Project

Participatory Health Enabled Through mHealth

C. Peter Waegemann

Vice President

Copyright 2009 mHealth Initiative Inc Boston MA.

All rights reserved.

mHealth Initiative proposes to

Change and improve healthcare through better communication Facilitate healthcare‟s adjustment to the era of cell phones Orchestrate policies, standards, and systems to facilitate the

delivery of healthcare through mobile technologies. Part of this challenge will be the creation of a consensus between payers and providers for better reimbursement for communication.

Address the expected shortage of family physicians by introducing systems that reduce visits through increased use of electronic communication

Enhance access to healthcare throughout the population Create the playing field for competing systems Educate and stimulate people to manage their healthcare and

wellness Improve public health delivery and surveillance

Proposal: A City- or Regional Model Demonstration Project

Based on Participatory Health Encouraging change in people‟s behavior toward health Simultaneous implementation of

New communication patterns PHR on the phone Disease management through communication Guidelines and protocols through browsers Integrate consumer health applications mDevice documentation trials

Optional: Emergency/Ambulance Services Public Health Surveillance Region-wide Appointment System

Project is designed to

Reduce healthcare cost through better communication and a reduction of visits

Improve the quality of care

Reduce disparities in the delivery of healthcare

Encourage young people to live healthier

Make the healthcare system more convenient and efficient

Address the anticipated shortage of family physicians through a system that will facilitate delivery of care through more communication and fewer visits

Project will enable people/patients/consumers to

Better understand their health Manage their essential health data on their cell phone

or other mobile device (mDevice) Improve health through communication with wellness

and care providers 24x7 as needed Participate in an open and transparent decision

process regarding health, health care, and wellness efforts

Participate in financial decisions related to their health Receive more efficient care (easier appointments,

reduced waiting time, less time lost with inefficient visits)

Project will

Link healthcare and wellness providers with one another and with patients/consumers in an unprecedented way within a community to help improve the health conditions of the population.

It will enable providers to Be better prepared for decision making in care issues through

advance information Access guidelines, protocols, disease-specific information at

the point of care Make EMR documentation more efficient and tolerable

through point-of-care documentation options Provide better care through continuous communication with

patients, other providers, and payers Reduce crisis care (that is emergency care) through greater

connectedness with the patient

The project is designed to demonstrate

Meaningful, practical use of the concept of better communication in healthcare

Before and after measures of healthcare costs as influenced by enhanced communication

Savings in healthcare costs through higher efficiency How patients can be motivated to become active partners in

their wellness/health care How young people can be drawn into managing their

wellness/health How disparities in healthcare delivery can be reduced through

improved communication Better and less costly outcomes from disease management

based on ongoing communication in a participatory healthcare environment

mHealth Initiative Role

mHI will be the enabler of the medical community.

It will create the playing field for patients and providers to participate and for companies to compete in providing services.

The outcome of this project could potentially influence the national strategy on health.

What is the mHealth Community?

People: Patients, consumers, children, adults, and seniors, whether healthy or ill, are encouraged to become active participants in their wellness and health matters, including keeping a personal health record; researching and learning about relevant health topics.

Healthcare providers: From hospitals to clinicians, from occupational therapists to chiropractors, from dentists to podiatrists, from long-term caregivers to child development coaches, from home health nurses to school nurses, all those involved in traditional or alternative medicine

Wellness providers: Health coaches, sports and wellness trainers, massage therapists, nutrition therapists and coaches, activity coaches, and others helping people to live healthier

Public health Pharmacies Health plans and payers

First Challenge

How to get people to participate?

Involvement

New communication

Advertising, PR, other motivations

How to change communication? Patients must be stimulated to communicate on a

regular basis.

Providers must be guided to change workflow and systems in order to make such communication time saving and productive.

A new reimbursement system must include adequate payments for communication and accessing resources to guide care.

Security and confidentiality policies and guidelines must be created.

Change of communication

New pre-visit pattern

Continuous communication between patients and caregivers (email and text)

Professional medial information communities

Device data capture and integration

New communication–based nursing systems

Home care and monitoring systems

Project will improve health communication

First, new continuous communication with text, email and voice will supplement and enhance the traditional visit-based communication system.

Second, active participation of all stakeholders with the patient/consumer at the center will replace the physician and hospital-centric care model.

Third, the use of the Internet and its access through mobile phones will facilitate new ways to access, transmit, and document information and reduce disparities in access to and delivery of healthcare

PHR for people

History of PHR

Failures of existing PHR companies

Smart cards, USB drives, CDs – cell phone

Need to educate people

Community coordination

Integration with provider systems Not limited to hospitals and clinics

PHR on the phone

Learning from industry

Creating multiple homes for data

First covering of a region-wide continuity of care project

Implementing Disease Management

Objective: Collect „before and after‟ data

Showcase specific applications

Resources for the provider

Bring more guidelines to the point of care

Project Goals

Changing healthcare through better communication

Helping healthcare to adjust to the era of cell phones

Orchestrating policies, standards, systems

Creating the playing field for competing systems

Educating people why they should manage their health

Project with 6 Parts

1. Continuous Communication

2. PHR on the Phone

3. Guidelines and Protocols at P-o-C

4. Resources for Patients

5. P-o-C Documentation

6. Communication-based Disease Management

Optional - Desirable

7. Emergency Medicine

8. Public Health Surveillance and Notification

9. Regional Appointment System

Part 1: More digital and voice communication will increase the quality of care, reduce visits, and reduce healthcare costs

Goal: Create a health ecosystem that enables better and more communication among and between all healthcare participants – patients/consumers, healthcare providers, wellness providers, and others.

In order to do accomplish this: Patients must be stimulated to communicate on a regular basis.

Providers must be guided to change workflow and systems in order to make such communication time saving and productive.

A new reimbursement system must include adequate payments for communication and accessing resources to guide care.

Security and confidentiality policies and guidelines must be created.

Potential companies that may participate in Part 1

Those providing

Text messaging management systems

Secure email systems

Cell phone systems for seniors

Home care monitoring systems

Patient support communication systems, such as medication reminders, appointment management systems, patient health advice systems, systems that are capturing medical device data, etc.

Part 2: Continuity of care through cell phone-based PHR will create interoperability, reduce medical errors, and reduce costs

mHealth Initiative seeks to encourage all those living within the demonstration project are to have a copy of their PHR accessible through their cell phone.

Consumer can decide which elements of their health status information are to be shared with whom.

More than three quarters of all personal health records (including Google and Microsoft) are based on the Continuity of Care Record data set. For integration into legacy systems, HL7‟s CCD version of the CCR may be used.

Potential companies that may participate in Part 2

Those providing PHR systems that may be accessed through the mobile phone

As there will be several providers, users in the test project will select the system that fits their needs best.

Part 3: Providing guidelines and protocols as well as other relevant information to the caregiver at the point of care through cell phones’ web browsers

The goal is to enable clinicians to use guidelines and protocols at the point of care

mHealth Initiative will work with the vendor community to encourage them to make such information easily available on mDevices.

It will also work with the clinical community to prepare and encourage them to adopt and use the devices as valuable digital assistants.

Potential companies that may participate in Part 3

Those providing access to

Formularies

Guidelines and protocols

Medication selection systems

Physician support

Nursing support

Other resources

Part 4: Encourage people to use new health resources and create the infrastructure for such consumer health resources

mHI will use advertising and PR campaigns to encourage people to use many of the systems currently available to live healthier and to maintain health.

Potential companies that may participate in Part 4

Numerous systems exist today to guide people in regard to medications, nutrition, activity, and other life style issues.

The project will give maximum exposure of such systems to the project community in order to measure their impact.

Part 5: Use of mDevices at the point of care to access information and document into the EMR

Efforts to implement electronic medical record (EMR) systems are challenged by the burden of documentation.

mDevices enable clinicians at the point of care To access relevant information from various

sources including the provider‟s information system

To document patient information

To transmit patient information

Potential companies that may participate in Part 5

Those providing

Phone-based documentation systems

Integration and documentation systems that are mobile phone-based

Input and integration systems for EMRs

Speech recognition systems

Other documentation systems such as display systems that can display the screen content of a mobile phone onto a wall or other surface

Part 6: Communication-based disease management

For diabetes, asthma, hypertension, and other conditions to demonstrate improved quality of care and reduced emergency visits

mHealth Initiative‟s roles in the implementation of disease management programs will be Coordinating their interoperability and integration Educating providers of the possibilities of communication-

based disease management Educating and guiding patients in regard to their new roles

and their benefits Working with providers to implement systems that can handle

communication-based disease management Working with various vendors on the implementation process Measuring and recording benefits and financial outcomes Comparing various approaches for national implementations

Potential companies that may participate in Part 6

Those providing disease management solutions based on better communication and mobile phone use for Diabetes Asthma Hypertension Heart disease Depression Obesity Pregnancy/OB Other conditions

Part 7 (optional): Making relevant information available in the emergency room to increase the quality of care and reduce costs

Emergency medical services (EMS) should convert from paper-based collections of data to mDevice-based collections that can be sent in advance to the Emergency Department.

Any person within the Participatory Health Project should be assured that she can expect to receive healthcare from professionals who are informed about her allergies, medications, and essential health issues and therefore do not have “to act blindly” as in the past.

Potential companies that may participate in Part 7

Those providing

PDA-based systems to capture emergency data

Voluntary patient identification system (VUHID)

Database systems

Emergency Department information systems

Part 8 (optional): Public health surveillance and notification systems to be included in the mHealth community

This optional part includes, but is not limited to Automating selected reports from providers and patients on

their progress in specific conditions that impact the public health, e.g., flu epidemics, HIV/AIDS, TB.

Tapping into a wealth of information within the Participatory Health community

Establishing targeted disease surveillance within the region Designing and implementing systems that can notify people

in case of health emergencies such as cases of bioterrorism and natural disasters.

Improving access to the total population so that traditionally difficult-to-reach segments are not excluded, thereby better enabling them to be aware of and to have access to public health programs.

Potential companies that may participate in Part 8

Those providing

Linkage to public health departments

Management systems for surveillance

Management systems for notification by mobile phone

Part 9 (optional): On-line appointment systems

The proposal is to create a regional database where a patient can search by health plan, medical specialty, disease specialty, and other criteria for a provider.

It should be possible for patients not only to search but to be able to book appointments online.

Potential companies that may participate in Part 9

Those providing

Online systems and database design.

Status

Development

Acceptance

Time frame

Looking for support

Thank you!

C. Peter Waegemann

Vice President for Development, mHI

p.waegemann@mhealthinitiative.org