HIMSS Mobile “How To” Guide

HIMSS mHealth Physician Task Force

HIMSS mHealth ‘How To’ Guide

• David Lee Scher, MD, FACP, FACC, FHRS

• Alisa Niksch, MD

• Megan Ranney, MD, MPH

• Brian Rothman, MD

Why Mobile Digital Health Tech Today?

The Big Picture

• Simple math: more patients via ACA, shortage of physicians and other providers

• The need to track patients, inventory, and processes

– ACO accountability

– ROI=cost savings, not revenue in 2015

• Mobile is a part of everyday life outside of healthcare

•ACOs

•Mega-merged organizations

•Retail medical care

Today’s Healthcare Landscape: New Business Models

•Bundled payments

•Risk/Gain sharing

•Readmission penalties

Today’s Healthcare Landscape:

New Payment Models

Today’s Healthcare Landscape: New Care Models

•Transitional care

•Remote patient monitoring

•Aging at home

•Participatory medicine: Role of the caregiver

Why Mobile Digital Health Tech Today?

The ‘In the Trenches’ Picture

• Clinicians are tethered to PCs

• EHRs are not intuitive. – Apps can fill void

• Communication, patient monitoring & reference tools need to be mobile, safe, and secure

• Mobile needed for digital patient education

Why a ‘How To’ Guide?• Legitimate concerns about quality, security, safety of mobile technologies, apps

• Up until recently no regulatory guidance

• Mobile presents unique challenges

• Lack of a central reference guide for adoption of mobile

• To understand obstacles to using mHealth to improve healthcare quality and cost from all perspectives

mHealth and Complex Care Models

• Complex care implies:

– High frequency of chronic disease states, comorbidities

– Multiple stakeholders: physicians, healthcare facilities, payors, patients, caregivers,

– Disparate communication and record keeping capabilities

– Additive human factors: adherence, cost, health literacy, mental health issues

Purpose of the “How To” Guide

• To help address challenges of care in the current healthcare landscape

• To increase awareness of available technologies which can:

– Improve patient investment in their own health

– Improve safety and quality of care

– Improve physician workflow efficiency

– Improve patient and family satisfaction

Why an mHealth “How-To” Guide?

•To understand obstacles to using mHealth to improve healthcare quality and cost from an individual, institutional, and systemic perspective

Why an mHealth “How-To” Guide?

•For clinicians: How do you know if a tool is what you need? What tools are out there?

•For C-suite executives: How do you know if a tool is worth investing in?

Why an mHealth “How-To” Guide? Clinicians

•How do you know if a tool is what you need? – Does it address a clinical problem?

– Does it improve your time efficiency or decrease workflow?

– Is it something your patients will see as value?

– Does it interoperate well with the EHR?

– Has it been shown to do what it claims to?

– Has it been vetted for security and privacy issues by your IT department?

Why an mHealth “How-To” Guide? The C-Suite

Why an mHealth “How-To” Guide? The C-Suite

• How do you know if a tool is worth investing in?

– Is it something your clinician IT champions want or see value in?

– Is it something your IT department has vetted?

– Does it add marketing value to the enterprise?

– Is it something which can translate to patient satisfaction?

– Does it address a clinical or workflow problem?

– Is it something potentially valuable as a joint business venture?

Why an mHealth “How-To” Guide?

• mHealth tools must achieve functionality in key areas:

– Clear benefit and incentives to the consumer (patient and connected caregivers)

– Actionable measures with mechanism for feedback

– To assist in bridging health literacy gaps

– Integration with other health IT systems

Leveraging mHealth for New Care Models

•ACOs: Real-time mobile analytics, communications

•Mega-merged organizations: Inventory management, communications, standardization of UX

•Retail Medical Care: Patient education tools

Leveraging mHealth for Challenges in Care

• Discharge process: Scheduling, medication reconciliation

• Chronic disease management: Remote patient monitoring, telehealth

• Care coordination:: Communications tools, mobile clinical trials

• Aging at home: Personal/environmental sensors, social

Why an mHealth “How-To” Guide?

To guide implementation of mHealth initiatives to achieve the Triple Aim*

*Institute for Healthcare Improvement

Better Care

Better Health

Lower Costs

The National Quality Strategy (NQS): How does mHealth fit in?

• NQS: Agency for Healthcare Research and Quality (AHRQ) through HHS

• Six priorities based on the triple aim

The NQS: How does mHealth fit in?

• 6 priorities for U.S. healthcare quality:

Patient SafetyPerson and Family-

Centered Care

Effective communication and Care Coordination

Prevention and treatment of leading causes of mortality

Health and Well-Being

Affordable Care

mHealth & the NQS

• How can mHealth improve Patient Safety?

Patient SafetyPerson and Family-

Centered Care

Effective communication and Care Coordination

Prevention and treatment of leading causes of mortality

Health and Well-Being

Affordable Care

mHealth & the NQS

• Priority 1: Patient Safety:

– Automated hospital discharge surveys

– Can use mHealth to improve satisfaction & safety:

• Point of care mobile CPOE, EHR, staff messaging

• Mobile EHR accessibility

• Text-messaging discharged patients discharged

mHealth & the NQS• How can mHealth create patient-centric care? How can

mHealth streamline communication?

Patient SafetyPerson and Family-

Centered Care

Effective Communication and Care Coordination

Prevention and treatment of leading causes of mortality

Health and Well-Being

Affordable Care

mHealth & the NQS

• STRATEGIES 2 & 3: Patient-Family-Centered Care & Effective Communication:

– Increasing use of “connected care” devices for monitoring of chronic disease

• wireless scales for CHF patients

– Patient access to data

• “OpenNotes” for EHR data

– Mobile self-reporting tools

• Automated text message data alerts to caregivers

• Self-tracking tools for depression, sleep, etc.

mHealth & the NQS• How can mHealth encourage/sustain healthy lifestyle

habits? How can mHealth help manage chronic disease?

Patient SafetyPerson and Family-

Centered Care

Prevention and treatment of leading causes of mortality

Health and Well-Being

Affordable Care

Effective communication and Care Coordination

mHealth & the NQS

• Strategies 4 & 5: Prevention; and Health & Well-Being

– Prevention is presently difficult to achieve

– Mobile health can facilitate this with patient engagement tools.

• Preventing depression w/SMS messaging high-risk teens presenting to the ER (iDOVE)

• SMS message programs for smoking cessation (text2quit)

• Apps to reduce relapse after Rx for alcohol abuse (iCHESS)

• SMS messaging to create “care teams” (SenseHealth)

mHealth & the NQS

• Will mHealth achieve reduced cost of care?

Patient SafetyPerson and Family-

Centered Care

Effective communication and Care Coordination

Prevention and treatment of leading causes of mortality

Health and Well-Being

Affordable Care

mHealth & the NQS

• Strategy 6: Affordable Care

– Jury still out BUT:

• Early studies suggest mHealth and remote patient monitoring initiatives can improve adherence, reduce visits/admissions, and improve satisfaction

– Integrated/targeted mHealth programs demonstrate potential for decrease in hospitalization costs

mHealth Technology’s Role

•Technology is not a magic bullet solution… but tools which can aid in the creation of effective care coordination models

Case Studies from the HIMSS mHealth Physician

Task Force• Remote Patient Monitoring

– Evolution with new biosensors, quest for more clinical data and use cases

– Barriers to Adoption

• How mHealth Can Transform the Delivery of Acute Care

• Mobile technology to support care transitions

HIMSS Resources

•The Value of Remote Patient Monitoring (RPM) Physicians’ Perspectives

-History of RPM and its evolution

-Current case studies

-New models of reimbursement and cost of care

HIMSS Resources

Remote Patient Monitoring (RPM) - Security and Other Adoption Barriers

- Security and data privacy concerns

- Limited business models

- Physician adoption barriers, including buy-in for new technologies

- Cost of deployment and training

- Etc., etc.,…

HIMSS Resources

Mobile Technology Selection to Support Care Transitions

– Advantages and obstacles of mHealth as mode of improved communication between caregivers

– Introduction of Digital Health Selection Framework

– Lays out need for setting criteria for selecting digital health technologies

HIMSS Resources

mHealth: Improving Patients’ Health Before, During, and After an Acute Care Visit

-Need for evidence-based mHealth solutions for clinician use and buy-in

-Value of text/SMS messaging for behavior change and compliance

Digital Health Technology Selection Framework