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
Since founding the Medical Records Institute more than 26 years ago, Waegemann spent many years trying to determine how much (if any) costs savings EMRs would bring to healthcare spending. Waegemann, however, said that he could be sure that after looking at the benefits of mHealth and the mission of mHealth, that it will save billions of dollars for the industry.
mHealth savings will come from patients using mobile devices to research and manage health issues on the Internet. Waegemann offered an example: A patient might walk out of a doctor's office and research something the physician mentioned during the meeting. mHealth savings will also come from better communication between wellness and care providers; patients using online communities to connect with and learn from other patients with similar conditions; patients using mobile devices to communicate with payers and learning about the best options for treatment; clinicians using mobile devices to access guidelines, formularies and protocols.
Mobile phone not a panacea device
Waegemann noted that the mobile device alone won't be enough for clinical use. The mHI espouses the three screens mentality, which Waegemann attributed to Microsoft: The smartphone, the tablet/laptop and the larger mounted screen for high resolution images. Waegemann predicted that the "projector keyboard" might help smartphones encroach on the second screen's market share, but he noted the technology might come out in 2010 or it might not hit the market for any number of years.
Meaningful use couples nicely with mHealth
Waegemann noted that the current focus is on "meaningful use" for health technologies, especially EMRs. Waegermann believes that mHealth will be integrated into this next phase of healthcare on top of and as a part of the drive for "meaningful use."
Technology is ready, time to implement
If there is one message to take home from these two days, Waegemann said, it was that the technology is ready and we just need every clinic to sit down and figure out how to change. The technology is here but we need to change our workflow and how we are treating patients. We need to change healthcare from being physician-centered to involve all participants, he said. Waegemann pointed to nine players in participatory healthcare: Insurance companies, public health, primary care providers, hospitals, other caregivers (dentists), long term care providers, financial institutions, alternative health tservices, consumer/patient and wellness/health systems.
mHealth is much more than connectivity or wireless health, Waegemann said. It is based on the future of semantic web and interoperability. It is based on participatory health, but it is enabled by mobile devices. mHealth provides better quality of care, Waegemann said. It is more economical and more convenient, if done right. mHealth is not a fad -- it is a revolution that is moving very fast, he explained. We need to address standards, work for change and move now, Waegemann concluded.
12 clusters for mHealth applications
mHI co-founder Claudia Tessier presented the 12 clusters of mHealth applications following Waegemann's keynote:
1) Patient Communications: Patients can use their mobile device to prepare for their doctor's visit by selecting a caregiver, booking an appointment or filling out surveys ahead of time for discussion during the visit. mHealth apps could also serve as a educational tool for doctors to use to discuss symptoms and conditions with patients during visits. Care providers can also push out reminders for appointments or medications by using mHealth apps and services. Patients can use their phone to access personal health records and continuity of care records, too.
2) Access to web-based resources: Patients and providers already use mobiles to do this for healthcare resources today.
3) Point of Care documentation for physicians and clinicians: Patient history, transmitting data via mobile. Issues for this cluster include: Accuracy, authentification, interoperability between mDevices and HIS/EMR.
4) Disease Management: Applications that help patients manage chronic conditions like diabetes, dermatology, asthma, smoking cessation, hypertension, weight control etc. initially, but other chronic conditions are getting it as well. This category has huge overlap others, Tessier said. Issues for this cluster include: FDA approval, aggregating data, proof of ROI.
5) Education Programs: Teaching, monitoring, coaching but not just for the patient. mHealth can be used for teaching colleagues of clinicians, too. Standards are needed here, Tessier said.
6) Professional Communication: Specific disease-related communities for patients and specialist communities for clinicians fall into this cluster. This can be done ensuring confidentiality.
7) Administrative Applications: Improving efficiency of workflow at the office. Mobile clinical assistants, etc. Self check-in -- wouldn't it be nice to do this once? Staff communications. Asset tracking. Surgical instruments, etc. Scheduling, bed management. Ease of communication. Financial charge capture.
8) Financial Apps: Applications that help consumers deal with the financials of healthcare, understanding their insurance, etc.
9) Ambulance/EMS: Connecting the EHR to emergency workers to give them a clearer picture of the patient’s history.
10) Public Health: Using mobiles to track diseases, epidemics, bioterrorism and disseminate information about outbreaks.
11) Pharma/Clinical Trials: Clinical research opportunities through data collection from mobiles.
12) Body Area Network applications: While this sounds too futuristic, it is being done today, Tessier noted. Wearable sensors that collect biometric data and interface with mobile phones to record and transmit.
