| Date post: | 18-Dec-2014 |
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Self Improvement |
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Participatory Health:
The New Game in Town
C. Peter Waegemann
Vice President, mHealth Initiative“One of 20 Most Influential People in Healthcare”
(HealthLeaders)
Copyright 2009, mHealth Initiative Inc., Boston MA. All rights reserved.
The Revolution of
Participatory Health
and
mHealth
Participatory Health
Active Participation of
– People
– Healthcare providers
– Wellness providers
– Public health
– Pharmacies, labs, others
– Health plans and payers
Active Participation of
People
Whether
healthy
or ill
Patients
Consumers
Children
Adults
Seniors
•Are encouraged to become active
participants in their wellness and health
matters
•Change their life style
• Keep a personal health record
•Spend personal resources on living
healthier
•Research and learn about relevant health
topics
• Be involved in cost issues for their
healthcare and participate in healthcare-
related cost decisions.
The Vision of mHealth
Consumers, People,
Patients
Public Health
Emergency Services
Clinicians and other
care providers
Administrative Staff
What is mHealth?
Enables continuous communication with the provider
Brings the power of the Internet to the mobile user
Patient/consumer to control and manage their essential health data on mDevice
Enables care provider to document and get decision support at point of care
New applications using disease management applications
New way to enable interoperability in healthcare
Much different and bigger than telemedicine or “wireless hospital applications”
Requires restructuring
Enables participatory health
Three Generations of HIT
1970-1997 Computer-based
Patient Records
Document Imaging
Practice
Management
Systems
EDI Messages
CHINs
1998-2009
eHealth
5 eHealth Systems
RHIOs
PACs
CPOE
Medical Communities
EMRs
2010-
Participatory Health
Consumers
New Communication
Participants’ Coordination
mHealth
Ecosystem Interoperability
New Financial Systems
Workflow, workflow,
workflow
Problem
Patients often see their clinicians only periodically and for short periods of time.
Patients need to remember all health symptoms and health related events (observations of daily living – ODLs) within a very short visit that may be emotionally laden.
Change: Pattern of Care
• Periodic visit when needed
• Patient needs to visit care
provider
• Too little time for
communication
• Patient not a participant in the
decision process (financial and
clinical)
• Wellness providers not
included
• Continuous care focus
and communication
• Person/Patient
participates
• Wellness providers
included
• Care community linked
concerning patient data
access and resources
Types of Communication
1. Patient to provider (pre-engagement)
a. General inquiry
b. Appointment
c. Insurance coverage or cost
2. Provider-patient interactively
a. Appointment confirmation/reminder
b. Reason for visit: Agenda
c. Referrals and other care management communication, e.g. „How r u?’
d. Other
3. Patient education
Credit: Nardo Manalato
APPOINTMENT REMINDERS – 135 characters (including spaces)
##firstname## u have a ##time## appt ##apptdate## with Dr. ##providerlastname## 2 cancel appt call ##Phonenumber##. Txt STOP 2 end msgs
MAMMO – 156 characters (including spaces)
##firstname##, u got a letter from KAISER asking u 2 book an appt for a Mammogram. If u HAVEN’T made an appt call 888-888-8888 today! Txt STOP to end msgs
PAP SMEAR – 156 characters (including spaces)
##firstname##, u got a letter from KAISER asking u 2 book an appt for a Pap Smear. If u HAVEN’T made an appt call 888-888-8888 today! Txt STOP to end msgs
CVD LABS – 155 characters (including spaces)
##firstname## U got a letter from KAISER 2 get lab work done. If u HAVEN'T been 2 the lab, please do so. Questions call ##PatientCID##. Txt STOP 2 end msgs
Text Messaging
Appointments
Medication reminders
General inquiries
Administrative questions
Non-healthcare related communication
Health promotion
Patient-initiated communication
Need to reschedule appointment
Need for prescription refill (?)
Problem
Physicians and other practitioners cannot memorize all formularies, guidelines, protocols, health plan instructions, or all of new developments in the scientific body of medicine.
Easy access at the point of care
Provide access to web sites through smart phone browsers
Accessing Information at the Point of Care
Patient health information
Insurance eligibility information
Care decision support information Formularies
Guidelines and protocols
Disease management information
Access to scientific body of medicine
Other
Problem
Physicians and other practitioners often provide patient care without knowing what has been done previously and by whom, resulting both in wasteful duplication and in clinical decisions that do not take into account critical data related to patient health.
For over 2,000 years,
the patient was rarely
informed about the
medical circumstances.
Disease details were left
to doctors. As recently
as 1965, patients were
not allowed to see
medical books in
publicly funded libraries
HIPAA gives the
patient the right
to a copy of the
medical record
1999-2000
Internet
opens up
health
information
13 million
Personal Health
Records
Dot.com
bubble
bursts
Concern
over
Internet
reliability
2007-2008
Health 2.0:
Disease-
specific
Communities
2002-2006
Patient
support
groups
develop
Professionally
guided
disease
communities
will support
new
research.
guidelines
and protocols
7 million PHRs
10 mill. PHR-Lites
3-4 mill. PPPs
2010
20% EMR
Implementation
Interoperability
through
ecosystems
PHR
Developments
Continuity of Care and
Interoperability
Not from Standards Work
Proprietary Ecosystems:
– Microsoft
– Dossia
– Continua
– Others
Telecommunications-based Interoperability
Personal Health Record on
the Phone
Interoperability through the patient
After the smart card, USB, CD
experiences
Can use any phone
Current Projects
Problem
How to get physicians, nurses and other practitioners to document at the point of care?
Point-of-Care Documentation
The problems of documentation
when away from the computerInaccurate
Scribbled down
NOT GOOD HEALTHCARE
A TEST
frequent or
pregnant?
routine or
positive?
1000u or
10000?
hypertension
or
hypotension?
negative or
hepatitis?
Point-of-Care Documentation
Three parts:1. Computer use at the point of care2. Accessing information
a. Within the systemb. Outsidec. PHR
3. Documenting User preferences Technologies Integration
Problem
Is there a way of disease management that is more effective and reduces costs?
Answer: Communication-based Disease Management
Cell Phone Application Cluster: Disease Management
Wonders of better communication
Currently focused on
Diabetes
Asthma
Dermatology
Preventive care in pregnancy
Smoking cessation
Hypertension
Teaching, Monitoring, and Coaching
New applications in nursing and other areas
Administrative Applications
Wide range of applications Provider – Patient applications
Staff communication
With others
Text v. email
RFiD: Asset management Inventory
Patient Flow
Financial Applications
Charge capture
Providers accessing eligibility info
Providers sending bills
Payers in active communication with patients and providers
Online real-time adjudication
Reporting of disease outbreaks
Instructing patients
Bioterrorism
Surveillance
Population notifications
Other
Population Health Communication in Participatory Health
Analyzing the Change
Traditional
Physician at
Center
Paper-based
and Memory-
based
Information
Systems
Symptom/
Crisis/Visit
Knowledge
Development
in Research
Setting
eHealth
Beginning of patient-
friendly care
Document Imaging
EMRs, PACS, CPOE,
Others
Computer use with
minimum change in roles
and workflow
Clinical data interpretation
is (often) intuitive and
limited by pattern recall for
inference and deductions
Beginning of Disease
Management
Quality is best evidence
supplied consistently
Participatory Health
Healthcare is ongoing and the patient
communication is the point of service
mDevices and continuous
communication are the basis of care
From provider HIT systems to a
network of applets and functions
providing DSS
Knowledge development from all
participants
Quality is best evidence supplied
uniquely through personalized care
Team Analysis
Well-being is integrated
Behavioral aspects integrated
Analyzing the Change
Traditional
Physician at
Center
Paper-based
and Memory-
based
Information
Systems
Symptom/
Crisis/Visit
Knowledge
Development
in Research
Setting
eHealth
Beginning of patient-
friendly care
Document Imaging
EMRs, PACS, CPOE,
Others
Computer use with
minimum change in roles
and workflow
Clinical data interpretation
is (often) intuitive and
limited by pattern recall for
inference and deductions
Beginning of Disease
Management
Quality is best evidence
supplied consistently
Participatory Health
Healthcare is ongoing and the patient
communication is the point of service
mDevices and continuous
communication are the basis of care
From provider HIT systems to a
network of applets and functions
providing DSS
Knowledge development from all
participants
Quality is best evidence supplied
uniquely through personalized care
Team Analysis
Well-being is integrated
Behavioral aspects integrated
Analyzing the Change
Traditional
Physician at
Center
Paper-based
and Memory-
based
Information
Systems
Symptom/
Crisis/Visit
Knowledge
Development
in Research
Setting
eHealth
Beginning of patient-
friendly care
Document Imaging
EMRs, PACS, CPOE,
Others
Computer use with
minimum change in roles
and workflow
Clinical data interpretation
is (often) intuitive and
limited by pattern recall for
inference and deductions
Beginning of Disease
Management
Quality is best evidence
supplied consistently
Participatory Health
Healthcare is ongoing and the patient
communication is the point of service
mDevices and continuous
communication are the basis of care
From provider HIT systems to a
network of applets and functions
providing DSS
Knowledge development from all
participants
Quality is best evidence supplied
uniquely through personalized care
Team Analysis
Well-being is integrated
Behavioral aspects integrated
mHI’s Vision of some Participatory
Health Functions
Phone identification
Pre-service automated check-in
Pre-service communication
Care applets guide the clinician
Real-time financial bill submission
Real-time adjudication
Additional fee services by provider
Continuous care communication
mHealth Community
Participatory health
mHealth implementation
More: www.mhealthinitiative.org
Wishing You a great time at this conference and a happy transition into
the era of participatory health and mHealth
C. Peter Waegemann
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