sehf 2014 | tackling the tsunami: building an mhealth strategy
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Tackling the Tsunami: Building an mHealth Strategy
David Lee Scher, MD, FACP, FACC, FHRS Director, DLS Healthcare Consulting, LLC
digitalhealthconsultants.com Clinical Associate Profess or Medicine
Pennsylvania State College of Medicine
“The most valuable commodity that I know of is information”. –Gordon Gekko, “Wall Street”
What is mHealth?
Diverse application of wireless and mobile technologies designed to improve health research, health care services and health
outcomes .
Pew Internet/CHCG Surveys
Developments Supporting mHealth Adoption
• Implementation of electronic health records • Release of FDA Guidance on Mobile Medical
Apps • Growth of Patient advocacy (Health 2.0,
Quantified Self movement), Social Media • Wearable sensor and remote monitoring
technology development
Why is mHealth Good for Patients?
• SOMETHING MUST BE DONE to IMPROVE HEALTHCARE • Promotes patient engagement (self-management) • Provides educational resources and content development • Improves doctor-patient relationship • Creates personalization of healthcare -> ?better outcome • Convergence of many technologies -> simplification,
convenience • Supports caregivers’ mission
Which Mobile Apps Patients Want Their Doctor to Have
• 42%: An app to see their test results. • 33%: App connected to remote monitoring
devices. • 30%: Access to patient health records via
mobile device. • 13%: Didn’t think apps would help improve
care at all. Source: 2012 Ruder Finn mHealth Report
• GENERAL HEALTHCARE AND FITNESS – Fitness & nutrition – Health tracking tools – Managing medical conditions – Medical compliance – Wellness (traditional and corporate)
• MEDICAL INFORMATION – Reference – Diagnostic Tools – Continuing Medical Education (CME) – Alerts and Awareness
• REMOTE MONITORING, COLLABORATION, AND CONSULTATION – Remote monitoring (safety) – Remote Consultation – Remote Collaboration
• HEALTHCARE MANAGEMENT – Logistical & payment support – Patient health records
Facts About Health Apps*
• 97,000 mHealth applications are listed on 62 full catalog app stores.
• 15% are designed for healthcare professionals (CME, RPM, healthcare management).
• 42% of apps: Paid business model.
• Top 10 mHealth apps generate 4 million free and 300,000 paid downloads per day
*Research2guidance, 3/13
Barriers to Adoption of mHealth
• Incomplete regulatory guidance • Lack of reliability, security/privacy • Lack of mobile strategy by providers (BYOD, M2M
integration), payers • Lack of smart phones by older, chronically ill pts • Lack of business models • Lack of proven reimbursement, return on
investment • Physicians’ fear of high volume useless data
>90,000 medical
apps/programs
Clinicians: “Not
medically sound”
Consumers: <1/10 of
apps used more than
once
Business: “Doesn’t make me money”
From Megan Ranney, MD
Remote Patient Monitoring
Attributes of Ideal RPM
• Provide continuous surveillance with only actionable, trending data
• Unobtrusive • Interoperable with other devices and
EHR/portals • Have associated robust analytics with
clinical decision support
Mobile Cardiac Monitoring
Diabetes
Transdermal Patch w/Continuous Glucose Monitoring
Blood Pressure Monitoring
Pulmonary Monitoring
Complete Vital Sign/GPS Monitoring
Sensors: MEMS
• Implantable Sensors • Wearable Sensors • Biochemical sensors: glucose, pulse ox • Positioning sensors
Wearable Physiologic Monitoring
Footwear Sensors
mHealth: Smart Phone Capabilities
Medication Adherence Apps
• MyMedSchedule • Mymeds • RxMindMe • GloCaps
Proteus Digital: The Ultimate Adherence App
Role of Social Media in mHealth
• SoMe is mobile • Patients use smartphones for health
information • Patient-centered companies emerging • New market/business model for Pharma and
med device companies
Social Media: Critical Role inmHealth Strategy
4/6 Most Used Mobile Apps are SoMe-Based*
*GlobalWebIndex, 2013
SoMe and Healthcare
Online patient support groups – Clinical trial recruitment – Peer and caregiver support – Disease specific education – Healthcare navigation – Convenience – Anonymity
mHealth and Clinical Trials
Advantages of Mobile Clinical Trials
• Recruitment of patients via social media • Real-time adverse event reporting • Bidirectional patient-provider interactions
eliminate visits • Easier communications among all trial
stakeholders (regulators, sponsors, investigators) • Facilitates medication adherence (reminders, pill
sensors) • More efficient data collection, reporting, auditing • NO MORE FAXES!
Healthcare is still working in silos in many European countries
Hospital Care Physician Care Emergency Care Outpatient Care
No cross-border workflows, processes, no data exchange and access
Absence of legal and regulatory frameworks, e.g. for liability
Missing health-economic validation and bench-marks
No incentives for providers, payers and patients to use mHealth
Rainer Herzog, HealthActiveConsulting ©
Regulatory agencies and policy makers
• National / international standard protocols for e-/m-Health • Security and privacy of data
• Data integrity, availabilty and auditability • Risk management
Food & Drug Administration
(FDA) USA
Medical Device
Directive (MDD)
EU
Office of the National
Coordinator (ONC) USA
CE Quality Mark
EU
A Strategic Framework for Hospitals and Health Systems Present and Future State of mHealth
New Care Models Technology
ROI and Payments Policy
Privacy and Security
Standards and Interoperability
www.himss.org/mobilehealthit/roadmap
New Care Models: Healthcare in Transition
• Acute care Chronic Disease Management • Aging at Home • Hospital Readmission Prevention • Caregiver Involvement
mHIMSS Roadmap
• ROI/Payment: Addresses financial aspects of mobile tech adoption
• Legal & Policy: FDA mobile medical app Guidance • Standards & Interoperability: Types of networks,
communication patterns, standards above and below the network layers, network/storage tradeoffs, syntax and data, app standards, Blue Button Interface
• Technology: Factors to consider in app development • Privacy & Safety: Current state and future considerations
What is the Best Measure of the State of Adoption?
The HIMSS Mobile Technology Member Survey, 2013
Released February 26, 2014
HIMSS Survey: Respondent Profile
• 62%: IT professionals • 27%: Responsible for developing the
organization’s mobile tech policy • 38%: Member of committee responsible for
developing the organization’s policy on mobile tech
• 22%: Responsible for implementation and operation of mobile tech
Highlights of 2013 HIMSS Mobile Tech Survey
• Prioritization of Mobile Technology: Average score: 5.25
• Maturity of Mobile Technology Environment:
Characterized at 3.95, increased from 3.33 in 2012
• Impact of Mobile Technology on Patient Care: 33%: will substantially or dramatically impact patient care, decreased from 2/3 in 2012
Takeaways From HIMSS Survey
Mobile Technology Policy: 59% have mobile tech policy, 29% in
development. App Development:
Apps within their organization likely to be developed by third party.
½ plan to expand app usage. Barriers to Mobile Technology Use: #1= Funding
Significance of the Survey
• Identifies the decision-makers • Identifies market penetration more
accurately than industry analysts • Identifies pain points of mobile tech
adoption • Useful for developers, analysts,
healthcare enterprises, IT vendors
Challenges • Increase awareness and mobile tech by older
consumer/patients • Need filtered actionable data/alerts • Full connectivity with EHRs • Clinical efficacy studies • Interoperability among apps and platforms • Complete, reasonable and appropriate regulatory
requirements • Funding for mobile strategies (private, public)
Questions?
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