Can health apps really improve patient care?

Healthcare today is hugely centralized, delivered through sparse infrastructure: clinics and hospitals, and a sparse workforce: clinicians. There is an estimated shortfall of 7 million doctors globally. This results in delays to treatment and care, limited access to clinicians, and high health and social care costs.

Healthcare providers are increasingly looking to technology to shrink the vast gap between supply and the demand for their services. Alongside this, the pandemic restrictions dramatically affected our behavior, with huge numbers embracing online versions of the activities that previously meant leaving our homes. With its many online substitutes, this society-wide “new normal” has eradicated the last shreds of resistance to technology that existed in some parts of the healthcare establishment. Previously perceived as a threat, technology now helps institutions and the professionals within to improve access, affordability, and healthcare quality.

This article examines the effectiveness of mobile healthtech solutions that provide remote patient monitoring (RPM) and patient self-management.

How useful are RPM (remote patient monitoring) apps?

Remote patient monitoring apps can capture health measurements giving physicians great efficiency in monitoring patients’ overall condition and triaging concerns. RPM solutions usually include a mobile application and, often, a connected device capable of capturing a range of health measurements.

App-connected devices include commonplace products like Apple Watch, Fitbit, and Withings - and more specialized medical devices like pulse oximeters, blood pressure cuffs, and digital stethoscopes. These devices can help track the patient’s heart rate, blood pressure, glucose levels, weight gain and loss, or even levels of stress.

Remote patient monitoring apps enable any user to become part of a powerful decentralized health system and capture clinical-grade health measurements. They also act as an early warning system, shifting risk away from hospital facilities and making earlier interventions possible.

Here are two examples:

Feebris

A UK-based solution mainly for elderly, more vulnerable patients. Feebris is not an individual health measurement app. Instead, it consists of an app, portable sensors, a web portal, and support services, allowing non-clinical care teams to capture data and offer personalized escalation recommendations to each patient. In this way, Feebris helps address the scarcity of hospital/clinic infrastructure.

Whereas patients would normally need to wait for their physician to be available, with the help of Feebris they can visit or be visited by a community healthcare worker. Feebris described their solution as a “virtual patient round”. 

Feebris provides these capabilities:

• Conducts end-to-end patient check-ups, capturing high-quality data and identifying patient next steps
• Automatically tailors the patient's check-up options in response to their current state of health
• Connects wirelessly to pulse oximeters, blood pressure cuffs and digital stethoscopes, so patient health data is seamlessly captured directly and synchronized with the web portal, where clinicians can see the data
• At the end of a patient check-up, the app calculates a patient risk score and recommended response based on National Early Warning Score (NEWS).

Kardia

Kardia is a US-based, FDA cleared app and subscription service that allows individuals to accurately obtain EKG (also known as ECG or electrocardiogram) results and detect six of the most common arrhythmias. In addition, Kardia provides:

• An EKG result reviewed by board-certified cardiologists, on a quarterly basis
• Tracking of the patient’s heart health over time
• Ways to share EKGs: send EKGs to doctors, caregivers, or family members
• Access to the EKG history from any device
• Help tracking blood pressure and medication routines. Set reminders to enter blood pressure data and medication information.

So, how useful have these apps proven themselves to be?

Feebris

This solution has been trialed in care homes for the elderly in the UK, allowing the homes to do regular health monitoring of residents with chronic or acute conditions. The aim is to support triage in the care home and enable remote GP decision-making to avoid unnecessary hospital admissions.

The trial is still underway but, so far, indications have been positive. The head of the care homes group hosting the trial says:

“Nurses are still at the forefront of care, but Feebris gives carers additional skills and helps spread the workload. During the Covid-19 pandemic, two of our nurses were at high risk, so our senior carers have been able to step in and take observations instead.”

“It helps to reduce the stress and anxiety of the resident, it reassures staff they are making the right decisions, plus it also helps us to articulate information to the GP.”

In a separate case study, Feebris was used to assist in the measurement of patients’ respiratory rates. Respiratory rates are one of the vital signs physicians still measure manually, which results in inaccuracies. The Feebris study found that, by automatically giving feedback during the process to the health practitioners who were using sensors (such as a pulse oximeter and a digital stethoscope) to estimate patient respiratory rates, the reliability of the results increased, in comparison to the manual method.

Kardia

Kardia is FDA cleared and CE marked. Federal and international bodies have reviewed and cleared it for the following uses:

• Record, store, display and transfer single-channel EKG
• Detect the presence of atrial fibrillation and normal sinus rhythm

A study was conducted using Kardia as an EKG device. Atrial fibrillation (AF) is a common cardiac arrhythmia, affecting an estimated 33.5 million individuals worldwide. The study aimed to discover if more frequent testing for AF would benefit patients.

The first prospective randomized trial evaluating the ability of remote EKG acquisition and transmission with a handheld device with remote interpretation to screen for atrial fibrillation (AF) in at-risk people over 65 years of age over an extended period of time (1 year).

The remote EKG approach was shown to be at least three times more likely to identify atrial fibrillation than the routine care approach.

Nineteen patients in the iEKG (remote EKG) group were diagnosed with AF over the 12-month study period versus 5 in the RC (routine care) group.

Additionally, The majority of iEKG patients were satisfied with the device, finding it easy to use without restricting activities or causing anxiety.

The study is available to read here.

From available evidence and comments, it appears health apps in this category are capable of delivering value to patients and healthcare professionals alike. It’s also worth noting that the value of RPM solutions increase when patients live long distances from the nearest hospitals and clinics.

How useful are patient self-management apps?

Patient self-management apps encourage patients to embrace optimal behavior patterns during treatment and recovery. This is beneficial wherever existing behaviors work against the patient fully benefiting from their treatment.

“Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations.”

The apps range in complexity from simple reminders to ensure medications are taken regularly and on time, for example, to combined active engagement in a treatment program, including education.

Here is an example of a sophisticated self-management app:

MySugr

The MySugr app helps more than 3 million individuals with diabetes in over 60 countries worldwide. It is a multifunctional app that helps patients monitor and manage their diabetes day by day. The app also provides a wealth of specialist support information, all available on the patient’s smartphone.

Under EU regulations, the mySugr Logbook is a Class IIa medical device and the mySugr Bolus Calculator is a Class IIb medical device. The mySugr Logbook is available as an exempt device under FDA regulation in the United States.

The MySugr app’s extensive capabilities include:

• Daily journal
• Insulin dose calculator
• Insulin intake record
• Insulin pump controller
• Visual analytics

The app can connect to blood glucose monitors allowing it to estimate a patient’s HbA1c (average blood glucose for the last two to three months) levels.

The app’s usefulness can be extended by purchasing extra features, such as the ability to connect a blood glucose meter.

So, how useful have self-management apps proven themselves to be?

Here, we’ll use type 1 diabetes as an example, where patient perceptions of treatment efficacy, deficits in diabetes self-management skills and knowledge, lack of social support, and the daily burden of managing their disease are negatively impacting adherence to the treatment regimens prescribed to patients.

In a 2019 study of a diabetes mobile self-management app, the outcome was summarized as:

“The mobile diabetes management app can prompt positive changes in glucose control in a very short time period and that the impact may be even greater in individuals with less well-controlled diabetes. Importantly, the positive trend data on mean blood glucose and glycemic variability further suggest that educator-led coaching and unlimited access to blood glucose test strips has a positive impact on both user satisfaction and, importantly, the sustainability of favorable changes, which may lead to long-term improvements in glucose control.”

Achieving target glucose levels early in diabetes is the main objective for many health professionals treating diabetes. This study, and others looking into the efficacy of diabetes self-management, conclude that improvements in staying within glucose targets are more common amongst users of this app.

Is mobile remote patient monitoring really worth it?

Apps like Feebris clearly show value in terms of improved outcomes. Feebris has proven effective in two different contexts – elderly UK care and children’s health in urban Indian slums – demonstrating:

• Reduced avoidable GP and urgent care referrals with the potential to save health systems billions of pounds
• Health issues caught earlier with a reduction in their severity as a result
• Increased GPs’ and other health providers’ capacity to treat their most vulnerable patients
• Improved patient and staff experience.

How can health apps be used in the future?

This table displays potential future value propositions for mobile healthcare apps.

The information in the table above is from “What is the clinical value of mHealth for patients?”

Conclusion

With growing pressure on global healthcare systems and as people increasingly turn to technology to access all kinds of services, mobile health apps are playing an increasingly important role in patients’ lives. As a result, both healthcare professionals and patients have increased trust in these apps, and believe these apps are able to help them. Additionally, studies conducted so far suggest that these solutions can be used to maximize patient care and improve treatment effectiveness in a range of situations.

If you are interested in building a healthcare app, feel free to get in touch with us: hello@allbright.io.