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Does mHealth need a doctor’s prescription?
 It’s a simple question: Do mobile health tools require a doctor’s prescription? Or will the main driver for mHealth services bubble up from consumers and patients largely without care providers weighing in?
Throughout the keynote sessions at the mHealth Initiative’s event in Washington D.C. this week, the focus was squarely on care providers’ adoption of mobile technologies, their integration to EMRs and the opportunity subsequently created for patients and consumers. While yesterday’s morning keynote presentations mentioned patients’ self-directed interest in mHealth, it was more in passing, as an after thought or as a consequence of physicians’ adoption.
Rob Havasy, an mHI event attendee and business analyst at the Center for Connected Health in Boston reacted to the focus on providers with a succinct message to his Twitter followers: “When providers adopt consumers will engage.” That message was also apparent in his recent blog post on the larger mHealth opportunity a few weeks ago (revisit it here).
During lunch another attendee agreed that it needs to start with care providers — the lackluster adoption of PHRs, like those offered by Google Health and Microsoft’s HealthVault, demonstrate that most consumers aren’t likely to quickly adopt connected health solutions. These online platforms are most useful when used in conjunction with connected health devices that can populate them with personal health information. Care providers need to educate patients about these devices and services.
Last fall, I interviewed Insignia Health’s CEO Chris Delaney who explained his firm’s categorization of “activated” patients: The lowest level, Level 1, are those patients who do not take an active role in managing their own health for a variety of reasons, but mostly because they believe they aren’t in charge. This patient group is also known as the “frequent fliers” in the emergency room. The group is also the most likely to be readmitted to the hospital after 30 days. They are also the least adherent to medication and other care plans (Delaney said they are around 20 to 30 percent adherent). They also make up most of the health care costs in the U.S., Delaney said. On the other end of the spectrum is the most activated patient group, called the Level 4 group. These patients already take good care of themselves — they are about 80 percent adherent to their medications and are eager to maintain their health regimens and remain in control of their own health. The e-Patient falls into this group. Level 4 patients are very interested in mobile health.
Of course, even e-Patients believe in a strong relationship with their care providers: e-Patient Dave deBronkart recently formed the Society for Participatory Medicine with his physician Dr. Danny Sands. deBronkart said he and his doctor are co-chairs of the organization, which aims to promote best practices for patients working together with their care providers as responsible partners.
While adoption of mHealth services will undoubtedly benefit from a number of drivers pushing it along simultaneously, it seems that right now, anyway, there is a growing consensus that care providers need to step up and punch out a much needed m-prescription.
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@mHI Neurologist: Docs just need willpower
“Where I am should not limit what I can do or how I get it done,” asserted Dr Andrew Barbash, Neurosciences Director at Maryland-based Holy Cross Hospital during his keynote presentation at the mHealth Initiative’s event in Washington D.C. Barbash’s presentation, entitled, “Integrating mHealth in a Physician’s Practice” was a fast-paced talk that described Barbash’s own adoption of mobile applications at his facility. Barbash was quick to point out that in some cases he did not wait around to ask for permission from his higher ups.
“Pay me for my time and my efficacy,” Barbash said. “I can find and pay for whatever tools I need to get the task done. Nobody told [physicians] to go out and buy iPhones or… Treos. Mobile health and the telecommunications industry is making it easy for us to get the tools we need. [That's true for] patients too. The healthcare industry needs to get out of the way in some cases.”
Barbash flashed his Verizon Wireless-powered Google Droid phone while at the podium: “I am a big Google fan. They understand the nature of search, which is the process that underlies all of thought. That’s [another] long discussion, but for a neurologist, it’s very interesting. I figured I would get shot for this, but I loaded Google Chat [an instant messaging application] on all [my department's] physicians’ computers. Now, my phone doesn’t [ring] anymore. I get a text message.”
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@mHI Medical Minutes: Incentive for mHealth
Last year Washington DC-based George Washington Medical Center teamed up with WellDoc and Medicaid PPO clinic, Chartered Health Family Clinic to determine the efficacy of an intensive mobile phone based program for Medicaid patients with diabetes. The program is currently underway.
“I was told if we could get this to work with this population, we could probably do it anywhere,” Dr. Richard Katz of the George Washington Medical Center said during his presentation at the mHI event in Washington D.C.
Katz said the program aims to cut down on emergency department visits and hospitalizations, improve diabetes HEDIS goals, reduce A1c, improve self-management of co-morbities, improve medical adherence, decrease medical errors and enhance medical information exchange.
In Washington D.C. if a patient is discharged from the hospital and goes to a city clinic, there is only a one in ten chance that the clinic has any information about that discharge, Katz said. That is a health information exchange problem, but if that data was residing on a cell phone app or personal health record — that HIE problem begins to go away.
I would like to say that this program has cost effectiveness and sustainability, but better health may be more efficient but not necessarily more cost effective. There are going to be more costs, but hopefully they are not excessive, Katz said. The current mobile phone-based diabetes program Katz’s team is facilitating cost under $200,000 to implement, he said.
Katz explained that early attempts to recruit 150 patients with diabetes at the DC clinic proved difficult: His initial seven scheduled interviews produced seven no-shows. So, he upped the incentive.
“This system requires a smartphone,” Katz said. “We are not just going to send text messages — It is what it is.”
Some 27 percent of the people who own mobile phones in the U.S. use smartphones and within the Medicaid population smartphone adoption is very small, Katz said. Most use prepaid phones and services. Katz decided to offer participants in the program an upgrade to a web-enabled phone at a subsidized rate. He called it “Medical Minutes.”
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@mHI FCC: mHealth for economic growth, jobs
During his keynote this morning at the mHI event in Washington D.C., the FCC’s Digital Healthcare Director Dr. Mohit Kaushal pointed to Haiti earthquake survivor Dan Woolley’s use of an iPhone first aid application to treat his own compound fractured leg and head wound: “This miraculous story would not have been possible a few years ago… but it’s just the tip of the ice berg,” Kaushal said. Kaushal predicted that with the FCC’s national broadband policy [set to be published in March], many more of these types of mHealth stories will be made possible.
Kaushal made note of the thousands of health-related mobile applications and pointed to AirStrip Technologies, Corventis, Intel Health Guide and Medtronic as examples of companies working in the space.
Mobile will have a huge role in transforming healthcare, Kaushal said. This growing industry is a potential source of economic growth and job creation. The FCC’s broadband plan is hoping to advance mHealth, but there are still a number of barriers. Infrastructure, wireless spectrum, regulation concerns, reimbursement and payment reform are all key issues that the FCC believes are important to the growth of mHealth.
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@mHI AT&T details four iPhone Hospitals
AT&T Industry Solutions Practice Manager for Healthcare John Hamilton and Senior Healthcare Marketing Manager for Mobility Product Management Tammi DeVore provided details on hospital wide launches of iPhones at four care facilities in North America: Doylestown Hospital, Cedars-Sinai Medical Center; and Mt. Sinai Medical Center. While we have written about each of these hospitals’ iPhone adoption in the past, Hamilton and DeVore offered up more specifics:
Cedars-Sinai Medical Center has created a HIPAA compliant web portal that is optimized for the iPhone’s Safari web browser. Unlike most iPhone apps, this deployment is really just a website optimized for the iPhone, as opposed to an application hosted on the phone itself. The portal includes access to patient information and consolidates information from 30 hospital systems for 8,000 of Cedars-Sinai’s workers — each of whom is now an iPhone users, according to AT&T. Hamilton noted that perhaps most remarkable, the 8,000 users conduct about 20,000 sessions on the mobile portal everyday.
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@mHI Startup boasts 150K paying mHealth users
“Text messages — SMS — Can you create powerful content in 140 characters or less?” mDhil’s founder Nandu Madhava asked during his presentation at the mHI event in Washington D.C. “My answer: Yes. Look at Twitter. Basic texts are not only for creating information, but also for creating change. I launched our service in March 2009 and we now 150,000 paid users have accessed our content. Do you know of a more successful mHealth company? Let me know if you do.”
mDhil offers text messages with information on various health topics, including: diabetes, H1N1, maternal health, female reproduction and male reproduction. While these subjects are commonly taught in the U.S., mDhil is currently exclusively operating in India, where some of these topics, particularly sexual health topics are not commonly discussed. mDhil charges approximately 65 cents per message. The startup partners with wireless operators including Idea Cellular, Airtel, Reliance, which get a substantial cut of revenue from each message sent.
Madhava and the team at mDhil is working toward 1 million users by the end of 2010 and hopes to hit 3 million by the end of 2011. Consider that there are currently 525 million mobile users in India (that number is growing very quickly 12 million to 14 million more each month) and Madhava’s ambitions may not seem so out of reach.
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@mHI The mHealth "revolution" is unstoppable
The Mobile Health Initiative (mHI) event in Washington D.C. this morning began with two keynotes from the mHI’s founders Peter Waegemann and Claudia Tessier, who built on their previous presentation of the mHI’s 12 clusters for mHealth and overall vision for mHealth’s opportunity.
While it may not be too surprising given the mHI’s previous focus on EMRs as the Medical Records Institute, the thrust of much of their presentations were on provider-prescribed and physician-driven mHealth applications as opposed to consumer- or patient-directed. As one attendee noted, consumer adoption would follow physician adoption, but a good portion of the current activity in mHealth seems to be the other way around. Here’s a summation of the two presentations:
How long before the “mHealth Revolution”?
It might take 15 or 20 years but the mHealth revolution will happen, Waegemann said. It is important to realize, however, that mobile systems are just enablers of change, they are not creating the changes, he said. The real change needs to be in structural changes and systems changes, like payment reform.
eHealth vs. mHealth
Waegemann then explained that the main difference between eHealth and mHealth is that eHealth focuses on technologies. eHealth wants to make healthcare different by pushing technologies to it, while mHealth focuses on behavioral and structural changes, he said. The vision of e-Health is that computers will make healthcare processes more efficient, which is the idea driving electronic medical records (EMR) systems adoption. On the other hand, the vision for mHealth includes collecting data through text, images, emails and supporting patient-hood, Weagemann said. It includes transferring the scientific body of medicine to manageable apps in the hands of the provider enabling the creation of new tools.
Billions in costs savings Continue >>
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10 more takes: Healthcare industry on iPad
HITSP Chair Dr. John Halamka: “The iPad comes closer to my requirements than other devices on the market. However, the ideal clinical device would include a camera for clinical photography and video teleconferencing. Entering data via the touch screen with gloved hands may be challenging on a capacitance touch screen. Holding the iPad with one hand means hunt and peck typing with the remaining hand. The device is a bit large for a white coat pocket, may be hard to disinfect, and may not be tolerant of dropping onto a hospital floor. I look forward to trying one to validate these assumptions. My general impression is that it is not perfect for healthcare, but it is closer than other devices I’ve tried.” More (John D. Halamka, MD, MS is CIO of the Beth Israel Deaconess Medical Center, CIO and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician.)
Mountain View-based El Camino Hospital Vice Chief of Clinical Operations, Cheryl Reinking: “You could use this [iPad] in the operating room, when you need to document things quickly, or in the lab,” Reinking told the SF Chronicle. “Physicians could use the device at the bedside to make notes, or use it as a reference for medications. It could be an amazing tool.” More
Dr. Javeed Siddiqui, associate medical director for the Center for Health and Technology at UC Davis Medical Center: “It’s portable and it’s lightweight,” he said. “It has touch screen, a Web browser — and all those features can be utilized as a way to integrate technology in patient care.” More
Kaiser Permanente is assessing whether the iPad would be a fit for a trial it is conducting in Sacramento, called “Destination Bedside.” KP aims to choose a tablet for use at its hospitals nationwide, according to the Sacramento Bee. More
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eCardio: 20,000 hearts monitored wirelessly
Wireless remote monitoring for patients with heart conditions is fast becoming a crowded space for wireless health companies — CardioNet, the only pureplay wireless health company to have gone public and LifeWatch, a Switzerland-based company are just two of the big players in this ever popular field. Last month we noted that Corventis had received FDA approval for its MCOT system, which put it in competition with the two industry stalwarts.
Before Corventis entered the market, however, Houston-based startup eCardio, founded in 2004, was on the scene. The Houston Chronicle recently caught up with eCardio and profiled the start-up in a roundup of Houston-based innovators.
What’s eCardio’s elevator pitch? eCardio offers a device that lets doctors monitor patients’ hearts remotely. More details? ”Patients wear a device the size of a BlackBerry on their hip or around their neck as well as two electrodes that monitor the heart’s electrical activity. A microprocessor in the wireless device analyzes the data and transfers data to the company’s monitoring center, where it’s verified and sent to the doctor,” according to the Houston Chronicle report.
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CardioNet: 300,000 hearts monitored wirelessly
We reported earlier this week that Houston, TX-based wireless cardiac monitoring startup, eCardio had monitored about 20,000 patients to date. Today, CardioNet, one of the first wireless cardiac companies to go to market has announced that it just passed 300,000 patients monitored by its Mobile Cardiac Outpatient Telemetry (MCOT) service.
“With 300,000 patients having now benefited from our MCOT service, it is evident that an increasing number of physicians view real-time, 24/7 monitoring of cardiac arrhythmias as crucial to identifying and preventing life-threatening cardiac-related events such as stroke,” Randy Thurman, CardioNet Chairman, President and CEO, stated in a company release. “The continued availability and adoption of MCOT also brings value to the entire healthcare continuum as it enables physicians to manage arrhythmias before they manifest into more severe conditions that demand significantly greater costs and resources to treat.”
One of CardioNet’s biggest competitors is LifeWatch, which has an exclusive deal with Verizon Wireless. San Diego-based Corventis also recently launched a competing MCOT service after gaining regulatory approval from the FDA earlier this year.
For more on CardioNet read the press release
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A&D, AWS, MedApps, Nonin aid Haiti
A group of telehealth companies has come together to donate remote monitoring services and devices to care workers in Haiti following the catastrophic 7.0 magnitude earthquake that struck the country last month. A&D Engineering, Advanced Warning Systems, Digicel, MedApps and Nonin have agreed to jointly donate equipment and infratructure toward the relief efforts. The group’s “telehealth ecosystem,” however, will not launch until after rescue and recovery has been completed and longterm relief efforts can begin, the companies said.
According to the group’s press release, A&D Engineering will donate scales, blood pressure monitors and stethoscopes, while Nonin will send portable pulse oximeters — Digicel, one of the biggest wireless carriers in the Caribbean plans to provide the complimentary connectivity for the devices.
More from the group’s press release: Continue >>
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Shorts: Data tsunami; Quantified living; SMS
Data tsunami to overwhelm: According to a survey sponsored by Dell and conducted by HIMSS, small and medium sized hospitals in the US, Europe and China are not ready for the “wave of data” that is set to “inundate” their systems over the next couple of years. More
Another entrant in the person locator service for Alzheimer’s patients and others: “Aerotel Medical Systems of Holon, Israel has partnered with EcoTec of Tampere, Finland to bring the GeoSkeeper personal tracker and communication system to Finnish consumers. The watch-like device has GPS and mobile phone functionality to allow users to send their coordinates if they are calling for help.” More
The power of what is perhaps mobile’s simplest offering: SMS — “Mobile Health Interventions, a new company dedicated to transforming the delivery of health services, [recently] announced the launch of its innovative health text messaging applications: Health Txts and Custom Txts.” More
The ultimate “quantified living” report? Man quantifies and details his every activity in 2009 then releases annual report. More
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Shorts: mAfrica; Health IT survey; AT&T M2M
Working toward “m-Africa”: One mobile health leader has three tenets for a successful launch in a developing market: Price innovation, product reengineering and process innovation and realignment are the “three Ps” for creating a model where global technology can be “made or incubated in a developing country, as well as supporting and stimulating local innovations in and sustainable technology transfer to developing countries.” This concept, named m-Africa, was developed on the Barcelona-based Global Living Labs’ platform. “The Sinseprod-Global Living Lab initiative focuses on how to develop health service around m-health technology,” according this report in Telecoms.com More
Survey says Health IT budget increases: Research firm StatCom surveyed 440 healthcare executives and determined that a majority expect to increase their health IT spending in 2010: ”It is good news that, even in the midst of a challenging economic environment, most hospitals plan to increase IT budgets in 2010,” StatCom President Karl Straub stated in a company press release. “In an era where healthcare facilities are closely monitoring their expenditures, an increase in IT budgets, if focused on solutions that can deliver improved patient throughput and productivity will have a positive impact on the healthcare industry.” More
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| February 4 , 2010 Edition |
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mHI’s International mHealth Networking and Web Conference
Feb. 3 – 4, Washington, DC
The conference will be a resource for clinicians, C-level executives, HIT professionals, health information management professionals, biomedical engineers, health information systems professionals, mobile health and telecommunication professionals, payers, government agencies, developers, vendors, and other healthcare stakeholders to learn strategies for new communication patterns and for improving healthcare through these new technologies. The objective of the conference is to provide a comprehensive overview of the twelve mHealth healthcare application clusters that mHealth Initiative has identified.
More info
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Institute for Health Technology Transformation’s Winter Health IT Summit
Feb. 9 – 10, Phoenix, AZ
This hosted event brings together C-level, physician, practice management and IT decision-makers from North America’s leading provider organizations and physician practices. For two full days, executives interact with a national audience of peers, national leaders and solution providers featuring the latest solutions for practice management, mobility, telemedicine, outsourcing, IT infrastructure, next-generation electronic medical records, disease management, and more.
More info
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WLSA and Continua Health Alliance Mobile Healthcare Symposium 2010
Feb. 9, San Diego, CA
Continua Health Alliance and the Wireless-Life Sciences Association (WLSA) have joined together to bring the industry a valuable and compelling Symposium! Join speakers and industry experts from both groups for a day of insightful Mobile Health Solutions keynotes, panel discussions on the state of the environment, product demonstrations and networking opportunities with venture capital and development organizations.
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Continua Winter Summit 2010
Feb. 10 – 12 San Diego, CA
Continua Members can take part in unparalleled networking opportunities, free industry educational sessions and face-to-face Work Group meetings during the Summit. Join the alliance today and take advantage of this event!
More info
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Mobile and Wireless Healthcare 2010
Feb. 24, Birmingham, UK
Mobile and wireless technologies offer the opportunity to secure the delivery of more patient-centred care. Better access to knowledge at the point of care also increases overall efficiency and reduces costs.
This one-day conference will bring together healthcare IT professionals and clinicians alike to explore how to realise the benefits of mobile and wireless technologies both on the ward and in the community.
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16th Annual Wharton Health Care Business Conference
Feb. 25 – 26, Philadelphia, PA
The annual Wharton Health Care Business Conference is a leading health care forum for industry professionals, academics, and students. The two-day event typically attracts over 700 attendees across the nation and features distinguished speakers, panel discussions, special events, and various networking opportunities.
This year’s conference, entitled Breaking Barriers: Innovation Leading to Change, will explore the groundbreaking ways in which companies and individuals across every sector of health care are leading change in an increasingly dynamic field.
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HIMSS 2010
March 1 – 4, Atlanta, GA
HIMSS tracks new and growing areas in health IT that could bring the greatest value to the greater healthcare community. At HIMSS10, we have developed learning and networking opportunities in the most high-growth or high-demand sectors. In addition, the exhibit floor will be showcasing the most innovative product and service solutions in the industry.
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WOHIT Conference and Expo
March 15-18, Barcelona, Spain
WoHIT 2010 will for the first time be held in conjunction with the European Union’s annual High Level eHealth Conference on 15-18 March 2010 in Barcelona, Spain. The objective is to create the largest European high level platform for stakeholders sharing the common goal of advancing eHealth in Europe.
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International CTIA Wireless 2010
March 23-25, Las Vegas, NV
The International CTIA WIRELESS® show represents a $1 trillion global marketplace that brings together wireless and converged communications, wireless broadband, applications, mobile web and data.
For 25 years, International CTIA WIRELESS® has been THE premier marketplace for all things wireless. Don’t miss 2010—guaranteed to be another crucial and groundbreaking event for the industry. Join us for the next era of Mobile Life!
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Seventh Annual Healthcare Unbound Conference & Exhibition
July 19-20, San Diego, CA
The conference focuses on networks, platforms and applications for technology-enabled participatory medicine. Topics to be covered include remote monitoring, home telehealth, mhealth and ehealth for promoting wellness and managing chronic diseases.
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