The document summarizes 12 clusters of mobile health (mHealth) applications for healthcare. It describes each cluster including patient communication applications, access to web-based resources, point-of-care documentation, disease management, education programs, professional communication, administrative applications, financial applications, emergency care, public health applications, pharmaceutical/clinical trials applications, and body-area networks. For each cluster, it provides examples of current applications and considerations for developing standards and evaluating the applications. The document was presented at an mHealth seminar by the CEO of the mHealth Initiative.

1. The 12 mHealth
Application Clusters
mHealth Initiative Seminar
San Francisco
September 18, 2009
Claudia Tessier RHIA
CEO and President
Copyright 2009 mHealth Initiative Inc., Boston MA. All rights reserved.

2. Mobile Phones at the End of the
First Decade of the 21st Century
Worldwide mobile subscriber base >4 billion
Landline phones: 1.2 billion
TV sets in use: 1.4 billion
Registered automobiles: 850 million
People using PCs: 950 million
Access to internet: 1.3 billion
People with at least 1 credit card: 1.5 billion
population has a mobile phone).

3. 12 Mobile Phone Application Clusters
in Healthcare
1 Patient 2 Access to 3 Point-of-
Communication Web-based Care
4 Disease
Management
Resources Documentation
12 Body 5 Education
Area Network Programs
11
Pharma/Clinical
6 Professional
Communication
10
Public 9 8 Financial
Health Ambulance/EMS Applications 7 Administrative
Applications

4. Application Cluster #1
Patient Communication
Before visit During visit
Selection of caregiver Patient education
Pre-visit communication Financial and administrative
Text message Care communication
Email Post-visit and general
Photos
Text messages
Appointment reminders
Email
Appointment request and
Continuity of care
scheduling
Medication reminders
Agenda
Questions (with photos if
Insurance info
applicable)
Update demo data
Patient education
Advance check-in
In the care process
PHR (CCR)
References
Consumer/patient
providing information

5. 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, etc.

6. Preferred Communication: The Phone
as Identification
Programs like the airlines’ “Remember Me”
provide
A direct path to information about you when
calling from a phone number pre-registered with
your provider.
The system recognizes your phone number,
instantaneously pulls up your information and
even greets you by name.
All of this information is available within a few
seconds at the beginning of the call

7. Benefits of mHealth Patient
Communication Systems
More communication between clinician and
patient leads to
Better quality of care
Greater continuity of care
Greater efficiency
Fewer visits
Lower costs

8. Considerations
All communication must be clear and
customizable (usability)
Reason for visit
Both parties need acknowledgement This may
even be more important for the provider because it will allow them to
be better prepared and confirm that tests required for the visit have
been done.
Requires new workflow, parameters and
protocols
ID Systems: Photo and “Remember me”

9. Considerations
Requires new reimbursement system
Do all communications have equal value? If nine
communications are required in one instance and five in
another, are they paid the same?
How do you measure the amount of work required by the
physicians behind the scenes for each communication?
Would compensation paradigms that include a frequency
component invite abuse?
Can the evaluation of the value/compensation be
automated or does it need a new bureaucracy?
Is this another good reason to move to capitated
compensation structures so that providers are free to
focus on the optimal way to arrive at best case
outcomes?

10. Considerations
Providers must have an auto responder function
about emergencies
What is the difference between text messaging
and telephone messages in terms of impact and
liability?
Perhaps the terminology should be “emailing or
text messaging” since text messages are limited
to 160 characters, which may be too limiting.
All communication should be logged and saved
for a minimum period.
Everything that isn’t easily and automatically
identifiable as unnecessary (such as appointment
reminders) should be saved in an EMR, otherwise
time/money is wasted deciding on what’s worthy.

11. Standards Needed
Patient ID
Structured communication
Security/confidentiality
Provider workflow issues

12. Application Cluster #2:
Access to Web-based Resources
Formularies
Guidelines and protocols
Decision support
Telemedicine guidelines
Accessing specific CCR information
Patient’s comments re Web
Patient directives
PHR
For providers and patients

13. Lexi-Comp References
Credit: Renee McLeod

14. Drug Programs
Credit: Renee McLeod

15. Search PubMed
(Pub Search is a free application)
Credit: Renee McLeod

16. Application Cluster #3:
Point-of-care, Real-time Documentation
The promise of EMRs at your
fingertips anywhere, anytime
Access patient history in real-time
Document (capture patient information
capture and generate report) in real-time
Transmit patient information in real-time
Navigate patient information in real-time

17. Real-time, point-of-care
information capture!!!
Is documentation
like this acceptable
anywhere other
than in healthcare?
• Legibility
• Structure
• Meaning
• Completeness

21. Issues
Accuracy
Authentication
Interoperability
mDevices to HIS and EMR
Medical devices wireless communication
EMC
Data integrity

22. Accessing Patient Information
Interoperability
From internal system
From a Website
From the phone card

23. Application Cluster #4:
Disease Management
Currently focused on
Diabetes
Asthma
Dermatology
Preventive care in pregnancy
Smoking cessation
Hypertension

24. Diabetes
Several companies
Applications
Parents to monitor their children
Patients to monitor and report their health
data

25. Record Blood Sugar Intake
Record Instant feedback Follow up

26. Meal Planning Questions

27. Disease Management Issues
FDA approval
Proof of ROI
Collection of projects/experiences
Aggregation of data

28. Application Cluster #5:
Education Programs
Teaching, monitoring, coaching…
New applications in nursing and other
areas
Teaching patients self-care, monitoring,
expectations
Need standards

29. Application Cluster #6:
Professional Communication
Preferred communication channels for lab,
pharmacy, etc.
Colleagues
Specialty-specific communities
Disease-specific experiences
Ask the expert!

30. Application Cluster #7:
Administrative Applications
Provider-patient Asset tracking
applications Surgical instruments
Financial data Medical records
Demographic data Equipment
Non-clinical data
Appointments
Patient flow
Self check-in
management
Reminder Scheduling
Admissions/discharges
Staff communication
Internal
Bed management
External
Third parties
Payers
Labs
Other providers

31. Application Cluster #8:
Financial Applications
Charge capture
Providers accessing eligibility info
Providers sending bills
Patients accessing coverage and co-pay
information
Payers in active communication with
patients and providers
Online real-time adjudication

32. Application Cluster #9:
Emergency Care
Not starting with a “blank sheet”
Potential need for record locator system
Substantial cost reductions expected
San Diego experience

33. Application Cluster #10
Public Health
Reporting of disease outbreaks
Swine flu, for example
Alerting providers
Instructing patients
Bioterrorism
Surveillance
Population notifications
Increasing adoption in developing countries
Other

34. Application Cluster #11
Pharma/Clinical Trials
Clinical trials
Automatic, scheduled and ad hoc information
transmission
Rely on instrument rather than patient for
routine data collection
Patient feedback systems

35. Application Cluster #12:
Body-area Networks (BAN)
Mobile wearable or implanted sensors that
monitor vital body parameters and
movements and wirelessly transmit data from
the body to provider or elsewhere via a home
base
Examples
Heart monitor could alert pending heart attack
Auto-inject insulin for patient whose blood sugar
drops
Sports activity monitoring: speed, distance, heart
rate, blood pressure
Fantasy? - Exchange business cards (or patient
demographic data) with a handshake?
Big issue: Security

36. mHealth Initiative Plans
Develop online resource to record and
access information about mApps
By application cluster
By device
By disease
Information from vendors
Information and feedback from users

37. Thank you!
www.mhealthinitiative.org
c.tessier@mhealthinitiative.org
617-816-7513