OK, so it’s going to take some time for mHealth to reach quotidian jargon, healthcare provider acceptance, obtain reimbursement status, and demonstrate improved outcomes with clinical trials. None of this however, interferes with adoption based solely on cost savings without incurring increased morbidity or mortality. Rationing is a hot button word now because we have reached the proverbial blood from the stone healthcare economic Waterloo. It will happen, but can happen in a manner that is not denying appropriate care, but economically (not medically) wasteful care. And mHealth can help in this regard. Apple has created a special silo for medical apps. I think the next step is to have mHealth platforms and apps be called something other than apps. The word connotes entertainment and convenience tools. Health technology deserves a different term if nothing else than to emphasize that it should be utilized daily (if and more so if appropriate), versus 90% of apps that are downloaded and disregarded after a few months. But I digress.
There is a movement afoot to start denying reimbursement for emergency department visits for Medicaid patients for ‘non-emergent’ conditions. The difficulties with classification of entities as non-emergent as well as the choice of targeted population are topics for another forum. However, the initiation of this type of policy in the current healthcare climate should not surprise anyone. Budget experts are proponents of offsetting budget cuts for every incentive or stimulus proposed. Seems logical, right? Well so does having a cheaper alternative in place before significant cuts in healthcare access are imposed. That’s where mHealth comes in.
The spectrum of mHealth technologies is as vast as that of the ‘dot coms’ in years past. Out of these will come a Microsoft, Google, or Facebook that will change the world. Others will be impactful, but not game changers. Still more will be useful to targeted sectors of the population. That being said, mHealth is going to be a part of mainstream healthcare in a big way in the future. The time to which this occurs will be a result of a combination of necessity and significant contribution of specific innovations. There are simple types of mHealth, however, primarily involving communication, that can fit into the system immediately and save money. SMS text messaging between a provider and patient in the system tied to fully functioning patient portals in EHRs is a start. This technology is here! IT is a lot cheaper than ER visits for truly non-emergent conditions. In fact, this technology tied with telehealth technology can even determine a priori in most cases, whether the condition is indeed non-emergent or emergent. This addresses concerns about the lack of human interaction and potential medicolegal concerns to a significant degree. Vital signs glucose monitoring, and other types of technologies are here as well. I am not proposing the use of any specific mHealth technology here, just asking for a wakeup call to get mHealth on the board when significant changes to access as mentioned above are enacted. Nothing is airtight regarding a ‘fix’ to the crisis that healthcare faces today. The Perfect Storm of increased need (by virtue of healthcare reform) and shortages of providers and economic resources is here. We must stop burying our heads in the sand and stop kicking the can down the road. MHealth can help now. We just need forward thinking people who have the authority, coupled with mHealth expert scientists to get together and discuss implementation of the best, simplest, and most cost effective mHealth solutions available NOW to immediately save money. The rest of the ‘dot com’ mHealth movement can then progress with survival of the fittest (read useful, determined in clinical studies, and cost saving).
