Participatory Health Waegemann M Hi091809


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Presentation of mHealth enabling Participatory Health, by Peter Waegemann, at mHealth Initiative Seminar in San Francisco, September 18, 2009

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Participatory Health Waegemann M Hi091809

  1. 1. Participatory Health: The New Game in Town C. Peter Waegemann Executive Director, mHealth Initiative “One of 20 Most Influential People in Healthcare” (HealthLeaders) Copyright 2009 mHealth Initiative Inc. Boston.
  2. 2. Impact of Technologies • Electricity • Automobile • TV • Computer/Internet • Mobile Phone
  3. 3. I’m a new kind of person – I’m a Mobile Computer Person • Wireless Voice Communication • Texting • Email • PDA Functions: Calendar, Notes, Contacts, Clock, Weather, Search Functions • GPS • Lifestyle Functions: Yoga, eBooks, Music, Transportation, Banking, Identification, Networking, etc.
  4. 4. Trends of Our Times Consumers do the work – Bank tellers – Travel agents – Check-in counters at airports Making Information Available to Anyone From Sporadic to Continuous Communication Social Networking Technology: from Big to Small From Forced Legacy Systems to “Easy Use Systems” From ‘Authority-centric’ Systems to Wiki Economics
  5. 5. Participatory Health Active Participation of – People – Healthcare providers – Wellness providers – Public health – Health plans and payers – Pharmacies, labs, others
  6. 6. Active Participation of People •Are encouraged to become active Whether participants in their wellness and health healthy matters or ill •Change their life style • Keep a personal health record • Patients •Spend personal resources on living • Consumers healthier • Children •Research and learn about relevant health • Adults topics • Seniors • Be involved in cost issues for their healthcare and participate in healthcare- related cost decisions.
  7. 7. Healthcare Providers Medical Networking – All provider types – Pharmacies, labs, etc. – Public Health – Health plans and payers – Professional networking within your hospital or clinic
  8. 8. Three Generations of HIT 3 Participatory Health 2 Consumers 1 eHealth New Communication Computer-based 5 eHealth Systems Participants’ Coordination Patient Records mHealth RHIOs Document Imaging Ecosystem Interoperability PACs Practice New Financial Systems CPOE Management Systems Medical Communities Workflow, workflow, EDI Messages EMRs CHINs 1998-2009 workflow 1970-1997 2010-2020
  9. 9. What is e-Health? E-Health 1 2 3 4 5 Electronic Electronic Electronic Electronic E-Public Health Administrative Financial Clinical Research Systems Systems Systems Systems Systems Electronic Electronic Electronic Population Environmental Safety: Imaging Pharmacy Health Record Health Health Terrorism Systems Systems Systems Alert and Health Promotion Defense PACs Document Caregiver Health Processes Electronic Imaging-based Medical System Record Systems
  10. 10. What is mHealth? ♦ Communication-enabled new ways to communicate with patients and people – Disease management – Effective Care Processes ♦ Allowing people to research health topics – Physicians – People ♦ People and patients to share experiences – From “Summary at Visit to ODLs” ♦ Mobile computing at the point of care ♦ Affecting change in the healthcare system
  11. 11. mHealth Change in Workflow People’s Involvement in Wireless Health Communication and Computing Devices New Financial System New Systems: Decision-support and SPCs Trust and Ease of Use
  12. 12. Problem #1 Patients often see their clinicians only periodically and for short periods of time. They need to remember all health symptoms and health related events (observations of daily living – ODLs) within a very short visit that may be emotionally laden.
  13. 13. Types of Communication 1. Patient to provider (pre-engagement) a. General inquiry b. Appointment c. Insurance coverage or cost 2. Provider-patient interactively a. Appointment confirmation/reminder b. Reason for visit: Agenda c. Referrals and other care management communication, e.g. ‘How r u?’ d. Other 3. Patient education
  14. 14. Text Messaging • In general, fewer than 5% of adults are currently able to communicate with their providers electronically • When asked, 62% of adults stated that electronic communication would influence their choice • 75% stated they wanted to schedule appointments electronically • Harris Interactive: Feb. 8, 2007 • 50% of 12 to 24 year olds send or receive text messages • Ipsos: 2007 Credit: Renee McLeod
  15. 15. Text Messaging • Appointments • Medication reminders • General inquiries • Administrative questions • Non-healthcare related communication • Health promotion • Patient-initiated communication – Need to reschedule appointment – Need for prescription refill (?)
  16. 16. Problem #2 Physicians and other practitioners cannot memorize all formularies, guidelines, protocols, health plan instructions, or all of new developments in the scientific body of medicine.
  17. 17. Easy access at the point of care Provide access to web sites through smart phone browsers
  18. 18. Accessing Information at the Point of Care Patient health information Insurance eligibility information Care decision support information Formularies Guidelines and protocols Disease management information Access to scientific body of medicine Other
  19. 19. Cell Phone as Information Resource at the Point of Care Formularies Guidelines and protocols Decision support Telemedicine guidelines Patient’s comments re Web Patient directives
  20. 20. Exploding every week • iPhone has several hundred health and medical applications
  21. 21. Problem #3 Physicians and other practitioners often provide patient care without knowing what has been done previously and by whom, resulting both in wasteful duplication and in clinical decisions that do not take into account critical data related to patient health.
  22. 22. The Race for Interoperability •OSI Level •Microsoft •Object Management Group (CORBAmed) •DICOM/RSNA: EHI •HL7 •ASTM E31 •Google •Others
  23. 23. DIFFICULTIES Interoperability Workflow Documentation ity bil ROI ra peo er Int R EH
  24. 24. 1. Too much information 2. No uniform arrangement 3. Interoperability Composite Clinical Dataset Structured Data Elements – Not R EH Documents
  25. 25. Cell Phone Insurance Patient Card Provider Interoperability PHR 1. Too much information 2. No uniform arrangement 3. Interoperability Clinical Basis Dataset Structured Data Elements – Not R EM Documents
  26. 26. For over 2,000 years, the PHR patient was rarely Concern over Developments informed about the 2010 medical circumstances. Internet Disease details were left reliability to doctors. As recently as 7 million PHRs 1965, patients were not 10 mill. PHR-Lites allowed to see medical 3-4 mill. PPPs books in publicly funded Interoperability libraries 20% EMR ased through Implementation R-b bubble CC ecosystems Professionally bursts guided 13 million disease Personal Health 2007-2008 communities Records will support Health 2.0: new 2002-2006 Disease- research. Patient specific guidelines 1999-2000 support and protocols Communities Internet groups HIPAA gives the opens up develop patient the right health to a copy of the information medical record
  27. 27. Personal Health Record on the Phone • Interoperability through the patient • After the smart card, USB, CD experiences • Can use any phone • Current projects
  28. 28. Problem #4 How to get physicians, nurses and other practitioners to document at the point of care?
  29. 29. Using the CCR as the base, a clinician can now dictate or record through speech recognition – or with keyboard or stylus This opens up a wide range of workflow options at the point of care
  30. 30. As such recordings will be integrated over the next 18 months with online protocols (new and existing), a new process of electronically enabled care will emerge
  31. 31. EMR on the iPhone Credit: Renee McLeod
  32. 32. Problem #5 Is there a way of disease management that is more effective and reduces costs? Answer: Communication-based Disease Management
  33. 33. Disease Management Applications Wonders of better communication Currently focused on Diabetes Asthma Dermatology Preventive care in pregnancy Smoking cessation Hypertension
  34. 34. 30 patients random assignment Intervention (n=15) received cellphone software with real-time feedback of blood glucose levels, displayed medication regimens and requested additional data needed to evaluate diabetes management. Average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients. Quinn, CC, Clough, SS, Minor, JM, Lender, D, Okafor, MC, Gruber‐Baldini, A.  WellDoc Mobile Diabetes Management Randomized Controlled Trial: Change in  Clinical and Behavioral Outcomes and Patient and Physician Satisfaction. Diabetes  Technology & Therapeutics. June 1, 2008, 10(3): 160‐168.  doi:10.1089/dia.2008.0283.
  35. 35. Teaching, Monitoring, and Coaching Applications New applications in nursing and other areas
  36. 36. Changing Communications within Hospitals Nurses use mobile technology 67% of nurses carry two or more mobile communication devices Spyglass Consulting, 2008 88% of nurses had three phone numbers Ascendant Systems, 2008 Nurses are mobile* Walk an average of 3 miles (up to 5) per shift regardless of racetrack, corridor, or radial design facility Spend 31% of shift in the patient room Spend 38% of shift at the nurses station Spend 24% on the unit and 7% off the unit * Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3):25-34. Credit: Renee McLeod, Arizona State University
  37. 37. Nurses Nurses need access in real time; they spend 35% of shift in documentation* 3% in the patient’s room 81% at nurses station 15% on the unit 1% off the unit Smart phones can be HIPAA compliant Smart phones access the secure server * Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3):25-34. Credit: Renee McLeod, Arizona State University
  38. 38. Professional Communication Preferred communication channels for lab, pharmacy etc. Colleagues Specialty-specific communities
  39. 39. Administrative Applications Wide range of applications Provider – Patient applications Staff communication With others Text v. email RFiD: Asset management Inventory Patient Flow
  40. 40. Financial Applications Charge capture Providers accessing eligibility info Providers sending bills Payers in active communication with patients and providers Online real-time adjudication
  41. 41. Emergency Care in Participatory Health Not starting with a “blank sheet” Potential need for record locator system Substantial cost reductions expected
  42. 42. TapChart increases Productivity ♦By using TapChart and Palm mobile devices SDMSE, has returned more ambulances back in-service to the community, in excess of 16,500 hours ♦Without having to actually add additional units to the streets
  43. 43. What It Takes to Save a Life ♦Mobile communication ♦Care software ♦Integration into IS ♦Change Example for eHealthcare of the Future
  44. 44. Population Health Communication in Participatory Health Reporting of disease outbreaks Instructing patients Bioterrorism Surveillance Population notifications Other
  45. 45. Pharma/Clinical Trials Clinical trials Patient feedback systems
  46. 46. Future solutions Hospital policies need to reflect the constant change in technology Understand what you can police and monitor Cell phones have cameras and recorders Policies must apply to everyone and everyone needs to help enforce Healthcare facilities (hospitals, ambulatory care, etc.) must work with healthcare educators Credit: Renee McLeod, Arizona State University
  47. 47. What is mHealth? Bringing the power of the Internet to the mobile user Patient/consumer to control and manage their essential health data on mDevice New communication vehicle for care communication New applications using disease management applications at the point of care Methods to create interoperability in healthcare Enables integration of all healthcare participants Interoffice wireless connectivity is a commodity Much different and bigger than telemedicine or “wireless hospital applications”
  48. 48. mHealth Community Participatory health mHealth implementation More:
  49. 49. Peter’s Vision Phone identification Pre-service automated check-in Pre-service communication Care applets guide the clinician Real-time financial bill submission Real-time adjudication Additional fee services by provider Continuous care communication
  50. 50. What does this mean for Providers? Restructuring is unavoidable Solutions are not limited to new technologies Prepare staff for Participatory Health Create a mHealth strategy Balance Solutions and Effect
  51. 51. Hurdles Interoperability Confidentiality Standards Coordination of Participants
  52. 52. Wishing You a great time at this seminar and a happy transition into the era of participatory health and mHealth C. Peter Waegemann