A 2011 talk delivered at the NFAIS annual conference. The focus was a review of current trends in mobile referential and patient data within the healthcare industry

1. Healthcare Mobile Information Flow
Victor Camlek
VP Market Intelligence
Thomson Reuters Healthcare & Science
March 2011

2. A WORLD OF DATA. DELIVERED.
HEALTHCARE & SCIENCE SOLUTIONS
Operations & Planning & Regulatory Clinical Performance Clinical Clinical Decision
Providers
Finance Marketing Reporting Improvement Workflow Support
Action OI® crmView® Clinical CareDiscovery® Clinical Xpert® Micromedex® 2.0
Strategic
Services 100 Top Hospitals® Pharmacy Xpert®
Cost Fraud & Health Plan Care Consumer
Containment Abuse Management Management Engagement
Payers
Advantage Suite Advantage HEDIS Physician Consumer Health
Suite Performance Solutions
Medical Episode
Grouper DataProbe Assessment
Research & Clinical Trials Regulations Commercialization Post-Launch
Pharma
Discovery
Thomson Reuters Thomson Reuters IDRAC Medical Literature Comparative
Pharma Pharma Analyzer Effectiveness Research
Integrity
Research Evaluation Authoring & Publishing Research & Discovery
Researchers
Thomson Reuters Research EndNote® Web of Knowledgesm
Analytics
ScholarOne Web of Science
InCites, Journal Citation
Reports, ScienceWire
©2011 Thomson Reuters 1

3. Headline News:
The capabilities of mobile technology are
greatly influencing the practice of medicine
TODAY!
As the technology matures there is potential that a huge
amount of workflow content may become available
for use over mobile devices.
What will this continue to mean for STM Publishers and
their customers?

4. Healthcare: Converging Mobile Markets
mHealth Telemedicine
Mobile Devices Mobile Solutions for
Interactive Data
Management
Mobile Content
3

5. mHealth Definition
• mHealth
– The practice of medical and public health supported by mobile devices
– Sub-segment of e-Health
– The use of mobile devices in collecting community and clinical health
data; delivery of healthcare information to practitioners, researchers, and
patients; and, real-time monitoring of patient vital signs, and direct
provision of care (Telemedicine)
mHealth gets into the actual practice of medicine, which is one
of the reasons that it has been embraced by the World Health
Organization as a way to manage healthcare in third-world
countries.
4

6. Telemedicine Definition
• Telemedicine
– An application of clinical medicine where medical information is
transferred through interactive audiovisual media for the purpose of
consulting, and sometimes remote medical procedures or examinations
– Includes two concepts
• Real time (synchronous) and store-and-forward
• Home Health (asynchronous)
– Mobile devices may or may not be used
• Mobile telehealth: provision of medicine via a mobile unit
• Services may involve mobile technology used by a mobile vehicle associated to
a medical facility
Telemedicine includes some mobility and is often mentioned
within the context of the mobile market. However it involves the
connection of at least two points to either perform or monitor
patient care.
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7. Mobile Content Definition
• Referential healthcare-related content
• May include:
– Disease monographs
– Drug-related content
– Order sets
– Protocols
– Social networking content
• Electronic Medical Record(EMR)/Electronic Health Record(EHR)
• The ability to combine referential and patient-related data creates a
mobile solution
The capability for content to be delivered over a mobile device
combined with interaction with patient-related data represents a
current market in which various companies participate.
6

8. Mobile Solutions for
Interactive Data Management Definition
• Mobile Solutions for Interactive Data Management
– Solutions that permit users to achieve mobile access to data from
Hospital Information Systems (HIS) using at least one data presentation
format
– Solutions must possess a data access layer that obtains and
deconstructs information from disparate HIS systems, and repackages
the information around a patient object
– Provides a mobility platform for interactive data retrieval and
transmission
This is the core space where STM content providers may be
interested in serving.
7

9. Healthcare Mobility and STM Publishers
Content Workflow Platform Devices mHealth Telemedicine
• Referential • EHR Ability to stage, • Handheld • Patient The use of
• Drug Data • Charge re-configure and PDA‟s Monitoring medical
• Clinical Capture message data • Smartphones devices information
from an HIS or • Mobile exchanged from
• Journals • Patient Index • iPod Touch
source system to telemedicine/ one site to
• News • CPOE a variety of • iPad another via
telecare
• Guidelines • Order Sets devices • iPhone devices electronic
• Rounding • Android • MP3 players communications
• Scheduling • Windows for the health
for mLearning
Mobile and education of
• Patient Alerts • Laptop the patient or
• Lab Data • Net books computers healthcare
• Financial/ • Mobile Carts and desktops provider and for
Billing Mgmt • Mobile • Data collection the purpose of
• Performance Diagnostic software improving patient
Mgmt Software tools care.
• Diagnostic • Workstations Telemedicine
Imaging includes
consultative,
STM Content Space + Workflow Data diagnostic, and
treatment
services
STM Opportunity Content Enablers Adjacent Areas
8

10. This market is in an early stage
Healthcare Mobility and STM Publishers
Content Workflow Platform Devices mHealth Telemedicine
• Referential • EHR/EMR Ability to stage, • Handheld • Patient The use of
• Drug Data • Charge re-configure and PDA‟s Monitoring medical
• Clinical Capture message data • Smartphones devices information
from an HIS or • Mobile exchanged from
• Journals • Patient Index • iPod Touch
source system to telemedicine/ one site to
• News • CPOE a variety of • iPad another via
telecare
• Guidelines • Order Sets devices • iPhone devices electronic
• Rounding • Android • MP3 players communications
• Scheduling • Windows for the health
for mLearning
Mobile and education of
• Patient Alerts • Laptop the patient or
• Lab Data • Net books computers healthcare
• Financial/ • Mobile Carts and desktops provider and for
Billing Mgmt • Mobile • Data collection the purpose of
• Performance Diagnostic software improving patient
Mgmt Software tools care.
• Diagnostic • Workstations Telemedicine
Imaging includes
consultative,
STM Content Space + Workflow Data diagnostic, and
treatment
services
STM Opportunity Content enablers Adjacent Areas
9

11. Mobile Devices Definition
• Mobile Devices
– Traditionally “Pocket-sized computing devices,” typically having a display
screen with touch input or a miniature keyboard
– The definition is evolving as larger mobile devices appear (iPad, Net-books)
– Not all of these devices can access all public or proprietary mobile networks,
however, as they develop more will be able to include direct mobile access
• Mobile Devices may include:
– Smartphone
– Mobile computer/Mobile cart/Mobile monitor
– Personal digital assistant/enterprise digital assistant including the Blackberry
– Digital still camera (DSC)/Digital video camera (DVC or digital camcorder)
– Portable media player
– e-book reader
– Pager Advances in mobile device technology
– Personal navigation devices are fueling mobility as a growing medical
– iPad (as of 2010) application 10
Confidential – Do Not Distribute

12. Relevant Handheld Devices
BlackBerry Palm Nokia Windows Phone Android Phone
Motion computing,
mobile computer and
mobile cart
iPod Touch
iPhone 4G iPad NetBook
11
Confidential – Do Not Distribute

13. Market Dynamics:
• Worldwide mobile device sales to end users equaled 1.6 billion units in 2010,
a 31.8 percent increase from 2009
• Smartphone sales to end users were up 72.1 percent from 2009 and
accounted for 19 percent of total mobile communications device sales in
2010
• Worldwide mobile phone sales to end users reached 32.7 percent growth in
the fourth quarter of 2010, with sales of 452 million units
• Gartner forecasts worldwide mobile application store downloads to reach
17.7 billion downloads in 2011, a 117 percent increase from an estimated 8.2
billion downloads in 2010
• According to the MDsearch Smartphone Survey, 53% of physician
respondents own a smartphone and 63% of those physicians are using
mobile medical applications
• EMR vendors have begun to offer remote access to EMRs via smartphone
applications (Example: Epic Systems partnership with Apple announced in
2009 for a mobile EHR pilot)
• Source: Gartner Research; 'Forecast: Mobile Application Stores, Worldwide, 2008-2014'
Mdsearch: and Mobile Health Q1 2010 State of the Industry. Mobilehealthnews, 12
2010 report
Confidential – Do Not Distribute

14. STM Participants: Early Signs of Differentiation
• “Large healthcare publishers such as Hearst Business Media, Reed
Elsevier, Thomson Reuters, and Wolters Kluwer have a portfolio of
products that support clinicians, healthcare providers, and payers
along the healthcare workflow. These products are still evolving as
the technologies mature.”
• “The main components include traditional reference and journal
content; teaching and training applications (particularly for nursing).”
• “The most highly competitive area is in clinical decision support
tools, where order sets and drug reference databases are the most
common product.”
• “There will be increased focus on content integration with work-flow
needs and just-in-time delivery driving competitive features and
pricing. As much of the evidence as possible should be embedded in
content-based software.”
Source: Outsell, Inc., Growth Trends in the Market for Clinical
Decision Support Tools, June 2010 13

15. HC Mobility: Notable Service Providers
Referential Content and Clinical Workflow
Analysis Sources
• UnBound Medicine • TR Clinical Expert
• Medicine Central • Patientkeeper
• Evidence Central • Global Care Quest
• ePocrates • Dr. First
• Lexi-Comp • IQMax
• Dynamed • Theradoc Expert
• Diagnosaurus Systems
• Skyscape • Pharmacy OneSource
(Sentri7)
• Up-to-date
• MedMind (CareFusion)
• Tarascon Pocket
Pharmacopia • Premier Safety
Surveillor
• TR Micromedex products
• Cogon Systems
• MedAptus
• CureMD
• Zynx, First DataBank
• Elsevier – First Consult
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Confidential – Do Not Distribute

16. The Concept and The Potential
• Today:
– All relevant information derived from a patient encounter
may be documented and transmitted to a mobile device
– However, previous information documented in various
medical records will not be readily available until there is
additional progress creating EHRs (Electronic Health
Records)
– The available data may be combined with value-added
referential content delivered to a mobile device at the
point of care
• Tomorrow:
©2008 Thomson Reuters
– Even more information will become consistently available
at the point of care and for use during ongoing treatment
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17. Thomson Reuters CLINICAL XPERT AGGREGATES PATIENT DATA
FROM THE HOSPITAL AND DELIVERS IT DIRECTLY TO CLINICAINS
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18. CLINICAL XPERT ADDRESSES HOSPITALS‟ CLINICAL AND
BUSINESS CHALLENGES…
• Enhances clinician efficiency
• Champions informed decision at the point-of-care
• Address CMS and Joint Commission initiatives
• Identifies high-risk patients quickly via clinical surveillance
• Promotes patient safety and reduces medical errors
• Reduces lost or inaccurate charges (CX Billing)
• Facilitates clinician communication
• Improves physician satisfaction and relationship with the hospital
• Creates competitive advantage for recruiting clinicians
• Serves as an HIS downtime solution, providing uninterrupted access to
patient information when the HIS is not available
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19. Clinical Xpert Solutions
Solution Attributes
CareFocus Generic surveillance tool capable
of supporting any clinical area
Clinical Xpert Navigator Rounding, Mobility and Tracking
to support clinicians across
locations when managing patients
Pharmacy Xpert Intelligent dashboard, pharmacy
specific surveillance, quality
drug/disease content, department
management reporting
©2008 Thomson Reuters
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20. Pharmacy Xpert Product Description
• Pharmacy Xpert consists of three primary components
• Xpert design to support
pharmacy decision support
• Links to HIS systems
Pharmacy • Patient specific drug
Application interaction checking, IV Index
and calculators
• Drugdex
• Diseasedex GM
Micromedex • Drug REAX
• IV Index
Content
• Pre-built pharmacy
profiles
• Patient data
• Real-time surveillance
Clinical Xpert Foundation • Mobility
• Integration with any HIS
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21. Clinical Xpert: Value Proposition
• Patient Safety/Improved Outcomes:
– Real time patient surveillance to:
• Manage patient specific drug therapy effectively
• Identify patients at risk
• Improved cost management
– IV to PO proactive conversion
– Antimicrobial therapy management
– ADE (Adverse Drug Events) prevention
• XPert software:
– „Just what I need to know‟ – targeted, relevant information needed to
make optimal decisions
– Evidence-based surveillance and recommendations
– Intelligent user design anticipates information needs
• Technology ROI
– Works with any HIS system
– CCOW (Clinical Context Object Workgroup)(context management)
©2008 Thomson Reuters
compliant
– Implementation resource requirements minimal
– Infrastructure designed to support multiple Xpert systems
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22. Business Model Issues
• Solutions include two components:
– Software needed to access, manage and transmit the
data
– Content, including referential content available via
subscriptions, tailored to meet the needs of the mobile
device customer
©2008 Thomson Reuters
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23. Business Model Issues
• Costs associated with HIMS data conversation
• Technology challenges
– Data access layer capabilities
– Messaging layer to devices
– Mobile device platform strategy
• End-User issues
– Who is the actual customer (Institutional Providers, Physicians,
Pharmacists, others)
– Willingness-to-pay
– Quality assurance
• Regulatory issues
– Privacy
– Data Integrity
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24. Business Model Options
• Software model: • Capital investment
– Perpetual lease – Requires institutional
participation
– Maintenance
– Includes subscription to
– Updates content
• Subscription-based • Suitable for content
• Less likely
• Transaction-based
• Provides service to
• Sponsorship organizations
• Advertising • Less likely
• Shells are available to
• App Store for download
enable usage by those with
institutional access or
“skinny” versions of content 23

25. Technical Issues
• Technical Options
– Web-based approach
• Quickest approach
• Not a complete solution (no off-line capability; can use
various device features)
– Vendor Specific (You pick the winner or sink the cost)
• Works within capabilities of specific device/platform
• Some platforms have limitations (Apple does not permit Flash
and 3G usage; it avoids apps that impact network resources)
– Hybrid Digital Platform
• Permits service to multiple device platforms
• The issue is choosing the right platform
©2008 Thomson Reuters
• Recommended Reading: “Building Applications for the Mobile
Web, Best Practices,” at Thomson Reuters Legal, 10/28/10
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26. Challenges Moving Forward
• The path to the highest quality solution sets will
require additional progress in electronic health
records (EHRs)
– Interoperability challenges
– Data standardization challenges
– Adoption challenges (perhaps overcome in the US by
Meaningful Use requirements)
• We are at an early phase that could be the
beginning of a path to even greater benefits based
upon the ability to access and utilize a very high
volume of existing data that will become available
as EHRs are fully adapted for use in mobile
devices.

27. U.S. Hospital EHR Adoption Forecasts
90
Hospitals with EHRs (%)
100 85
75 80
80 65
60
40
40
20
12
20
0
2009 2010 2011 2012 2013 2014 2015 2016
100
Hospitals with EHRs (%)
80
60 Any
Basic
40
Advanced
20
0
2009 2010 2011 2012 2013 2014 2015 2016
*Hospitals in this instance are considered to be acute care, non-federal hospitals; baseline penetration rates are derived from an analysis by Jha, et al in Health
Affairs (October 2010) based on the March-September 2009 AHA health IT survey (N=3101); forecasts modeled based on primary and secondary research with
health care CIOs
Source: Frost & Sullivan

28. U.S. Physician EHR Adoption Forecasts
100
89
85
81
80 74
66
Physicians (%)
57
60
49
44
41
40 35
29
24
21
18 17 17
20
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
*EHR = any EHR with basic or advanced capabilities

29. Conclusion
• Mobility is already providing important services to
healthcare professionals
• Moving forward, there should be increasing
adoption of EHRs by 2016
• The combination of widespread EHRs plus more
advanced wireless device features should have a
profound effect on the level of information that will
be available and useful at the point of care
• Future business models will need to account for
higher amounts of data available at the point of
care, along with the software investment required
to access data from various systems
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