How Mount Sinai uses mHealth to pave the way for more robust patient care

By John DeGaspari

The exploding number of healthcare apps ready for download on smartphones and tablets is impressive and shows no sign of letting up. But the real story of their potential impact is far more than a case of raw numbers. Longer term, mobile apps will have a profound effect on the management of chronic diseases and population health. The key is more meaningful and timely communication between doctor and patient.

Two examples at Mount Sinai Medical Center in New York illustrate how apps are being used now to expand the scope and quality of care for existing patients. Just as significantly, they provide a venue for ongoing doctor-patient communication, collaboration with other medical specialties, and the opportunity to apply novel treatments virtually.

Ashish Atreja, a gastroenterologist and assistant professor of medicine at Mount Sinai, has worked with Mount Sinai's AppLab to develop an app for the treatment of inflammatory bowel disease (IBD). In an interview, he described it as a continuous engagement model that can help the hospital's physicians keep a "finger on the pulse" of each patient suffering from IBD--9,000 patients across Mount Sinai's seven hospitals.

"We are moving toward a more continuous and proactive care model across the entire population," Atreja said.

The app is available for download on the iPhone and Android, and can be accessed on personal computers. The patient answers two sets of questions--one pertaining to gastrointestinal symptoms and the other to quality of life--that provide him or her with a score of whether or not they are in control of their disease. If not, the patient is urged, via an automated message, to contact his or her physician. Patients are encouraged to log on once every two weeks.

Atreja noted that gastroenterologists are not necessarily trained to treat psychosocial symptoms tied to quality of life issues, but he sees this as an opportunity to reach out to other specialists, such as psychiatrists, in the treatment of IBD. He said that treatments such as meditation and deep breathing could be beneficial for improving the quality of life for IBD patients, and can be adapted to telemedicine.

He described the app as dual facing to the patient and physician, which connects the two in an objective manner to provide a complete story of the patients. Mount Sinai has started to apply the IBD app model--a structured approach to symptom tracking that is linked to decision management--to other chronic diseases, such as migraine headaches, rheumatoid arthritis and heart failure.

In a separate development, an app was created to allow the physicians in the Mount Sinai Doctors Faculty Practice to offer consultations using a secure digital connection via smartphones. Aida Vega, director of the Mount Sinai Family Practice Associates, Primary Care Program, said the app is limited to existing patients.

"With our practices, we wanted to make sure that these were patients who were established and who had a real database in the office; that we knew their allergies, medications, and health problems, so we cold make good decisions on a virtual visit that would impact their health," she said in an interview.

Patients can schedule a virtual visit and discuss a health problem via mobile device, according to Vega. In her view, the ability to see the patient and doctor face to face provides a level of intimacy to the doctor-patient interaction. As the app evolves, she said it might be possible to incorporate virtual tools to monitor physical conditions in the home and convey the information virtually to the doctor. Vega said that initially, the app is targeted toward patients who are tech savvy and who own a smartphone, but said that eventually it could be used by patients who find it difficult to travel and need ongoing care in the home.

One hurdle is insurance reimbursement: many insurers do not reimburse for virtual consultations. "Physicians want to offer the service but also want to be compensated for their time," Vega said.

Time will tell whether or not these apps ultimately will fly. How conscientious will patients be about entering their data once the novelty of the app wears off? How dedicated will doctors remain if they are not reimbursed for their time? And how seamlessly can these apps be integrated into the physicians' workflow?

If those issues can be addressed effectively, mobile apps can have a transformative effect on patient care and population health management. - John (@johndeg)