Building Better, More Accurate Mobile Health Apps and Devices Through Inclusion

How do you define mHealth?

The ‘m’ in mHealth is for mobile, so it's really a focus on anything that you can do with a mobile or wireless device for health purposes. It's actually a bit of an older term. More often these days you'll hear people refer to digital health. It’s a term that includes mHealth, but also includes health information technology, general wearable devices, telehealth, telemedicine and personalized medicine that involves technology and health. 

What are the current shortcomings with mHealth devices and technology?

I think the biggest challenge with mobile health is that the pace of change on the industry side is so much faster than what happens in a traditional academic setting. What you end up with are solutions that can lack the same strong evidence base that they have when they come through that more methodical university-centric development.

Finding balance between those two is vital – these solutions are dealing with people’s health. Having trust in the app or device that’s built is important for that reason, and evidence can help with that. When you look at technology development and testing, there are often updates and fixes to deal with bugs. Working with solutions that deal with people’s health means it’s really important to get it right. You can't just throw something out there and then fix the bugs after the fact in the same way that you would with a game because it matters for individuals' lives and health. Having a high-quality solution the first time is essential.

These technologies can also present accessibility challenges. Can you talk about the digital divide?

It's a real challenge, and it manifests in a few ways. For example, if you have a solution that depends a lot on being able to have real-time access to the internet, and you live in a rural area where your bandwidth is slower, that creates barriers. If your first language is not English, you may have more trouble finding solutions that are good for you because so much development can overlook that. At the mHealth Impact Lab, our work is very conscious about including people from a variety of different backgrounds and considering the needs of different populations in our testing to try to avoid these digital divides.

What does mHealth currently do well?

The biggest area of opportunity where mobile health can really help is bringing the power to patients to help manage their own health outside the clinic walls. 

Mobile health gives doctors more information from your everyday life so that they’re more informed. At the same time, it can also give you more information about your health needs, and can even bring some kinds of services and support to you at home. It can improve conversations with your providers because communication is easier with shared information, and it provides access to resources outside their office that you might not otherwise have. 

What are some successful examples the mHealth Impact Lab is currently working on showing that patient empowerment?

There are several: 

• The director of our lab, Sheana Bull, is working with the School of Medicine to co-lead a project that is focusing on text reminders for those on heart medications to help if they have a refill gap. So if they miss a refill, we reach out to them automatically through one of a few different types of text messages to give a gentle reminder – a behavioral nudge. This is to help see if technology like this can help overcome barriers that are interfering with the ability to get already-prescribed medications filled to help people stay on life-saving medication long term. 

• We're also working on a project with UCHealth and CU Innovations right now that is focused on behavioral health care. It’s a solution that’s integrated with the UCHealth mobile app to help support people with anxiety and depression who are at risk of something worsening in this stressful world that we live in. Its goal is to help providers reach out to those patients if they need extra help based on their own data shared on their own phone.

• There are also two studies we’re working on with wearable remote patient monitoring for cancer patients who just had bone marrow transplant or CAR T-cell therapy to help with a condition called febrile neutropenia – which is basically when your white blood cells, because of the cancer treatment, don't respond as well, so you're more likely to get infections. Wearable monitoring helps with this in two ways. One, patients can be monitored by a virtual care team for follow-up so they can avoid an emergency situation if their monitors detect a fever, other symptom exacerbations or side effects. And secondly, it allows patients to return to the comfort of home, requiring less hospital time after procedures like these.

From a consumer perspective, what's the easiest way to identify accurate health-related apps or devices?

For apps, while it’s not always the most reliable way, looking at ratings, comments and feedback is a really good start. Beyond that, I would recommend people look for an app or device that has some level of clinical evidence: something that’s able to say, ‘We partnered with this hospital or these doctors to try this, and these are the results that we found.’ Companies tend to highlight when they have done research studies and have actual evidence behind their product, so you can find this kind of information online. Some good places to look are in tech news reports, company websites, and yes, in announcements through traditional academic settings like CU.