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mHealth and Hospitals

Posted on December 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’ve been doing quite a bit of thinking around the topic of mobile health thanks to all the #mHealth14 tweets I’ve been seeing on Twitter. One of the major takeaways I’ve seen from this year’s mHealth Summit and previous mHealth Summits was the prediction that one day mobile health and connected health and all the other variations will one day just be health.

I think it is true that mobile and connected health will eventually just be standard healthcare. However, it’s not today. In fact, I think that’s why most hospitals haven’t hopped on board mobile health yet. They are waiting for mobile health to be a standard of health. This tweet seems to capture some of this feeling.

Most of the hospitals I know see mobile health as a tool as opposed to a solution. Is it because we’re early in the market? Maybe, but I think there’s a lot more to this discussion.

When I think about hospitals and mHealth, I think there are three ways that they are adopting these mobile health technologies: existing vendors, rogue apps, and research dollars.

Existing Vendors
This is the most common use of mobile health in hospitals. However, most hospital CIOs and other hospital IT professionals wouldn’t even think of it as mobile health. They already think of it as health.

The best example of this is with the EHR vendors. Many of them are rolling out mobile interefaces for their EHR. Is that mobile health? Absolutely. However, the hospital didn’t really think about it as mobile health. They thought of it as implementing their EHR software. It just turns out that the mobile health implementation of EHR software made sense in that situation.

We see this happening across a wide variety of hospital apps. You can be sure that this will continue and only accelerate as these enterprise software vendors finally get their mobile health development complete.

Rogue Apps
Every hospital I know has made a lot of effort to manage mobile devices. Search for BYOD and surrounding topics and you’ll find a ton of conversation about this topic. One major part of this discussions is around rogue apps. Even if the hospital doesn’t allow the rogue mHealth app on the hospital devices, that’s not going to stop a doctor from downloading it on their personal smart phone. Sure, some hospitals have policies against some of this stuff, but rogue apps are alive and well in hospitals all over the country.

Rogue apps reminds me of shadow IT. I guess that rogue apps are a form of shadow IT. So, the concept isn’t new. What’s the lesson? Find a way to empower your users to be able to bring in outside apps that can be used in the hospital. Just because you play ignorant doesn’t mean your hospital’s not responsible for them just the same.

Research Dollars
This is where I see most of the mHealth efforts by hospitals. If it’s not coming from a current vendor, then they usually use some sort of research dollars to “experiment” with mobile health. For some reason it feels better for a hospital to hide behind a “research project” or a “pilot implementation.” Some of it has to do with the procurement and approval process. Other times, they’re just afraid to commit to something that’s not fully tested.

I don’t think mHealth being a pilot project or research project is a bad thing. In fact, I think this is the major reason why mobile health and connected health are still separate from health. Until we have enough time to prove out these ideas, the healthcare establishment won’t be ready to accept them. Once they’ve proven themselves, they’ll just become a standard part of healthcare.

Is mobile going to play an important part of the future of healthcare? Absolutely. Will it take some time to prove out the various methodologies in order for the healthcare establishment to adopt these mHealth technologies? Yes. This is how I see the evolution of mHealth in hospitals. What have you seen?

mHealth Technology Market Exploding

Posted on June 13, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Driven largely by the growth in remote patient monitoring, the mobile health marketing is expanding rapidly, with the global market expected to reach $10.2 billion USD by 2018, according to Transparency Market Research.

According to TMR, the global mHealth market added up to just $1.3 billion in 2012, but should grow at a compound annual growth rate of 41.5 percent through 2018, with monitoring services contributing heavily to the total.

According to the researchers, the global mHealth market’s explosion is being driven by factors such as growing adoption of smartphones and the rising incidence of chronic diseases.  Also, the incredible growth in the availability of smartphone applications has created new channels for communication between patients and healthcare providers, a connection which further feeds the emergence of new applications.

According to TMR’s analysis, remote monitoring services currently make up the largest share of the global mHealth market, or about 63 percent, followed by diagnostic services and healthcare systems strengthening. And monitoring services will continue to be the fastest growing segment in global mHealth, given this technology’s ability to help ameliorate acute conditions such as coronary artery disease, hypertension, and congestive heart failure, the group notes.

These findings are underscored by related figures from Kalorama Information, which just released a report tagging the telemedicine patient monitoring market as having grown from $4.2 billion in 2007 to over $10 billion in 2012.

While they’re are clearly engaged in some forms of remote monitoring here and there, this approach is still at an early stage for most hospitals, as reimbursement for hospital-based remote monitoring is scant or non-existent in some cases, Kalorama notes.

However, the home healthcare and remote location health monitoring markets are already well-positioned to grow, and are poised to expand using wireless, handheld and ambulatory devices that replace older monitoring equipment, Kalorama researchers say.

What Do Patients Need From EMRs?

Posted on November 14, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?

FCC Says Wireless Health Should Be “Routine” Within Five Years

Posted on September 28, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This week, the FCC made an announcement which, I think, is likely to have far-reaching implications, including for providers, hospitals, wireless vendors and medical device makers. *So* much is going on in this announcement that I think I’ll have to parcel it out into a series, so stay tuned.

But let’s start with the basics. In the announcement, the FCC said that it plans to implement on the key recommendations made by an independent mHealth task force.

Perhaps the most dramatic news is that the FCC seems ready to push for making mHealth “a routine medical best practice” by 2017.  Despite doctors’ increasing reliance on mobile devices, that’s a tall order — or even a nearly impossible one depending on how comprehensive your definition of mHealth is.  Regardless, this looks like a watershed moment.

The agency has already taken several steps that advance wireless healthcare networking, including:

*  Medical Body Area Networks:  The FCC recently released an order allocating spectrum for Medical Body Area Networks, networks of small sensors attached to a patient that continuously report results.

*  Medical Micropower Networks:  Last year, the FCC adopted rules enabling a next generation of  wireless medical devices used to restore functioning to paralyzed limbs. The MMN is an ultra-low-power wideband network consisting of transmitters, which are implanted in the body to take the place of damaged nerves.

FDA/FCC Partnership:  Since 2010, the FCC has been working in partnership with the FDA to help bring communications-related medical devices quickly and safely to market.

But this is just the beginning, folks. As you’ll see over following installments, the FCC is taking on not only the broad policy goal of “mHealth by 2017″ but taking several steps that should help to lay the groundwork to make this happen.

Are they enough?  Let’s talk about it. I’ll get into what some of the proposals are, and how much impact they’re likely to have, in coming HospitalEMRandEHR.com articles.  So don’t turn that channel!

Connecting Mobile With Desktop A Chore

Posted on July 31, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Readers, I’m guessing  you’ve seen the same stats I have, which suggest that doctors are crazy about tablet use, as well as smartphones.  And we’d probably all agree that using both for clinical tasks makes sense in a lot of environments.

The thing is, few doctors are actually using these devices in day to day practice management, according to a recent study.  A survey of 1,190 physicians published in June found that 75 percent of doctors use their desktop for practice management tasks, according to American Medical News.  The study was published by little blue book directory and its parent company Sharecare.

Truthfully, doctors have a perfectly reasonable motive for doing so: they need the greater power and larger screens desktop computers provide. Not only that, they get to use their hospitals’ EMR in its original form, rather than through a Citrix or other client awkwardly shoehorned onto an iPad or Android tablet.

So, what to do to make the transition between these devices more seamless — and mobile devices better integrated into the mix? In a piece by Healthcare IT News‘ Michelle McNickle, whose work, like John, I’m beginning to find addicting, chief scientist at M.Modal Juergen Fritsch outlines some key steps in bridging the “mobile-desktop divide.” Here’s a few ideas on what needs fixing:

Inadequate apps:  Many of the apps physicians use most often aren’t available for tablets or the iPhone. Workarounds exist, but they’re crude.

Speech recognition is critical:  Doctors are already used to dictating into cellphones to do clinical documentation, so making tablets documentation friendly is very important.

Create a hybrid strategy: Don’t demand that physicians go all-mobile in one swoop, Fritsch suggests. Combine multiple devices and make the experience as similar as possible from device to device.

Educate doctors on the latest offerings:  Doctors who used the initial round of apps and interfaces on mobile devices were probably irritated, as they were fairly cumbersome. CIOs and CMOs should make sure they educate physicians on current offerings, which will probably appeal to them much more.

To put in my own quibble, my sense from researching the matter is that the biggest force holding back mobile use is simply getting EMR vendors to create native clients for tablets and phones. Even if they’re not fully-featured, they should at least be cleanly usable.  What do you think?

Health IT Can Change Delivery Models From The Outside In

Posted on July 2, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As we all mull over the implications of the recent Supreme Court decision affirming the key pillar of the health reform law, transformation is definitely in the air.  Hey, if nothing else, we’ve got a presidential election on the way, and it’s likely there will be big changes — either yanking back parts of PPACA or expanding it significantly — when the new POTUS steps in.

This is a great time for the health IT world to assert its place in the system and change the way care is delivered. Of course, I don’t have anything like the space to cover this topic in full  but a few ideas that I think have high potential include:

* Hospital At Home:  This Johns Hopkins model delivers care at home to patients who could use hospital-level care but aren’t likely to deteriorate. It can lower costs by almost one-third and reduce complications, researchers say. Let’s step up and bring sophisticated mhealth apps and remote monitoring to power this further.

*Medical Body Area Networks: With the approval of specifically-dedicated spectrum for MBANs, the FCC has kicked off what should be a revolution in health monitoring, both for consumers interested in self-care and for clinicians. Where can we take it this year?  For example, will consumers wear their network, connected to a receiver in their car, and transmit their own data as they come into an ED for care?  The mind boggles.

* Prescribe An App: This is an area which is juuust getting a foothold in American medicine — though as the linked article notes, the Department of Health in England has created a list of 500 apps for primary care docs to prescribe to patients. The practice can only grow here as evidence helps us sift out the best apps.

*Patient Portals:  Yeah, so what, they’re required under Meaningful Use anyway. So why am I listing them here? Because a nice interspersing of the above technologies with a robust,  user-friendly portal has nearly unlimited potential for medical collaboration:  video visits, telemedicine, mobile visits and check-ins and so on. Although, John also wrote about some of the challenges of patient portals recently on EMR and EHR.

Of course, I’ve said nothing about EMRs themselves, which obviously lie at the center of this Web.  But for a reason. I’m taking the position that in most cases, given the incredible mhealth explosion, care delivery change is going to push in from outside the hospital rather from within. Am I wrong there?

Are iPads Good For Healthcare? A Few Video Viewpoints

Posted on April 17, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Within, say, six months of its introduction, bloggers were already waxing rhapsodic over the potential of the iPad to transform the practice of medicine.

Many industry observers still do see the iPad as one of the defining moments in health IT, and many clinicians couldn’t be parted from their iPad with a crowbar.

But these days, as news of iOS security issues become more widespread, hospitals struggle with integrating iPads into their infrastructure and doctors grow weary of the iPad’s awkward data entry format, the elegant device is making some enemies as well as friends. OK, not enemies, exactly, but for some clinicians and IT leaders that early thrill is gone.

Given how perceptions of the device are shifting, I thought it’d be interesting to take a look at three takes on the iPad today. The first is from a hospital CIO, the second an interview with a doctor an Israeli hospital, and the third with a US physician. Check them out; there’s an interesting range of perspectives here.

At Mayo Clinic, Patients Getting Loaded iPads That Guide Them Through Stay

Posted on April 5, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, we give you a short case study on how the Mayo Clinic is using content- and app-loaded iPads to move the patient smoothly and happily through their experience there.

I don’t know about  you, but these kind of applications really excite me. The patient shown here isn’t just being given an iPad to meander about with, he’s been supplied a tool filled with useful information that better orients him to his process at the hospital.

“The iPad is a nice way to navigate through some of those resources and keep track on a daily basis that you’re doing the things you need to do to make sure you’re doing the things that you should be,” heart patient Randy Sterner tells the interviewer, who seems to find the app easy to use.  (“It made him feel like a part of the process,” notes Sterner’s wife.)

Among the things the iPad app does is allow Sterner to report on, say, levels of pain he feels or exercise he has done. These reports are broadcast instantly to the healthcare team working on his case.

The iPad app in question was created by a team led by Dr. David Cook, who hoped to meet a need that wasn’t being met.  I say, bravo. This seems like a wonderful idea.

Billing App For Doctors Should Catch Hospitals’ Eye

Posted on April 2, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, I’m going to do something I seldom do — talk about a specific app and what it represents in terms of trends.  The product, SwiftPayMD, is interesting not only because it seems to be solving an important problem, but also because it may be one of the early entrants in a new category of mobile software.

The product,  which runs on the iPhone/iPad, is made by a startup called Iconic Data. Iconic describes SwiftPayMD as a “mobile revenue cycle management app” which lets doctors submit diagnosis and billing codes directly to their office while still at their local hospital.

Hmmm. A mobile revenue cycle management app. What, you mean a product that acknowledges that doctors on the move need not only to access, review and enter clinical data, but also to keep the money coming in?  It’s astounding!  It’s revolutionary!  It’s…a no-brainer.

While I admit I didn’t find any major studies on the subject, it does look as if the app developers and (slow moving) firms on the revenue cycle management side are starting to get it that if you’re going to document, read data and diagnose on the road, you might as well bill for your time too.

A Google search on the words “mobile revenue cycle management” doesn’t turn up a lot that’s on  point, though it does seem that there’s a few small providers in this space, including one focused on anesthesiology.  But my guess is that this will change dramatically within the next six months. The idea just makes sense.

In summary, I guess I’m saying that we’re looking at something really important here. While I haven’t tested SwiftPayMD — and thus, can’t begin to predict whether it will be a major player — the idea is almost certain to catch fire.

Now, I’m tossing the ball to you, hospitals. Is this an opportunity for you?  Should hospital IT departments supply branded apps which allow doctors to collect money faster (and perhaps their own institutions as well)?  Seems like a good idea to me.

Consumer Health IT Tools Could Allow Self-Prescribing

Posted on March 23, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Should patients be allowed to use online questionnaires, patient kiosks or other self-assessment technologies to determine the need for and obtain medications which now require prescriptions?  The FDA is taking up just that question this week in hearings at its DC headquarters.

The FDA is looking at ending prescription requirements for drugs used for several chronic conditions, including diabetes, asthma, high blood pressure, migraines and high cholesterol. It seems that the FDA has been paying close attention to the tech world, including movements like mobile tracking of health and the general trend toward self-assessment and consumer data collection.

According to iHealthBeat, the FDA thinks it might be a good idea to let consumers figure out whether they need certain medications by answering questions posed on a Website (a practice which, it should be noted, has been common on what are now rogue pharmaceutical sites) or perhaps respond to questions at a patient kiosk. I imagine that if enacted, such rules would apply to smartphones and tablets too.

A pharmacist from UC-San Diego quoted in the story argues that while some members of the public will be able to manage the information needed and make good decisions, others won’t. This is definitely a legitimate concern.

As I see it, though, our job in the health IT industry is to study models like these and see what failsafes we can put into to make self-prescribing as bulletproof as taking money out of an ATM machine.

It’s going to take sophisticated logic to get the right questions out there, smart machines to make inadvertent answers almost impossible, and crystal clear UIs to keep consumers oriented, but I think this has to happen.  After all, consumers are adopting health IT more and more each day. The barn door is open and the horse is running around, so let’s saddle it and leverage that energy!