Mobile health technologies are most utilized now in the outpatient setting either for health and wellness by consumers or by providers primarily for the purpose of informational resources. The reasons for this are multiple, primarily related to marketing business models and lack of regulatory or connectivity requirements. However, the greatest potential in both cost savings and improved patient outcomes lies in the inpatient and transition to outpatient care areas. In another article, I discussed how mHealth technologies could help accountable care organizations (ACOs). http://davidleescher.com/2011/09/17/why-mhealth-will-be-critical-for-the-success-of-acos/ which will be reimbursement ‘covered entities’ over the inpatient and outpatient transitional periods. I now will cover what I think are other key clinical opportunities for mHealth for hospitals, regardless of whether they are in an ACO or not. I will give examples that are practical and not easily appreciated by administrators who aren’t in the workflow pattern of patient care, especially the 96% of CEOs that are not physicians.
1. Provider Use: Portability of EHRs on a tablet for physicians and nurses in the hospital allows for more efficient healthcare delivery. The provider does not need to retreat to a work station to enter notes, review records, or medications. As a physician alone on the weekend, I remember all too often seeing a patient at the bedside after reviewing the medications at the workstation, then getting paged to an outside line, and returning to the bedside not remembering the meds or labs. This necessitated another trip to the work station’s PC on the other side of the patient floor. And so it went all weekend. With tablet portability, med changes can be made more accurately at the bedside immediately while seeing the patient, reviewing .changes in pertinent symptoms or physical exam. So one may see there is certainly potential for improved efficiency and decreasing errors. Easy access to the Internet or apps containing practice guidelines, information on drugs, devices also promotes a higher quality of immediate care.
2. Patient education: Patients are too often told about tests they are going for or procedures recommended too late for them to absorb the indications, logistics, test or procedure process, risks, or alternatives to them. They are many times too intimidated or ill-informed to ask appropriate questions. This leads to anxiety, inability to share information with caregivers or family, and a situation which may lead to an absence of truly informed consent. It fosters a deterioration of the patient-provider relationship and increases the risk of medico-legal consequences. Wireless technologies assisting the provider in explaining a diagnosis, test, or procedure visually increases the comfort and ultimate satisfaction of the patient. A wireless keyboard with the television as a computer loaded with patient education tools is something that would be available throughout the hospital stay for these purposes. Assistants on the floor can help patients and caregivers navigate the program. Far-fetched? I think not.
3. Remote monitoring: Wireless technologies are used to monitor patients at the bedside. Newer technologies with body sensors do it more efficiently and may transmit the information anywhere, including the smartphone of a physician.
4. Communications: There are multiple wireless technologies which facilitate communications in the hospital. This results in increased efficiency, more prompt care (elimination of delays from overhead or pocket paging systems), and promotes better care (communication from the patient bedside).
5. Transitioning to outpatient care: Mobile health solutions, whether they be apps, body sensors, or other types of remote monitoring may, in the future, be customized for the patient prior to discharge so that the personalized therapeutic program is in effect before the patient leaves the hospital, resulting in fewer errors and a smoother transition. Pre-discharge teaching to the patient and caregiver may also be accomplished with technologies described above.
In summary, mHealth, will be a useful and important part of healthcare. Hospital CIOs already appreciate the potential upside of these technologies. Hospitals are focused on meeting Meaningful Use requirements these days. However, if one is to consider patient outcomes, hospital costs, and patient satisfaction, the benefits described of wireless health products cannot be ignored.
