mHealth: Doctor in your pocket

Elena O'Meara
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Since the eHealth Law took effect on January 1, 2016, it has become apparent that digitization also affects the healthcare system. Its objective is to improve the digital infrastructure of healthcare. For several years, a subcategory of electronic healthcare solutions has enjoyed increasing popularity: mHealth.

The term mHealth stands for mobile health. "It refers to electronically assisted healthcare through the use of mobile devices such as smartphones, tablets, wearables or smartglasses," explains Dr. Urs-Vito Albrecht, Director of the multidisciplinary research team PLRI MedAppLab, which studies the use of health apps for medical purposes.

According to a 2016 study by Deloitte and Bitcom e.V., approximately 79 percent of German residents own a smartphone. Of these, 42 percent have downloaded at least one health or fitness-related app on their device, which in turn is being used daily by about 39 percent of Germans.

The market features many fitness apps that simplify training tracking. Nutrition apps offer advice in terms of recipes and calorie content. And thanks to reminder apps, users won’t forget to take their medications or drink a sufficient amount of liquids.

Having said that, it is not always easy to determine whether some apps represent an actual medical device or a mere lifestyle product. According to the German Federal Institute for Drugs and Medical Devices, only a fraction of the more than 100,000 available health apps are considered medical apps in the strictest sense. Only two percent meet the stringent standards set by the Medical Devices Act. It stipulates that a health app is only admissible as a medical device if it serves "the detection, prevention, monitoring, treatment or alleviation of diseases."

Patients with chronic conditions also benefit from mobile helpers

Though many of the available solutions encourage a healthier lifestyle, they are not necessarily required to ensure health. Yet a range of other mobile options is especially useful for patients suffering from chronic diseases such as diabetes, high blood pressure or asthma. Next to athletes and overweight people, patients with chronic diseases represent the mHealth market’s largest target audience.

The study titled "mHealth App Developer Economics" by research2guidance sees a correlation between the prevalence of chronic diseases and the success of health apps. The study finds that there is a strong trend towards patient-centered care where the patient takes an active role in managing his/her disease. Thanks to mHealth, patients increasingly become experts in all facets of their disease. They are reminded to take their medication, are able to document side effects and parameters and monitor their condition on their own. It ultimately makes it easier for the attending physician to treat the disease thanks to the transmitted data. What's more, the patient does not have to spend time on actual office visits.

At this point, nearly one-quarter of more than 20 million patients with chronic diseases in Germany have a connected monitoring system that is able to communicate with a mobile device.

Disease management with apps and wearables.

Due to the increase in average life expectancy, the proportion of chronically ill people in our society is growing. They are thus a popular target group for the mHealth market.

Checking your blood glucose, calculating your insulin dose, documenting the results – diabetics are tasked with managing their diabetes on a daily basis. Blood glucose meters, insulin pump systems and sensors that automatically handle many of these tasks without the need for patients to constantly being concerned by their disease promise to make life significantly easier. Abbott's FreeStyle Libre is a glucose monitoring system with an integrated sensor where a tiny needle pushes under the skin when the device is attached. The measured glucose level can be scanned and interpreted by a corresponding reader device or a smartphone app.

The MyTherapy app by SmartPatient is designed to not only remind patients to correctly take their medication on time but to also document and analyze patient values. Another available option is to schedule activities, rest periods and appointments. The app creates an individual task list with assignments to be checked off daily. One added incentive: users can directly see whether they have met their self-imposed goals and thus assess their own progress. The app's research partner is the Charité Berlin, whose pilot study revealed that users with chronic diseases noticed a "significant improvement in adherence and improved mental wellbeing".

Prospects and risks of mHealth

Data protection plays a key role, especially in the age of digitization. Many users are still skeptical when it comes to entering their personal health information, even though data protection regulation for health apps has become very extensive by now. Meanwhile, by accessing this information, physicians recognize great opportunities in understanding and diagnosing patients. "It would be a great help if they could receive reliable and sensibly processed information," emphasizes Julia Hagen of Bitcom e.V..

In fact, one risk of health apps is a potential misdiagnosis. Experts caution against strict obedience to concrete treatment recommendations and encourage healthy skepticism in users. "App companies are often newcomers to the healthcare sector and lack the sensitivity that’s necessary to ensure quality during the development in this area," explains Dr. Albrecht. As a result, you can find both safe and premium products and products of inferior quality on the market in equal measure. Today, especially younger people are used to rely on information technology in everyday life without spotting the difference in quality or questioning the reliability.

Special online portals like AppCheck or HealthOn offer support when people make their selection. Here users can obtain information and ratings of health apps and find answers to data protection concerns and the health benefits of respective apps. Last year, the Federal Ministry published the CHARISMHA study, which pinpoints the prospects and risks of health apps and encourages developers to make all information in the app descriptions transparent to users. This also pertains to the qualifications of the writers.

That being said, in addition to the existing weaknesses, the head of the study, Dr. Albrecht, also sees one crucial advantage of mHealth applications. "They are very convenient and deliver high performance, and can be seamlessly integrated into everyday life and the particular life situation."

Will smartphones soon replace an office visit?

Reliable reminders, easy documentation, and accurate data evaluation – even though these mobile options make it considerably easier to manage a disease, they are only supplementing a medical treatment managed by a physician. Dr. Albrecht attests that "although mHealth undoubtedly supports various healthcare processes, mHealth will generally speaking not make a doctor's visit obsolete, and that is actually not its goal in the first place." This is also why the physician-patient relationship or the doctor's advice will remain an integral part of the treatment in the future.

mHealth: Doctor in your pocket