Among the most interesting examples of mHealth app development and research demonstrated at the recently concluded Medicine 2.0 Congress were those from the Department of Veterans Affairs.
To recap, the VA system serves over 22 million Veterans with over 9 million obtaining health care from the VA.
With the rapid growth of smart mobile devices, the VA recognized an opportunity to integrate mobile electronic health records, social media, and remote documentation.
The ease of mobile devices allows the VA system to serve their constituents with an enhanced user interface across the nation, especially in rural areas that may be a long distance from direct VA services or providers.
Utilization of mobile applications through the VA can then be specified to help treat patients with specific issues (eg. pain, diabetes, etc) that may overcome logistical barriers. Through the utilization of mobile apps, the overall interaction between VA patients and their physicians is not removed, but rather communication is enhanced.
The VA Panel on Mobile Health showcased the spectrum of apps specific to the VA system. Many apps were created to help clinicians, such as mobile EHR access, medication resources, and laboratory results, but there were also a large number of apps focused on patients. Some of these apps allowed patients to access their health records and laboratory values, while others allowed patients to refill their prescriptions.
Standing out amongst these apps, however, were patient-centered apps focused on disease state management.
Perhaps the most impressive app in the VA App Library, and one that has garnered awards such as the American Telemedicine Association Innovation Award, is the PTSD Coach app. It was presented by Dr. Julia Hoffman, one of the main developers and who currently works at the VA National Center for PTSD.
The app addresses the burgeoning needs of our veterans suffering from PTSD as they return from current and past conflicts. The app allows veterans to enter their level of distress, guiding them through a series of questions and providing access to phone numbers and other resources in case of distress.
In this case, the use of mobile health technology is an opportunity to reach out to those at risk, especially in rural or other areas where VA services may not be directly accessible. Dr. Hoffman told an impressive anecdote of its potential when, two hours after it launched on the app store with no publicity, a vet called the PTSD hotline after using the app.
Working with Open mHealth, the motive was to create a functioning and secure patient app that can also provide meaningful data to clinicians. I believe the one great way of presenting the idea of open mHealth is when Dr. Hoffman said, “No app should be and island.” In light of past reviews I have conducted on patient centric apps, I can see what she meant by this. All too often, apps on the current market rely of patients recording their data and then manually sharing it. Data is lost and fails to help move along the process of mHealth in a clinical and scientific meaningful way.
The version of the PTSD Coach currently available on the iOS and Android market is a standalone product.
However, working with Open mHealth, the VA has created PTSD Explorer that will be integrated into the VA’s EHR to help cross the bridge between direct patient data and provider care. Data will be visualized via web-based mechanisms (ClinVis) to display results in a clinical meaningful way to help providers and patients recognize what is occurring. This way, providers will be able to assess and evaluate patients through the app and help make clinical judgements to help provide care.
Additionally, data will also be utilized to help build information on the community with shared data that can be used as a source of evidence for technological development from personal to population application.
For me, this means a lot. The fact the VA is taking the steps to integrate open mHealth and link data from apps into their EHRs overcomes one of the biggest limiting factors in the use of patient centric apps. It is my hope that, as the VA progresses in this initiative, others will take up the call of open mHealth and create apps available to the market for ease of communication between patients and providers.
Perhaps in the future apps will then play a larger role in day-to-day health care activities due to the integration of up-to-date patient specific data available to providers, and data can be utilized to recognize population data on a meaningful scientific way from direct patient involvement.
To learn more about Open mHealth, refer to the peer reviewed article at the Journal of Medical Internet Research: Chen C, et al “Making Sense of Mobile Health Data: An Open Architecture to Improve Individual- and Population-Level Health”, J Med Internet Res 2012;14(4):e112: http://www.jmir.org/2012/4/e112/