This document outlines the mobile health (mHealth) marketplace and patient-centric apps. It discusses how apps can enhance patient self-care and medication adherence. It also delineates approaches for guiding patients to mHealth apps and tools. The mHealth app market largely remains "buyer beware" with FDA regulation pending. Current evidence is stronger for texting than apps in improving outcomes, but many studies are underway. mHealth offers opportunities to improve patient engagement, activation, and health.

1. Helping Your Patients Make
Sense of the mHealth
Marketplace
Kevin A. Clauson, PharmD

2. Objectives
Outline mobile health (mHealth) market and
patient-centric apps currently available
Discuss the use of apps to enhance patient
self-care and improve medication adherence
Delineate approaches of how to guide
patients to mHealth apps and tools

3. Outlining
the
mHealth
App
Market

4. mHealth is the use of mobile devices
and global networks to deliver health
services and information

5. In 1996,
mobile phone
penetration in
the US &
territories (e.g.
Puerto Rico)
was only 16%
With Without
phone phone
Source: CTIA December 2011

6. Mobile phone
penetration
in the US has
risen to 105%
(half are now
smartphones)
Source: CTIA December 2011

7. Smartphone share by operating system
1.1% 0.7%
4.0%
11.4%
Android (Google)
iPhone
BlackBerry
50.9% Windows
Symbian (Nokia)
31.9% Other
Source: comScore MobiLens May 2012.

8. Pay-a$-you-go
phones are still
used by ~ 70
million people in
the US
CTIA Wireless Industry Indices: Semi-Annual Data Survey Results, 2012.

11. Patient-centric iPhone apps*
2% 1%
3%
2% Other
4% 18% Cardio Fitness
Diet
5%
Stress/Relax
5% Strength Training
Women's Health
Mental Health
5%
16% Chronic Dx
Calculator
7% Sleep
Emergency
Smoking Cess
8% Med Adherence
14%
10% PHRs
Source: Segmentation of Consumer Health Apps, MobiHealthNews Research, April 2012. *n~13,600

12. Why
patient-
centric
apps?

13. Paternalistic approach to healthcare*
*Legacy model

14. “As opposed to the doctor-centric, curative
model of the past, the future is going to be
patient-centric and proactive.”
- NIH Director (Past)
Elias A. Zerhouni, M.D.

16. Consumers want to use health apps
To keep track of
health information 48.5
To help manage
58.4
disease or drug
To gain information 91.1
0 20 40 60 80 100
Percent
Source: Consumer Health Information Corporation, April 2011 (n=395),

17. All adults
84% use
cell phones
35% have apps
24% use apps
The average number of
Adapted from: Purcell K. Information 2.0 and Beyond:
apps on a smartphone is
Where are we, where are we going, Pew Internet &
American Life Project. March 2011 & Nielsen, 2012.
41

18. Demographic groups most likely to
download a health app
All (n=658) 29%
Urban (n=203) 33%
Suburban (n=322) 29%
Rural (n=100) 20%
18-29 (n=224) 28%
30-49 (n=276) 32%
50+ (n=145) 20%
0% 10% 20% 30% 40%
Percentages of those who have downloaded a health app
Source: Pew Research Center’s Internet & American Life Project, July 25-August 26, 2011 Tracking Survey.

19. Enhancing
patient
self-care
and
adherence

20. Personal Health Record
(PHR)

23. WiFi body scale
with HealthVault
or iPhone app
integration

25. What is the only “health app” in the
Top 5 most used apps?
(hint)

26. What is the only “health app” in the
Top 5 most used apps?
(answer)

31. Bant app
www.jmir.org/2012/3/e70/

32. Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the
self-management of adolescent Type 1 diabetes: A pilot study. J Med Internet Res 2012;14(3):e70.

35. Scan QR code
for the Medicine
2.0’12 research
abstract !
http://bit.ly/OaMiR3

36. RunKeeper

45. Can
Texting
Help
Patients?

48. Adhere to me.
Not the other way around.

49. Text BABY to 511411
Envia BEBE al 511411
para Español
www.text4baby.org

50. Texting to
improve
sunscreen use
Arch Dermatol 2009;145(11):1230-6.

51. Lancet 2011;378(9785):49-55.
Smoking cessation support
delivered via text messaging

52. Textus interruptus

53. It’s Not
Just
Mobile
Phones…

54. “Most technology needs to go
to finishing school”
- David Rose

57. iBGStar

58. “When purchasing the iBGStar at my local
Walgreens, it had not yet reached the store
shelves, and the pharmacist was not even aware
of its existence. However, after retrieving the
device from the back, there was a natural buzz
around the pharmacy staff. In fact, the tech who
rang up my order actually snapped a picture of
the iBGStar on her iPhone. Whether you like it
or not, there is a certain magical appeal to the
iPhone, and this can go a long way with a
disease like diabetes.”
- David Ahn, M.D.
www.imedicalapps.com/2012/06/ibgstar-iphone-glucometer-review/3/

61. Guiding
Patients to
mHealth
Apps and
Tools

65. eHealth
Literacy Lily
Model
J Med Internet Res 2006;8(2):e9.

66. Final
Issues to
Consider…

67. The
Dark Side
of mHealth
(hey, we are here at Disney)

68. Frequency of cell phone problems
Several times/day Once/day Few times/week Less often Never
Slow download speeds 12% 9% 25% 31% 21%
(Internet/email/app users)
Spam/unwanted texts 4% 4% 17% 44% 31%
(texters)
Dropped calls 6% 6% 19% 41% 26%
(cell phone owners)
0% 20% 40% 60% 80% 100%
Source: Pew Research Center’s Internet & American Life Project Spring Tracking Survey, March 15-April 3, 2012.

72. Br J Dermatol 2009;160(6):1273-85.
http://ftc.gov/opa/2011/09/acnecure.shtm

73. Summary Points
The patient-centric app marketplace largely
remains ‘buyer beware’ with final FDA regulation
pending
Current evidence is stronger for texting than apps
in improving clinical outcomes/QOL indicators,
but numerous studies are underway
mHealth is a rapidly expanding arena offering
opportunities to improve patient engagement,
activation, and health

74. Images
http://blog.nielsen.com/nielsenwire/consumer/among-mobile-phone- http://itunes.apple.com/us/app/runkeeper-gps-running-
users-hispanics-asians-are-most-likely-smartphone-owners-in-the-u-s/ walking/id300235330?mt=8
http://cowbgonaca.blogspot.com/2011/06/wallpaper-for-android- http://itunes.apple.com/us/app/runkeeper-gps-running-
mobile.html walking/id300235330?mt=8
http://www.iphonewallpaperblog.com/wp- http://www.doctormole.com/
content/uploads/2010/12/Windows-7black-iphone4Walpaper.jpg http://itunes.apple.com/us/app/florida-hospital-er-
http://www.mac-wallpapers.com/Apple-Wallpapers/white-apple-logo- wait/id426645573?mt=8
wallpaper/ http://itunes.apple.com/us/app/biooncology-hd/id439099630?mt=8
http://www.laptopsteria.com/wp-content/uploads/2011/06/blackberry- https://qpid.me/
logo.jpg http://bedsider.org/
http://www.onestopwebmasters.com/wp-content/uploads/2011/04/hp- http://www.myicondom.com/
logo.jpg
http://sanaakosirickylee.files.wordpress.com/2012/03/piggy-bank.jpg http://scriptyourfuture.org
http://9to5google.files.wordpress.com/2011/12/android-market-growth- http://www.walgreens.com/topic/mobile/apps/learn_about_mobile_text_
10-billion.png?w=657&h=629 alerts.jsp
http://www.engadget.com/2012/03/03/apple-app-store-25-billion/ http://www.doh.state.fl.us/family/mch/text4baby/text4baby.html
http://en.wikipedia.org/wiki/File:NIH_Clinical_Research_Center_aerial.j http://www.vitality.net/docs/pharma_presentation.pdf
pg http://www.fitbit.com/
http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Is- http://blogs-images.forbes.com/kashmirhill/files/2011/02/A-day-on-
Healthcare-Self-Service-Online-Enough-to-Satisfy-Patients.pdf Fitbit.jpg
http://www.microsoft.com/en-us/healthvault/ http://mobihealthnews.com/wp-content/uploads/2009/02/healthvault-
http://www.windowsphone.com/en-US/apps/daa5bf42-cf02-4327-97cf- logo.jpg
0721ca4ff7a2 http://www.misfitwearables.com/health_device_at_a_glance
http://www.windowsphone.com/en-US/apps/daa5bf42-cf02-4327-97cf- https://play.google.com/store/apps/category/HEALTH_AND_FITNESS?fe
0721ca4ff7a2 ature=category-nav
http://www.cvs.com/promo/promoLandingTemplate.jsp?promoLandingId http://www.imedicalapps.com/2012/07/glucose-buddy-app-diabetes-
=mobile-apps patients-clinicians/
http://images.mobilefun.com/graphics/450pixelp/34456.jpg http://www.happtique.com/
http://mygazelleapp.com/ http://farm4.static.flickr.com/3248/3150680372_7df65fc712_o.jpg
http://mygazelleapp.com/tour/ http://mhealthwatch.com/republicans-urge-fda-fcc-to-move-faster-on-
http://www.journaldugeek.com/files/2012/06/cat-video-youtube-logo.jpg mhealth-app-approvals-19049/
http://eerc.ra.utk.edu/etcfc/images/youtube-logo.jpg http://www.imedicalapps.com/2012/06/congress-leaves-fda-complete-job-
mobile-health-apps-regulation/
http://pillboxie.tumblr.com/ http://mobihealthnews.com/11980/types-of-medical-apps-the-fda-will-
http://bantapp.com/ regulate/
http://www.jmir.org/2012/3/e70/ http://mobihealthnews.com/11978/fda-wont-regulate-these-apps-for-now/
http://itunes.apple.com/us/app/endogoddess/id464431379?mt=8 http://itunes.apple.com/us/app/pill-reminder-by-
http://itunes.apple.com/us/app/glucose-buddy-diabetes- drugs.com/id453359236?mt=8
helper/id294754639?mt=8 http://itunes.apple.com/us/app/webmd/id295076329?mt=8
http://www.medicine20congress.com/ocs/index.php/med/med2012/paper http://www.blogit.com.br/blog/wp-
/view/917 content/uploads/2010/02/Blogit_acneapp.jpg

75. Center for Consumer Health Informatics Research
www.CCHIR.org

76. Recommended Poolside Surfing
 iMedicalapps.com
 MobiHealthNews.com
 mHealthWatch.com
 Medgadget.com
 Hashtag #mhealth
 Participatorymedicine.org

77. Questions
Kevin Clauson, PharmD
clauson@nova.edu
@kevinclauson
www.CCHIR.org