5 minute read

Although we can’t predict what the post-pandemic world will look like, it is certain that it will bear little resemblance to the period preceding the current crisis.

Mobile health and Internet technologies have been developing at breakneck pace, reflecting the recent focus on telehealth, as well as the omnipresence of cell phones. As of April 2020, there were 260 million smartphone users in the United States and 3.5 billion globally:¹ evidence  that mobile technology has transcended any geographic, ethnic or socioeconomic borders once in its way.

As of 2018, the global mHealth app market had an estimated value of 11.17 billion USD, with anticipated compound annual growth rate (CAGR) of 21.1% between 2019 and 2026.² Today mHealth apps enable providers to monitor patients remotely using digital biomarkers, in order to initiate interventions before symptoms reach a critical threshold.

For example, Mindstrong Health Services, a California-based provider for individuals with serious mental illness, monitors tap reaction times and variability on its proprietary app to assess for manic episodes.³  If the patient’s tapping patterns fall outside of 2 standard deviations above or below normal values, a care manager contacts the patient using a secure text function to determine if that individual requires immediate treatment. Not only can this reduce the severity of the intervention, but it enables the patient to maintain agency of his/her behavioral health.

Suicide prevention is an area ripe for mobile interventions, with current mHealth apps enabling users to self-monitor for affective disorders, initiate relaxation techniques or safety plans and contact emergency hotlines. Some apps also include chatbot functions, although users are warned not to use these automated responders if they are considering suicide.⁴

Current psychodiagnostics can assess patients for Big Five (BF) Personality Inventory⁵, while emerging physical activity monitoring tracks heart rate variability, stages of sleep, speed, time, distance, calories burned and more, to motivate patient adherence for lifestyle modifications.

As of 2018, the global mHealth app market had an estimated value of 11.17 billion USD

There is one major caveat to mobile technology’s ever-expanding roster of sensing capabilities: the impact on user privacy, particularly as it regards sensitive medical information. This is particularly relevant for anyone using mHealth applications in research.

In an article addressing the issue, authors Kargl et al stated that: “Current legal frameworks for privacy and data protection clearly state that collecting a consent form from study participants is not sufficient in most cases. Additional technical and organizational measures should be put in place to increase privacy protection.”⁶

In 2018, the European Union implemented General Data Protection Regulation, to address the processing of personal data in mobile sensing. At this point, the United States does not have an equivalent set of rules, although the Federal Trade Commission is entrusted with enforcing personal privacy.

Hoepman suggests the following strategies to protect patient privacy in research design: minimize, separate, aggregate, hide, inform, control, enforce and demonstrate. He states that “personal data should be processed at the highest level of aggregation with the least possible detail in which it is (still) useful.”⁷

For those of us who are in the business of healthcare provision and/or research and may not have the IT expertise to understand all of the issues involved, it’s important to seek out those who do. In some cases, off the shelf personal engineering technologies (PETs) may provide enough functionality to secure research subject data.⁸ In larger, more involved studies or for practices considering launching their own mHealth apps, consider adding legal and technical experts to the development team.

References:

1. Statista (2020). Smartphones in the US.; Number of Smartphone Users Worldwide from 2019 to 2021. Statista.com.
2. Fortune Business Insights (2020). mHealth Apps Market to Rise 21.1% CAGR till 2026; Increasing Number of Novel Products will Aid Market Growth says Fortune Business Insights ™. Globalnewswire.com.
3. Dagum, P. & Montag, C. (2019). Ethical Considerations of Digital Phenotyping from the Perspective of a Healthcare Practitioner. In Baumeister, H. & Montag, C., Eds. Digital Phenotyping and Mobile Sensing: New Developments in Psychoinformatics. Springer Science. pp. 13-30.
4. Martinego, L. et al. (2019). Suicide prevention and depression apps’ suicide risk assessment and management: a systematic assessment of adherence to clinical guidelines. BMC Medicine Open Access. Vol. 17. No. 231. pp. 1-12.
5. Sariyska, R. & Montag, C. (2019). An Overview on Doing Psychodiagnostics in Personality Psychology and Tracking Physical Activity via Smartphones. In Baumeister, H. & Montag, C., Eds. Digital Phenotyping and Mobile Sensing: New Developments in Psychoinformatics. Springer Science. pp. 45-64.
6. Kargl, F., van der Heijden, R., Erb, B. & Bosch, C. (2019). Privacy in Mobile Sensing. In Baumeister, H. & Montag, C., Eds. Digital Phenotyping and Mobile Sensing: New Developments in Psychoinformatics. Springer Science. pp. 3-12.
7. Hoepman, J. (2014). Privacy design strategies. In IFIP international information security conference. Springer Science. pp. 446-459.
8. Kargl, F., van der Heijden, R., Erb, B. & Bosch, C. (2019). Privacy in Mobile Sensing. In Baumeister, H. & Montag, C., Eds. Digital Phenotyping and Mobile Sensing: New Developments in Psychoinformatics. Springer Science. pp. 3-12.