Background and basics
The case for GPs using mHealth
Greater use of mHealth in a planned and strategic way should help support, complement and enhance the way general practice delivers care and in the way it communicates and engages with patients and other health professionals. mHealth’s potential advantages for general practice include:
- accessing medical information and resources anywhere and at anytime
- gaining immediate access to patient records and prescriptions from any location (eg aged care facilities, home visits)
- using video conferencing for remote diagnosis and professional support/education
- monitoring patients remotely through video or information collected by devices/apps
- supporting patients to adhere to medication schedules by sending direct/personalised reminders
- delivering online consultations to patients who cannot attend the practice.
As the functionality and accessibility of mHealth tools continues to expand, so will its possible uses.
The aim of implementing an mHealth strategy is to harness these advantages in order to reap the benefits of improved communication and accessibility to information, which should ultimately lead to improved health outcomes.
Why haven’t we already adopted mHealth?
When considering how other sectors, such as banking and retail, have embraced mobile technology, it seems as though the health sector has lagged behind, even though the potential benefits here are huge.
Mobile health by its very nature implies that users (patients and healthcare providers) are always part of a connected network. This increases the variety, velocity and volume of information that is received, sent and available to users. It also increases the complexity of potential issues around security and responsibility.
Several factors have acted as barriers to mHealth’s adoption in general practice.
Privacy and security
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Privacy plays an essential part in establishing trust with GPs and the general practice team
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The healthcare sector has traditionally relied on providers retaining complete control of end-to-end health information systems, ensuring patients’ privacy and confidentiality are respected, protected and contained. However, the rise of mobile health devices and technologies means government regulators and health practitioners have had concerns about ensuring patients have the same level of confidence in the health sector within a more open system.
The challenge is to allow innovation that still ensures data safety, reliability and security.
Regulation
Regulatory issues related to the use of mobile technology in healthcare arise due to different motivations. While the motivation for regulation is market driven in other sectors, healthcare regulations focus is on patient safety, which results in a less dynamic environment for information and technology innovation.
The usual approach to regulation in healthcare is to require the provider to maintain a closed system. While this provides privacy and security, there is a lack of interoperability between different communication systems.
Mobile health technologies need to be interoperable in order to achieve the benefits mHealth offers to healthcare delivery.
The challenge is allowing interoperability between systems while maintaining the safety of services and high levels of privacy protection for healthcare information.
Incentives
In order to increase the uptake of mHealth in general practice, Medicare Benefits Schedule (MBS) rebates need to reflect the amount of work required to help patients improve health outcomes with mobile tools.
Why mHealth matters
While barriers to mHealth in general practice remain significant, its adoption is progressing at an increasingly rapid rate due to external factors (national policies such as the National eHealth Strategy, demographic shifts) and internal factors (individuals accepting and adapting to changes in the way we communicate and do business).
Overall, the drivers for the growth in mHealth are similar to those in other sectors: rising consumerism, increasing information dependence and need for greater efficiency.
External drivers of mHealth adoption
For some time, major trends in healthcare have included:
- reforms focusing on the automation of aged care and chronic disease management, driven by technologies such as electronic medical records and remote monitoring
- a move towards ‘personalised medicine’ and customisation of care.
These trends have now been accelerated by advances in mHealth and the possibility of productivity gains that come from its use. For example, in the United States (US), using remote monitoring technologies to manage chronic diseases is predicted to save nearly
$200 billion over the next 25 years. Savings come from improved workflow for clinicians working remotely, better point-of-care information delivery and enhanced efficiencies in routine management, such as billing, scheduling and claims processing.1
GPs are familiar with the growing pressures on the health system due to the ageing population and the rise in chronic and complex conditions. The traditional episodic and illness-oriented healthcare delivery models need to shift toward a model that is prevention- based and patient-focused – similar to the person-centred medical home.
The use of technology has the potential to be a key enabler of the person-centred medical home. Effective use of mHealth helps shift healthcare from a ‘doctor provides cure’ model to one where patients are active partners in care, making choices and more able to take increasing responsibility for their own health. Mobile technology can provide access to patient records regardless of where clinicians or patients are located, facilitating better communication and information sharing. As a result, mobile technologies have the capacity to enhance care delivery. Additionally, there is potential to use data collected via mobile tools to:
- develop customised care plans for patients
- identify high-risk patients
- anticipate problems and provide early interventions.
Internal drivers of mHealth adoption
Every general practice uses communication tools (eg voice calling, email, video conferencing), information systems (eg electronic health records, practice administration and laboratory information systems), and information resources and clinical software applications.
While most of this functionality was previously only available via a desktop computer, more and more clinical information is now available on mobile devices. Driving forces leading health professionals to adopt mHealth in their day-to-day practice include:
- increase in business efficiency and patient care by providing services to individuals who usually face a number of barriers to access at any time or location
- cost-reduction opportunities (eg SMS appointment reminders substantially reduce costs from missed attendance)
- greater flexibility in care workflows
- better communication and access to information resources at the point-of-care
- timely access to patient and clinical data
- consumers who want greater transparency, convenience and value.
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32% of patients say they have a healthcare, wellness or medical app on their smartphone and 80% have one or two health apps they use on at least a weekly basis
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A recent survey conducted by PwC’s Health Research Institute found that 32% of patients say they have a healthcare, wellness or medical app on their smartphone or tablet, more than double than in 2013, and 80% have one or two health apps they use on at least a weekly basis.2 While few doctors are prescribing health apps today, most say they are willing to prescribe them for sleep monitoring, exercise/weight management and chronic disease management.2
| Patients, family and carers |
| General practice |
Community care |
Home |
Telehealth to assist with self-care
Teleconsultation for those who are
hard to reach or have mobility issues |
Video conferencing with care team and patient
Telehealth to maintain helpful behaviours and apps to support people to self-care |
Internet-based therapeutic interventions and support
Telehealth for
post-operative recovery assessment |
| Telemedicine with specialists |
Medication management apps to encourage correct use of medication |
Telehealth to support rehabilitation |
Table 1. mHealth: Connecting patients and the general practice team
What do I need to know before adopting mHealth into my practice?
Implementing mHealth in a way that maximises benefits and minimises issues requires an understanding of how it affects a practice’s culture and processes/policies.
Ensuring legal compliance
The Australian Privacy Principles (AAPs) and the RACGP’s Standards for general practices (4th edition) require confidentiality and privacy of personal health information be safeguarded.
Neither standard SMS nor emailing is considered a secure method of communication. Your practice is legally obliged to consider patients’ privacy and confidentiality in all decision-making processes related to the implementation of a mobile strategy. Patients may consent to use of these unsecured systems if they fully understand the security risk.3
Understanding how mobile technologies intersect with general practice
Whether you’re a GP, practice manager or practice nurse, being aware of the potential benefits of mHealth and how mobile technologies affect delivery of care and patient experience can enhance your capacity to lead and inspire other members of the general practice team.
Building an mHealth culture
General practice staff members are encouraged to be proactive in empowering patients to understand their rights and responsibilities in relation to mHealth. This toolkit can help your practice build a culture of mHealth in which the rights and responsibilities of everyone involved in care, including patients, are secured and respected.
Building on existing systems
Many general practices are already utilising mHealth. This toolkit provides an opportunity for your practice to review and, where applicable, enhance your current activities in the area of mobile technology.