Date post: | 05-Dec-2014 |
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Health & Medicine |
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mHealth in Everyday Practice Plain Talk
September 7, 2012 Steve Heilman M.D., FACEP
System Vice President and Chief Medical Information Officer
Integrated Delivery Network of
Five Not-for-Profit Hospitals
14 Out-patient Centers
1.4 Million yearly patient encounters
$1.5 Billion yearly revenue
12,000 Employees
500 Employed Providers
2,000 Physician Medical Staff
2,000 Licensed Beds
60,000 Admissions/year
Norton Healthcare
Key Messages for Discussion
• mHealth Overview
• Clinician Utilization
• Patient Engagement
• Population Management and Research
• Healthcare Reform and mHealth
• Adoption Barriers
What is mHealth?
• The use of mobile and wireless devices to improve health outcomes, healthcare services and health research
• Applications of mHealth include: – Utilizing devices to collect community and clinical
health data
– Delivery of healthcare information to clinicians, researchers, and patients
– Remote monitoring
– Remote provision of care
Routine Clinician Applications
Quick and easy access to cloud based data– drug guides, medical alerts, journal summaries and medical references.
Routine Clinical Applications
Electronic Medical Record (EMR) Access – dedicated native applications to access patient data, refill prescriptions, review and release labs, communicate with staff and patients via secure messaging.
Routine Clinical Applications
Access to Personal Health Record (PHR) information
Routine Clinical Applications
Remote Monitoring Access
New Applications for Clinicians
• Digital Dermatoscopes
• Digital Stethoscopes
• Ultrasound applications
• Medical Imaging Review
Home Monitoring Applications
• Bluetooth devices – scales, glucose monitors, BP, Medication dispensers
• Positive Feedback
• Patient Education
New Applications
• Microchip patch/ Ingestible event monitors
• Cardiac Monitoring
Population Management/ Research
• Telemedicine – enabling the provision of care anywhere. ? mHealth
• Physician Specialty Shortages
Population Management/ Research
• Asthmapolis
Population Management/ Research
• Home monitoring can improve outcomes • Columbia University1 – telehealth and data collection
from glucometers - greater↓HbA1c compared to control group
• Weight and vitals monitoring in CHF patients2,3 - ↓office visits 10% ↓home visits 65%. ↓ six month mortality rate 56.2%
1. Shea S, Weinstock R, Starren J, and etc. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically
Diverse, Medically Underserved Patients with Diabetes Mellitus. J Am Med Inform Association 13:40-51, 2006. 2. Cleland J, Louis AA, Rigby AS, and etc. Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and
Death, Journal of the American College of Cardiology 45(10):1654, 2005. 3. Goldberg LR, Piette JD, Wals MN, and etc. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure
the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 146:705-712, 2003.
Population Management/ Research
• Africa (Malawi)– Addressing HIV infection with mHealth
– Texting HIV test results, treatment instructions
– Relay results of treatments back to public health
– Prevention messages to high risk groups
Healthcare Reform and mHealth
• Fee for service – Reimbursement based on Volumes ≠ improved adoption efficient tools
• Accountable Care Organizations
• Value Based Purchasing
• Capitated Care
• Bundled Payments
• Security • Integration • Licensing Regulations • Bandwidth • Reimbursement • Patient Engagement/Compliance • Physician Acceptance
Adoption Barriers
Choices to Make
Questions?