The 12 mHealth

Application Clusters
mHealth Initiative Seminar
San Francisco
September 18, 2009

Claudia Tessier RHIA

CEO 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 Healthcare
1 Patient 2 Access to 3 Point-of-
Communication Web-based Care
4 Disease
Management
Resources Documentation

12 Body 5 Education
Area Network Programs

11
Pharma/Clinical
6 Professional
Communication
10
Public 9 8 Financial
Health Ambulance/EMS Applications 7 Administrative
Applications
Application Cluster #1
Patient Communication
Before visit During visit
„ Selection of caregiver „ Patient education
„ Pre-visit communication „ Financial and administrative
‡ Text message „ Care communication
‡ Email Post-visit and general
‡ Photos
„ Text messages
„ Appointment reminders
„ Email
„ Appointment request and
„ Continuity of care
scheduling
„ Medication reminders
„ Agenda
„ Questions (with photos if
„ Insurance info
applicable)
„ Update demo data
„ Patient education
„ Advance check-in
„ In the care process
„ PHR (CCR)
„ References
„ Consumer/patient
providing information
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 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
Communication Systems
‡ More communication between clinician and
patient leads to
„ Better quality of care
„ Greater continuity of care
„ Greater efficiency
„ Fewer visits
„ Lower costs
Considerations

‡ All communication must be clear and

customizable (usability)
‡ Reason for visit
‡ Both 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
protocols
‡ ID Systems: Photo and “Remember me”
Considerations
‡ Requires 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?
Considerations
‡ Providers must have an auto responder function
about emergencies
‡ What 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 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 McLeod

Drug Programs

Credit: Renee McLeod

Search PubMed
(Pub Search is a free application)

Credit: Renee McLeod

Application Cluster #3:
Point-of-care, Real-time Documentation

„ The promise of EMRs at your

fingertips 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

Real-time, point-of-care
information 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
Application Cluster #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
Application Cluster #5:
Education Programs
‡ Teaching, monitoring, coaching…
‡ New applications in nursing and other
areas
‡ Teaching patients self-care, monitoring,
expectations
‡ Need standards
Application Cluster #6:
Professional Communication
‡ Preferred communication channels for lab,
pharmacy, etc.
‡ Colleagues
„ Specialty-specific communities
„ Disease-specific experiences
„ Ask the expert!
Application Cluster #7:
Administrative Applications
‡ Provider-patient ‡ Asset tracking
applications „ Surgical instruments
‡ Financial data „ Medical records
‡ Demographic data „ Equipment
Non-clinical data
Patient flow
‡
‡
‡ Appointments
‡ Self check-in
management
‡ Reminder „ Scheduling
„ Admissions/discharges
‡ Staff communication
‡ Internal
„ Bed management
‡ External
‡ Third parties
‡ Payers
‡ Labs
‡ Other providers
Application Cluster #8:
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
Application Cluster #9:
Emergency Care
‡ Not starting with a “blank sheet”
‡ Potential need for record locator system
‡ Substantial cost reductions expected
‡ San Diego experience
Application Cluster #10
Public Health
‡ Reporting of disease outbreaks
„ Swine flu, for example
‡ Alerting providers
‡ Instructing patients
‡ Bioterrorism
‡ Surveillance
‡ Population notifications
‡ Increasing adoption in developing countries
‡ Other
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
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
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
c.tessier@mhealthinitiative.org
617-816-7513