Propeller Health's respiratory management platform

Mobile apps for clinical management have tremendous potential to help providers and patients to manage chronic ailments together and to expand access to care. However, lack of interoperability with electronic health records, a dearth of outcomes research as well as concerns about reimbursement, regulation and individual privacy are standing in the way, according to a newly published issue brief from the Commonwealth Fund.

"Challenges to broader adoption of apps include the lack of objective research to evaluate outcomes, uncertainty about how to pay for and encourage the use of cost-effective apps, and the absence of a regulatory framework that standardizes development to ensure performance. If this infrastructure is developed, apps may serve as a catalyst to stimulate the transformation of health care generally and target low-income populations to expand access to care and help reduce health disparities," reads the issue brief, co-authored by Sharon Silow-Carroll, New York-based managing principal of Health Management Associates, a research and consulting firm that focuses on publicly financed healthcare programs such as Medicare and Medicaid, and Barbara Markham Smith, a principal in the company's Washington office.

"For widespread adoption to occur, clinical management apps will need to be incorporated into provider reimbursement schemes and integrated into EHR systems and other health information technologies. Such apps also will need to be rigorously evaluated and regulated to ensure their safety, performance, and effectiveness," the paper continues.

"There are still a lot of unknowns," Silow-Carroll explained to MobiHealthNews. "Growth is tempered by these unknowns."

But the landscape is starting to change.

The paper cited a Harris Interactive survey from June that found that more than a third of smartphone owners were very interested in mobile communications with their doctors, either to ask questions, receive test results, request prescription refills or make appointments.

Silow-Carroll said that interest should rise on the provider side as the Meaningful Use EHR incentive program moves into Stage 2, which requires hospitals and medical practices to engage at least 5 percent of their patients through electronic means. "That whole world seems to be getting pushed along a bit by Meaningful Use," Silow-Carroll said.

In the Harris survey, interest was higher for younger demographics. "Moving toward mobile apps also is a generational thing," Silow-Carroll said. 

Silow-Carroll and Smith submitted their work for publication before the Food and Drug Administration issued its final guidance on regulation of mobile health apps. The September move does provide some clarity, but Silow-Carroll was not willing to say definitively that the guidance fixes any underlying problems. "We'd have to take another look at that," she said. UPDATE: Following the publication of this article, the Commonwealth Fund updated the issue brief Nov. 12 to mention that the FDA had finalized its guidance. Silow-Carroll now believes the guidance "should provide consumer and provider comfort with and adoption of approved apps."

The paper said apps for asthma and diabetes management "hold particular promise," and discussed the efficacy of a Bluetooth-enabled sensor from Asthmapolis—now called Propeller Health—that tracks use of rescue inhalers. "Capturing this information enables patients and their physicians to see whether asthma attacks are happening more often in conjunction with certain activities, in certain locations, or on certain days, allowing them to adjust medications and other treatment regimens as needed," the authors wrote.

Apps like these may be of limited usefulness for overall health, however. "Many developers promote single-function clinical management apps," the authors noted. "At the other end of the spectrum, some prominent integrated health systems such as Kaiser Permanente, Group Health Cooperative, and the Geisinger Health System offer their members access to apps to promote comprehensive medical management, from appointment scheduling to patient–provider communication to tools to manage chronic conditions," the paper said.

No matter how functional clinical management apps are, they need to fit into patient routines and provider workflows, and they need to protect privacy, the authors noted. There also needs to be a clear business case to bring mobile apps into clinical care, they added.

"We are waiting for more evidence of the effectiveness and cost effectiveness of these apps," Silow-Carroll said.

"To date, there is little robust utilization and outcomes data on the effects of clinical management mobile technologies, with systematic reviews finding limited evidence of their benefits or mixed results. Some studies have found early indications of added value from use of clinical management apps, but final results are still a few years away," the paper concluded.