Mobile Health: Disruptive Innovation forMobile Health: Disruptive Innovation forPatient Centered EngagementPatient Centered Engagement

NISTNIST22 May, 201322 May, 2013

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• Founded in 1997 as a leader in Mobile SecurityFounded in 1997 as a leader in Mobile Security

• Healthcare Focus starting in 2009 Healthcare Focus starting in 2009

• Award-winning technology: MobiSecureAward-winning technology: MobiSecure® ® and and

MobiPublisherMobiPublisher®®

• Platform with $60 million Technology investmentPlatform with $60 million Technology investment

• 20 patents & 28 patent applications20 patents & 28 patent applications

The Private Securities Litigation Reform Act of 1995 provides a The Private Securities Litigation Reform Act of 1995 provides a ““safe harborsafe harbor”” for forward-looking statements. Certain information included in this document (as well as information included in oral statements or for forward-looking statements. Certain information included in this document (as well as information included in oral statements or

other written statements made or to be made by the company) contains statements that are forward-looking, such as statements relating to anticipated future revenues of the company and success of other written statements made or to be made by the company) contains statements that are forward-looking, such as statements relating to anticipated future revenues of the company and success of

current product offerings. Such forward-looking information involves important risks and uncertainties that could significantly affect anticipated results in the future and, accordingly, such results may current product offerings. Such forward-looking information involves important risks and uncertainties that could significantly affect anticipated results in the future and, accordingly, such results may

differ materially from those expressed in any forward-looking statements made by or on behalf of the company. For a description of additional risks and uncertainties, please refer to the companydiffer materially from those expressed in any forward-looking statements made by or on behalf of the company. For a description of additional risks and uncertainties, please refer to the company’’s filings s filings

with the Securities and Exchange Commission and with the Canadian Securities Administrators in the EDGAR filing system.with the Securities and Exchange Commission and with the Canadian Securities Administrators in the EDGAR filing system.

The information contained in this presentation and its attachments contains privileged, confidential and protected from disclosure. Please ensure that you do not forward, disseminate, distribute or copy this The information contained in this presentation and its attachments contains privileged, confidential and protected from disclosure. Please ensure that you do not forward, disseminate, distribute or copy this

presentation and its attachmentspresentation and its attachments. .

DiversinetDiversinet

Mobility Will Change Health and HealthcareMobility Will Change Health and Healthcare

• There are 5.9 billion mobile subscribers (that's 87% of the world population). Mobile devices allows providers to connect providers and patients.

• 81% of patients want online access to schedule appointments and fill out forms

• 78% will go online to access medical histories and share data with their physician

• 59% of patients 28-46 will switch to a physician with a greater online presence Source – Intuit Health Care Check-up Survey 2010

3... Powering Care Coordination Through Mobility ...

mHealth Market Growth and mHealth Market Growth and DriversDrivers

• PricewaterhouseCoopers and mobile operator industry association GSMA expect global mobile health revenues to hit $23 billion by 2017, with the biggest markets in Europe and the Asia-Pacific region.

• Revenues from remote patient monitoring services that use mobile networks will rise to $1.9 billion globally by 2014 1

• The wireless home health market looks to $4.4 billion by 2013, according to Parks (US market alone)1

• The Patient-Provider mHealth apps for Care is expected to grow 270% per year to reach $1.1B by 2017²

• Multiple mHealth Market Drivers: • Cost savings & Improved treatment ⁴

• Federal mandates & tax incentives (HITECH, Meaningful Use) ³

• Health regulatory/privacy requirements 4

• Remote monitoring & med reminders

• Increased Smartphone use by doctors & users

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1) mHealth predictions: $1.9B, $4.4B, $4.6B? By: Brian Dolan | Apr 14, 20102) mHealth Adoption for Patient Engagement – Chilmark Research May 20123) ScienceDaily, May 1, 20084) Emrandhipaa.com, Details of Obama’s EMR Stimulus Package

mHealth will be a strategic investment

mHealth extends the ability of the entire healthcare sector to extend their solutions securely through mobility

Mob

ilityM

ob

ilityM

ob

ilityM

ob

ility

Mobility

EmpowermentEngagement

Activation

Electronic Medical RecordElectronic Medical RecordElectronic Medical RecordElectronic Medical Record

Health Information ExchangeHealth Information ExchangeHealth Information ExchangeHealth Information Exchange

Patient Health Record CompaniesPatient Health Record CompaniesPatient Health Record CompaniesPatient Health Record Companies

Medical Devices CompaniesMedical Devices CompaniesMedical Devices CompaniesMedical Devices Companies

Disease Management CompaniesDisease Management CompaniesDisease Management CompaniesDisease Management Companies

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Telehealth CompaniesTelehealth CompaniesTelehealth CompaniesTelehealth Companies

Healthcare OrganizationsHealthcare OrganizationsHealthcare OrganizationsHealthcare Organizations

Health Plans/ PayersHealth Plans/ PayersHealth Plans/ PayersHealth Plans/ Payers

Growing Security Risk for Mobile Health

• Frequency of patient data losses at healthcare organizations increased by 32% in 2011

compared to 2010, with 49% of respondents citing lost or stolen computing devices such as

laptops, tablets, and smartphones. At the same time, 81% of Healthcare Providers use mobile

devices to store or transmit data yet 50% do nothing to protect the data. *

• Data breaches in U.S. hospitals create a potential economic burden of $6 billion dollars

annually – forcing IT departments to focus heavily on preventing security breaches before they

occur and bridge the divide between mobility and security*

• The HIT Policy Committee, which advises HHS, voted Sept. 6 to accept recommendations from

its Privacy and Security Tiger Team to require multi-factor authentication in certain cases

involving remote access to patient information for Stage 3 of the HITECH Act electronic health

record incentive program. • The authentication would have to meet NIST Level of Assurance 3 standards. Level 3 includes the use of soft

OTP tokenshttp://www.healthcareinfosecurity.com/multi-factor-authentication-gets-boost-a-5095?rf=2012-09-10-eh

• Stage 3 is slated to begin in 2015, and rules are in the early discussion stages at the Department of Health

and Human Services. * Second Annual Benchmark Study on Patient Privacy & Data Security Ponemon Institute, December 2011

... Powering Care Coordination Through Mobility ... 6

NIST NIST

• Diversinet was invited to present at the National Cybersecurity Center of Excellence (NCCoE) on April 17, 2013 to explore Health IT Components that support the Mobile IT Use Case (http://csrc.nist.gov/nccoe/hit/index.html)

• Use Case Sending an electronic prescription Receiving a lab result Sending a patient lab results and instructions to see a specialist Checking a patient into a hospital under Dr. Smith’s care Sending or receiving consultation information Requesting that a hospital discharge a patient Viewing hospitalized patients’ charts Sending a referral (e.g., clinical information to another physician) Ordering an imaging test

• Meeting Highlights

Attendees: RSA, Microsoft, Intel,  Cisco, Symantec, McAfee, Good technology,  RayTheon, etc.    Other attendees  included - Trustwave, Fiberlink, West Health Institute, MedTec

CRADA being established

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• Pin # for Client Access

• Content Destroyed After Failed Attempts

• Content Encrypted

• Client Bound to Mobile

Strong Authentication & Encryption for Mobile Applications/Devices

Bilateral2 Factor Authentication

One Time Password One Time Password SSL Pipe

EncryptedContent Repository

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Customer Enterprise Server(s)

CustomerMobile App

mobiPublisher™™

Features:•2-Way OTP – anti-Phishing•Double Encryption – Not Dependent Upon SSL•Local Use of Device Features and Interfaces

FIPS 140-2

SOAP API

A Scalable Model for Mobile Security

Customer ConfiguredApplication

Messaging

Questionnaires

Graphical Results

Guest Users/Portal

Or Wallet SDK

AES Encrypted Exchange

mobiPublisher®Server

One Time Password One Time Password

HITECH Stage 2Loyalty

OfferingsACO Year 1: Quality reporting

ACO Year 2: Quality payment

Quality Monito

ring

and

Preventiv

e

Engagement

mPH

R and

Appointm

ent

Schedulin

g

Mobile Health Adoption Trends

Rate

of

Adopti

on

Native EHR

2010Strategic InitiativesStrategic Initiatives

2011 2012 2013 2014 2015Affordable Care Act Passed

HITECHStage 1

Messaging and acc

ess

HITECH

... Powering Care Coordination Through Mobility ...

mHealth ChallengesmHealth Challenges

• Rapid Proliferation of Mobile Solutions No common data model on patient reported outcomes (Describe sleep, mood

side effects, etc) Apps are not interoperable Apps are not scalable or have adequate security Provider v. Patient focused apps

• Innovation competing against interoperability Millions of apps that do not have providers in the provider workflow Eco System based on an open framework

• Standalone mobile strategy or apps will not achieve the transformational impact. It will take innovation and experimentation using a system based mobile strategy enabled by a secure and flexible enterprise mobile platform

mHealth ChallengesmHealth Challenges

• Evidence shows mHealth adoption is slow as we are evolving our understanding of:

How to activate and persistently engage patients on their health and healthcare

How social determinants of health, preferences & lifestyle influence health behavior change

How to personalize approaches to our patients as unique consumers who respond differently to our attempts to engage, activate and behavior change

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The red dot represents the average number of minutes (100) a patient spends with a provider per year and the white represents the 525,600 minutes in a year

Problem: Need to engage patients in the Problem: Need to engage patients in the white spacewhite space

“Patient engagement is the blockbuster drug of the century”Leonard Kish

Understanding Patients…Understanding Patients…

Patient Activation= Better HealthPatient Activation= Better Health

Engaged Patients LOWERS COSTEngaged Patients LOWERS COST

• Disease management programs online and engagement as demonstrated by a Blue Cross Blue Shield: a $9.81 return for every dollar spent.

• Factoring all results from all of these studies, and it amounts to a $4.51 return for every dollar spent to build and implement patient engagement programs

http://insights.wired.com/profiles/blogs/healthcare-s-solution-is-here-it-just-needs-to-take-flight#ixzz2KooO5hbg

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Solution to the Cost Problem: Engaged Solution to the Cost Problem: Engaged PatientsPatients

Recent NQF Commissioned PaperRecent NQF Commissioned Paper

“An extended set of standardized key data elements, structure, and implementation guidelines to support the broader vision of care coordination and patient-centered care, including the co-management of longitudinal care

plans, does not yet exist. “

Seven domains are needed for integrated patient care, proposed by Singer et.al.

1.Coordinated within care team

2.Coordinated across care teams

3.Coordinated between care teams and community resources

4.Continuous familiarity with patient across time

5.Continuous proactive and responsive action between visits

6.Patient-centered - the extent to which providers consider the needs, preferences, values, and capabilities of the patient, family members, and other caregivers

7.Shared responsibility - based on shared responsibility between patient and caregivers for optimizing health

Health Information Technology to Support Care Coordination and Care Transitions:Data Needs, Capabilities, Technical and Organizational Barriers, and Approaches to Improvement

Lipika Samal, MD, MPHOmar Hasan, MBBS, MS, MPHArjun K. Venkatesh, MD, MBA

Lynn A. Volk, MHSDavid W. Bates, MD, MSc

Brigham and Women’s Hospital, Boston, MA

• Eating patterns

• Medication taking

• Physical activity

• Risky drinking

• Sleep quality

• Smoking/tobacco use

Behavioral characteristics

Estabrooks, Paul A, et.al., “Harmonized patient-reported data elements in the electronic health record: supporting meaningful use by primary care action on health behaviors and key psychosocial factors, J Am Med Inform Assoc 2012;19:575-582 doi:10.1136/amiajnl-2011-000576

Patient Characteristics

Psychosocial characteristics

• Anxiety and depression

• Stress

• Quality of Life

• Demographics, Preferences, and Social Determinants of Health

• Health Literacy/numeracy

• Care Plans with Adherence Monitoring

Harmonizing Patient Generated Data

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Framework for Patient Centered Framework for Patient Centered EngagementEngagement

What is mobiHealth Wallet What is mobiHealth Wallet TMTM ? ?

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Enabling Core Technology: mobiPublisherTM

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Enterprise Mobile PlatformEnterprise Mobile Platform

Secure - Write Once Deliver Across All Mobile Platforms

Care Coordination Engine

Mobile App Platform with content management

(Customers configure our template based care and set alerts and reminders based

on the care plan)

MobiSecure SDK

Secu

re

Publis

her

&

mess

en

ger

Secu

re

Publis

her

&

mess

en

ger

Target Outcomes: Reduced Readmission, Improved Adherence & Compliance, etc

CONTENT:Care Pathways,

Care Plans,Patient Education

CONTENT:Care Pathways,

Care Plans,Patient Education

INTERFACES:

EHRHIE

Medical Devices

INTERFACES:

EHRHIE

Medical Devices

MobiSecure Platform

Mobile Application Solutions

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Key Customers and Partners

Mobile case management to support

10K wounded warriors and extended

care givers, with BYOD over 280

devices. Secure messages,

appointment reminders,

questionnaires, mood tracking.

Decision made to expand to over

10K+ users.

Being the first to receive FDA clearance

for its device-agnostic mobile patient

monitoring applications, mobiSecure®

SDK will power ultra secure messaging,

HIPPA compliant, with FIPS 140-2 military

grade security for all consumer

smartphones, tablets, and mobile

devices.

Secure patient to clinic

communication and PHR, using

portal & mobile devices. Connecting

PHR, EMR, Lab Results, Providers,

Patients. Controlled PHI sharing for

dependents empowering caregivers.

mCare Wounded Warriors San Antonio, TexasOntario, Canada

US ARMY

Mihealth

Value PropositionValue Proposition

Patients and Families

Patients and Families

HCOs, ACOs,

PCMHs, & Payers

HCOs, ACOs,

PCMHs, & Payers

Health Informatio

n Exchanges

Health Informatio

n Exchanges

Population Health

Population Health

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Our Story of an Empowered Patient: Carl Our Story of an Empowered Patient: Carl

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Patients receive care in multiple settingsPatients receive care in multiple settings

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Carl Downloads Data and Establishes ProfileCarl Downloads Data and Establishes Profile

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Carl’s Profile Personalizes his Care PlanCarl’s Profile Personalizes his Care Plan

Tracking Adherence to Care Plan GoalsTracking Adherence to Care Plan Goals

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Wallet supports consumer mediated exchangeWallet supports consumer mediated exchange

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Providers are able to view Carl’s RecordProviders are able to view Carl’s Record

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Primary Care Provider is Notified of ED VisitPrimary Care Provider is Notified of ED Visit

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Care Plan is Easily Customized & UpdatedCare Plan is Easily Customized & Updated

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Carl is Engaged and Improving His HealthCarl is Engaged and Improving His Health

SummarySummary

• Mobile Health is still emerging

• A sustainable business model for mobile health

• Adoption has been limited due to Reimbursement Emerging understanding of patients and how they make decisions about health

and healthcare Workflow: Provider-Patient Engagement Data Silos ROI

• Future: mHealth will disrupt current healthcare model

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Thank youThank you

Hon Pak, MD, FAAD, CEO

hpak@diversinet.com

210.831.4700

Susan Hull, MSN, RN

Chief Health Informatics Officer

shull@diversinet.com

707.400.8995

David Annan

Chief Technology Office

dannan@diversinet.com

+1 416.756.2324 X232