HIMSS Mobile “How To” Guide

HIMSS Physician

mHealth Task Force

HIMSS mHealth ‘How To’ Guide

• David Lee Scher, MD, FACP, FACC, FHRS

• Alisa Niksch, MD

• Megan Ranney, MD, MPH

• Lou Diamond, MD

• Brian Rothman, MD

Why Mobile Digital Health Tech Today?

The Big Picture

• Simple math: more patients via ACA, shortage of

physicians and other providers

• The need to track patients, inventory, and

processes

– ACO accountability

– ROI=cost savings, not revenue in 2015

• Mobile is a part of everyday life outside of

healthcare

Why Mobile Digital Health Tech Today?

The ‘In the Trenches’ Picture

• Clinicians are tethered to PCs

• EHRs are not intuitive.

– Apps can fill void

• Communication, patient monitoring & reference tools need to be mobile, safe, and secure

• Mobile needed for digital patient education

•ACOs

•Mega-merged organizations

•Retail medical care

Today’s Healthcare Landscape:

New Business Models

•Bundled payments

•Risk/Gain sharing

•Readmission penalties

Today’s Healthcare Landscape:

New Payment Models

Today’s Healthcare Landscape:

New Care Models

•Transitional care

•Remote patient monitoring

•Aging at home

•Participatory medicine: Role of the

caregiver

mHealth and Complex Care Models

• Complex care implies:

– High frequency of chronic disease states,

comorbidities

– Multiple stakeholders: physicians, healthcare

facilities, payers, patients, caregivers,

– Disparate communication and record keeping

capabilities

– Additive human factors: adherence, cost,

health literacy, mental health issues

Why a ‘How To’ Guide?• Legitimate concerns about quality, security, safety of mobile technologies, apps

• Up until recently no regulatory guidance

• Mobile presents unique challenges

• Lack of a central reference guide for adoption of mobile

• To understand obstacles to using mHealth to improve healthcare quality and cost from all perspectives

Purpose of the “How To” Guide

• To help address challenges of care in the current healthcare landscape

• To increase awareness of available technologies which can:

– Improve patient investment in their own health

– Improve safety and quality of care

– Improve physician workflow efficiency

– Improve patient and family satisfaction

Why an mHealth “How-To” Guide?

•To understand obstacles to using

mHealth to improve healthcare

quality and cost from an individual,

institutional, and systemic

perspective

Why an mHealth “How-To” Guide?

•For clinicians: How do you know if a

tool is what you need? What tools

are out there?

•For C-suite executives: How do you

know if a tool is worth investing in?

Why an mHealth “How-To” Guide? Clinicians

•How do you know if a tool is what you need?

– Does it address a clinical problem?

– Does it improve your time efficiency or decrease workflow?

– Is it something your patients will see as value?

– Does it interoperate well with the EHR?

– Has it been shown to do what it claims to?

– Has it been vetted for security and privacy issues by your IT department?

Why an mHealth “How-To” Guide? The C-Suite

Why an mHealth “How-To” Guide? The C-Suite

• How do you know if a tool is worth investing in?

– Is it something your clinician IT champions want or see value in?

– Is it something your IT department has vetted?

– Does it add marketing value to the enterprise?

– Is it something which can translate to patient satisfaction?

– Does it address a clinical or workflow problem?

– Is it something potentially valuable as a joint business venture?

Why an mHealth “How-To” Guide?

• mHealth tools must achieve functionality in key areas:

– Clear benefit and incentives to the consumer (patient and connected caregivers)

– Actionable measures with mechanism for feedback

– To assist in bridging health literacy gaps

– Integration with other health IT systems

Leveraging mHealth for New Care Models

•ACOs: Real-time mobile analytics,

communications

•Mega-merged organizations: Inventory

management, communications,

standardization of UX

•Retail Medical Care: Patient education

tools

Leveraging mHealth for Challenges in Care

• Discharge process: Scheduling, medication

reconciliation

• Chronic disease management: Remote patient

monitoring, telehealth

• Care coordination:: Communications tools,

mobile clinical trials

• Aging at home: Personal/environmental sensors,

social

Why an mHealth “How-To” Guide?

To guide implementation of mHealth initiatives to achieve the Triple Aim*

*Institute for Healthcare Improvement

The National Quality Strategy (NQS): How does mHealth fit in?

• NQS: Agency for Healthcare

Research and Quality (AHRQ)

through HHS

• Six priorities based on the triple

aim

The NQS: How does mHealth fit in?

• 6 priorities for U.S. healthcare quality:

Patient SafetyPerson and Family-

Centered Care

Effective

Communication and

Care Coordination

Prevention and

treatment of leading

causes of mortality

Health and Well-Being Affordable Care

mHealth & the NQS

• How can mHealth improve Patient Safety?

Patient SafetyPerson and Family-

Centered Care

Effective

communication and

Care Coordination

Prevention and

treatment of leading

causes of mortality

Health and Well-Being Affordable Care

mHealth & the NQS

• Priority 1: Patient Safety:

– Automated hospital discharge surveys

– Can use mHealth to improve satisfaction

& safety:

• Point of care mobile CPOE, EHR, staff

messaging

• Mobile EHR accessibility

• Text-messaging discharged patients

mHealth & the NQS• How can mHealth create patient-centric care? How can

mHealth streamline communication?

Patient SafetyPerson and Family-

Centered Care

Effective

Communication and

Care Coordination

Prevention and

treatment of leading

causes of mortality

Health and Well-Being Affordable Care

mHealth & the NQS

• STRATEGIES 2 & 3: Patient-Family-Centered Care & Effective Communication:

– Increasing use of “connected care” devices for monitoring of chronic disease

• wireless scales for CHF patients

– Patient access to data

• “OpenNotes” for EHR data

– Mobile self-reporting tools

• Automated text message data alerts to caregivers

• Self-tracking tools for depression, sleep, etc.

mHealth & the NQS• How can mHealth encourage/sustain healthy lifestyle

habits? How can mHealth help manage chronic disease?

Patient SafetyPerson and Family-

Centered Care

Prevention and

treatment of leading

causes of mortality

Health and Well-Being Affordable Care

Effective

communication and

Care Coordination

mHealth & the NQS

• Strategies 4 & 5: Prevention; and Health & Well-Being

– Prevention is presently difficult to achieve

– Mobile health can facilitate this with patient engagement tools.

• Preventing depression w/SMS messaging high-risk teens presenting to the ER (iDOVE)

• SMS message programs for smoking cessation (text2quit)

• Apps to reduce relapse after Rx for alcohol abuse (iCHESS)

• SMS messaging to create “care teams” (SenseHealth)

mHealth & the NQS

• Will mHealth achieve reduced cost of care?

Patient SafetyPerson and Family-

Centered Care

Effective

communication and

Care Coordination

Prevention and

treatment of leading

causes of mortality

Health and Well-Being Affordable Care

mHealth & the NQS

• Strategy 6: Affordable Care

– Jury still out BUT:

• Early studies suggest mHealth and remote

patient monitoring initiatives can improve

adherence, reduce visits/admissions, and

improve satisfaction

– Integrated/targeted mHealth programs

demonstrate potential for decrease in

hospitalization costs

mHealth Technology’s Role

•Technologies are not magic bullet

solutions… but tools which can

aid in the creation of effective care

coordination models

Case Studies from the HIMSS mHealth Physician

Task Force

• Remote Patient Monitoring

– Evolution with new biosensors, quest for more

clinical data and use cases

– Barriers to Adoption

• How mHealth Can Transform the Delivery of Acute Care

• Mobile technology to support care transitions

HIMSS Resources

•The Value of Remote Patient Monitoring (RPM) Physicians’ Perspectives

-History of RPM and its evolution

-Current case studies

-New models of reimbursement and cost of care

HIMSS Resources

Remote Patient Monitoring (RPM) -

Security and Other Adoption Barriers

- Security and data privacy concerns

- Limited business models

- Physician adoption barriers,

including buy-in for new technologies

- Cost of deployment and training

- Etc., etc.,…

HIMSS Resources

Mobile Technology Selection to Support Care Transitions

– Advantages and obstacles of mHealth as mode of improved communication between caregivers

– Introduction of Digital Health Selection Framework

– Lays out need for setting criteria for selecting digital health technologies

HIMSS Resources

mHealth: Improving Patients’ Health Before,

During, and After an Acute Care Visit

-Need for evidence-based mHealth

solutions for clinician use and buy-in

-Value of text/SMS messaging for

behavior change and compliance

Digital Health Technology Selection Framework

• A living document

• Developed by clinician KOLs in digital health

technology

• Segmented for administrators and clinicians

• Supported by best practices

The mHealth ‘How To’ Guide

THANK YOU