Everyone has to agree that the concept of being able to prescribe something as simple as a mobile app that can improve your medical condition is very cool. Although David Shaywitz’s warning is a good one: It’s hard to improve health, and it can be very difficult to get patients to stick with a treatment long enough to make a difference.

He’s absolutely right that those are the challenges for mobile health apps. Although, while that is the challenge of mobile health apps, as an entrepreneur it is also the huge opportunity. It will be hard for a mobile health apps to really improve health. Although those that do achieve that noble and important goal will receive a HUGE reward. Just like pharmaceutical companies that discover a new drug that improves health end up with a huge financial windfall, the mobile health apps will see the same result.

Of course there are a lot of important questions about how to know which mobile health apps really do improve health. What’s going to be the filter? Who and how will we measure the effectiveness of all these apps? Then, of course will there be someone monitoring the mobile health apps the way we monitor drugs? Many of these questions will need answers, but I’m quite certain that some mobile health apps will improve health and those that do will be very successful.

I wonder if any EHR companies have thought about how to integrate mobile health app prescription into their EHR. It’s a bit premature to really do so, but I’ll be interested to see how they make it happen.

How to Track Your Health – Jump on the Self-Logging Bandwagon

Posted on February 6, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Last week, I wrote about Margalit Gur-Arie’s idea for a national health data repository. Commenters, including Gur-Arie, had some great comments. And one of the things that came out of that post was that if there is ever a community run national database, I would happily log my health data into it, and maybe do it for my parents and kids as well. But I don’t really have a great track record of health-logging. I’m not a Quantified Self afficionado, I don’t even check my weight on a regular enough basis. Having my husband photograph me and gauging my weight by the relative puffiness of my cheeks is what constitutes a weight check in my universe. So what are the odds of me going through piles of paper records and typing it all up for a UHR? Slim to none, but a girl can still dream.

Wired published an article late last month on How to Use Tech to Track Your Health, just for people like me. Don’t worry, assures the article, self-logging ain’t that hard, it’s probably so easy even a cavewoman can do it.

Now, just because the article is on Wired doesn’t mean it comes with awesome pedigree and stellar writing. People, it’s 2012, not 1992. If I hear about one more app that sends you text reminders about getting your annuals done, I’m going to barf. Ditto for those tired ovulation trackers. I don’t know who I blame more. the tech companies that come up with these novel solutions after every iPhone developer and their mother has already created a dozen apps and websites around the idea, or the Wired writer who thought it was newsworthy enough to include in her round-up of the most happening ideas. Either way, I don’t care. I don’t want to know about any more reminder and calendar apps, not unless this magical app connects me directly to someone like Simon Cowell or Idris Elba (ok, I have a thing or two for Brit accents). See, there’s a business idea for you – have celebrities become our health coaches and cheerleaders. Some of us might be ready to pay for the privilege.

There are the usual sleep-pattern analyzer apps and personal sleep coaches that help you get a good night’s worth.

Kvetching aside, not everything in the Wired article sounded like it was floated circa the 1900s. I quite liked reading about the BodyMedia biometric patch that apparently works like one of those ciggie patches, and logs your sleep, heart rate etc for upto a week. It is intended to be used a week prior to your appointments, presumably so you can bombard your doctor with the aforesaid minutiae. I also liked the Moodscope idea – you can go to the Moodscope website and play a game, and your reponses to the game are used to gauge your mood. I can imagine how useful that could be to people who might be prone to depression or who want to chart what external stresses produce what reactions in them.

I haven’t used any of the apps or gadgets mentioned in the article, so I’m just reacting at a very surface level to the idea behind the product/service. And your mileage may, of course, vary.

Check it out here.