COMPREHENSIVE GUIDE TO MOBILE HEALTH/ TELEHEALTH

In 2016, the Journal of Telemedicine and Telecare released a study revealing the distinct benefits of mobile health technology for the elderly population, and many of them centered on increased dependence. But what is mobile health exactly, and how can it benefit you or a loved one?

Mobile Health Defined

Mobile health, sometimes referred to as “mHealth” or “telehealth,” involves using some type of mobile or wireless device to tend to your healthcare needs.

By definition then, mobile health can mean one of two things:

  1. Obtaining medical attention, information, and/or advice via phone, tablet, or some other type of wireless communication device. This is often referred to as telemedicine and examples of this type of mobile healthcare would include using an app to meet with your doctor by video, using website-based chat services to obtain medical advice, or accessing your own medical information via a secure online portal provided by your doctor or healthcare system.

The American Telemedicine Association (ATA) indicates that telemedicine is “a significant and rapidly growing component of health care in the United States,” with approximately 200 networks and 3,500 service sites in use today. Even governmental agencies such as the Veterans Health Administration are regularly using this technology to help promote health and wellness within the populations they serve.

  1. Using wireless technologies to transmit health information to healthcare providers for diagnostic or treatment purposes. Mobile health is also used to describe heart rate monitors, wearable blood glucose monitors, and other types of devices that enable a healthcare provider to track a patient’s health over a certain period of time without having to keep him or her in a medical care facility. This type of mobile health is used to either help identify whether a particular health issue may exist or to ensure that proper treatment levels are being achieved.

Benefits of Telemedicine

The Centers for Disease Control and Prevention (CDC) reports that 84.6 percent of adult Americans have had contact with a healthcare provider at least once in the past year, contributing to a total of 990.8 million physician office visits annually. That amount of time reduces to six months when considering those aged 65 and older, according to the 2016 National Health Survey.

What benefits can mobile health offer this set of individuals? There are many.

  • Provides instant access to healthcare information. As of March 2018, there were 47,911 mHealth apps available in the Apple App Store according to Statista. Some of these require that individuals enter their own health-related information and others collect the data themselves. Either way, applications like these provide individuals with immediate access to their own healthcare information whether they are home, at work, traveling, or anywhere else in the world.
  • Can track own health more easily. Another benefit of telehealth applications is that they allow individuals to more easily track their own health data. No more asking doctors to forward test results and no more being completely unaware of what changes your healthcare provider sees from one visit to the next. Now, you can can simply log-in to the systems and find that information for yourself.
  • Potentially improves recovery outcomes. Research has found that by using a wearable device patients are experiencing more positive results when recovering from cardiac surgeries, engaging in pulmonary rehabilitation, and managing chronic conditions, such as diabetes. This makes mobile health applications an important piece of the patient recovery process.
  • Offers more healthcare options for patients with mobility or transportation issues. The U.S. Census Bureau reports that mobility is the most common disability for Americans aged 65 and older, a factor which can make it much harder for them to tend to their healthcare needs. Plus, some individuals simply lack reliable transportation, making it difficult for them as well. Mobile healthcare solves both of these issues by making it easier for people to receive the care they need without having to physically go to a doctor’s office.
  • Makes it easier to fit tending to one’s health into a busy schedule. A 2015 study published in The Journal of General Internal Medicine found that out of 1,369 participants, 15.6 percent reported that time constraints kept them from obtaining medical care. This included constraints related to being too busy to take the time to see a doctor, as well as being faced with clinics that had inconvenient hours. In this way, mobile health options can help make it much more convenient to fit doctor’s appointments and certain diagnostic testing options into your or a loved one’s schedule, even if there is limited time available.
  • No in-office wait time. The average wait time in a doctor’s office ranges from 13 minutes and 22 seconds to 25 minutes and 57 seconds depending on the state you live in, according to data conducted by Vitals. Not only can this time be daunting, but it can also affect your satisfaction with the medical care you receive. According to Vitals, it was discovered that a wait time in excess of 21 minutes and 55 seconds can turn the experience into a negative one. Thus, not having to physically sit and wait in a doctor’s office for things that you can handle over the internet means more time in your day to take care of all of your other obligations—with a more positive outlook!
  • Repeat and follow-up visits become more convenient. In some cases, healthcare practitioners want to see patients as a follow-up to their initial appointment. In others, such as those related to chronic health conditions, regular visits may be required to ensure the condition is being properly managed. Some of these visits could be handled via video call or by secure messaging systems (email, chat, or text), reducing the need to physically attend what are typically fairly quick visits.
  • Decreases risk of spreading germs. If you’ve ever been in a doctor’s office and ended up sitting next to someone who is sneezing and coughing, then you know how troubling this scenario can be. Rightfully so, because after visiting 10 doctor’s offices, Inside Edition’s investigative team found that one-half of them tested positive for staphylococcus aureus, a bacteria responsible for skin infections and pneumonia. That’s not to say that all healthcare facilities are littered with germs, but if your immune system is already compromised or you simply don’t want to risk getting sick, mobile healthcare options can help lower your risk of picking up the latest germs.
  • Better access to your own healthcare provider while traveling. Some people spend a decent amount of time away from home, either due to traveling or because they may split their time between two different residences. By using telehealth options when care is needed, depending on the application, individuals in these types of scenarios generally have the option of sticking with the same primary care provider—or at least the same healthcare system—regardless of where they are geographically at the time.
  • It’s cheaper. The ATA reports that mobile health options provides costs savings for patients “through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.” This all reduces the amount of money you or a loved one has to spend on medical care.

Potential Telemedicine Cons

Even though there are many benefits to using telemedicine to tend to you or your loved one’s medical needs, there are some cons. Here are a few to consider, courtesy of University of California Berkeley.

  • Diagnosis-related issues. Because you’re simply chatting online or sending in pictures of your medical concern via an app, the doctor’s ability to assess your condition correctly could be somewhat compromised. This may make it harder to get a proper diagnosis and learn what is really going on with you, potentially delaying effective treatment or much worse.
  • Lack of personalized care. When you see the same doctor in person for a number of years, he or she has the opportunity to really get to know you. Subsequently, you get to know him or her as well, so you start to develop a level of trust. This type of bond and trust can be lost with mobile health options, especially if you get a different healthcare practitioner each time you use the application.
  • Connectivity issues. If you’re talking to your doctor via video, you need a steady internet connection or you’re going to run into trouble. Besides, there’s not much worse than being cut off mid appointment only to have to call back and start the whole process over again. This can be extremely frustrating, especially if you aren’t feeling well.

Conditions Doctors can Diagnose, Monitor, and Treat Via Mobile Devices

As a patient or prospective patient, you may be wondering what types of conditions can potentially be diagnosed, monitored, and treated via the telehealth approach. While every application and device is different, here are a few health issues that some practitioners are capable of addressing remotely:

Type of Care Needed Health Conditions
Urgent or Acute Care Allergies, back pain, bronchitis, cellulitis, colds, conjunctivitis, diarrhea, flu, headache, migraine, pneumonia, rashes, sinus infections, skin infections or anomalies, sprains, urinary tract infections, and vomiting
Chronic Condition Care Acne, allergies, asthma, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), diabetes and pre-diabetes, epilepsy, high blood pressure, high cholesterol, hypertension, lung diseases, metabolic syndrome, and thyroid conditions
Preventative Care Metabolic syndrome, smoking cessation, and weight loss counseling
Men’s & Women’s Health Family planning, menopause, premenstrual syndrome (PMS), prenatal care, prostate screening, sexual dysfunctions, and vaginal or yeast infections
Health Monitoring Services Various health conditions including anemia, chronic diseases, inflammation, fatigue, fertility, sleep issues, sexually transmitted diseases, thyroid, and vision in addition to determining whether prescription drug and/or vitamin levels are at healthy and/or therapeutic levels
Mental Health Care Counseling, mood disorders, stress management


Telehealth and HIPAA

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, which was created to ensure that patients’ private medical information is protected as much as legally possible. Traditionally, this has involved actions that healthcare agencies must take in office-type settings, but it now has applications in the online space as well.

That’s why the U.S. Department of Health & Human Services Office for Civil Rights (OCR) has created a web page specifically for health apps and HIPAA rules. On this page, the OCR shares that the only HIPAA-covered entities are “health plans, health care clearinghouses and most health care providers” and their business associates. These include their vendors, subcontractors, and web and app developers. Essentially, anyone who works for or with healthcare companies is required to not discuss or disclose your personal medical information.

However, when it comes to applications where the individual inputs his or her information directly—essentially managing the app without any involvement of a healthcare provider—HIPAA does not apply. For instance, if you download an app and input all of your blood pressure readings for the last six months, that information is not protected under HIPAA.

In short, if the application you use is provided by a HIPAA-covered entity, your medical data is protected. But if the application is one wherein you populate the data yourself and it operates completely independently from your healthcare providers, your data is not protected.

Best Mobile Health Apps

Mobile health apps can generally be divided into two basic categories. One set is full of apps related to improving physical health, and the second set features those used to enhance mental health. So, what are the best ones?

Best physical health apps

Which apps work best if what you want most is maximum physical health? The answer to this question depends largely on your goals. With that in mind, here are some of the most common goals and the top clinically rated apps that can help achieve them:

Goal App
Exercise more often FitBit
Eat healthier, manage your weight Noom
Manage your stress Headspace
Quit smoking Clickotine
Drink less alcohol Drinkaware
Manage your type 2 diabetes BlueStar
Manage your asthma Propeller

You can also do a search for the best apps based on the device you intend to use. For instance, Android Authority shares the 10 best health apps to use if you have an Android, whereas Wearable offers a list of mobile health apps that work in conjunction with the Apple Health app that comes standard on most iPhones and iPads.

Top Mental Health Apps

If you’d like to address your mental health remotely, you can do that too. In the following chart, you can see some of the top-rated mental health apps, separated by whether they are free or if they require either a one-time payment or a regular subscription fee:

App Type Free Apps Premium Apps
General Mental Health What’s Up Mood Kit
Addiction Quit That! Twenty-Four Hours a Day
Anxiety Mind Shift

Self-Help for Anxiety Management (SAM)

CBT Thought Record Diary (Android or iOS)

Bipolar Disorder Bipolar Disorder Connect

Stigma

IMoodJournal
Depression Happify

MoodTools

Talkspace Online Therapy
Eating Disorders Recovery Record

Rise Up and Recover

Lifesum

Obsessive-Compulsive Disorder nOCD Worry Watch

Live OCD Free

Post-Traumatic Stress Disorder (PTSD) PTSD Coach

Breathe2Relax

Schizophrenia UCSF PRIME (Android or iOS)
Stress Calm Headspace
Suicide Prevention MY3


Top Apps if You Want to Speak to a Doctor

What if you want an app that can connect you directly to a doctor? According to Healthline, there are seven telemedicine apps that are top of the line, and they are:

  • MDLIVE: You can usually get a doctor online in less than 15 minutes with this app.
  • LiveHealth Online: This app offers board-certified doctors, therapists, and dieticians, plus some of the doctors are fluent in Spanish.
  • Amwell: Connect with a doctor, dietitian, or psychologist of your choice on this app.
  • First Opinion: Offers free chatting and you’re assigned a dedicated doctor and team so you talk to the same people every time.
  • MyTeleMed: Your doctor has a dedicated phone number so you can leave a detailed message for him or her and your call will be returned after the message has been reviewed.
  • Lemonaid: From receiving a diagnosis to getting a prescription, you can do it all on this app. The online consultations are $25 each and any meds prescribed can either be delivered or picked up at a local pharmacy.

Telemedicine Cost Considerations

The ATA shares that insurance will sometimes cover the costs associated with telemedicine. For instance, Medicare will usually pay for telehealth options that fall under “physician services,” such as those related to remote radiology, pathology, and cardiology services. In certain cases, this insurance program will also pay for videoconferencing and remote patient monitoring.

When it comes to private insurance plans, the ATA reports that 34 states and the District of Columbia currently require private insurance companies to pay for telehealth services the same way they do in-person services. However, it’s always best to check with your individual provider so you know the exact mobile healthcare coverage for your specific medical insurance plan.

Factors to Consider When Choosing a Telehealth Provider

With so many different web and mobile-based applications available, it may feel overwhelming to know which one to choose. To find the one that works the best for you or a loved one, it helps to consider these factors:

  • Cost. How much does the application cost to use or download? What are the costs if you want to speak with a doctor? Are there any additional costs you should be aware of with regard to other services, such as if you need a prescription called in?
  • Ease of use. How easy is the application to open and use? Does it have a logical flow or do you find yourself getting lost while moving through the application? Does it crash often?
  • Communication types. What options does the application offer for getting and keeping in touch with the healthcare professionals on staff? How can you communicate with them? Is it via video, audio, by chat, or text message?
  • Wait time. If you request an online medical appointment, how long does it take to connect with a doctor or other medical professional?
  • Connection quality. Once you’re connected with a healthcare professional, is the quality of the connection good? Can you hear each other okay? If it is by video, are you able to talk without the screen freezing?
  • Doctor-related considerations. Are you connected to the same doctor every time or do you get a new practitioner with each new call?
  • Language. If your native language is not English, does the app offer the ability to speak with a doctor who is fluent in your first language?

When to Make an Actual Office Visit

Even though mobile health is a great way to get medical care without having to take a trip to an actual doctor’s office, there are some instances in which an online doctor isn’t your best option.

For instance, and this may be obvious, but Doctor on Demand says that it cannot treat you if you have multiple broken bones, are experiencing chest pain, are coughing up blood, have lacerations, have experienced a loss of consciousness, need help dealing with pediatric ear infections, have suffered severe burns, or if you have a spinal cord injury or traumatic brain injury.

Essentially, if your illness or injury requires that a doctor perform some type of procedure for your diagnosis or treatment, you need to go to a doctor’s physical office. Additionally, if your injury is severe enough to require immediate medical intervention to prevent severe damage or loss of life, mobile health is absolutely not the best option.

However, if you’re battling a recurring or chronic issue, or have a minor illness or injury, then telehealth may be a suitable and more convenient alternative. And with all of the options available in the mobile health space today, you have many choices when it comes to choosing the best telehealth provider for you.

Sources:
journals.sagepub.com/doi/full/10.1177/1357633X16649790
http://www.americantelemed.org/main/about/telehealth-faqs-
https://www.cdc.gov/nchs/fastats/physician-visits.htm
https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2016_SHS_Table_A-18.pdf
https://www.statista.com/statistics/779910/health-apps-available-ios-worldwide/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391303/
https://www.census.gov/newsroom/press-releases/2014/cb14-218.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/
http://www.commonwealthfund.org/press-release/2016/new-11-country-health-care-survey-us-adults-skip-care-due-costs-struggle
https://www.vitals.com/about/portfolio/wait-time-report-2017
https://www.insideedition.com/investigative/25692-are-dangerous-germs-lurking-in-your-doctors-office-investigation-puts-waiting-rooms-to-the-test
http://www.americantelemed.org/main/about/about-telemedicine/telemedicine-benefits
http://www.berkeleywellness.com/healthy-community/health-care-policy/article/telemedicine-right-you
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
https://hipaaqsportal.hhs.gov/
https://www.doctorondemand.com/what-we-treat/medical

Million Physician Office Visits Annually

Telemedicine is a significant and rapidly growing component of health care in the United States with approximately 200 networks and 3,500 service sites in use today.

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