The digital health explosion
Consumer health technology can provide great insight into patients’ health outside of the provider’s office, especially as more people have access to broadband internet, smartphones, and wearable devices such as smartwatches. Regulatory definitions of “digital health” are expanding rapidly. The FDA includes “mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine” among categories of digital health, and is examining guidance around several topics including the development of mobile medical applications.
Mobile health technology is the most accessible format of digital health care. Just ten years ago, mobile health applications (“mobile apps”) were used mostly by a small niche of the healthcare industry to address specific issues and needs. Now, there are 3.6 billion smartphone users worldwide as of 2020, and over 4 billion users projected by 2023. Half of the world’s population will have access to some form of mobile health technology in their pocket. Mobile health technology is now a multi-billion dollar industry with numerous stakeholders and end-users covering a broad spectrum of digital health issues and expertise. There are over 318,500 mobile health apps available in the Apple and Google app stores and there are at least 200 new apps added to the health category daily.
Mobile health apps have become an important tool in the healthcare sphere. These apps have the potential to create closer connections between patients and their providers, allow patients to manage their own health more independently, and save billions of dollars by reducing hospital and emergency department visits. Mobile health apps can also streamline time-intensive processes, such as triaging patients to determine who needs to come into the office for appointments, and automating paper-based workflows once handled in the clinic. Shifting to models of care that incorporate apps allows providers to focus more of their attention on in-person visits and those patients who need it most.
emocha was one of the first mobile health app platforms ever launched. Clinician-scientists at Johns Hopkins University deployed the mobile technology to monitor HIV+ and AIDS patients in Uganda in 2008. The technology has undergone many transformations and iterations, and now serves as the centerpiece of emocha’s digital medication adherence program for monitoring several infectious diseases and chronic conditions, including tuberculosis, hepatitis C, opioid use disorder, and asthma. The technology was also modified to monitor symptoms, report exposure, and track vaccinations during the COVID-19 pandemic.
What is validity?
Few apps marketing themselves in the healthcare sphere can demonstrate rigorous evidence that they deliver on their health promises. By assessing whether and how a mobile app was validated, clinicians and health plans can take an informed approach toward guiding their patients and members to better tools. Validity can be measured across multiple domains. Mobile health technology and programs can be evaluated in three key areas: clinical validation, technical validation, and system validation.
- Clinical validation: Is there any evidence that the solution improves a condition-specific outcome? How does the solution compare to the current gold standard of care, particularly in a real-world scenario with the target population?
- Technical validation: How accurately does the solution measure what it claims to measure? Is the solution secure? Has the solution been tested for interoperability with clinics’ current data collection and analytics platforms?
- System validation: Does the solution integrate easily and well into patients’ lives, provider workflows, and healthcare systems generally? Is it easy to learn how to use and understand? Will patients and providers want to use it on a regular basis?
Why does it matter?
To address dissatisfaction with traditional models of care, payers and providers must adapt to consumers’ desires for broader use of digital capabilities to deliver care, like apps and other services. New Center for Medicare and Medicaid (CMS) pay-for-performance measures in areas such as Comprehensive Diabetes Care and Asthma Medication Ratio (AMR) mean that health plans now have to consider consumer preferences for digital interactions with their providers. More than half of patients surveyed by Accenture in 2019 were more likely to use a provider that offers remote and telemonitoring. The same survey found patients with more complex needs–such as chronic illness–are particularly interested in alternate care modalities. Alternatives should give patients more control and facilitate deeper or more convenient relationships with their providers.
Although federal and state guidance for telehealth tools is expanding, health plans are still uncertain about how to adapt these new technologies into their population health management programs. Health plans will need to carefully navigate new considerations, such as how effectively the technology and program can deliver the expected health outcomes and health savings, how to ensure data privacy and security, and how they can help their members integrate into their daily routines and care.
emocha is a mobile health tool with a growing base of clinical evidence
emocha’s asynchronous video-based technology is based on the CDC-endorsed practice of Directly Observed Therapy to verify dose-by-dose adherence to medication. Its effectiveness has been evaluated across several different disease conditions including tuberculosis, OUD, and Hepatitis C.
Clinical validation
emocha has been used as a tool to secure and measure medication adherence in several clinical research studies and trials.
- In a study on Hepatitis C patients’ medication adherence, researchers found that patients using emocha achieved 96% adherence to their direct-acting antiviral treatment regimen.
- TB controllers in Texas working in the aftermath of Hurricane Harvey found that patients using emocha were still able to achieve very high adherence to their medication regimens despite huge disruptions from the disaster. Ninety-seven percent (97%, 59 out of 61) of emocha video DOT patients were 100% adherent to their treatment. Forty-seven patients receiving standard, in-person DOT (i.e. no emocha) were unable to have their medication doses observed by clinic staff, prolonging treatment for an average of 16 days.
- Additionally, in an evaluation of three public health departments in Maryland, emocha secured 94% mean adherence and saved public health departments approximately $1400 per patient.
Technical validation
Treatments are at their most effective and lead to better outcomes for patients when medication is taken exactly as prescribed. emocha’s video directly observed therapy measures medication adherence. When we can directly observe patients taking their medications, we can be more confident of true adherence rather than relying on indirect measures like medication possession. Preliminary research from a TB clinic in Sydney, Australia, found that patients using emocha achieved 95% adherence. Adherence was comparable to traditional in-person adherence (95.3%), and a greater proportion of doses were directly observed using emocha (78.6%) compared to in-person (66%).
emocha takes our commitment to patients’ privacy and data security seriously. All of the app’s communication functions are HIPAA-compliant with end-to-end data encryption. Our commitment to privacy has been repeatedly acknowledged by the risk management platform Ostendio. Ostendio awarded emocha the MyVCM Trust Network of the Year award in 2020 in recognition of our information security.
System validation
emocha is consistently well received by both patients and providers.
- In a pilot study on the effectiveness of asynchronous video DOT to increase medication adherence in three TB clinics in Maryland, both staff and patients showed enthusiasm about increased treatment flexibility, convenience, and patient privacy.
- In a survey of patients in the TB Control Program in Ciudad Juárez 90%, not only enjoyed using the smartphone-based solution but also actively preferred it to in-person DOT.
emocha is feasible to implement and acceptable to patients with substance use disorder, who also struggle acutely with medication adherence.
- In a study using asynchronous video DOT to treat opioid use disorder (OUD), most patients (71%) reported being “very satisfied” with the application. Participants reported liking the accountability and structure of the mobile app and its ease of use, and over 90% of participants were able to use the application to successfully upload videos.
