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SeHF 2014 | Tackling the Tsunami: Building an mHealth Strategy


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SeHF 2014 | Tackling the Tsunami: Building an mHealth Strategy

  1. 1. Tackling the Tsunami: Building an mHealth Strategy David Lee Scher, MD, FACP, FACC, FHRS Director, DLS Healthcare Consulting, LLC Clinical Associate Profess or Medicine Pennsylvania State College of Medicine
  2. 2. “The most valuable commodity that I know of is information”. –Gordon Gekko, “Wall Street”
  3. 3. What is mHealth? Diverse application of wireless and mobile technologies designed to improve health research, health care services and health outcomes .
  4. 4. Pew Internet/CHCG Surveys
  5. 5. Developments Supporting mHealth Adoption • Implementation of electronic health records • Release of FDA Guidance on Mobile Medical Apps • Growth of Patient advocacy (Health 2.0, Quantified Self movement), Social Media • Wearable sensor and remote monitoring technology development
  6. 6. Why is mHealth Good for Patients? SOMETHING MUST BE DONE to IMPROVE HEALTHCARE Promotes patient engagement (self-management) Provides educational resources and content development Improves doctor-patient relationship Creates personalization of healthcare -> ?better outcome Convergence of many technologies -> simplification, convenience • Supports caregivers’ mission • • • • • •
  7. 7. Which Mobile Apps Patients Want Their Doctor to Have • 42%: An app to see their test results. • 33%: App connected to remote monitoring devices. • 30%: Access to patient health records via mobile device. • 13%: Didn’t think apps would help improve care at all. Source: 2012 Ruder Finn mHealth Report
  8. 8. • GENERAL HEALTHCARE AND FITNESS – – – – – Fitness & nutrition Health tracking tools Managing medical conditions Medical compliance Wellness (traditional and corporate) • MEDICAL INFORMATION – – – – Reference Diagnostic Tools Continuing Medical Education (CME) Alerts and Awareness • REMOTE MONITORING, COLLABORATION, AND CONSULTATION – Remote monitoring (safety) – Remote Consultation – Remote Collaboration • HEALTHCARE MANAGEMENT – Logistical & payment support – Patient health records
  9. 9. Facts About Health Apps* • 97,000 mHealth applications are listed on 62 full catalog app stores. • 15% are designed for healthcare professionals (CME, RPM, healthcare management). • 42% of apps: Paid business model. • Top 10 mHealth apps generate 4 million free and 300,000 paid downloads per day *Research2guidance, 3/13
  10. 10. Barriers to Adoption of mHealth • Incomplete regulatory guidance • Lack of reliability, security/privacy • Lack of mobile strategy by providers (BYOD, M2M integration), payers • Lack of smart phones by older, chronically ill pts • Lack of business models • Lack of proven reimbursement, return on investment • Physicians’ fear of high volume useless data
  11. 11. Clinicians: “Not medically sound” >90,000 medical apps/programs Consumers: <1/10 of apps used more than once Business: “Doesn’t make me money” From Megan Ranney, MD
  12. 12. Remote Patient Monitoring
  13. 13. Attributes of Ideal RPM • Provide continuous surveillance with only actionable, trending data • Unobtrusive • Interoperable with other devices and EHR/portals • Have associated robust analytics with clinical decision support
  14. 14. Mobile Cardiac Monitoring
  15. 15. Diabetes
  16. 16. Transdermal Patch w/Continuous Glucose Monitoring
  17. 17. Blood Pressure Monitoring
  18. 18. Pulmonary Monitoring
  19. 19. Complete Vital Sign/GPS Monitoring
  20. 20. Sensors: MEMS • • • • Implantable Sensors Wearable Sensors Biochemical sensors: glucose, pulse ox Positioning sensors
  21. 21. Wearable Physiologic Monitoring
  22. 22. Footwear Sensors
  23. 23. mHealth: Smart Phone Capabilities
  24. 24. Medication Adherence Apps • • • • MyMedSchedule Mymeds RxMindMe GloCaps
  25. 25. Proteus Digital: The Ultimate Adherence App
  26. 26. Role of Social Media in mHealth • SoMe is mobile • Patients use smartphones for health information • Patient-centered companies emerging • New market/business model for Pharma and med device companies
  27. 27. Social Media: Critical Role inmHealth Strategy
  28. 28. 4/6 Most Used Mobile Apps are SoMe-Based* *GlobalWebIndex, 2013
  29. 29. SoMe and Healthcare Online patient support groups – Clinical trial recruitment – Peer and caregiver support – Disease specific education – Healthcare navigation – Convenience – Anonymity
  30. 30. mHealth and Clinical Trials
  31. 31. Advantages of Mobile Clinical Trials • Recruitment of patients via social media • Real-time adverse event reporting • Bidirectional patient-provider interactions eliminate visits • Easier communications among all trial stakeholders (regulators, sponsors, investigators) • Facilitates medication adherence (reminders, pill sensors) • More efficient data collection, reporting, auditing • NO MORE FAXES!
  32. 32. Healthcare is still working in silos in many European countries Hospital Care Physician Care Emergency Care Outpatient Care No cross-border workflows, processes, no data exchange and access Absence of legal and regulatory frameworks, e.g. for liability Missing health-economic validation and bench-marks No incentives for providers, payers and patients to use mHealth © Rainer Herzog, HealthActiveConsulting
  33. 33. Regulatory agencies and policy makers Food & Drug Administration (FDA) USA Office of the National Coordinator (ONC) USA Medical Device Directive (MDD) EU CE Quality Mark EU • National / international standard protocols for e-/m-Health • Security and privacy of data • Data integrity, availabilty and auditability • Risk management
  34. 34. A Strategic Framework for Hospitals and Health Systems Present and Future State of mHealth New Care Models Technology ROI and Payments Policy Privacy and Security Standards and Interoperability
  35. 35. New Care Models: Healthcare in Transition • • • • Acute care  Chronic Disease Management Aging at Home Hospital Readmission Prevention Caregiver Involvement
  36. 36. mHIMSS Roadmap • ROI/Payment: Addresses financial aspects of mobile tech adoption • Legal & Policy: FDA mobile medical app Guidance • Standards & Interoperability: Types of networks, communication patterns, standards above and below the network layers, network/storage tradeoffs, syntax and data, app standards, Blue Button Interface • Technology: Factors to consider in app development • Privacy & Safety: Current state and future considerations
  37. 37. What is the Best Measure of the State of Adoption? The HIMSS Mobile Technology Member Survey, 2013 Released February 26, 2014
  38. 38. HIMSS Survey: Respondent Profile • 62%: IT professionals • 27%: Responsible for developing the organization’s mobile tech policy • 38%: Member of committee responsible for developing the organization’s policy on mobile tech • 22%: Responsible for implementation and operation of mobile tech
  39. 39. Highlights of 2013 HIMSS Mobile Tech Survey • Prioritization of Mobile Technology: Average score: 5.25 • Maturity of Mobile Technology Environment: Characterized at 3.95, increased from 3.33 in 2012 • Impact of Mobile Technology on Patient Care: 33%: will substantially or dramatically impact patient care, decreased from 2/3 in 2012
  40. 40. Takeaways From HIMSS Survey Mobile Technology Policy: 59% have mobile tech policy, 29% in development. App Development: Apps within their organization likely to be developed by third party. ½ plan to expand app usage. Barriers to Mobile Technology Use: #1= Funding
  41. 41. Significance of the Survey • Identifies the decision-makers • Identifies market penetration more accurately than industry analysts • Identifies pain points of mobile tech adoption • Useful for developers, analysts, healthcare enterprises, IT vendors
  42. 42. Challenges • Increase awareness and mobile tech by older consumer/patients • Need filtered actionable data/alerts • Full connectivity with EHRs • Clinical efficacy studies • Interoperability among apps and platforms • Complete, reasonable and appropriate regulatory requirements • Funding for mobile strategies (private, public)
  43. 43. Questions?