cognizant reports | july 2012

• Cognizant Reports

Executive SummaryFinding innovative ways to improve clinical outcomes is of great importance to payers, providers and consumers alike, and mobile technology is at the center of this pursuit. While cost reduction and improved outcomes ultimately require process and technological changes at multiple levels, mobility is seen as having the potential to transform healthcare practically overnight and in novel ways — that is, if security and privacy challenges are appropriately tackled with an enterprise-wide mobility policy. Only then can better, cheaper and more efficient delivery of healthcare become possible.

Our research shows that healthcare organizations that are able to bring together disparate data as part of an overall mobility and connected health effort will forge ahead.

The pervasiveness of mobile devices is forcing the industry to adapt to changing operational needs, as well as the lifestyle requirements and expectations of a growing portion of the population. Moreover, the continued pressure to cut costs will drive development of new mobile remedies across the healthcare industry, such

U.S. Healthcare: Mobilizing Care and ClaimsMobility has forever changed how healthcare is delivered. The desire for improved productivity, lower costs and higher quality care is prompting providers and payers to adopt enterprise-wide mobility strategies. The goal: greater efficiency, self-empowerment and a healthier population.

as apps that deliver remote diagnostics and diagnoses in locations where it is either too expen-sive or impractical for caregivers and patients to be proximate.

On the payer side, mobile apps will increasingly enable patients to more conveniently monitor claim status. By empowering patients, payers will reap cost savings that they can pour back into core business activities and contribute to the overall healthcare industry’s mission of saving lives.

However, to improve consumer care and com-fort, providers and payers must embrace enterprise-wide mobility strategies that protect data privacy and prevent security lapses, hack-ing and malware. Also, healthcare organizations must first figure out how to co-exist with and extend legacy systems and processes to accom-modate the ever-evolving capabilities of mobile OS platforms and devices. This requires an imme-diate fix that will only take shape once standards are codified and followed, enabling healthcare organizations across the ecosystem to achieve long-awaited operational cost relief.

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Mobile Device Ubiquity The number of smartphones and other mobile devices in use globally is growing astronomically. Approximately 900 million tablets will have been purchased by 2016, which means approximately 12% of the world’s population will own a tablet. Smartphone purchases are expected to grow at a CAGR of 14.5% between 2010 and 2016.1

According to a 2011 survey by the Healthcare Information and Management Systems Society (HIMSS), nearly 89% of physicians in the U.S. use a mobile device, as do 32% of patients surveyed by HIMSS (see Figure 1).2

The mobile applications market in the healthcare industry was estimated at $100 million in 2010 and is projected to reach $1.7 billion in 2014.3 In 2010, 63% of U.S. physicians used mobile health, or “m-health,”4 apps, which is projected to reach 100% in 2013 (see Figure 2, next page).

Healthcare's Increasing Use of Mobile Historically, patient care was delivered at particular locations and at particular times. However, with the ubiquity of mobile devices, this is set to change. Both baby boomers and millennials are embracing mobile technology that provides immediate feedback and guidance on their health.5 Increasingly, even the elderly are using home monitoring devices for chronic or co-morbid health conditions. This allows them to monitor their vital health indicators and take control of their own health management.6

Physicians are also using these measurements to decide whether professional intervention is necessary.

As the average age of populations around the world rises, the demand for primary-care physicians is also increasing; as a result, the delivery of care will likely become more difficult and expensive. Moreover, it will not always be possible for the patient and physician to be in the same location at the time of an emergency. Advancements in mobile, wireless and other tech-nologies will enable remote patient monitoring and diagnosis to help address such emergencies. Remote patient monitoring will solve the issue of proximity, while mobile technology can ensure the delivery of flexible care outside the traditional healthcare setup.

Healthcare providers already use mobile devices such as smartphones and tablets to examine, consult, diagnose, treat and follow up with patients. Payers use mobile devices for insur-ance premium payments, collecting and process-ing claims data, locating physicians, providing directions to low-cost retail clinics and managing care for customers. Consumers use mobile appli-cations for wellness and fitness management, as well as accessing information, such as locating doctors and clinics (see Figure 3, page 4).

Telehealth’s Growing PopularityTelehealth’s7 acceptance as a safe and effective way to deliver care is growing. According to

Base: 164 HIMSS members

Figure 1

Source: HIMSS Survey, October and November 2011

Use of Mobile Devices by Professional Groups

Other

None of the Above

Patients

Administrative/Support Staff

Healthcare Executives

Non-Physician Clinicians

Physicians

3%

3%

32%

62%

70%

84%

89%

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“The World Market for Telehealth: A Quantitative Market Assessment, 2011 Edition,” by InMedica and IMS Health, the global market for telehealth is expected to reach $1 billion by 2016 and could jump to $6 billion by 2020. Consequently, the number of individuals using telehealth through mobile devices is bound to rise (see Figure 4, page 5).

Tracking Health Indicators in Real Time With the advent of mobile devices, patients now have the ability to monitor their health indicators by the second and contact their physician with any concerns. Patients mainly track weight, vital signs, calorie intake, sleep patterns, etc. in real time (see Figure 5, page 6).8

Companies such as Medtronic provide mobile applications (running on Apple iOS devices) that help clinicians access data, such as cardiac device diagnostics and patient data, directly from their mobile devices, thus connecting cardiac device patients to their clinic and physician from any location.

Early Success in Improving Healthcare Many organizations in the healthcare industry have implemented clinical and administrative mobile solutions. On the clinical side, key solu-tions include imaging, medication administration and electronic medical record (EMR) systems. On the administrative side, organizations are using inventory management, financial analytics and personal contacts or calendars.

Physicians deploy solutions for health informa-tion exchanges, e-prescriptions and comput-erized order entry. Other applications include real-time location systems, patient scheduling and patient check-in and check-out systems.9 Previously, doctors were passive recipients of information gleaned from product information brochures, manuscripts, sales representatives and journals. Now, the sources have changed to e-details, blogs, mobile apps, Twitter, portals and social networks. All the stakeholders in the current context — doctors, patients and care- givers — are digitally connected.

Mobility has four key advantages:

• Access to EMR for viewing and entering real-time patient data, information shar-ing and consultation. Making EMR systems accessible through mobile devices results in 60% faster documentation of vital signs and 83% less data being transcribed manually.10

• Faster insights, leading to speedier decision-making.

• Reduced time spent managing records, improved data capture, reduced errors and improved quality of provider interaction with patients.

• Ability for patients to view their own records and seek help as needed.11

Drivers in the Payer IndustryMobility drivers for business-to-business (B2B) and business-to-consumer (B2C) are widely divergent. In the B2B context, medical claims

Figure 2

Source: Chilmark Research

* Projected

U.S. Physician Adoption of Smartphone and Apps

0%

20%

40%

60%

80%

100%

No smartphone Have smartphone, no content app use Have smartphone, use content apps

Dec. 2008 Dec. 2009 Dec. 2010 Dec. 2011 Dec. 2012* Dec. 2013*

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processing is inherently suited to benefit from mobility. Mobile data entry with the right built-in error correction and validation reduces errors and the need for adjudication at the payer end. Mobility can help in the sales process, as well. With real-time information available through mobile devices, there is a direct impact on incremental revenue.

In the wellness and care management link in the value chain, mobile-enabled remote sensors will help deliver care at a lower cost in a non-hospital setting, directly impacting the bottom line. In the B2C context, better mobile solutions will broaden the customer base and attract demographic segments considered less costly to serve (i.e., younger and more educated populations). Inter-active exercise trackers and basic guides about calorie intake will help payers in wellness and care management. Once these systems are integrated with healthcare records and with healthcare providers, there will be a multiplier effect on the industry as a whole.12

Impact of Emerging Technologies Cloud-based services are being used in the healthcare industry to exchange medical, financial and other sensitive data across health-care information exchange (HIE) networks. As business processes are transformed to support mobile devices, the intersection of mobility with cloud will become an important factor in IT strategies.

One beneficiary will be rural health collectives,13 which will increasingly gain access to this critical data through cloud services. The healthcare provider setting is subject to large volumes of data and processing needs, such as imaging, real-time health information, prescription details and comprehensive analyses of medical condi-tions. An epidemic or a natural disaster would necessitate robust and flexible storage and systems in the healthcare setting.14

According to research by Markets and Markets (M&M), approximately 32% of healthcare facili-ties surveyed already use cloud applications. Of those not yet in the cloud, 75% intend to be there over the next three to five years.15

Healthcare organizations that have imple-mented or are implementing cloud solutions have realized annual average savings of up to 20%. Cloud usage for medical applications is predicted to grow at a CAGR of 18% through 2015. The key benefits of cloud-based services for healthcare organizations include:

• Service is provided and paid for on demand.

• Network access to all computing resources is persistent.

• Interaction with the service provider is minimal, reducing required management effort to near-zero.

Figure 3

Source: “Telehealth Defined, Explained and Explored,” Frost and Sullivan, 2011

Telehealth Markets

Professional

CustomerFocus

Consumer

Consumer/Non-HealthcareApproaching Telehealth

Core Telehealth Traditional Healthcare and Telemedicine

Industry FocusHealthcare

InformationCommunication

Technologies

Mobile healthsoftware

Fitness apps

Wellness apps Health coaching

Wellness systems

PERSPatient portals

PHR Activity monitoring

Medication dispensing

Remote vital signs

Diabetes monitoring

ECG monitoring

Mobiletelemedicine

Sleep apnea

Tele-imaging

Tele-pharmacy

EMR/EHRHIE

Robotic telepresence

Simulation/Training

Mobility/Tablets

Mobile Information gathering and delivering

Remote videoconsultation

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Challenges Implementing MobilityA major source of concern among patients and the medical community is the potential for “doctor distraction” resulting from the use of mobile devices. Instances of doctors making personal calls during surgery, nurses checking airfares during surgery and technicians texting while operating bypass machines have been reported.16 Ensuring responsible use of mobile devices by healthcare professionals is crucial. Friction between younger and older physicians can also result from their differing understanding and use of technology.17

The security of mobile devices in healthcare orga-nizations is also a potentially tricky area. A lost or stolen mobile device costs more than any other type of data breach. A study by the Ponemon Institute found that 62% of lost or stolen mobile devices contained sensitive information.18 It is, therefore, important for healthcare organiza-tions to devise an enterprise-wide mobile security strategy.

Methods that can enhance security include mobile device management (MDM) solutions with remote device wiping, mobile application management (MAM) with application-level security and policy features, encryption of mobile devices and anti-theft technology. Consumers will increasingly demand a healthcare setting where their privacy

and security concerns are adequately addressed (see Figure 6, next page).

Hospitals are increasingly feeling the constraints of outdated wireless networks. An adequate IT infrastructure is required to support expand-ing volumes of healthcare data within hospitals. Managing the large quantity of actionable data, securing patient data and managing interoper-ability are among the challenges that hospitals need to overcome.

A RoadmapTo address the security challenges, a comprehen-sive policy for all employees and contractors who use mobile devices should be developed. Hacking and malware infections must be handled using application control and patching. Integration of various technologies and applications with legacy systems is a must. Universal standards should be developed and regulations put in place to ensure privacy and security.

Myriad data sources and technologies, as well as legacy systems, generate fragmented data. To create operational efficiencies, this data needs to be integrated as part of the overall mobility and connected health effort, although a lack of standards in how to do so remains a challenge. A comprehensive strategy encompassing plat-form, applications, approaches and users is,

Number of subscribers

Figure 4

Source: InMedica, August 2011

* Projected

World Market for Telehealth: Subscribers by Disease Condition

0

100,000

200,000

300,000

400,000

500,000

600,000

2010 2011 2012* 2013* 2014* 2015*

CHF Chronic obstructive pulmonary disease Diabetes Hypertension

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therefore, critical. Otherwise, the switching costs for embracing enterprise mobility will make the transition prohibitively expensive.

Apart from the security challenges, healthcare organizations must also address usability require-ments, technical challenges, battery issues, failed transmission, synchronization issues, network issues, device breakdown and input adaptability.

Paper-intensive processes should be reduced to maximize efficiency gains. If the data is

captured in real time with built-in error checking, it will save time, which is of critical importance. The management of infrastructure, data storage and applications can be entrusted to an external partner, and the entire package can be used on a pay-per-use model. This will free up resources to focus on the most critical activity for a healthcare provider — saving lives.

RecommendationsTo successfully identify and adopt mobility solutions and benefit from the value that

Figure 6

*Has a blog, uses Twitter, Facebook or YouTube to communicate and engage with patients

Source: PwC HRI Consumer Survey, 201119

Consumers Seek Privacy, Security

Attributes that would cause consumers to select one hospital over another if cost, quality and access were equal

5%

17%

20%

28%

30%

Social media presence*

Electronic health records

Other, such as doctorrecommendations, location

Online consultations with doctor

Clear privacy/security policies

Figure 5

Source: PwC Health Research Institute (HRI) Physician and Consumer Survey, 2010

Health Indicators that Consumers and Physicians Want to Track

10%

20%

30%

40%

50%

60%

70%

Weight Vital signs

Calories/fat consumed

Exercise/ physical activity

Sleep patterns

Blood sugar

Acid reflux/indigestion

Digestive health

Physicians Consumers

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Footnotes1 Patrick Thibodeau, “Expecting a Recession, Gartner Urges ‘Creative Destruction’,” Computerworld,

Oct. 17, 2011, http://www.computerworld.com/s/article/9220914/Expecting_a_recession_Gartner_urges_creative_destruction.

2 Angela Dunn, “Only 38% Have a Mobile Policy: HIMSS Releases Survey, Launches MHIMSS,” Hl7 Standards, Dec. 15, 2011, http://www.hl7standards.com/blog/2011/12/15/only-38-have-a-mobile- policy-himss-releases-survey-launches-mhimss/.

3 Brian Dolan, “By 2014, $1.7 Billion Market for Mobile Apps in Healthcare Enterprise,” MobiHealthNews, Nov. 22, 2010, http://mobihealthnews.com/9581/by-2014-1-7b-market-for-mobile-apps-in-healthcare-enterprise/.

4 The Global Observatory for eHealth (GOe) defines mobile health, or “m-health,” as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices.

5 Julee Thompson, “Providers and Patients are Embracing Mobility,” HealthcareITNews, Sept. 30, 2011, http://www.healthcareitnews.com/news/providers-and-patients-are-embracing-mobility.

6 ibid.

7 The delivery of healthcare at a distance using electronic means of communication, such as remote monitoring of patient health conditions and transmitting this information to clinicians.

8 HRI commissioned an online survey in the summer of 2010 of 2,000 consumers and 1,000 physicians regarding their use and preference of mobile technologies in the U.S.

9 “Provider’s Perceptions: Mobility in Healthcare, 2011,” Billian’s HealthDATA and Porter Research, August 2011, http://www.ciosummits.com/media/pdf/solution_spotlight/porter_providers-perceptions.pdf.

10 “Using Mobility to Improve Patient Interactions,” Sybase, 2011, http://m.sybase.com/files/Data_Sheets/Sybase_Better_Patient_Interactions.pdf.

11 “Mobility Advantage: Health Care Made Easier, 2011,” Sybase, 2011, http://m.sybase.com/files/ White_Papers/Sybase-Mobility_Advantage-Health_Care_Made_Easier_wp.pdf.

mobility can bring, organizations need to devote time and resources to visioning and planning. This will provide the necessary foundation for strong execution. Without this prepara-tion, healthcare organizations will not get the envisioned value from their mobility investments.

Our recommendations for healthcare organiza-tions looking to make the enterprise mobility leap include:

• Establish a mobility center of excellence or similar working group.

• Decide on an appropriate mobility strategy, based on the organization’s business and tech-nological maturity and operational objectives.

• Assess the various mobility solutions that can be deployed and process changes required to meet these overall objectives.

• Work with a partner that understands the full spectrum of mobility technologies and implications, including mobility trends, data security, systems integration, application development platforms, etc.

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AuthorsYuvaraj Velusamy, Researcher, Cognizant Research CenterSanjay Fuloria, Senior Researcher, Cognizant Research Center

Subject Matter ExpertsSuresh Ganesan, Assistant Vice President, Cognizant Life Sciences and HealthcarePatricia Birch, Vice President, Cognizant Business Consulting, Healthcare PracticeJeffrey Wallace, Assistant Vice President, Cognizant Mobility Business Development Head

DesignHarleen Bhatia, Creative DirectorSuresh Sambandhan, Designer

12 “Health Insurance Mobility: Myriad B2B and B2C opportunities for Payors Throughout the Value Chain,” Everest Global, Inc., 2011, http://www.everestgrp.com/wp-content/uploads/2011/08/POV- HC-Payer-Mobility-December-2011.pdf.

13 Rural health associations focused on the health of people in the vicinity.

14 Srinivasan Sundara Rajan, “Challenges and Solutions for the Healthcare Industry in Cloud Computing,” Cloud Computing Journal, Jan. 24, 2011, http://cloudcomputing.sys-con.com/node/1685234.

15 Barbara Filkins, “Cloudy with a Chance of Better Healthcare: Security and Compliance Fundamentals for Protecting e-Health Data,” SANS, September 2011, http://www.sans.org/reading_room/analysts_program/arcsight-ping-healthcare.pdf.

16 Matt Richtel, “As Doctors Use More Devices, Potential for Distraction Grows,” The New York Times, Dec. 14, 2011, http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all.

17 “Mobile Health Technology Trends for 2012,” The Mobile Enterprise, Jan. 25, 2012, http://www.rapid-valuesolutions.com/blog/mobile-health-technology-trends-for-2012-3/.

18 “Seven Tips for Securing Mobile Workers,” Ponemon Institute, May 2011, http://m.softchoice.com/cms/brands/sophos/pdf/sophos_seven_tips_securing_mobileworkers_4.pdf.

19 PwC’s Health Research Institute commissioned an online survey of 1,000 U.S. adults in fall 2011.

References“Trends for the Mobility-Enabled Healthcare Enterprise and Security Threats, Vulnerabilities, and Countermeasures,” Booz Allen Hamilton, HIPAA Conference, May 2011, http://csrc.nist.gov/news_events/HIPAA-May2011_workshop/presentations/day1_HIPAA-conference2011-secure- mobile-and-wireless.pdf.

“Achieving Better Patient Care and Efficiency through Mobility in the Age of Healthcare Reform,” MedTech, 2011, https://secure.logmeinrescue.com/Common/Pdfs/MedTech_wp.pdf.

“Healthcare Unwired, New Business Models Delivering Care Anywhere,” PricewaterhouseCoopers, 2010, http://www.pwc.com/us/en/health-industries/publications/healthcare-unwired.jhtml.

About Cognizant

Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 140,500 employees as of March 31, 2012, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world.

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