Can Moneyball Become Moneycare?: How Predictive Informatics can Make mHealth a Success

Posted on September 30, 2024 by davidleescher

I knew the story of Billy Beane and the Oakland A’s long before I saw the movie. As an avid baseball fan (Yankee fan since age 5, without apology), I followed the story of how informatics were used to bring a lowly $39M team to the brink of making the World Series, putting together the ultimate fantasy statistically successful baseball team. The methodology is now the business model of all of baseball. As I sat and watched the movie, I couldn’t help but wonder why the same methodology couldn’t be used to improve health care with mHealth technologies.

Informatics is defined in the Webster dictionary as “the collection, classification, storage, retrieval, and dissemination of recorded knowledge treated both as a pure and an applied science.” Informatics has certainly been used in medicine. The LACE index was developed in Canada to predict death and readmission rates after discharge from the hospital (Published in the Canadian Medical Assn Journal, 2010. However, yet another study in the Journal of General Internal Medicine (2011,Volume 26, Number 7, 771-6), neither providers nor a published algorithm were able to accurately predict which patients were at highest risk of readmission. This type of informatics is known as Predictive informatics (PI), the combination of predictive modeling and informatics which is applied to healthcare, pharmaceutical, life sciences and business industries. Good evidence that PI works is found in hospitals which utilize the Web-based eDischarge™ software-as-a-service (SaaS). The readmission rate fell for the second straight year to 14%, significantly below the national average of 20% for hospitals of comparable size, according to the Curaspan Health Group. (http://connect.curaspan.com/content/curaspan-hospital-customers-cut-readmission-rate-below-national-average-and-saved-almost-260

The utilization of PI in the treatment or clinical pathways that would be part of an mHealth platform could significantly impact healthcare, by incorporating informatics as well as best practice guidelines. PI itself can determine which mHealth tools or platforms would be best for a specific patient at the time of diagnosis, discharge from the hospital, or post-procedure. The patient’s cell phone or other device can be programmed automatically, activating one or multiple apps (or meddis-see http://davidleescher.com/2011/09/26/why-mhealth-apps-shouldn%E2%80%99t-be-called-apps/). The possibilities are endless. PI concerning behavioral patterns can be used to prevent or reverse obesity, smoking, non-adherence with medications or follow-up care, and more. This is not to say that computers will rule the world. But we don’t have to reinvent the wheel when it comes to gathering or utilizing data. The use of PI has been utilized in the business sector for years and is the backbone of companies like FedEx, Google, and Amazon. There is more data out there than we will even know what to do with (a subject for another blog), and we need to harness it to digestible, beneficial forms. PI is certainly one of them.

Billy Beane was ridiculed. His ideas changed baseball. Mobile health is not toys or gadgets. It is serious technology that is easily usable. But to get to that point, we must step out of the box that providers are given in medical school. It no longer holds. There are over 2500 practice guidelines. Do we expect docs to know all of them? Do we expect them to know all of them in their respective specialties (cardiology has already almost too many to count)? No. So let’s make medicine and mHealth a bit like the 2002 Oakland Athletics, built on predictive informatics.

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Health Economics Getting Ripe Quickly for mHealth Technology?

Posted on September 27, 2024 by davidleescher

A recently released commissioned study by the National Business Group on Health verified what most people have already experienced: That employers are footing less of an employee’s health insurance premium bill. In the survey, 25% of executives queried stated that the most effective way to curb health care costs is by having the employee share in an increased share of the expense. 39% of the executives said they will increase the in-network deductible amount and 63% said they will increase the employees’ share of the premium contribution (most stating it will be a less than 10% increase). Interestingly, only one percent of respondents said that focusing on quality-based networks and physician resistance was given as one of the contributing reasons. The report can be found at:

http://www.businessgrouphealth.org/pdfs/Plan%20Design%20Survey%20Report%20Public.pdf

The rising co-pays and deductibles have resulted in employees seeking less health care. This has resulted in an absolute lower spending for health care by insurance companies. The poor economy has likely contributed to this phenomenon as well. This is in addition to the nine million people who became uninsured between 2008 and 2010 who have been found to decrease or delay getting health care by 72% (found in a study by the Commonwealth Fund).

Another study by the Kaiser Foundation recently released (http://ehbs.kff.org/pdf/8226.pdf) showed that the average increase in health insurance premium from 2001-2011 increased by 113% while the worker’s contribution to the premium rose 131%. This does not include deductibles that are paid by employees (81% of PPO plans, 69% of POS plans, and 29% of HMO plans. In addition, the percentage of workers now enrolled in high deductible health plans (deductibles over $1000 has increased dramatically (from 16% to 50% for businesses with 3-199 employees). How

The above observations are sobering examples of how the general economy affecting businesses has a trickle down effect of what I would call a functional decrease in health care access. Functional because these patients on paper have access by virtue of their insurance but they do not seek care because of the associated costs.

Mobile health solutions speak to exactly these issues. Why? Because adoption of widespread mHealth technologies can do many good things to the bottom line of payers which may trickle down to employers and then employees. The lower cost of mHealth is intuitive by virtue of the fact that these technologies are relatively extremely cheap, many times requiring just a cell phone, and predominantly tools readily available (computer pad, PDA, proprietary mobile device, etc.). It is something that is potentially so effective in reducing health care costs that it should be purchased by insurers (who can then potentially have the technology imbedded seamlessly in their patient portals) and then incentivized to patients with the prospect of either lower deductibles, premium rebates, or other means. The mHealth promoting wellness, weight loss, or medication adherence will then decrease spending of healthcare dollars on the back end in the treatment of diseases by preventing them in the first place.

Of course not all mHealth technologies will result in cost savings and prospective studies would certainly assist payers and providers in assessing cost effectiveness. Since cost effectiveness is something the mHealth industry is touting, the least that can be done is to demonstrate it in studies. The EHR industry, much more accepted than mHealth, has yet to show this.

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Why mHealth Apps Shouldn’t be Called Apps

Posted on September 26, 2024 by davidleescher

The estimated number of US smartphone users grew from 42 million to 61 million from 2009 to 2010. The number of phone apps grew at a significantly higher rate. Some of the key findings from “The Mobile Movement: Understanding Smartphone Users,” a study from Google and conducted by Ipsos OTX, an independent market research firm, are that 81% browse the Internet, 77% search, and 68% use an app. Of course, a smart phone app must be distinguished from a mere website shortcut. There are an estimated 306,500 iPhone apps and 90,000 iPad apps and approximately 200,000 Android apps. According to a mobihealth news report, “The World of Health and Medical Apps” (http://mobihealthnews.com/research/the-world-of-health-and-medical-apps/), there are 5820 health, fitness, and medical apps. Over the period spanning 2010, there were a constant 28% of apps that were opened only once and never again.

The popular saying, originally an advertisement, is “There’s an app for everything.” That is getting to be true in the health sector as well. The word app conjures up a cute entertainment or game program, a convenience tool to do anything from finding the closest clean restroom to getting a real live customer service representative quickly, or a quick way of obtaining news. It is warmly received by the brain, much like the word puppy, kitten, or baby. Some trigger a response from our autonomic nervous systems as necessities and bring about immediate emotional feedback (a sense of security, a thought of comfort food or destination, a loved one, etc). They are the source of banter between new acquaintances as ice breaking conversation bits, like the weather, music, or the movies were for older generations. The potential for the importance of mHealth in health care is such that medical apps should be distinguished in terminology from all other apps. Because of their impact on health, as well as the fact that some of them will literally be medical tools, this distinction is warranted. The change in designation would foster a different attitude towards these items. This is necessary in order for people to take them seriously, ‘using’ them daily if not more, and not abandon them in the same manner as the apps. This technology is in its marketing infancy. Now is the time to design the language of the industry. A change in designation from ‘apps’ will benefit all stakeholders (payers, providers, hospitals and other facilities, government agencies, and consumers) by having designations that will be more practical.

I do not propose proprietary names, but generic ones with practical significance. Medical apps may have wide and varied goals. The mHealth app designations should be made with those in mind, yet keep the number to a practical minimum. Some apps will fall into more than one category, and can be designated by the primary utility, or have its components separately designated, or to more than one, depending upon perhaps whether the designation is for regulatory, marketing, or other purpose. Apps may also morph via consumer demand, technological development, or both, thereby creating a need to change the designation.

There are presently health, fitness and medical apps for consumers and apps for medical professionals. Mobile health apps deserve their own place and nomenclature in technical, social, and professional jargon. I would like to propose calling the mHealth app a “meddi” (pronounced meddee). The pleural would be “meddis” (pronounced medeez). Beyond this initial designation, I would then divide them into learning or Lmeddi for pure educational applications conveying purely didactic information, Hmeddi for health and wellness applications that are either interactive or messaging tools for maintaining health and fitness, and Rxmeddi for applications for the diagnosis and treatment of symptoms or diseases. These distinctions may help in organizing the meddis on phone, tablet, or other devices, for regulatory and potential reimbursement purposes, and for development and marketing purposes.

mHealth is going to create a new health care paradigm. Its importance therefore warrants its applications to be viewed and treated uniquely. This is already evident with a separate iTunes ‘silo’ of medical apps, with government proposals for support and regulation, and with developing business models, (http://davidleescher.com/2011/09/23/business-models-of-mhealth/). Its applications are deserving of a distinct terminology as well.

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Business Models of mHealth

Posted on September 23, 2024 by davidleescher

PriceWaterhouse Coopers’ Health Research Institute released a comprehensive report describing business models and opportunities for the mobile health industry.

The majority (57%) of American adults used a laptop or mobile phone to access the Internet in a 2010 poll. 78% of these people searched for Internet-based health information, versus 79% of those only using a desktop PC and 59% of all American adults.

The first model is the operational/business model in which providers see mHealth as more efficient and beneficial to the patient. One-third of physicians according to the study, make decisions based on incomplete information and that mHealth by providing more robust and timely information from the patient or device can result in better care. Forty percent of physicians stated that they can eliminate up to 30% of office visits with information provided by mHealth technology. 56% of physicians said it would expedite decision-making. 39% said it would decrease time to perform administrative tasks. 36% estimated that it would increase colleague collaboration, 29% believe it would allow more time to spend with patients, and 24% it would not affect their day-to-day work. Interestingly, physicians surveyed related that lack of leadership support, privacy/security issues, and reimbursement are seen as the major roadblocks to adoption of mHealth.

The second model is what is described as the consumer products and services model. This model is consumer focused and driven. 50% of those surveyed would utilize mobile health technology. 20% of people surveyed say they would use it to monitor fitness or wellbeing and 18% want their doctors to monitor their health conditions via the technology.

The third model is the Infrastructure business model aimed at connecting and increasing speed of health information and services, dovetailing with the operational business model. Aspects of this model include interoperability with EHRs, security issues, and addressing the decreasing bandwidth concern.

The report emphasizes the market and needs of mobile health but the lack of business models to support the technology that will address both acute and chronic health problems as well as preventive health. The Health Research Institute \estimates the annual consumer market for remote/mobile monitoring devices to be $7.7 billion to $43 billion, based on the varying amounts that surveyed people would be willing to pay for subscriptions and possibly mobile devices (less than $10/month and $75 respectively).

Interestingly the report goes on to say that preliminary mHealth studies show that provider revenue decreases with the use of mHealth and sites a few studies. Cost-efficient healthcare is certainly one of the goals of mHealth, however, in the current system of fee-for service or rewarding treatment of existing diseases per encounter or procedure, and not the patient’s outcome, there exists a financial conflict of interest for providers to adopt mHealth. The advent of outcomes-based reimbursement would be a huge boost for mHealth technology. Insomuch as ACOs are not gaining large footholds in the near future, this push for reimbursement might suffer. It has, however, been addressed nicely by CMS in the past with implanted cardiac rhythm device remote monitoring and follow-up.

The majority of physicians polled (88%) would like to track/monitor their patients at via remote monitoring. Of interest is the both consumers and physicians responded with weight being the most desired parameter to follow. This has profound implications. It shows that both consider obesity to be the number one priority in healthcare. It shows that consumers may be more motivated to lose weight than previously thought. It is also important because obesity spawns other chronic illnesses such as diabetes, high blood pressure, sleep apnea, chronic lung disease, and heart disease. It is also easy to track remotely and can be easily done with technology available today.

Payers realize the value of mHealth. Companies like Kaiser-Permanente state they are aware of the importance of people’s mobility and their desire for independence. Michael Mathias, Aetna’s chief technology officer sums up the mission of mHealth well. “The days of mass communication are over. We can now deliver customized communications through mobile apps, online, telephonically, or through the mail based on our understanding of how each member wants to be communicated with.” This tells us two things: That payers already value mHealth, and that they are ready to pay for it. We must deliver quality technology that makes it worth their while to pay for.

The entire study may be viewed at (need to register to obtain):

http://pwchealth.com/cgi-local/hregister.cgi?link=reg/healthcare-unwired.pdf

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Clinical Studies Highlighted in HHS Task Force Recommendations for mHealth Text Messaging

Posted on September 22, 2024 by davidleescher

The Text4Health Task Force of the HHS made recommendations to the Secretary of HHS regarding text messaging for mHealth. (There is currently an evaluation of the text4baby program, a public-private partnership that is the first free-to-end-user health text messaging program available nationwide).

It was a comprehensive document with recommendations regarding the following:

· Facilitating Text Messaging Development

· Research and Evaluation

· Partnership Among Federal Government Agencies and with Non-Federal Organizations

· Coordination Across HHS

· Integration of Health Text Messaging/mHealth with Other HHS Health Information Technology Priorities (EHR, cloud computing, health games, etc). The task for recommends that HHS align text messaging/mHealth activities with other HHS Health IT priorities.

· Delineating Privacy/Security Issues.

· Regulatory Issues: Establishing regulatory guidelines.

 

In the Recommendations regarding studies, the following is stated: “Future health text messaging programs by HHS, or in which HHS is a partner (not specified whether operational partner or reimbursement partner) should also include a scientific evaluation component.” One of the guiding principles, “To Establish Plans for Evaluation and Implementation” is to ‘conduct formative usability and user-centered research with the target audience at the beginning of the project and when major program changes occur.”

The regulatory recommendation states that relevant HHS agencies including the FDA conduct research on future trends and establish regulatory guidelines for interactive systems. These guidelines will no doubt include quality control regulations that will involve clinical testing of the technologies prior to and perhaps post-marketing, much like other medical devices.

The recommendation about integration of mHealth with other HHS HIT priorities has huge mHealth industry implications. This is the recommendation that puts all of mHealth on the table, in the spotlight, and highlights government recognition of many other aspects of mHealth technology besides text messaging. In addition it stresses the importance of interoperability of these technologies with EHRs, blending the overall IT efforts of the ONC.

So clearly these set of recommendations are great news for mHealth. They essentially signal the dawn of mHealth with regards to recognition as a useful medical tool. They signal government’s commitment on a large scale to supporting the industry’s goals. They signal the initiation of the patient management side bookend of the HITECH Act. However, they also signal the expansion of regulatory aspects of mHealth. Hopefully, as alluded to in recommendations to work with non-Federal organizations and private sector endeavors, they do not imply significant impediments to the research, development or marketing of worthy technology from either a technical or economic standpoint. We all await the HHS’s adoption and implementation of these recommendations with hopefully public opinions raised before the final rules are decided. The recommendations may be found at: http://www.hhs.gov/open/initiatives/mhealth/recommendations.html

 

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What Will it Take to Give Traction to mHealth Technology?

Posted on September 20, 2024 by davidleescher

The present state of affairs of mHealth is such that its most enthusiastic proponents are those in the industry itself. This stems from the lack of awareness of mHealth which may ultimately range from publicity of an extremely useful healthcare tool to its full utilization, which may change the framework of all healthcare delivery. One can debate at this point how developed or essential this technology will evolve into. Those in the industry are appropriately enthusiastic about the possibilities based on a number of observations. Healthcare is at the point of being unacceptably costly to not just the American society but of all Western societies. It is interesting that the USA and Europe have traveled very different paths on the road of healthcare delivery and financing but have both arrived at the same prohibitive cost place at roughly the same time. Contributing to this is the high cost of developing and adopted technologies in healthcare delivery, as well as provider shortages. Mobile health has seen its biggest adoption and successes thus far in underdeveloped nations where shortages of both finances and providers has been historically abysmal. Mobile technology, primarily in the form of cell phones has risen more rapidly there than in developed nations because of the lack of communication infrastructure including the Internet.

There are many mHealth technologies in use today and even many more in development. The range of utility corresponds to the many areas of healthcare. From wellness and preventive medicine to behavioral aspects of patient-centric care, and treatment of chronic diseases (vis a vis frequent messaging with a provider, medication, prescription, and appointment reminders). Mobile health brings closer the patient and caregiver as well, putting them in many instances literally ‘on the same page’ of healthcare information and protocol. They are all intended to decrease healthcare costs and/or result in better outcomes or maintain wellness. The technology is a huge paradigm shift in medicine insomuch as it has the patient as the center and focus of healthcare (a logical place but heretofore has been the provider). The extreme diversity of services (a tribute to the developers that have the insight to address all these aspects of health and disease management) itself feeds to slow adoption progress. How, one may ask? It doesn’t, by definition, lend itself to a single identity known as mHealth which can be easily related to by society, legislators, payers, providers, and consumers, in other words, all the stakeholders in health care. There are already different standards that are now set for mHealth technologies, as recently laid out by the FDA. These standards are appropriate insomuch as some apps have more direct medical consequences as others, and there is a difference with regards to patient confidentiality.

The proposed regulations can be found at: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm263280.htm

So what will it take for mHealth to gain traction if it is to be recognized, adopted and effective?

  • Recognition: It may take a combination of things for mHealth to become part of the lexicon of everyday discussion about healthcare among all people. Perhaps a breakthrough technology that affects such a substantial illness or population sector that it cannot be ignored. It may take a celebrity to bring the issue to the mainstream press (stranger things have happened). It may take a champion in the White House or Congress to highlight the industry.
  • Adoption: This is another stumbling block. There have been many recognized beneficial advances in diagnosis, treatment, and awareness initiatives which have been slow to become adopted. This is the human factor in healthcare. Mobile health is dawning at the same time that electronic health records are, with the latter gaining more traction primarily due to mandates and financial incentives. They both have the same goals of improved outcomes at cost savings. Randomized clinical trials are the way drugs and devices are typically approved by the FDA and approved for reimbursement by CMS and others. Realistically, reimbursement should always be tied to something that has been shown to be beneficial. Many times something that intuitively is beneficial is shown not to in an objective well run study.
  • Effective: . Clinical trials are sorely needed for mHealth technologies. This was well stated by Dr. Harlan Krumholz, a well-known physician champion of evidence-based medicine. http://www.technologyreview.com/business/38483/?p1=BI

They must be rigorously designed to show technology feasibility and clinical benefit to the consumer and provider, and cost efficiency to the investor and payer. The follow-up needs to be long enough to demonstrate a statistical significance that would uphold scientific review. The pilot studies thus far performed are little more than intriguing to stakeholders, industry participants or investors/ observers. They are not evidence that the specific technology is useful in a meaningful way.

Capital investors are at this time at most lukewarm about mhealth technologies. Uncertainties about reimbursement as well as lack of objective clinical trials are the main concerns. These are benchmarks of medical devices. The best chance for success is going to be for developers of technologies that believe in the benefits of their products, the mindset to subject them to rigorous trials, and to join together with others in the industry to raise awareness about a very exciting addition to healthcare.

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Gender Differences in Utilization of Healthcare IT: A Reflection of the Bigger Picture

Posted on September 18, 2024 by davidleescher

According to the National Center for Health Statistics, more women research health topics on the Internet than men. This holds true across all age groups except those over 65, where Internet usage for healthcare searches was low among both genders. This does not surprise me, as a physician who recently left practice. Women are more proactive in healthcare whether it be for themselves or for significant others. They are more likely to accompany their SO to a medical appointment than vice versa to serve as a patient advocate. They ask more questions as well as do more research on their own. This gender difference may be related to factors that make them ask for car directions more often (before GPS days).

Men are more ‘nuts and bolts’ and black and white with regards to questions about their surgical procedure, for example. How will it affect their work, recovery period, and how soon it can be performed? Women are more interested in alternative treatments, effects on general lifestyle, and complications (though I always explained the procedure, alternative treatments, recovery, and risks equally thoroughly with both genders). These are generalizations, but reflect 20 years of my experience. I personally observed the higher rate of Internet usage for healthcare research by women.

Differences in healthcare between men and women are not new. It is well-known that women get less appropriate cardiac care than men. Women are not enrolled in clinical trials to the same extent as men. There are now initiatives in the National Institutes of Health focused on equal recruitment of women in clinical trials.

In most categories of Internet activity, more men than women participate. However, women spend more time online. So it is interesting that women outnumber men with regards to healthcare related internet searches. Women also utilize social networking sites more than men. Perhaps they exchange more healthcare related discussions in these interactions. It reflects the increased interest in healthcare in general among women than men. Women are more apt to pursue preventive medicine pathways then men.

There is not much in any literature or online regarding the differences in IT utilization between men and women. Hopefully, the National Center for Health Statistics will continue to monitor and get more specific about this topic. It is fascinating and perhaps the Internet will be the tail that wags the dog with regards to improving healthcare in both sexes!

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How mHealth Can Immediately Save Healthcare Dollars

Posted on September 17, 2024 by davidleescher

OK, so it’s going to take some time for mHealth to reach quotidian jargon, healthcare provider acceptance, obtain reimbursement status, and demonstrate improved outcomes with clinical trials. None of this however, interferes with adoption based solely on cost savings without incurring increased morbidity or mortality. Rationing is a hot button word now because we have reached the proverbial blood from the stone healthcare economic Waterloo. It will happen, but can happen in a manner that is not denying appropriate care, but economically (not medically) wasteful care. And mHealth can help in this regard. Apple has created a special silo for medical apps. I think the next step is to have mHealth platforms and apps be called something other than apps. The word connotes entertainment and convenience tools. Health technology deserves a different term if nothing else than to emphasize that it should be utilized daily (if and more so if appropriate), versus 90% of apps that are downloaded and disregarded after a few months. But I digress.

There is a movement afoot to start denying reimbursement for emergency department visits for Medicaid patients for ‘non-emergent’ conditions. The difficulties with classification of entities as non-emergent as well as the choice of targeted population are topics for another forum. However, the initiation of this type of policy in the current healthcare climate should not surprise anyone. Budget experts are proponents of offsetting budget cuts for every incentive or stimulus proposed. Seems logical, right? Well so does having a cheaper alternative in place before significant cuts in healthcare access are imposed. That’s where mHealth comes in.

The spectrum of mHealth technologies is as vast as that of the ‘dot coms’ in years past. Out of these will come a Microsoft, Google, or Facebook that will change the world. Others will be impactful, but not game changers. Still more will be useful to targeted sectors of the population. That being said, mHealth is going to be a part of mainstream healthcare in a big way in the future. The time to which this occurs will be a result of a combination of necessity and significant contribution of specific innovations. There are simple types of mHealth, however, primarily involving communication, that can fit into the system immediately and save money. SMS text messaging between a provider and patient in the system tied to fully functioning patient portals in EHRs is a start. This technology is here! IT is a lot cheaper than ER visits for truly non-emergent conditions. In fact, this technology tied with telehealth technology can even determine a priori in most cases, whether the condition is indeed non-emergent or emergent. This addresses concerns about the lack of human interaction and potential medicolegal concerns to a significant degree. Vital signs glucose monitoring, and other types of technologies are here as well. I am not proposing the use of any specific mHealth technology here, just asking for a wakeup call to get mHealth on the board when significant changes to access as mentioned above are enacted. Nothing is airtight regarding a ‘fix’ to the crisis that healthcare faces today. The Perfect Storm of increased need (by virtue of healthcare reform) and shortages of providers and economic resources is here. We must stop burying our heads in the sand and stop kicking the can down the road. MHealth can help now. We just need forward thinking people who have the authority, coupled with mHealth expert scientists to get together and discuss implementation of the best, simplest, and most cost effective mHealth solutions available NOW to immediately save money. The rest of the ‘dot com’ mHealth movement can then progress with survival of the fittest (read useful, determined in clinical studies, and cost saving).

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Why mHealth Will be Critical for the Success of ACOs

Posted on September 17, 2024 by davidleescher

ACOs, or accountable care organizations, are approved and regulated groups of physicians, hospitals and other providers that the government hopes will become units of health care. These units will be reimbursed for a patient’s given admitting hospital diagnosis until that diagnosis is fully treated even after discharge. The reimbursement will be shared by the institution and all providers who partook in the care of the patient. Both mHealth and ACOs will be intertwined and become pivotal players in the future of health care. In addition, mHealth will be critical to the success of ACOs. Here’s how:

  • The reimbursement to ACOs for a patient’s specific diagnosis will be tied to the patient’s outcome, no longer to procedures performed or duration of stay. This will apply to post-hospital discharge services as well. MHealth will be utilized to substitute for or assist monitoring patients post-discharge. Vital signs, blood monitoring of glucose, electrolytes, blood oxygen levels, ECG, and many other parameters will be mHealth managed.
  • MHealth platforms will be used for coordination of care among providers from hospital discharge to those participating post-discharge. Primary care providers, specialists, outpatient facilities (rehab institutions, nursing homes, outpatient testing facilities, etc) will all ‘be on the same page’ with regards to the patient’s medications, progress and treatment plan. MHealth will also serve as a vehicle for closer communications between the patient and health care provider.

MHealth-derived information will then be seamlessly directed to the patient’s EHR, pharmacy, and insurer, thereby closing the loop on the spectrum of the important participants in the patient’s care.

  • MHealth tools that the patient will use to encourage and support lifestyle changes, medication adherence platforms, and better patient-caregiver-provider communications will also ultimately result in a better patient outcome.

ACOs success hinges on IT for the appropriate tracking of the patient’s care. This applies to inpatient as well as outpatient situations. What mHealth will do, in summary, is to play an integral role in the post-discharge care of the patient from a clinical standpoint, assisting providers in the transmission of timely useful clinical data. In addition, it will be a toll that the patient will utilize to comply with provider instructions, and to afford better communication among providers, caregivers, and the patient. All of these will ultimately lead to a better patient outcome, which will be the benchmark of success of an ACO.

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Five Reasons Why mHealth is the Holy Grail of Participatory Medicine

Posted on September 17, 2024 by davidleescher

Mobile health or mHealth is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information. MHealth has been utilized in underdeveloped countries for many years due to inaccessibility to scarce health care resources as well as the widespread use of cell phones. Developments in health care in the Western world have very recently spurned interest in mHealth in developed countries.

  1. A present and worsening shortage of both primary care physicians, and an even greater shortage of specialists, coupled with health care reform which is aimed at increasing access of health care will make face to face care more difficult. This, in some areas, has spurned the telehealth industry, whereby a physician will literally see you over the Internet. Physician shortages and the cost of this technology (most services charge as an office visit and require insurance) limit the widespread potential success of such endeavors. MHealth initiatives will actually increase contact of the provider and patient via text messaging, email, and communication of sensor-derived physiologic data (see below).
  2. Obesity is now the biggest threat to the health of Western countries. It is responsible for the skyrocketing rise of high blood pressure, diabetes, coronary artery disease and even stroke in young people. Most chronic diseases like these are preventable with simple lifestyle changes. MHealth can effect these changes with educational messages, lifestyle reminders, and the transmission of physiologic sensing data (blood pressure, heart rate, blood oxygen levels, EKG tracing, and others).
  3. The cost of health care is now literally prohibitive as a percentage of our total national budget. Technological and pharmaceutical development costs due to research, development and regulatory requirements are also at unsustainable levels. Therefore, both the public and private sectors are embracing mHealth as a solution. The government is making significant funding available for mHealth development. Large medical device companies are looking to smaller mHealth companies as a vital future of their business plans.
  4. The shift of hospital and provider reimbursement from diagnosis-related fee for service management of diseases to to one of outcomes measured goals necessitates better patient participation. MHealth is a tool that can facilitate better patient care coordination once a patient leaves the hospital. It will hopefully prevent many office clinic visits and hospitalizations as well. Outcomes based care will necessitate close provider-patient contact upon hospital discharge. It may decrease the need for home visits by nurses and others due to transmission of information, both clinical and descriptive by the patient.
  5. The advent of more widespread use Meaningful Use of electronic health records (EHRs) is ripe for mHealth. Information from mHealth-derived technologies can deliver clinical information directly into EHRs or even cell phones or PDAs to the patient’s provider. Increasing interoperability of EHRs will lend itself to receiving information from MHealth programs. Educational materials in the patient’s EHR can be transmitted to mHealth applications as well. MHealth programs like medication-adherence, lifestyle changing reminders, and programs related to education of medical procedures (improving informed consent) have been developed. These all interact with EHRs. All viable mHealth technologies will be expected to feed into EHRs. This will maximize transparency, increase access, and result in better care coordination.

In summary, mHealth, is pivotal in participatory medicine’s goal of having the patient be the center of healthcare coordination, ultimately preventing and best treating chronic diseases, which utilize the vast majority of health care resources.

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