Tackling the Tsunami: Building an mHealth Strategy

David Lee Scher, MD, FACP, FACC, FHRS Director, DLS Healthcare Consulting, LLC

digitalhealthconsultants.com Clinical Associate Profess or Medicine

Pennsylvania State College of Medicine

“The most valuable commodity that I know of is information”. –Gordon Gekko, “Wall Street”

What is mHealth?

Diverse application of wireless and mobile technologies designed to improve health research, health care services and health

outcomes .

Pew Internet/CHCG Surveys

Developments Supporting mHealth Adoption

• Implementation of electronic health records • Release of FDA Guidance on Mobile Medical

Apps • Growth of Patient advocacy (Health 2.0,

Quantified Self movement), Social Media • Wearable sensor and remote monitoring

technology development

Why is mHealth Good for Patients?

• SOMETHING MUST BE DONE to IMPROVE HEALTHCARE • Promotes patient engagement (self-management) • Provides educational resources and content development • Improves doctor-patient relationship • Creates personalization of healthcare -> ?better outcome • Convergence of many technologies -> simplification,

convenience • Supports caregivers’ mission

Which Mobile Apps Patients Want Their Doctor to Have

• 42%: An app to see their test results. • 33%: App connected to remote monitoring

devices. • 30%: Access to patient health records via

mobile device. • 13%: Didn’t think apps would help improve

care at all. Source: 2012 Ruder Finn mHealth Report

• GENERAL HEALTHCARE AND FITNESS – Fitness & nutrition – Health tracking tools – Managing medical conditions – Medical compliance – Wellness (traditional and corporate)

• MEDICAL INFORMATION – Reference – Diagnostic Tools – Continuing Medical Education (CME) – Alerts and Awareness

• REMOTE MONITORING, COLLABORATION, AND CONSULTATION – Remote monitoring (safety) – Remote Consultation – Remote Collaboration

• HEALTHCARE MANAGEMENT – Logistical & payment support – Patient health records

Facts About Health Apps*

• 97,000 mHealth applications are listed on 62 full catalog app stores.

• 15% are designed for healthcare professionals (CME, RPM, healthcare management).

• 42% of apps: Paid business model.

• Top 10 mHealth apps generate 4 million free and 300,000 paid downloads per day

*Research2guidance, 3/13

Barriers to Adoption of mHealth

• Incomplete regulatory guidance • Lack of reliability, security/privacy • Lack of mobile strategy by providers (BYOD, M2M

integration), payers • Lack of smart phones by older, chronically ill pts • Lack of business models • Lack of proven reimbursement, return on

investment • Physicians’ fear of high volume useless data

>90,000 medical

apps/programs

Clinicians: “Not

medically sound”

Consumers: <1/10 of

apps used more than

once

Business: “Doesn’t make me money”

From Megan Ranney, MD

Remote Patient Monitoring

Attributes of Ideal RPM

• Provide continuous surveillance with only actionable, trending data

• Unobtrusive • Interoperable with other devices and

EHR/portals • Have associated robust analytics with

clinical decision support

Mobile Cardiac Monitoring

Diabetes

Transdermal Patch w/Continuous Glucose Monitoring

Blood Pressure Monitoring

Pulmonary Monitoring

Complete Vital Sign/GPS Monitoring

Sensors: MEMS

• Implantable Sensors • Wearable Sensors • Biochemical sensors: glucose, pulse ox • Positioning sensors

Wearable Physiologic Monitoring

Footwear Sensors

mHealth: Smart Phone Capabilities

Medication Adherence Apps

• MyMedSchedule • Mymeds • RxMindMe • GloCaps

Proteus Digital: The Ultimate Adherence App

Role of Social Media in mHealth

• SoMe is mobile • Patients use smartphones for health

information • Patient-centered companies emerging • New market/business model for Pharma and

med device companies

Social Media: Critical Role inmHealth Strategy

4/6 Most Used Mobile Apps are SoMe-Based*

*GlobalWebIndex, 2013

SoMe and Healthcare

Online patient support groups – Clinical trial recruitment – Peer and caregiver support – Disease specific education – Healthcare navigation – Convenience – Anonymity

mHealth and Clinical Trials

Advantages of Mobile Clinical Trials

• Recruitment of patients via social media • Real-time adverse event reporting • Bidirectional patient-provider interactions

eliminate visits • Easier communications among all trial

stakeholders (regulators, sponsors, investigators) • Facilitates medication adherence (reminders, pill

sensors) • More efficient data collection, reporting, auditing • NO MORE FAXES!

Healthcare is still working in silos in many European countries

Hospital Care Physician Care Emergency Care Outpatient Care

No cross-border workflows, processes, no data exchange and access

Absence of legal and regulatory frameworks, e.g. for liability

Missing health-economic validation and bench-marks

No incentives for providers, payers and patients to use mHealth

Rainer Herzog, HealthActiveConsulting ©

Regulatory agencies and policy makers

• National / international standard protocols for e-/m-Health • Security and privacy of data

• Data integrity, availabilty and auditability • Risk management

Food & Drug Administration

(FDA) USA

Medical Device

Directive (MDD)

EU

Office of the National

Coordinator (ONC) USA

CE Quality Mark

EU

A Strategic Framework for Hospitals and Health Systems Present and Future State of mHealth

New Care Models Technology

ROI and Payments Policy

Privacy and Security

Standards and Interoperability

www.himss.org/mobilehealthit/roadmap

New Care Models: Healthcare in Transition

• Acute care Chronic Disease Management • Aging at Home • Hospital Readmission Prevention • Caregiver Involvement

mHIMSS Roadmap

• ROI/Payment: Addresses financial aspects of mobile tech adoption

• Legal & Policy: FDA mobile medical app Guidance • Standards & Interoperability: Types of networks,

communication patterns, standards above and below the network layers, network/storage tradeoffs, syntax and data, app standards, Blue Button Interface

• Technology: Factors to consider in app development • Privacy & Safety: Current state and future considerations

What is the Best Measure of the State of Adoption?

The HIMSS Mobile Technology Member Survey, 2013

Released February 26, 2014

HIMSS Survey: Respondent Profile

• 62%: IT professionals • 27%: Responsible for developing the

organization’s mobile tech policy • 38%: Member of committee responsible for

developing the organization’s policy on mobile tech

• 22%: Responsible for implementation and operation of mobile tech

Highlights of 2013 HIMSS Mobile Tech Survey

• Prioritization of Mobile Technology: Average score: 5.25

• Maturity of Mobile Technology Environment:

Characterized at 3.95, increased from 3.33 in 2012

• Impact of Mobile Technology on Patient Care: 33%: will substantially or dramatically impact patient care, decreased from 2/3 in 2012

Takeaways From HIMSS Survey

Mobile Technology Policy: 59% have mobile tech policy, 29% in

development. App Development:

Apps within their organization likely to be developed by third party.

½ plan to expand app usage. Barriers to Mobile Technology Use: #1= Funding

Significance of the Survey

• Identifies the decision-makers • Identifies market penetration more

accurately than industry analysts • Identifies pain points of mobile tech

adoption • Useful for developers, analysts,

healthcare enterprises, IT vendors

Challenges • Increase awareness and mobile tech by older

consumer/patients • Need filtered actionable data/alerts • Full connectivity with EHRs • Clinical efficacy studies • Interoperability among apps and platforms • Complete, reasonable and appropriate regulatory

requirements • Funding for mobile strategies (private, public)

Questions?