Developments in both the sophistication and affordability of mobile technologies using custom-designed hardware and software are changing how healthcare is delivered, received and researched. Healthcare workers and pioneers alike are embracing mobile technology, including social media educational tools, mobile apps, wearables and other digital tools.

Ambulatory monitoring or telemonitoring has been routine practice for preventing heart failure for many years (1). However, recent advances in smartphone and tablet technology have allowed the development of highly integrated and complex information systems. Mobile technology removes geographical and temporal boundaries by remotely communicating and monitoring real-time physiological information guaranteeing user interoperability, and importantly– connectivity. These functions, including more basic features (such as automatic reminders for medication or therapy) could hugely benefit the efficiency and quality of healthcare.

How does this influence healthcare systems and how it is likely to evolve in the future?

The potential for doctors and nurses to monitor patients remotely through internet-connected devices could streamline healthcare systems. On-duty doctors could receive the required data such as blood glucose levels, ECG data or mood ratings; then diagnose, prescribe treatment as well as monitor therapeutic effects via remote monitoring; and share this patient data on a centralised system.

Mobile technology could vastly reduce administration times, permitting knowledge transfer and faster decision-making and delegation of tasks – compared with the current system of handwritten notes, fixed terminals and pagers – drawing nurses away from their patients. Mobile and digital technology could allow nurses be at their patients’ bedsides whenever required ultimately improving the quality of care.

Outpatients and caring at home

There is also a desire to shift the point of care to the outpatient setting and the patient’s home, and this necessitates innovations in technology. Mobile technology is already popular in several specialist medical fields, including oncology, cardiology, diabetes and mental health.

Currently available mobile technology allows earlier diagnosis as well as both long-term and long-distance monitoring of patients with cardiovascular diseases(2). Healthcare costs and hospital admission can be reduced by remotely monitoring cardiac patients using implantable devices (3). Post-hospital patients can benefit from routine ECG measurement and data transmission from home to hospital; data captured by ECG devices at home by patients are transmitted to the hospital using wireless networks and the internet (4). Likewise, the field of oncology has many relevant apps at its disposal (5)and a recent pilot study of these shows great promise in monitoring in-hospital chemotherapy as well as management and treatment of cancer at home (6).

Application of mobile technology in diabetes mellitus care is making rapid strides and could transform how this condition is managed for both patient and practitioner: self-reported glucose data can transmitted, amassed with relevant physiological data, and analysed (7); data-support apps can assist with decision smaking, and in some cases direct patients to make decisions without their clinician’s input (8). Facilitating a holistic approach, patients with diabetes can use the information presented by apps to help guide their choices of medication doses, foods, or exercises.

Currently, diagnosis of mental states has been based on subjective self-reporting by patients. However, although a relatively new application in psychiatry, using mobile technology the emerging data is very encouraging with respect to both assessment (9) and intervention (10).  Mobile technology can be used for measurements (e.g., functional behaviours, mood states, and psychotic symptoms), and providing unique information concerning relationships between daily life contexts, behaviours, and experiences.

Mobile technology in research

Underlying mechanisms of disease can only be understood by measurements of physiological parameters. The generalisability of these measurements to real-life settings can be limited when using questionnaires or tests performed in practices or hospitals. The ultimate goal for clinical researchers is to be able to provide biological markers (biomarkers)of disease, in order to assess and diagnose patients on a very individual basis. By utilising these novel technological tools – including mobile applications and handheld microcomputers like smartphones and tablets, there is an opportunity to measure physiology, cognition and other behaviours and to proactively treat conditions in patients before complications have progressed.

Considerations, limitations and future refinements

The torrential amount of data streaming from such devices must be managed efficiently, as doctors will not have time to analyse this information unless it leads to improved patient outcomes, time-saving, or economic benefit. Therefore mobile app software for decision support must be developed to deal with interpretation of this physiological data. According to an Ipsos report, the future application of mobile technology in healthcare must be clarified. Although its use in monitoring was the top function identified, most new doctors (73%) couldn’t say exactly what they wanted it to do (11).Other challenges with mobile technology usage include the appropriate maintenance of professional relationships between colleagues, and between doctors and patients as well as patient privacy. As with all healthcare interventions, high quality adequately powered trials are required to evaluate effects on objective outcomes.

Mobile technology has great translational capacity and is a powerful tool for facilitating the personalised care that is very much needed across healthcare, although its full potential remains to be realised. As digital-native, younger generations move through the ranks of healthcare, mobile innovations will be increasingly embraced and become commonplace.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

1. Roglieri JL, Futterman R, McDonough KL, Malya G, Karwath KR, Bowman D, et al. (1997): Disease management interventions to improve outcomes in congestive heart failure. The American journal of managed care. 3:1831-1839.
2. Neubeck L, Lowres N, Benjamin EJ, Freedman SB, Coorey G, Redfern J (2015): The mobile revolution–using smartphone apps to prevent cardiovascular disease. Nature reviews Cardiology. 12:350-360.
3. Banchs JE, Scher DL (2015): Emerging role of digital technology and remote monitoring in the care of cardiac patients. The Medical clinics of North America. 99:877-896.
4. Brunetti ND, Amodio G, De Gennaro L, Dellegrottaglie G, Pellegrino PL, Di Biase M, et al. (2009): Telecardiology applied to a region-wide public emergency health-care service. Journal of thrombosis and thrombolysis. 28:23-30.
5. McCann L, Maguire R, Miller M, Kearney N (2009): Patients’ perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity. European journal of cancer care. 18:156-164.
6. Doyle-Lindrud S (2014): Mobile health technology and the use of health-related mobile applications. Clinical journal of oncology nursing. 18:634-636.
7. Klonoff DC (2013): The current status of mHealth for diabetes: will it be the next big thing? Journal of diabetes science and technology. 7:749-758.
8. Rao A, Hou P, Golnik T, Flaherty J, Vu S (2010): Evolution of data management tools for managing self-monitoring of blood glucose results: a survey of iPhone applications. Journal of diabetes science and technology. 4:949-957.
9. Granholm E, Loh C, Swendsen J (2008): Feasibility and validity of computerized ecological momentary assessment in schizophrenia. Schizophrenia bulletin. 34:507-514.
10. Spaniel F, Vohlidka P, Kozeny J, Novak T, Hrdlicka J, Motlova L, et al. (2008): The Information Technology Aided Relapse Prevention Programme in Schizophrenia: an extension of a mirror-design follow-up. International journal of clinical practice. 62:1943-1946.
11. http://www.emarketer.com/Article/Europes-Doctors-Embrace-Digital-HelpersUp-Point/1012837?ecid=NL1002