mhealth: technology changing health care

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E. Rachel MutruxDirector, Missouri Telehealth Network

Operations Director, Missouri HIT Assistance CenterState Director, Heartland Telehealth Resource Center

Center for Health Policy Health Policy Summit 2013

mHealth: Technology Changing Health Care

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Jama, 10/24/2013 definition:

“use of

mobile telecommunication technologies

for the delivery of health care and in support of wellness”

mHealth definition

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Mobile Phones & Smart Phones1. Digital divide is smaller for

phones than for Internet2. Mobile phone technology

easier/cheaper to roll out to large areas than fixed technologies

3. Mobile phones immune to social prejudices

Male/female; rural/urban; young/old

Cost effective & cost saving

Why mHealth?

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Dr. Sebelius lists 3 forces driving mHealth1. $$- unsustainable cost of healthcare

2. Wireless & technology!!3. Need for individualized medicine

Per capita spending on healthcare, Kaiser Foundation

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Measurement Tracking- diet, exercise Blood sugar, blood pressure

Diagnostic Portable imaging Sensors

Treatment Chronic disease management Remote clinical trials

Comprehensive Dissemination of health information Disease surveillance Prevention & Wellness interventions Education & awareness Helpline

Applications of mHealth

Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45(1), 184-198.

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Nexercise Free app that tracks exercise- GPS Uses support system Allows you to win points- money

Fooducate Scan bar codes to get nutrition

information Grades food choices (A,B,C) Suggests better alternatives

Consumer Focused

Examples

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Clinical Reference Apps The Merck Manual WebMD Medscape

Diagnostic Apps Mobile MIM- FDA approved for radiology AirStrip- Cardiology App- see EKG

Public Health Apps For Cancer prevention- Target Heart Rate

Calculator, Calorie Counter, Cigarette Calculator

Telehealth Apps Videoconferencing Tele MDID- developed here at MU!!

Disease Management Apps Asthma Crohn’s Diary Kidney Diet

Provider Focused Examples

Near Site Clinic – University Hospital

Far Site

Tele- MDID Project

The iPad apps were deployed to 10 far sites, as well as MU dermatology clinics. Pre-launch and post-launch internet-based surveys were distributed to far site patient presenters and dermatology clinic providers in 2013.

9University of Missouri Institutional Review Board (IRB) #1207257.

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Texting improves health outcomes Effective chronic disease management Effective self-management of disease and

successful clinical outcomes Better quality of life Reduction of error Better control of infectious diseases in

developing countries. Accessibility of healthcare in rural areas. Cost effective Better medication adherence Texting leads to better medication adherence Better maternal child health Improve attendance to healthcare appointments

**caveat much research was inconclusive showing need for additional research

Early mHealth research

outcomes

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Current reimbursement structurePhysician concerns

Reducing face-to-face interaction Increased workload

Security, PrivacyUnder-regulation- Over-regulation SafetyBig-Brother

mHealth Challenges

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Estimated 100,000 apps on the market today

Health & Wellness apps are leading adoption!- LoseIt! Fitbit

Healthcare moving out of the Dr. office to the patient

Improve health, increase access, decrease cost

Potential of mHealth

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E. Rachel MutruxPhone: 573-884-7958E-mail:

mutruxe@health.missouri.edu

Contact information:

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Reference List

1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20west/22%20mobile%20health%20west.pdf2)A mobile telephone-based interactive self-care system improves asthma control Eur Respir J 2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810 3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.-4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Telemedicine and e-Health, 18(6), 420-426.5) http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-young-asthmatics/2013-05-026)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagement-decisionmaking-health-out-2729886-1.html?CMP=OTC-RSS7) Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012). Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for asthma. 8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from www.scopus.com9)http://www.ey.com/Publication/vwLUAssets/mHealth_Report_January_2013/$FILE/mHealth%20Report_Final.pdf