Smartphone Applications in Palliative Homecare

INTRODUCTION

Over the last few years use of short message services (SMS) and smartphone-based communication applications in health care has shown its wide application and potential to improve access to health care; enhance efficiency of service delivery; improve diagnosis, facilitate timely treatment and support public health programmes.[1234] This effective means of communication is providing timely and accurate results to the correct recipient, safeguarding their privacy and confidentiality and avoids misunderstanding and misinterpretation of the results. There are various uses of mobile phone message services and smartphone-based communication applications such as: Appointment remainders;[5] to monitor chronic medical conditions;[6789] to improve treatment compliance;[1011] to provide psychological support;[1213] managing communicable diseases via contact tracing and partner notification for sexually transmitted illnesses[1415] and to promote health promotion programs like smoking cessation.[1617]

Tata Memorial Hospital uses many modes of health related e-communications such as web based electronic medical records (EMR) where patients and families can access their medical records, blood investigations, scans and all patient-related information using an individual patient login key and password. This information can be accessed at home or any other remote setting using a computer or smartphone. The other modes of e-communications used are e-mail, short message service (SMS), multimedia messaging service (MMS) and WhatsApp (text, pictures, and video). Although these applications are not substitute for face-to-face interview and clinical examination, in most of the situations especially in palliative care setting it minimizes needless transport of the patient, cost and logistics involved. It also provides a means for quick information sharing, cuts the waiting time and facilitates initiation of the treatment at the earliest. It also forms a means of communication with local general practitioner and local health care provider such that continuity of the care is maintained.[18]

CASE REPORT

DISCUSSION

Moribund patients with advanced life-limiting illness can receive continued care at home with the help of collaborative and ongoing support from the palliative home care team and local family physician. Audio-visual communications aided through smart phone applications can improve this facilitation. Using applications like WhatsApp messenger, which allows the user to share clinical images, clinical video, photograph of reports, photograph of medications and text messages can bring palliative home care management to a new level by enhancing the channels of communication between patient, palliative care doctor, caregiver and local family physician. This technology is useful in palliative care for the patients lacking access to medical services due to both debilitating medical condition and geographic isolation. A study done by Coyle et al. demonstrated certain benefits such as limited need for daily physical examination and assessment, screening for a need for a clinical visit or admission, communication assistance to patients who cannot speak or hear and increased satisfaction by the patient and the caregivers.[19] In a palliative care setting it also decreases monetary burden on caregiver as it saves the cost of travel and consultations and prevents unnecessary hospital admission and investigations.

The current smartphone applications like WhatsApp messenger is much cheaper and easily available when compared to the teleconferencing systems. The most teleconferencing solutions pertain to the transfer of electronic medical data from one institution to another, only a small percentage of such programs can be applied to home health care. It is a worldwide phenomenon to incorporate the newer technologies into the field of health and social care, even though there is lack of evidence to support this.[20]

The rapid development, adoption and use of various smartphone applications also present with crucial challenges for clinicians and users. The important challenges are to ensure patient confidentiality, safety, establish cost-effectiveness and engage patients and clinicians to optimize their use in health decision-making. Although healthcare and academic institutions should support the improvements offered by technological advances, they must do it within a supervised framework, after thoroughly evaluating clinical outcomes and unintended consequences. Challenges in using mobile phone applications in health care also include incomplete coverage of mobile networks across regions, lack of standards, and possible information overload.[21]

At present we have a mobile user society and the worldwide deployment of mobile and wireless networks and the wireless infrastructure in health care is able to provide healthcare to anyone, anytime, and anywhere without constraints of location or time. It's application in palliative home care has demonstrated significant improvement in control of physical symptoms, address non-physical issues and improves patient satisfaction. Special attention needs to be given to its potential benefits and challenges in palliative care and certainly its open a new area of research in palliative care.[22]

CONCLUSIONS

• Smartphone applications in palliative homecare are a novel cost-effective approach in providing timely and effective care

• Improves symptom control, helps in continued care at home and prevents unnecessary hospitalization

• Improves patient and caregiver satisfaction.