The Jackson Coker Special Report on Apps, Doctors, and Digital Devices, originally published in October 2011, was featured in an online article today with the headline “80% of Doctors Use Smart phones and Medical Apps in Everyday Medical Practice.” If one delves a bit more into the facts, the 80% quoted in the Jackson and Coker report is derived from yet another study by Aptilon reported in April, 2011by mobihealthnews stating that 61% of physicians had smart phones, estimated to grow to 84% in 2012. It is interesting to note that in none of these studies or articles are there specific statistics for mobile app use. This article, thus quotes a study which quotes another post quoting yet another study, none of which provide data on mobile app use. Another mobihealthnews post, however, did specifically site a study of physicians demonstrating the use of medical apps to be 38%, projected to increase to 50% by 2012. These observations aside, it is now clear that mobile apps are playing a greater role in healthcare. Most physicians do utilize mobile apps for reference purposes. Despite exuberance in the technology community, there is much skepticism and resistance in the medical community about the adoption of medical apps for ‘prescribing’ purposes. Ways in which digital health technologies may be more easily adopted by physicians have been reviewed in a previous post. Some of the potential reasons for pushback by physicians are considered below:
1. Lack of reimbursement. As fee for service continues to be the financial model of most of healthcare today, any additional patient care workload whether it be a new procedure or technology is met first with the question “Is it a reimbursable service?” This is a reality for providers, hospitals, and companies developing the technologies. Changes in reimbursement models, emphasis on hospital cost containment, and the entrance of large corporations to the medical app development industry might mitigate this obstacle
2. Bad taste from EHRs. Physicians are still experiencing the pain of adoption of electronic health records, Though medical apps differ significantly from EHRs with regards in technology, purpose, and ease of use, they might be the objects of a backlash to patient management technologies in general.
3. Many physicians are still ideologically distant from participatory medicine. The Society for Participatory Medicine defines Participatory Medicine as a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners. Many physicians are not used to patients being active partners in healthcare. The paternalistic nature of the way care is delivered still lives in the fabric of medicine today. It is hoped that medical apps are tools which will dismantle this mindset and pave the way for participatory medicine.
4. Medical apps do not represent sophisticated technology. There is a belief in the medical marketing community that unless a technology is robotic, made from materials never seen, performs a task never witnessed, or costs more than $1M, it is neither ‘cool’ enough for a physician to get excited about nor sexy enough for a hospital to advertize that it has the only one on the block. While some apps are connected to relatively sophisticated tools or utilize complex nanotechnology, even apps simple enough as SMS texting can potentially make a significant difference in patients’ lives. Physicians need to get excited about this whole new care delivery model which engages patients, and will hopefully save money and simplify care.
5. Physicians don’t believe medical apps will be effective tools. This could be the biggest hurdle. In its recommendations to the HHS, the Text4Health Task Force recommended “Future health text messaging programs by HHS, or in which HHS is a partner (not specified whether operational partner or reimbursement partner) should also include a scientific evaluation component.” This is neither binding nor refers to other mHealth technology. While all app developers will not be able to afford nor desire to conduct clinical trials, the simple question as to whether an app is effective is a natural and valid one. Well-conducted clinical trials have been performed already for some technologies. Johns Hopkins University’s Global Health Initiative is conducting efficacy studies of medical apps, and should shed some light on this arena.
While these are reasons why physicians might not view medical apps as important tools in their present armamentarium, changes in the healthcare landscape will propel them to prominence.