Mobile data final

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A 2011 talk delivered at the NFAIS annual conference. The focus was a review of current trends in mobile referential and patient data within the healthcare industry

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Mobile data final

  1. 1. Healthcare Mobile Information FlowVictor CamlekVP Market IntelligenceThomson Reuters Healthcare & ScienceMarch 2011
  2. 2. A WORLD OF DATA. DELIVERED.HEALTHCARE & SCIENCE SOLUTIONS Operations & Planning & Regulatory Clinical Performance Clinical Clinical Decision Providers Finance Marketing Reporting Improvement Workflow Support Action OI® crmView® Clinical CareDiscovery® Clinical Xpert® Micromedex® 2.0 Strategic Services 100 Top Hospitals® Pharmacy Xpert® Cost Fraud & Health Plan Care Consumer Containment Abuse Management Management Engagement Payers Advantage Suite Advantage HEDIS Physician Consumer Health Suite Performance Solutions Medical Episode Grouper DataProbe Assessment Research & Clinical Trials Regulations Commercialization Post-Launch Pharma Discovery Thomson Reuters Thomson Reuters IDRAC Medical Literature Comparative Pharma Pharma Analyzer Effectiveness Research Integrity Research Evaluation Authoring & Publishing Research & Discovery Researchers Thomson Reuters Research EndNote® Web of Knowledgesm Analytics ScholarOne Web of Science InCites, Journal Citation Reports, ScienceWire©2011 Thomson Reuters 1
  3. 3. Headline News: The capabilities of mobile technology are greatly influencing the practice of medicine TODAY!As the technology matures there is potential that a hugeamount of workflow content may become availablefor use over mobile devices.What will this continue to mean for STM Publishers andtheir customers?
  4. 4. Healthcare: Converging Mobile Markets mHealth Telemedicine Mobile Devices Mobile Solutions for Interactive Data Management Mobile Content 3
  5. 5. mHealth Definition• mHealth – The practice of medical and public health supported by mobile devices – Sub-segment of e-Health – The use of mobile devices in collecting community and clinical health data; delivery of healthcare information to practitioners, researchers, and patients; and, real-time monitoring of patient vital signs, and direct provision of care (Telemedicine) mHealth gets into the actual practice of medicine, which is one of the reasons that it has been embraced by the World Health Organization as a way to manage healthcare in third-world countries. 4
  6. 6. Telemedicine Definition• Telemedicine – An application of clinical medicine where medical information is transferred through interactive audiovisual media for the purpose of consulting, and sometimes remote medical procedures or examinations – Includes two concepts • Real time (synchronous) and store-and-forward • Home Health (asynchronous) – Mobile devices may or may not be used • Mobile telehealth: provision of medicine via a mobile unit • Services may involve mobile technology used by a mobile vehicle associated to a medical facility Telemedicine includes some mobility and is often mentioned within the context of the mobile market. However it involves the connection of at least two points to either perform or monitor patient care. 5
  7. 7. Mobile Content Definition• Referential healthcare-related content• May include: – Disease monographs – Drug-related content – Order sets – Protocols – Social networking content• Electronic Medical Record(EMR)/Electronic Health Record(EHR)• The ability to combine referential and patient-related data creates a mobile solution The capability for content to be delivered over a mobile device combined with interaction with patient-related data represents a current market in which various companies participate. 6
  8. 8. Mobile Solutions forInteractive Data Management Definition• Mobile Solutions for Interactive Data Management – Solutions that permit users to achieve mobile access to data from Hospital Information Systems (HIS) using at least one data presentation format – Solutions must possess a data access layer that obtains and deconstructs information from disparate HIS systems, and repackages the information around a patient object – Provides a mobility platform for interactive data retrieval and transmission This is the core space where STM content providers may be interested in serving. 7
  9. 9. Healthcare Mobility and STM PublishersContent Workflow Platform Devices mHealth Telemedicine• Referential • EHR Ability to stage, • Handheld • Patient The use of• Drug Data • Charge re-configure and PDA‟s Monitoring medical• Clinical Capture message data • Smartphones devices information from an HIS or • Mobile exchanged from• Journals • Patient Index • iPod Touch source system to telemedicine/ one site to• News • CPOE a variety of • iPad another via telecare• Guidelines • Order Sets devices • iPhone devices electronic • Rounding • Android • MP3 players communications • Scheduling • Windows for the health for mLearning Mobile and education of • Patient Alerts • Laptop the patient or • Lab Data • Net books computers healthcare • Financial/ • Mobile Carts and desktops provider and for Billing Mgmt • Mobile • Data collection the purpose of • Performance Diagnostic software improving patient Mgmt Software tools care. • Diagnostic • Workstations Telemedicine Imaging includes consultative,STM Content Space + Workflow Data diagnostic, and treatment services STM Opportunity Content Enablers Adjacent Areas 8
  10. 10. This market is in an early stage Healthcare Mobility and STM PublishersContent Workflow Platform Devices mHealth Telemedicine• Referential • EHR/EMR Ability to stage, • Handheld • Patient The use of• Drug Data • Charge re-configure and PDA‟s Monitoring medical• Clinical Capture message data • Smartphones devices information from an HIS or • Mobile exchanged from• Journals • Patient Index • iPod Touch source system to telemedicine/ one site to• News • CPOE a variety of • iPad another via telecare• Guidelines • Order Sets devices • iPhone devices electronic • Rounding • Android • MP3 players communications • Scheduling • Windows for the health for mLearning Mobile and education of • Patient Alerts • Laptop the patient or • Lab Data • Net books computers healthcare • Financial/ • Mobile Carts and desktops provider and for Billing Mgmt • Mobile • Data collection the purpose of • Performance Diagnostic software improving patient Mgmt Software tools care. • Diagnostic • Workstations Telemedicine Imaging includes consultative,STM Content Space + Workflow Data diagnostic, and treatment services STM Opportunity Content enablers Adjacent Areas 9
  11. 11. Mobile Devices Definition • Mobile Devices – Traditionally “Pocket-sized computing devices,” typically having a display screen with touch input or a miniature keyboard – The definition is evolving as larger mobile devices appear (iPad, Net-books) – Not all of these devices can access all public or proprietary mobile networks, however, as they develop more will be able to include direct mobile access • Mobile Devices may include: – Smartphone – Mobile computer/Mobile cart/Mobile monitor – Personal digital assistant/enterprise digital assistant including the Blackberry – Digital still camera (DSC)/Digital video camera (DVC or digital camcorder) – Portable media player – e-book reader – Pager Advances in mobile device technology – Personal navigation devices are fueling mobility as a growing medical – iPad (as of 2010) application 10Confidential – Do Not Distribute
  12. 12. Relevant Handheld Devices BlackBerry Palm Nokia Windows Phone Android Phone Motion computing, mobile computer and mobile cart iPod Touch iPhone 4G iPad NetBook 11Confidential – Do Not Distribute
  13. 13. Market Dynamics: • Worldwide mobile device sales to end users equaled 1.6 billion units in 2010, a 31.8 percent increase from 2009 • Smartphone sales to end users were up 72.1 percent from 2009 and accounted for 19 percent of total mobile communications device sales in 2010 • Worldwide mobile phone sales to end users reached 32.7 percent growth in the fourth quarter of 2010, with sales of 452 million units • Gartner forecasts worldwide mobile application store downloads to reach 17.7 billion downloads in 2011, a 117 percent increase from an estimated 8.2 billion downloads in 2010 • According to the MDsearch Smartphone Survey, 53% of physician respondents own a smartphone and 63% of those physicians are using mobile medical applications • EMR vendors have begun to offer remote access to EMRs via smartphone applications (Example: Epic Systems partnership with Apple announced in 2009 for a mobile EHR pilot) • Source: Gartner Research; Forecast: Mobile Application Stores, Worldwide, 2008-2014 Mdsearch: and Mobile Health Q1 2010 State of the Industry. Mobilehealthnews, 12 2010 reportConfidential – Do Not Distribute
  14. 14. STM Participants: Early Signs of Differentiation• “Large healthcare publishers such as Hearst Business Media, Reed Elsevier, Thomson Reuters, and Wolters Kluwer have a portfolio of products that support clinicians, healthcare providers, and payers along the healthcare workflow. These products are still evolving as the technologies mature.”• “The main components include traditional reference and journal content; teaching and training applications (particularly for nursing).”• “The most highly competitive area is in clinical decision support tools, where order sets and drug reference databases are the most common product.”• “There will be increased focus on content integration with work-flow needs and just-in-time delivery driving competitive features and pricing. As much of the evidence as possible should be embedded in content-based software.” Source: Outsell, Inc., Growth Trends in the Market for Clinical Decision Support Tools, June 2010 13
  15. 15. HC Mobility: Notable Service Providers Referential Content and Clinical Workflow Analysis Sources • UnBound Medicine • TR Clinical Expert • Medicine Central • Patientkeeper • Evidence Central • Global Care Quest • ePocrates • Dr. First • Lexi-Comp • IQMax • Dynamed • Theradoc Expert • Diagnosaurus Systems • Skyscape • Pharmacy OneSource (Sentri7) • Up-to-date • MedMind (CareFusion) • Tarascon Pocket Pharmacopia • Premier Safety Surveillor • TR Micromedex products • Cogon Systems • MedAptus • CureMD • Zynx, First DataBank • Elsevier – First Consult 14Confidential – Do Not Distribute
  16. 16. The Concept and The Potential • Today: – All relevant information derived from a patient encounter may be documented and transmitted to a mobile device – However, previous information documented in various medical records will not be readily available until there is additional progress creating EHRs (Electronic Health Records) – The available data may be combined with value-added referential content delivered to a mobile device at the point of care • Tomorrow:©2008 Thomson Reuters – Even more information will become consistently available at the point of care and for use during ongoing treatment 15
  17. 17. Thomson Reuters CLINICAL XPERT AGGREGATES PATIENT DATAFROM THE HOSPITAL AND DELIVERS IT DIRECTLY TO CLINICAINS 16
  18. 18. CLINICAL XPERT ADDRESSES HOSPITALS‟ CLINICAL ANDBUSINESS CHALLENGES…• Enhances clinician efficiency• Champions informed decision at the point-of-care• Address CMS and Joint Commission initiatives• Identifies high-risk patients quickly via clinical surveillance• Promotes patient safety and reduces medical errors• Reduces lost or inaccurate charges (CX Billing)• Facilitates clinician communication• Improves physician satisfaction and relationship with the hospital• Creates competitive advantage for recruiting clinicians• Serves as an HIS downtime solution, providing uninterrupted access to patient information when the HIS is not available 17
  19. 19. Clinical Xpert Solutions Solution Attributes CareFocus Generic surveillance tool capable of supporting any clinical area Clinical Xpert Navigator Rounding, Mobility and Tracking to support clinicians across locations when managing patients Pharmacy Xpert Intelligent dashboard, pharmacy specific surveillance, quality drug/disease content, department management reporting©2008 Thomson Reuters 18
  20. 20. Pharmacy Xpert Product Description• Pharmacy Xpert consists of three primary components • Xpert design to support pharmacy decision support • Links to HIS systems Pharmacy • Patient specific drug Application interaction checking, IV Index and calculators • Drugdex • Diseasedex GM Micromedex • Drug REAX • IV Index Content • Pre-built pharmacy profiles • Patient data • Real-time surveillance Clinical Xpert Foundation • Mobility • Integration with any HIS 19
  21. 21. Clinical Xpert: Value Proposition • Patient Safety/Improved Outcomes: – Real time patient surveillance to: • Manage patient specific drug therapy effectively • Identify patients at risk • Improved cost management – IV to PO proactive conversion – Antimicrobial therapy management – ADE (Adverse Drug Events) prevention • XPert software: – „Just what I need to know‟ – targeted, relevant information needed to make optimal decisions – Evidence-based surveillance and recommendations – Intelligent user design anticipates information needs • Technology ROI – Works with any HIS system – CCOW (Clinical Context Object Workgroup)(context management)©2008 Thomson Reuters compliant – Implementation resource requirements minimal – Infrastructure designed to support multiple Xpert systems 20
  22. 22. Business Model Issues • Solutions include two components: – Software needed to access, manage and transmit the data – Content, including referential content available via subscriptions, tailored to meet the needs of the mobile device customer©2008 Thomson Reuters 21
  23. 23. Business Model Issues• Costs associated with HIMS data conversation• Technology challenges – Data access layer capabilities – Messaging layer to devices – Mobile device platform strategy• End-User issues – Who is the actual customer (Institutional Providers, Physicians, Pharmacists, others) – Willingness-to-pay – Quality assurance• Regulatory issues – Privacy – Data Integrity 22
  24. 24. Business Model Options• Software model: • Capital investment – Perpetual lease – Requires institutional participation – Maintenance – Includes subscription to – Updates content• Subscription-based • Suitable for content • Less likely• Transaction-based • Provides service to• Sponsorship organizations• Advertising • Less likely • Shells are available to• App Store for download enable usage by those with institutional access or “skinny” versions of content 23
  25. 25. Technical Issues • Technical Options – Web-based approach • Quickest approach • Not a complete solution (no off-line capability; can use various device features) – Vendor Specific (You pick the winner or sink the cost) • Works within capabilities of specific device/platform • Some platforms have limitations (Apple does not permit Flash and 3G usage; it avoids apps that impact network resources) – Hybrid Digital Platform • Permits service to multiple device platforms • The issue is choosing the right platform©2008 Thomson Reuters • Recommended Reading: “Building Applications for the Mobile Web, Best Practices,” at Thomson Reuters Legal, 10/28/10 24
  26. 26. Challenges Moving Forward• The path to the highest quality solution sets will require additional progress in electronic health records (EHRs) – Interoperability challenges – Data standardization challenges – Adoption challenges (perhaps overcome in the US by Meaningful Use requirements)• We are at an early phase that could be the beginning of a path to even greater benefits based upon the ability to access and utilize a very high volume of existing data that will become available as EHRs are fully adapted for use in mobile devices.
  27. 27. U.S. Hospital EHR Adoption Forecasts 90 Hospitals with EHRs (%) 100 85 75 80 80 65 60 40 40 20 12 20 0 2009 2010 2011 2012 2013 2014 2015 2016 100 Hospitals with EHRs (%) 80 60 Any Basic 40 Advanced 20 0 2009 2010 2011 2012 2013 2014 2015 2016*Hospitals in this instance are considered to be acute care, non-federal hospitals; baseline penetration rates are derived from an analysis by Jha, et al in HealthAffairs (October 2010) based on the March-September 2009 AHA health IT survey (N=3101); forecasts modeled based on primary and secondary research withhealth care CIOs Source: Frost & Sullivan
  28. 28. U.S. Physician EHR Adoption Forecasts 100 89 85 81 80 74 66 Physicians (%) 57 60 49 44 41 40 35 29 24 21 18 17 17 20 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year*EHR = any EHR with basic or advanced capabilities
  29. 29. Conclusion• Mobility is already providing important services to healthcare professionals• Moving forward, there should be increasing adoption of EHRs by 2016• The combination of widespread EHRs plus more advanced wireless device features should have a profound effect on the level of information that will be available and useful at the point of care• Future business models will need to account for higher amounts of data available at the point of care, along with the software investment required to access data from various systems 28

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