mhealth application clusters
DESCRIPTION
Presentation by Claudia Tessier at mHealth Initiative's Seminar in San Francisco, September 18, 2009TRANSCRIPT
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 CenturyWorldwide mobile subscriber base >4 billionLandline phones: 1.2 billion TV sets in use: 1.4 billion Registered automobiles: 850 millionPeople using PCs: 950 million Access to internet: 1.3 billionPeople with at least 1 credit card: 1.5 billion population has a mobile phone).
12 Mobile Phone Application Clustersin Healthcare
1 Patient Communication
2 Access to Web-based Resources
3 Point-of-Care Documentation
4 Disease Management
5 Education Programs
6 Professional Communication
7 Administrative Applications
8 Financial Applications
9 Ambulance/EMS
10Public Health
11Pharma/Clinical
12 Body Area Network
Application Cluster #1Patient Communication
Before visitSelection of caregiverPre-visit communication
Text messageEmailPhotos
Appointment remindersAppointment request and scheduling AgendaInsurance infoUpdate demo dataAdvance check-inPHR (CCR)Consumer/patient providing information
During visit Patient educationFinancial and administrativeCare communication
Post-visit and generalText messagesEmail Continuity of careMedication remindersQuestions (with photos if applicable)Patient education In the care processReferences
Text Messaging
AppointmentsMedication remindersGeneral inquiriesAdministrative questionsNon-healthcare related communicationHealth promotionPatient-initiated communication
Need to reschedule appointmentNeed for prescription refill, etc.
Preferred Communication: The Phone as Identification
Programs like the airlines’ “Remember Me”provide
A direct path to information about you when calling from a phone number pre-registered with your provider. The system recognizes your phone number, instantaneously pulls up your information and even greets you by name. All of this information is available within a few seconds at the beginning of the call
Benefits of mHealth Patient Benefits of mHealth Patient Communication SystemsCommunication Systems
More communication between clinician and More communication between clinician and patient leads topatient leads to
Better quality of careBetter quality of careGreater continuity of careGreater continuity of careGreater efficiencyGreater efficiencyFewer visitsFewer visitsLower costsLower costs
Considerations
All communication must be clear and customizable (usability)Reason for visitBoth parties need acknowledgement This may even be more important for the provider because it will allow them to be better prepared and confirm that tests required for the visit have been done.
Requires new workflow, parameters and protocolsID Systems: Photo and “Remember me”
ConsiderationsRequires new reimbursement system
Do all communications have equal value? If nine communications are required in one instance and five in another, 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 to focus on the optimal way to arrive at best case outcomes?
ConsiderationsProviders must have an auto responder function about emergenciesWhat is the difference between text messaging and telephone messages in terms of impact and liability? Perhaps the terminology should be “emailing or text messaging” since text messages are limited to 160 characters, which may be too limiting. All communication should be logged and saved for a minimum period. Everything that isn’t easily and automatically identifiable as unnecessary (such as appointment reminders) should be saved in an EMR, otherwise time/money is wasted deciding on what’s worthy.
Standards NeededPatient IDStructured communicationSecurity/confidentialityProvider workflow issues
Application Cluster #2:Access to Web-based Resources
FormulariesGuidelines and protocolsDecision supportTelemedicine guidelinesAccessing specific CCR informationPatient’s comments re WebPatient directivesPHR
For providers and patients
Lexi-Comp References
Credit: Renee McLeodCredit: Renee McLeod
Drug Programs
Credit: Renee McLeodCredit: Renee McLeod
Search PubMed(Pub Search is a free application)
Credit: Renee McLeodCredit: Renee McLeod
Application Cluster #3: Point-of-care, Real-time Documentation
The promise of EMRs at your fingertips anywhere, anytimeAccess patient history in real-timeDocument (capture patient information capture and generate report) in real-timeTransmit patient information in real-timeNavigate patient information in real-time
Real-time, point-of-care information capture!!!
Is documentation like this acceptable anywhere other than in healthcare?
• Legibility
• Structure
• Meaning
• Completeness
IssuesAccuracyAuthenticationInteroperability
mDevices to HIS and EMR Medical devices wireless communication
EMCData integrity
Accessing Patient InformationInteroperabilityFrom internal systemFrom a WebsiteFrom the phone card
Application Cluster #4: Disease Management
Currently focused on DiabetesAsthmaDermatologyPreventive care in pregnancySmoking cessationHypertension
DiabetesSeveral companiesApplications
Parents to monitor their childrenPatients to monitor and report their health data
Record Blood Sugar Intake
Record Instant feedback Follow up
Meal Planning Questions
Disease Management IssuesFDA approvalProof of ROICollection of projects/experiences
Aggregation of data
Application Cluster #5: Education Programs
Teaching, monitoring, coaching…New applications in nursing and other areasTeaching patients self-care, monitoring, expectationsNeed standards
Application Cluster #6: Professional Communication
Preferred communication channels for lab, pharmacy, etc.Colleagues
Specialty-specific communitiesDisease-specific experiencesAsk the expert!
Application Cluster #7: Administrative Applications
Provider-patient applications
Financial dataDemographic dataNon-clinical dataAppointmentsSelf check-inReminder
Staff communicationInternalExternal
Third partiesPayersLabsOther providers
Asset trackingSurgical instrumentsMedical recordsEquipment
Patient flow management
SchedulingAdmissions/dischargesBed management
Application Cluster #8:Financial Applications
Charge capture Providers accessing eligibility infoProviders sending billsPatients accessing coverage and co-pay informationPayers in active communication with patients and providersOnline real-time adjudication
Application Cluster #9: Emergency Care
Not starting with a “blank sheet”Potential need for record locator systemSubstantial cost reductions expectedSan Diego experience
Application Cluster #10Public Health
Reporting of disease outbreaksSwine flu, for example
Alerting providersInstructing patients BioterrorismSurveillancePopulation notificationsIncreasing adoption in developing countriesOther
Application Cluster #11 Pharma/Clinical TrialsClinical trials
Automatic, scheduled and ad hoc information transmissionRely on instrument rather than patient for routine data collectionPatient feedback systems
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 baseExamples
Heart monitor could alert pending heart attackAuto-inject insulin for patient whose blood sugar dropsSports activity monitoring: speed, distance, heart rate, blood pressureFantasy? - Exchange business cards (or patient demographic data) with a handshake?
Big issue: Security
mHealth Initiative PlansDevelop online resource to record and access information about mApps
By application clusterBy deviceBy diseaseInformation from vendorsInformation and feedback from users
