Presented by Steven Heilman, MD, FACEP on September 7, 2012 at the third annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. mHealth in Everyday Practice
Plain Talk
September 7, 2012
Steve Heilman M.D., FACEP
System Vice President and Chief Medical Information Officer

2. Norton Healthcare
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

3. Key Messages for Discussion
• mHealth Overview
• Clinician Utilization
• Patient Engagement
• Population Management and Research
• Healthcare Reform and mHealth
• Adoption Barriers

4. 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

5. Routine Clinician Applications
Quick and easy access to cloud based data– drug
guides, medical alerts, journal summaries and medical
references.

6. 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.

7. Routine Clinical Applications
Access to Personal Health Record (PHR) information

8. Routine Clinical Applications
Remote Monitoring Access

9. New Applications for Clinicians
• Digital Dermatoscopes
• Digital Stethoscopes
• Ultrasound applications
• Medical Imaging Review

10. Home Monitoring Applications
• Bluetooth devices – scales, glucose monitors,
BP, Medication dispensers
• Positive Feedback
• Patient Education

11. New Applications
• Microchip patch/ Ingestible event monitors
• Cardiac Monitoring

12. Population Management/ Research
• Telemedicine – enabling the provision of care
anywhere. ? mHealth
• Physician Specialty Shortages

13. Population Management/ Research
• Asthmapolis

14. 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.

15. 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

16. 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

17. Adoption Barriers
• Security
• Integration
• Licensing Regulations
• Bandwidth
• Reimbursement
• Patient Engagement/Compliance
• Physician Acceptance

18. Choices to Make

19. Questions?