Transforming Healthcare with mHealth Solutions August 2011

Transforming Healthcare
with mHealth Solutions
The Opportunities, Efficiencies, and ROI of Mobile Technology
August 2011 Copyright © Galvin Consulting and Technology Coast Consulting

Transforming Healthcare with mHealth Solutions
2 Copyright © Galvin Consulting and Technology Coast Consulting August 2011
TABLE OF CONTENTS
Executive Summary....................................................................................................................5
Target Audience .........................................................................................................................8
Background and Methodology ...................................................................................................9
Current State of Mobile Technology in Healthcare Organizations............................................10
mHealth Market Trends.......................................................................................................10
Mobility to Quell the “Perfect Storm” ........................................................................................... 10
Bring Your Own Device (BYOD) ..................................................................................................... 11
Physicians at Forefront of Mobility Adoption ................................................................................ 11
Healthcare Ecosystem Embraces Mobility..................................................................................... 12
Healthcare Organizations Increasingly Provide Standardized Mobility Support.............................. 12
Accountable Care Organizations Increasingly Important ............................................................... 13
Growth Data.........................................................................................................................15
Sources of mHealth Growth.......................................................................................................... 15
Mobile Product Roadmaps and Healthcare IT Investments......................................................16
Mobile Application Technology Market Segmentation ............................................................19
Enterprise Applications..................................................................................................................... 19
Small and Medium Business Applications.......................................................................................... 20
Consumer Applications ..................................................................................................................... 21
Healthcare Transformation through Mobility ..........................................................................21
Innovation ........................................................................................................................................ 22
Efficiencies ....................................................................................................................................... 25
Improved Patient Outcomes ............................................................................................................. 27
Mobility ROI ..................................................................................................................................... 29
Technology Overview...............................................................................................................34
Mobility Vendor Business Models..................................................................................................... 34
Form Factor/Hardware ..................................................................................................................... 37
User Preferences vs. Developer Preferences..................................................................................... 40
Application Type: Native, Web, Hybrid and HTML5 .......................................................................... 41
Mobile Enterprise Application Platform (MEAP) Vendors........................................................43
Single Platform MEAPs..................................................................................................................... 43
Multi-platform MEAPs ...................................................................................................................... 44
Rising Niche Mobile Developers........................................................................................................ 46
Packaged Healthcare Applications .................................................................................................... 47
MEAP Technology Differentiators ..................................................................................................... 51
Mobile Device Management (MDM) Vendors..........................................................................56
Why MDMs are Important in Healthcare Mobility............................................................................. 56
MDM Vendors’ Views of the Healthcare Market ............................................................................... 57
MDM and Security in the Healthcare Setting..................................................................................... 60
MDM Features of Special Interest to Healthcare Customers.............................................................. 65

MDM Vendor Profiles ........................................................................................................................ 68
AirWatch ...................................................................................................................................... 68
McAfee......................................................................................................................................... 69
MobileIron.................................................................................................................................... 70
Motorola Solutions ....................................................................................................................... 72
SAP............................................................................................................................................... 74
Zenprise........................................................................................................................................ 75
Regulation and mHealth Product Development.......................................................................79
Policies and Procedures............................................................................................................81
Internal Battles for IT Resources ..............................................................................................83
Healthcare Mobility Pain Points and Technology Solutions .....................................................85
Looking to the Future ...............................................................................................................89
The Future is Now............................................................................................................................. 89
Federal Regulation Nudges mHealth Forward.................................................................................... 89
Extending the Value of Legacy Healthcare Equipment and Devices.................................................... 90
Remote Care Expected to Expand...................................................................................................... 90
mHealth to Reach New Markets........................................................................................................ 91
Viral Mobility to Combat Viruses....................................................................................................... 92
Recommendations and Conclusions.........................................................................................93
About the Analysts ...................................................................................................................95
License......................................................................................................................................96
No Unauthorized Distribution ..................................................................................................96
Disclaimer.................................................................................................................................96
Contact Information .................................................................................................................96

LIST OF TABLES
Table 1: Overview of mHealth Use Case Findings Across the Healthcare Continuum
Table 2: Mobility Platform Features Relevant to Healthcare Settings
Table 3: Native, Web, Hybrid and HTML5 Applications
Table 4: MEAP Profiles by Application Type and OS Support of Native Applications
Table 5: MEAP Focus on Healthcare
Table 6: MEAP Development Approach and Security Features
Table 7: MDM Focus on Healthcare
Table 8: MDM Security Offerings
Table 9: MDM Features of Special Interest to Healthcare Customers
Table 10: Considerations for Implementing Mobility Policies and Procedures
Table 11: Sample Reimbursement Policy Matrix
Table 12: Healthcare Mobility Pain Points and Technology Solutions
LIST OF FIGURES
Figure 1: Where mHealth Can Offer Promise
Figure 2: ACO Synergies with mHealth Solutions
Figure 3: Growth Opportunities
Figure 4: Mobility Enterprise-Friendly Progress
Figure 5: mHealth Solution Providers and Application Categories
Figure 6: Doctor and Dentist Offices Benefit from Mobile Applications
Figure 7: Profiled Innovations
Figure 8: Profiled Efficiencies
Figure 9: Improved Patient Outcomes
Figure 10: Mobility ROI
Figure 11: Before Selecting a MEAP
Figure 12: Before Selecting a MDM
Figure 13: New Regulation
Figure 14: Current Regulation

EXECUTIVE SUMMARY
Mobility in the general workforce is expected to increase at an unprecedented rate in the
coming years, both in the United States and overseas. Mobility in the healthcare sector will
mirror that trend as healthcare providers, insurers, consumers, and government leaders all
search for ways to increase efficiencies, lower costs, and improve patient care. Many
healthcare professionals are looking to new mobility technologies as a way to solve some of the
industry’s most pressing problems. These thought leaders believe society is on the cusp of
dynamic change in the way healthcare is both provided and consumed.
Mobilizing healthcare employees, as well as extending enterprise applications to customers,
requires a significant commitment and the redirection of vital resources. To the discomfort of
some legacy healthcare application developers, it may mean rethinking the value of the current
enterprise roadmap against the potential ROI gains of mobility initiatives. After all, not all
projects can be green-lighted. Theoretically applications that deliver the most value to the
widest audience should take precedent - or so most CIOs would like to believe. There is no
guarantee that the disruptive invasion of mobile initiatives will drive value in healthcare
organizations. But if the concept of mobility does not challenge the healthcare IT status quo,
which one could argue needs to be challenged regardless, then it is hardly disruptive.
Nevertheless, we believe mobility in healthcare has the potential to transform – indeed, has
already begun to transform – the medical arena.
This study includes the latest research on the healthcare industry's mobile successes as gauged
by two fundamental measurements, revenues and costs. Given the sensitive nature of
healthcare, we parse these topics into relatable, human metrics. The research is highly
attentive to the sensitivities of enterprise budget considerations as well:
 Revenue opportunities come in many forms. Had we only looked at hard data, this would
have been an easy point to miss. In speaking to our subject matter experts, we uncovered
the subtleties of how putting patients first is not only good medicine, but good business.
More to the point, we reveal how healthcare organizations are harnessing emerging mobile
technology to create new markets and forge deeper patient/provider relationships too. We
explore how the unique characteristic of mobility allows a cross-section of healthcare
providers to expand beyond traditional healthcare management objectives. The combined
“stickiness” of a mobile app and the intensely personal nature of mobile device interaction
create the perfect opportunity for customer intimacy and loyalty.
 Cost efficiency: We chose to focus on the healthcare vertical precisely because of its well-
publicized cost management issues. If mobility has a valid value proposition for lowering
costs and improving productivity, one could not ask for a better testing ground than
healthcare IT. Healthcare workers were mobile long before anyone thought of “mobility” in
terms of smartphones and tablets. But mobile healthcare solutions have a long and
expensive history of being proprietary, and often inconvenient. This study focuses on the
new generation of mobility. Specifically, we explore how the marriage of smartphones and

tablets with apps and mobile Web enables progressive operational changes, improves
information accessibility and increases data accuracy in healthcare systems.
 Mobility ROI: Any seasoned technology research analyst will attempt to derive or extract
some measure of an implemented technology’s Return on Investment. Most seasoned
technology analysts acknowledge that organizations do not make this an easy job for those
analyzing a technology’s value to the business. We pressed our subject matter experts, who
in many cases were responsible for allocating significant portions of their enterprise’s
budget, to articulate their expectations of tangible returns. A major focus of every
interview was to identify where healthcare organizations are seeing material productivity
gains and tangible savings resulting from mobility investments.
Healthcare mobility goes beyond delivering information efficiently. Healthcare is an industry
that has particular form factor and information delivery needs. For this study we reached out
to leading mobility developers and their users to understand which devices, mobile operating
systems and mobile application platforms are preferred in healthcare settings. The technology
analysis of the report goes on to address infrastructure requirements. Primary research for an
earlier study, Smartphones in the US Enterprise, revealed a wide gap among enterprise
managers regarding their knowledge of enabling mobile technology. This study profiles the
leading technology used to build mobile applications (Mobile Enterprise Application Platforms,
or MEAPs) and manage the applications and partnered devices once deployed to end-users
(Mobile Device Management or MDM).
“mHealth” is a relatively new term that describes an organized system of mobile devices used
to collect community and clinical health data, either via mobile devices or integrated medical-
based peripherals. The collected healthcare information is delivered to practitioners,
researchers or patients, real-time. Innovative Uses of Mobile Technology in Healthcare
features cutting-edge mHealth achievements from diverse healthcare entities, ranging from
start-ups to established medical institutions. We address how mobilized patients, caregivers,
physicians and rehabilitation providers are changing the way medicine is provided and received,
as well as the major players enabling these new innovations and efficiencies in healthcare.
Table 1 encapsulates the primary research findings uncovered through interviews with
healthcare providers and executives, insurers, pharmaceutical industry representatives and
mHealth solution developers. mHealth solutions described in the table are featured
throughout the study.

Table 1: Overview of mHealth Use Case Findings across the Healthcare Continuum
User mHealth Solution Benefits
Hospitals  Electronic Health
Records, Health
Information Exchange
 Telehealth/remote care
 Patient self-registration
using tablets
 Bar code scanning
 Accessibility of patient data; reduction in
procedures and tests; fewer medical errors
 Improved patient access to physicians; increased
billable hours
 Lower administrative costs; faster service
 Improved supply chain efficiency/accuracy;
increased productivity; lower risk of compliance
breaches
Doctors,
Nurses
 Electronic Health
Records, Health
 Peripheral devices
integrated into mHealth
solutions
 Accurate and timely feedback to patients; ease of
coordinating remote providers; streamlined
consultations
 Regular patient monitoring; increased
productivity; reduced travel time
 Real-time updates of patient data; ability to offer
“untethered” care outside of traditional settings
Insurance
Companies
 Consumer self-help apps  Ease of locating specialists and services in
network; lower costs with drug cost-comparison
shopping; increased consumer usage of plan
benefits; better management of medical expense
accounts
Suppliers  Mobile apps replace
paper-based forms; bar
code scanning
 Increased accuracy and lower costs; compliance-
certified apps meet regulatory requirements
 Community-based retail stores use mobility to
improve ACO care coordination
Pharmacies  Drug reference and drug
interaction apps
 Mobile access to back-
office systems
 Real-time access to data to advise doctors and
patients on drug therapies and associated risks
 Enables pharmacists to interact with patients “in
the aisles” with access to real-time patient data
Drug and
Medical
Supply CRM
 Mobile CRM apps for
“detail” sales
representatives
 More efficient and accurate order processing;
improved compliance in sample distribution;
digital signature capture
Federal
Agencies
 Electronic Health
Records, Health
 Ability to identify and catalog worldwide
epidemiologic trends
Consumers  Symptom checker
 Apps with integrated
peripheral devices
 Social engagement-based
solutions
 Insurance benefit apps
 Interactive apps to identify appropriate care
providers
 Accurate and timely feedback of health data;
rapid throughput of test results to providers
 Improved care/lower costs through home
healthcare
 Greater emphasis on patient-centered care;
reduced isolation of convalescing patients
 Increased knowledge of cost/benefit trade-offs

TARGET AUDIENCE
Innovative Uses of Mobile Technology in Healthcare serves a multi-faceted audience within
enterprise, operational, end-user and public agency settings.
The research results and analysis target enterprise managers and executives tasked with
mobilizing workers in hospitals, healthcare organizations, rehabilitation clinics and other
healthcare settings, specifically:
 Regional healthcare operation managers can learn about significant savings realized by
small-to-medium operations that successfully deployed mobile applications.
 Mobilized healthcare providers including physicians, nurses, technicians, and all other
caregivers in the healthcare continuum that wish to leverage smartphones and tablets
for improving productivity and patient care will find the study highly relevant.
 Healthcare-focused executives at insurance companies, federal and state health
regulatory agencies, healthcare industry organizations, and groups with a vested
interest in improving patient outcomes and lowering overall healthcare costs, can learn
how mobility enables efficient workflow processes.
 Enterprise vendors selling mobility solutions to the healthcare industry, including both
products and services, can translate the study into a guide to the key drivers,
opportunities, efficiencies and ROI healthcare end-users seek, both today and in the
future.

BACKGROUND AND METHODOLOGY
Primary and secondary research for this study took place during April – July 2011 and included
interviews with healthcare IT executives, physicians, nurses, and other healthcare providers.
Additionally, qualitative research findings were gathered through the use of an online survey
tool, from participation in Webinars and online forums, and from live discussions at industry
events.
Report contributors included CXOs, VPs, directors and managers. Participants were
represented from marketing, sales, technology, and business analyst perspectives and provided
both tactical, as well as strategic feedback regarding their organization’s healthcare mobility
technology. Respondents represented hospitals, insurance companies, pharmaceutical
companies, pharmacies, healthcare IT, healthcare education, telecommunications providers,
mobile enterprise application platform vendors, mobile device management vendors, back-
office vendors and their partners, end-users, industry experts, and healthcare entrepreneurs.
End-user research targeted North American and European based hospitals, providers, and
vendors with at least several thousand employees. Over 50 percent of respondents had over
5,000 employees in their organizations.

CURRENT STATE OF MOBILE TECHNOLOGY IN HEALTHCARE ORGANIZATIONS
mHealth Market Trends
Many experts agree that mobility has the potential to play a key role in the changing healthcare
market. It’s a real force – a global trend and a revolutionary movement, according to many
observers. The investments chasing the healthcare mobility market have the attention of many
healthcare executives and traditional enterprise vendors, many of whom are trying to
understand how mobility can impact their business. We offer the following perspective:
A cardiologist we spoke with recounted a key moment from a statistics course he attended
several decades ago. His statistics professor framed the role that data should play in medical
practice. Paraphrasing, the professor began the lecture with: “Here is all you need to know
about statistics for the rest of your career: If it always happens, you need to know it. If it
sometimes happens, you should know it. If it never happens, you don’t need to know it.” After
this brief statement, the professor ended the lecture,
making a lasting impression on his students. The
cardiologist agreed with his professor's basic premise –
trends are only important if they impact doctors’ daily
routines. Indeed, the nascent market of mHealth is
showing strong signs of ubiquity. A February 2011
report authored by Pyramid Research found that more
than 200 million mobile health applications are used by
doctors and patients today, and more than 600 million
medical apps will be available by 2012. (Source:
Pyramid Research)
Members of the healthcare community we interviewed
believe mobility will pervade most healthcare settings at
a pace that will challenge those tasked with harnessing it. Mobility’s impact is only expected to
accelerate as the burden for improving patient care and lowering medical costs shift to those
providing, and receiving, healthcare. Below we describe trends around smartphones’ and
tablets’ expanding roles in healthcare settings.
Mobility to Quell the “Perfect Storm”
According to one physician, the United States and many developed countries are positioned at
the center of a “perfect storm” in terms of needing mobility tools to help solve healthcare
issues. In the United States, there has been a monumental push for healthcare reform.
Although controversial, many experts agree that the healthcare system as it currently exists is
unsustainable. In addition, the worldwide economic downturn has led to fewer resources being
available for managing patient needs.
A February 2011 report
authored by Pyramid
Research found that more
than 200 million mobile
health applications are used
by doctors and patients
today, and more than 600
million medical apps will be
available by 2012. (Source:
Pyramid Research)

A chronic shortage of workers, many of whom are “burnt
out,” is only expected to worsen as budget cuts decrease
medical provider compensation. Demographics play a
key role, as many developed countries have an aging
population with high levels of chronic disease too
expensive to manage long term. Finally, there is
increasing pressure from federal authorities to adopt
Electronic Health Records (EHRs) and a Health
Information Exchange (HIE).
Bring Your Own Device (BYOD)
As mobile technology moves into the healthcare setting,
one of the key drivers of this movement is the push from
consumers demanding that their personal mobile
devices are supported by healthcare IT departments.
Industry experts generally agree that it is very common
in healthcare settings for individual-liable devices to
enter the work place. Physicians lead the category of
healthcare professionals who procure and use their own
tablets or mobile phones for patient care. Patient-facing
shift workers, such as nurses and technicians, are more
likely to work on corporate purchased mobile devices
that move within, but do not leave, the healthcare
facility.
Physicians at Forefront of Mobility Adoption
Government funding to implement EHRs into medical
practices is a catalyst driving doctors to embrace mobile
technology. The American Recovery and Reinvestment
Act of 2008 provides up to $44,000 per physician under
Medicare or up to $65,000 over 6 years, under Medicaid.
Most respondents reported, however, that mobility
technology is infrequently, if ever, being used in EHR
deployments at this point in time. Nevertheless, it is
doctors who are bringing mobile devices into hospitals
and other extended healthcare settings, demanding
access to hospital networks and applications.
Physicians have embraced tablets more readily than
smartphones due to tablets’ superior form factor, such
as a larger screen size and longer battery life. Apple’s
iPad, in particular, is viewed as especially well designed
Where mHealth Can
Offer Promise
 A shortage of workers
places higher productivity
demands on current
healthcare professionals.
 Aging populations with
chronic disease levels
require careful monitoring.
 Higher operational costs
necessitate leveraging
existing enterprise
investments to the fullest
extent.
Drivers of mHealth
Adoption
 Hospital staff bringing
personal devices to work.
 American Recovery and
Reinvestment Act which
provides $44,000-to-
$65,000 per physician.
 Physicians are ardent
adopters of tablets and find
new uses for them on the
job.
iPad mania: According to a
February 2011 study by
Aptilon, 79 percent of
physicians prefer the iPad,
compared with 12 percent of
doctors who prefer a
Windows-based tablet and
nine percent who prefer an
Android device.

for the healthcare setting and has been adopted by many physicians. According to a February
2011 study by Aptilon, 79 percent of physicians prefer the iPad, compared with 12 percent of
doctors who prefer a Windows-based tablet and nine percent who prefer an Android device.
Executives at SAP agree with other industry observers who report widespread usage of tablets
in the healthcare mobility market. Company representatives report they are seeing an
especially large deployment of iPads and Samsung Galaxy tablets within the healthcare setting.
Healthcare Ecosystem Embraces Mobility
Point-of-care providers such as physicians, nursing staff, emergency response teams, hospital
“Innovation Centers” (centers that focus on best practices, technology testing, prototyping,
product evaluations, safety, training, and simulations), and pharmacies are fueling strong
demand. Peripherally there is marked interest in mobile technology from clinicians, support
staff, and outreach coordinators, as well as healthcare students, executives, field sales
representatives, human resources managers, information technology workers, marketing
employees, strategy personnel, and finance/administration employees – essentially all facets of
the healthcare ecosystem. Healthcare consumers are a forceful undercurrent in the mHealth
market, as the thousands of healthcare apps downloaded by millions of users attest.
Healthcare Organizations Increasingly Provide Standardized Mobility Support
Recently, many healthcare organizations have begun to offer a standardized program of
support for mobile devices, as opposed to accommodating “one-off” requests by individual
doctors. This was an informal, but prevalent trend that emerged when mobile devices were
just emerging in hospitals and healthcare settings. According to one leading MDM vendor, it is
only very rarely that organizations do not have some sort of policy in place currently that is
either providing the device itself or providing support for the device at an institutional level.
Some organizations that do not purchase mobile devices for employees are providing grants or
reimbursements that allow users to choose their own device.
“Behaviorally we’ll support whatever the doctors want. Some people on my staff
question this because there are so many devices to support. Why do we support any
device? It was a political decision. We’re a small community and there is little
competition. It took us a long time to convince doctors to implement EHRs; we didn’t
want to put up a wall to discourage their progression to use and adopt more technology.
iPhones and Android-based phones are used most often. We don’t endorse one over the
other. We put out instructions for those devices we’ve tested.”
VP, Information Technology, Non-Profit Hospital Group in Florida

Accountable Care Organizations Increasingly Important
In addition to an influx of new devices and device types,
new organizations are emerging to support changing
healthcare needs. One type of organization that is
increasingly mentioned as a harbinger of future
healthcare is an Accountable Care Organization, or ACO.
Although some vendors confessed confusion around
ACOs, noting that ACOs are a “new idea, a gray area”
with requirements that are still not well understood,
physicians reported that ACOs are expected to move
care to a more community-based model, avoid the use
of expensive emergency services, engage in better
continuity and coordination of care to prevent more
serious complications, decrease variations in care, and
demonstrate better outcomes, including no re-
hospitalization within 30 days of discharge.
Nowhere is this example more prominent than the home
healthcare category. Independa, a developer of mobile
technology to enable home healthcare, is one example.
Using Independa’s mobile solution, transition from an
aged individual's place of residence to the next stage in
long term care, such as a nursing home, can conceivably
be delayed. Care managers of individuals with
healthcare conditions can enlist Independa’s interactive
“Angela” platform to monitor and manage a patient’s
care.
The complete Angela solution consists of an intuitive
Windows-based touchscreen tablet designed for the in-
home care provider or patient, and Web service for the
care manager to establish thresholds, reminders and
alerts. While health and safety information is collected
within the cloud-based application, having Angela
provides additional visibility and flexibility in remote
care, above and beyond the inherent and significant
benefits of social engagement. For example, thresholds
can be presented to the care recipient for behavioral
change considerations, or medication compliance can be
offered much more visually using the touchscreen
format.
ACO Synergies with
mHealth Solutions
 Like mHealth, ACOs have
the potential to become
“game changers” due to
their promise of improved
coordination and
continuity of care.
 ACOs are expected to
drive care to a patient-
centered home
healthcare.
 ACOs will promote better
communication and
coordination between
providers, including
primary care, specialists,
pharmacists, and
therapists, as well as the
patient.
 ACO initiatives will drive
the integration of health
information, including
electronic health records,
health information
exchange, and decision
support.
According to an executive at
Johnson Controls, “Fully
realized ACOs and their
outreach will need to be
fueled by mobility.”

If aged individuals have a blood pressure condition their adult children want to proactively
manage, medication reminders and blood pressure level thresholds can be established via the
Angela Web service. The patient or care provider can confirm medications are being taken and
blood pressure readings are in a normal range using Angela. This functionality can be extended
to a number of health management scenarios and categories of patients. Mobile solutions such
as Angela engage care managers with care receivers, promote good health management habits
and help families avoid preventable acute scenarios.
Importantly, ACOs will also need to decrease medical errors, an objective that will be facilitated
with the use of EHRs and integrated decision support. For example, a doctor who orders an
inappropriate medication for a patient due to an allergic reaction would see a pop-up message
alerting him or her to the likely adverse effects and suggesting an alternative. Likewise, a
duplicate test that has been ordered for a patient would also trigger a pop-up message, alerting
medical staff to the unnecessary test, thereby saving money and avoiding unnecessary
radiation exposure for the patient.
As care increasingly moves to the community and patients’ homes and ACOs attain a greater
status and presence, some observers believe that mobile technology will be more critical in
these venues, and not necessarily in large hospital settings. As this happens, the need for
monitoring technology is expected to increase for acute care issues, as well as chronic diseases.
Indeed, acute care and chronic disease management are an increasing focus for retailers
throughout many communities. In January 2011, for example, Walgreens announced that,
through its pharmacy, health and wellness services, it is also becoming a “critical component of
new accountable care organizations by expanding opportunities with health systems.” CVS and
Walmart are expected to be major players in this market as well, providing pharmacy and retail
medical expertise to improve ACO care coordination.
An IT Director with a pharmaceutical wholesaler agrees about the importance of mobile devices
in the emerging ACO environment. He notes that “ACOs will be a primary concern for our
pharmacy customers, especially hospital and alternate care facilities. As these organizations
are formed, it will become increasingly important that we provide solutions that cross
organizational divides.”
And let’s not forget the consumer. The spirit of ACO has permeated the healthcare end-user,
according to insurance provider Humana. As a greater proportion of healthcare costs have
shifted to consumers, patients have become more conscientious about medical cost
management. They look to their insurers to validate that they are using their healthcare
benefits to their full advantage. Common patient inquiries include in-network provider
searches, generic or alternative dosage prescription options, medical spending account
management, and urgent care locator. Humana studies consumer trends closely and has
designed a self-service mobile app called “MyHumana” based on customer service usage
patterns.

Growth Data
When discussing mobility in the healthcare market,
observers and experts use terms such as “explosive”
and “exponential” to describe the projected growth in
devices, applications, and software. Physician demand
for smart devices, particularly tablets, is expected to
drive this growth, but other healthcare workers are also
pushing for increased mobility, particularly given the
dual goals of improved patient care and lower costs.
Research reflects mobile health initiatives becoming a
significant part of overall healthcare IT budgets. An
InfoWorld article published in May 2011 cites a study by
RNCOS. The study estimates healthcare IT spending in
the United States is expected to reach $40 billion in
2011. Of that, the mobile health market is estimated to
be worth $2.1 billion at the end of 2011, or 5.3 percent
of total healthcare IT spending.
Multi-billion dollar budgets notwithstanding, healthcare
is considered by many to be a laggard in terms of
adoption of new technologies. The healthcare industry
earned this reputation because it is risk averse –
technology in healthcare must first be fully proven
before IT leaders will adopt it into a healthcare setting.
Indeed, many observers point out that progress in
healthcare mobility has required a push from the
federal government to adopt technology from other
verticals and take these technological advances into the
healthcare setting.
Sources of mHealth Growth
There is some disagreement over the impetus for the
current sense of urgency regarding mobility in
healthcare. Some observers believe the growth in
mobility is coming from the bottom up, as consumers
bring devices into healthcare organizations and
increasingly use personal-liable devices in a professional
setting. Moreover, as consumers become increasingly
comfortable with technology, they will recognize that
they do not have to physically be in a doctor’s office but
When examining growth
opportunities, Motorola
Solutions believes there are
two distinct categories of
hospitals that are looking to
mobilize their workforce:
 Large, 300+ bed hospitals,
which have first generation
voice (such as legacy
telephony infrastructure)
and point solutions, and
have purchased single
devices. This type of
organization typically
purchases a team solution
in which there is
interoperability of
different devices, such as a
voice-over-wireless LAN
handset, VOW LAN phone
(voice in/out of hospital),
or a dual phone that works
on wireless cell phones.
After having had voice for
a few years, these
customers want to move
from a point strategy to a
more complete strategy
centered around voice. In
essence, they want an end-
to-end communications
strategy.
 <300 bed hospitals, which
have typically had some
type of mobility, such as a
hybrid of different devices,
but not a comprehensive
strategy. For smaller
organizations, cost is the
biggest hindrance in terms
of an end-to-end mobility
strategy.

can have care brought to them, through mobility devices and telemedicine.
Projections indicate that over one third of all smartphone holders worldwide, or 1.4 billion
people globally, will be using mHealth solutions within the next five years, according to
research2guidance. As this happens, providers will realize that the whole world is their market,
with healthcare organizations reaching out to patients in different time zones and on different
continents.
Other industry experts believe the impetus is more top down, as health care organizations,
insurers, and the federal government all push to make dramatic changes, primarily as a way to
lower costs. Corporate growth emanates from multiple directions. Pyxis Mobile, a MEAP
vendor, sees strong demand in the drug and medical device manufacturer market.
Pharmaceuticals developers are putting mobile applications in the hands of their sales
representatives at the point of data collection, resulting in more efficient order processing and
higher data accuracy. Reduced administration is enabling more face-time between
pharmaceutical sales representatives and their base of physicians.
At this early stage of healthcare mobilization, growth and usage patterns will continue to take
form. However, to believe that the growth of mobility is haphazard or accidental is a
misconception. Market success, especially where technology is concerned, is incidental – a
means to reducing costs or improving patient care. An increasing demand for mobile solutions
in healthcare settings signals that mobile solutions work, and work well.
MOBILITY PRODUCT ROADMAPS AND HEALTHCARE IT INVESTMENTS
Conversations with mHealth buyers and sellers highlight how mobile technology product
development can impact healthcare IT purchasing trends – and vice versa. There is palpable
excitement about the growth of mobility in the healthcare vertical, including widespread device
usage and an explosion of healthcare applications. Future medical practitioners are being
indoctrinated into the realm of mHealth. Through informal polling, Epocrates estimates up to
70 percent of medical schools now have a mobile device requirement or recommendation for
medical students. Mobile technology is being integrated into students’ training in anticipation
of future digitized healthcare practices. Enterprise managers’ concern over security and patient
privacy had deterred mass adoption of new MOSs until very recently.
Officials at McAfee report that they have seen an accelerating ramp of greater numbers of
healthcare organizations using mobile devices since 2010, with the inflection point being the
introduction of the iPhone 3GS in mid-2009, which allowed data-at-rest encryption. Other
MDM vendors point to the launch of iOS 4 as the watershed moment when compliance-
conscious IT managers allowed iOS devices into their enterprises.

Security Managers viewed iOS 4, with deeper support of
Exchange ActiveSync, as proof of Apple’s commitment to
corporate users’ needs. Exchange policy settings such as
password creation rules, expiration, and history;
disabling camera usage; and requiring manual
synchronization while roaming to reduce roaming fees
removed iOS’s multiple barriers-to-entry within many
conservative enterprises. Apple’s consumer device was
finally ready for healthcare markets and, as a result, CIOs
and CISOs could no longer deny healthcare staff requests
for iPhones. Instead, the focus turned to questions
about scaling and ensuring compliance.
The pent-up demand led to unprecedented market
growth, especially for iOS devices. Good Technology
analyzed usage patterns among thousands of its
enterprise customers from January 2011 to March
of2011. The study showed that iOS devices represented
just under 70 percent of new devices activated by Good
Technology during this period. Healthcare organizations
had the second highest iPad adoption rate, contributing
to nearly one-quarter of all iPad activations by the end of
March 2011.
MDM providers generally agree that the US market is
moving toward a 100 percent smartphone penetration
level, including in the healthcare vertical. According to
McAfee’s VP of Mobility David Goldschlag, “The same
way everyone has a cell phone, everyone will soon have
a smartphone. Penetration will trend toward 100
percent. Once everyone owns a smartphone, the job of
the enterprise will be to open the network in a
controlled way. Governance will be indifferent to
ownership. As such, enterprises get the benefit of
mobility without bearing the cost of mobility.”
Consider for a moment how 100 percent smartphone
penetration might be divided among mobility technology
vendors. Apple’s demonstrated sensitivity to mobility
policy control in regulated industries was a calculated
success. Apple’s strategy allowed iOS to win market
share in many healthcare enterprises, even as Android’s
rate of growth outpaced iOS for the last quarter of 2010.
Mobility Enterprise-
Friendly Progress
 iPhone 3GS introduction
allowed data-at-rest
encryption.
 iOS 4 support of Exchange
ActiveSync includes policy
settings such as password
creation rules, expiration,
and history; disabling
camera usage; and
requiring manual
synchronization while
roaming to reduce
roaming fees.
 Android has improved
security for email and
vendors have formed
partnerships with
NitroDesk; SAP offers
applications with its SQL
Anywhere mobile
database and
synchronization
technology.
 Third party
communication
framework vendors, such
as OIS, provide
interoperability among
distributed objects. This
alleviates custom
integration between
disparate Android devices
with other devices and
back-end systems.

Android’s consumer-centric product roadmap
is welcomed by third parties that see
economic advantages in buffering Android’s
perceived sub-standard enterprise
functionality. In February 2011, SAP
announced initiatives to improve Android’s
security for email, in partnership with
NitroDesk, and applications with SAP’s SQL
Anywhere mobile database and
synchronization technology. Android device
manufacturers have aligned interests in
improving Android’s corporate reputation.
This is evidenced by Samsung’s and SAP’s
joint program to deliver Afaria Advanced
Enterprise Security (AES) for Android to
Samsung Galaxy S devices.
There are unanticipated entrants in the pure-play mobility market. Companies such as
Objective Interface Systems (OIS) are responding to the unmet enterprise needs that Android’s
consumer market fixation presents. OIS develops cross-industry communication software with
a strong niche in military defense and avionics systems – envision F15 fighters engaged in dog-
fights while collected data is transmitted to central command.
OIS felt its experience in providing secure, high-performing communication frameworks and
integration platforms for “failure is not an option” systems could address numerous Android
MOS enterprise pain points. For example, there is disparity between Android’s smartphone
and tablet operating systems, with further MOS variation among Android’s device
manufacturers. OIS's ORBexpress allows developers to write one set of core logic that
facilitates secure communication from Android apps to corporate applications and enterprise
networks. Because ORBexpress is designed to provide interoperability among distributed
objects, both connected and Wi-Fi or Bluetooth remote medical devices are also easily
integrated. There is no incremental adaptation required for different device or MOS versions.
While Google focuses on captivating the mobile consumer market to promote its search
marketing and mobile ad model, organizations such as SAP, Samsung and OIS are staking their
product development on ensuring Android’s B2B success. At present, Apple’s iOS enterprise
roadmap appears to be resonating with healthcare IT purchasers. Later in the “Mobility Vendor
Business Models” section we address Microsoft’s and RIM’s bold new technology investments
and implications for healthcare organizations. Healthcare IT purchasers that understand how a
mobility vendor’s product roadmap aligns with their internal IT strategy can help ensure a cost-
effective, compatible long-term fit.
“The same way everyone has a cell
phone, everyone will soon have a
smartphone. Penetration will trend
toward 100 percent. Once everyone
owns a smartphone, the job of the
enterprise will be to open the
network in a controlled way.
Governance will be indifferent to
ownership. Enterprises get the
benefit of mobility without bearing
the cost of mobility.”
David Goldschlag, McAfee VP of
Mobility

MOBILE APPLICATION TECHNOLOGY MARKET
SEGMENTATION
Mobile applications are emerging as one of the highest
growth areas within the healthcare mobility market.
According to a director at a US-based hospital, “The
most significant mobile healthcare projects we are
working on are new health applications. We have
multiple projects that will enable mobile access to
applications (including new mobile applications),
security applications that support mobile clients, and
updates to existing applications to support them.”
Executives at McAfee concur, noting “It’s all about
applications and helping to make data more useful in
more places while controlling the data.” An executive
at MobileIron also agreed, adding that all healthcare
organizations have a need for mobility applications.
Usage areas include rehabilitation care, inventory
control, and instructions to and from patients and
instructors.
Unlike the broader app market, app sales are not the
only primary revenue source. Solution providers for
mHealth applications see growth in the adjacent
markets of Bluetooth or Wi-Fi enabled medical
devices, sensors and point-of-care solutions that feed
data to healthcare apps. In fact, the mHealth
peripheral market could reach beyond professional
healthcare settings. A Mobile Executive Business Lead
for MyHumana believes the market has a strong desire
for biometric device compatibility with mHealth
consumer apps. And as the mobile market has proven,
solutions providers are quick to respond.
Enterprise Applications
In May 2011, Ford Motor Company reported that it
has been working with WellDoc, Medtronic, and SDI
Health to create a prototype system to monitor health
issues, such as asthma and congestive heart failure,
while driving. If a driver is in danger, the system can
display and transmit alerts using Ford’s SYNC in-car
mHealth solution providers
believe there are two primary
categories of applications:
 B2C (Business-to-Consumer):
Peripherals will allow
healthcare workers to take
metrics, such as weight and
blood pressure, and send
readings via a network
provider. There are many
ways mobile devices become
part of a patient's life and
allow patients to be much
more proactive in managing
their health. In one study
hemophilia patients with
smartphones uploaded and
sent wound pictures to their
doctors. When used in this
way, the device becomes very
personal.
 B2E (Business-to-Enterprise):
Mobility applications replace
paper forms using a
convenient form factor. B2E
applications allow greater
access to patients when
medical providers are on call
or otherwise out of the office.
TeleNav, developers of mobile
solutions for remote workers,
estimates that organizations
can save $100/form by
substituting mobile workforce
management solutions to
enter, validate and transact
patient data, instead of relying
on manual data entry
processes. Speed is an added
benefit as front and back-end
processes are no longer
separated by time and
distance.

connectivity capabilities, transmitting information via
Bluetooth and downloading data from the cloud. The
SYNC platform also uses AppLink to allow drivers to
access smartphone applications via voice commands.
Ford is reportedly exploring other healthcare tools,
including applications that would allow drivers to find
the nearest medical provider or pharmacy.
Using a medical application for iPhones and Android
devices called “ResolutionMD Mobile,” doctors in
Europe have started using mobile devices to
determine if a patient suffered an acute stroke. With
the use of compression technology, images can be
transmitted over the Internet then streamed to a
mobile app or Web browser, where doctors can
manipulate the brain-scan imagery. Results found that
doctors reach the same diagnosis using a mobile
phone as they do when using conventional technology
in 94 percent of cases. The Food and Drug
Administration is currently considering approval for
this application in the United States.
When deploying healthcare applications, larger
organizations tend to have more sophisticated IT
organizations and larger headcount, resulting in more
in-house application development. Smaller
organizations that may be later in the adoption
process or lack the technical sophistication or
headcount may prefer instead to partner with outside
vendors.
Small and Medium Business Applications
Small-and-medium sized hospitals are using
applications in healthcare mobility. For example, an IT
executive responsible for the mobility strategy at a
collection of small hospitals in Florida stated that her
organization is working with its EMR vendor to have
native iPad applications built for doctors to order
directly from their tablets or smartphones. Doctors
can request additional and selective lab orders, in their
office or while they are traveling. If a physician is
alerted by the nursing staff about a follow-up item,
Doctor and Dentist
Offices Benefit from
Mobile Applications
MacPractice, based in Lincoln,
Nebraska, introduced an iPad
application in May 2011 that
allows patients to electronically
enter their medical information
directly into an iPad.
“Clipboard” comes in four
different versions:
 MD for physicians
 DDS for dentists
 DC for chiropractors
 20/20 for eye doctors
After a patient enters his or her
information, the data is
automatically sent to a doctor’s
practice-management
application and electronic health
records. Patients can also read
and sign HIPAA privacy forms on
Clipboard.
Key benefits of the system
include:
 Fewer data-entry errors
 Less time spent by patients
and staff inputting information
 The ability to schedule future
appointments
 The option of printing
insurance forms
 Electronic claims filing

that doctor can launch an application, review the vital statistics and notes, and add items.
In the near term, this IT executive is taking a simplistic approach, avoiding complex
programming that “won’t work on tablets currently” due to synchronization issues of pulling
information from different third-party databases. In the future, however, the hospital is
evaluating Windows-based applications on tablets with different operating systems and
different capabilities.
Consumer Applications
WebMD is a classic case study in consumer demand directly shaping technology. WebMD
stood as a symbol of new possibilities and consumer empowerment in the dot.com era.
WebMD organized, explained and presented complex medical concepts, making the daunting
topic of health far less mysterious to millions of healthcare recipients. WebMD’s popularity
skyrocketed because the more consumers learned, the more they wanted to know. WebMD’s
popular Symptom Checker, which provides actionable information, speaks to the depth of
understanding that today’s sophisticated healthcare consumer expects.
Mobilizing healthcare content is the natural progression in meeting consumer demand. The
Android mobile app launched in May “helps consumers in their decision-making and health
improvement efforts by providing 24/7 access to mobile-optimized health information and
decision-support tools, including WebMD's Symptom Checker, Drugs & Treatments, First Aid
Information and Local Health Listings.” Humana confirms strong influence of consumer
preferences, adding that consumers not only want what they want, but they also eschew
irrelevant information.
The motivation is once again economics. Consumers are under increasing financial pressure to
share the burden of managing their own health. Consumers, like insurers, recognize the
potential savings of commoditized medical care for low-risk health issues such as common colds
and minor cuts and sprains. Mobile applications allow consumers to make informed choices
before spending their valuable healthcare dollars on medications and services, potentially
saving thousands per household and billions on an aggregate basis.
HEALTHCARE TRANSFORMATION THROUGH MOBILITY
Study participants cited several organic benefits from introducing mobile technology into
healthcare settings. Innovative mHealth solutions have created new business models,
expanded existing markets, or lent a competitive edge to otherwise “old tech” organizations.
Healthcare professionals described important productivity gains resulting from the real-time
accessibility and interactivity of healthcare data. We found the most compelling use case
themes centered on improved patient care/patient outcomes.
Regardless of the benefit – innovation, efficiency or quality – healthcare professionals ranging
from physicians to operations staff acknowledge mobility’s tangible benefits. No less important

are the “soft dollar” benefits, such as reduced frustration
from data inaccessibility; lower rates of “burn out”
stemming from inefficient processes; greater awareness
of global shifts in diseases (such as the 2009 H1N1
pandemic flu); and a conveyed sense of empowerment
from being well informed.
Innovation
When the terms “cutting edge” and “healthcare” are
paired, one typically thinks of breakthroughs in disease
treatment, such as extending the life of cancer patients.
One might also imagine progressive diagnostic
equipment, predictive tests or futuristic medical devices
like a bionic limb. Rarely, if ever, does healthcare IT earn
a reputation for being innovative. Mobility is quickly
changing the perception of IT’s ability to catalyze
innovation in healthcare settings.
Healthcare innovation will allow medical providers to
access information at the point of care so they can make
well-informed decisions for their patients. While the
existing infrastructure does a poor job of supporting this,
the post-2015 generation of medical records will be
fully-digitized to support continuity of care. Mobility is
already playing a key role in the federal EHR mandate.
For example, mobility will allow doctors to see what
other providers or care givers are doing for, or
prescribing to, patients. Medical progress notes will be
viewable by all caregivers. In essence, the consumer
becomes the central figure of the coordinated care
team.
Hospitals and physicians are already starting to extend
Protected Health Information (PHI) access to employee-
owned devices. According to the director of a large, US-
based hospital, “We will be doing this using new mobile
security applications that can enforce device-based
security.” Other hospital executives are also extending
PHI access to personal devices, while also ensuring that
strong security measures are in place. According to one
executive, “We’re requiring device encryption for
downloaded data.” Another stated, “We are utilizing a
Profiled
Innovations
Insurance: MyHumana’s User
Interface design prompts
insured customers to consider
the affordable option of
Urgent Care as an alternative
to an Emergency Room visit.
Home Healthcare: Independa
incorporates social
engagement features in its
home healthcare mHealth
solution to reduce the
isolation and stress often
experienced by elderly and
infirm patients.
Personal Mobile Health App:
Integrates biometric and
sensor data into a personal
health management mHealth
solution. Encourages use of
mobile technology to manage
personal health goals.

variety of security solutions to encrypt the data being sent to devices as well as being able to
track and wipe the devices if lost. Agreements with users are being initiated so they
understand the risk.”
It is understandable that hospital executives are tentative about introducing consumer mobile
devices into their conservative, regulatory-centric organizations. As mentioned earlier, there is
an anti-professional perception that affixes itself to staff using smartphones, and to a lesser
degree tablets, in healthcare settings. Yet we observed that the marriage of consumer habits
and healthcare data is where impressive innovations are taking place. Why? Because
consumers like, or more accurately demand, instant results from their technology.
Smartphones help consumers navigate, save money, learn, organize, communicate and manage
their time. Why should healthcare providers and patients expect any less from their mobile
experience?
MyHumana, a recipient of the first Appy Award for “Best Medical App,” blends consumer usage
patterns with mobile conveniences. The innovative component can be found in the app’s
ability to potentially influence healthcare consumption patterns. For example, if a Humana
customer is traveling and in need of immediate medical care, the MyHumana app can list local
Urgent Care facilities, leverage the phone’s GPS to provide directions and tap the search engine
for the facility’s phone number. According to a Humana representative, “Urgent Care visits,
when right for the patient, help employers keep benefit costs down. In some cases the ER is the
right place to go. When a consumer needs immediate help, Humana wants that consumer to
have the Urgent Care finder accessible to determine if that's the best option.”
Not coincidently, the Urgent Care finder is prominently positioned within the UI. MyHumana’s
Urgent Care locator serves up a relatively affordable healthcare service option that consumers
might otherwise overlook. In the future, the MyHumana app will go a step further by offering a
symptom checker. Consumers will be presented with a range of options such as doing self-care,
going to urgent care or going to the hospital. MyHumana’s formulary for innovation – relevant,
timely information plus consumer choice – is simple, but effective.
A Senior Manager with TeleNav sees the market awakening to the possibilities mHealth
promises in home healthcare. “The whole mobility movement has been right around the
corner for seven years. There is a preponderance of workers not using mobile technology to
the fullest extent. Organizations that were early adopters of mobile were influenced by Nextel,
which served the market well. Some healthcare organizations are excited about smartphone
capabilities, some have great trepidation. If the company puts the device in their employees’
hands, will the employee go from work time to Facebook time?” Perhaps the better question is
whether the combination of mobility, social networking and healthcare is a positive or negative
influence. The answer may depend on the application of these technologies.
Independa, a technology start-up focused on the home healthcare market, developed “Angela”
with the dual focus of combining mobility and social engagement synergies. Independa’s

founder explained that social isolation is a common issue for infirm or elderly individuals.
Loneliness can cause house-bound patients to become depressed, sometimes leading to self-
neglect. Additionally, isolation can be a major source of stress, potentially exacerbating existing
health conditions. Once again, UI plays a key role in “stickiness.” The lighthearted and
engaging aspects of Angela, such as photo and video access to friends and family, are featured
alongside appointment and medication reminders. Independa presents responsible health
management features evenly with enjoyable daily interactions, subtly conveying that these
categories are equally important.
We explored subject matter experts’ opinions of future innovation. These individuals pointed to
integration of biometric and sensor data with mobile applications. Healthrageous, a mobile
healthcare app developed on the Pyxis Mobile MEAP platform, is designed to accept input from
a range of biometric devices. Healthrageous combines individuals’ biometric data with their
predetermined preferences and guides users to better health management through goal
setting, action plans and community support. Integration of data from heterogeneous
healthcare devices is a natural progression of technology and supports federal EHR initiatives.
However the noteworthy organic change is occurring at the social, rather than technological,
level. Individuals are gradually sharing every aspect of their personal lives with these small but
powerful devices and increasingly depending on them for managing their time, money, and
now health.
We observe investments supporting mHealth innovations to grow or maintain market share.
Mobile healthcare technology promotes consumer empowerment and creates new channels
for selling goods and services. For example, one individual interviewed for this study who
developed consumer mobility technology that helps to safely resolve emergency healthcare
situations, pointed to increasing numbers of consumers “shopping around” for healthcare
“deals” due to increasingly high healthcare deductibles. These consumers are bypassing
insurance companies and going directly to health care providers. Humana, which insures
millions of individuals, is working to ensure their consumers and prospects are getting the most
value from their existing insurance policies. According to a Humana executive, there are over
25,000 visitors to Humana’s mobile web services each month, many of whom are interested in
purchasing insurance. Humana is determined to foster these relationships: “We want to
assure our members have what they need, when and where they need it. We want them to
have Humana at their fingertips.”
Efficiencies

Our discussion of efficiency is addressed with two
important segments in mind – what it means to
healthcare workers, and what it means to consumers.
The stressful nature of helping unwell patients makes
any efficiency a welcome addition to healthcare settings.
Just as healthcare workers feel the pressure of providing
for their patients’ needs, patients can easily feel lost in
an ecosystem that is frequently characterized by
discontinuous providers, processes and paperwork.
Consumers are often left to weave elements of their
personal health management plan together. Mobility’s
growing role in collecting and imparting information is
changing how healthcare providers and patients interact.
Healthcare workers are a zealous base of mobile
technology adopters, having discovered that significant
productivity gains can be achieved using mHealth
solutions. Instead of sitting in their offices tethered to a
desktop computer, physicians now move freely
throughout the hospital environment, using their tablets
to review MRIs, X-rays, and other patient data with the
patients and patients’ families, in locations that are
convenient to all parties. Patient information can be
easily referenced from disparate online medical
enterprise applications, databases and other resources.
When a MEAP solution that supports integration is used,
the physician has the experience of interacting with a
composite mobile application, even though there are
several underlying data sources.
The National Health Service’s (NHS) University Hospitals
Birmingham (UHB), based in the UK, is at the forefront of
uniting critical patient information and then presenting
time-sensitive data and images to geographically
separate collaborative teams. NORSE, UHB’s
Neurological On-call Referral System, leverages
BlackBerry devices to provide emergency room doctors
with real-time assistance from UHB’s neurological
specialists. The system connects the neurological center
of excellence with the consulting physician. Case notes
and patient history are shared between the NHS and
UHB medical teams to accelerate the speed of diagnosis
and treatment.
Profiled
Efficiencies
Hospitals: Unite critical
patient information, then
present time-sensitive data
and images to geographically
separated collaborative
neurological and trauma
teams to rapidly diagnose and
treat head-injury victims.
Data Administration: Tablets
are used to enlist patient
assistance in completing
hospital admissions data.
Tablets also allow physicians
and hospital staff to update
patient records at the point of
care.
Pharmacies: Tablet and
smartphone pharmaceutical
apps will bring back-office
functionality to hospital and
retail pharmacists, allowing
them to interact more with
hospital staff and patients.

Efficiency was a key consideration in designing
NORSE. NHS used Webalo’s mobile
development platform to quickly develop the
system, without adding any additional IT
development or operations staff. NHS is able
to create new healthcare apps within short
timeframes – days or even hours in some
cases. Like the mobility contagion affecting the
entire healthcare industry, mobile application
development tools are increasingly being
viewed as a means to greater productivity in
healthcare settings.
Data input is a key area where mobile technology is expected to create greater efficiencies.
Tablets are also being given to patients to complete registration and admittance forms. For
example, Tara Cares, a support organization for nursing, senior living, and assisted-living
centers, replaced its manual system of collecting patient and resident data with Windows
Mobile-powered HP devices and device management software SOTI MobiControl. Tara Cares
staff can now enter patient and resident data into the devices and upload the information in
real time over wireless networks to a back-end server.
Because mobile devices can be used to capture patient data initially without the need for
cumbersome and duplicate paper forms on subsequent visits, the use of this technology is also
expected to reduce errors because it does not need to be re-entered by administrative staff at
healthcare organizations. As the VP of Information Technology at one US hospital stated, “I
would like to see mobile technology as the main conduit for clinicians entering the necessary
[patient] data. I hope more clinicians see mobile devices as they do their stethoscope or IV
Pump - as a tool to take care of the patient.”
Medical data processing is transforming due to mobile technology and is viewed by the industry
as a very positive paradigm shift. Instead of physicians typing notes or scheduling follow-up
care after their daily rounds with patients, providers are using mobile devices to update patient
information at the point of care. Experts state that physicians with mobile devices who enter
the information into the mobile app immediately, whether in the patient’s room or right
outside the patient’s room, have a much higher chance of being able to document the
information without interruption, leading to more accurate, timely and comprehensive notes.
In the pharmaceutical arena standardized mobile devices are replacing a cadre of proprietary
and expensive mobile-to-mobile (M2M) devices, many of which have single-use functionality.
Pharmaceutical wholesalers that support independent, retail chain and hospital pharmacies
have a patchwork quilt of legacy and acquired systems. These vendors are moving toward
industry-standard solutions that are platform agnostic. According to one industry executive,
Instead of sitting in their offices
tethered to a desktop computer,
physicians can now move freely
throughout the hospital
environment, using their tablets to
review MRIs, X-rays, and other
patient data with patients and
patients’ families, in locations that
are convenient to all parties.

“Because the mobile revolution is taking place in the
consumer world, pharmacy buyers and consumers are
bringing their personal devices, and their expectations
about what these mobile apps can do for them. Vendors
want to link into Android, iOS, RIM, and Windows.”
Sweeping productivity gains will continue as mHealth
solutions deliver back-office system functionality to
patient-facing pharmacists and healthcare providers.
Healthcare professionals view these productivity gains in
human terms as well, noting that their improved work
capacity translates into the gift of time with their
patients. A US hospital director reports that physicians
estimate they save 30 minutes each day doing rounds as
a result of mobility devices; clinical staff have estimated
similar savings for numerous departments. TeleNav has
received feedback from its clients stating that home
healthcare professionals are often able to see one
additional patient per day and can focus their time with
each patient on their health concerns, instead of
paperwork.
According to one physician who is heavily involved in
telemedicine, greater efficiencies will take place due to
greater adoption, better advances, increased confidence
about security, and timely responsiveness. Rapid
responsiveness has been a double-edge sword in terms
of data overload for healthcare workers. Users need to
learn to balance responsiveness with data overload. In
general, however, most observers agree that providing a
more timely response adds value.
Improved Patient Outcomes
Healthcare apps can provide critical checks and balances
in scenarios where rapid decisions can lead to tragic
mistakes. mHealth solutions deliver more precise
results. For example the integration of bar code
scanning into healthcare apps can ensure that the
correct amount and frequency of medicine dosages are
administered.
We observe mobility facilitating rapid throughput of
Improved Patient
Outcomes
Bar Code Scanning:
Integration with healthcare
apps for accurate dosing.
Rapid Throughput:
Coordinated diagnostics are
aggregated from remote
physicians and test centers via
mobile devices for faster
diagnoses.
Pharmaceutical Substitutions:
Mobile apps recommend
alternative brands and dosing
to lower cost of drug
therapies.
Telemedicine: Mobile
applications, displaying
images and test results,
facilitate remote
doctor/patient interaction.

patient follow-up care. For example, women with a suspicious finding on a mammography will
spend time waiting for follow-up readings. The patient may also need an ultra-sound, which
could take several days for testing and interpretation. A biopsy may then be ordered, which
takes additional days to read. In total, a patient may wait many weeks to find out if the results
are suspicious for breast cancer.
In contrast, a project done by the Arizona Telemedicine Program showed that the amount of
time from a suspicious finding on a mammography to completing all of the testing and
procedures could be accomplished in less than eight hours, providing answers to patients
rapidly and accurately. Using an “ultra-rapid breast care process” (URBC), the process bundles
telemammography, telepathology, and teleoncology services and provides input from virtual
physicians in each of these fields. Diagnostic elements have been refined to ensure accuracy,
speed, and integration with multi-disciplinary care management plans. Results are available to
the oncologist or surgeon for immediate discussion with the patient by mobile phone or via
video conferencing. Telehealth rapid breast care patients prefer telephone (including mobile
phone) contact by the clinician or oncologist for immediate results. The service is has been
commercialized by UltraClinics, a company created by the University of Arizona.
Physicians prescribing medications to their patients understand patient involvement is good
health management. Due to soaring drug costs, patients will often forego, dilute or otherwise
modify their medications. Recognizing that medication lapses can result in preventable
emergencies and exacerbate chronic conditions, pharmaceutical and medical community
leaders have taken steps to make medications affordable. Humana is using its mobile app to
engage patients in this process. MyHumana can suggest generic alternatives, dosage variations
and substitutions to prompt pharmaceutical consumers to ask their doctors or pharmacists
about affordable drug alternatives. Patients who previously felt they only had two options –
risk their finances or their health – are able to have a meaningful dialog with their providers
about affordable drug therapies. MyHumana can also provide price comparisons of the same
drug across multiple retail or mail-order pharmacies.
For patients in developing countries, smartphones and tablets are expected to add a whole new
dimension to how people access health services and information in general. With telemedicine,
for example, patients and their providers are doing much more than just teleconferencing,
they’re actually sharing information, including
knowledge and best practices that are evidence-
based. Mobile devices are enabling these types of
interactions.
Many doctors believe that the use of mobile
technology in healthcare will result in better access
to services, leading to better health outcomes and
– if done correctly – more affordable healthcare.
This is due to the fact that there will be better
Many doctors believe that the use
of mobile technology in healthcare
will result in better access to
services, leading to better health
outcomes and – if done correctly –
lower costs.

continuity of care, better surveillance, and earlier
detection of problems so that expensive and serious
complications can be prevented. There will also be less
hospitalization and lower rates of re-hospitalization,
along with a decrease in the use of emergency services
as consumers are empowered to play a decisive role in
their own health management.
Mobility ROI
Some healthcare organizations report that they are not
being required to demonstrate mobile return on
investment as stringently as they are in other areas of
information technology. Bypassing ROI modeling is
sometimes the case where emerging technologies are
concerned, because there are few, if any, established
benchmarks. A VP of Information Technology at a US
hospital, for example, noted that “Demand is such right
now that we don’t see the normal objections to budget
requests.” Other organizations reported that having the
support and financial backing from line of business units
can be even more important than demonstrating
tangible ROI.
Seasoned managers competing for IT resources know
that the blank check mentality wears off once emerging
technology becomes established technology. In fact,
MEAP and MDM vendors interviewed for this study
commented that operations-oriented mobility RFPs are
seen in decreasing numbers. According to these
vendors, the recent enterprise customer initiatives are
strategic, sweeping and almost always involve IT. The
heightened visibility and growing importance placed on
mobilizing workforces is putting mobility squarely in
competition with other IT initiatives. Therefore,
healthcare mobility evangelists will have to form
compellingly high ROI models. For that reason, we
present different business cases that mobility project
sponsors are using when trying to secure resources for
their mHealth projects.
 Administrative costs: Real-dollar savings are difficult
to prove, but offer the most persuasive argument for
mobility projects. Labor is among the largest outlays
Mobility ROI
HARD DOLLAR BENEFITS
 Reduced administrative
overheard
 Reduced physician travel
time
 Increased physician
billable hours
 Less wasted inventory
 Fewer redundant
procedures
SOFT DOLLAR BENEFITS
 Greater accessibility of
information
 Lower frustration due to
inefficiencies
 More engaging patient
interactions
 Improved patient safety
due to data timeliness and
accuracy
VARIABLES THAT IMPACT ROI
 MOS of devices deployed
 Mobile application type
 MEAP vendor selection
 MDM vendor selection
 Ability to leverage other
current IT investments
 Future enterprise strategy

for any healthcare organization. Patient data can be captured and maintained at the point
of care, eliminating the need for medical transcription and administrative resources.
Budgets for back-office staff can be reallocated to patient-facing staff.
 Billable hours: The average physician can repurpose 130 administrative hours each year by
using a mHealth solution. This translates into an annual savings of $10,010 per physician.
This time can be redirected away from administrative duties to engaging with patients or
collaborating with other medical professionals. Marginal increases in patient interactions
directly contribute to higher patient satisfaction ratings and more physician billable hours
that increase hospital revenues.
 Travel: Travel costs can be reduced for employees who can communicate via voice, data,
and video instead of physically traveling to other locations. The iPad’s superior graphics and
crisp resolution earned the device praise among early adopters of image-intensive practices
such as radiology, cardiology, orthopedics, obstetrics and neurology. Physicians’ reclaimed
travel time can be used to see more patients, thereby generating additional revenue.
 Supply Chain: Following labor, inventory is a second major category prone to inefficiency.
Mobile supply chain solutions improve inventory accessible without contributing to excess
inventory carrying costs. A Motorola Solutions executive interviewed for this study stated
that typical excess inventory in healthcare is between 25 and 50 percent. This individual
added that there are many hard dollar savings currently taking place within the healthcare
supply chain, some as a direct result of mobility technology, such as automating the
healthcare products receiving process and tracking medical supplies through the delivery
process.
 Eliminating redundant procedures and tests: Hard dollar savings are also evidenced by the
reduction in waste, including unnecessary visits to the Emergency Room if a closer and less
expensive urgent care facility could be found, as well as redundant diagnostics tests. One
Hard dollar savings: Equipping physicians with mHealth solutions can directly increase
hospitals’ top line revenues, while reducing administrative overhead.
--Average annual US physician salary: $200,000
--Average weekly US physician salary: $200,000/52 weeks = $3,850
--Average US physician hours worked per week: 50 hours
--Average US physician hourly rate: $3,850/50 hours = $77
--Average daily time saved from mHealth solution: 30 minutes
--Average daily cost saved from mHealth solution: $77 x .5 (30 minutes) = $38.50
--Average annual cost saved per physician: $38.50 x 260 workdays/year = $10,010
VP, Information Technology, Non-Profit Hospital Group in Florida

physician recounted the story of a patient who avoided an unnecessary X-ray after a pop-up
menu on his tablet alerted the doctor to the fact that the patient had had the same test
several weeks prior to that appointment. Preventing waste in the healthcare colossus is
clearly a win-win for everyone.
 Soft dollar savings: Some healthcare IT experts feel that mobility ROI is often perceived in
soft dollar improvements for clinical work, which is measured in terms of worker
productivity gains over a period of time. Operational performance can benefit from timely
and accessible patient information. Medical staff are less frustrated and less prone to burn-
out from inefficient processes. Physicians can have more meaningful conversations with
patients using data and images displayed on tablets. While difficult to measure, high-
functioning healthcare organizations are better prepared to safely and effectively care for
patients, a key goal for most hospitals. For example, instead of spending valuable time
relaying patient status updates to an incoming shift of nurses, critical patient data can be
generated in a report using an EMR application.
 Competitive advantage: ROI is often one of perception: If hospitals fail to embrace new
technology, there is the possibility that they will be viewed as resistant to change and
unsophisticated. At the “C” level, hospital executives feel they are risking their competitive
edge if they are not viewed as early and aggressive adopters of mHealth solutions.
 Financial Implications: The financial penalties of a compliance breach are also very costly,
as are devices that are being supported but that are unused and sitting in a “desk drawer.”
Mobile Device Management vendor Zenprise noted, for example, that one customer using
its Mobile Manager solution found that it was spending $180,000 annually on devices that
had not been used within the past six months. In this instance, the Zenprise customer was
paying for devices that were not being used, illustrating the point that, in order for mobile
device management to be cost effective, users needed to actually use their devices.
Overall, we found a high interest level in ROI calculations, both by vendors and by providers.
According to one executive at a pharmaceutical wholesaler, “Getting real financial support will
be difficult unless we can quantify and justify the benefits that mobility will bring.” Users and
providers alike strongly suspect that mobile device usage in this industry delivers healthy, if not
tremendous, returns on investment.
From vendors’ perspectives, many Mobile Device
Management vendors admit that their ROI
calculations are done at a high level across many
different industries, and not for specific verticals.
One executive at an MDM who had recently
completed an industry-wide ROI study stated his
belief that ROI in healthcare is not different from
other industries. Instead, ROI has more to do with
the scale and size of the organization.
Determining accurate ROI figures is dependent upon
“Getting real financial support will
be difficult unless we can quantify
and justify the benefits that
mobility will bring.”
IT Director, Pharmaceutical
Wholesaler

the Mobile Operating Systems and device types, mobile application, and mobile development
and management technology used. One must also consider the healthcare operation or
department and the role of the individual using the mHealth solution. Additionally, accurate
ROI figures are dependent upon the time frame to realize the ROI and composition of the
technology investments currently existing in the enterprise.
TECHNOLOGY OVERVIEW
MOBILE ENTERPRISE APPLICATION PLATFORM (MEAP) VENDORS

TECHNOLOGY OVERVIEW
MOBILE ENTERPRISE APPLICATION PLATFORM (MEAP) VENDORS
MOBILE DEVICE MANAGEMENT (MDM) VENDORS

TECHNOLOGY OVERVIEW
In examining mobility in healthcare, many experts report that the technology is fundamentally
horizontal. At the same time, however, the technology garners favor from vertical industries
based on application development environments, mobile operating system stability and
security, availability of hardware form factors, application distribution ecosystems and third
party support. Some verticals may not need encryption at all or to a significant extent, while
others, including healthcare, will require significant levels of encryption. In contrast, healthcare
does not require data controls at the level that a trading system at a bank requires. In essence,
there is a layering of tools within each vertical, and within that a layering of configurations.
When selling solutions to specific verticals, vendors need to promote their offerings in a vertical
manner, in essence “verticalizing” what are essentially horizontal technologies. According to a
senior executive at McAfee, “Companies should be as vertically-focused as possible.”
Mobility Vendor Business Models
Arguably, there are four industry giants – Apple, Google, Microsoft and RIM – that dominate
the mobile space. By dominate, we mean impact almost every mobility decision a healthcare
organization will make. Apple, Google, Microsoft and RIM are regarded foremost as mobile
operating system (MOS) developers. But each company’s span of influence is much broader
than its MOS and should be considered in the full context of how it can influence healthcare
objectives. For example, Apple and RIM are the exclusive designers of the hardware devices
that run their MOSs. They also share a common philosophy of a closed architecture that
disallows variations of the MOS. Apple and RIM exercise unilateral control of their respective
customers’ experiences. Since March 2011,
however, RIM seems to be embracing the wider
world by creating a run-time application to
support Android apps on RIM’s PlayBook and
QNX-based BlackBerry smartphones.
Google’s Android is an open system that permits
Android developers to take liberties with the UI,
as well as integrate applications, peripherals and
proprietary systems without relying upon
Android-provided APIs. The various Windows
platforms, though flexible from a UI configuration
and back-end integration perspective, have
become less malleable over time as Microsoft
asserts tighter controls on the user experience.
This direction is expected to continue with
successive Microsoft MOS releases. According to an interviewed software engineer WP7’s
closed architecture is a welcome sign to IT professionals. The WP7 OS runs managed
applications, meaning CPU cycles are strictly controlled through the OS, not the memory or
The WP7 OS runs managed
applications, meaning CPU cycles
are strictly controlled through the
OS, not the memory or hardware.
Microsoft’s OS design and new
certification process stand in the
way of users installing anything
malicious, unlike with previous
Windows Mobile versions where
phones could become unstable
from installing third party
applications.

hardware. Microsoft’s OS design and new certification process stand in the way of users
installing anything malicious, unlike with previous Window Mobile versions where phones
would become unstable from installing third party applications.
Microsoft, the grandfather of the mobile tablet industry, first launched the Windows Tablet PC
Edition approximately one decade ago. Windows Mobile and Windows CE were replaced by
Windows Phone 7 (WP7), and effectively sunsetted since the new smartphone operating
system does not support any pre-WP7 applications. Windows 7 supersedes Windows CE and
Windows Mobile for supporting tablets and other mobile devices, including ruggedized devices.
Hospitals and other patient settings have collective fortunes invested in Microsoft’s mobile
solutions and do not take the prospect of porting to net-new mobile operating systems lightly.
Like Google, Microsoft relies on third party hardware manufacturers such as Dell, Fujitsu, HP,
HTC, LG and Samsung, to develop the hardware that runs its various MOSs.
It is incumbent upon Google and Microsoft to not only win end-user favor, but technology
partner mindshare, in order to be commercially successful. Healthcare IT purchasing
departments have more options and arguably greater negotiating power when shopping
Android and Windows-based hardware. But the complexity of choosing among dozens of
hardware form factors cannot be disassociated from this perceived buying power.
The mHealth apps that currently, or will in the future, exploit the strengths and weaknesses of
each MOS and form factor are a key dynamic unto themselves. There’s the question of how
mobile apps are created. Once again we observe Android handing over control to third party
Mobile Enterprise Application Platform (MEAP) providers entirely. While many of the MEAPs
we profile support BlackBerry, iOS and Windows platforms, RIM, Apple and Microsoft left little
to chance and offer their own MEAPs. All four vendors entrust mHealth application
development to their partner community. Microsoft has a longstanding stake in the healthcare
sector with HealthVault, an online individual health management system. Google Health is a
similar service that incorporates apps and information sharing. In June 2011 Google announced
that it will retire Google Health in January 2012 because the service “didn't scale as we had
hoped.” Healthcare organizations should consider the meaningful investments mobile vendors
have made in understanding and serving their markets.
Widespread adoption of Android and iOS devices has ignited a flurry of mHealth development.
Research reveals that consumer favorability is not the only consideration. Developer
motivation plays an undeniable role. The popularity of Android devices has attracted many to
the Android developer program but has failed to satisfy developer support expectations. The
Android apps are especially susceptible to piracy and have overall more technical support issues
due to the open nature of Android’s development platform. Android developers also inherit
direct responsibility for billing issues, a task that Apple buffers for its developers. Developers
should consider healthcare file app size limits and distribution options, which not only vary by
app market, but change frequently as well. If remote downloads are the only options that may
constrain developers that wish to embed large video files into the healthcare app.

Mobile Device Management (MDM) has traditionally been the domain of third parties. RIM,
through the acquisition of Ubitexx in May 2011, will offer an MDM solution. Ubi-Suite will work
in conjunction with the BlackBerry Enterprise Server to manage and secure iOS and Android
devices, excluding push technology and setting IT management policies. Microsoft has
enterprise server, security and endpoint management solutions that can conceivably be
repurposed for Mobile Device Management. The pervasiveness of Microsoft applications in
enterprises is often a key selling point, because organizations are able to leverage their current
license investments for multiple uses.
What the above analysis implies, but is up to each healthcare organization to empirically
confirm, is that there is no clear winner among Apple, Google, Microsoft and RIM. If one
vendor had a clear advantage, there would not be four multi-billion dollar behemoths
contending for mobile market share. Each platform must be considered in the context of the
organization’s current enterprise investment and future mobility strategy.
Table 2 summarizes the relative characteristics of each vendor’s platform, or business model,
that many healthcare mobile technology purchasers consider when developing a mobility
strategy. Although many of these categories could be applicable to other industries, primary
and secondary research reveals that these are the variables particularly relevant to healthcare
settings.
A caveat: The Mobility Platform Features Relevant to Healthcare Settings Table is based on a
best-efforts basis at the time of publishing. The analysis is based upon all operating systems
provided by the vendor currently in commercial use. In the case of Microsoft, this includes
Windows Mobile, WP7 and Windows 7 for tablets. IT managers and other interested parties
should check with their mobile device vendors for specific features and functionalities in which
they are interested.

Table 2: Mobility Platform Features Relevant to Healthcare Settings
Feature Apple Google Microsoft RIM
MOS is consistent from smartphone to tablet,
promoting ease of development, deployment,
administration and 3
rd
party support.
● ○ ○ ○
MOS is standardized across all smartphones and does
not vary by hardware device manufacturer.
● ○ ● ●
Offers a tablet with a large screen size for which
many mHealth applications are optimized.
● ● ● ◓
Open architecture allows UI customization for
specific patient categories such as aged or sensory
impaired.
○ ● ◓ ◓
Multiple hardware vendors drive competition and
drive down hardware costs.
○ ● ○ ●
Supports Microsoft Exchange ActiveSync security
features for pass code protection and remote wiping,
which are imperative for healthcare devices.
● ◓ ● ◓
Offers open architecture for back-end integration
without relying exclusively on provided APIs.
○ ● ◓ ○
Flash support for playing medical tutorials, healthcare
videos, etc.
● ● ● ●
Operating System works on healthcare-specialized
ruggedized devices.
○ ● ● ○
Provides Bluetooth and Wi-Fi support to connect to
medical devices and sensors.
● ● ● ●
Has a Mobile Enterprise Application Platform (MEAP). ● ○ ● ●
Has a Mobile Device Management solution. ○ ○ ◓ ●
Leading in the consumer market. ● ● ○ ○
Form Factor/Hardware
Many of the discussions for this report focused on form factor – making sure that the device
being used in the healthcare setting is appropriate for the task at hand. Observers generally

Transforming Healthcare with mHealth Solutions August 2011

Transforming Healthcare with mHealth Solutions August 2011

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