mHealth in Everyday Practice Plain Talk

September 7, 2012 Steve Heilman M.D., FACEP

System Vice President and Chief Medical Information Officer

Integrated Delivery Network of

Five Not-for-Profit Hospitals

14 Out-patient Centers

1.4 Million yearly patient encounters

$1.5 Billion yearly revenue

12,000 Employees

500 Employed Providers

2,000 Physician Medical Staff

2,000 Licensed Beds

60,000 Admissions/year

Norton Healthcare

Key Messages for Discussion

• mHealth Overview

• Clinician Utilization

• Patient Engagement

• Population Management and Research

• Healthcare Reform and mHealth

• Adoption Barriers

What is mHealth?

• The use of mobile and wireless devices to improve health outcomes, healthcare services and health research

• Applications of mHealth include: – Utilizing devices to collect community and clinical

health data

– Delivery of healthcare information to clinicians, researchers, and patients

– Remote monitoring

– Remote provision of care

Routine Clinician Applications

Quick and easy access to cloud based data– drug guides, medical alerts, journal summaries and medical references.

Routine Clinical Applications

Electronic Medical Record (EMR) Access – dedicated native applications to access patient data, refill prescriptions, review and release labs, communicate with staff and patients via secure messaging.

Routine Clinical Applications

Access to Personal Health Record (PHR) information

Routine Clinical Applications

Remote Monitoring Access

New Applications for Clinicians

• Digital Dermatoscopes

• Digital Stethoscopes

• Ultrasound applications

• Medical Imaging Review

Home Monitoring Applications

• Bluetooth devices – scales, glucose monitors, BP, Medication dispensers

• Positive Feedback

• Patient Education

New Applications

• Microchip patch/ Ingestible event monitors

• Cardiac Monitoring

Population Management/ Research

• Telemedicine – enabling the provision of care anywhere. ? mHealth

• Physician Specialty Shortages

Population Management/ Research

• Asthmapolis

Population Management/ Research

• Home monitoring can improve outcomes • Columbia University1 – telehealth and data collection

from glucometers - greater↓HbA1c compared to control group

• Weight and vitals monitoring in CHF patients2,3 - ↓office visits 10% ↓home visits 65%. ↓ six month mortality rate 56.2%

1. Shea S, Weinstock R, Starren J, and etc. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically

Diverse, Medically Underserved Patients with Diabetes Mellitus. J Am Med Inform Association 13:40-51, 2006. 2. Cleland J, Louis AA, Rigby AS, and etc. Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and

Death, Journal of the American College of Cardiology 45(10):1654, 2005. 3. Goldberg LR, Piette JD, Wals MN, and etc. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure

the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 146:705-712, 2003.

Population Management/ Research

• Africa (Malawi)– Addressing HIV infection with mHealth

– Texting HIV test results, treatment instructions

– Relay results of treatments back to public health

– Prevention messages to high risk groups

Healthcare Reform and mHealth

• Fee for service – Reimbursement based on Volumes ≠ improved adoption efficient tools

• Accountable Care Organizations

• Value Based Purchasing

• Capitated Care

• Bundled Payments

• Security • Integration • Licensing Regulations • Bandwidth • Reimbursement • Patient Engagement/Compliance • Physician Acceptance

Adoption Barriers

Choices to Make

Questions?