Could mHealth be used against patients?
Undoubtedly, we are seeing great advances in the realm of mobile technology and health. Often times called mobile health (or mHealth for short), this new field of medicine centers on engaging patients through their mobile devices to focus on improvements in personal health.
mHealth initiatives have seen an impact across the globe, whether through text messaging service to patients in Africa advising on getting tested for HIV and nearby clinics, patient notifications via their cell phones in Southeast Asia to take their daily medication for Tuberculosis treatment, and to the United States where Apple is developing its new smartphone and pushing healthkit integration into hospitals EHR.
While these great advances have shown in research to be beneficial, with greater benefits to come once uptake and sustainability in programs is achieved by health systems, a concern is lingering that may prevent patient uptake. Namely, privacy and penalization against those that seek to integrate mHealth into their personal lives.
In the first case, privacy is of definite concern. When fear and lack of trust is burgeoning in the wake of the celebrity nude photo scandal, users of their devices start to question whether anything they do via their mobile devices is safe. How can we know whether the data we put into our phones about our daily health (such as vitals) are safe against others trying to access it?
The privacy issue may not deter some users, as I have met many that do not care whether someone ‘hacks’ their phone and can tell how far they walked that day, or whether their glucose levels were high for that day. What they are concerned about, is whether their insurance company will start accessing that data and penalize them.
Take for instance a recent case mentioned in The Guardian, where a Fitbit Fitness device will be used in a case currently in court to demonstrate a decrease in physical activity after a physical interest. This case could set a precedence whereby such devices can be used as objective evidence in certain situations.
So what does this mean? For me, a concern would be that those that choose to use mHealth could find their data thrown back at them. Do you track your medication adherence via an app? Well, if you are not adherent could that be used against you? How about physical activity? The medical records demonstrate instructions to be active so much, and yet all the data collected from your device says you’re not active.
Could insurance companies seek to hold this against patients? Could they enforce the use of mHealth to collect data and then penalize those that are not adherent with regimens or instructions related to their health? I think these are pertinent questions and will be of concern, especially as we integrate our smartphones increasingly into our everyday activities and health.