mhealth application clustrs.tessier

The 12 mHealth Application Clusters

June 4 mHealth Initiative SeminarWashington DC

Claudia Tessier RHIACEO and President

Copyright 2009 mHealth Initiative Inc., Boston MA. All rights reserved.

Total worldwide mobile subscriber base: >4 billion (almost 50% world population)

Landline phones: 1.2 billion

TV sets in use: 1.4 billion

Registered automobiles: 850 million

People using PCs: 950 million

Access to internet: 1.3 billion

People with at least 1 credit card: 1.5 billion population has a mobile phone).

12 Mobile Phone Function Clusters in Healthcare

- General Technology View -

1 Patient

Communication2 Access to

Web-based

Resources

3 Point-of-

Care

Documentation 4 Disease

Management

5 Education

Programs

6 Professional

Communication

7 Administrative

Applications

8 Financial Applications

9 Ambulance/EMS

10Public

Health

11Pharma/Clinical

12 Body

Area Network

Application Cluster 1Patient Communication

During visit Patient education

Financial and administrative

Care communication

General (inc. post-visit) Text messages

Email

Continuity of care

Medication reminders

Questions (with photos if applicable)

Patient education

In the care process

References

Before Visit Selection of caregiver

Pre-visit communication• Text message

• Email

• Photos

Appointment reminders

Appointment request and scheduling

Agenda

Insurance info

Update demo data

Advance check-in

PHR (CCR)

Consumer/patient providing information

Text Messaging

Appointments

Medication reminders

General inquiries

Administrative questions

Non-healthcare related communication

Health promotion

Patient-initiated communication

Need to reschedule appointment

Need for prescription refill

Preferred Communication

Programs like the airlines’ “Remember Me” provide

A direct path to information about you when calling from a phone number pre-registered with your provider.

The system recognizes your phone number, instantaneously pulls up your information and even greets you by name.

All of this information is available within a few seconds at the beginning of the call

Benefits of mHealth Patient Communication Systems

More communication between clinician and patient leads to

Better quality of care

Greater continuity of care

Greater efficiency

Fewer visits

Lower costs

mHealth Agenda for Communication

All communication must be clear and customizable (usability)

Reason for visit

Both parties need acknowledgement This may even be more important for the provider because it will allow them to be better prepared and confirm that tests required for the visit have been done.

Requires new workflow, parameters and protocols

Considerations

ID Systems: Photo and “Remember me”

New reimbursement system Do all communications have equal value? If nine

communications are required in one instance and five in another, are they paid the same?

How do you measure the amount of work required by the physicians behind the scenes for each communication?

Would compensation paradigms that include a frequency component invite abuse?

Can the evaluation of the value/compensation be automated or does it need a new bureaucracy?

Is this another good reason to move to capitated compensation structures so that providers are free to focus on the optimal way to arrive at best case outcomes?

Considerations

Providers must have an auto responder function about emergencies

What is the difference between text messaging and telephone messages in terms of impact and liability?

Perhaps the terminology should be “emailing or text messaging” since text messages are limited to 160 characters, which will often be too limiting.

Message/email Style

Standardize structured text or free text

Occasional need for a more personal touch

Text/emailing creates a superior audit trail to telephone messaging, so assuming that the provider has acted properly, it reduces liability and the likelihood of litigation.

Fail-safe controls are required to ensure a timely response to all communications, otherwise a new avenue of liability would be created.

Need patient agreement and clear guidelines

Guidance where text messaging should be used; what requirements for response and saving it (data base, EMR document).

Considerations

All communication should be logged and saved for a minimum period.

Everything that isn’t easily and automatically identifiable as unnecessary (such as appointment reminders) should be saved in an EMR, otherwise time/money is wasted deciding on what’s worthy.

Standards Needed

Patient ID

Structured communication

Security/confidentiality

Provider workflow issues

Application Cluster 2Access to Web-based Resources

FormulariesGuidelines and protocolsDecision supportTelemedicine guidelinesAccessing specific CCR informationPatient’s comments re WebPatient directivesPHRFor providers and patients

Lexi-Comp References

Credit: Renee McLeod

Drug Programs

Credit: Renee McLeod

Search PubMed(Pub Search is a free application)

Credit: Renee McLeod

Application Cluster 3 Point-of-care, Real-time Documentation

The promise of EMRs at your fingertips anywhere, anytime

• Access patient history in real-time

• Document (capture patient information capture and generate report) in real-time

• Transmit patient information in real-time

• Navigate patient information in real-time

Issues

Authentication

Interoperability

mDevices to HIS and EMR

Medical devices wireless communication

• EMC

• Data integrity

Accessing Patient Information

Interoperability

From internal system

From a Website

From the phone card

Cluster 4: Disease Management

Currently focused on

Diabetes

Asthma

Dermatology

Preventive care in pregnancy

Smoking cessation

Hypertension

Diabetes

Several companies

Applications

Parents to monitor their children

Patients to monitor and report their health data

Instant feedback Follow up

Record Blood Sugar Intake

Record

Meal Planning Questions

Disease Management Issues

FDA approval

Proof of ROI

Collection of projects/experiences

Aggregation of data

Cluster 5: Teaching, Monitoring, and Coaching

New applications in nursing and other areas

Teaching patients self-care, monitoring, expectations

Need standards

Application Cluster #6: Professional Communication

Preferred communication channels for lab, pharmacy etc.

Colleagues

Specialty-specific communities

Disease-specific experiences

Ask the expert!

Application Cluster #7: Administrative Applications

Provider-patient applications

• Financial data• Demographic data• Non-clinical data• Appointments• Self check-in• Reminder

Staff communication• Internal• External

Third parties• Payers• Labs• Other providers

Asset tracking Surgical instruments Medical records Equipment

Patient flow management Scheduling Admissions/discharges Bed management

Application Cluster #8:Financial Applications

Charge capture

Providers accessing eligibility info

Providers sending bills

Patients accessing coverage and co-pay information

Payers in active communication with patients and providers

Online real-time adjudication

Not starting with a “blank sheet”

Potential need for record locator system

Substantial cost reductions expected

San Diego experience

Application Cluster #9: Emergency Care

Reporting of disease outbreaks

Swine flu, for example

Alerting providers

Instructing patients

Bioterrorism

Surveillance

Population notifications

Other

Application Cluster #10Public Health

Clinical trials

Automatic, scheduled and ad hoc information transmission

Rely on instrument rather than patient for routine data collection

Patient feedback systems

Application Cluster #11 Pharma/Clinical Trials

Mobile wearable or implanted sensors that monitor vital body parameters and movements and wirelessly transmit data from the body to provider or elsewhere via a home base

Examples Heart monitor could alert pending heart attack

Auto-inject insulin for patient whose blood sugar drops

Sports activity monitoring: speed, distance, heart rate, blood pressure

Fantasy? - Exchange business cards (or patient demographic data) with a handshake?

Big issue: Security

Application Cluster #12 Body-area Networks

mHealth Initiative Plans

Develop online resource to record and access information about mApps

By application cluster

By product

By disease

Information from vendors

Information and feedback from users

Thank you

www.mhealthinitiative.org

c.tessier@mhealthinitiative.org

617-331-4140