The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction
Section snippets
Issues around integration of mHealth into the clinical care workflow
There are many issues and challenges that must be overcome to develop and implement mHealth technology in clinical settings. We searched MEDLINE, PubMed, Web of Science and World Wide Web from inception to December 2015 and selected relevant studies focused on mHealth in relationship to PA assessment, counseling and interventions for CVD risk reduction to include in this review. Specific considerations include privacy and security, validity, clinical utility, clinical integration and behavior
Privacy and security of mHealth technology
Mobile health technology has shown the potential to optimize the management of CVD and other chronic diseases by empowering patients through better health self-monitoring and education.14., 15., 16., 17. However, several challenges are present when patient's data are utilized and monitored in the healthcare setting. A common issue is the privacy and security of health information. A robust framework and guidelines are already established and utilized in software development for electronic
Validity of wearable activity monitors
An advantage of sensors and WAMs is that they provide an objective estimate of PA. The technology to monitor PA with accelerometry-based devices has been available for 25 years, but the explosion of consumer-oriented WAMs is a relatively new phenomenon. A key to the popularity of these devices has been their ability to directly link data to Web and mobile technology to provide direct access to PA patterns as well as estimates of sleep and energy expenditure. Surprisingly, these devices are
Clinical utility
A critical challenge for integrating mHealth apps and WAMs to assess PA as part of routine care is the applicability of such data for clinical decision-making. Several studies in the areas of smoking cessation,39 diabetes40 and weight loss41 have shown a missing link between evidence-based clinical guidelines and mHealth apps and WAMs. This poses a critical issue regarding the meaningful use of integrating PA data generated by mHealth technology to guide behavioral change and lifestyle
EMR and clinical workflow integration
Another barrier for the adoption of mHealth apps and WAMs is the lack of integration of PA data into EMRs, clinical workflow and referrals to the community care team to support lifestyle interventions. These integrated software platforms will be bound by HIPAA and HITECH rules since patient health information would be directly incorporated into the EMR. Security is also a major issue for mHealth apps as they are used on portable devices that may have increased risk for data breach by
Behavior change programming
Systems and structures for behavior change programming are essential to fully realize the potential of mHealth technology. While coaching and brief counseling can be provided directly in the clinical setting, there are also options for referral to community care providers that are well-positioned to provide behavior change programming.65 It is recommended that health systems looking to integrate objective PA data into clinical workflow and EMRs develop comprehensive use-case scenarios as a
Evidence on the use of mHealth technology and CVD risk reduction
Several interventions have shown promising results in promoting PA through digital tracking and personalized feedback.13., 17., 73., 74., 75. The mActive study used real-time smartphone PA tracking and an automated text-based intervention, showing increased steps/day among patients enrolled in the texting feedback system compared to those without the texting component.76 The SMART MOVE randomized trial revealed significant increases in PA with the implementation of a mobile application, the
Future trends in objective PA monitoring
The future of WAM devices is progressing, with advances in simplicity, reliability and automation. Devices will continue to become smaller and more seamlessly integrated into jewelry and clothing, facilitating continuous tracking of PA patterns and other biometric and health outcomes. One direction is for “smart clothing” that can integrate data collection and analysis. AiQ clothing and OMsignal are some of the companies producing biometric garments with the ability to measure vital signs, PA
Conclusion and recommendations
Mobile health is a valuable technology that can help implement clinical guidelines and recommended behavior change strategies to improve the quality of care and health status of patients with CVD risk.1 The rise and rapid evolution of mHealth technology has the potential to guide personalized medicine interventions and strengthen the relationship between patients and healthcare providers, increasing engagement and compliance with healthy lifestyle changes.
Multiple PA stakeholders, including
Statement of conflicts of interest/disclosures
Dr. Lobelo is on the advisory board of the American College of Sports Medicine' Exercise is Medicine initiative; Dr. McConnell is currently on leave from Stanford and employed by Verily Life Sciences.
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Statement of Conflicts of Interest: see page 591.