Leveraging mHealth in a Post-Reform Era         Edward Marx    Texas Health Resources          December 2012              ...
Texas Health Resources       Texas Health Mission       To improve the health of the people in the communities       we se...
Edward Marx•   Husband to Julie Harding Marx•   Father to Brandon & Talitha Marx•   Passion for God, Family, People, Triat...
My Biggest Fear During Primaries
Mobile HealthDEFINITION & DRIVERS                       5
mHealth DefinedTerm used for the practice of medicine and publichealth, supported by mobile devices.The use of mobile and ...
mHealth – “Perfect Storm”                                            ARRA driven adoption                                 ...
Ubiquitous
Mobile HealthFROM THEORY TO ACTION                        11
Opportunities•   Accountable Care•   Well-Being•   Value Based Purchasing•   Triple Aim•   Direct to Employer•   Health In...
14
Mobile HealthTEXAS HEALTH STRATEGY                        15
Choluteca Bridge                   16
mHealth Strategy              • Provider   People              • Patient              • Use cases   Process              •...
mHealth Framework   • Clinical                        • Clinical     setting                           setting            ...
PROVIDER MOBILITY
Phones (Percentage of All Responses)
Tablets (Percentage of All Responses)
Provider Mobility: EHR    • Clinical                        • Clinical   Canto      setting                           sett...
Provider Mobility: EHR• Current state            • Future plans   – 741 subscribers,         – Android support     all iOS...
Provider Mobility: OB    • Clinical                        • Clinical   OB      setting                           setting ...
Provider Mobility: OB• Current state  – Realtime, read-only access to tracings of maternal    uterine contractions and fet...
Provider Mobility: Cardiology    • Clinical                        • Clinical   Cardiology      setting                   ...
Provider Mobility: Cardiology• Current state            • Future plans   – Read-only access to      – Android support     ...
Provider Mobility: ICU    • Clinical                        • Clinical   Patient      setting                           se...
Provider Mobility: ICU• Current state  – Read-only access to realtime waveforms and vital    signs data; historical view o...
Provider Mobility: Stroke    • Clinical                        • Clinical   Care      setting                           se...
Provider Mobility: Stroke• Current state  – Realtime, bi-directional audio/video interaction    between neurologist and pa...
Provider Mobility: Messaging   • Clinical                        • Clinical     setting                           setting ...
Provider Mobility: Messaging• Current state  – Vocera pilot for THPG hospitalists at THHEB  – Evaluating UC capabilities
Provider Mobility• Future needs and considerations  – Providers: non-physician clinical staff  – Workflows     • Secure me...
PATIENT MOBILITY
Patient Mobility: EHR         • Clinical                        • ClinicalMyCare     setting                           set...
Patient Mobility: EHR• Current state               • Future plans   – Same functionality as       – Acute care setting    ...
Patient Mobility: Wayfinding                               40
Patient Mobility: Monitoring    • Clinical                        • Clinical      setting                           settin...
Patient Mobility: Monitoring• Current state              • Future plans   – Real-time and              – Add videoconferen...
Patient Mobility: NICU          • Clinical                         • ClinicalPeek-a-boo setting                           ...
Patient Mobility: NICU• Bi-directional audio/video interaction between  – Family and neonate  – Family and care team• Depl...
Patient Mobility• Future needs and considerations  – Consumer apps  – Wearable devices  – Integration with diagnostic equi...
Next…
Gartner Hype Cycle
Mobile HealthCHALLENGES & LESSONS                       48
Usability              Reality                           Happiness            Expectations
mHealth Challenges•   One size does not fit all•   Vendor support of multiple form factors/devices•   UI that drives adopt...
mHealth Lessons•   Access to the right data through simplified interfaces•   Ubiquitous connectivity required•   Has to wo...
mHealth Security Challenges•   Security Challenges…•   Platform Differences•   Mobile Device Management (MDM)•   Data Secu...
Six Takeaways…•   We are at the proverbial tipping point•   Usability drives adoption•   You need to have a defined, agile...
Marx Contact•   Blog       http://histalk2.com/category/ed-marx/•   Twitter    http://twitter.com/marxists•   LinkedIn   w...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Pr...
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iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Presentation “Leveraging mHealth in the Post Reform Era”

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Opening Keynote: "Leveraging mHealth in the Post Reform Era" - Health IT Summit in Austin!

Texas Health Mission
To improve the health of the people in the communities we serve

Texas Health Vision
Texas Health Resources, a faith-based organization joining with physicians, will be the health care system of choice

Innovative Technology Solutions
Innovate, transform, and serve

Mobile Health Definitions

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  • The scenes from the left are from Star Trek—the original series (Dr. “Bones” McCoy and his tricorder) and “The Next Generation” (with a more advanced model). The sketch on the right is from Star Wars Episode I – “The Phantom Menace”, the first of the three prequels. In both movies, mobile devices are used at the point of care to perform diagnoses and, in the Star Wars example, deliver drug therapy. In the Star Wars scene, data from a blood sample is collected from the mobile device and transmitted wirelessly to “the cloud” on a starship, where it is analyzed. It is from this analysis that Anakin Skywalker is identified to be the prophesied “chosen one” who will bring balance to the Force. The point is that although these are scenes from science fiction, these capabilities exist with smart phones today.For mobile health--specifically mobile medical apps--to be successful in a patient care setting, six principles must be taken into consideration, according to PricewaterhouseCoopers Managing Director Christopher Wasden, .Wasden said mobile health has matured beyond novelty and eventually will become core to the practice of medicine, he believes that there is still a way to go before it gets there."Mobile health technology is the first--and perhaps the only--technology that physicians have adopted more quickly and aggressively than IT departments can support," he said. "But [patients] stop using apps most often because we find a better one. People abandon the old for the new. This is clearly a market that has a long way to go before we find the secret sauce for success."According to Wasden, the six principles include interoperability, integration, intelligence, outcomes, socialization and engagement."Apps and devices need to be able to talk and share information with one another," Wasden said. "And they need to do more than just spit out data that patients [entered]."To that end, Wasden said, mobile medical apps should be able to come up with recommendations for what patients need to do differently in their lives."Connected health is only valuable if we're comfortable being told we're ugly," he said. Ultimately, Wasden said that successful mobile medical app use is contingent on changing human behavior."As we take digital info and put it in a form factor that we can put in their hands so [doctors] can stand next to patients, it changes the user experience and the practice of medicine," he said.
  • I went to Wikipedia to find an authoritative answer and to my surprise, this actually made sense:
  • So even as I was getting more interested in mHealth, it is still hard to define. There are touchpoints everywhere with mobile health. Every day we hear about a new gadget that can be plugged into the iphone, so what is mobile health?
  • Moving from volume to value
  • Not going to spend time on gee whiz, you will see some of that laterNot going to spend time on rules and regulations, you have plenty of that
  • Dr. Anthony Lee
  • Dr. Cythia Robbins
  • The RTHS must be assembled from a combination of new and existing applications and systems, technologies, management tools and best practices. The RTHS depends heavily upon the agility and robustness of the underlying IT infrastructure — the real-time infrastructure (RTI) if you will. An RTI is achieved when IT resources are integrated and interoperable, event-driven and service-oriented, and capable of being dynamically configured, optimized and scaled to meet the necessary service levels for an enterprise to effectively perform in the here and now. Some of the technologies that characterize the RTI include:Server, storage and workstation virtualizationRemote hosting, cloud computing and infrastructure utilitiesIT service management toolsLocation- and condition-sensing technologiesWireless and mobile devicesPortals of all typesMiddleware for messaging, alarms and notifications, and device integrationA focus on high availability, disaster recovery and business continuityEndpoint security and data loss prevention measures
  • iHT2 Health IT Summit in Austin 2012 – Edward W. Marx, SVP & Chief Information Officer, Texas Health Resources, Keynote Presentation “Leveraging mHealth in the Post Reform Era”

    1. 1. Leveraging mHealth in a Post-Reform Era Edward Marx Texas Health Resources December 2012 ACPE.ORG 1
    2. 2. Texas Health Resources Texas Health Mission To improve the health of the people in the communities we serve Texas Health Vision Texas Health Resources, a faith-based organization joining with physicians, will be the health care system of choice Innovative Technology Solutions Innovate, transform, and serve
    3. 3. Edward Marx• Husband to Julie Harding Marx• Father to Brandon & Talitha Marx• Passion for God, Family, People, Triathlon & Tango• Colorado State University (BS, MS)• Army Combat Engineer Officer/Combat Medic• Healthcare IT Leadership Career• Texas Health Services Authority Board Chair• Worldwide Councils for Cisco, Microsoft and HP• SMU Engineering School Advisory• TCU Business School Advisory• UTD School of Management Advisory
    4. 4. My Biggest Fear During Primaries
    5. 5. Mobile HealthDEFINITION & DRIVERS 5
    6. 6. mHealth DefinedTerm used for the practice of medicine and publichealth, supported by mobile devices.The use of mobile and wireless devices to improvehealth outcomes, healthcare services, and healthresearch.
    7. 7. mHealth – “Perfect Storm” ARRA driven adoption of EMR exceeded expectations EMR/ HIE adoptionClinical apps, andremote carepatient monitoring Mobility Mobile device applications adoption Smartphone and tablet/ slate adoption increasing 8
    8. 8. Ubiquitous
    9. 9. Mobile HealthFROM THEORY TO ACTION 11
    10. 10. Opportunities• Accountable Care• Well-Being• Value Based Purchasing• Triple Aim• Direct to Employer• Health Insurance Exchanges 13
    11. 11. 14
    12. 12. Mobile HealthTEXAS HEALTH STRATEGY 15
    13. 13. Choluteca Bridge 16
    14. 14. mHealth Strategy • Provider People • Patient • Use cases Process • Settings • Applications Technology • Infrastructure
    15. 15. mHealth Framework • Clinical • Clinical setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    16. 16. PROVIDER MOBILITY
    17. 17. Phones (Percentage of All Responses)
    18. 18. Tablets (Percentage of All Responses)
    19. 19. Provider Mobility: EHR • Clinical • Clinical Canto setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting Haiku
    20. 20. Provider Mobility: EHR• Current state • Future plans – 741 subscribers, – Android support all iOS (Q4, 2012) – Read-only access to – Dictation (2013) CareConnect – Image capture (2013) – eRx in development – Charge capture (2013)
    21. 21. Provider Mobility: OB • Clinical • Clinical OB setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    22. 22. Provider Mobility: OB• Current state – Realtime, read-only access to tracings of maternal uterine contractions and fetal heart rate – 125 subscribers, multiple platforms
    23. 23. Provider Mobility: Cardiology • Clinical • Clinical Cardiology setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    24. 24. Provider Mobility: Cardiology• Current state • Future plans – Read-only access to – Android support EKGs (Q4, 2012) – 500 subscribers, – EKG interpretation all iOS (2013) – Expanding access to – Optimize adoption, EKGs from EMS determine value (2012) – Integration with CareConnect, in development
    25. 25. Provider Mobility: ICU • Clinical • Clinical Patient setting setting Monitoring Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    26. 26. Provider Mobility: ICU• Current state – Read-only access to realtime waveforms and vital signs data; historical view of telemetry alarms – Not yet licensed at THR – THP pilot approved by Heart & Vascular Service Line and ITSC• Next step – Pilot at THP
    27. 27. Provider Mobility: Stroke • Clinical • Clinical Care setting setting Connect Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    28. 28. Provider Mobility: Stroke• Current state – Realtime, bi-directional audio/video interaction between neurologist and patient – Specialized telestroke application (Dr. Hinton) in use at THD, THDN – Evaluating Epic telehealth capabilities: THP pilot (Q4, 2012)
    29. 29. Provider Mobility: Messaging • Clinical • Clinical setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    30. 30. Provider Mobility: Messaging• Current state – Vocera pilot for THPG hospitalists at THHEB – Evaluating UC capabilities
    31. 31. Provider Mobility• Future needs and considerations – Providers: non-physician clinical staff – Workflows • Secure messaging • Data entry (orders) • Mobile PACs – Epic vs. UC for videoconference/telehealth
    32. 32. PATIENT MOBILITY
    33. 33. Patient Mobility: EHR • Clinical • ClinicalMyCare setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    34. 34. Patient Mobility: EHR• Current state • Future plans – Same functionality as – Acute care setting Web-based patient portal – Available to patients seen by THPG CareConnect providers or hospitalized at THR – 420 users, iOS and Android
    35. 35. Patient Mobility: Wayfinding 40
    36. 36. Patient Mobility: Monitoring • Clinical • Clinical setting setting Patient Provider Patient Provider • Non- • Non- clinical clinical setting setting
    37. 37. Patient Mobility: Monitoring• Current state • Future plans – Real-time and – Add videoconference asynchronous capability monitoring of vital – To be considered for signs; care plans, Care Transition patient education program (pHealth) – Nearing completion of – Potential initiative for AT&T heart failure Campaign 2017 research study – THAZ disease management, in development
    38. 38. Patient Mobility: NICU • Clinical • ClinicalPeek-a-boo setting setting Patient Provider Family Provider • Non- • Non- clinical clinical setting setting
    39. 39. Patient Mobility: NICU• Bi-directional audio/video interaction between – Family and neonate – Family and care team• Deployed at THD• Interest at THFW, THP• Seeking alternative vendor (AT&T)
    40. 40. Patient Mobility• Future needs and considerations – Consumer apps – Wearable devices – Integration with diagnostic equipment – Convergence with social media – Implications for population health management
    41. 41. Next…
    42. 42. Gartner Hype Cycle
    43. 43. Mobile HealthCHALLENGES & LESSONS 48
    44. 44. Usability Reality Happiness Expectations
    45. 45. mHealth Challenges• One size does not fit all• Vendor support of multiple form factors/devices• UI that drives adoption – speed & resolution• Managing devices, power & ruggedness• Security, HIPAA, FDA• Integration and interface• Wireless bandwidth availability• Potential medical device interference 50
    46. 46. mHealth Lessons• Access to the right data through simplified interfaces• Ubiquitous connectivity required• Has to work all the time, be intuitive and fast• Has to have great user interface• Start small and build on success• Must work well over slow, intermittent connections• Vendors not simply “also have a wireless solution”• Pick a strong partner willing to go at risk 51
    47. 47. mHealth Security Challenges• Security Challenges…• Platform Differences• Mobile Device Management (MDM)• Data Security Risk is Real• Not if but when….• Devices: Personal vs. Corporate-Owned
    48. 48. Six Takeaways…• We are at the proverbial tipping point• Usability drives adoption• You need to have a defined, agile strategy• Start now with something and grow• The future isnt about mobile; its about mobility• Security is about resiliency
    49. 49. Marx Contact• Blog http://histalk2.com/category/ed-marx/• Twitter http://twitter.com/marxists• LinkedIn www.linkedin.com/in/edwardmarx• FaceBook www.facebook.com/edwardmarx• Email edwardmarx@texashealth.org

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