mhealth 12 apps

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The 12 mHealth

Application Clusters

mHealth Initiative SeminarSan Francisco

September 18, 2009

Claudia Tessier RHIACEO and President

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



Mobile Phones at the End of the

First Decade of the 21st

Century Worldwide mobile subscriber base >4 billion

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 Application Clusters

in Healthcare1 Patient

Communication2 Access to

Web-based

Resources

3 Point-of-

Care

Documentation

4 Disease

Management

5 Education

Programs

6 ProfessionalCommunication

7 Administrative

Applications

8 FinancialApplications9Ambulance/EMS

10PublicHealth

11Pharma/Clinical

12 Body

Area Network



Application Cluster #1

Patient CommunicationBefore 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/patientproviding information

During visit

Patient education

Financial and administrative Care communication

Post-visit and general

Text messages

Email Continuity of care

Medication reminders

Questions (with photos if

applicable) Patient education

In the care process

References



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, etc.



Preferred Communication: The Phone

as Identification

Programs like the airlines’ “Remember Me” provide

A direct path to information about you whencalling from a phone number pre-registered withyour provider.

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

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



Benefits of mHealth PatientBenefits of mHealth Patient

Communication SystemsCommunication Systems More communication between clinician andMore communication between clinician and

patient leads topatient leads to Better quality of careBetter quality of care

Greater continuity of careGreater continuity of care

Greater efficiencyGreater efficiency Fewer visitsFewer visits

Lower costsLower costs



Considerations

All communication must be clear andcustomizable (usability)

Reason for visit

Both parties need acknowledgement This mayeven be more important for the provider because it will allow them tobe better prepared and confirm that tests required for the visit havebeen done.

Requires new workflow, parameters andprotocols

ID Systems: Photo and “Remember me”



Considerations Requires new reimbursement system

Do all communications have equal value? If ninecommunications are required in one instance and five inanother, 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 tofocus 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 messagingand telephone messages in terms of impact andliability?

Perhaps the terminology should be “emailing or

text messaging” since text messages are limitedto 160 characters, which may be too limiting.

All communication should be logged and savedfor a minimum period.

Everything that isn’t easily and automaticallyidentifiable as unnecessary (such as appointmentreminders) 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 #2:

Access to Web-based Resources Formularies

Guidelines and protocols

Decision support

Telemedicine guidelines

Accessing specific CCR information Patient’s comments re Web

Patient directives

PHR

For providers and patients



Lexi-Comp References

Credit: Renee McLeodCredit: Renee McLeod



Drug Programs




Search PubMed

(Pub Search is a free application)


A li i Cl #3




Point-of-care, Real-time Documentation

The promise of EMRs at your

fingertips anywhere, anytimeAccess patient history in real-time

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

Transmit patient information in real-time

Navigate patient information in real-time

Real-time point-of-care



Real time, point of careinformation capture!!!

Is documentation

like this acceptable

anywhere other

than in healthcare?

• Legibility

• Structure

• Meaning• Completeness



Issues Accuracy

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

A li ti Cl t #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



Record Blood Sugar Intake

Record Instant feedback Follow up



Meal Planning Questions



Disease Management Issues FDA approval

Proof of ROI Collection of projects/experiences

Aggregation of data





Education Programs Teaching, monitoring, coaching…

New applications in nursing and otherareas

Teaching patients self-care, monitoring,

expectations Need standards





Professional Communication Preferred communication channels for lab,

pharmacy, etc. Colleagues

Specialty-specific communities

Disease-specific experiences Ask the expert!





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





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





Emergency Care Not starting with a “blank sheet”

Potential need for record locator system Substantial cost reductions expected

San Diego experience





Public Health Reporting of disease outbreaks

Swine flu, for example

Alerting providers

Instructing patients

Bioterrorism

Surveillance

Population notifications

Increasing adoption in developing countries Other





Pharma/Clinical Trials Clinical trials

Automatic, scheduled and ad hoc informationtransmission

Rely on instrument rather than patient forroutine data collection

Patient feedback systems





Body-area Networks (BAN) Mobile wearable or implanted sensors that

monitor vital body parameters andmovements and wirelessly transmit data fromthe body to provider or elsewhere via a homebase

Examples Heart monitor could alert pending heart attack

Auto-inject insulin for patient whose blood sugardrops

Sports activity monitoring: speed, distance, heartrate, blood pressure

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

Big issue: Security



mHealth Initiative Plans Develop online resource to record and

access information about mApps

By application cluster

By device

By disease Information from vendors

Information and feedback from users



Thank you!

www.mhealthinitiative.org

[email protected]

617-816-7513

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