This document discusses the concept of participatory health and the role of mobile technologies, known as mHealth. It argues that mHealth will transform healthcare by enabling active participation of patients, providers, and other stakeholders through technologies like mobile phones. This will allow things like continuous communication between visits, accessing health information and decision support at the point of care, remote monitoring for disease management, and financial applications like real-time billing. However, challenges like interoperability and standards must be addressed. The document advocates for providers to prepare for this change by developing mHealth strategies and balancing new technologies with workflow impacts. Overall, mHealth is presented as a way to improve outcomes while reducing costs through more participatory and connected care.
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Participatory Health: The New Game in Town
1. Participatory Health:
The New Game in
Town
C. Peter Waegemann
Executive Director, mHealth Initiative
“One of 20 Most Influential People in Healthcare”
(HealthLeaders)
Copyright 2009 mHealth Initiative Inc. Boston.
3. I’m a new kind of person – I’m a
Mobile Computer Person
• Wireless Voice Communication
• Texting
• Email
• PDA Functions: Calendar, Notes, Contacts,
Clock, Weather, Search Functions
• GPS
• Lifestyle Functions: Yoga, eBooks, Music,
Transportation, Banking, Identification,
Networking, etc.
4. Trends of Our Times
Consumers do the work
– Bank tellers
– Travel agents
– Check-in counters at airports
Making Information Available to Anyone
From Sporadic to Continuous Communication
Social Networking
Technology: from Big to Small
From Forced Legacy Systems to “Easy Use
Systems”
From ‘Authority-centric’ Systems to Wiki
Economics
5. Participatory Health
Active Participation of
– People
– Healthcare providers
– Wellness providers
– Public health
– Health plans and payers
– Pharmacies, labs, others
6. Active Participation of People
•Are encouraged to become active
Whether participants in their wellness and health
healthy
matters
or ill
•Change their life style
• Keep a personal health record
• Patients
•Spend personal resources on living
• Consumers
healthier
• Children
•Research and learn about relevant health
• Adults topics
• Seniors
• Be involved in cost issues for their
healthcare and participate in healthcare-
related cost decisions.
7. Healthcare Providers
Medical Networking
– All provider types
– Pharmacies, labs, etc.
– Public Health
– Health plans and payers
– Professional networking within your
hospital or clinic
8. Three Generations of HIT
3
Participatory Health
2 Consumers
1 eHealth New Communication
Computer-based 5 eHealth Systems Participants’ Coordination
Patient Records mHealth
RHIOs
Document Imaging Ecosystem Interoperability
PACs
Practice New Financial Systems
CPOE
Management
Systems Medical Communities
Workflow, workflow,
EDI Messages EMRs
CHINs 1998-2009 workflow
1970-1997 2010-2020
9. What is e-Health?
E-Health
1 2 3 4 5
Electronic Electronic Electronic Electronic E-Public Health
Administrative Financial Clinical Research Systems
Systems Systems Systems Systems
Electronic Electronic Electronic Population Environmental Safety:
Imaging Pharmacy Health Record Health Health Terrorism
Systems Systems Systems Alert and
Health Promotion Defense
PACs Document Caregiver Health Processes
Electronic
Imaging-based Medical
System Record
Systems
10. What is mHealth?
♦ Communication-enabled new ways to communicate with
patients and people
– Disease management
– Effective Care Processes
♦ Allowing people to research health topics
– Physicians
– People
♦ People and patients to share experiences
– From “Summary at Visit to ODLs”
♦ Mobile computing at the point of care
♦ Affecting change in the healthcare system
11. mHealth
Change in Workflow
People’s
Involvement in
Wireless Health
Communication and
Computing Devices
New Financial
System
New Systems:
Decision-support and
SPCs Trust and Ease of
Use
12. Problem #1
Patients often see their clinicians only
periodically and for short periods of
time.
They 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.
13. 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
14. Text Messaging
• In general, fewer than 5% of adults are
currently able to communicate with their
providers electronically
• When asked, 62% of adults stated that
electronic communication would influence
their choice
• 75% stated they wanted to schedule
appointments electronically
• Harris Interactive: Feb. 8, 2007
• 50% of 12 to 24 year olds send or receive
text messages
• Ipsos: 2007
Credit: Renee McLeod
15. 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 (?)
16.
17. Problem #2
Physicians and other practitioners
cannot memorize all formularies,
guidelines, protocols, health plan
instructions, or all of new
developments in the scientific body of
medicine.
18. Easy access at the point of care
Provide access to web sites through
smart phone browsers
19. 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
20. Cell Phone as Information Resource
at the Point of Care
Formularies
Guidelines and protocols
Decision support
Telemedicine guidelines
Patient’s comments re Web
Patient directives
22. Problem #3
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.
24. DIFFICULTIES
Interoperability
Workflow
Documentation
ity
bil ROI
ra
peo
er
Int
R
EH
25. 1. Too much
information
2. No uniform
arrangement
3. Interoperability Composite
Clinical
Dataset
Structured Data
Elements – Not
R
EH
Documents
26. Cell Phone
Insurance
Patient Card
Provider
Interoperability PHR
1. Too much information
2. No uniform
arrangement
3. Interoperability Clinical Basis
Dataset
Structured Data
Elements – Not
R
EM
Documents
27. For over 2,000 years, the PHR
patient was rarely Concern
over
Developments
informed about the 2010
medical circumstances. Internet
Disease details were left reliability
to doctors. As recently as 7 million PHRs
1965, patients were not 10 mill. PHR-Lites
allowed to see medical 3-4 mill. PPPs
books in publicly funded Interoperability
libraries Dot.com 20% EMR ased through
Implementation R-b
bubble CC ecosystems
Professionally
bursts
guided
13 million disease
Personal Health 2007-2008 communities
Records will support
Health 2.0: new
2002-2006
Disease- research.
Patient specific guidelines
1999-2000 support and protocols
Communities
Internet groups
HIPAA gives the opens up develop
patient the right health
to a copy of the information
medical record
28. Personal Health Record on the
Phone
• Interoperability through the patient
• After the smart card, USB, CD experiences
• Can use any phone
• Current projects
29. Problem #4
How to get physicians, nurses
and other practitioners to
document at the point of care?
30. Using the CCR as the
base, a clinician can now
dictate or record through
speech recognition – or
with keyboard or stylus
This opens up a wide
range of workflow
options at the point of
care
31. As such recordings will
be integrated over the
next 18 months with
online protocols (new
and existing), a new
process of electronically
enabled care will emerge
33. Problem #5
Is there a way of disease
management that is more effective
and reduces costs?
Answer: Communication-based
Disease Management
34. Disease Management
Applications
Wonders of better communication
Currently focused on
Diabetes
Asthma
Dermatology
Preventive care in pregnancy
Smoking cessation
Hypertension
35. 30 patients random assignment
Intervention (n=15) received cellphone
software with real-time feedback of blood
glucose levels, displayed medication regimens
and requested additional data needed to
evaluate diabetes management.
Average decrease in A1c for intervention
patients was 2.03%, compared to 0.68% (P <
0.02, one-tailed) for control patients.
Quinn, CC, Clough, SS, Minor, JM, Lender, D, Okafor, MC, Gruber‐Baldini, A.
WellDoc Mobile Diabetes Management Randomized Controlled Trial: Change in
Clinical and Behavioral Outcomes and Patient and Physician Satisfaction. Diabetes
Technology & Therapeutics. June 1, 2008, 10(3): 160‐168.
doi:10.1089/dia.2008.0283.
37. Changing Communications within Hospitals
Nurses use mobile technology
67% of nurses carry two or more mobile
communication devices Spyglass Consulting, 2008
88% of nurses had three phone numbers Ascendant Systems, 2008
Nurses are mobile*
Walk an average of 3 miles (up to 5) per shift
regardless of racetrack, corridor, or radial design facility
Spend 31% of shift in the patient room
Spend 38% of shift at the nurses station
Spend 24% on the unit and 7% off the unit
* Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion
study: How do medical-surgical nurses spend their time? The Permanente Journal,
12(3):25-34.
Credit: Renee McLeod, Arizona State
University
38. Nurses
Nurses need access in real time; they
spend 35% of shift in documentation*
3% in the patient’s room
81% at nurses station
15% on the unit
1% off the unit
Smart phones can be HIPAA compliant
Smart phones access the secure server
* Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion
study: How do medical-surgical nurses spend their time? The Permanente Journal,
12(3):25-34.
Credit: Renee McLeod, Arizona State
University
40. Administrative Applications
Wide range of applications
Provider – Patient applications
Staff communication
With others
Text v. email
RFiD: Asset management
Inventory
Patient Flow
41. Financial Applications
Charge capture
Providers accessing eligibility info
Providers sending bills
Payers in active communication with
patients and providers
Online real-time adjudication
42. Emergency Care in Participatory
Health
Not starting with a “blank sheet”
Potential need for record locator system
Substantial cost reductions expected
43. TapChart increases Productivity
♦By using TapChart and Palm mobile devices
SDMSE, has returned more ambulances
back in-service to the community, in excess
of 16,500 hours
♦Without having to actually add additional
units to the streets
44. What It Takes to
Save a Life
♦Mobile communication
♦Care software
♦Integration into IS
♦Change
Example for eHealthcare of the Future
45.
46. Population Health Communication
in Participatory Health
Reporting of disease outbreaks
Instructing patients
Bioterrorism
Surveillance
Population notifications
Other
48. Future solutions
Hospital policies need to reflect the
constant change in technology
Understand what you can police and monitor
Cell phones have cameras and recorders
Policies must apply to everyone and everyone
needs to help enforce
Healthcare facilities (hospitals, ambulatory
care, etc.) must work with healthcare
educators
Credit: Renee McLeod, Arizona State
University
49. What is mHealth?
Bringing the power of the Internet to the mobile user
Patient/consumer to control and manage their essential
health data on mDevice
New communication vehicle for care communication
New applications using disease management applications
at the point of care
Methods to create interoperability in healthcare
Enables integration of all healthcare participants
Interoffice wireless connectivity is a commodity
Much different and bigger than telemedicine or “wireless
hospital applications”
51. Peter’s Vision
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
52. What does this mean for
Providers?
Restructuring is unavoidable
Solutions are not limited to new technologies
Prepare staff for Participatory Health
Create a mHealth strategy
Balance Solutions and Effect
54. Wishing You a great time at this seminar
and a happy transition into the era of
participatory health and mHealth
C. Peter Waegemann
p.waegemann@mhealthinitiative.org