mHealth Application Clusters

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Presentation by Claudia Tessier at mHealth Initiative's Seminar in San Francisco, September 18, 2009

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<ul><li>1.The 12 mHealthApplication ClustersmHealth Initiative Seminar San FranciscoSeptember 18, 2009Claudia Tessier RHIACEO and PresidentCopyright 2009 mHealth Initiative Inc., Boston MA. All rights reserved. </li></ul> <p>2. Mobile Phones at the End of the First Decade of the 21st Century Worldwide mobile subscriber base &gt;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). 3. 12 Mobile Phone Application Clustersin Healthcare 1 Patient2 Access to3 Point-of- CommunicationWeb-basedCare 4 Disease ManagementResourcesDocumentation12 Body 5 Education Area NetworkPrograms 11 Pharma/Clinical 6 Professional Communication 10 Public98 Financial Health Ambulance/EMS Applications 7 Administrative Applications 4. Application Cluster #1 Patient CommunicationBefore visitDuring visitSelection of caregiverPatient educationPre-visit communication Financial and administrative Text message Care communication EmailPost-visit and general PhotosText messagesAppointment remindersEmailAppointment request andContinuity of careschedulingMedication remindersAgendaQuestions (with photos ifInsurance infoapplicable)Update demo dataPatient educationAdvance check-inIn the care processPHR (CCR)ReferencesConsumer/patientproviding information 5. Text Messaging AppointmentsMedication remindersGeneral inquiriesAdministrative questionsNon-healthcare related communicationHealth promotionPatient-initiated communicationNeed to reschedule appointmentNeed for prescription refill, etc. 6. Preferred Communication: The Phone as IdentificationPrograms like the airlines Remember Me provideA 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 7. Benefits of mHealth Patient Communication SystemsMore communication between clinician andpatient leads toBetter quality of careGreater continuity of careGreater efficiencyFewer visitsLower costs 8. Considerations All communication must be clear andcustomizable (usability)Reason for visitBoth 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 andprotocolsID Systems: Photo and Remember me 9. ConsiderationsRequires new reimbursement systemDo 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 thephysicians behind the scenes for each communication?Would compensation paradigms that include a frequencycomponent invite abuse?Can the evaluation of the value/compensation beautomated or does it need a new bureaucracy?Is this another good reason to move to capitatedcompensation structures so that providers are free tofocus on the optimal way to arrive at best caseoutcomes? 10. ConsiderationsProviders must have an auto responder functionabout emergenciesWhat is the difference between text messagingand telephone messages in terms of impact andliability?Perhaps the terminology should be emailing ortext 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 isnt easily and automaticallyidentifiable as unnecessary (such as appointmentreminders) should be saved in an EMR, otherwisetime/money is wasted deciding on whats worthy. 11. Standards NeededPatient IDStructured communicationSecurity/confidentialityProvider workflow issues 12. Application Cluster #2: Access to Web-based Resources Formularies Guidelines and protocols Decision support Telemedicine guidelines Accessing specific CCR information Patients comments re Web Patient directives PHR For providers and patients 13. Lexi-Comp References Credit: Renee McLeod 14. Drug Programs Credit: Renee McLeod 15. Search PubMed (Pub Search is a free application)Credit: Renee McLeod 16. Application Cluster #3: Point-of-care, Real-time Documentation The promise of EMRs at yourfingertips anywhere, anytime Access patient history in real-time Document (capture patient information capture and generate report) in real-time Transmit patient information in real-time Navigate patient information in real-time 17. Real-time, point-of-care information capture!!!Is documentationlike this acceptableanywhere otherthan in healthcare? Legibility Structure Meaning Completeness 18. IssuesAccuracyAuthenticationInteroperabilitymDevices to HIS and EMRMedical devices wireless communicationEMCData integrity 19. Accessing Patient InformationInteroperabilityFrom internal systemFrom a WebsiteFrom the phone card 20. Application Cluster #4: Disease ManagementCurrently focused on Diabetes Asthma Dermatology Preventive care in pregnancy Smoking cessation Hypertension 21. DiabetesSeveral companiesApplicationsParents to monitor their childrenPatients to monitor and report their healthdata 22. Record Blood Sugar Intake Record Instant feedback Follow up 23. Meal Planning Questions 24. Disease Management IssuesFDA approvalProof of ROICollection of projects/experiencesAggregation of data 25. Application Cluster #5: Education ProgramsTeaching, monitoring, coachingNew applications in nursing and otherareasTeaching patients self-care, monitoring,expectationsNeed standards 26. Application Cluster #6: Professional CommunicationPreferred communication channels for lab,pharmacy, etc.ColleaguesSpecialty-specific communitiesDisease-specific experiencesAsk the expert! 27. Application Cluster #7: Administrative Applications Provider-patient Asset tracking applications Surgical instrumentsFinancial dataMedical recordsDemographic dataEquipmentNon-clinical dataAppointmentsPatient flowSelf check-inmanagementReminderSchedulingAdmissions/discharges Staff communicationInternalBed managementExternal Third partiesPayersLabsOther providers 28. Application Cluster #8: Financial ApplicationsCharge captureProviders accessing eligibility infoProviders sending billsPatients accessing coverage and co-payinformationPayers in active communication withpatients and providersOnline real-time adjudication 29. Application Cluster #9: Emergency CareNot starting with a blank sheetPotential need for record locator systemSubstantial cost reductions expectedSan Diego experience 30. Application Cluster #10 Public HealthReporting of disease outbreaksSwine flu, for exampleAlerting providersInstructing patientsBioterrorismSurveillancePopulation notificationsIncreasing adoption in developing countriesOther 31. Application Cluster #11 Pharma/Clinical Trials Clinical trials Automatic, scheduled and ad hoc information transmission Rely on instrument rather than patient for routine data collection Patient feedback systems 32. Application Cluster #12: Body-area Networks (BAN) Mobile wearable or implanted sensors that monitor vital body parameters and movements and wirelessly transmit data from the body to provider or elsewhere via a home base Examples Heart monitor could alert pending heart attack Auto-inject insulin for patient whose blood sugar drops Sports activity monitoring: speed, distance, heart rate, blood pressure Fantasy? - Exchange business cards (or patient demographic data) with a handshake? Big issue: Security 33. mHealth Initiative PlansDevelop online resource to record andaccess information about mAppsBy application clusterBy deviceBy diseaseInformation from vendorsInformation and feedback from users 34. Thank you! www.mhealthinitiative.orgc.tessier@mhealthinitiative.org 617-816-7513 </p>