For Jonathan Ware, M.D., the best mHealth app is the one in his pocket.
The medical director of population health management at Florida's Orlando Health carries PT Pal around with him on his iPhone. The physical therapy app, which is also available for Android devices, can be used by patients on their own or in concert with their physical therapists.
Ware's job responsibilities at the nonprofit healthcare system, in addition to hospitalist rounds and managing four accountable care organizations, includes introducing new medical devices and programs into various departments. After using PT Pal himself, he's getting it into the hands of his physicians and physical therapists.
But like many busy people currently rehabbing an injury, Ware doesn't have a lot of free time to go to PT. So he's using PT Pal to rehab -- often on work time during short breaks -- a twisted left ankle he suffered in April rushing down a flight of hospital stairs.
Pilot planned for pediatric PT practice
I was going a bit nuts. I thought there had to be an app for this. I couldn't find it, so I built it.Naveen KhanCEO, PT Pal
And he'll soon observe PT Pal in action in a pediatric clinic trial overseen by John Dimino, manager of acute care and outpatient rehabilitation services at Orlando Health's Arnold Palmer Hospital for Children. One advantage of the app for pediatric patients with disabilities such as cerebral palsy is that patients, their caregivers and therapists will be able to record videos of their own movements andaccess them in the app, instead of trying to reach what could be an unattainable ideal presented by a model, Ware noted.
Ware says PT Pal makes it easy for him, and Orlando Health patients, to understand the sometimes tricky exercises in the physical therapy canon. Traditionally, therapists send their charges home with printed pictures of the movements, most of them derived from 1980s vintage stock and which many patients find hard to follow and easy to lose -- contributing to high non-compliance rates in many PT settings.
"Some of our physical therapy patients drop out. Those who show up for appointments only retain about 40% of it," Ware said. "A lot of them leave the paperwork in the car and find it three weeks later."
Gentle reminders of tough rehab work
PT Pal also reminds users when it's time to do their PT work, a gentle reinforcement mechanism that is a key part of the mHealth methodology, akin to the buzzes and blips that popular consumer devices such as the Jawbone UP and Fitbit bands use to remind wearers they've been immobile too long.The program actively supports such patient engagement by actually making the hard work and occasional tedium of physical therapy sometimes approach fun, Ware said.
"It's nice to see a video of what you're doing, or a picture," Ware said. "And it's really nice for me to have the reminder. It's like having the iPhone schedule it."
The story of PT Pal's inventor and CEO, Naveen Khan, a Los Angeles resident, dovetails with Ware's and others' frustrations with the limitations of traditional physical therapy.
The British-born Khan -- who met Ware and introduced him to her product at a February HIMSS conference in Orlando -- imagined the app when she was rehabbing from a bone marrow biopsy but was too busy at her management job at a big company.
"I couldn't fit in my PT," Khan said. "I was going a bit nuts. I thought there had to be an app for this. I couldn't find it, so I built it."
U.S. clinics sign on
That was a little over a year ago. Now, PT Pal has more than 200 individual users and is in place in more than 25 U.S. clinics and hospitals. Khan, meanwhile, says she has a number of deals brewing.
A new version of the program was released in July that is optimized for the iPad and adds video recording, among other features. The app now hosts videos of about 400 different PT exercises. Khan is planning to add new capabilities in future updates, such as game-like features for pediatric patients.
Khan and company CIO John Dzivak tout other benefits for the technology that mesh with trends in the EHR and mHealth worlds.
One that stands out is compliance, the lack of which is an oft-observed major drawback of physical therapy. Many PT clinics lack tracking capabilities to monitor how many of their prescribed exercises patients are doing, not to mention electronic records of their progress at home.
Dzivak pointed out that insurance companies and doctors and therapists themselves perhaps ought to be able to know patients' compliance rates. Each exercise has its own CPT (Current Procedural Terminology) code, so payers can track compliance rates by specific exercise.
"One of the goals of PT Pal was to get people to do their exercises," he said. "Payers have been interested in the compliance rate. They're paying for the rehab. If I'm a payer, I don't want to know what was prescribed. I just want to know the percent that was completed. Before, it was just anecdotal."
Potential side benefit: Meaningful use compliance
Another benefit of the app is the ability it gives patients to contribute to their own electronic health record by noting and recording their own PT exercise activity, Dzivak noted. One of the criteria for stage 2 of the Centers for Medicare and Medicaid meaningful use is allowing patients to do that.
Khan, who is also trained as a lawyer, said in addition to healthcare reform issues, devising the program for herself originally came down to a simple issue.
"As a single mom working for corporate America, PT Pal provided the ability to do [physical therapy exercises] anytime, anywhere," she said.
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