Leveraging mHealth

in a Post-Reform Era

ACPE.ORG 1

Edward MarxTexas Health Resources

December 2012

Texas Health MissionTo improve the health of the people in the communities we serve

Texas Health VisionTexas Health Resources, a faith-based organization joining with physicians, will be the health care system of choice

Innovative Technology SolutionsInnovate, transform, and serve

Texas Health Resources

Edward Marx

• Husband to Julie Harding Marx• Father to Brandon & Talitha Marx• Passion for God, Family, People, Triathlon & Tango• Colorado State University (BS, MS) • Army Combat Engineer Officer/Combat Medic• Healthcare IT Leadership Career• Texas Health Services Authority Board Chair• Worldwide Councils for Cisco, Microsoft and HP• SMU Engineering School Advisory• TCU Business School Advisory• UTD School of Management Advisory

Serve, Shape, Study & Share

My Biggest Fear During Primaries

“Yes but y

ou Gov P

erry appointed a M

arxist

to le

ad Texas H

IT!”

DEFINITION & DRIVERS

Mobile Health

5

mHealth Defined

Term used for the practice of medicine and public health, supported by mobile devices.

The use of mobile and wireless devices to improve health outcomes, healthcare services, and health research.

mHealth is

the firs

t tech

nology that

physician

s adopted

more quick

ly and ag

gressiv

ely th

an IT

could su

pport…

mHealth – “Perfect Storm”

8

EMR/ HIE adoption

Mobile device adoption

Mobility applications

ARRA driven adoption of EMR exceeded expectations

Smartphone and tablet/ slate adoption increasing

Clinical apps, and remote care patient monitoring

More people have access to sm

art

phones than clean water (Tides C

enter)

Ubiquitous

Smartphones surpasse

d stethoscopes

Perfect Storm Emboldened by

Federal and State Regulation

FROM THEORY TO ACTION

Mobile Health

11

• Accountable Care• Well-Being• Value Based Purchasing• Triple Aim• Direct to Employer• Health Insurance Exchanges

13

Opportunities

14

Keys to Success

Physician & Patient Engagement

TEXAS HEALTH STRATEGY

Mobile Health

15

Choluteca Bridge

16

mHealth Strategy

• Provider• PatientPeople

• Use cases• SettingsProcess

• Applications• InfrastructureTechnology

mHealth Framework

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

PROVIDER MOBILITY

Phones (Percentage of All Responses)

Tablets (Percentage of All Responses)

Provider Mobility: EHR

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

Canto

Haiku

Provider Mobility: EHR

• Current state– 741 subscribers,

all iOS– Read-only access to

CareConnect– eRx in development

• Future plans– Android support

(Q4, 2012)– Dictation (2013)– Image capture (2013)– Charge capture (2013)

Provider Mobility: OB

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

OB

Provider Mobility: OB

• Current state– Realtime, read-only access to tracings of maternal

uterine contractions and fetal heart rate– 125 subscribers, multiple platforms

Provider Mobility: Cardiology

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

Cardiology

Provider Mobility: Cardiology

• Current state– Read-only access to

EKGs– 500 subscribers,

all iOS– Expanding access to

EKGs from EMS– Integration with

CareConnect, in development

• Future plans– Android support

(Q4, 2012)– EKG interpretation

(2013)– Optimize adoption,

determine value (2012)

Provider Mobility: ICU

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

Patient Monitoring

Provider Mobility: ICU

• Current state– Read-only access to realtime waveforms and vital

signs data; historical view of telemetry alarms– Not yet licensed at THR– THP pilot approved by Heart & Vascular Service

Line and ITSC

• Next step– Pilot at THP

Provider Mobility: Stroke

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

CareConnect

Provider Mobility: Stroke

• Current state– Realtime, bi-directional audio/video interaction

between neurologist and patient– Specialized telestroke application (Dr. Hinton) in

use at THD, THDN– Evaluating Epic telehealth capabilities: THP pilot

(Q4, 2012)

Provider Mobility: Messaging

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

Provider Mobility: Messaging

• Current state– Vocera pilot for THPG hospitalists at THHEB– Evaluating UC capabilities

Provider Mobility

• Future needs and considerations– Providers: non-physician clinical staff– Workflows

• Secure messaging• Data entry (orders)• Mobile PACs

– Epic vs. UC for videoconference/telehealth

PATIENT MOBILITY

Patient Mobility: EHR

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

MyCare

Patient Mobility: EHR

• Current state– Same functionality as

Web-based patient portal

– Available to patients seen by THPG CareConnect providers or hospitalized at THR

– 420 users, iOS and Android

• Future plans– Acute care setting

ACPE.ORG 40

Patient Mobility: Wayfinding

Patient Mobility: Monitoring

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderPatient

Patient Mobility: Monitoring• Current state

– Real-time and asynchronous monitoring of vital signs; care plans, patient education

– Nearing completion of AT&T heart failure research study

– THAZ disease management, in development

• Future plans– Add videoconference

capability– To be considered for

Care Transition program (pHealth)

– Potential initiative for Campaign 2017

Patient Mobility: NICU

• Non-clinical setting

• Non-clinical setting

• Clinical setting

• Clinical setting

Patient Provider

ProviderFamily

Peek-a-boo

Patient Mobility: NICU

• Bi-directional audio/video interaction between– Family and neonate– Family and care team

• Deployed at THD• Interest at THFW, THP• Seeking alternative vendor (AT&T)

Patient Mobility

• Future needs and considerations– Consumer apps– Wearable devices– Integration with diagnostic equipment– Convergence with social media– Implications for population health management

Your appt at Regence is scheduled for 11/18/2010 at 1:15pm, XXX addressTo change/ Cancel, click-to-call xxx-xxx-xxx

Next…

Gartner Hype Cycle

CHALLENGES & LESSONS

Mobile Health

48

Usability

Reality

Expectations

Happiness

• One size does not fit all • Vendor support of multiple form factors/devices• UI that drives adoption – speed & resolution• Managing devices, power & ruggedness • Security, HIPAA, FDA• Integration and interface• Wireless bandwidth availability • Potential medical device interference

50

mHealth Challenges

• Access to the right data through simplified interfaces• Ubiquitous connectivity required• Has to work all the time, be intuitive and fast• Has to have great user interface• Start small and build on success• Must work well over slow, intermittent connections• Vendors not simply “also have a wireless solution”• Pick a strong partner willing to go at risk

51

mHealth Lessons

mHealth Security Challenges

• Security Challenges…• Platform Differences• Mobile Device Management (MDM)• Data Security Risk is Real• Not if but when….• Devices: Personal vs. Corporate-Owned

Six Takeaways…

• We are at the proverbial tipping point• Usability drives adoption• You need to have a defined, agile strategy• Start now with something and grow• The future isn't about mobile; it's about mobility• Security is about resiliency

Marx Contact

• Blog http://histalk2.com/category/ed-marx/• Twitter http://twitter.com/marxists• LinkedIn www.linkedin.com/in/edwardmarx• FaceBook www.facebook.com/edwardmarx• Email edwardmarx@texashealth.org