Siva Subramanian, PhD, is senior vice president of mobile products for Zynx Health. He joined Zynx Health as part of the Zynx acquisition of CareInSync, of which he was the founder and CEO. Under his leadership, in December 2012 CareInSync launched the nation’s first mobile care navigation network linking acute hospitals to aftercare settings including skilled nursing facilities, other hospitals and physician practices. He has 18 years of business entrepreneurial and product development leadership experience in healthcare and telecom communications industries and holds one U.S. patent in the area of high performance network computing. He is the former director of product management for Avaya Healthcare Solutions (now Nortel). An expert in care transitions interventions (Project RED, CTI), he is also the author of Project BOOST: The ROI on Reducing Readmissions published by the Society of Hospital Medicine as part of Project BOOST, a nationwide project addressing care transitions. He earned his doctorate from North Carolina State University.
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. Without question it is better, faster and easier access to all types of health information, along with secure, immediate communication - all from the palm of your hand. According to The Joint Commission, the leading cause of medical errors is poor communication, with failed patient handoffs playing a “role in an estimated 80 percent of serious preventable adverse events.” Having a single device to access patient health information, see which colleagues are assigned to the care team, obtain data from other providers (including those in your referral network or community) and send and receive secure text messages will dramatically improve care coordination and close the gaps that currently exist. By making it easy for your clinicians to communicate and share information, you succeed improving outcomes and reducing avoidable readmissions.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. Anything that promotes more engagement between providers and patients. The most obvious example is the patient portal, led in part by Meaningful Use Stage 2. Portal technology is a start, but it will continue to be used by a small percentage. Over the next five years, however, I believe we’re going to experience a tremendous expansion in the methods and level of communication between providers and patients. It won’t just be one way, either. Rather than relying solely on office visits, physicians who apply mobile care practice tools can more easily monitor patients and engage with them wherever and whenever needed. This expansion of the provider/patient relationship will be driven by the confluence of three major trends:
- Payer policy expansion to cover use cases supported by mHealth. We expect to see more post-acute care services enabled by mHealth become eligible for reimbursement, starting with CMS programs. Already, physicians are earning payment for post-acute care coordination. The number and type of such reimbursable mobile care services will grow and evolve to include non-physician services, such as remote patient engagement self-help activities using interactive video or online tools.
- Healthcare technology innovation targeting the elderly. While mHealth technology has become easier for the more tech-savvy “smartphone” consumer to adopt, it needs to evolve further to become more usable, specifically by patients who consume a disproportionally greater share of per-capita healthcare services. This group is often intimidated by technology and thus has difficulties using what many of us take for granted. With giants like Apple, Google and Facebook entering the healthcare arena, this space is ripe for new innovation focused on the elderly and at-risk patients with chronic care needs.
- Smartphone adoption by elderly patients. As Baby Boomers begin to surpass retirement age, smartphone adoption will have grown to a saturation point; hence, payers and providers will finally accept smartphone communication as a more meaningful means of patient communication.
Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?
A. In the near future I predict personalized medicine leveraging personalized data on smartphones will be amazing! We’re already observing the start, albeit slow, of patients using their smartphones and tablets to manage their health, using wristbands, watches and other wearables to capture information, and applications such as Apple’s HealthKit to enter and track all sorts of data. But that data isn’t really being used by providers, which is a shame, because it can provide a great deal of insight into how their patients live day-to-day - what they eat, when and how much they exercise, how much sleep they’re getting, and so forth. These are all factors that have an impact on health typically bypassed in a routine physician visit. The user-generated data can also show indications of trends and send alerts that allow care management teams to create interventions long before problems become acute, allowing patients to be healthy at home instead of going to a hospital to be treated.
When you combine that information with the great strides being made in genomics you get to a whole new level of personalized medicine. For example, we know that patients in certain demographics have a propensity toward specific chronic conditions. Software that can take that knowledge and match it against an individual’s genetic makeup, as well as their lifestyle and any psycho-social factors, can provide a very accurate picture of that individual’s health in order to prevent rather than treat problems. It’s what population health management is trying to do, but a lot of PHM is based on utilization data. In other words, it’s backward-looking. We want to get to the point of being forward-looking. mHealth can be a big contributor in this area.
