Opportunities and Limitations in Mobile Technology

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We read with great interest the review article by Rothman et al.1 We would like to highlight additional areas of import with regard to mobile health applications (mHealth apps). We are choosing to use “mHealth” rather than the author’s term “connected health” because it is both an established MeSH entry term and describes the use of mobile technology in health care.
A discussion of mHealth is incomplete without mention of the Fast Health Interoperability Resources standard and Substitutable Medical Applications and Reusable Technologies on Fast Health Interoperability Resources. This critical evolution in the electronic medical record allows mobile apps to access stored information, creating powerful opportunities for both provider- and patient-facing apps, many of which are already being deployed.
The authors argue against native cross-platform development in favor of web-based solutions. However, cross-platform development is undergoing rapid evolution and should not be summarily dismissed. One example among many is the Xamarin ecosystem. It is widely used in outside industry allowing extremely powerful apps to be built using cross-platform code. This platform allows apps to utilize numerous hardware features, including cameras, accelerometers, and global positioning system information. Although seemingly a minor technical detail, the initial approach to app development—especially the choice of development ecosystem—can significantly impact downstream capabilities and should be carefully considered by researchers interested in the mHealth space.
The review would have also benefited from a brief discussion of app analytics. The capture, analysis, and visualization of metadata have become very easy to integrate into apps. Solutions are offered by numerous vendors for all major mobile device operating systems; open-source analytics and surveying solutions have been developed as well. Combining analytics metadata with user feedback will be critical in understanding mobile app use—findings that have been presented previously and are currently in peer review.2
The literature on mobile technology’s effectiveness and desirability among learners is mixed. While modern learners may be comfortable with technology, Ellaway et al3 found a disparity in the value of mobile apps in clinical decision support (CDS, high) versus its value in learning (lower, heterogenous). Previous work deploying a mobile app containing an anesthesia calculator (CDS) and lectures (didactics) to residents and anesthesiologist assistant students demonstrated substantially greater use of the CDS piece.4 Learners demonstrated a preference for traditional educational modalities (lectures, intraoperative didactics) over mobile apps for didactics (unpublished communication). We should modulate our excitement for mobile technology as a driver of the “andragogical approach”; learners seem to want educator engagement as much as educators want learner engagement. The role of mobile technology in education is likely to be as nuanced as our learners themselves.
The future of mHealth will be driven less by the computational power of the devices and more by advances in electronic medical record integration and cross-platform development of just-in-time CDS tools. Detailed analytics will provide feedback in the app development lifecycle. We applaud the authors for their summary of this rapidly changing landscape.
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