RTI International

RTI International is a trade name of Research Triangle Institute. www.rti.org

mHealth at RTI International: How Mobile Technologies Are Changing the Practice of Medicine & Public Health

Robert Furberg, PhD, MBA; Clinical Informaticist

March 16, 2012

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“That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.”

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“That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.”

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GE’s Pocket Mobile Echocardiography (PME) device

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mHealth describes a broad range of telecommunications and multimedia technologies within a wireless care delivery architecture.

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Continuum of mHealth tools

Measurement• Sensor sampling in

real time• Integration with

health data

Diagnostic• POC Diagnostics• Portable imaging• Biomarker sensing• Clinical decision

making

Treatment• Chronic disease

management• Remote Clinical

trials• Disaster

support/care

Global• Service Access• Remote

treatment• Dissemination of

health information

• Disease surveillance

• Medication tracking and safety

• Prevention and wellness interventions

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mHealth is patient-focused, social, and consumer-initiated.

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Top ten targets for mHealth Alzheimer’s: 5 million Americans. Wireless sensors can track the vital signs of

patients as well as their location, activity, and balance. Asthma: 20 million Americans. Wireless can track the respiratory rate and peak flow

so patients can use inhalers before an attack occurs. Breast Cancer: 3 million Americans. Women can use a wireless ultrasound device at

home and send the scan to the doctor–won’t have to go in for a mammogram. Chronic Obstructive Pulmonary Disorder (COPD): 10 million Americans. Wireless

can monitor FEV1, air quality and oximetry. Depression: 19 million Americans. Wireless can monitor medication compliance,

activity and communication. Diabetes: 21 million Americans. Wireless can monitor blood glucose and hemoglobin. Heart Failure: 5 million Americans. Wireless can monitor cardiac pressures, fluids,

weight and blood pressure. Hypertension: 74 million Americans. Wireless can continuously monitor blood

pressure and track medication compliance. Obesity: 80 million Americans. Wireless scales can track weight and wireless

sensors can track calories in/out and activity levels. Sleep disorders: 15 million Americans. Wireless sensors can monitor each of the

phases of sleep for quality of rest, detect apnea and track vital signs.

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The highest level of mobile telephone use is among adolescents, younger adults, socioeconomically disadvantaged populations, less educated young adults, and people who rent or frequently change addresses. (Franklin, 2003; Faulkner, 2005; Koivusilta 2007)

Further, a high level of mobile telephone use is associated with lower levels of self-rated health, higher BMI, and engaging in health-compromising behaviors. (Lajunen, 2007; Koivusilta, 2005)

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Sample CAHIT Projects

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Improvements and Upgrades to AHRQ’s electronic Preventive Services Selector (ePSS)

Client: AHRQ Purpose:

To refine and expand the Electronic Preventive Services Selector (ePSS) by:

1. Conducting user research2. Developing new content3. Recommending new features

and processes

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Improvements and Upgrades to AHRQ’s electronic Preventive Services Selector (ePSS)

http://epss.ahrq.gov/PDA/index.jsp

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Communication-Focused Technologies

Client: AHRQ Purpose:

Develop, implement, and evaluate multifaceted, tailored, proof-of-concept intervention delivered through short-message service (SMS) aimed at improving health care quality and outcomes for HIV-positive patients treated in an ambulatory care setting

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Adherent He shoots! He scores! Perfect med adherence. Great job!

Non-adherent It’s going to be a great day. This is your med reminder.

Sex risk Undetectable is respectable, but your partners are still infectable. Play safe.

Substance risk Going out tonight? Be safe. Party smart.

General health and well-being Take care of yourself today. Eat healthy foods, don’t stress out, get some exercise and sleep well.

Social support Worried about telling friends and family your status? We can help you find the right words. Call HB at 773-388-8865.

Patient involvement Ask your provider questions. If you don’t understand the answer, keep asking until you do.

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Recruitment Enrollment(n=52)

Medical Record Review

Pre-intervention Survey

Assignment to Message

Cluster

Exposure to Intervention

(90 Days)

Patient Interviews

(n=9)and

Clinic Staff Interviews

(n=5)

Medical Record Review

Post-intervention Survey(n=46)

Parallel Data Collection:Input from Study Implementation Team - Text Messaging Archives - Feedback from Site Study Coordinator

Message Cluster:· Medication Adherence· Sexual Risk Reduction· Substance Use Risk Reduction· Social Support

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Summary of Findings

Among HIV positive MSM, intervention was associated with a statistically significant

increase in knowledge, change in beliefs, reduction in risk behaviors, increase in perceived social support, and improved medication adherence (self reported and

clinical data)

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Improved self-reported adherence

Missed dosein past7 days

Forgotto take

medication

Slept throughdose time

0%10%20%30%40%50%60%70%80%90%

100%100%

81%

62%53%

38%

23%

Baseline Follow-up

% o

f Par

ticip

ants

Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those nonadherent at baseline.

n=21 n=17

Participants Receiving Medication Reminder Messages

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Contact

Robert D. Furberg, PhD, MBAClinical Informaticist Center for the Advancement of Health IT919.313.3726rfurberg@rti.org