As health care reform marches on, there is continued pressure to deliver care for lower-cost and higher quality in order to provide more value. With smart phone technology becoming ubiquitous in the general population, leveraging this patient owned resource has become the focus of both large Silicon Valley-based corporations as well as independent technology entrepreneurs. Thus far the majority of focus has been dedicated towards health and wellness apps with little attention paid towards the development of apps that will prove clinically useful to a surgeon. The numbers are simply staggering, with there being more than 50,000 health related apps yet less than 200 are FDA approved for clinical use.
Nearly two-thirds of Americans now own a smart phone according to Pew Internet Research. Even more telling is that these devices are already replacing home computers and land-based Internet access. In fact smartphone use is so pervasive that for lower socioeconomic groups the smart phone serves at the primary point of connectivity to the Internet. Clearly the ownership of smart phones is growing exponentially and projections are that within just a short period of time these phones will soon be owned by more than 80% of the population.
My entry into this space came as a result of a need to develop patient centered content to deliver to my patients as appropriate discharge instructions following surgery. I soon realized that appropriate content was lacking both from a health literacy perspective as well as from a “usefulness” perspective. I think we can all agree that the standard discharge instructions of “call your doctor for temperature greater than 101, increasing pain, increasing redness, or nausea/vomiting” do little to prepare a patient for self-care following major surgery.
The “holy grail” of mobile health (mHealth) in clinical medicine/surgery has yet to be found. And it is not without having vast resources thrown at this problem. The notable San Francisco-based healthcare accelerator Rock Health has countless numbers of venture capitalists yearning to throw hundreds of millions of dollars at ambitious start-ups attempting to tackle this problem. In fact, this is exactly what I see as a reason that no solution exists. With no disrespect towards entrepreneurs in Silicon Valley, it must simply just be stated that you need clinical expertise to tackle such a large and complex problem. Current investment and business models focus on developing a minimum viable product to make money first and secondarily to solve a healthcare problem.
The solution to our woes will be one that is driven by a collaborative effort from experienced healthcare providers to have an “in the trenches” expert knowledge base, sophisticated programmers, business savvy entrepreneurs, and designers who are interested in user interface optimization. A collaborative effort between the University of Washington Department of Surgery as well as Seattle-based technology gurus is one such startup with appropriate resources to tackle a very complex problem. mPOWEr seeks innovative ways to leverage mobile technology in order to assess surgical wounds. An additional start-up, Synced Care, involving collaboration between technology groups and Baylor College of Medicine is also developing novel solutions towards patient engagement and early post-op complication detection. Recent pilot trials by both groups have demonstrated feasibility with future work proposed in order to demonstrate clinical utility and benefit.
While technology giant Apple has entered the space with its research kit whether or not this tool will prove useful in surgical disease has yet to be determined. Currently less than one third of healthcare providers and organizations use mobile phones to foster patient engagement. Certainly the resources possessed by Apple are limitless compared to an entrepreneurial start-up but you first need to get people to use the technology as a start – something that is done rarely in current day healthcare.
The scalability and availability of mobile technology represents an extremely attractive opportunity towards further improving our quality of surgical care. Combining principles of patient centered design, gold standard clinical care in decision-making, and behavioral psychology expertise to foster engagement will likely result in a clinically useful product. The future is now, as current technology and expertise is ever present. However as academic surgeons, investigators, outcomes experts, we must be engaged in the development of these solutions in order to ensure they are clinically meaningful and useful in rendering high quality care for our patients.
