Wireless health technologies and healthcare IT (with electronic health records or EHRs as the most visible component) are both burgeoning sectors of healthcare business. They have similarities and differences which I would like to explore. The market for both of these sectors is huge.
Both mHealth and HIT proponents claim they will make healthcare more efficient and save money. HIT is government mandated in a sense, insomuch as penalties will eventually be doled out for non-adopters who accept Medicare. Wireless technologies are more directed to the purchaser in a somewhat friendlier less intrusive presentation. EHRs are seen as tools for the provider and administrator, and mHealth is seen as a more patient-centric less provider labor-intensive instrument. EHRs are now used my most providers in some way and we are well into the first year’s distribution of financial incentives for Meaningful Use. While MU is a clear priority for hospital administrations, adoption has been slower than anticipated. Barriers include poor implementation, expense, and physician resistance. Many physicians invested in IT systems, and when their practices were bought by hospitals, they had to adopt the hospitals’ systems, resulting in a financial loss as well as having to learn another system. Some physicians go to multiple hospital systems and have to learn different HIT technologies for data and order entry. HIT systems may be from one vendor or components from various vendors or ‘home grown.’ Connectivity of mHealth technologies with EHRs will be important for a few reasons. Patient portals (PHRs) will be the point of much data from mHealth technologies into the EHR. The PHR will be the way in which patients and caregivers can integrate their data with other part of the EHR, and how the provider can synthesize the data with workflow patient management. Therefore, the adoption of EHRs is may be seen as a prerequisite for success of mHealth presence in the healthcare market. This is exclusive of the many wireless technologies aimed at health and wellness that may not benefit from interoperability. EHR adoption will have a positive impact on that of mHealth in that it will have people thinking digitally about healthcare. They will also hopefully be the ones pressuring their providers to get digital in many ways.
The HIT administrator in the hospital setting (I am using the hospital setting since most physicians are hospital owned and therefore fall under the domain of the hospital CIO) will be the one to ultimately make decisions about which mHealth technologies will interact with the HIT system. There may be pressure by providers about the use of computer tablets and desired apps. Security issues will come into play. Will providers be able to use their personal IT in the hospital for patient management? On-site versus off-site computing (Cloud-based) question would move expenses from capital expenses to operating ones.
Administrators who have IT as a long term priority over that of brick and mortar will see wireless technologies as a natural progression of how the system can, through the power of data integration with best clinical practice, result in the efficiency and cost savings that both mHealth and HIT claim as benefits. HIT must be made more adaptive to clinical practice and avoid the drop and click total template management temptation of providers. That will result in mistakes and inappropriate care.
HIT is a natural marketing, educational, and technical partner of mHealth. EHRs must have mHealth in mind during iterations, and certainly mHealth technologies targeted towards diagnosis and management of diseases (acute or chronic) must be designed and implemented with EHRs and other HITs in mind.
The purchaser’s cost for mHealth technology and services will be much less than HIT. However, both mHealth and HIT will need to demonstrate cost savings. Perhaps both sectors will, each as a group, develop strategies for demonstrating cost savings. Opportunities abound, and approaching maximal use should be done in a calculating fashion, involving all the stakeholders. mHealth can learn from EHRs mistakes and successes.
Lastly, EHRs and HIT are usually institution-based and mHealth’s strength is that is makes the patient the focus and the interactions are wireless, decreasing hopefully the need for both hospitalizations and office visits. As Dell CEO Eric Dishman pointed out at the MGMA conference recently, “We want to make sure that care coordination and the focus of care doesn’t have to just be a clinic or hospital. Increasingly, the nurse or the certified nursing assistant or the volunteer community health worker is going to need to interact with patients through electronic means.”