Health Apps will be “prescribed” by clinicians for their patients in the near future. This article tries to sketch out how this “TechRx” and “Apps Pharmacy” process could/should develop.
According to a recent report from Healthcare Information Management Systems Society, there are about 17,000 healthcare apps currently in use. This compares to a reported 300,000 iphone/ipad apps total. The Apps Store model for basic health and wellness apps is now well understood by consumers: Caveat emptor (buyer beware) with somewhat helpful web consumer feedback, some advertising, and lots of word of mouth. All early adopters have had the experience of buying a junk app that we did not bother seeking our $1.99 refund on. This model is probably OK for a few more years for basic health apps. Most users are pretty sophisticated; “buyer beware” is pretty hard-wired into the internet and apps stores. People will migrate to trusted brands. There will be a few horror stories along the way.
The more sophisticated health apps that are now being built deeper into care pathways, however, will need a different standard. These important apps will be designated by caregivers as part of the care plan. Much as physicians were also apothecaries in the early days of drug therapy (really the first two millennia), e-therapy will often be prescribed and filled by the same provider. A clinician managing a diabetic will help enroll her patient on the Bant app (from University Health Network), a surgeon discharging a breast reconstruction patient will give his patient a tablet with a wound monitoring app like the QoC app (from Women’s College Hospital), and drug companies will release purpose-built apps for specific medications like Warfarin that require careful monitoring.
Home monitoring will also be an important early growth segment. Expanding home care is a key to a sustainable health care system, and apps can facilitate this expansion by enhancing home monitoring. Adoption is exploding in this area and in the next few years home monitoring and virtual home visits will become normal parts of many care plans for chronic conditions and post-acute care. Home care agencies in Ontario are working with Ontario Telemedicine Network to create tele–home care providers in three Local Health Integration Networks. Teleccommunications companies (notably Telus in Canada) and the proliferation of home monitoring services (start-ups like Numera and established players like IBM and Philips) are all bringing attention and investment to this area. These “corporate apps” will have tighter quality controls and will quickly become the subject of regulatory interest as they become ubiquitous. Initially, physicians will react to these apps as they reacted to patient education materials on the web — asking where they are coming from and why they are reliable. Eventually, they will prescribe them and control them jointly with their patients.
When it comes to wellness apps, we will continue to see a Wild West market and caveat emptor will be the norm, with some light regulation of the more egregious claims and quackery. The analog here is vitamins and nutraceuticals. Having vitamin supplements freely available carries some minor risk that we accept and monitor. As with groceries and healthy eating, there will be a blurring of lines. Anyone who has played Just Dance 3 on their Kinect can testify to the wellness promoting aspects of modern gaming. I expect to see Kinect (or competitors) in most seniors’ homes and LTC facilities by the end of the decade, providing virtual reality exercising, communication with family, and some low level fall monitoring. Seniors as gamers will horrify current gamers, I’m sure.
Patient education materials have also been moving from paper to the web for two decades. This trend will continue and accelerate as patient education materials move to tablets and smartphones. Mobile phones and tablets provide a much better platform for ongoing patient education. Education materials will move from being static to dynamic. This will blur the line between patient education and monitoring apps, eventually raising the question, again, of how patient education apps are regulated and certified. In order to ensure patients receive accurate and accessible information, physicians will need to prescribe high-quality apps at the point of care.
How will this important new industry organize itself? Here are some projections. In the medium term, we will see the emergence of a clear separation between prescribing (TechRx) and fulfillment (the apps pharmacy). A patient at discharge will be given a TechRX for a care pathway app, home monitoring, patient education, and a health, wellness and/or nutrition app recommendation. These will correspond to today’s follow-up visit, home care visit, patient education pamphlet, and some vitamins. Obviously the TechRx apps will be highly customized to the individual diagnosis and case.
Fulfillment (the apps pharmacy), on the other hand, may exist within the hospital, through a retail provider, or through free samples provided by the clinician. As noted above, there will be a migration path that goes through an intermediate model of physician/apothecary delivery. The companies that provide apps that fall into only one or two of the four segments described above will need to determine how to fit within the apps pharmacy value chain and there will be a consolidation period with tremendous channel conflict and overlap. Because these are technology substitutions the revenue models may provide encouragement or barriers depending on the incentive structures. These will need to be thought through and changes will need to be nimbly handled. In general, bundled pricing models and contact capitation will incentivize fluid adoption of new care models.
Ultimately, consumers themselves will play a huge role in this transition. When you or a family member go in for a procedure or are diagnosed with a chronic condition, you should ask the question: what is the best app for my condition? How do I contact my nurse on Skype? What should I load on my phone or tablet for education, for monitoring? The good news is that we are learning to do this every day as part of our normal lives.
The iPad is less than two years old, yet it is already common to run into grandparents who video visit with their grandkids. This is patient-friendly stuff that will help anyone managing their care to do so better and with more support from their care providers. A promising vision for our future.
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