Fig. 1 – Blackberry, Android and iPhone appears to be the fastest growing mobile platform.Fig. 2 – Consumers between age group of 50-70 years appears to be the main targeted group.
Numbers stating people in Europe and US suffering from the common diseases 40 million people have cardiac arrhythmia, 200 million people have high blood pressure, 60 million people are diabetic, and 180 million people have severe elevation of blood lipids. Berg Insight estimates that 250 million people in the EU and the US suffer from one or several diseases that may require home monitoring. World market worth of the chronic diseases The global market for cardiac monitoring is worth less than US$ 300 million, mainly in the US.The blood pressure monitoring world market is worth about US$ 800 million, with a growth rate of 9 percentThe world glucose level monitoring market is worth US$ 8.9 billion, and is growing at a rate of 11 percent annually.The global lipid monitoring market is worth approximately US$ 100 million and is growing by 7 percent annually.
Until NowIndependent Medical Devices for each functionNot fully integrated with hospital and healthcare information systems to share dataManual Data collection and AnalysesCare limited to hospitals, clinics and healthcare providersLimited wireless availability in hospitals but growingProgressing ToBetter Connectivity and communication Between healthcare providers and their patientsAs well as their devicesNext Generation of medical devices seamlessly connecting to each otherBuild enabling platforms as enabling tools to bridge devices with other systemsTransition of care beyond hospitals and doctors’ care to patient’s home and beyondInteroperable – Devices can communicate with consumer electronic products with data sent to mobile phones, PC and health hubsLeverage 3G, LTE and Wi-Max advancesDisease Management and MonitoringFitness and Online Personal Training systemsmHealth and TelemedicineAnalytical Tools for Healthcare
In recent years, mHealth has emerged as an important sub-segment of the field of electronic health (eHealth). While there is no widely agreed-to definition for these fields, the public health community has coalesced around these working definitions: ■ eHealth: Using information and communication technology (ICT)—such as computers, mobile phones, and satellite communications—for health services and information. ■ mHealth: Using mobile communications—such as PDAs and mobile phones—for health services and information. mHealth and eHealth are inextricably linked—both are used to improve health outcomes and their technologies work in conjunction. For example, many eHealth initiatives involve digitizing patient records and creating an electronic ‘backbone’ that ideally will standardize access to patient data within a national system. mHealth programs can serve as the access point for entering patient data into national health information systems, and as remote information tools that provide information to healthcare clinics, home providers, and health workers in the field.
In South Africa, one quarter of the population is estimated to be infected with HIV, but less than 3% know their status. Project Masiluleke, a South Africa NGO, is resolved to decrease this knowledge gap and halt the spread of HIV/AIDs by its innovative mHealth initiative.It is in the process of sending three hundred and sixty five million text messages—one million per day - to encourage people to be tested and treated for HIV/AIDS and TB. Messages are written in local languages, and are used to direct recipients to the National AIDS Helpline. Once patients have called, representatives of the hotline provide information about testing services and locations. Initial results from a beta test of the project indicated that it helped to nearly triple call volume to the helpline in the three weeks during which it ran. The next step will be to expand the system geographically and in new disease areas – such as providing information about TB resources and treatment.Back-up info: Project Masiluleke takes advantage of the popularity of ‘Please Call Me’ (PCM) services, which are widely used in South Africa and throughout Africa. These free text messages are used by individuals without phone credit to prompt recipients to call them. PCM messages contain the words ‘Please Call Me,’ and the phone number of the sender. The remaining 120-character spaces can be filled with advertising, but Project Masiluleke sponsor MTN is donating the space in one million messages each day to be used for HIV/AIDS and TB-related information. The message content is provided by outreach and service organization iTeach. The project partners are building in rigorous monitoring and evaluation of the project by, for example, linking calls to the helpline to PCM text messages through the use of distinct phone numbers that allow organizers to verify the number of calls generated by the program.
It used to take months before the Amazon health agency could receive consolidated data on dengue infections - a constant challenge due in this region of Brazil to heavy rainfall during most of the year, and local methods for storing water in homes—both of which have been shown to promote mosquito breeding. ….with the Data Gathering tool, this same data can be collected in days.. The goals of the project are all about saving time to save lives. The Amazonas Health Department undertook the first full implementation of the solution, which began in October 2008 - more than 400 results were gathered during the tests by a team of 20 field professionals in the course of two days, all with GPS information. The state is now one of the most efficient at containing the spread of the virus relative to other states in Brazil, due partly to its partnership with Nokia on the Data Gathering mHealth initiative.Users report the tool is flexible and easy to use. As Luzia de Melo Mustafa, an Amazonas health agent, affirms, “It’s easier, quicker and more practical. You type it and send it right away, it goes straight to the server. Then the data is consolidated and we can get the result immediately and, consequently, we may take the right actions, what we need to do. The devices are providing us with precision; the information we need to develop [effective responses] in the areas where the infection levels are high.”
HIPPA - Health Insurance Portability and Accountability Act (1996)GXP – Good Programming (X) PracticesHITECH - Health Information Technology for Economic and Clinical Health ActFDA – Food and Drug AdministrationCIA -
1. Mobility in Healthcare A Webinar By Endeavour Software Technologies Presenters : Jayaraman Raghuraman (Raghu) Ajay Gabale www.techendeavour.comImage Credits: Gasshead, LLC, WellDoc, Inc
2. Copyrights and Ownership - DisclaimerAll ownership of ideas, products and solutions referenced in this presentation belongto the people and companies who have created and have the rights and copyrights tothe solutions and ideas. This session is educational and the speaker and Endeavourdoes not own rights to this incredible work being done across the world. Material hasbeen derived from the internet, articles and journals as well as experiences ofEndeavour in Healthcare
3. Vision and Agenda• Vision – Explore the immense increase of mobile technologies and it’s increasing use in healthcare• Agenda – Growth in Mobile Technologies and Devices – Leveraging Mobility in Healthcare – Advances and Opportunities – Examples of Innovations in Healthcare using Mobile Solutions – About Endeavour• Value to You as Participants – Help in generating ideas of use of mobile solutions in your domain in healthcare – Evaluate Endeavour’s work in mobility and it’s applicability to your organization as partners or vendors
4. Section 1:The Tremendous Global Growth inMobile Technologies and Devices
5. Incredible Growth of Mobile Users and Phones • 4.6 billion mobile phones worldwide (3.6 billion users) • Will Grow by another 2 billion within next 6 years!! • 45.5 million people in the United States own Smartphones - 90% of households • 91% of Americans keep their handset near them 24 hours a day
6. Growth is Global and not just here in the USA! • Exploding growth in developing countries – 128m new subscribers in India (660 mln users in 2010) – 89m in China – 96m in Africa in 1 year – Adding 9 mm subscribers monthly in India, China • Worldwide penetration – 60% in 2009 to grow to 74% in 2013 • 500 mm PC, 4 billion cell phones, 50+ billion devices with data ports • Smartphones : 500 million in use globally by 2012 • 10% increase in mobile phone adoption results in 0.8% increase in GDP per person
7. Growth in Internet, SMS, Broadband and Data • Portables (Laptops, Netbooks, Tablets) account for 60% of sales – More than 3.7 mln iPADs sold in 3 months • Total Mobile Broadband users : 200 million (2009) to grow to 2 billion by 2014. • Broadband Households: 429 million (2009). 88 million (China), 84 million (USA) • Text Messaging exploding – 4.1 billion messages sent daily in USA – 2.1 trillion messages from AP in 2010 • Mobile data including SMS contribute 25% of mobile revenue
8. Growth in Internet, SMS, Broadband and Data (cont’d) • 62% of US subscribers used some form of mobile data services in 2009 • There are more than 257 million data- capable devices • In January, Gartner Research predicted that more people will access the Web by phone than PC by 2013 • 5000% data increase in 5 yrs
9. Growth of mobile devices in Healthcare • 72 percent of U.S. physicians use Smartphones – Up from 50 percent in 2007 • The number of physicians using Smartphones in 2009 doubled • Physicians access some medical apps 15 to 20 times a day • 53% of chronic disease patients have cell phone access • 60 million people to be benefited using remote Patient Monitoring devices by 2013 • 75-80% of adult internet users seek medical data online
10. Growth in Mobile Device Usage 48.8 80% 75%50 44.3 70% 66%45 70% 64% 62% 60%40 48% 50%35 40%30 30%25 20.6 1Q 09 19.4 20% Age20 1Q 10 15.4 10%15 10.5 9.6 10.2 0% 8.210 6.8 4.4 5 1.6 0 Symbian Blackberry iPhone OS Android WinMob Others 35.0 45.9 112.2 806.3 -0.9 Data source: Gartner Data source: Forrester Research Figure. 1 Figure . 2 Worldwide Smartphone market share by OS Age Wise Cell Phone Ownership
11. Technology Adaption by Chronic Condition People 89%90% 81% 76%80% 70% 68%70% 60%60% 52%50% No Condition 1 Condition40% 32% 2+ Conditions30% 23%20%10%0% Go Online Have a Cell Phone Send/ Receive text messages Source: Chronic diseases and the Internet, Few Internet and American Life Project, March 2010
12. Section 2:Leveraging Mobility in Healthcare –Advances and Opportunities
13. Mobile Solutions for Healthcare – Changing Environment Until Now Progressing To • Independent Medical Devices for • Better Connectivity and communication each function – Between healthcare providers and their • Not fully integrated with hospital patients and healthcare information – As well as their devices systems to share data • Seamless Device Integration, Interoperable with consumer devices • Manual Data collection and Analysis • Platform enabling • Transition of care beyond hospitals and • Care limited to hospitals, clinics doctors’ care to patient’s home and and healthcare providers beyond • Limited wireless availability in • Leverage 3G and 4G network hospitals but growing • Disease Management and Monitoring • Lifestyle management • mHealth and TelemedicineFact : 8 in 10 Americans expressed interest in • Analytical Tools for HealthcaremHealth Solutions (CTIA Survey – Oct 09)
14. Adoption of Mobility in Healthcare Biometric Data Monitoring Education Chronic and Disease and Reference WellnessHealth and Areas Home Epidemic Telecare for data the elderlycollection Provider Hospital and Patient and Clinical Apps Solutions
15. Mobility in Health Care – Hospitals and Clinics Medical Event Alerts Calendars and Appointments Patient History Metabolic Standards Up-to-date Medical Reference Tests/Medication AlertsTests/Medication Alerts Physician Patient HistoryPatient History Job SchedulePhysician Instructions Raise Drug RequisitionReal time Coaching Metabolic StandardsAppointments Patient Caregiver HIS Asset Tracking Physician Instructions Demand & Capacity Management Ready Reckoner Job Scheduling & Tracking Real time Coaching People Tracking Business Analytics Lab Admin Integration with Insurance providers Technicians Pharmacist Stock Check Stock Level Alerts Fulfill Drug Requisition
16. Mobile Health (mHealth) Defined mHealth (n) – the delivery of health care services via mobile communication devices Health Electronic Health mHealth Services ServicesSlide Owner and Courtesy : Vital Wave Consulting Photo: UN and UN Foundation 16
17. Solutions Across the Healthcare Spectrum Data Collection and Monitoring andEducation and Awareness Record Access Medication Compliance SMS/Text Messaging in Applications to enter and Maintain care-giversupport of health programs access patient data appointments, Medication regime Analysis, Diagnosis and Disease and Emergency Health and Consultation Tracking Administrative Systems Access to staff or Use mobile devices to send Allow access to mHealth information via mobileand receive disease incidence and public health systems devices for diagnosisCredits: UN Foundation, Vital Wave Consulting
18. The Application Store – Healthcare Applications • iPhone has simplified the discovery of applications for variety of uses, to help developers bring them to consumers – Fitness and Wellness – Healthcare – Education • Growing trend of healthcare business applications by new breed of organizations as well as established companies such as Abbott, Johnson & Johnson, etc • Cross Platform – - Blackberry, Google Android, Windows, Symbian • Use Of Features – Location, Camera, Video – Voice and phone • Top Healthcare Applications include Fitness and Diet • Trend towards Hospital applications and then Home
19. Section 3:Examples of Innovations inHealthcare Using Mobile Solutions
20. MedApps – Health Anywhere Using Personal Health Devices (PHD)Credits : MedApps – www.medapps.net
21. Smartphone Healthcare Application Examples Epocrates for Medical New England Medical Journal Reference for Education and ResearchCredits : Epocrates,Inc , Massachusetts Medical Society
22. Smartphone Healthcare Application Examples Airstrip OB for Diagnosis Allscripts for PHRCredits : Airstrip Technologies, AllScripts Solutions
23. Applications – Medical Record Capture Digipen technology manipulates and converts the handwritten medical records into any digital format, bringing in control and efficiency to “daily” on the move reporting for medical staff. Once the form is handwritten and completed, it only takes a few minutes for the information to be converted and sent to medical servers securely while mobile user is on move. Digipen technology reduces operating cost, speeds up processes, prevents valuable data being lost or altered giving medical records as a true reflection of what is being captured at the site.Credits : Digipen Benelux BV
24. Case Study - Project Masiluleke Disease Awareness Health Objective Build awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread Country South Africa Techniques Used ‘Please Call Me’ service - free text messages Impact Partners • 365 Million text messages – one MM per Praekelt Foundation, iTeach, National day – being sent (2008-2009) Geographic, Nokia Siemens • Encourage people to be tested and treated Networks, MTN, Ghetto Ruff, Children of South for HIV/AIDS and TB African Legacies, Aricent, PopTech!, frog design and National AIDS Helpline Photo: Praekelt FoundationSlides Owner and Courtesy : Vital Wave Consulting 24
25. Case Study - Data Gathering Data Gathering Health Objective Containing the spread of the Dengue virus Country Brazil Impact Techniques Used • Data collection times dramatically reduced Customized questionnaires distributed to field (from months to days) health agents’ mobile phones. Health data and GPS location information are integrated to enable • 400 test results gathered by 20 field immediate analysis and identification of areas professionals in two days, all with GPS with high infection levels. information (paper-based system would have taken 2-3 months for lesser information) Partners • End-user acceptance very high Nokia, Amazonas State Health Ministry Photo: Wikimedia CommonsSlides Owner and Courtesy : Vital Wave Consulting 25
26. Endeavour Case Study: ACOMS – Hospital Management SystemBusiness ImperativeEndeavour’s mandate was to develop a BlackBerry based mobile application to assisthealthcare service providers in real time resource planning and scheduling using sophisticateddemand and capacity management procedures. Solution Features Complete mobile solution for demand and capacity management Reports Alerts and notifications on BlackBerry Alerts based on census, staffing, acuity Actions based on workflow defined in the system Integration with Enterprise database User Benefits The BlackBerry enabled solution provided healthcare unit real-time access to demand and capacity information of the facility / department in the hospital. Credits : Vistaar Health Solutions
27. Endeavour Case Study: Anesthesia Clinical Tutor and Calculator (AcTC)This application was developed to bridge the gap between clinical anesthesia & reference books &practical functioning. This guides anesthetists by assembling easy to use interactive tools, performs allcomplex calculations & gives instant results with guided explanations.Credits : Gasshead LLC.
28. Endeavour Case Study: Orthopedics Hyperguide The CME Mobile Application for doctors and healthcare providers. Audio, Video, White papers of relevant Orthopaedic field along with quiz taking ability on the iPhone and BlackBerry.Credits : Vindico Medical Education
29. Endeavour Case Study: Surgical Equipment Supply Chain The application was created for Windows Mobile handheld devices for meeting the needs of the sales agents for both Inventory assignment / Order Capture as well as Marketing / Merchandizing / Sales activities.Credits : Surgisoft Inc.
30. Regulatory Practices and Requirements for the Mobile Healthcare Industry • Specific Compliance Needs for Healthcare Applications – HIPPA Compliance – CIA, HITECH Compliance – GXP • FDA Approval for medical applications – Disease Management – Patient Care – eHealth and mHealth applications • Accessibility to disabled, visually impaired, other users – Section 508 compatibility – Using Device Settings (iPhone Voiceover, Blackberry) – Text phones for the deaf – Over 100 Voiceover iPhone applications • Servers, web sites and mobile devices are in compliance with HIPPA regulations. • All employees/ developers are required to be certified in HIPPA regulations.
31. Regulatory Practices and Requirements for the Mobile Healthcare Industry • Personal information protected using Secure Sockets Layer (SSL) technology. – SSL is an industry standard that encrypts information provided, to avoid decoding of that information by anyone. • Messaging Center Contents. – The company will not read or disclose to third parties private messaging center communications that are transmitted using Application Services. • Application Services – Except as required to operate the service or as otherwise authorized by law.
32. Healthcare Mobile Solutions – Emerging Trends• West Wireless Institute • Investments by large wireless and – Dr. Eric Topol, Gary and Mary West semiconductor organizations – Qualcomm, Scripps Health – Healthcare Mobility Devices – Mission - advance health and wellbeing around the world – Healthcare Mobile Solution – driving growth of data by identifying, validating and accelerating the use of services innovative and cost-effective wireless solutions to critical, unmet medical and community needs • Healthcare Investments for Productivity – Disease Management and Chronic Care – www.westwirelesshealth.org – Clincial Trials for new drugs• Opportunities for Healthcare Technology • Bringing Healthcare to the masses in Professionals developing world – Extend enterprise healthcare solutions to leverage the power of mobility – UN Foundation – Connect HIS with eHealth and mHealth solutions – mHealth initiatives – Government, NGO, Private – Measurement is the Key – What is the VALUE ADDITION? – Huge Opportunities for Software Applications
33. Section 4:About Endeavour
34. Who We Are Enterprise Mobility Strategic Consulting. Product Delivery We are a specialist Mobility company since 2002 We Analyze, Recommend and Execute Mobility Roadmaps “What would be the best mobile platform to launch our latest software product. What should be our Enterprise-wide Mobile strategy for the next 2 years. Should we plan on re-developing our Mobile Applications? Can you help us develop those.”“We have 250 senior deal makers traveling world wide.How can we get them to access their corporate data systems securely on the mobile.How do we secure mobile data. Data in transit.”
35. Our Offerings We undertake mobile test strategy, device and application porting, test planning, design and execution via a dedicated QA Lab – EQuAL** We analyze, recomme Mobile Quality nd and execute Assurance Mobility Roadmaps Opportunity Assessment (MOA) We architect, design, develop and deploy mobile enterprise solutions through dedicated RDE* teams*RDE – Research and Development Centre**EQuAL – Endeavour Quality Assurance Lab
36. Marquee Clients
37. Thank You• Contact Information – Jayaraman Raghuraman (Raghu), VP – North America – Email: Raghu@techendeavour.com – Phone : (512) 275-6105 – Company: www.techendeavour.com (Endeavour Software Technologies, Inc – THE MOBILITY COMPANY) – Follow us on Twitter : @EndeavourTech, @mobilitycompany
39. Endeavour Case Study: Anesthesia Clinical Tutor and Calculator (AcTC) Area Features• Education • Patient Data Entry and Vital Statistics• Business Case • Different Anesthetic setups• Learning the art of Anesthesia requires a solid – Fluid needs, medication and patient specific understanding of the science of Anesthesia and blood requirements based on scenarios mastery of details – Standard GA, RSI ED Dept, Neurology,• Need for a handheld tool Vascular, MAC cases – MH (Malignant Hyperthermia) Guides – to perform complex calculations – Interactive Tutor and Help Screens – give instant results with guided – Drug Screen explanations to ensure coverage of critical points • Analgesic, Emergency, Paralytics, Sedatives, Reversals, Anti-etnetics, and Solution more• ACTc is designed to teach interactively, on – Labs modern PDAs, the everyday calculations and • Common lab values used in Anesthesia clinical flow involved in Anesthesia Practice. • New additions of a PH/ETCO2/K• Mobile Application on Windows Mobile, Palm – Regional and soon on iPhone • Anatomical 3D images• Bridges Gap between clinical anesthesia, • Spiral and Epidural Guides ( Opiates reference books and practical functioning Duration, Side Effects, 2 level• Easy to use suite of tools with instant results Regression, Age/Pregnancy Dosing, Updated Dermatome and Peripheral Developed by nerve charts) Gasshead, LLC – Dr. Anthony Young – Updated Blood Screens and Resuscitation Information – Inhalation Agent Guides
40. Orthopedics Hyperguide CME Mobile Application for doctors and healthcare providers. Audio, Video, White papers of relevant Orthopaedic field along with quiz taking ability on the iPhone and BlackBerry Key Features Benefits Secured login & registration. Accessing Orthopaedics Hyperguide View/play the orthopedic Hyperguide’s educational content anytime, anywhere is contents. easier than ever Contents can be video, podcasts, tutorials or Earn CME while reading engaging lectures. tutorials, viewing online lectures or User can filter the contents of their interest listening to expert podcasts through modules, category and custom Stream or download content at your search. convenience User can download the contents to view/play Bookmark content that is most relevant to during his downtime. your clinical needs User can participate in quiz and certificate CME certificate will be e-mailed to you will be emailed at successful completion. within minutes User can manage the in-progress, fail and passed quizzes through quizzes screen. Application supports offline mode to view/play the downloaded contents.
41. Endeavour Case Study: ACOMS – Hospital Management System Area Features• Hospital Service Management • ACOMS Operational Control Center – Enterprise Visibility System-wide view of demand and Business Case capacity• Next generation of Hospital Service • Resource Management (e.g. Beds, Xray, MRI Management Solution to streamline line scanners, etc) functions of a hospital • Real-time facility dashboard• Enable mobile hospital administrators and caregivers to manage resources effectively • Alerts and Ticker • Based on staffing, census, acuity Solution • Highly scalable and Highly available• A Mobile and Web Solution that streamlines functions of a Hospital including • ACOMS “on-the-go” Portable version of ACOMS designed for Mobile Devices – Resource Demand and Capacity Management • Small memory and display utilization, – Patient Registration, Medical Services, • Minimal input and No storage required Appointment scheduling to Billing and • ACOMStracker - Real-time Resource Tracking Accounting • Appointments scheduling and tracking• Operations Center - Real time Dashboard and • Available on Blackberry mobile devices Alerts• Used by Hospital staff as well as doctors and nurses Developed by• Vistaar Healthcare Solutions, NJ
42. Endeavour Case Study: Anesthesia Clinical Tutor and Calculator (AcTC) Area Features• Education • Patient Data Entry and Vital Statistics• Business Case • Different Anesthetic setups• Learning the art of Anesthesia requires a solid – Fluid needs, medication and patient specific understanding of the science of Anesthesia and blood requirements based on scenarios mastery of details – Standard GA, RSI ED Dept, Neurology,• Need for a handheld tool Vascular, MAC cases – MH (Malignant Hyperthermia) Guides – to perform complex calculations – Interactive Tutor and Help Screens – give instant results with guided – Drug Screen explanations to ensure coverage of critical points • Analgesic, Emergency, Paralytics, Sedatives, Reversals, Anti-etnetics, and Solution more• ACTc is designed to teach interactively, on – Labs modern PDAs, the everyday calculations and • Common lab values used in Anesthesia clinical flow involved in Anesthesia Practice. • New additions of a PH/ETCO2/K• Mobile Application on Windows Mobile, Palm – Regional and soon on iPhone • Anatomical 3D images• Bridges Gap between clinical anesthesia, • Spiral and Epidural Guides ( Opiates reference books and practical functioning Duration, Side Effects, 2 level• Easy to use suite of tools with instant results Regression, Age/Pregnancy Dosing, Updated Dermatome and Peripheral Developed by nerve charts) Gasshead, LLC – Dr. Anthony Young – Updated Blood Screens and Resuscitation Information – Inhalation Agent Guides
43. Applications – Fitness and Wellness Lost It! for Fitness iFitness for ExerciseCredits : Lose It, iFitness