Gail Borgatti Croall, MD, is the chief medical officer for HealthSpot, the developer of a comprehensive healthcare delivery platform combining cloud-based software with integrated biomedical equipment at their HealthSpot kiosks. She practiced as a pediatrician for 17 years and was the senior vice president and CMO for Anthem commercial products and, before that, CMO for OptumHealth Care Solutions with United HealthGroup, before joining HealthSpot. She currently sits on the board of directors for both the Visiting Nurse Association of Southwest Ohio and The Emily Program, and is on the Cognitive Scale Advisory Board.

Q. What's the one promise of mHealth that will drive the most adoption over the coming year?

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A. The true promise of mHealth is access and convenience. mHealth technology gives us the ability to do same-time appointments and integrate various levels of data, assessment of clinical info and biometric information and real-time communication. Immediate access to providers and data is becoming increasingly important in today’s landscape. Real-time healthcare transactions are one of the key aspects of mHealth that will drive consumer adoption, just like banking or online shopping. Consumers already have adopted smart phones exponentially across all populations. mHealth allows people to take an active role in managing their own health and well-being, which ultimately will lead to better health outcomes and lower healthcare costs.

Q. What mHealth technology will become ubiquitous in the next 5 years? Why?

A. I like to use the analogy of the transformation of our banking system to describe mHealth technology and its adoption. In the past, we needed to go the bank in person to deposit paper checks. Today is quite different - we hardly ever go to the bank. Just as we use technology to manage our banking today, we are using technology to make everything in life more convenient and immediate. Mobile phones have changed the way we do business, changed the way we socialize and will transform healthcare as well.

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I recently read that 98 percent of text messages are read. That statistic blew me away, especially when you think of it in terms of what text messages can do for healthcare – for example, medication and appointment reminders and cost and quality transparency. With mHealth and mobile technology, people are more likely to be engaged in their healthcare, and engagement drives behavior change for preventive care as well as the ability for people to better manage chronic conditions.

mHealth technology will also drive better access to healthcare, enabling the transfer of information and increased healthcare access not only in rural areas but in urban areas as well. For example, it is not uncommon that a mother whose children are on Medicaid has to take two buses to get to the clinic in an urban area. With medical provider shortages that we are facing, making healthcare more accessible, convenient and efficient is critical. mHealth is creating transformation for providers, payers, health systems and consumers and it supports the shift from volume-based care to outcomes-based care.

Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?

A. There are many, but three things stand out to me as cutting-edge technology in healthcare.

• Implantable sensors have the ability to monitor body changes before an event happens. They can predict a cardiac event, which is very significant since one in four deaths is cardiac related.
• We will see rapid change in how we get our lab results. We are seeing changes in point of care technology, enabling immediate results. HealthSpot is actually working to integrate point of care technology into the HealthSpot stations in the future, enabling real-time lab results.
• The third innovation that I’m seeing is technology that impacts behavioral health.  An example is the use of avatars, particularly for pediatric behavioral health and cognitive behavior therapy or post- traumatic stress disorder for veterans.

There is an explosion of technology happening right now and I’m excited every day to see what evolves in the healthcare world.

Q. What mHealth tool or trend will likely die out or fail?

A. Many healthcare apps that are in the market lack the ability to sustain or change behavior because they are not personalized to the individual. Eventually the excitement over new stand-alone apps wears out because they are not integrated into the consumer’s total healthcare experiences or influencers. mHealth and telehealth technologies need to be integrated, allowing healthcare providers and patients to be able to holistically look at the data to sustain the outcome and understand what interventions are tied to those outcomes. We need to turn information into actionable and impactful interventions that improve health outcomes.

Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?

A. Google Glass is an example of technology for consumers that did not take off; however, it does have real-time applications. One example is the use of Google Glass for emergency medical personnel or other healthcare providers in disasters or with the military, with the ability for real-time connectivity into the emergency room or specialists to help provide triage and virtual care. From the consumer perspective, however, there did not seem to be a good value proposition, and therefore it did not have consumer adoption. 

As far as success goes, I am really impressed with the high quality of integrated biomedical devices that we use in our stations and the incredible positive consumer response. The HealthSpot station surveys have shown 98 percent of patients were satisfied with the visit and would recommend the experience to friends and family. There was a similar high satisfaction rate from providers who used the technology.

With these devices, a patient can put an otoscope in his or her own ear and see what the doctor sees. It’s very different than what we’re used to, and it brings engagement to a whole new level through an interactive examination. It changes the way we traditionally thought of patient interaction and how it plays a role in extending the physicians practice reach and provides a platform for virtual health for their patients.

Q. What's your biggest fear about mHealth? Why?

A. Continued fragmentation is my biggest fear. If mHealth technology is a stand-alone capability that doesn’t get integrated into the entire health and wellness picture, it will not succeed. Many mhealth solutions are in silos right now, making it difficult for consumers to manage their overall health and well-being.

I also believe that security and privacy of data remain a big concern for this space. We have to help consumers own their own longitudinal health data.

Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?

A. The consumer is going to be the main driver to push mHealth forward. Consumers are responsible for more and more of their healthcare costs and will embrace these new technologies that drive access, convenience and improved health outcomes.

There’s still a lot of work to be done on how you measure value-based outcomes and the impacts of different interventions in healthcare. Showing value-based outcomes and what types of intervention are driving the outcome will be what pushes mHealth to the next level. We need to understand the use of that data and what it means individually for each patient. It is a combination of all of these things happening at once that will make mHealth ubiquitous to transform healthcare. This is the next evolution of where healthcare goes. mHealth, if integrated properly and creating value, will transform how a physician practices, how their office workflow is managed and how you as an individual consumer will access the healthcare system and healthcare information.

Q. What are you working on now?

A. From a strategic standpoint, HealthSpot is bringing healthcare to the consumer by putting our stations in Rite Aid pharmacies throughout Ohio. We are putting the doctor’s office through this virtual technology out into the community, where people live. Our first focus is to get the stations in places where people are likely to shop, and these tend to be pharmacies, so we’re really excited about the partnership with Rite Aid rolling out this summer.

Consumers can walk up to the station or make an appointment online and virtually see a physician at a time that is convenient for the consumer. HealthSpot works with health systems in the community that the patient is likely to have a connection to already. This increases continuity of care and allows the HealthSpot station to be an extension of the physician practice. The other part of our strategy is for the consumer to have a record of those visits via the HealthSpot Electronic Health Record.

HealthSpot envisions a future where its fully integrated software platform and integrated medical devices enable a rich experience for consumers and providers, where it makes the most sense to get care, whether that’s the pharmacy, at work or, eventually, the home, and will support not only episodic visits but wellness, prevention, medication management, behavioral health and chronic condition support. HealthSpot is exploring bringing its technology and patient experience to the home as part of the company’s vision for the evolution of healthcare.

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