Steve Barrow has seen the emergence of mobile health care technology in California over recent years, and he could only watch.
"There are so many new cell phone applications for health care," said Barrow, the executive director of the California State Rural Health Association. "There are apps for asthma, for diabetes, for heart disease, you name it."
The problem in rural areas, Barrow said, is connectivity. If cell phone coverage goes in and out across remote areas, then rural consumers will have fewer cell or smartphones. And even the ones who do acquire the technology won't feel they can rely on it, he said.
But all of that may be starting to change.
"The connectivity is rapidly changing in remote rural areas," Barrow said. "Sometimes it's still spotty, but in most places, you can use them."
That's more than a convenience, Barrow said. In rural areas, distance is a major obstacle to getting good care -- so the health apps on smartphones could mean the difference between poor- or good-quality health care.
"It's intriguing how fast it's coming up as an issue," Barrow said. "You can reduce the number of times people need to physically come into the clinic, and people can stay healthier."
Mobile Use Rising
According to a recent study released by the Pew Internet & American Life Project, 85% of adult Americans own a cell phone, and more than half of those devices are smartphones. It's the smartphones that offer real health care opportunities, said Susannah Fox, co-author of the study, since they are really computers that make phone calls.
"Now the Internet has become a de facto second opinion," Fox said. "People are going online for a supplement to the home care that's actually practiced." Whenever people have a medical question, they Google it, she said, "anytime, anywhere, the moment a question occurs. Now the Internet is always with you."
Will Ross, founding project manager for Redwood MedNet, a not-for-profit community-based health information exchange in rural Northern California, said smartphone health care technology is too new to really make any distinctions between rural and urban use, but also said the possibilities of those mobile apps are limitless.
"There's a lot you can do," Ross said. "By following your physical activity on Facebook, for example, they enable individual and community action to take place. You and your five friends can collaborate on a weight-loss competition."
You can track diabetes or blood glucose levels, he said. "And there's one app, where you can set it on your nightstand and in the morning you can understand your sleep pattern, how much sleep you got. Or you can calculate the number of steps you take and communicate it to your health account."
New to Everyone
The technology is still nascent, Ross said. "There's all of this stuff going on right now, and none of it has hit the big time," he said.
Fox said a majority of smartphone users have looked up medical information, but most users don't access health information on a regular basis.
"For better or worse, people are not thinking about their health all the time," Fox said. "It is still pretty much a breaking-glass-and-emergency kind of activity."
Rural use of the technology is generally lower, Fox said. "Rural Americans still lag behind [urban and suburban consumers] in Internet use, and that includes cell phone use," Fox said. "There are statistically significant differences."
According to Pew research:
- Nationally, 85% of adults have a cell phone, but that dips to 77% in rural areas;
- Of those cell phone users, 53% own a smartphone, compared with 38% of rural users; and
- Roughly 32% of urban smartphone users have looked for medical information online, compared with 18% of rural users.
Use of smartphone apps technology, though, among rural and urban users is fairly even, Fox said. "Rural users are about the same as urban and suburban users, at about 11%, in terms of adoption of apps," she said.
Those using apps tend to be younger, Fox said, and that's one of the things that intrigues Barrow about the possibilities of auxiliary health care through mobile technology.
"For youth, it's an interesting thing; they're used to using the cell phone modality," Barrow said. "And in rural areas, we have such a hard time connecting with youth. This is something they can use, rather than coming into the clinic setting."
But widespread adoption of health apps, whether urban or rural, is still far off, Fox said. "While information-seeking is starting to come to a boil, adoption of health apps is still set on simmer," she said.
Connectivity Is King
The main issue in rural areas has been -- and will continue to be -- one thing, according to Ross.
"It's really about broadband," Ross said. "We're really talking about broadband and the Wi-Fi cloud and that's what makes portability possible. And in rural areas, we continue to have horrible broadband."
Even if broadband were to magically appear in rural areas, Ross said, that would not be enough for widespread adoption. "We have a compound difficulty here," Ross said. "If we had fiber ready to go into all the homes, people who are low-income still might not be able to afford the line, or be able to afford those cell phone minutes."
That's a problem that won't go away in rural areas, even if mobile signals get stronger, Ross said. "Even if we drag the fat pipes to everyone's doorstep this is a really substantial digital divide," he said.
It's a divide that will continue to narrow, according to Barrow, as mobile signals strengthen in rural communities. It's also possible that the expansion of broadband to health care facilities in rural areas eventually might be opened up to the community at-large that those facilities serve.
However quickly or slowly the conversion happens, Barrow said, the benefits of mobile health care technology and applications make particular sense for remote users in rural settings. It's just a matter of time and effort, he said, to make it part of the health care landscape.