how do you get patients to actually use your patient portal secure messaging

Secure messaging over the patient portal increased in-office visits by six percent. 

Patient portals have long been championed as the new and innovative strategy for improving patient engagement and access to quality healthcare. Patients can communicate with their providers about health concerns using secure messaging and become activated in their own health.

However, new research indicates that there could be some adverse effects of patient portal secure messaging, primarily in driving up in-office patient visits.

“While there are a number of plausible arguments for the benefits of e-visits, it is also possible that the adoption of e-visits may increase the consumption of healthcare services since easier access to healthcare providers may generate additional reasons for an office visit without any attendant health benefit,” said the researchers, who hail from the Wharton School at the University of Pennsylvania and the Wisconsin School of Business at University of Wisconsin-Madison.

“Thus, the impact of e-visits on physician utilization and health outcomes is an empirical question, the answer to which is important for understanding whether and how to promote this technology.”

Frequent clinic visits can have a direct impact on clinician caseload and number of clinicians employed, the researchers argued. These factors also have an effect on patient access to healthcare, especially for patients who did not adopt the patient portal or who are new patients at the primary care clinic.

The researchers looked at secure messaging rates and office visit patterns for over 14,000 patients at a large primary care clinic system. The team also looked at how these clinic visits affected patient health and access to care for patients who did not have the clinic’s patient portal.

Overall, secure messaging resulted in six percent more in-office visits and seven percent more phone call visits, the researchers found. There was also a positive correlation between the number of office visits and health outcomes (measured using LDL cholesterol and hbA1c levels). When adjusting for external factors, that correlation became negligible.

Secure messaging removes a clinic “gatekeeper” from patient care access, the researchers pointed out. Patients who secure message with their providers about a concern do not have to go through front-office staff or nurses before accessing their clinician or scheduling an appointment, potentially resulting in an influx of visits, the researchers posited. 

Deliver better healthcare through effective use of secure mobile messaging

The research team also found that visits arising from secure messaging are coming at the cost of patients who are portal non-adopters. Patients who do not have the patient portal have fewer telephone visits monthly, although there was no difference in the number of in-office visits for these patients.

Healthcare professionals should continue to encourage patient portal adoption and use with these patients. Physicians have a regulatory obligation to drive patient portal adoption and they want to ensure all of their patients can equally reap the benefits of the technology.

New patients who had not yet visited the practice also bore the brunt of increased office visits, the researchers said.

“Interestingly, we find that the additional visits appear to come at the sacrifice of new patients: after adopting e-visits, providers see 15 percent fewer new patients each month,” the team found. This means that physicians saw 1.59 fewer new patients each month.

Some clinics may be better suited for accommodating appointment influxes than others, the researchers said.

“The overall impact of e-visits on a health system will depend on the extent to which a system is (a) at capacity, and (b) compensated on a fee-for-service basis,” the team explained. “In particular, the bottom line will improve for health systems which are not at capacity and in which physician compensation is primarily on a fee-for-service basis since e-visits can increase physician utilization.”

However, these results may be bad news for providers working with a value-based or capitated reimbursement model. Clinicians are not reimbursed for the time they spend communicating with patients via the patient portal, nor are they paid a la cart for resultant in-office visits.

Additionally, these results challenge popular sentiment in the healthcare industry. Experts have long praised patient portals for being effective in streamlining patient-provider communication and potentially reducing the number of in-office visits providers must conduct. That may not be the case, the researchers concluded.

“We also show that provider e-visit adoption is linked to about a 15% reduction in the number of new patients each month, challenging notions that e-visits may increase provider capacity by offloading some care to an online channel,” the team said. “Together, our findings highlight the importance of considering patient and physician responses when introducing new models of service delivery in healthcare.”

Clinicians have long feared that patient portals would create more work for them. Responding to surveys about patient access to clinician notes and portal functionality, physicians expressed concern that patients could communicate in any given moment. Some even feared that patients would over-utilize the tools in an effort to receive “free” healthcare.

Going forward, providers will need to exercise good judgment when answering patient queries to determine the best path forward. It may not be wise for primary care clinics to allow in-office visits to become out of hand, but it is also important for providers to take secure messaging requests seriously.

Using both medical expertise and strong communication skills, providers should work to mitigate problems via secure message when possible and appropriately address larger problems as they escalate.

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4 key concerns in healthcare mobile security options to permit hipaa compliance

Accounting for healthcare mobile security within the IT budget and maintaining HIPAA compliance are essential considerations in the current environment. 

It can be daunting to choose the right mobile tools to help a healthcare organization stay innovative. It can be even more daunting though to ensure that mobile security remains a top priority and that PHI stays secure.

Healthcare IT leaders might see the value in implementing mobile options, but studies show that security is often a top concern.

How can entities properly budget for mobile options? What are the potential consequences if a HIPAA violation occurs? Why is employee training so critical for strong mobile security?

Four key considerations with mobile security. Organizations of all sizes must budget for cybersecurity, choose the right mobile tools, conduct regular employee training, and maintain HIPAA compliance with all devices.

Enable secure text messaging from any healthcare interface

Choosing the right mobile healthcare tool

Different mobile solutions will be beneficial at different healthcare organizations. Secure messaging might be necessary for larger hospital systems with specialty clinicians who need to communicate with patients. Smaller providers might not require the same mobile strategies.

Regardless, mobile security must be a key consideration throughout the entire decision-making process.

Direct secure messaging is becoming more popular, for example. DirectTrust is a non-profit trade alliance that facilitates secure HIE through the Direct Protocol. July 2017 numbers showed a 15 percent increase in the number of trusted Direct addresses able to share PHI.

There was also a reported 68 percent increase in the number of healthcare organizations served by DirectTrust health information service providers (HISPs) and engaged in Direct exchange.

The American Hospital Association’s Hospital & Health Networks (H&HN) Most Wired rankings showed that nearly three-quarters of the Most Wired hospitals offer secure messaging with clinicians on mobile devices.

Seventy-four percent said they use secure emails for patients and families to maintain contact with the care team when patients require ongoing monitoring at home. Sixty-two percent of respondents also said they can simplify the prescription renewal process by letting patients make the requests on mobile devices.

“The Most Wired hospitals are using every available technology option to create more ways to reach their patients in order to provide access to care,” AHA President and CEO Rick Pollack said in a statement. “They are transforming care delivery, investing in new delivery models in order to improve quality, provide access and control costs.”

Pagers are however still a popular tool for many healthcare organizations, according to a study published in the Journal of Hospital Medicine. Nearly 79 percent of respondents said they are provided pagers for communications, while 49 percent said they receive patient care–related (PCR) communication through pagers.

Fifty-three percent of 567 clinicians also said they received standard text messages once or more per day.

For secure messaging, 26 percent of 549 of those surveyed said that their organization had implemented a secure messaging option that was being utilized by some clinicians.

Overall, healthcare providers need to opt for mobile options that will aid staff members in daily operations without compromising data security.

Budgeting for necessary mobile security tools


Cybersecurity budget and resource constraints are often cited by providers as hindrances to data security. Healthcare organizations cannot expect to properly keep data secure if they do not have the necessary funds to purchase, implement, and utilize the right security tools.

With mobile security, this could include budgeting for mobile device management (MDM) solutions if BYOD is being used in a hospital. Or, a provider might need to ensure that it can afford to hire a CISO to help lead the security team.

A recent Spok survey that was administered by CHIME found that 56 percent of healthcare CIOs say that budget and resource constraints are the largest threat to patient data security. Ninety-five percent of respondents also said they were concerned about data becoming compromised, while approximately one-quarter stated they are unsure how much PHI is being shared unsecurely.

“Mobility and clinical process improvements are important to hospital leaders, and CIOs plan to make impactful changes,” the survey authors explained. “However, the execution remains a work in progress.”

Sixty-nine percent of those surveyed said mobile strategies were a key initiative to improving clinical and operational outcomes. The survey also found that 40 percent of CIOs are considering or planning to hire consultants in the next 12 months to aid in the mobile communications process.

However, a ZingBox survey from July 2017 revealed that some healthcare IT decision makers find traditional security solutions used for securing laptops and servers were also enough for IoT connected medical device security. This could indicate inconsistent approaches when it comes to choosing which investments are necessary for healthcare security.

Seventy percent of respondents said their traditional security solutions were enough, while nearly 75 percent added that they are confident or very confident that all devices connected to their network are protected.

Organizations need to have communication between the C-suite and IT teams, ensuring that everyone understands the areas in which stronger data security measures are required. Mobile security solutions can differ from traditional legacy options, and applicable privacy and security tools need to be budgeted for and implemented properly.

Implementing regular employee training


Once a mobile option has been chosen and then budgeted for, employees at all levels must be trained and educated on how to use it. Employees are often cited as a top security threat to an organization, as it only takes one individual to download a malicious link, have a smartphone stolen, or send PHI to the wrong email.
OCR’s July Cybersecurity Newsletter underlined the importance of data security training, especially as the threat landscape continues to evolve.

Understanding HIPAA compliance for mobile options


The HIPAA Security Rule does not require specific technology solutions when it comes to mobile device technical safeguards. HHS does require that entities implement reasonable and appropriate security measures for standard operating procedures.

For mobile security, this means for example that a hospital utilizing smart phones will need to implement applicable security measures for those devices. This could include having remote wipe capability. That way if a phone is lost or stolen, the hospital can delete any potentially sensitive information on the device before it can fall into the wrong hands.

“HHS recognizes that covered entities range from the smallest provider to the largest, multi-state health plan,” HHS explains on its site. “Therefore the Security Rule is flexible and scalable to allow covered entities to analyze their own needs and implement solutions appropriate for their specific environments. What is appropriate for a particular covered entity will depend on the nature of the covered entity’s business, as well as the covered entity’s size and resources.”

Failing to adhere to HIPAA regulations with mobile devices could lead to heavy fines. OCR reached a $2.5 million settlement with Pennsylvania-based CardioNet in April 2017 for lacking mobile security safeguards.

“Mobile devices in the health care sector remain particularly vulnerable to theft and loss,” OCR Director Roger Severino said in a statement. “Failure to implement mobile device security by Covered Entities and Business Associates puts individuals’ sensitive health information at risk. This disregard for security can result in a serious breach, which affects each individual whose information is left unprotected.”

Mobile devices can assist healthcare organizations, but security cannot be an afterthought. Choosing the right tools, training employees, and focusing on HIPAA compliance will help covered entities find the right balance between innovation and security.

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why messaging fails to meet hipaa requirements

Using a smartphone to send a quick text message or e-mail has become second nature to most of us. But some healthcare providers take advantage of that convenience to communicate with colleagues and patients, not realizing that they could be violating HIPAA regulations by sending protected health information (PHI).

Consultants and attorneys who work with providers on HIPAA compliance say texting PHI is a fairly common problem. SMS text services and Apple’s iMessage do not meet HIPAA requirements that insist providers maintain the confidentiality, integrity and availability of PHI. Among the troubles with text messaging are keeping information from being seen by an unauthorized recipient, keeping it secure, and making sure the information is available in the patient’s medical record.

Deliver better healthcare through effective use of secure mobile messaging

Behavioral providers who would like to use text messaging must exercise caution, says Sharon Hicks, a senior associate with Open Minds, a market research firm focused on health and human services. “Being able to informally communicate with people who are in treatment situations has shown some efficacy in studies,” she says, “but the technical aspects of getting it done correctly are arduous and keep people from exploiting the technology as broadly as it could be used.”

For example, she says, some studies indicate that text messages offering encouraging statements are reinforcing and help people stick to a care regimen.

“The difficulty is that you have to be careful not to put any protected health information in those messages,” she says.

And it’s just the content of the messages alone that must be considered.

“If a message includes personally identifiable health information, the principal risk I have seen is an unintended recipient,” says Nathan Mortier, an attorney with the firm Mellette PC in Williamsburg, Va. “We have all texted the wrong person. Many providers don’t realize that if they are going to be texting health information to other providers, if they text the wrong person protected health information, it becomes a breach subject to pretty stringent reporting requirements.”

Also, there could be medical decision-making taking place in a written format that is not being saved in the patients’ records, and therefore not available to future providers caring for the patients or the patients themselves.

“What we have seen is that texting often replaces phone calls,” Mortier says. “Phone calls are not recorded and added to the medical record, but texts create a written record, and written records need to be included in the patient’s medical record if they include PHI and are relevant to a patient’s care,” he says.

Secure messaging apps

For messaging between providers, there are a number of new apps available on the market, and many of them purport to be compliant with HIPAA requirements. These apps generally require that individuals log in with a specific user name and password beyond what is on the mobile device. This helps ensure that the person entering information or using the service is verified, Mortier says. They may also have features that help automate the routing of messages to electronic health record (EHR) systems. Some EHR vendors are starting to offer add-on integrated secure messaging services.

Likewise, some health texting apps also include a feature that will limit the universe of recipients of information.

“Instead of having access to their entire contact list on your phone, it might only allow texts to other providers involved in that patient’s care,” Mortier says.

Another important feature of these applications is that they don’t store any information on the device. If a physician logs in to an EHR or secure texting app on a phone and views information, as soon as they close the app, that information is gone.

Many providers do some type of secure messaging with patients through their EHR’s patient portal. But as Open Minds’ Sharon Hicks notes, if you are trying to interact with someone on a daily or weekly basis, it becomes a burden for them to log in to get a secure message.

“If I am willing to log into the patient portal, you know I am already engaged,” she says. “Secure messaging is a potential way to help engage people who are not easy to engage.”

Healthcare-focused messaging services will eventually become popular, Hicks predicts, because both consumers and providers want an informal and easy way to communicate. “We are in this world where texting is normal, and it is much easier. We haven’t created the work flows to take advantage of all the new technology,” she says, “but people want ease of use and self-service tools because that is what they are used to in all other aspects of their lives.”

Expanding the use of text messaging

One behavioral provider network that relies heavily on its technology platform is considering how text messaging can play a bigger role in patient communications. New York-based AbleTo operates a network of 300 licensed therapists and behavior coaches around the country, providing psychotherapy to patients via phone or secure video on a proprietary platform it has created.

“Currently we are using text messaging as appointment reminders and for rescheduling, but when we think about text messaging, it is really about extending the treatment experience,” says Aimee Peters, chief clinical officer. “We have a patient portal that has digital tools available to the patient. As an extension of that, we think about providing notifications and suggestions to practice at home the skills they learn in therapy sessions.”

Text-based support provides an opportunity to celebrate wins and success, Peters adds. Patients can let therapists know they made progress or had an important event or breakthrough, and providers can reinforce that through text messaging back to the patient.

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healthcare data storage options: on-premise, cloud and hybrid data storage

Healthcare organizations are challenged with selecting the on-premise or cloud storage solution that best suits their health IT infrastructure.

Healthcare organizations are building their IT infrastructures to be more flexible and scalable to meet the growing data demand. With value-based incentives for data analytics and the increased number of connected medical devices constantly collecting data, organizations are challenged with storing clinical data in a way that is both HIPAA-compliant and easy for authorized users to access.

Traditionally, healthcare organizations have shied away from cloud data storage in favor of on-premise options because of the control IT administrators have over physical datacenters. However, entities are recently more likely to implement cloud storage into their IT infrastructure to some extent because of the reduced maintenance costs and improved HIPAA-compliance.

Cloud data storage options offer a flexible and scalable environment at a lower cost than on-premise deployments, which is appealing to covered entities. Organizations exploring data analytics are expecting their storage requirements to steadily increase as Internet of Things (IoT) and mobile devices collect data that needs to be stored.

One of the biggest data storage challenges healthcare organizations face is how to piece together legacy systems while integrating new systems into the infrastructure. Many entities cannot afford to mass migrate data from one storage system to the other, which is why interoperability between different cloud vendors is necessary for a smooth transition.

Not every healthcare organization will benefit from the same type of data storage, which makes choosing a storage deployment a challenge for any organization. HITInfrastructure.com will discuss the benefits and drawbacks of different storage options and explore the potential of on-premise hosted virtualized storage solutions.

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most healthcare institutions using non HIPAA-compliant messaging apps

Dive Brief:
A new study from Infinite Convergence Solutions finds just 1 in 4 healthcare institutions that have designated an official mobile messaging platform are using an internal app. The others are directing staff toward regular consumer messaging apps that do not provide the security required to comply the Health Insurance Portability and Accountability Act (HIPAA).

The study also finds just 8% of healthcare institutions prohibit the use of consumer apps for employee communication.

The company concludes many healthcare institutions lack the knowledge popular consumer apps do not meet the technical safeguards that HIPAA requires.

Dive Insight:
While much of the issue is around lack of knowledge by healthcare institutions, those grappling with the issue may be pleased to hear employees overwhelmingly say they would embrace a secure solution.

According to the study, 51% of healthcare employees report their institution does not have an official messaging platform, but 92% of them say they would use a company-wide platform if one was implemented, and 64% said it would make communication at their job easier.

"Healthcare institutions need to get serious about meeting their employees’ needs and providing a secure, internal messaging platform that not only allows HIPAA compliance, but also replaces outdated communication systems, like pagers, in order to increase productivity and serve patients faster,” Anurag Lal, CEO of Infinite Convergence Solutions, said in a prepared statement.

The company launched the study in October and surveyed 500 professionals in the finance/banking, healthcare, retail and legal industries.

Among its other findings:
Sixty-five percent of healthcare respondents said they use email the most for business communication, followed by 22% using mobile messaging the most and 13% using voice-calling the most.

As for why more respondents aren't using mobile messaging the most: Thirty-one percent prefer email or phone; 19% say there’s no paper trail; 18% say it’s not as secure as phone or email; 17% say it’s too informal; and 16% say it isn't authorized by their company.

Vectramind Healthcare messaging Platform

Message security is the top concern with mobile messaging for business communication.

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mental health utilizing secure messaging

Calls are no longer considered the norm as texting is now the preferred mode of communication for the younger generation. Nearly all communication and daily tasks are managed through their smart devices, making them more comfortable with the convenience of text messages. Counselors and therapists continue to embrace texting as a way to enable communication with child and adolescent patients.

Although it is not the most traditional form of therapy, teenagers are more accustomed to text messaging. Therapists understand the need to become more accepting of this channel of communication in order to provide better care to their patients. Whether confirming an appointment, checking in, or engaging in brief conversations, more mental and behavioral health providers are adopting text messaging protocols and approaches to foster better relationships with their patients.

Providers are required to take the necessary safeguards to keep communication HIPAA compliant and to keep their patient’s data safe. Most are using encrypted phones, saving contacts with patient identification numbers or by their initials in order to remain compliant and avoid HIPAA violations. Although these are not the safest nor the most convenient options, it is understood that patient data must be secured.

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mobile security strategies for common healthcare providers

With more providers implementing mobile options, overcoming common mobile security concerns is critical for organizations to stay innovative.

As covered entities and business associates continue to adopt mobile security strategies, it can be increasingly difficult to find tools that are innovative but do not compromise security.

Mobile app privacy and security worries and maintaining HIPAA compliance are often top concerns for healthcare organizations in terms of overall mobile security.

Even if a covered entity has a mobile device management (MDM) solution, it just takes one staff member to download an unsecured app to potentially compromise patient data.

Or, an organization may start using an app that is not in fact HIPAA compliant. Sensitive data could become exposed, and may even lead to the entity facing an OCR HIPAA settlement for potential violations.

By reviewing common concerns and what federal tools have been put in place to help providers overcome them, covered entities and business associates can work toward implementing strong and current mobile security strategies.

Understanding mobile app security concerns
Healthcare application security is one of the top pain points for covered entities that are looking to implement mobile options. Organizations want physicians and staff members to utilize smart phones and tablets, but also want to ensure that ePHI and patient data remain secure.

A study released in early 2017 found that more than one-quarter of IT decision makers were not fully confident in their organization’s MDM solution.

The survey was released by Jamf and conducted by Vanson Bourne, with researchers interviewing 550 global healthcare IT decision makers within organizations of all sizes in the US, UK, France, Germany, and Australia.

Eighty-four percent of respondents concurred that their organization is HIPAA compliant, however approximately half said they are not very confident in their organization’s ability to quickly adapt to changing regulations.

Furthermore, 83 percent of those surveyed admitted that security as their top concern with mobile devices for employees, while 77 percent listed data privacy as a key worry. Forty-nine percent stated that inappropriate employee use of devices was their top concern.

Similarly, a Substitutable Medical Applications, Reusable Technology (SMART) Health IT study from February 2017 found that privacy and security with third-party healthcare apps was a key provider concern.

Vectramind Healthcare messaging solutions

KLAS interviewed clinical leadership at larger healthcare organizations about how they currently use apps, what they would like to see in the future, and what concerns they have with healthcare apps.

Approximately half of the respondents said that healthcare app privacy and security was a key worry, followed by app credibility and the ongoing app maintenance.

“For years, healthcare providers have been adopting increasingly integrated healthcare IT (HIT) suites from a single vendor, but healthcare apps buck this trend, with many organizations looking to third-party vendors to supply niche solutions to improve organizational efficiency and patient care,” the report’s authors wrote. “The recent passage of the 21st Century Cures Act, which states that a year from now open APIs will be necessary for EHR system certification, is expected to drive further growth in the app ecosystem.”

Healthcare organizations must ensure that they are using apps that already have necessary privacy and security measures built in. Staff members at all levels need to be properly trained, and should not download apps that have not been cleared by an entity’s IT or security department. Maintaining HIPAA compliance with mobile apps, devices HIPAA compliance is another top pain point for healthcare organizations that are trying to implement mobile devices. Convenience and usability are key for daily operations, but that ease of use cannot be traded over data security. The right balance must be found.

The ONC released an online tool and guidelines to help clarify potential legal concerns and ease provider worry over mobile app security.

ONC collaborated with the Federal Trade Commission (FTC), the Food and Drug Administration (FDA) and OCR to create the tool, and said that mobile apps must be created in a secure way.

“This interactive tool helps guide developers through a short assessment of their app with a series of questions about the nature of the app, including its function, the data it collects, and the services it provides to its users,” wrote ONC Chief Privacy Officer Lucia Savage, J.D. and ONC Senior Health Information Privacy Program Analyst Helen Caton-Peters, MSN, RN.

Mobile app developers must understand how HIPAA regulations would potentially apply to mobile applications, as well as how any apps would be affected by the FTC Act, the FTC’s Health Breach Notification Rule, and the Federal Food, Drug and Cosmetics Act (FD&C Act).

ONC also published a report that discussed companies that offer wearables, mobile health apps, and websites that publish health data.

Sidley Austin LLP Partner Anna Spencer explained in an earlier interview with HealthITSecurity.com that the report explained that when health technology is used by a covered entity, such as a healthcare provider, and that technology collects, stores, or uses individually identifiable health information, the health information on the device is protected by the HIPAA rules.

“Thus, in health technology used by individuals to manage their own health, but not offered or provided to the individual by a HIPAA covered entity or business associate, is outside of HIPAA's scope,” Spencer said.

Foley Hoag attorney Jeremy Meisinger added that healthcare organizations must determine exactly whether HIPAA applies to the type of information that a device is gathering.

“There can be a potential for just whenever there is something vaguely health related, there’s this assumption that it creates something like a health record, to which HIPAA is applicable,” Meisinger stated. “Any company developing some type of technology like that, or is developing an app that works in tandem with something like that, wants to be really clear with what is being gathered.”

Whether a healthcare provider is utilizing wearables or smart phones, understanding how the devices use and store sensitive data is critical. Understanding how state and federal laws will apply to mobile devices will also ensure that organizations remain compliant.

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solutions for engaging hard-to-reach populations

Designing a mobile strategy to engage, activate high-risk populations
Healthcare organizations often struggle to adequately engage and address the health needs of high-risk populations such as Medicaid and Medicare beneficiaries.

Yet they don’t need to look far for the technology necessary to address this shortcoming. The solution is already in the palms of their consumers’ hands ­– in the form of mobile phones.

Mobile messaging is one of the most high-impact, low-cost methods of communication. With mobile phone ownership rates high across all major demographics, mobile messaging has bridged socioeconomic and generational gaps. Eighty-six percent of low income individuals and 78% of seniors own a mobile phone, according to data from Pew Research Center. What’s more, nearly 80% of Medicaid members text, as reported by Mobile Marketer.

With such high levels of adoption, strategic mobile messaging programs are uniquely poised to activate and engage vulnerable populations. While many healthcare organizations are already reaching out to patients via mobile message to offer appointment reminders and prescription notifications, the true value of mobile messaging lies in its ability to foster a meaningful, two-way dialogue between consumers and organizations tasked with delivering quality care.

Proven Benefits of Interactive Messaging
New results from a study conducted using tailored text message outreach to 17,000 Inland Empire Health Plan (IEHP) Medicaid members illustrates the benefits of an analytics-driven mobile messaging program. The study revealed that interactive text messages are highly successful at deepening member engagement, improving awareness of plan offerings and driving increased self-activation, encouraging members to take a hands-on approach to their care. As evidence suggests, those with the skills, ability and willingness to manage their own health tend to have better health outcomes, generating lower healthcare costs overall.

The tailored messages were found to be significantly more effective in increasing knowledge and changing member behavior than one-way texts. In the IEHP study, analytics-based, interactive texts were found to:

Increase awareness of appropriate settings for care: The number of members reporting they would visit the emergency department for a minor condition dropped from 11% to 4% by the end of the three-month study.

Improve response rates: IEHP’s interactive messages had a response rate of 8.2% compared to a mere 1.1% response rate for standard, one-way text messages.

Encourage member activation: 10% of study participants engaged in a series of health challenges. Of those members who opted-in, 33% reported completing the challenges.

The findings show that members were significantly more knowledgeable about the services available to them and how to best use these services. With Medicaid members visiting the ED at twice the rate of those carrying private insurance, this increase in awareness and activation illustrates significant potential to help members seek the right level of care at the right time and place, driving the overall cost of care down.

Putting It into Practice

So, how can healthcare organizations take advantage of these learnings?

To start, it’s helpful to identify a few challenges your organization wants to address, such as medication adherence, gaps in care, or new member navigation. From there, tailored message workflows can be developed to align with these priorities. In the study, IEHP first identified several specific areas where it wanted to increase member knowledge and activation. Message workflows were then developed to support these key priorities, with a focus on the following areas: choosing a doctor, using the nurse advice line, scheduling routine care, finding an urgent care clinic, operating the community resource center, and offering health tips and challenges.

IEHP accomplished this by leveraging a variety of message types, including:

Informational messages – such as “Call IEHP at 888-123-4567 if you need health advice and want to talk to a nurse.” Open-ended questions – such as “Imagine that you wake up in the middle of the night with a sore throat. How would you use IEHP to get care? Please reply in your own words. Thanks!”

On-demand resources and challenges – such as “If you need urgent care, text URGENT for information about a nearby IEHP urgent care clinic” or “For new ways to take care of your health, text TRY and we’ll send you health tips and challenges.”

Interactive polls – such as “See your doctor for your annual physician exam and routine care. His or her phone number is on your IEHP card. Do you know who your doctor is? Reply YES or NO.”

These messages offered members the opportunity to answer in an open-ended fashion, using natural language processing (NLP) to interpret and analyze responses, allowing IEHP to engage with members by establishing a two-way dialogue. The results were overwhelmingly positive, with 91% of IEHP members reporting that the mobile messages had improved their overall knowledge of IEHP services by the end of the study period.

Implementing an interactive mobile messaging strategy creates significant opportunities for healthcare organizations of all sizes to improve population health while simultaneously improving care quality, resulting in a reduction of overall healthcare spending and improved health outcomes.

Organizations that aren’t taking advantage of this highly effective means of communicating with their audiences will be left behind as the industry moves to embrace consumerism and value-based care, placing a greater emphasis on engaging patients in their health.

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healthcare application management growth seeks containers

Healthcare application management becomes more critical as more apps are built and deployed.

Healthcare application management solutions become more necessary as organizations build and adopt more custom applications as part of their health IT infrastructure.

Organizations across all major industries are developing individual apps to address specific internal and external functions, according to a recent Grand View Research report. Many choose to develop different app sets for each job within the organization, making managing these apps essential to the entity’s success.

App management solutions are essential to operations and to support app maintenance, optimization, support, and migration.

“As the technological adoption gains velocity in the industry, delivery models and service scopes are set to exhibit a dramatic change with software-as-a-service and cloud deployments playing a significant role in the market,” report authors stated.

Healthcare application management is a large part of mobility management strategies and also allow clinicians to treat patients more quickly by making the applications they need readily available on their preferred devices. Application management solutions also ensure that all apps are functioning properly and providing users with the correct information.

Healthcare application management solutions can help healthcare applications remain HIPAA-compliant through their entire lifecycle. App management solutions alert IT administrators to unusual activity by monitoring app operations and security protocols.

Security has always been a top healthcare mobile security concern, and with the number of healthcare mobile apps organizations are deploying rising rapidly, management solutions are more important than ever to ensure data is being accessed correctly and securely.

Healthcare organizations are beginning to embrace bolder strategies when it comes to application management. Containers-as-a-service (CaaS) are being used more often to manage containers and healthcare applications.

A recent Research and Markets report estimates that the CaaS market will grow at a CAGR of 34 percent through 2023.

The transition to hybrid cloud, faster and more flexible deployment, and cost savings are the main driving factors for CaaS adoption across all major industries, according to report authors. Increased adoption over the next five years will drive vendors to develop better and more effective tools.

Healthcare organizations are gaining interest in containers as more mobile apps are being built and deployed for workflow operations and mobile initiatives. Containers are more secure by design than several other mobile deployment options, which makes them appealing for HIPAA compliance and protecting patient information.

Containers provide naturally increased security by separating data. Containers access PHI by clearance level or department protects data in other containers. While the data in the breached container is still compromised, the other containers are virtually separated and unaware of each other, making cross-penetration impossible.

Organizations are using containers more often to build, deploy, and manage apps. Containers also enable digital transformation because they increase IT infrastructure density.

Container management solutions are constantly being developed. Earlier this week, Skytap announced the release of Skytap Container Management, which will allow organizations to develop, deploy, and run traditional enterprise and containerized applications together in the Skytap cloud.

Skytap developed its application management tool to accelerate application modernization in the wake of rapid IT infrastructure digitization.

“This transformation requires enterprises to evolve IT infrastructure, processes, and architecture,” Skytap said in a statement. “Organizations in every industry need to replace legacy hardware with cloud resources, implement agile and DevOps processes, and adopt new application architectures, including containers. Executing this transition enables faster, safer, and more efficient software delivery, which is the cornerstone of on-demand digital services that customers expect.”

Skytap’s solution takes enterprise applications that are locked in the datacenter and moves them to containers in the cloud.

Organizations need healthcare application management solutions that are not only secure, but also flexible enough to adapt to future app development initiatives.

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90% Of healthcare institutions employ non hipaa-compliant messaging apps

Although healthcare is driven by federal regulations regarding privacy and security of protected patient data such as HIPAA, an Infinite Convergence Solutions study has found 92 percent of healthcare institutions are currently employing messaging apps that are not HIPAA-compliant. Further, just one-quarter of all healthcare institutions that have an official mobile messaging platform employ an internal, company-authorized app, meaning the rest rely on consumer-facing apps and services that cannot provide the level of security necessary to meet federal regulations.

The October 2015 survey queried 500 professionals across the finance/banking, healthcare, retail, and legal industries regarding their mobile messaging habits and behaviors.

“The global healthcare industry is under strict privacy and security regulations to protect patient information, but our study finds that the vast majority of healthcare institutions are not using mobile messaging services that are compliant with these regulations,” Anurag Lal, CEO of Infinite Convergence Solutions said in a prepared statement. “Healthcare employees communicate inherently sensitive information, like patient prescriptions, medical information, etc., yet their employers do not have the proper mobile messaging security infrastructure in place to adhere to HIPAA or other regulatory requirements.”

The study found 65 percent of healthcare respondents communicate most frequently for business via email, 22 percent employ mobile messaging, and 13 percent use voice calling. When asked why mobile messaging was not their method of choice, participants cited preferring to send emails or make calls (31 percent), no paper trail associated with mobile messaging (19 percent), lack of security (18 percent), too informal (17 percent), and the action is not authorized by the company (16 percent).

Message security was ranked the primary concern with mobile messaging for business communication, and over half (57 percent) said the decision of which communication method to use is based primarily on the immediacy of information that needs to be communicated.

When it comes to third-party messaging apps, 52 percent of respondents reported using SMS/MMS to communicate followed by GChat, Facebook Messenger, and WhatsApp. Surprisingly, only 8 percent reported third-party messaging apps are prohibited by their company, while 9 percent say they prefer not to use such apps.

Forty-two percent said they are confident the majority of their business correspondence is secure using third-party messaging apps, while 20 percent reported they do not believe it to be secure. Thirty percent reported such apps are completely secure for business communication.

“We are seeing a rapid adoption of mobile messaging in healthcare as the industry looks to work faster, improve patient care and reduce wasteful spending,” Lal said. “The problem is that many healthcare institutions are not aware that the messaging apps and services that are popular for daily personal use do not follow the administrative, physical and technical safeguards that HIPAA requires.”

“We’ve found that 91 percent of healthcare employees use mobile messaging at least a few times per week for business communication. Healthcare institutions need to get serious about meeting their employees’ needs and providing a secure, internal messaging platform that not only allows HIPAA compliance, but also replaces outdated communication systems, like pagers, in order to increase productivity and serve patients faster.”

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little to show for proliferation of apps in the health industry

Over the last decade, Kenya has seen a proliferation of mobile apps aimed at tackling various health challenges.

But at the same time, the impact of a majority of these m-health innovations is yet to be fully felt.

“We know that there are all manner of apps out there. But we need to ensure that they are really benefitting the patient,” Mr Onesmus Kimani, the head of e-health at the Ministry of Health (MoH) told the Business Daily. He noted that the government was working on a soon to be launched e-health policy whichwill guide innovations in the sector while ensuring that they are patient centred.

Dr James Mwanzia, a Nairobi based health systems consultant, said that technology is now an integral component of all development sectors and should thus be fully embraced.

Compared to the economic sector where mobile money apps like M-Pesa are thriving, he regreted that the health sector is lagging behind yet it has a direct impact on people’s lives. “But we are beginning to make in-roads in this area, so people shouldn’t give up. They may be sitting on a revolution like M-Pesa!” Dr Mwanzia stated that for health apps to be successful, there is a need for continuous data collection on the preferences and concerns of people using the platforms.

Whereas most apps can automatically generate data on user trends, he noted that having a customer care service or call centre is necessary to get more indepth information.

“It’s from such feedback mechanisms that you identify problems that need to be addressed so as to improve the performance of an app.”

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here’s how telehealth tools help hearing health professionals improve patient care

New technology is constantly being developed to improve our ability to diagnose, treat, and care for a variety of medical conditions. One up-and-coming technology trend is telehealth. Some of the telehealth tools that we have already seen include services that enable video conferencing between doctors and patients, and apps that assist in patient care. In the field of hearing care, such tools also improve healthcare delivery for both patients and service providers.

TeleHealth tools save time for professionals and patients

It is common practice in hearing care to bundle the cost of consultations and service provision into the price of the hearing aid. As such, follow-up and fine-tuning appointments after hearing aid sales are often free of charge. Dedicated telehealth tools like texting apps offer a secure platform for patients and hearing care professionals (HCPs) to easily communicate and problem-solve in a few minutes without an office visit. Hearing telehealth apps can even allow HCPs to remotely adjust the hearing aids’ settings. This is convenient for the patient, but also saves the HCP valuable appointment time.

Telehealth apps can also contain simple instructional videos, FAQs, and troubleshooting guides so that patients have the information readily available to them on their smartphone. This way, they can often easily solve their problems before contacting the HCP and feel empowered with greater confidence in their new hearing experience.

Telehealth apps help hearing care professionals widen their reach

Telehealth apps can bring patients and HCPs closer than ever before. With a reduced number of necessary in-office appointments eliminated by in-app messaging and calls, and remote hearing aid tuning features, HCPs can attract patients who live physically farther away, and are therefore less inclined to make repeated trips to the office. Similarly, they can provide services to less mobile patients who may be house-bound or live in care facilities.

Telehealth enables patient satisfaction monitoring

Patients buying new hearing aids typically have a two- to four-week home trial period before making the final purchase decision. Patient satisfaction during this time is crucial to the ultimate adoption of hearing aids. Unfortunately, this is also typically a “blind spot” for HCPs, because with the patient out of their office, they are not physically present to answer question and provide guidance when problems arise.

Telehealth apps for hearing aids allow wearers to rate their daily satisfaction. Apps can assign various listening activities for the patient to complete, such as “have dinner at a noisy restaurant” or “listen to music”, and then ask the patient to rate their satisfaction with the hearing aids in those situations. Satisfaction ratings are sent to HCP via the app, so that the latter can actively intervene to address patient concerns in a timely manner without waiting until the next follow-up appointment.

Telehealth apps serve as a practice differentiator

The hearing care industry is a competitive field. Patients can choose from independent hearing care practices, those affiliated with physicians, hearing aid dispensing chains, “big box” wholesale stores, or even bypass the HCP altogether and choosing an amplification product online or “off the shelf.”

One of the ways a hearing care professional can stand out from the crowd is by offering exceptional service. With in-app text and call features, telehealth apps promise potential patients access to the hearing care professional’s expertise and guidance even outside of regular office hours, the convenience of fewer in-office visits, and in-app usage and troubleshooting information. These advantages can be promoted as a part of the “white glove service” that HCPs can leverage to promote their practice.

Telehealth tools are good for business

Telehealth tools can help HCPs generate revenue in more than one way. First of all, time is money. By reducing the number of follow-up visits, telehealth apps help free up more time for professionals to attend to revenue-generating tasks, such as diagnostics or new patient fittings. And the increasing number of younger, tech-savvy, and smartphone-dependent patients with hearing loss will be attracted to HCPs who offer conveniences like telehealth apps.

Ultimately, patient satisfaction leads to business success. By being able to monitor patient satisfaction with their new hearing aids during their home trial period, and intervene quickly when problems and doubts arise, professionals can use telehealth apps to minimize barriers that otherwise result in hearing aid returns.

Although there are smartphone apps now that help us with almost every aspect of our lives, telehealth tools that use such technology are still relatively new to the hearing care profession. As they become increasingly powerful and popular, we can expect them to bring even more benefits to patients and hearing care professionals in the future.

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how apps and ai technologies can improve communication in the healthcare industry

In 2014, an event occurred that forever transformed online communication. For the first time ever, mobile internet use became more common than PC/desktop browsing. Simply put, more people began to use mobile devices to connect with businesses, organizations and the healthcare industry.

In the healthcare industry, one of the keys to success for any hospital is its ability to communicate with patients, doctors and other stakeholders. How can the use of cutting-edge technology improve these communication processes? Let’s find out.

Unleashing New Innovations In Communication Via Apps

How much time and money do medical practices and hospitals spend on communicating with patients about lab results, appointments and care messages? Perhaps the more important question is, what happens when these communications fail?

As the population becomes more connected, people value being able to address their medical concerns using apps. Confidence in apps has certainly grown by leaps and bounds in the retail sector, with nearly 50% of all purchases being made on a mobile device.

If we take a cue from the Mayo Clinic, we can see how powerful apps can be in regard to healthcare.The Mayo Clinic provides an app to patients that: Offers healthy living advice; Provides appointment requests; Delivers lab and X-ray results; and Supports doctor office-patient messaging.

Traditionally, the amount of human labor associated with these tasks could be tremendous. Imagine how much more efficient office staff could be if freed from performing these chores. Furthermore, we can envision how care improves with automated communication: Calls and information are susceptible to becoming botched by human error, while apps can provide a running log of all activity so there’s no question as to whether or not communication occurred.

In the past, having a website was an adequate online presence. The next step was to make sure your site was mobile friendly: If users could not read your web content on their smartphone, many potential contacts were lost. The next logical step is being able to interact fully with your audience via apps.

In addition to the Mayo Clinic, apps like these have been embraced by leading institutions such Massachusetts General Hospital, the Cleveland Clinic, UCLA and many others. The trend is likely to continue as these early adopters continue to gain a distinct competitive advantage.

This move toward increased digitalization is not reserved strictly for the largest healthcare centers. In fact, app development can be customized at an affordable cost for nearly any size hospital, medical center or multi-physician practice.

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seventh annual spok survey finds additional opportunities in hospital mobile strategies

Spok, Inc., a wholly owned subsidiary of Spok Holdings, Inc. (SPOK) and the global leader in healthcare communications, today released the first of two reports on the results of the annual mobility strategies in healthcare survey. This research, conducted by Spok since 2011, is designed to assess mobile workflow enablement progress and trends in hospitals across the country. More than 300 healthcare professionals throughout the U.S. responded to this year’s questions about mobile strategy development, bring your own device (BYOD) policies, communications infrastructure, and opportunities to improve mobile communications.

“This year we expanded our research to allow a deeper look at how hospitals are developing, maintaining, and executing on their mobile strategies,” said Hemant Goel, president of Spok. The purpose of the survey was to examine various aspects of mobile planning and communications, and the findings will be released in two parts:

Part 1: The Evolution of Mobile Strategies in Healthcare looks at how hospitals include strategic business and clinical goals in the planning process.

Part 2: The State of Mobile Communications in Healthcare: Devices, Infrastructure, and Access will present details around mobile device types and communication infrastructures.

The Evolution of Mobile Strategies in Healthcare report focuses solely on the larger topics of mobile strategy development and maintenance. “Based on participant responses in this first installment of our findings, we see that mobile strategies are becoming more established in healthcare, and that most hospitals are making revisions as needed to keep these plans relevant and up-to-date. Ninety-three percent of hospitals with mobile strategies in place more than a year have updated their mobile plans,” continued Goel.

The study findings also show that there is an opportunity for planning teams to include more strategic hospital initiatives within mobile plans. Survey participants were presented with a list of objectives, from improving nurse-to-physician communications to speeding Emergency Department (ED) bed turnover. They were asked if each objective was an identified hospital goal, and whether or not it was also a part of their mobility strategy. Respondents cited inclusion of hospital goals in their formal mobile plan less than 20 percent of the time. This may indicate an opportunity for hospitals to elevate mobile planning as a strategic initiative that advances broader hospital objectives.

The composition of mobile strategy planning teams was another improvement area identified in this research. “One of the key insights from this survey is the opportunity to better incorporate clinician involvement in the planning and deployment of these comprehensive mobile enablement plans,” said Dr. Andrew Mellin, chief medical officer of Spok. Survey data reveals that doctors are included in less than 40 percent of mobile strategy planning teams, and nurses in less than 30 percent. “The clinical perspective is vital to ensuring that any new mobile process or infrastructure change will take into account the real-world challenges and opportunities of clinical workflows and user experiences. Medical staff that serve on planning committees may also act as champions to promote new solutions. This clinical viewpoint can increase the strategic value of mobile initiatives. For example, a secure messaging app could be used not just as a tool for data security but also as a catalyst to support process changes like speeding admissions from the ED or improving patient outcomes by enabling fluid care team communication and collaboration.”

The research also revealed that more hospitals are hiring outside experts to be part of mobility strategy planning teams. “The answers we received demonstrate that consultants have a valuable role to play in helping hospitals with their mobile planning efforts,” added Goel. “We know that mobile enablement is a lot more than giving users an app. It requires alignment among communication goals, clinical needs, and security requirements. Experienced industry experts can assist with balancing these sometimes competing priorities. We’ve seen demand for our professional services group grow steadily as more customers look for help in meeting their mobility goals.”

For more detail about the objectives included in mobility strategies, why hospitals review their mobile plans, the composition of mobile planning teams, and more, visit this resource page

The second installment of this research, The State of Mobile Communications in Healthcare: Devices, Infrastructure, and Access, will be released in May. It will delve into the details about what devices are supported, what challenges hospitals are experiencing with their mobile device usage, and where the biggest opportunities for mobile improvements are over the next three to five years.

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five things you need to know about mobile messaging

Are you using email and phone to keep in touch with current customers or users? What do your open rates look like? Mobile messaging is a dominant force in 2017 communications trends and is projected to take off through 2020. Capitalizing on this, I've spent the past four years growing healthcare messaging platform, working to solve the inefficient communication problem within the healthcare industry.

To make the most of mobile, we first took an operational look at the inner workings of the healthcare industry. Our team found that through tweaking communications systems with the integration of a cloud-based messaging platform, doctors could manage their practices better and people were happier (even healthier). And to continue building in this space, our team is constantly researching the latest trends in the future of messaging. We know how powerful messaging technology is, and continues to be, in industries that are just beginning to harness the power of consumer technology.

From our own experience, here’s what you need to know about mobile messaging:

People Read Your Messages
A recent study found that the open rate of mobile messages is 98%, versus 22% for email. In general, people have multiple email addresses, spam filters, and firewalls that you have to cut through to get your messaging heard. While email apps exist on mobile devices, the app is not used as frequently nor is as intuitive as a mobile messaging app. On the other hand, 90% of people read a mobile message within the first three minutes.


Mobile messaging apps have an average rate of over 60% within the first year of usage, according to Statista. Retention rates are especially important when it comes to keeping existing customers engaged. As consumer preferences shift towards mobile messaging, business should move toward the front that has maximum viability and impact.

I also think the UX of messaging applications will be important moving forward. Industries looking to provide a solution will have to balance novelty with familiarity. Because arguably, retention rates stem from the ease of use for the individual.

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study shows patients like remote monitoring via mobile app for follow-up care

Dive Brief:

Access to a mobile app that allowed ambulatory breast reconstruction patients to submit photos and report information to physicians resulted in fewer post-surgery follow-up appointments, according to a study published by JAMA Surgery.

Out of 65 women treated between February 1, 2015, and August 31, 2015, 32 women with access to the app attended a mean of 0.66 in-person visits while 33 women without the app attended a mean of 1.64 in-person visits.

There were no significant differences in telephone calls with physicians, satisfaction scores or complications between the two groups, although women with access to the app sent more emails to their physicians and reported higher convenience scores.
Dive Insight:

One obstacle that has hindered adoption of technology in healthcare has been doubt over its ability to replace in-person care. However, results such as these are slowly helping to break down barriers holding technology back, especially as patients increasingly indicate their preference for more consumer-friendly services.

Out of 32 women in the study who had access to the app, 30 (97%) agreed or strongly agreed that their follow-up care was convenient. Meanwhile, only 16 of 33 (48%) women without access to the app agreed or strongly agreed that their follow-up care was convenient. This response lends credence to surveys that suggest patients would appreciate digital tools that allow communication with their physicians.

For instance, 62% of those surveyed for a report published June 2016 by Salesforce said they would consider virtual appointments with physicians. Another 61% who had been hospitalized or knew someone who had been hospitalized reported that post-discharge communication with physicians could be improved.

Some healthcare providers have begun to experiment with new care delivery systems that rely heavily on technology. For instance, One Medical, which operates a network of retail clinics, allows patients email and video chat with physicians, send photographs, refill prescriptions and schedule appointments via a website and mobile app. These tools are not only convenient for patients, they also streamline administrative tasks for One Medical physicians and employees.

While the potential for technology to transform healthcare is there, the transformation has not occurred as quickly as some might have hoped. Former CMS Acting Administrator Andy Slavitt, in a recent Q&A with HIStalk, expressed frustration with health IT vendors for engaging in self-congratulatory behavior even though their products arguably make physicians jobs more difficult. A study published September 2016 by Annals of Internal Medicine found physicians spend about half of their workdays on EHR and administrative tasks.

Despite frustration with the slow pace of progress that technology is making in healthcare, the potential is still there. “I don’t think anybody should lose promise in the power of what technology can do,” Slavitt said.

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top 15 interesting healthcare messaging statistics

Here are some interesting data on healthcare stats   ( source :) The Office of the National Coordinator for Health IT found that about

• 41% of hospitals were able to send and receive secure messages in 2013. 
• CDC’s National Center for Health Statistics found that about 40.4% of physicians said they have used secure messaging and about 8.4% said they had the necessary technology but had not used it. 
• An internal survey in 2013 found that new members of Kaiser Permanente Northern California reported higher satisfaction rates and were more likely to re-enroll if they used secure messaging. 
•  The survey also linked secure messaging use with better quality care and improved logistics.
Here are a few statistics about the information sources that physicians seek when using mobile devices according to a Wolters Kluwer Health infographic: 
•  72% of physicians access drug information from smartphones. 
• 63% of physicians access medical research from tablets. 44% of physicians communicate with nurses and other staff from smartphones.

Growing number of mobile health apps and app downloads (Source) :

• To date, 61% of people have downloaded an mHealth app.

For example, Philadelphia-based Hahnemann Hospital conducted a pilot study that introduced a mobile app that supported email and text messaging to over 350 congestive heart failure patients. During this study, patients received email and text message reminders to get them to schedule follow-up appointments after being discharged from the hospital.

As a result, the hospital was able to reduce its 30-day readmissions by 10% that was a 40% improvement over their baseline.

• Readmissions also decreased to 16% for patients who received messages, and the readmissions rate for those who confirmed an appointment was 8.8%, compared to 15.4% for those who didn’t confirm. 
• At the end of the 10-month pilot, it was clearly demonstrated that not only could mobile apps help patients to keep their appointments to get the proper follow-up care; it could contribute to reduced hospital costs.

• Of the 100,000 mobile health apps in app stores around the world, 85% of apps are for wellness while the remaining 15% are for medical. Most apps are free to use or free to get started, but there’s also a large portion of apps that are paid. 
• Of the mHealth apps available in major app stores, 42% of them adhere to a paid business model.

In 2014 alone, Research2Guidance reported that there were over four million free downloads of mHealth apps every day. That number is expected to keep growing.

By 2017, it’s predicted that 50% of smartphone users will have downloaded mobile health apps.

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