By Russell Kirkscey | STC Member
Smartphone apps for mobile health (mHealth) have multiplied in the past few years, with over 325,000 available in 2017 (Research2Guidance 2017). mHealth seeks to untether technology from traditional desktop computers and enable people to wear or carry wireless devices and record data for themselves or their healthcare providers. The rapid rise of these technologies increases the chances that technical communicators might work on a project involving mHealth apps.
Technical communicators can contribute to such processes in an array of areas, including the development of related user guides and training materials. These contributions relate to the idea of patient experience design (PXD) by enhancing the usability of new and emerging health and medical technologies (Melonçon 2017). To make such contributions, technical communicators must understand the uses, benefits, and limitations of mHealth technologies.
Defining mHealth Apps
Most of us know mHealth technologies from activity trackers, such as the Fitbit, which is designed to provide feedback and motivation to improve general wellness. But advocates of mHealth have also argued smartphone apps can maintain and improve patient health, safety, and quality of life while providing meaningful real-time data to both patients and their healthcare providers (Isaković et al. 2016). The Google Play Store and the Apple App Store have categories dedicated to medical, health, and fitness tools; these range widely in performance, content, and use. Additionally, digital publishers also create mHealth apps for proprietary distribution to health and medical organizations.
mHealth apps can be generally considered as tools for:
- Independent use by people without a requirement for patient-provider interaction
- Healthcare provider use only; and
- Integration of information shared between patients and healthcare providers.
Let’s look at these differences a bit more.
Independent Patient Use
Apps in this category may support people who want to improve their health and fitness without the guidance of healthcare providers. A search on Google Play returns thousands of options in this category, including ones that encourage people to drink water, exercise, count their calories, and monitor their blood pressure. Another genre for independent use may help people living with a disease. Jointfully Osteoarthritis, for instance, provides methods to track medications, minimize pain, and receive video tutorials for physical therapy.
Healthcare Provider Use
This category of apps comprises tools to support the work of healthcare experts. Examples include protocol information for paramedics, a reference guide for prescriptions, and an instrument for finding patient veins by using a smartphone’s flash. These apps may also provide medical staff with recommendations for treatment based on submission of symptoms and screening results. For example, researchers have recently developed and evaluated a clinical support tool to use with pregnant women who have pre-eclampsia. Functions in the app include the ability to measure oxygen saturation, access patient records, and input testing data (Dunsmuir et al. 2014).
Integrated Information for Patients and Providers
A third category of apps focuses on incorporating direct communication between patients and healthcare providers. The associated benefits include remote diagnosis and monitoring of patients. These apps may also decrease unnecessary testing and treatment, which can save consultation time and insurance payments.
Both patients and healthcare providers are interested in the possibilities for using such integrated apps. For example, prostate cancer patients would be willing to use an app to monitor their symptom management and receive real-time communication with their healthcare providers (Nyman et al. 2017). Apps in this category might also increase physicians’ abilities to communicate with and treat asthma patients (Van Boven et al. 2015). While the development of integrated apps is increasing, their use may weaken face-to-face communication and harm patient-provider relationships (Mutingi et al. 2014).
Essential Notes for Technical Communicators
Apps that are available for anyone to download commonly include a disclaimer noting these technologies are for informational use only. These disclaimers also often state that individuals should consult their healthcare providers to determine the apps’ appropriate uses.
No certification exists for these apps to qualify for distribution on the open market. As a result, healthcare experts may not necessarily provide input during their development (Higgins 2016).
Researchers investigating mHealth app quality them have reported mixed results. For example, a study evaluated an interactive app designed to give information to parents considering vaccinations for their children and found a significant gain in knowledge (Fadda et al. 2017). However, another study analyzed 218 pregnancy-related apps available in the Apple App Store. It found that 41 percent did not address modern birth control methods, while only 10 percent were directed at younger people (Mangone et al. 2016).
One of the challenges of using mHealth apps is the possible misuse of intelligent software. Developers should ensure that they handle user data appropriately (Shugalo 2018). Apps created for the open marketplace should have clear and appropriate end-user license agreements. This action will allow people to opt into or out of personal data collection, especially if developers intend to sell user information to third parties for advertising purposes. Developers should also make appropriate arrangements to guarantee security of information stored on cloud-based servers.
Additionally, developers who work in the healthcare industry must also abide by the regulations outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This legislation calls for the de-identification of data by removing specific fields from each patient’s record. To address such requirements, hospital systems and insurance organizations have begun to transfer patient information to electronic health records. This move has increased the complexity of safeguarding personal information.
In terms of data security, key items for technical communicators to keep in mind include:
- Understanding that apps may unintentionally release personal information;
- Developing appropriate measures to guarantee the security of data;
- Working within state and federal privacy regulations; and
- Learning about electronic health records.
Doing so can lead to the development of materials that are both usable and meet regulatory requirements.
mHealth Apps and the Marketplace
Research2Guidance is a company that supports digital healthcare innovation, and it produces annual reports on the status of mHealth apps. Such materials can help developers better understand the process necessary to bring their products to market successfully and efficiently. According to Research2Guidance’s latest report, small publishers and independent developers use email, social media campaigns, and online advertising to draw customers. However, nearly half of all mHealth app developers now collaborate directly with healthcare providers, health insurance companies, or healthcare organizations (Research2Guidance 2018).
Monetizing strategies for mHealth apps on the open market vary greatly. Prices on Google Play range from free (Surgical Procedures Free App for Self-Learning) to $279.99 (Atlas of Minimally Invasive Surgical Operations). Yet many free apps contain advertisements that support their developers. Other mHealth apps deliver a free version with fewer features and then prompt users to subscribe to a more elaborate version for a set fee or a yearly subscription.
Several app publishers have also begun to produce tools tailored to the specific content and educational needs of clients including hospitals, clinics, pharmacies, and health insurance providers. For example, Healthwise offers multimodal health education apps based on their growing video, text, and image library. Welvie focuses on decision support for surgery that gives options and risk analyses. Healthdialog has partnered with Rite Aid to develop a patient portal that allows people to upload data from fitness and health monitoring apps. They can then use these technologies to send providers information that includes the user’s exercise regimens, heart rate, blood sugar levels, and blood pressure.
In relation to technical communication, developers need to consider a few central issues, including the best ways to:
- Use customer discovery interviews to find the appropriate set of users;
- Monetize the work;
- Advertise the product; and
- Contract with an established app publisher.
Addressing such factors can be key to contributing value to app development and use.
The mHealth app market continues to grow as people become more comfortable with using their smartphones to monitor their health and medical issues and to communicate with their healthcare providers. Technical communicators bring many competencies that mHealth app development teams require. This overview of these products can help as a starting point for a broader understanding of this relatively new field.
Dunsmuir, Dustin T., Beth A. Payne, Garth Cloete, Christian Leth Petersen, Matthias Görges, Joanne Lim, Peter von Dadelszen, Guy A. Dumont, and J. Mark Ansermino. “Development of MHealth Applications for Pre-Eclampsia Triage.” IEEE Journal of Biomedical and Health Informatics 18.6 (2004): 1,857–1,864.
Fadda, Marta, Elisa Galimberti, Maddalena Fiordelli, Luisa Romanò, Alessandro Zanetti, and Peter J. Schulz. “Effectiveness of a Smartphone App to Increase Parents’ Knowledge and Empowerment in the MMR Vaccination Decision: A Randomized Controlled Trial.” Human Vaccines & Immunotherapeutics 13.11 (2017): 2,512–2,521.
Higgins, John P. “Smartphone Applications for Patients’ Health and Fitness.” The American Journal of Medicine 129.1 (2016): 11–19.
Isaković, Maša, Urban Sedlar, Mojca Volk, and Janez Bešter. “Usability Pitfalls of Diabetes MHealth Apps for the Elderly.” Journal of Diabetes Research 2016.
Mangone, Emily Rose, Victoria Lebrun, and Kathryn E Muessig. “Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis.” JMIR MHealth and UHealth 4.1 (2016).
Melonçon, Lisa. “Patient Experience Design: Expanding Usability Methodologies for Healthcare.” Communication Design Quarterly Review 5.2 (2017): 19–28.
“MHealth Developer Economics: Current Status and Future Trends in Mobile Health 2017/2018.” Research2Guidance 2017. https://research2guidance.com/product/mhealth-economics-2017-current-status-and-future-trends-in-mobile-health/.
“MHealth Developer Economics: How mHealth App Publishers Are Monetizing Their Apps.” Research2Guidance 2018. https://research2guidance.com/product/mhealth-economics-how-mhealth-app-publishers-are-monetizing-their-apps/.
Nyman, Maria, Catharina Frank, Ann Langius-Eklöf, Karin Blomberg, Kay Sundberg, and Yvonne Wengström. “Patients’ Perspective on Participation in Care with or without the Support of a Smartphone App during Radiotherapy for Prostate Cancer: Qualitative Study.” JMIR MHealth and UHealth 5.7 (2017).
Shugalo, Inga. 2018. “A Brief Guide to MHealth Apps Security and Privacy Threats.” The Doctor Weighs In. 27 September 2018. https://thedoctorweighsin.com/mhealth-apps-security-privacy/.
RUSSELL KIRKSCEY (firstname.lastname@example.org) is an Assistant Professor of English and Technical and Professional Writing at Penn State Harrisburg. He studies how and why people make decisions about health care. His focus is on shared decision-making, which involves equal participation between providers and patients in their discussions about treatment and management options.