BOSTON – In the US, there are big disparities in access to healthcare – from rich to poor patients, from urban to rural residents. But one researcher argues that a solution could be provided by something virtually everybody has: a mobile phone.
Mobile devices are becoming an increasingly important tool in healthcare – for instance, monitoring blood pressure or helping diabetics manage their disease. “The pervasiveness provides the means to grapple with persistent health disparities in the US,” says Elizabeth Mynatt, executive director of the Institute for People and Technology at the Georgia Institute of Technology.
At the annual conference here of the American Association for the Advancement of Sciencem, Mynatt said mobile devices can underpin new models of patient-centred healthcare delivery that set out to address inequality in access based on incomes, education or physical distance from healthcare facilities. At the same time, actively incorporating input from patients and caregivers with mobile devices can improve the standard of care overall.
Mynatt is the lead author of a roadmap for future research in smart and pervasive healthcare in the US, which was published earlier this month. The document describes how the prevalence and increasingly powerful diagnostic capabilities of mobile phones means they can now compete with expensive specialist equipment. Coupled with real-time analytics, this is opening the way to patient-centred healthcare delivery that can improve prevention, control the growing expense of chronic disease management and address persistent health disparities.
Monitoring diabetes – the mobile way
In one project which Mynatt is overseeing, patients newly-diagnosed with diabetes are equipped with mobile phone and web tools that enable them to get instant advice. “They can become their own detective, answering questions about what to eat for breakfast, what to order in their favourite Chinese restaurant,” she said.
Rather than focussing on the abstract task of managing blood glucose levels, the devices help people to work out the best regimes for themselves. “They can set it up as an experiment. For example, what happens to my blood sugar if I have orange juice for breakfast?” Mynatt said.
The result is that people feel empowered, and can manage their conditions with less reliance on direct access to clinical care.
In another project, patients newly-diagnosed with breast cancer who live in a remote rural area of Georgia are given a tablet computer with all the information about their diagnosis and treatment plan.
“They get day-to-day support from the system – for example, it tells them, three days after chemotherapy, ‘the side-effects you are suffering are normal.’ It’s not just about treatment but survivorship,” said Mynatt.
Reducing disparities in care
By communicating via the tablet, care coordinators and nurses can ensure that patients – who may be two hours or more distant from the treatment centre – have everything they need to get to appointments. “Often they can’t afford the gas to drive there,” Mynatt said.
In other cases patients cannot afford the treatment and need help with funding, or assistance with childcare. “It is a way to lower the barriers and disparities in care,” said Mynatt.
The tablet computers also help the breast cancer patients better manage the side effects of chemotherapy, and reduce the number of emergency room visits, according to Mynatt.
The model is now being applied beyond cancer in what Mynatt termed just-in-time adaptive interventions, which integrate information about an individual’s emotional and physical state to their electronic healthcare records. For instance, in the area of mental health, analyses of social engagement or of the amount of sleep, exercise and diet can point at a possible relapse and trigger timely interventions.
Mynatt said this could form the basis of “proactive healthcare services” in which nurses can monitor patients via a dashboard and “prioritise who to reach out to.”
Gaps in funding
The jury is still out on whether patient outcomes are improving in the diabetes and breast cancer projects. As Mynatt explained to Science|Business, it is a challenge to get funding for outcomes studies in the US. Grants for outcomes research would normally come from the National Institutes for Health (NIH), whereas it was the National Science Foundation that funded her diabetes and cancer projects.
“You’ve got to get funding for the systems, and then get NIH funding for the work on outcomes,” Mynatt said.
The funding gap is just one of the problems holding back further development of patient-centreed healthcare on mobile devices. There is also a lack of technical experts in clinical care and of clinical expertise at tech companies. “You need to find forward-thinking healthcare systems to deploy it,” Mynatt said.
The final results of the patient outcomes study in the diabetes project are expected within the next six months. Mynatt said the results look good so far, with good glucose control in a very diverse patient population. The cancer outcomes results are due in a year.