mHealth in Everyday Practice Plain Talk September 7, 2012 Steve Heilman M.D., FACEPSystem Vice President and Chief Medical Information Officer
Norton Healthcare Integrated Delivery Network of Five Not-for-Profit Hospitals 14 Out-patient Centers 1.4 Million yearly patient encounters $1.5 Billion yearly revenue 12,000 Employees 500 Employed Providers 2,000 Physician Medical Staff 2,000 Licensed Beds 60,000 Admissions/year
Key Messages for Discussion• mHealth Overview• Clinician Utilization• Patient Engagement• Population Management and Research• Healthcare Reform and mHealth• Adoption Barriers
What is mHealth?• The use of mobile and wireless devices to improve health outcomes, healthcare services and health research• Applications of mHealth include: – Utilizing devices to collect community and clinical health data – Delivery of healthcare information to clinicians, researchers, and patients – Remote monitoring – Remote provision of care
Routine Clinician ApplicationsQuick and easy access to cloud based data– drugguides, medical alerts, journal summaries and medicalreferences.
Routine Clinical ApplicationsElectronic Medical Record (EMR) Access – dedicatednative applications to access patient data, refillprescriptions, review and release labs, communicatewith staff and patients via secure messaging.
Routine Clinical ApplicationsAccess to Personal Health Record (PHR) information
Population Management/ Research • Home monitoring can improve outcomes • Columbia University1 – telehealth and data collection from glucometers - greater↓HbA1c compared to control group • Weight and vitals monitoring in CHF patients2,3 - ↓office visits 10% ↓home visits 65%. ↓ six month mortality rate 56.2%1. Shea S, Weinstock R, Starren J, and etc. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus. J Am Med Inform Association 13:40-51, 2006.2. Cleland J, Louis AA, Rigby AS, and etc. Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death, Journal of the American College of Cardiology 45(10):1654, 2005.3. Goldberg LR, Piette JD, Wals MN, and etc. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 146:705-712, 2003.
Population Management/ Research• Africa (Malawi)– Addressing HIV infection with mHealth – Texting HIV test results, treatment instructions – Relay results of treatments back to public health – Prevention messages to high risk groups
Healthcare Reform and mHealth• Fee for service – Reimbursement based on Volumes ≠ improved adoption efficient tools• Accountable Care Organizations• Value Based Purchasing• Capitated Care• Bundled Payments