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Dr.	
  Mary	
  J.	
  Cronin	
                        	
  
	
                                                   	
  
	
                                                   	
  
	
                                                   	
  

                                                     	
  


                    Mobile	
  Health	
  2010	
       	
  

                                                     	
  

                                                     	
  
                                  	
  
                                                     	
  
                                  	
  
                                                     	
  
                                  	
  
                                                       	
  
                                  	
  [Pick	
  the	
  date]	
  
                                                       	
  

                                                     By	
  

                                                     Mary	
  J.	
  Cronin	
  
                                                     	
  

                                                     Prepared	
  for	
  


                                                     Renu Mobile™
                                                     	
  

                                                     	
  

                                                     	
  	
  July	
  27,	
  2010	
  
2	
  

	
  




                                                                                                                                                                      	
  

	
  

About	
  Renu	
  Mobile™	
  

Renu	
   Mobile	
   is	
   an	
   innovative	
   mobile	
   marketing	
   enabler	
   that	
   specializes	
   in	
   unique	
   and	
   highly	
   effective	
  
solutions	
   that	
   target	
   mobile	
   phones	
   and	
   the	
   mobile	
   consumer.	
  	
   The	
   company	
   is	
   one	
   of	
   the	
   first	
   to	
  
specialize	
  in	
  ecologically	
  responsible	
  marketing	
  via	
  mobile	
  phones,	
  and	
  boasts	
  a	
  combined	
  20	
  years	
  of	
  
mobile	
   experience	
   servicing	
   agencies	
   and	
   brands	
   worldwide.	
  	
   A	
   full	
   creative	
   services	
   team	
   including	
  
copywriters,	
   graphic	
   designers	
   and	
   video	
   editors	
   provide	
   mobile-­‐specific	
   campaign	
   development.	
   The	
  
company	
   presently	
   works	
   with	
   a	
   number	
   of	
   clients	
   across	
   a	
   spectrum	
   of	
   different	
   industry	
   segments,	
  
and	
   offers	
   a	
   full-­‐service	
   suite	
   of	
   text	
   message,	
   mobile	
   2D	
   barcodes	
   and	
   mobile	
   browser	
   products	
   to	
  
execute	
  mobile	
  strategies.	
  

For	
  More	
  Information	
  

For	
  more	
  information	
  about	
  Renu	
  Mobile,	
  or	
  for	
  a	
  discussion	
  of	
  mobile	
  health	
  products	
  and	
  strategies,	
  
e-­‐mail	
   gotext@renumobile.com,	
   call	
   617-­‐240-­‐4674	
   or	
   visit	
   the	
   Renu	
   Mobile	
   website	
   at	
  
www.renumobile.com	
  	
  	
  

About	
  the	
  Author	
  
	
  
Mary	
   J.	
   Cronin,	
   Ph.D.	
   is	
   a	
   Professor	
   of	
   Information	
   Systems	
   at	
   Boston	
   College,	
   Carroll	
   School	
   of	
  
Management.	
  	
  Her	
  latest	
  book	
  is	
  Smart	
  Products,	
  Smarter	
  Services:	
  Strategies	
  for	
  Embedded	
  Control	
  
(Cambridge	
   University	
   Press,	
   2010).	
   	
   This	
   book	
   analyzes	
   the	
   impact	
   of	
   connected	
   health	
   solutions,	
  
mobile	
  and	
  wireless	
  applications	
  and	
  medical	
  devices	
  on	
  the	
  healthcare	
  industry.	
  	
  	
  Dr.	
  Cronin	
  is	
  a	
  Partner	
  
at	
  MedHealthWorld	
  and	
  Editor	
  of	
  the	
  SPEC	
  (Smart	
  Product	
  Ecosystem	
  Connections)	
  web	
  site.	
  	
  
	
  

	
  

	
  

	
  

                      ©	
  Renu	
  Mobile	
  2010	
   	
                 	
           	
           	
           All	
  Rights	
  Reserved	
  
3	
  

	
  

                                                                          	
  

                                                 MOBILE	
  HEALTH	
  2010	
  

Table	
  of	
  Contents	
  
	
  
Introduction:	
  	
  Consumer	
  Readiness	
  for	
  Mobile	
  Health	
  Services	
  .............................................. 4	
  
           Primary	
  Mobile	
  Channels	
  for	
  Reaching	
  Mobile	
  Consumers	
  with	
  Health	
  Information	
  
                                                                          	
  
Providing	
  Health	
  Information	
  and	
  Services	
  on	
  the	
  Mobile	
  Web............................................... 5	
  
        Best	
  Practices	
  for	
  Providers:	
  Mobile	
  Web	
  Design................................................................. 8	
  
	
  
Text	
  Messaging	
  for	
  Better	
  Health	
  and	
  Improved	
  Patient	
  Outcomes ........................................ 8	
  
        Best	
  Practices	
  for	
  Providers:	
  Health	
  Related	
  Text	
  Messaging ............................................. 12	
  
	
  
Smart	
  Phone	
  Health	
  Apps ..................................................................................................... 12	
  
        Issues	
  for	
  Providers	
  and	
  Vendors	
  in	
  Designing	
  and	
  Implementing	
  Health	
  Apps .................. 14	
  
        Best	
  Practices	
  for	
  Providers:	
  Smart	
  Phone	
  Health	
  Apps ..................................................... 15	
  
	
  
Innovative	
  Mobile	
  Services ................................................................................................... 15	
  
	
  
Conclusion:	
  	
  Lessons	
  from	
  Early	
  Implementations	
  and	
  Best	
  Practices.................................... 17	
  
	
  

Endnotes .............................................................................................................................. 18	
  
	
  

	
  

	
  
4	
  

	
  

Mobile	
  Health	
  2010	
  
                                                            	
  
        Strategies	
  and	
  Best	
  Practices	
  for	
  Implementing	
  Consumer	
  Mobile	
  Health	
  
                                 Information	
  Products	
  and	
  Services	
  
                 _____________________________________________	
  

Introduction	
  
Where	
   do	
   consumers	
   go	
   for	
   health	
   services	
   and	
   medical	
   information?	
   For	
   over	
   280	
   million	
   wireless	
  
subscribers	
  in	
  the	
  United	
  States,	
  the	
  answer	
  is	
  as	
  close	
  as	
  their	
  mobile	
  phone.	
  	
  Today’s	
  consumers	
  use	
  
their	
   mobile	
   devices,	
   especially	
   their	
   smartphones,	
   to	
   access	
   all	
   types	
   of	
   resources	
   -­‐-­‐including	
   health	
  
information	
   -­‐-­‐	
   on	
   the	
   go.	
   	
   The	
   widespread	
   adoption	
   of	
   smartphones	
   is	
   creating	
   a	
   strong	
   demand	
   for	
  
mobile	
  health	
  resources	
  that	
  will	
  address	
  a	
  broad	
  spectrum	
  of	
  health	
  care	
  needs.	
  	
  In	
  a	
  fall	
  2009	
  survey	
  
conducted	
   by	
   Harris	
   Interactive	
   and	
   the	
   CTIA	
   Wireless	
   Association,	
   78%	
   of	
   Americans	
   expressed	
   an	
  
interest	
   in	
   mobile	
   health	
   solutions,	
   including	
   interaction	
   with	
   physicians	
   via	
   mobile,	
   wireless	
   monitoring	
  
for	
  a	
  variety	
  of	
  medical	
  conditions,	
  and	
  home	
  health	
  monitoring	
  for	
  seniors.	
  	
  A	
  majority	
  of	
  participants	
  in	
  
the	
  survey	
  mentioned	
  that	
  access	
  to	
  mobile	
  health	
  services	
  and	
  information	
  would	
  give	
  patients	
  more	
  
peace	
  of	
  mind,	
  make	
  medical	
  care	
  easier	
  to	
  obtain,	
  allow	
  for	
  more	
  home	
  based	
  care,	
  and	
  give	
  patients	
  
more	
  freedom	
  and	
  choice	
  of	
  treatments.i

While	
  consumers	
  are	
  rapidly	
  transitioning	
  to	
  the	
  mobile	
  web	
  and	
  smart	
  phone	
  applications,	
  healthcare	
  
providers	
   and	
   health	
   IT	
   vendors	
   are	
   still	
   in	
   the	
   early	
   stages	
   of	
   implementing	
   mobile	
   health	
   solutions.	
  
Developing	
   and	
   delivering	
   high	
   value	
   mobile	
   health	
   services	
   is	
   a	
   fairly	
   recent	
   challenge	
   for	
   healthcare	
  
institutions,	
   care	
   providers	
   and	
   companies	
   serving	
   the	
   2.3	
   trillion	
   dollar	
   U.S.	
   healthcare	
   system.ii	
   	
   Best	
  
practices	
   for	
   providing	
   mobile	
   health	
   information	
   and	
   services	
   are	
   emerging,	
   along	
   with	
   lessons	
   learned	
  
from	
  the	
  early	
  efforts	
  of	
  mobile	
  healthcare	
  pioneers.	
  	
  	
  

This	
   report	
   is	
   provided	
   as	
   a	
   resource	
   for	
   healthcare	
   providers,	
   health	
   information	
   resource	
   providers,	
  
and	
   health	
   IT	
   companies	
   interested	
   in	
   implementing	
   effective	
   mobile	
   health	
   strategies	
   that	
   meet	
  
consumer	
   needs	
   and	
   improve	
   patient	
   outcomes.	
   	
   It	
   analyzes	
   the	
   U.S.	
   mobile	
   health	
   landscape	
   and	
  
strategies	
   for	
   developing	
   and	
   delivering	
   mobile	
   health	
   information	
   and	
   services	
   to	
   connected	
  
consumers.	
  	
  It	
  focuses	
  on	
  today’s	
  three	
  most	
  popular	
  mobile	
  health	
  channels:	
  access	
  to	
  resources	
  and	
  
services	
  from	
  a	
  mobile	
  web	
  browser;	
  delivering	
  text-­‐message-­‐based	
  health	
  information,	
  reminders	
  and	
  
alerts;	
   and	
   developing	
   mobile	
   health	
   applications	
   for	
   download	
   to	
   smartphones	
   and	
   discusses	
   how	
  
these	
   and	
   emerging	
   channels	
   such	
   as	
   mobile	
   video	
   and	
   barcode	
   scanning	
   are	
   being	
   used	
   to	
   inform	
  
consumers,	
  help	
  them	
  to	
  manage	
  their	
  health	
  more	
  effectively,	
  and	
  improve	
  patient	
  outcomes.	
  	
  	
  

The	
  experience	
  of	
  mobile	
  health	
  leaders	
  and	
  experts	
  is	
  summarized	
  in	
  short	
  case	
  studies,	
  use	
  cases	
  and	
  
best	
  practice	
  recommendations.	
  	
  
5	
  

	
  

	
  
Reaching	
  the	
  Mobile	
  Health	
  Consumer	
  
	
  

                    Providing	
  Health	
  Information	
  and	
  Services	
  on	
  the	
  Mobile	
  Web	
  
                                                                                  	
  
In	
   the	
   past	
   decade,	
   the	
   majority	
   of	
   Americans	
   have	
   come	
   to	
   rely	
   on	
   the	
   Internet	
   as	
   a	
   vital	
   health	
   and	
  
medical	
   information	
   resource.	
   	
   The	
   Pew	
   Research	
   Center	
   reports	
   that	
   80%	
   of	
   internet	
   users	
   looked	
  
online	
  for	
  health	
  information	
   in	
  2009.iii	
  	
  WebMD,	
  the	
  most	
  frequently	
  consulted	
  online	
  health	
  resource,	
  
averaged	
  82.1	
  million	
  unique	
  visitors	
  per	
  month	
  in	
  the	
  first	
  quarter	
  of	
  2010,	
  with	
  more	
  than	
  1.8	
  billion	
  
total	
  page	
  views	
  during	
  that	
  period.iv Many	
  of	
  the	
  consumers	
  surveyed	
  by	
  the	
  Pew	
  Center	
  say	
  that	
  the	
  
Internet	
   has	
   had	
   a	
   significant	
   impact	
   on	
   the	
   way	
   they	
   care	
   for	
   themselves	
   or	
   for	
   others.	
   These	
  
consumers	
   are	
   now	
   seeking	
   health	
   and	
   medical	
   services	
   on	
   their	
   mobile	
   devices	
   and	
   the	
   demand	
   for	
  
mobile	
   health	
   resources	
   is	
   expected	
   to	
   grow	
   quickly.	
   Gartner	
   Research	
   predicts	
   that	
   by	
   2012,	
   mobile	
  
health	
  monitoring	
  will	
  be	
  one	
  of	
  the	
  10	
  most	
  popular	
  mobile	
  application	
  categories.v	
  

As	
   smartphones,	
   mobile	
   browsers	
   and	
   wireless	
   data	
   plans	
   become	
   more	
   prevalent	
   in	
   the	
   United	
   States,	
  
many	
  consumers	
  rely	
   on	
  their	
   mobile	
  phones	
  for	
  immediate	
  access	
  to	
  online	
  information.	
  	
  According	
  to	
  
the	
  ComScore	
  MobileLens,	
  in	
  May	
  2010,	
  31.9%	
  of	
  all	
  U.S.	
  wireless	
  subscribers	
  were	
  using	
  their	
  phone’s	
  
mobile	
  browser.vi	
  	
  That	
  amounts	
  to	
  over	
  80	
  million	
  consumers	
  who	
  are	
  viewing	
  web	
  resources,	
  including	
  
online	
   health	
   sites,	
   from	
   their	
   phones.	
   	
   Mobile	
   health	
   consumers	
   are	
   researching	
   medical	
   issues,	
  
participating	
   in	
   social	
   networks	
   of	
   patients	
   to	
   discuss	
   specific	
   medical	
   conditions	
   and	
   treatments,	
  
checking	
  on	
  symptoms,	
  and	
  trying	
  to	
  locate	
  doctors,	
  clinics	
  and	
  emergency	
  rooms.	
  	
  They	
  expect	
  mobile	
  
web	
  performance	
  to	
  be	
  comparable	
  to	
  their	
  desktop	
  Internet	
  browsing	
  experience.	
  

Like	
   many	
   other	
   high	
   traffic	
   internet	
   health	
   resources,	
   the	
   National	
   Institute	
   of	
   Health	
   (NIH)	
   has	
  
responded	
   to	
   this	
   demand	
   for	
   mobile	
   health	
   information	
   by	
   launching	
   a	
   mobile	
   version	
   of	
   its	
  
MedlinePlus	
   web	
   site	
   for	
   consumers.	
   	
   Produced	
   by	
   the	
   National	
   Library	
   of	
   Medicine,	
   MedlinePlus	
   is	
   a	
  
source	
   of	
   consumer	
   information	
   about	
   diseases,	
   conditions,	
   drugs,	
   clinical	
   trials	
   and	
   treatments,	
   and	
  
related	
   wellness	
   issues	
   of	
   interest	
   to	
   patients	
   and	
   their	
   families.	
   	
   In	
   the	
   first	
   quarter	
   of	
   2010,	
   the	
  
MedlinePlus	
  web	
  site	
  (Figure	
  1)	
  received	
  38.5	
  million	
  visitors	
  and	
  183	
  million	
  page	
  views.vii	
  	
  	
  

	
  
6	
  

	
  




                                                                                                                                           	
  

                                                          Figure	
  1:	
  	
  MedlinePlus	
  Web	
  Site	
  

Noting	
   that	
   an	
   increasing	
   number	
   of	
   MedlinePlus	
   visitors	
   were	
   accessing	
   the	
   web	
   site	
   from	
   their	
   mobile	
  
phones,	
   NIH	
   developed	
   and	
   launched	
   Mobile	
   Medline	
   Plus	
   (Figure	
   2)	
   in	
   January	
   2010	
   with	
   design	
  
features	
   that	
   made	
   it	
   simple	
   for	
   mobile	
   consumers	
   to	
   find	
   and	
   retrieve	
   information	
   using	
   all	
   types	
   of	
  
mobile	
   phones,	
   from	
   iPhones	
   to	
   more	
   basic	
   cell	
   phones	
   with	
   smaller	
   screens	
   and	
   less	
   sophisticated	
  
mobile	
  web	
  browsers	
  (often	
  called	
  “feature	
  phones.”)	
  

	
  




                                                                                                                               	
  

                                                           Figure	
  2:	
  	
  Mobile	
  MedlinePlus	
  
7	
  

	
  

The	
  easy-­‐to-­‐navigate	
  design	
  of	
  Mobile	
  Medline	
  Plus	
  ensures	
  that	
  this	
  NIH	
  resource	
  is	
  readily	
  available	
  to	
  
the	
   majority	
   of	
   U.S.	
   wireless	
   subscribers	
   who	
   do	
   not	
   yet	
   own	
   smartphones.	
   	
   According	
   to	
   ComScore,	
  
smartphone	
   owners	
   accounted	
   for	
   only	
   20%	
   of	
   total	
   U.S.	
   wireless	
   subscribers	
   in	
   April	
   2010,	
   with	
   80%	
   of	
  
subscribers	
   using	
   feature	
   phones.	
   The	
   ComScore	
   data	
   also	
   shows	
   that	
   while	
   smartphone	
   users	
   are	
  
especially	
  active	
  in	
  browsing	
  for	
  information	
  and	
  downloading	
  apps,	
  “feature	
  phone	
  users	
  still	
  make	
  up	
  
nearly	
   half	
   of	
   all	
   users	
   accessing	
   mobile	
   browsers	
   and	
   apps.”	
   	
   The	
   ComScore	
   report	
   concludes,	
  
“Although	
   growth	
   in	
   application	
   usage	
   on	
   smartphones	
   continues	
   to	
   grab	
   the	
   spotlight	
   in	
   the	
   mobile	
  
                                                                                                                                                                          viii
market,	
  the	
  audience	
  using	
  their	
  mobile	
  browser	
  remains	
  larger	
  and	
  is	
  growing	
  just	
  as	
  quickly.”

The	
   Mayo	
   Clinic,	
   one	
   of	
   the	
   top	
   10	
   most	
   visited	
   sites	
   for	
   health	
   information,	
   is	
   targeting	
   all	
   mobile	
  
consumers	
  by	
  developing	
  well-­‐designed	
  mobile	
  browser	
  compatible	
  web	
  sites	
  that	
  highlight	
  most-­‐used	
  
resources	
  such	
  as	
  disease	
  information	
  and	
  symptom	
  checkers	
  (Figure	
  3)	
  as	
  well	
  as	
  by	
  offering	
  a	
  variety	
  
of	
  smartphone	
  consumer	
  health	
  applications	
  and	
  text	
  messaging	
  services.	
  




                                                                                                                                   	
  	
  	
  	
  	
  	
  	
  	
  	
  

                                                            Figure	
  3:	
  Mayo	
  Clinic	
  Web	
  Site	
  

The	
   Mayo	
   Clinic	
   describes	
   its	
   mobile	
   health	
   strategy	
   as	
   a	
   “mix	
   of	
   native and mobile Web applications
available across a variety of handsets and	
   platforms”	
   designed	
   to	
   serve	
   patient	
   needs	
   before,	
   during	
  
and	
  after	
  their	
  care	
  at	
  Mayo	
  Clinic	
  locations	
  as	
  well	
  as	
  providing	
  mobile	
  solutions	
  to	
  meet	
  the	
  needs	
  of	
  
physicians	
  and	
  care	
  providers.	
  	
  

                          "We are diligently focused on understanding the intricacies of a mobile platform and
                          the needs and desires of users," says Scott Eising, director of Advanced
                          Market/Product Development at Mayo Clinic. "We intend to pair our expertise in health
                          care with our growing understanding of the mobile world to develop products and
                          services that are optimized for the mobile audience." ix
8	
  

	
  

Best Practices for Providers: Mobile Web Design

Optimizing	
  web	
  sites	
  and	
  online	
  resources	
  for	
  the	
  mobile	
  consumer	
  is	
  a	
  fundamental	
  best	
  practice	
  for	
  
the	
   effective	
   delivery	
   of	
   mobile	
   health	
   information.	
   	
   Whether	
   or	
   not	
   a	
   health	
   information	
   resource	
  
decides	
   to	
   create	
   a	
   dedicated	
   mobile	
   web	
   site	
   like	
   the	
   NIH	
   Mobile	
   MedlinePlus,	
   or	
   wants	
   to	
   make	
   its	
  
primary	
  web	
  site	
  more	
  mobile-­‐browser	
  friendly,	
  there	
  are	
  a	
  number	
  of	
  web	
  design	
  strategies	
  to	
  bear	
  in	
  
mind,	
  including:	
  	
  	
  

        •    Make	
  it	
  easy	
  for	
  mobile	
  users	
  with	
  smaller	
  screen	
  feature	
  phones	
  to	
  navigate	
  the	
  site	
  and	
  to	
  find	
  
             the	
  most	
  frequently	
  consulted	
  site	
  information	
  and	
  services	
  
                    o Alphabetical	
  indexes	
  like	
  that	
  used	
  by	
  the	
  MayoClinic	
  web	
  (Figure	
  3)	
  are	
  a	
  good	
  design	
  
                           option	
  
        •    Provide	
  a	
  prominent	
  search	
  box	
  and	
  display	
  search	
  results	
  in	
  a	
  format	
  that	
  supports	
  quick	
  
             review	
  of	
  search	
  results	
  
        •    Provide	
  clear	
  descriptions	
  of	
  each	
  link	
  so	
  that	
  mobile	
  users	
  can	
  quickly	
  decide	
  if	
  a	
  link	
  leads	
  to	
  
             the	
  information	
  they	
  are	
  seeking	
  
        •    Limit	
  large	
  graphics	
  and	
  animation,	
  or	
  implement	
  an	
  intelligent	
  web	
  interface	
  that	
  recognizes	
  
             when	
  a	
  visitor	
  is	
  using	
  a	
  mobile	
  browser	
  and	
  provides	
  text	
  alternatives	
  	
  

                                                                                         	
  	
  
                                                                                         	
  
                Text	
  Messaging	
  for	
  Better	
  Health	
  and	
  Improved	
  Patient	
  Outcomes	
  
                         ___________________________________________	
  
	
  
The	
  burgeoning	
  popularity	
  of	
  the	
  iPhone	
  and	
  other	
  smartphones	
  in	
  the	
  U.S.	
  has	
  focused	
  media	
  attention	
  
on	
  the	
  hundreds	
  of	
  thousands	
  of	
  smartphone	
  apps	
  available	
  for	
  consumers,	
  including	
  a	
  wide	
  variety	
  of	
  
mobile	
   health	
   applications.	
   However,	
   a	
   less	
   frequently	
   publicized	
   but	
   far	
   more	
   ubiquitous	
   channel	
   for	
  
reaching	
  the	
  vast	
  majority	
  of	
  wireless	
  subscribers	
  is	
  text	
  messaging.	
  The	
  CTIA	
  estimates	
  that	
  more	
  than	
  
1.2	
   trillion	
   text	
   messages	
   were	
   sent	
   or	
   received	
   by	
   mobile	
   subscribers	
   in	
   the	
   U.S.	
   in	
   2009	
   and	
   texting	
  by	
  
consumers	
  continues	
  to	
  increase.x	
  	
  Almost	
  100%	
  of	
  today’s	
  mobile	
  phones	
  can	
  receive	
  and	
  respond	
  to	
  
text	
   messages,	
   and	
   many	
   consumers	
   subscribe	
   to	
   a	
   mobile	
   plan	
   that	
   includes	
   a	
   bundle	
   of	
   low-­‐cost	
  
messages	
   per	
   month,	
   making	
   texting	
   an	
   extremely	
   cost-­‐effective	
   means	
   of	
   communication.	
   	
   Health	
  
related	
  text	
  messages	
  can	
  easily	
  be	
  personalized	
  based	
  on	
  stated	
  subscriber	
  preferences,	
  for	
  example	
  by	
  
asking	
   subscribers	
   to	
   use	
   a	
   keyword	
   when	
   they	
   opt	
   in	
   to	
   a	
   text	
   service.	
   	
   Messages	
   can	
   be	
   scheduled	
  
according	
  the	
  needs	
  of	
  the	
  recipient,	
  from	
  multiple	
  times	
  per	
  day	
  in	
  the	
  case	
  of	
  medication	
  reminders	
  to	
  
daily	
  messages,	
  to	
  one-­‐time	
  alerts	
  and	
  notifications,	
  to	
  weekly	
  updates	
  on	
  health	
  topics	
  of	
  interest.	
  

Because	
   of	
   its	
   availability	
   to	
   almost	
   all	
   wireless	
   subscribers,	
   and	
   its	
   ability	
   to	
   deliver	
   highly	
   targeted	
  
messages	
   about	
   specific	
   healthcare	
   issues,	
   text	
   messaging	
   is	
   an	
   effective	
   way	
   to	
   communicate	
   health	
  
information	
   to	
   a	
   broad	
   population	
   of	
   consumers.	
   	
   	
   Health	
   literacy	
   online:	
   A	
   guide	
   to	
   writing	
   and	
  
designing	
  easy-­‐to-­‐use	
  health	
  Web	
  sites	
   by	
  the	
  U.S.	
  Department	
  of	
  Health	
  and	
  Human	
  Services’	
  Office	
  
9	
  

	
  

of	
   Disease	
   Prevention	
   and	
   Health	
   Promotion	
   (June	
   2010)	
   recommends	
   text	
   messaging	
   as	
   an	
   effective	
  
strategy	
   for	
   bringing	
   critical	
   health	
   information	
   to	
   consumers	
   with	
   limited	
   literacy	
   skills	
   and	
   limited	
   web	
  
access	
  and	
  online	
  navigational	
  experience,	
  noting	
  that	
  “Many	
  of	
  the	
  groups	
  receptive	
  to	
  the	
  use	
  of	
  text	
  
messaging	
  for	
  health,	
  such	
  as	
  adults	
  below	
  the	
  poverty	
  threshold	
  and	
  immigrants	
  and	
  refugees,	
  are	
  also	
  
likely	
  to	
  have	
  limited	
  literacy	
  skills.”	
  xi	
  

One	
   text	
   messaging	
   program	
   that	
   is	
   designed	
   to	
   improve	
   the	
   pre-­‐natal	
   care	
   of	
   pregnant	
   women	
   in	
  
underserved	
  populations	
  is	
  Text4Baby,	
  a	
  free	
  program	
  launched	
  in	
  February	
  2010	
  to	
  text	
  health	
  tips	
  and	
  
information	
   on	
   free	
   health	
   resources	
   in	
   either	
   English	
   or	
   Spanish.	
   Women	
   can	
   sign	
   up	
   for	
   the	
   service	
   by	
  
texting	
  BABY	
  (or	
  BEBE	
  for	
  Spanish)	
  to	
  511411	
  (Figure	
  4).xii	
  

In	
  its	
  first	
  three	
  months	
  of	
  availability,	
  over	
  36,000	
  women	
  had	
  signed	
  up	
  for	
  the	
  program	
  and	
  received	
  
more	
  than	
  1	
  million	
  free	
  text	
  messages	
  including	
  encouragement	
  to	
  visit	
  their	
  doctor	
  or	
  clinic	
  regularly	
  
for	
  screenings	
  and	
  advice	
  that	
  is	
  timed	
  to	
  each	
  participant’s	
  due	
  date.	
  	
  Text4Baby	
  has	
  created	
  a	
  direct	
  
communication	
   channel	
   to	
   a	
   previously	
   hard-­‐to-­‐reach	
   and	
   at-­‐risk	
   population	
   with	
   a	
   goal	
   of	
   reducing	
   the	
  
500,000	
  premature	
  births	
  and	
  28,000	
  infant	
  deaths	
  in	
  the	
  U.S.	
  that	
  might	
  be	
  prevented	
  by	
  regular	
  pre-­‐
natal	
  screenings	
  and	
  healthier	
  behavior.	
  	
  Text4Baby	
  is	
  already	
  finding	
  other	
  applications	
  for	
  delivering	
  
urgent	
   health	
   information	
   to	
   new	
   mothers	
   -­‐-­‐	
   for	
   example	
   it	
   delivered	
   a	
   special	
   text	
   message	
   in	
   May	
  
2010	
  to	
  alert	
  subscribers	
  to	
  the	
  recall	
  of	
  a	
  number	
  of	
  pediatric	
  medicines	
  and	
  provided	
  a	
  hotline	
  to	
  call	
  
for	
  more	
  information	
  about	
  the	
  recall.	
  	
  	
  




                                                                                                     	
  

                                       Figure	
  4:	
  	
  Sign	
  Up	
  For	
  Text4Baby	
  Text	
  Message	
  Program	
  

Since	
   text	
   messages	
   support	
   two-­‐way	
   communication	
   options	
   they	
   can	
   be	
   deployed	
   for	
   a	
   variety	
   of	
  
health	
  scenarios.	
  	
  As	
  in	
  the	
  Text4Baby	
  case,	
  brief	
  alerts	
  in	
  text	
  message	
  format	
  can	
  include	
  a	
  link	
  to	
  a	
  
web	
  site	
  or	
  a	
  phone	
  number.	
  	
  Recipients	
  can	
  click	
  on	
  the	
  phone	
  number	
  to	
  initiate	
  a	
  call	
  and	
  get	
  more	
  
detailed	
   information	
   about	
   the	
   alert.	
   	
   Mobile	
   consumers	
   can	
   also	
   text	
   in	
   questions	
   or	
   keywords	
   to	
  
receive	
   specific	
   information	
   as	
   needed,	
   in	
   a	
   mode	
   that	
   is	
   immediate	
   and	
   often	
   more	
   private	
   than	
  
searching	
  a	
  web	
  site	
  at	
  home	
  or	
  in	
  a	
  public	
  location.	
  	
  This	
  is	
  an	
  important	
  benefit	
  when	
  consumers	
  are	
  
seeking	
   information	
   and	
   resources	
   about	
   sensitive	
   health	
   issues	
   such	
   as	
   pregnancy	
   or	
   sexually	
  
transmitted	
  diseases.	
  
10	
  

	
  

The	
  Center	
  for	
  Disease	
  Control	
  and	
  Prevention	
  (CDC)	
  provides	
  mobile	
  health	
  information	
  and	
  resources	
  
on	
  its	
  mobile	
  web	
  site	
  as	
  well	
  as	
  through	
  a	
  variety	
  of	
  text	
  message	
  programs.	
  	
  Consumers	
  can	
  sign	
  up	
  on	
  
the	
  CDC	
  web	
  site	
  or	
  text	
  the	
  keyword	
  “HEALTH”	
  to	
  87000	
  to	
  begin	
  receiving	
  general	
  health	
  tips,	
  travel	
  
health	
  alerts,	
  and	
  during	
  the	
  flu	
  season,	
  updates	
  and	
  alerts	
  about	
  vaccine	
  availability	
  and	
  flu	
  outbreaks,	
  
and	
  other	
  emergency	
  health	
  information.	
  (Figure	
  5)	
  	
  These	
  messages	
  provide	
  phone	
  numbers	
  and	
  web	
  
links	
  that	
  the	
  consumer	
  can	
  access	
  directly	
  from	
  the	
  text	
  display	
  to	
  obtain	
  more	
  detailed	
  information.	
  




                                                                     	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
            	
  

                                                      Figure	
  5:	
  	
  CDC	
  Text	
  Message	
  Program	
  

The	
   CDC	
   AIDS	
   program	
   leverages	
   the	
   willingness	
   of	
   consumers	
   to	
   access	
   sensitive,	
   personal	
   information	
  
on	
  their	
  mobile	
  phones	
  by	
  providing	
  a	
  short	
  code	
  that	
  connects	
  consumers	
  to	
  information	
  about	
  AIDS	
  
and	
  HIV	
  testing.	
  	
  To	
  locate	
  the	
  nearest	
  HIV	
  testing	
  center,	
  a	
  user	
  can	
  simply	
  text	
  their	
  ZIP	
  code	
  to	
  566948	
  
(KNOWIT	
  on	
  the	
  phone	
  dial	
  pad)	
  and	
  immediately	
  get	
  a	
  return	
  message	
  listing	
  the	
  location	
  and	
  phone	
  
number	
  of	
  nearby	
  HIV	
  testing	
  centers.	
  	
  	
  (Figure	
  6)	
  




                                                                                                                                                                                                                                    	
  

                                  Figure	
  6:	
  	
  CDC	
  Program	
  for	
  HIV	
  Testing	
  and	
  AIDS	
  Information	
  

	
  

The	
  almost	
  universal	
  reach	
  of	
  text	
  messaging	
  and	
  its	
  growing	
  popularity	
  among	
  the	
  entire	
  demographic	
  
spectrum	
  of	
  wireless	
  subscribers	
  in	
  the	
  U.S.	
  has	
  encouraged	
  more	
  use	
  of	
  health-­‐related	
  texting	
  services	
  
11	
  

	
  

among	
  private	
  practice	
  groups	
  and	
  pharmacies,	
  especially	
  for	
  confirmations	
  and	
  reminders	
  about	
  clinic	
  
appointments	
  and	
  prescriptions	
  refills.	
  	
  	
  

Walgreens,	
   which	
   operates	
   7,522	
   drugstores	
   in	
   the	
   U.S.	
   as	
   well	
   as	
   over	
   700	
   Convenient	
   Care	
   health	
   and	
  
wellness	
   centers	
   at	
   workplace	
   sites	
   and	
   its	
   own	
   stores,	
   has	
   recently	
   expanded	
   its	
   delivery	
   of	
   mobile	
  
health	
   information	
   through	
   all	
   three	
   channels	
   –	
   it	
   re-­‐launched	
   a	
   mobile	
   Walgreens	
   web	
   site,	
   and	
  
launched	
   a	
   new	
   smartphone	
   app	
   designed	
   to	
   serve	
   the	
   needs	
   of	
   its	
   customers	
   for	
   variety	
   of	
   mobile	
  
health	
  services	
  (Figure	
  7).	
  

Walgreens	
  June	
  2010	
  announcement	
  about	
  its	
  mobile	
  health	
  focus	
  also	
  included	
  two	
  new	
  text	
  
messaging	
  services:	
  	
  

         •   Prescription Text Alerts – Receive a text message from Walgreens pharmacy when your
             prescriptions are ready or if there are any status changes. Customers can sign up for text alerts
             at any Walgreens pharmacy or online at www.walgreens.com/gomobile. Text alerts are also
             available in Spanish.
         •   Special Offer Texts – Get information about exclusive Walgreens deals and coupons via text
             message. Messages also provide important information and the latest services available both in
             store and online. Customers can sign up through the Walgreens mobile site or by texting
                                   xiii
             “Walgreens” to 21525.




                                                                                                                             	
  

	
  
                     Figure	
  7:	
  Walgreens	
  Highlights	
  Mobile	
  Services	
  Across	
  All	
  3	
  Mobile	
  Channels	
  

	
  
Offering	
  mobile	
  health	
  information	
  and	
  services	
  in	
  all	
  three	
  channels,	
  in	
  accordance	
  with	
  the	
  needs	
  of	
  
the	
   target	
   population	
   and	
   the	
   provider’s	
   goals	
   is	
   another	
   best	
   practice	
   for	
   mobile	
   health	
  
implementation.	
   	
   By	
   adding	
   a	
   text	
   messaging	
   option	
   and	
   re-­‐designing	
   its	
   web	
   site	
   for	
   easy	
   mobile	
  
browser	
  access,	
  Walgreens	
  is	
  responding	
  to	
  increased	
  consumer	
  interest	
  in	
  mobile	
  health	
  services.	
  
	
  
12	
  

	
  

Best Practices for Health Related Text Messaging
	
  
     • Text	
  message	
  health	
  information	
  services	
  must	
  be	
  based	
  on	
  explicit	
  permission	
  or	
  opt	
  in	
  by	
  the	
  
       mobile	
  subscriber.	
  	
  The	
  opt-­‐in	
  motivator	
  can	
  be	
  a	
  call	
  to	
  sign	
  up	
  for	
  text	
  info	
  on	
  a	
  web	
  site,	
  or	
  a	
  
       short	
  code	
  that	
  is	
  distributed	
  in	
  printed	
  materials,	
  advertising,	
  broadcast	
  media,	
  and	
  via	
  social	
  
       media.	
  
               o In	
  addition	
  to	
  explicit	
  permission	
  and	
  opt	
  in,	
  provide	
  clear	
  instructions	
  on	
  	
  how	
  to	
  stop	
  
                      receiving	
  messages	
  
     • Become	
  familiar	
  with	
  and	
  follow	
  all	
  consumer	
  privacy	
  guidelines	
  related	
  to	
  text	
  messaging	
  as	
  
       well	
  as	
  requirements	
  for	
  the	
  security	
  and	
  privacy	
  protections	
  for	
  personal	
  information	
  and	
  
       health	
  data	
  
     • Use	
  text	
  messages	
  as	
  a	
  prompt	
  to	
  consumer	
  action	
  –including	
  click	
  to	
  call	
  options	
  and	
  click	
  to	
  
       link	
  options	
  so	
  that	
  users	
  can	
  follow	
  up	
  as	
  needed	
  directly	
  from	
  the	
  text	
  message	
  
     • Integrate	
  text	
  messages	
  with	
  mobile	
  web	
  resources	
  and	
  smartphone	
  applications	
  to	
  provide	
  an	
  
       integrated	
  mobile	
  health	
  service	
  across	
  the	
  three	
  most	
  used	
  mobile	
  channels	
  	
  
	
  

	
  

	
  

                                          Smartphone	
  Health	
  Apps	
  
                               ___________________________________________	
  
	
  
At	
   the	
   beginning	
   of	
   2010,	
   Apple	
   announced	
   that	
   over	
   3	
   billion	
   apps	
   had	
   been	
   downloaded	
   from	
   the	
  
Apple	
  App	
  Store	
  -­‐-­‐	
  and	
  the	
  pace	
  of	
  mobile	
  app	
  downloads	
  continues	
  to	
  accelerate	
  as	
  more	
  consumers	
  
become	
   smartphone	
   owners.	
   	
   	
   According	
   to	
   Mobile	
   Health	
   News,	
   there	
   were	
   over	
   7,000	
   health	
   and	
  
fitness	
   apps	
   available	
   for	
   download	
   from	
   Apple’s	
   App	
   Store,	
   the	
   Android	
   Marketplace,	
   the	
   Blackberry	
  
and	
  Nokia	
  application	
  markets	
  in	
  the	
  first	
  quarter	
  of	
  2010,	
  with	
  about	
  30%	
  of	
  these	
  apps	
  designed	
  for	
  
use	
   by	
   physicians	
   and	
   other	
   medical	
   practitioners	
   and	
   the	
   remainder	
   targeted	
   at	
   health-­‐conscious	
  
mobile	
  consumers.	
  
	
  
Apple	
   does	
   not	
   release	
   data	
   about	
   the	
   number	
   of	
   downloads	
   for	
   specific	
   applications,	
   but	
   one	
   indicator	
  
of	
   the	
   widespread	
   popularity	
   of	
   smartphone	
   health	
   apps	
   is	
   WebMD’s	
   announcement	
   that	
   its	
   free	
  
WebMD	
   mobile	
   app	
   for	
   the	
   iPhone	
   had	
   1.6	
   million	
   downloads	
   in	
   its	
   first	
   3	
   months	
   of	
   availability.	
  	
  
WebMD	
  mobile	
  features	
  a	
  simple	
  user	
  interface	
  with	
  three	
  search	
  boxes	
  (Figure	
  8).	
  	
  By	
  describing	
  their	
  
main	
   symptoms,	
   users	
   can	
   search	
   for	
   more	
   information	
   about	
   a	
   medical	
   problem,	
   or	
   can	
   retrieve	
  
relevant	
  treatment	
  options	
  and	
  emergency	
  first	
  aid	
  techniques.	
  

The	
  Mayo	
  Clinic	
  provides	
  an	
  iPhone	
  symptom	
  checker	
  app	
  with	
  features	
  that	
  include	
  separate	
  searches	
  
for	
  adult	
  symptoms	
  and	
  child	
  symptoms.	
  	
  Search	
  results	
  give	
  users	
   guidance on self-care at home and
the app also provide access to the Mayo Clinic health data base. As	
  part	
  of	
  its	
  integrated	
  mobile	
  health	
  
13	
  

	
  

strategy,	
  the	
  app	
  links	
  users	
  to	
  information	
  about	
  care	
  available	
  at	
  nearby	
  Mayo	
  Clinic	
  locations	
  so	
  that	
  
users	
  who	
  need	
  to	
  consult	
  a	
  care	
  provider	
  can	
  make	
  an	
  appointment	
  to	
  do	
  so.	
  (Figure	
  8)	
  	
  	
  

	
  




                                                                        	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
                   	
  

                          Figure	
  8:	
  	
  iPhone	
  Symptom	
  Checker	
  Apps	
  from	
  Mayo	
  Clinic	
  and	
  WebMD	
  

The	
   Mayo	
   Clinic	
   and	
   WebMD	
   smartphone	
   apps	
   reflect	
   app	
   design	
   best	
   practices	
   by	
   making	
   the	
   user	
  
interface	
   simple	
   and	
   action	
   oriented,	
   as	
   well	
   as	
   linking	
   users	
   to	
   more	
   in-­‐depth	
   information	
   from	
   their	
  
web	
  sites.	
  	
  	
  

Healthagen,	
   LLC,	
   a	
   Colorado	
   company	
   founded	
   by	
   two	
   emergency	
   room	
   physicians,	
   provides	
   even	
   more	
  
integrated	
  health	
  care	
  options	
  with	
  its	
  iTriage	
  application.	
  	
  (Figure	
  9)	
  	
  Consumers	
  can	
  check	
  symptoms,	
  
locate	
  the	
  nearest	
  care	
  provider	
  or	
  clinical	
  resource	
  –ranging	
  from	
  hospital	
  emergency	
  rooms	
  to	
  urgent	
  
care	
  centers	
  and	
  pharmacies	
  	
  –	
  and	
  then	
  get	
  GPS-­‐based	
  turn-­‐by-­‐turn	
  directions	
  to	
  the	
  care	
  provider	
  of	
  
their	
  choice.	
  	
  Other	
  available	
  options	
  include	
  information	
  on	
  the	
  waiting	
  time	
  at	
  participating	
  emergency	
  
rooms,	
  calling	
  a	
  nurse	
  hot	
  line	
  for	
  consultation,	
  and	
  quality	
  of	
  care	
  reports	
  on	
  hospitals	
  and	
  physicians.	
  	
  	
  

In	
  summary,	
  iTriage	
  provides:	
  

                   •      Information	
  on	
  more	
  than	
  300	
  symptoms,	
  1,000	
  diseases	
  and	
  350	
  medical	
  procedures	
  
                   •      A	
  nationwide	
  directory	
  of	
  hospitals,	
  urgent	
  cares,	
  retail	
  clinics,	
  pharmacies	
  and	
  physicians	
  
                   •      Turn-­‐by-­‐turn	
  facility	
  directions	
  from	
  GPS,	
  IP	
  address	
  or	
  zip	
  code	
  locations	
  
                   •      Nurse	
  advice	
  lines	
  
                   •      Access	
  to	
  Google	
  Health	
  Personal	
  Health	
  Record	
  on	
  the	
  smartphone	
  app	
  
                   •      Detailed	
  quality	
  reports	
  from	
  HealthGrades	
  on	
  hospitals	
  and	
  physicians	
  
                   •      Emergency	
  Room	
  Wait	
  Times	
  for	
  hospitals	
  in	
  select	
  parts	
  of	
  the	
  country	
  
                   	
  
14	
  

	
  




                                                                                                                 	
  
                                                        Figure	
  9:	
  	
  Healthagen’s	
  iTriage	
  App	
  

	
  

In	
   June	
   2010,	
   Healthagen	
   announced	
   the	
   integration	
   of	
   iTriage	
   with	
   Google	
   Health	
   personal	
   health	
  
records	
  (PHR).	
  	
  Access	
  to	
  prescription	
  information	
  and	
  a	
  history	
  of	
  previous	
  care	
  is	
  a	
  particularly	
  useful	
  
service	
  for	
  consumers	
  who	
  must	
  seek	
  care	
  when	
  they	
  are	
  traveling,	
  or	
  who	
  are	
  responsible	
  for	
  keeping	
  
track	
  of	
  multiple	
  prescriptions	
  and	
  care	
  providers	
  for	
  their	
  family	
  members.	
  xiv	
  	
  



Issues	
  for	
  Care	
  Providers	
  and	
  Technology	
  Vendors	
  in	
  Designing	
  and	
  Implementing	
  Health	
  Apps	
  

In	
  addition	
  to	
  using	
  the	
  health	
  applications	
  designed	
  with	
  consumers	
  in	
  mind,	
  many	
  smartphone	
  owners	
  
are	
  downloading	
  medical	
  reference	
  and	
  clinician	
  apps	
  that	
  have	
  been	
  developed	
  for	
  use	
  by	
  physicians	
  
and	
  professional	
  care	
  providers.	
  	
  These	
  “crossover	
  apps”	
  may	
  be	
  used	
  by	
  consumers	
  for	
  inappropriate	
  
self	
  diagnosis	
  and	
  treatment	
  –	
  an	
  area	
  of	
  concern	
  for	
  care	
  providers	
  and	
  regulators.	
  

Apps	
  for	
  wireless	
  health	
  monitoring	
  of	
  vital	
  signs	
  such	
  as	
  blood	
  pressure,	
  blood	
  sugar	
  levels	
  and	
  heart	
  
rate,	
   as	
   well	
   as	
   balance	
   and	
   activity	
   levels,	
   are	
   becoming	
   more	
   common	
   as	
   high	
   resolution	
   digital	
  
cameras,	
   Bluetooth	
   and	
   Wi-­‐Fi	
   wireless	
   connections,	
   accelerometers	
   and	
   other	
   features	
   are	
   integrated	
  
into	
  the	
  latest	
  smartphones.	
  	
  Personal	
  and	
  home	
  health	
  monitoring	
  solutions	
  can	
  use	
  native	
  smartphone	
  
features	
  as	
  monitors,	
  or	
  link	
  external	
  biosensors	
  that	
  collect	
  patient	
  data	
  to	
  the	
  smartphone	
  and	
  send	
  
the	
  data	
  to	
  a	
  health	
  aggregation	
  site	
  or	
  a	
  clinician	
  for	
  review.	
  	
  Such	
  health	
  monitoring	
  apps	
  are	
  coming	
  
under	
   regulatory	
   scrutiny	
   to	
   determine	
   if	
   smartphones	
   are	
   serving	
   as	
   medical	
   devices	
   when	
   used	
   for	
  
certain	
   types	
   of	
   applications,	
   as	
   well	
   as	
   to	
   ensure	
   that	
   any	
   data	
   collected	
   during	
   patient	
   monitoring	
   is	
  
protected	
  as	
  required	
  by	
  HIPAA	
  and	
  other	
  health	
  information	
  privacy	
  and	
  security	
  regulations.	
  	
  	
  	
  

Ed	
   Daniels,	
   a	
   consultant	
   for	
   Point	
   of	
   Care	
   Partners,	
   sounds	
   a	
   cautionary	
   note	
   for	
   developers	
   of	
  
smartphone	
   health	
   applications	
   who	
   are	
   looking	
   to	
   enter	
   this	
   already	
   crowded	
   market.	
   	
   Some	
   of	
   the	
  
core	
   technologies	
   behind	
   symptom	
   checkers	
   and	
   other	
   apps	
   have	
   been	
   patented	
   by	
   large	
   health	
  
information	
  providers	
  and	
  early	
  entrants	
  into	
  the	
  mobile	
  health	
  space.	
  	
  Companies	
  developing	
  apps	
  with	
  
15	
  

	
  

features	
   that	
   may	
   be	
   protected	
   by	
   existing	
   patents	
   should	
   research	
   intellectual	
   property	
   barriers	
   to	
  
avoid	
   infringement	
   and	
   possible	
   litigation.	
   	
   In	
   addition	
   to	
   existing	
   data	
   protection	
   requirements,	
   FDA	
  
regulation	
  of	
  health	
  monitoring	
  apps	
  is	
  a	
  real	
  possibility.	
  According	
  to	
  Daniels,	
  “If	
  software	
  is	
  intended	
  to	
  
provide	
   cure,	
   mitigation,	
   treatment,	
   or	
   prevention	
   of	
   disease	
   then	
   the	
   FDA	
   may	
   consider	
   it	
   a	
   medical	
  
device.”	
  	
  	
  

Best Practices for Smartphone Health Apps

         •   Clarify	
  the	
  intended	
  use	
  and	
  target	
  user	
  of	
  the	
  application	
  as	
  part	
  of	
  the	
  development	
  process	
  
             and	
  highlight	
  the	
  app’s	
  intended	
  use	
  and	
  the	
  need	
  to	
  consult	
  a	
  physician	
  for	
  medical	
  advice	
  so	
  
             that	
  consumers	
  are	
  well	
  informed	
  about	
  what	
  to	
  expect	
  from	
  the	
  app	
  when	
  they	
  download	
  it	
  
         •   Provide	
  integration	
  with	
  relevant	
  mobile	
  health	
  resources	
  and	
  options	
  such	
  as	
  the	
  ‘locations	
  and	
  
             directions	
  to	
  a	
  healthcare	
  provider’	
  feature	
  of	
  iTriage	
  to	
  extend	
  the	
  value	
  of	
  the	
  app	
  
         •   Design	
  apps	
  with	
  user	
  safety	
  and	
  health	
  care	
  data	
  security	
  and	
  information	
  privacy	
  regulations	
  
             in	
  mind	
  
         •   Conduct	
  patent	
  and	
  intellectual	
  property	
  search	
  to	
  determine	
  if	
  the	
  underlying	
  technology	
  or	
  
             user	
  interface	
  features	
  are	
  already	
  patent	
  protected.	
  
         •   Be	
  aware	
  of	
  application	
  features	
  that	
  may	
  trigger	
  FDA	
  review	
  and	
  requirements	
  for	
  medical	
  
             device	
  certification	
  or	
  even	
  clinical	
  trials	
  if	
  developing	
  apps	
  that	
  serve	
  as	
  components	
  of	
  wireless	
  
             health	
  monitoring	
  solutions	
  	
  

                                                          	
  
                                                          	
  
                                       Innovative	
  Mobile	
  Health	
  Services	
  
                               ____________________________________________	
  
	
  

The	
   mobile	
   health	
   landscape	
   is	
   evolving	
   at	
   a	
   rapid	
   pace.	
   	
   As	
   the	
   three	
   primary	
   channels	
   discussed	
   in	
   this	
  
report	
  become	
  mainstream	
  options	
  for	
  delivering	
  mobile	
  health	
  services	
  and	
  information	
  resources	
  to	
  
U.S.	
  consumers,	
  new	
  smartphone	
  features	
  and	
  technologies	
  enable	
  even	
  more	
  innovative	
  mobile	
  health	
  
services.	
   	
   These	
   innovations	
   include	
   mobile	
   video	
   conferencing	
   and	
   teleconsultations	
   with	
   care	
  
providers	
   and	
   family	
   members,	
   integrated	
   text	
   and	
   mobile	
   browser	
   solutions,	
   and	
   mobile	
   barcode	
  
scanning	
  to	
  manage	
  prescriptions,	
  refills	
  and	
  medication	
  adherence	
  reminders.	
  	
  	
  

Renu	
   Mobile	
   has	
   developed	
   a	
   prototype	
   for	
   helping	
   families	
   manage	
   ADHD	
   symptoms	
   through	
   a	
  
combination	
  of	
  text	
  messaging	
  and	
  mobile	
  browser	
  information	
  access.	
  	
  This	
  solution	
  reflects	
  the	
  finding	
  
that	
  regular	
  coaching	
  reminders	
  have	
  proven	
  to	
  be	
  more	
  effective	
  than	
  relying	
  solely	
  on	
  meetings	
  with	
  
clinicians	
  to	
  manage	
  ADHD	
  and	
  it	
  leverages	
  the	
  ease	
  of	
  scheduling	
  text	
  messages	
  to	
  arrive	
  throughout	
  
the	
   day.	
   Using	
   a	
   family-­‐centered	
   team	
   treatment	
   approach,	
   the	
   prototype	
   can	
   be	
   configured	
   by	
   parents	
  
to	
  fit	
  the	
  specific	
  needs	
  of	
  their	
  ADHD	
  child.	
  The	
  child	
  receives	
  text	
  message	
  tips	
  at set times reinforcing	
  
ADHD	
  management	
  techniques	
  like	
  making	
  lists,	
  working	
  on	
  one	
  or	
  two	
  items	
  within	
  a	
  set	
  time	
  period,	
  
and	
  taking	
  frequent	
  breaks.	
  Texts	
  to	
  parents	
  remind	
  them	
  to	
  praise	
  appropriate	
  behavior,	
  provide	
  help	
  
16	
  

	
  

in	
   setting	
   achievable	
   short-­‐term	
   goals	
   and	
  tasks	
  that	
  can	
  be	
  accomplished	
  with	
  a	
  specific	
   time	
   period.	
  
Messages	
  contain	
  links	
  to	
  online	
  content	
  that	
  provides	
  more	
  details	
  on	
  ADHD	
  management.	
  

Care	
  providers	
  at	
  SeniorBridge,	
  a	
  leading	
  provider	
  of	
  integrated	
  care	
  management	
  for	
  the	
  elderly	
  and	
  for	
  
patients	
   with	
   complex	
   chronic	
   disease	
   conditions,	
   provide	
   their	
   clients	
   with	
   support	
   for	
   desktop	
   and	
  
mobile	
   Skype	
   video	
   calls.	
   	
   Mobile	
   Skype	
   connections	
   allow	
   family	
   members	
   who	
   live	
   at	
   a	
   distance	
   to	
  
participate	
   virtually	
   in	
   doctor’s	
   visits,	
   allowing	
   them	
   to	
   understand	
   more	
   about	
   the	
   medical	
   condition	
   of	
  
their	
   elderly	
   parent	
   and	
   to	
   ask	
   for	
   clarification	
   of	
   any	
   questions	
   that	
   come	
   up	
   during	
   a	
   visit.	
   	
   Many	
  
SeniorBridge	
   clients	
   are	
   homebound,	
   making	
   a	
   trip	
   to	
   visit	
   their	
   doctor	
   for	
   routine	
   check-­‐ups	
   a	
   major	
  
undertaking	
  that	
  may	
  actually	
  have	
  a	
  detrimental	
  impact	
  on	
  the	
  patient’s	
  health.	
  	
  At	
  the	
  same	
  time,	
  a	
  
face-­‐to-­‐face	
   interaction	
   with	
   the	
   patient	
   provides	
   important	
   indicators	
   to	
   the	
   care	
   provider	
   about	
   a	
  
patient’s	
   state	
   of	
   mind,	
   mental	
   alertness	
   and	
   overall	
   condition.	
   	
   As	
   more	
   doctors	
   adopt	
   the	
   option	
   of	
  
tele-­‐visits,	
   a	
   combination	
   of	
   home	
   health	
   monitoring	
   and	
   video	
   visits	
   can	
   provide	
   that	
   face-­‐to-­‐face	
  
experience	
  and	
  substitute	
  for	
  the	
  time	
  and	
  cost	
  of	
  many	
  routine	
  check-­‐ups.	
  	
  

Another	
  innovative	
  mobile	
  health	
  opportunity	
  is	
  the	
  use	
  of	
  mobile	
  2D	
  barcodes	
  to	
  provide	
  point-­‐of-­‐need	
  
information	
  about	
  prescription	
  drug	
  side	
  effects	
  and	
  potential	
  adverse	
  interactions	
  with	
  other	
  medicines	
  
or	
  foods.	
  	
  For	
  example,	
  a	
  consumer	
  could	
  use	
  their	
  smartphone	
  camera	
  to	
  scan	
  a	
  barcode	
  attached	
  to	
  
the	
  prescription	
  bottle	
  or	
  drug	
  information	
  sheet	
  provided	
  by	
  the	
  pharmacist	
  to	
  access	
  additional	
  details	
  
about	
   the	
   medicine	
   whenever	
   they	
   had	
   questions.	
   	
   Scanning	
   the	
   prescription	
   barcode	
   could	
   also	
  
automatically	
  set	
  up	
  text	
  message	
  reminders	
  to	
  take	
  the	
  medicine	
  at	
  the	
  proper	
  time	
  of	
  day,	
  to	
  follow	
  
instructions	
   such	
   as	
   avoiding	
   sunlight,	
   and	
   to	
   finish	
   the	
   entire	
   dose	
   even	
   if	
   the	
   symptoms	
   have	
   gone	
  
away.	
  	
  	
  
17	
  

	
  

Conclusion	
  
Analysts	
   predict	
   that	
   the	
   consumer	
   adoption	
   of	
   mobile	
   health	
   resources	
   and	
   services	
   will	
   continue	
   to	
  
accelerate	
  and	
  will	
  become	
  mainstream	
  by	
  2015.	
  	
  	
  It	
  is	
  already	
  possible	
  to	
  reach	
  over	
  280	
  million	
  mobile	
  
subscribers	
  with	
  a	
  health	
  related	
  text	
  message,	
  and	
  over	
  80	
  million	
  consumers	
  are	
  actively	
  using	
  their	
  
phone’s	
   mobile	
   browser	
   to	
   access	
   online	
   information	
   and	
   services.	
   Currently	
   available	
   mobile	
   health	
  
web	
  sites	
  and	
  smartphone	
  apps	
  are	
  accessed	
  by	
  millions	
  of	
  consumers	
  and	
  are	
  becoming	
  an	
  essential	
  
component	
  in	
  an	
  integrated	
  health	
  solution.	
  

Health	
   information	
   providers,	
   pharmacies	
   and	
   health	
   insurance	
   companies,	
   hospitals,	
   clinicians	
   and	
  
other	
   health	
   care	
   resource	
   providers	
   who	
   are	
   launching	
   new	
   mobile	
   health	
   initiatives	
   or	
   working	
   to	
  
improve	
  the	
  effectiveness	
  of	
  current	
  programs	
  can	
  benefit	
  from	
  emerging	
  best	
  practices	
  and	
  the	
  lessons	
  
of	
  early	
  implementations.	
  	
  These	
  include:	
  

         •   Select	
   the	
   mobile	
   channels	
   that	
   best	
   match	
   the	
   primary	
   goals	
   and	
   target	
   audience	
   for	
   your	
  
             program	
  	
  
                  o Text	
   messages	
   are	
   highly	
   effective	
   for	
   delivering	
   brief,	
   customizable	
   health	
   reminders	
  
                         and	
  alerts	
  to	
  almost	
  all	
  wireless	
  subscribers	
  
                                 Text	
   messages	
   with	
   embedded	
   links	
   and	
   phone	
   numbers	
   can	
   be	
   used	
   as	
   a	
  
                                        trigger	
  to	
  action	
  and	
  are	
  especially	
  well	
  suited	
  to	
  reaching	
  underserved	
  and	
  at	
  
                                        risk	
  populations	
  with	
  immediate	
  and	
  actionable	
  health	
  care	
  advice.	
  	
  	
  
                  o Mobile	
   optimized	
   web	
   sites	
   combine	
   easy	
   access	
   with	
   depth	
   of	
   information	
   and	
   can	
  
                         highlight	
   most	
   requested	
   information	
   and	
   search	
   options	
   in	
   a	
   mobile-­‐browser	
  
                         compatible	
  interface	
  
                  o Smartphone	
   apps	
   enable	
   integrated	
   access	
   to	
   health	
   resources	
   and	
   can	
   support	
   a	
  
                         variety	
   of	
   patient	
   interactions	
   including	
   health	
   monitoring,	
   access	
   to	
   personal	
   health	
  
                         records	
  at	
  the	
  point	
  of	
  need,	
  and	
  mobile	
  video	
  for	
  teleconsultations	
  with	
  care	
  providers.	
  
         •   Track	
   the	
   consumer	
   response	
   and	
   progress	
   toward	
   program	
   goals	
   so	
   that	
   mobile	
  
             communications	
  can	
  be	
  expanded	
  or	
  adjusted	
  as	
  response	
  indicates	
  
         •   Integrate	
  and	
  innovate	
  as	
  adoption	
  of	
  advanced	
  features	
  such	
  a	
  mobile	
  video	
  calling	
  reaches	
  a	
  
             critical	
  mass	
  of	
  the	
  target	
  population	
  for	
  your	
  service	
  
         •   Become	
   familiar	
   with	
   the	
   regulatory	
   environment	
   and	
   information	
   privacy	
   and	
   security	
  
             requirements	
  for	
  implementing	
  any	
  type	
  of	
  mobile	
  health	
  information	
  resource	
  or	
  service	
  	
  
	
  

Companies	
   should	
   also	
   consider	
   working	
   with	
   experienced	
   and	
   trusted	
   implementation	
   partners	
   to	
  
design,	
  pilot,	
  and	
  implement	
  their	
  mobile	
  health	
  solutions.	
  	
  	
  

	
  

	
  
18	
  

	
  

Endnotes
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
i
    	
  Harris	
  Interactive,	
  “National	
  Study	
  Reveals	
  mHealth	
  has	
  Vast	
  Appeal	
  in	
  America”	
  Press	
  Release,	
  October	
  8,	
  2009	
  	
  
ii
     	
  California	
  HealthCare	
  Foundation,	
  U.S.	
  Health	
  Care	
  Spending:	
  Quick	
  Reference	
  Guide,	
  2010,	
  available	
  online	
  at	
  
http://www.chcf.org/publications/2010/04/health-­‐care-­‐costs-­‐101	
  
	
  
iii
        	
  Pew	
  Internet,	
  “Health	
  Research,	
  available	
  online	
  at	
  http://www.authoring.pewinternet.org/topics/Health.aspx	
  
	
  
iv
        	
  WebMD	
  Health	
  Corp.	
  (WBMD)	
  Q1	
  2010	
  Earnings	
  Call	
  May	
  04,	
  2010,	
  transcript	
  available	
  online	
  at	
  
http://seekingalpha.com/article/202961-­‐webmd-­‐health-­‐corp-­‐q1-­‐2010-­‐earnings-­‐call-­‐transcript	
  
	
  
v
     	
  Gartner	
  Research,	
  “Gartner	
  Identifies	
  the	
  Top	
  10	
  Consumer	
  Mobile	
  Applications	
  for	
  2012,”	
  November	
  18,	
  2009,	
  
press	
  release,	
  available	
  online	
  at	
  http://www.gartner.com/it/page.jsp?id=1230413	
  
	
  
vi
        	
  ComScore	
  	
  July	
  8,	
  2010,	
  	
  	
  press	
  release,	
  available	
  online	
  at	
  
http://www.comscore.com/Press_Events/Press_Releases/2010/7/comScore_Reports_May_2010_U.S._Mobile_Su
bscriber_Market_Share	
  
	
  
vii
           	
  MedlinePlus	
  Use	
  Statistics	
  available	
  online	
  at	
  http://www.nlm.nih.gov/medlineplus/usestatistics.html	
  
	
  
viii
              	
  Comscore,	
  “Browser	
  Continues	
  to	
  be	
  More	
  Popular	
  than	
  Applications	
  for	
  Accessing	
  Mobile	
  Web,”	
  press	
  release,	
  
June	
  2,	
  2010	
  
ix
       	
  MayoClinic,	
  “Mayo	
  Clinic	
  Introduces	
  Two	
  Consumer	
  Mobile	
  Applications,”	
  press	
  release,	
  	
  March	
  1,	
  2010	
  

x
 	
  Andrew	
  Berg,	
  “Thumbs	
  Up	
  for	
  Texting”,	
  Wireless	
  Week,	
  June	
  21,	
  2010	
  available	
  online	
  at	
  
http://www.wirelessweek.com/Articles/2010/06/Business-­‐Thumbs-­‐Up-­‐Texting-­‐Mobile-­‐Content/	
  
	
  
xi
     	
  U.S.	
  Department	
  of	
  Health	
  and	
  Human	
  Services’	
  Office	
  of	
  Disease	
  Prevention	
  and	
  Health	
  Promotion	
  Health	
  
literacy	
  online:	
  A	
  guide	
  to	
  writing	
  and	
  designing	
  easy-­‐to-­‐use	
  health	
  Web	
  sites,	
  June	
  2010	
  available	
  online	
  at	
  
http://www.health.gov/healthliteracyonline/	
  
	
  
xii
        	
  California	
  Healthcare	
  Foundation,	
  Jane	
  Sarasohn-­‐Kahn,	
  “How	
  Smartphones	
  Are	
  Changing	
  Healthcare	
  for	
  
Consumers	
  and	
  Providers,	
  ”	
  	
  April	
  2020	
  and	
  Text4Baby	
  web	
  site	
  at	
  www.text4baby.org	
  
	
  
xiii
           	
  Walgreens	
  mobile	
  web	
  site	
  announcement,	
  available	
  online	
  at	
  
http://www.walgreens.com/topic/mobile/apps/learn_about_mobile_browser_app.jsp?ban=flh2_h_rx	
  
	
  
xiv
           	
  Healthagen,	
  “iTriage	
  Recent	
  News”	
  available	
  online	
  at	
  http://healthagen.com/	
  
	
  

				
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