What Does the Ideal Hospital mHealth Strategy Look like?


Most hospital IT administrators are presently dealing with Implementation of Stage 2 of Meaningful Use as well as planning for conversion to ICD-10 coding. Among more advanced institutions, the topic of the day is development of a mobile strategy. The vast majority of physicians and nurses are using their smartphones for professional purposes, mostly for reference purposes. I will discuss what I see as the most useful ways in which mobile health tools can improve processes and care.

1.    A BYOD policy. According to Wiki,” Bring your own device (BYOD)…is a term that is frequently used to describe the policy of permitting employees to bring personally owned mobile devices (laptops, tablets, and smart phones) to their place of work and use those devices to access privileged company information and applications.”  A BYOD policy is one which addresses security and privacy issues. Dr. John Halamka has written eloquently on the subject and I agree with his advice to make it a technology-based issue not a policy-based one.

2.    A hospital app formulary. These apps range from reference apps to those which will be recommended to patients (and even perhaps ones added which are recommended by patients).  The apps would be deemed to come from reliable sources. Operations (pertaining to coding, billing, personnel and room availability scheduling, etc), and patient education apps should also be included.  Staff input in choosing apps is important.

3.    Mobile patient management tools. Technology is rapidly evolving to assist providers in the hospital. There are robots utilizing telehealth  conveying real-time video and information from ICU patients to physicians at remote locations within or outside the hospital. Technologies such as Patient Touch allow nurses at the bedside to transmit and receive digital health information via mobile devices or smartphones.

4.    Mobile EHR. Although there are more than a few EHRs that have mobile platforms, most physicians are not utilizing mobile EHRs. However, when surveyed, 90% of physicians would like to use mobile EHRs. Although not specific to mobile EHRs, a significant finding of a recent study by the Pennsylvania Patient Safety Authority interestingly found that “of the 3,099 EHR-related events analyzed by the Authority, 2,763 (89 percent) were reported as “event, no harm,” meaning an error occurred but there was no harm to the patient. Ten percent of the reports (320) were reported as “unsafe conditions,” which also did not result in a harmful event. Fifteen reports involved temporary harm to the patient due to the following: entering the wrong medication, ignoring a documented allergy, failure to enter lab tests and failure to document.”  It was interesting that privacy and security were not the areas sited as causes of problems. Mobile EHRs though, certainly carry these issues and will bring security to higher visibility as concerns after adoption.

5.    Secure messaging. As part of Stage 2 of Meaningful Use, there needs to be secure messaging with patients. In addition, secure and HIPAA compliant messaging among providers and others in the hospital is warranted.

Hospitals present unique workplace issues and deserve special considerations regarding mobile technologies. IT personnel need to develop mobile strategies today.

About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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4 Responses to What Does the Ideal Hospital mHealth Strategy Look like?

  1. One of the first bits that must be considered in developing strategy is the payer mix for a given hospital. For example, what percentage of patients enter the hospital historically with private insurance vs. say a capitated Medicaid plan. On one hand, private pay likely means you would like to maximize billings assuming that you have been successful in the past with receiving a good portion of those claims (never 100%) and streamline cost; especially for those services that are not billable or less profitable. On the other hand, many hospitals are stuck with a high percentage of Medicare or Medicaid with low reimbursement and in a growing number of cases with capitated rates (meaning you can only get paid a fixed amount regardless of the services provided). Even in the private pay scenario profits come from surgeries and not from managing chronic disease. Not saying that hospitals are evil but they are certainly biased to want to perform more surgeries and minimize less profitable services.

    It’s a tricky thing to say what the best strategy is for ‘a hospital’. It depends on the specifics just like the promise of mHealth depends on a patient-centered approach and not a one size fits all mobile app.

    However, once you have strategy in place incorporating the hospital-centered delivery plan, then you can consider technology elements and integration to improve care while also caring for their bottom line.

    • Kevin, I would respectfully disagree. The mix of payers is irrelevant in the mission of developing a mobile health strategy. Readmission prevention and better outcomes are the goal. Mobile strategies include apps making billing, coding, other operations easier and more efficient. Granted strategies are customized depending upon the resources available, goals, size, technical support and other factors. Technology is never installed in a vacuum. However, all hospitals today require some mobile strategy because mobile is already in their hospitals. I fail to see how the payer mix relates to this. Right now a mobile strategy is best considered by hospitals who have already addressed satisfactorily MU and ICD-10 issues and have a strong IT base. ACOs fall into this category as well. As we move towards pay for performance and bundled payment schemes, mHealth will be adopted more quickly.

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