1) Home and specialty infusion professionals widely embrace mobile health technology, with 83% using apps to reference drug or clinical information and 40% using apps to communicate with coworkers. 2) Popular clinical apps used include Epocrates, Lexicomp, Medscape, and Micromedex for drug information, and effective app features include leveraging smartphone capabilities, linking to external sensors, and securely transmitting data. 3) While apps can help improve patient engagement and care delivery, barriers remain around evidence, integration, privacy, and reimbursement, though the mobile health market is expected to reach $31 billion by 2020.

1. JANUARY/FEBRUARY2016
18
Who among us doesn’t remember having a tele-
phone conversation while tethered to a landline
by a curly cord? It may not be surprising that
those clunky rotary dial devices are a thing of the past, but
it’s still fairly amazing that the “phones” that replaced them
are capable of performing so many functions. Besides call-
ing, we can text, video chat, e-mail, search the web, navi-
gate in an unfamiliar town, and amuse ourselves with any
number of apps—I’m partial to an electronic coloring book
called Colorfly.
With more than 1.5 million apps currently available, it
shouldn’t be surprising that many of these specialized bun-
dles of computer programming are useful tools for every-
day life.1
It also follows that health care would soon emerge
as fertile ground for app developers. There are an estimated
165,000 mobile health apps available to consumers. While
80% of them are designed for the broader health arenas of
fitness and wellness, a small but growing portion are tak-
ing on tasks that have the potential to improve health care
delivery.2
The explosion of mobile health technology is
creating tools that help clinicians engage and monitor pa-
tients, collect and analyze data, improve communications,
assistant in clinical decision making, provide individual-
ized information, and streamline operations—all welcome
advances in our fragmented health care system. Exhibit 1
offers a comprehensive look at the many ways health care
practitioners use mobile devices and apps.3
Tools of the Trade
Two-thirds of Americans have a smart phone.4
Among them
are health care providers, including home and specialty infu-
sion pharmacists, nurses, and reimbursement professionals,
who appear just as likely to use an app to research a medi-
cation as a restaurant choice. In general, home infusion pro-
viders are very receptive to mobile health technology. Ac-
cording to an informal survey of NHIA members, nearly 70%
reported using at least one health-related app in both their
personal and professional lives. These users bucked the tradi-
tional theories that apps are the purview of Millennials—the
majority were either 45-54 (37%) or 55-64 (35%).5
This is the
same age demographic as many of our industry’s pioneers,
so it could be that this group is made up of highly adaptable
providers who will make use of any and all available tools.
Regarding personal use, the most common health apps
used by our respondents paralleled consumer trends and
included fitness and activity trackers (67%) and diet and
nutrition information and trackers (55%). Just under half of
health app users interface with various parts of the health
care system, including connecting to insurance portals
(44%), accessing medical records (40%), and communicating
with providers (37%).5
When it comes to using mobile health technology in pro-
fessional activities, an astounding 83% of home infusion
practitioners in our survey reported using apps to reference
There’s an App for That
Home and Specialty Infusion Professionals
Embrace Mobile Health Technology
By Jeannie Counce
83% of home infusion practitioners in our survey reported
using apps to reference drug or other clinical information

2. JANUARY/FEBRUARY2016
19
drug or other clinical information (see Exhibit 2). Approx-
imately 40% used apps to communicate with coworkers or
connect to their organization’s IT system. And nearly one-
third (27%) use apps to prepare for licensing and certifica-
tion exams and take continuing education tests.5
For drug information, Epocrotes offers a quick and easy
reference, according to Barbara Petroff, MS, RPh, FASHP,
Pharmacy Manager at Soleo Health in Novi, Michigan. “In ad-
dition to looking up medication information, it offers med-
ical calculators, tables, and manufacturer information,” she
observes. “It is also a quick way to check interactions. Not
only do I use it for work, but I check physician medication
choices for my family while still in the office.”
“I use LexiComp for dosing, stability, and monitoring ques-
tions,” says Abby Bauman, PharmD, Home Infusion Pharma-
cists at Mercy Medical Center in Mason City, Iowa. Bauman
also uses UptoDate to search for clinical articles and other
content; both apps are subscription-based and the cost is
covered through her employer. “When I don’t have my lap-
top, the mobile apps allow me to answer questions and get
information quickly,” she adds.
Monica Zappa, RPh, Director of Pharmacy, Mahoning Val-
ley Infusion Care uses the LexiComp database at work, but
finds the Medscape app useful when she’s
on the go. “It is very easy to navigate
and has a section of useful cal-
culators,” she explains. “It
also lists herbal medi-
cations in the drug file
and includes them in
any drug-drug interac-
tions—I find this very
helpful.”
Although Microme-
dex is a clinical app,
Gayle Dunbar, BSHA, Re-
imbursement Supervisor at
Yakima Valley Memorial Infusion
Exhibit 1
How Health Care
Professionals Use Mobile
Devices and Apps
Information Management
• Write notes
• Record audio
• Take photographs
• Organize information and images
• View and read documents
• Access cloud service
Time Management
• Schedule appointments
• Schedule meetings
• Record call schedule
Health Record Maintenance and Access
• Access electronic medical records
• Access images and scans
• Electronic prescribing
• Coding and billing
Communications and Consulting
• Voice calling
• Video calling
• Texting
• E-mail
• Multimedia messaging
• Video conferencing
• Social networking
Reference and Information Gathering
• Medical textbooks and journals
• Literature searches
• Drug reference guides
• Medical news
Clinical Decision Making
• Clinical decision support systems
• Clinical treatment guidelines
• Disease diagnosis aids
• Medical calculators
• Laboratory test ordering
• Laboratory test interpretation
• Medical exams
Patient Monitoring
• Monitor patient health, vitals, and progress
• Collect clinical data
Medical Education and Training
• Continuing education
• Knowledge assessment tests
• Board exam preparation
• Case studies
• E-learning and teaching
• Skill assessment tests
Source: Ventola C. Mobile Devices and Apps for Health Care
Professionals: Uses and Benefits. Pharmacy & Therapeutics.
May 2014;39(5):356-364.
Exhibit 2
Clinical Apps Most Used in
Home and Specialty Infusion
Epocrates
Drip IV Calculator
Drug Info Line
Drugs.com
ICD-10 Consult
Lexicomp
MedCal
Medscape
Micromedex Drug Reference
Micromedex IV Compatibility
Micromedex Drug Interactions
WebMD
Source: National Home Infusion Association survey, 2015

3. JANUARY/FEBRUARY2016
20
Care, uses it to look up HCPC and CPT® codes, which are
essential to her job.
Infusion practitioners are not the only clinical experts who
have adopted mobile health technology. A 2013 survey of
nearly 3,000 physicians found that 74% use smartphones at
work. Nearly half (43%) reported using the devices to look
up drug information and about one-third (31%) make pre-
scribing decisions by smartphone.6
Aside from underscoring
the prevalence of smartphone and app use by health care
practitioners, these statistics show that members of a mul-
tidisciplinary care team are well-positioned to communicate
with one another on an evolving platform.
Patient Apps Designed to
Improve Care
While apps improve access to information used in clinical
decision making, they can also play a role in improving care.
As internet-based platforms expand, so do the possibilities
for combining mobile health solutions with cloud comput-
ing, sensors and wearables, and more.2
According to a recent
industry report, health care providers show an increased in-
terest in the use of mobile health apps for improving patient
engagement and the delivery of care, but barriers remain to
full adoption. These barriers include lack of scientific evi-
dence, limited health care system integration, regulator and
privacy unknowns, and few provisions for reimbursement. 2
Despite the challenges, mobile health is one of the fastest
growing categories in the app market, and is expected to
reach $31 billion by 2020.7
Not all clinical apps are successful, and certainly the se-
curity of protected health information is chief among con-
cerns that could thwart adoption. Device manufacturers
and makers of consumer-based apps may be able to share
patient information with third-party advertisers—and many
users may be surprised to learn that data used on these apps
outside a health care setting is not protected.8
Even when a
patient’s medical information is protected, an app’s software
could contain security flaws, or be hacked. Data contained
on smartphones, tablets, and laptops, which are easy to
steal, is also at risk, point out experts.8
Many app users still
harbor doubts over security and appropriate use of personal
health information collected by apps still remains fairly high.
Three-quarters (76%) of home infusion professionals report-
ed feeling “strongly” or “somewhat” concerned.5
See Exhibit
3 for features of clinical apps that are most effective.
Exhibit 3
5 Features of Effective
Clinical App
1. Leverages smartphone capabilities
2. Links to external sensors
3. Incorporates alerts and reminders
4. Graphically displays user data
5. Data is transmitted securely
Source: IMS Health
The long-standing problem of medication adherence of-
fers a prime example of leveraging smart phone function-
ality to interface with patients regarding their care plans.
Identified as a growing public health concern by the Centers
for Disease Control and Prevention (CDC), poor adherence
causes approximately 33% to 69% of medication-related hos-
pitalizations and accounts for $100 billion in annual health
care costs.9
Now a cadre of apps offer reminders for next dos-
es and refills; allow patients to log doses taken; and provide
medication information, such as adverse effects, toxicities,
and specialized provider notes. Some apps even allow pro-
viders to access and upload patient data logs, integrate med-
ication lists with specific drug information, and connect the
patient with pharmacy and primary care contacts.10
While there is no evidence to date that these apps im-
prove adherence or clinically relevant outcomes, several
studies demonstrate that text messaging improved medica-
tion adherence in several chronic conditions.11
Due to their proportionately high impact on health care
costs, patients with chronic conditions, who are often on
complex medication regimens, are a primary target group
for mobile health app developers. In terms of business po-
tential, diabetes leads the way with obesity, hypertension,
depression, and chronic heart disease rounding out the top
five disease states targeted for innovation. Follow-up and
monitoring as part of the general treatment plan is viewed as
the most promising way to integrate apps into patient care
with the greatest impact, and reminders are considered the
most easily implemented way of affecting patient behavior.7
Download This App and Call Me
in the Morning
One in 10 health apps now has the ability to link to a sensor
device—moving the trend that began with fitness trackers
into the realm of clinical care and patient monitoring.2
Today
we are seeing a growing pool of apps paired with wearable
technology designed to address specific medical problems.
For example, BlueStar by WellDoc, Inc. collects patient data
via a connected glucose monitor, and uses algorithms to cre-
ate an individualized self-management plan. The app also an-
alyzes the medical data and sends clinical recommendations
to the patient’s health care team.
This type of technology, which operates as a “medical
device” and has the ability to impact clinical care, must be
cleared through the U.S. Food and Drug Administration
(FDA). In 2014, the FDA cleared about two dozen digital
health apps, including a smartphone-based inhaler, a sys-
Mobile health is one of the
fastest growing categories
in the app market, and is
expected to reach $31 billion
by 2020.

4. JANUARY/FEBRUARY2016
21
tem for monitoring pulmonary artery pressure in heart
failure patients, a mobile diagnostic imaging reader, and
an app that tracks and reports the movements of Parkin-
son’s patients.12
These specialized tools can cost more than consum-
er-based apps—sometimes several hundred dollars. But,
developers hope that physicians will soon consider them
clinical interventions, similar to medication, and begin pre-
scribing them. While more than a third of U.S. physicians
indicate that they have recommended an app to patients,
most remain hesitant to do so in a truly prescriptive man-
ner.2
Industry analysts say that the idea of physicians actually
prescribing apps will be driven by several factors, including
payer and provider recognition of the potential role of apps
in health care management; creation of standard bench-
marks for security and privacy guidelines; curation and eval-
uation of health care apps; and integration of apps with oth-
er IT systems.2
Demonstrating clinical effectiveness is a slow process.
Today, there are some 300 clinical trials underway that uti-
lize health apps—the number has doubled in the past two
years—so new data on the impact of apps on clinical out-
comes may soon be forthcoming. 2
In the meantime, phy-
sician attitudes appear open to clinical apps with 75% of
physicians in one industry survey reporting that they found
remote patient monitoring to have high value.13
The need to manage elderly and chronic conditions will
continue to drive market growth for remote patient mon-
itoring tools, such as clinical-grade monitors, peripherals,
and other software, say experts. In addition, these tech-
nologies are emerging along with the paradigm shift away
from episodic care and towards continuous care. The timing
could amplify the possibility of mobile health playing a role
in early detection and provider response to preventable cri-
sis events.13
For these reasons, many health systems are developing their
own clinical apps. Functionality includes post-surgical recov-
ery, cardiac rehab, medication adherence for complex regi-
mens, and symptom management for specific disease states,
such as asthma and inflammatory bowel disease.14
In many
ways, the providers are betting on the effectiveness of an app
that’s offered—if not prescribed—as part of a treatment plan
as a means of reducing complications and readmissions.
Providers also realize that mobile health technology can
add value to the overall patient experience. In one exam-
ple highlighted in the Wall Street Journal, the University of
Michigan developed an app called Breast Cancer Ally as
tool to help patients manage the influx of information and
More than a third of U.S. physicians indicate that they have
recommended an app to patients.

5. JANUARY/FEBRUARY2016
22
instructions they receive throughout their journey with the
disease. A companion cancer pain management app, called
ePal, offers educational videos and supportive messages
along with medication reminders and the ability to request
medication refills. The app also performs regular prompts
for patients to assess their pain levels and can notify clini-
cians of an escalation.14
Patient Engagement
For years, virtual interactions between providers and pa-
tients meant providing an online portal for patients to ac-
cess to their electronic health records. Slow to take off due
to the need to navigate privacy regulations and a lack of IT
standardization, these tools, designed mainly by legacy IT
vendors, failed to engage patients in their health care in any
meaningful way. Now, as a new wave of tech companies en-
ters the market and raises the creative bar, a growing num-
ber of user-friendly provider and payer portals are now avail-
able—many via app. Patients can access information, such
as medical records or insurance benefits, and execute simple
interactions, such as schedule an appointment or check the
balance of their health savings account.
While patient portals are the primary means of most pa-
tient-provider interactions, many providers are stepping up
their game to offer advanced tools that benefit both parties,
often reaching beyond administrative tasks to include the
provision of care. More than one-third of home and specialty
infusion providers (35%) have a dedicated app, web portal, or
similar interface for engaging with patients in their homes.5
Bioscrip, for example, recently began using PingMD as an
easy way to communicate with patients on long-term chron-
ic therapies, such as nutrition, inotropes, and IVIG. “For these
high-touch therapies, there are traditionally a lot calls back and
forth between the care team and the patient,” explains Marvin
Siegel, RN, CRNI®, National Director of Nursing Operations.
“The patient gets regular calls to perform an assessment, check
their supply levels for reorder, and schedule a delivery. But the
pharmacist who asks clinical questions for an assessment isn’t
thinking about coordinating a delivery, and the patient coordi-
nator who is asking about supplies isn’t thinking about clinical
cues, so the information is fragmented.”
PingMD collects all the needed information at one time
through a scripted program the patient accesses at regular in-
tervals. The responses are then sent to the entire clinical team,
reducing repeat calls. The app also allows patients to contact
members of the care team any time with questions or prob-
lems using a secure text feature—they can even send photos.
“It’s faster and more efficient than using the 800 number for
after-hours issues,” observes Siegel, noting that the technology
has helped solve problems and avoid trips to the emergency
room. In one case a patient sent a photo of a pump that he
couldn’t stop alarming and the nurse noticed a clamp on the
line in the background.
Bioscrip staff can communicate with each other using Ping-
MD as well. “Our nursing scheduler found the group text func-
tion especially helpful,” recalls Siegel. She can send one message
about a particular patient who needs to be seen on a certain
day to the entire group and get a response in real time instead
of having to call down a list and wait for call backs.”
Exhibit 4
Organizational Strategy
Considerations for Health
App Adoption
• How are mobile health technologies enabling your
care delivery?
• Do they affect your payment model, IT roadmap, or
other business functions?
• Does your organization have a list of mobile health
apps that are approved to be recommended or pre-
scribed to patients?
• How and when can a mobile health app be recom-
mended to the patient?
• How information regarding patient use of apps be
shared across the collaborative care team and across
care settings?
• Who will be coaching patients on the use of the app?
• Who will be monitoring patient adherence and out-
comes?
• What is the curation and evaluation process for new
mobile health solutions?
• How are you benchmarking evidence as well as track-
ing effectiveness of interventions as you grow adop-
tion?
• What new competencies are needed for the various
members of your team?
Source: Adapted from: Austin R and Hull S. The Power of Mo-
bile Health Technologies and Prescribing Apps. Computers,
Informatics, Nursing. November 2104; 32(11):513-558.

6. JANUARY/FEBRUARY2016
23
The NHIA Home Infusion Therapy Module Program
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comprehensive Module Program as a CORNERSTONE for their training needs! With easy-to-
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seven self-study modules. Additionally, Modules 1, 2 and 7 now offer
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comprehensive guide to the various clinical, operational, and financial aspects of our business.
I highly encourage everyone to incorporate it into their training and competency plans.”
—Tony Powers, Pharm.D., CEO/Partner Medical Alternatives and involved in infusion pharmacy for over 25 years.
Home Infusion Therapy Module Program
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Prescribers are included in communications between pa-
tients and the care team, Siegel adds, noting that they appre-
ciate seeing lab values and updates as they occur. And, every-
thing is saved into PDF files that are electronically stored in the
patient’s medical record. “It’s really streamlined our operations.”
“Patient engagement is important because the patient is
the one constant in health care,” points out Nick Dougherty,
Founder and General Manager of VerbalCare. “We’ve shad-
owed health care workers and see that the transitions between
environments are the most challenging. With VerbalCare, the
patient’s account is theirs for life. They can pair with their care-
givers, family, hospital doctor, visiting nurses, and so on,” he says,
noting that future versions will go beyond communication to
automate workflow and address other challenges of fragment-
ed care.
The platform, which is used across the continuum, may be
the first that is specifically adapted for home and specialty in-
fusion. An early adopter program, developed in close partner-
ship with Medical Specialties Distributors (MSD) who acquired
VerbalCare in August, is currently underway and the product
should be available later in 2016. “Infusion providers are deliv-
ering high-quality, acute-level care with their hands tied behind
their backs because the patient isn’t five feet down the hallway,
he or she is 50 miles across town,” observes Dougherty. “The
patient situations can be so different, but they are all receiv-
ing complex, precise treatments where any deviation can land
them in the hospital.”
Dougherty asserts that VerbalCare improves communica-
tion or coordination that can address many of the challenges
that can interrupt therapy or land patients in the hospital. The
infusion version of the app should address additional techni-
cal and operational challenges, he says. “Medication adher-
ence, patient education, supply chain, workflow, understand-
ing patient satisfaction, discharge and transition of care, care
plans, and medication lists—all with centralized communica-
tion around the patient.”
Strategies for Embracing
Mobile Health
Perhaps one of the most promising aspects of mobile health
technologies is that they have the potential to connect the
health care silos. As our nation begins to view health care
more comprehensively, and patients assume more respon-
sibility for their care, well-designed apps could bridge the
gaps between settings and providers by improving com-
munication and allowing access to clinical information. It’s
also possible that clinical apps will prove effective tools in
influencing patient behavior with simple reminders as well
as individualized education and care instructions based on
remote monitoring data.
Whether your organization is currently using its own mo-
bile health technology, recommending off-the-shelf solu-
tions, or waiting to see what happens, there’s no question
an increasing number of tech-savvy patients are embracing
it. They will no doubt ask their health care providers about
apps that can enhance their health in various ways—from
education to direct interfaces with the care team. For this
reason, it’s important for provider organizations to be famil-
iar with the major apps on the market as well as within their
own industry and be able to advise patients seeking recom-
mendations. Exhibit 4 offers some considerations for top-to-
bottom health app adoption strategy.
Jeannie Counce is the Editor-in-Chief of INFUSION. She can
be reached at Jeannie.Counce@NHIA.org or 406-522-7222.
References
1. Number of apps available in leading app stores as of July
2015. Statistica. Available at: www.statista.com/statis-
tics/276623/number-of-apps-available-in-leading-app-
stores/ (accessed 12/15/2015).
2. IMS Institute for Healthcare Informatics. Patient adop-
tion of mhealth. 2015. Available for download at: www.
imshealth.com/en/thought-leadership/ims-institute/
reports/patient-adoption-of-mhealth#patient-adoption-
of-mhealth-exhibits (accessed 12/15/2015).
3. Ventola CL. Mobile device and apps for health care pro-
fessionals: Uses and benefits. Pharmacy & Therapeutics.
May 2014;39(5):356-364.
4. Pew Research Center.The Smartphone Difference. April,
Patient engagement is important because the
patient is the one constant in health care

8. JANUARY/FEBRUARY2016
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2015. Available at: www.pewinternet.org/2015/04/01/us-
smartphone-use-in-2015/ (accessed 12/15/2015).
5. NHIA. Survey on Health App Usage, December 2015. Un-
published.
6. Alvarez A. How are physicians using smartphones for pro-
fessional purposes? April 22, 2013. Available at: www.kan-
tarmedia-healthcare.com/how-are-physicians-using-smart-
phones-for-professional-purposes (accessed 12/15/2015).
7. Research2guideance. mHealth app market sizing
2015-2020. Available at: http://research2guidance.
com/2015/11/11/the-mhealth-app-market-will-
grow-by-15-to-reach-31-billion-by-2020/ (accessed
12/15/2015).
8. Pittman D. 5 problems with mobile health app security.
MEDPage Today. February 5, 2014. Available at: www.
medpagetoday.com/PracticeManagement/Information-
Technology/44161 (accessed 12/15/2015).
9. Osterberg L, Blaschke T. Adherence to medication. N Engl
J Med. 2005;353(5):487–497.
10. Dayer L, Heldebrand S, Anderson P, et al. Smartphone medica-
tion adherence apps: Potential benefits to patients and provid-
ers. J Am Pharm Assoc (2003). 2013 Mar-Apr; 53(2): 172–181.
11. Vervloet M, Linn AJ, van Weert JC, et al. The effectiveness
of interventions using electronic reminders to improve
adherence to chronic medication: a systematic review of
the literature. J Am Med Inform Assoc. 2012;19(5):696–704.
12. Dolan B. 23 notable FDA clearances for digital health
apps, devices so far this year. Mobihealthnews. Sep-
tember 24, 2014. Available at: http://mobihealth-
news.com/36795/23-notable-fda-clearances-for-dig-
ital-health-apps-devices-so-far-this-year (accessed
12/15/2015).
13. Davis J. Remote patient monitoring market booming
amid readmission fines, doctor shortages, report says.
Healthcare IT News. December 15, 2015. Available at:
www.healthcareitnews.com/news/remote-patient-mon-
itoring-market-booming-amid-readmission-fines-doc-
tor-shortages-report-says (accessed 12/20/2015).
14. Landro L. Doctors prescribe new apps to manage
medical conditions. Wall Street Journal. Novem-
ber 9, 2015. Available at: www.wsj.com/articles/doc-
tors-prescribe-new-apps-to-manage-medical-condi-
tions-1447094444 (accessed 12/15/2015).
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4 Product Recalls
A significant, practical and useful NHIA members-only benefit—made possible through the generous sponsorship of
the NHIA Future of Infusion Advisory Council (visit www.nhia.org/about/fiac.cfm for more on the FIAC).
If you’re an NHIA member and don’t receive INFUSION Express, please contact:
INFUSIONExpress@nhia.org