Mobile Apps in Clinical Settings


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Mobile health is an ever expanding field, and shows great promise for delivering care to remote patients. In this presentation at the ATA 2012 conference, Dr. Robert Ciulla demonstrates the potential for mHealth to improve care availability and how T2 is supporting that goal.

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Mobile Apps in Clinical Settings

  1. 1. Mobile Apps in Clinical Settings American Telemedicine Association 29 April 2012 Robert Ciulla, Ph.D. National Center for Telehealth & Technology Joint Base Lewis-McChord, Tacoma, WA 1
  2. 2. Interview with the Father of Cell Phones• 2011 ATA Opening Plenary: NY Times’ David Pogue interviews Dr. Martin Cooper
  3. 3. Life-Altering Mobility• Wharton School biggest “life changers” of past 30 years: – Internet, PC/laptop, mobile phones, email, DNA sequencing• From 2008-2010 mHealth consistently outpaced forecast growth and revenue – mHealth apps will continue on a steep growth curve as increasingly mobile technologies disrupt the market – Mobile apps are the single-biggest digital channel since the ‘90s and the Web
  4. 4. 1973… 2012• Mobile broadband subscriptions: 200 million in 2008 to 1.2 billion in 2011; projected to reach 3.8 billion by 2015• 2011: U.S. mobile health market at $718m• March 2012: 46% of American adults own smartphones – up from 35% in May 2011• By 2013, more users will connect to the Internet via mobile devices than PCs.• By 2013, 500m people will use mHealth apps
  5. 5. Health Care Survey• 2011-2012 survey of U.S. & int’l health IT – 85% support use of personal devices by physicians and hospital staff – 83% report their hospital supports clinician use of iPads in next 24 months – 60% reported their hospital supports electronic medical record mobile apps – 50% of hospitals to upgrade mobile health capabilities
  6. 6. What is Mobile Health (mHealth)?• “The practice of medicine and public health, supported by mobile devices.”• “The delivery of healthcare services via mobile communication devices.”• “Umbrella term for wireless devices that are used in healthcare. It includes mobile monitors worn by patients as well as smartphones that physicians and nurses use to obtain and disseminate information.”
  7. 7. If We Build It, Will They Use It?• Hong Kong physicians – Pragmatic, less concerned with ease-of-use and more interested in usefulness – Expressed concerns about the compatibility of the technology with their practices• Australian/Indian cross-national study – Tech acceptance is more likely when it supports clinical management – Barriers to use must be minimized
  8. 8. Mobile Issues• Physicians using mobile devices for patient care arent connected to practice or hospital IT systems• Physician concerns about privacy and security when adopting mobile health tools• Hospital networks need more bandwidth to support rapid exchange of data.
  9. 9. Getting Authentic(ated)• Authentication systems: –Something you know (password) –Something you have (ID badge, keycard) –Something you are (biometrics)
  10. 10. More Mobile Issues: Is It A Medical Device?• Food and Drug Administration (FDA)• Health Insurance Portability and Accountability Act (HIPAA)/ file- sharing
  11. 11. If We Build It, Will They Know How to Use It• Technology: what’s your comfort level?• Data are as good as human input allows• Applications: bugs, crashes (what if: lab results appended to wrong record)• Using both paper and electronic systems
  12. 12. Current Uses in Behavioral Health• Various disorders (developmental, cognitive, substances, mood, eating, sleep)• Informational, assessment, track/graph, interactive tools, self-monitoring prompts• Mobile apps’ many other capabilities: – Calendars, file-sharing, therapist audio-recordings, date-stamp homework assignments – Real-time audio/ video coaches (telehealth) – Global positioning system (GPS) – Wearable sensors (biofeedback) Luxton et al. – mHealth for Mental Health: Integrating Smartphone Technology in Behavioral Healthcare. Professional Psychology: Research and Practice. 2011, Vol.42, No. 6, 505-512.
  13. 13. If We Build It, Will They KnowHow to Use It in a Clinical Setting• Online workbooks• Telehealth• Mobile applications
  14. 14. Online Workbooks
  15. 15. Telehealth
  16. 16. Mobile Apps
  17. 17. Technology “CPGs”• A “how-to” instructional manual• What is a mobile application?• Clinical practice benefits – Availability, access to critical resources, communication, evidence-based content, assessment, tracking, remote monitoring, flexible encounters/ bridge• The “bipersonal field”/ asynchrony• Charting mobile communications• Storage of transmitted data• Practical exercises
  18. 18. T2 Mood Tracker Self-monitor, track and reference emotional experiences over a period of days, weeks and months. Features: - Self-rating on pre-populated categories - Full note adding - Graphed results - Fully customizable categories - User-set reminders for self-rating - Send results to providers (upcoming)18
  19. 19. LifeArmor Currently in beta version (soft release) A multi-topic application derived from to provide the user with knowledge and tools to cope with the many challenges faced by today’s service members. Features: - Multi-topic resource guide - Self-assessments of topic symptoms - Ease to manage, customizable views and favorites - Manage symptoms with coping tools - Video resources on topics19
  20. 20. mTBI Pocket Guide Clinical Practice Guidelines for treatment of mTBI Features: - Quick results with coding guidance - Symptom management lists - Summary of clinical recommendations - Patient education resources - Clinical tools and resources20
  21. 21. mTBI Co-occurring Conditions Toolkit Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health Features: – Guidance to primary care providers on the assessment and management of patients – Synthesizes information from the following VA/DoD CPGS: mTBI, PTSD, depression, chronic opioid therapy and substance use disorder21
  22. 22. Provider Resilience Deploying Summer 2012 Currently field testing downrange Self-care tool for health care providers who work with service members and who may need support in coping with burnout or compassion fatigue Features: - Quick dashboard view - Graphing to track resilience progress - Tools to assist increasing resilience - Inspirational value cards - User-set reminders to update assessments22
  23. 23. Provider Education
  24. 24. Service Delivery in the 21st Century• The (very) educated consumer.• Social networks• Participatory Medicine / Patient-Centered Medical Home• Consumer-centric• Security / privacy• Informatics (the “measured life”)• The virtual “clinical setting” 24
  25. 25. Next Generation25
  26. 26. Mobile Trivia• 70% of people sleep with their cell phone; 90% of “digital natives” (under 30)• There are more mobile phones in the world than toothbrushes.
  27. 27. Contact Information Robert Ciulla, Ph.D. Chief, Population & Prevention Programs |P3| National Center for Telehealth and Technology |T2| Joint Base Lewis-McChord, Tacoma, WA To view or download a copy of this presentation, visit