Participatory Health Waegemann M Hi091809

Copyright 2009 mHealth Initiative Inc. Boston.

Participatory Health: The New Game in Town

C. Peter WaegemannExecutive Director, mHealth Initiative“One of 20 Most Influential People in Healthcare”(HealthLeaders)

Impact of Technologies

• Electricity• Automobile• TV• Computer/Internet• Mobile Phone

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.

Trends of Our TimesTrends of Our Times

Consumers do the workConsumers do the work–– Bank tellersBank tellers–– Travel agentsTravel agents–– CheckCheck--in counters at airportsin counters at airports

Making Information Available to AnyoneMaking Information Available to AnyoneFrom Sporadic to Continuous CommunicationFrom Sporadic to Continuous CommunicationSocial NetworkingSocial NetworkingTechnology: from Big to Small Technology: from Big to Small From Forced Legacy Systems to From Forced Legacy Systems to ““Easy Use Easy Use SystemsSystems””From From ‘‘AuthorityAuthority--centriccentric’’ Systems to Wiki Systems to Wiki EconomicsEconomics

Participatory HealthParticipatory Health

Active Participation of Active Participation of –– PeoplePeople–– Healthcare providersHealthcare providers–– Wellness providersWellness providers–– Public healthPublic health–– Health plans and payersHealth plans and payers–– Pharmacies, labs, othersPharmacies, labs, others

Active Participation of People

••Are encouraged to become active Are encouraged to become active participants in their wellness and health participants in their wellness and health mattersmatters

••Change their life styleChange their life style

•• Keep a personal health recordKeep a personal health record

••Spend personal resources on living Spend personal resources on living healthierhealthier

••Research and learn about relevant health Research and learn about relevant health topicstopics

•• Be involved in cost issues for their Be involved in cost issues for their healthcare and participate in healthcarehealthcare and participate in healthcare--related cost decisions.related cost decisions.

Whether healthy or ill

• Patients• Consumers • Children• Adults• Seniors

Healthcare ProvidersHealthcare Providers

Medical NetworkingMedical Networking–– All provider typesAll provider types–– Pharmacies, labs, etc.Pharmacies, labs, etc.–– Public HealthPublic Health–– Health plans and payersHealth plans and payers–– Professional networking within your Professional networking within your

hospital or clinichospital or clinic

Three Generations of HIT

1Computer-based Patient Records

Document Imaging

Practice Management Systems

EDI Messages

CHINs

1970-1997

2eHealth

5 eHealth Systems

RHIOs

PACs

CPOE

Medical Communities

EMRs

1998-2009

3

Participatory HealthConsumers

New Communication

Participants’ Coordination

mHealth

Ecosystem Interoperability

New Financial Systems

Workflow, workflow, workflow

2010-2020

What is e-Health?E-Health

1Electronic

Administrative Systems

2Electronic Financial Systems

3Electronic

Clinical Systems

4Electronic Research Systems

ElectronicImaging Systems

ElectronicHealth Record

Systems

ElectronicPharmacySystems

Electronic Medical Record

Systems

Document Imaging-based

System

5E-Public Health

Systems

Population Health

Environmental Health

Caregiver Health Processes

Safety: Terrorism Alert and DefenseHealth Promotion

PACs

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

mHealth

Change in Workflow

Wireless Communication and Computing Devices

People’s Involvement in

Health

New Financial System

New Systems: Decision-support and

SPCs Trust and Ease of Use

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.

Types of Communication

1. Patient to provider (pre-engagement)a. General inquiryb. Appointmentc. Insurance coverage or cost

2. Provider-patient interactivelya. Appointment confirmation/reminderb. Reason for visit: Agendac. Referrals and other care management

communication, e.g. ‘How r u?’

d. Other3. Patient education

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 McLeodCredit: Renee McLeod

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 (?)

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.

Easy access at the point of care

Provide access to web sites through smart phone browsers

Accessing Information at the Point of Care

Patient health informationInsurance eligibility informationCare decision support information

FormulariesGuidelines and protocolsDisease management informationAccess to scientific body of medicineOther

Cell Phone as Information Resource at the Point of Care

FormulariesGuidelines and protocolsDecision supportTelemedicine guidelinesPatient’s comments re WebPatient directives

Exploding every week

• iPhone has several hundred health and medical applications

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.

The Race for The Race for InteroperabilityInteroperability•OSI Level•Microsoft•Object Management Group (CORBAmed)•DICOM/RSNA: EHI•HL7•ASTM E31•Google•Others

EHR

Inte

rope

rabil

ity

DIFFICULTIES

Interoperability

Workflow

Documentation

ROI

EHR

Structured Data Elements – Not Documents

1. Too much information

2. No uniform arrangement

3. Interoperability Composite Clinical Dataset

EMR

Structured Data Elements – Not Documents

Clinical Basis Dataset

Insurance

Provider Interoperability PHR

Patient Card

Cell Phone

1. Too much information

2. No uniform arrangement

3. Interoperability

For over 2,000 years, the patient was rarely informed about the

medical circumstances. Disease details were left to doctors. As recently as 1965, patients were not allowed to see medical books in publicly funded

libraries

HIPAA gives the patient the right to a copy of the medical record

1999-2000

Internet opens up

health information

13 million Personal Health Records

Dot.com bubble bursts

Concern over Internet reliability

2007-2008

Health 2.0:

Disease-specific Communities

2002-2006

Patient support groups develop

Professionally guided disease communities will support new research. guidelines and protocols

7 million PHRs10 mill. PHR-Lites3-4 mill. PPPs

2010

20% EMR Implementation

Interoperability through

ecosystemsCCR-based

PHR Developments

Personal Health Record on the Phone

• Interoperability through the patient• After the smart card, USB, CD experiences• Can use any phone• Current projects

Problem #4

How to get physicians, nurses and other practitioners to document at the point of care?

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

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

EMR on the iPhone

Credit: Renee McLeodCredit: Renee McLeod

Problem #5

Is there a way of disease management that is more effective and reduces costs?

Answer: Communication-based Disease Management

Disease Management Applications

Wonders of better communicationCurrently focused on

DiabetesAsthmaDermatologyPreventive care in pregnancySmoking cessationHypertension

30 patients random assignmentIntervention (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.

Teaching, Monitoring, and Coaching Applications

New applications in nursing and other areas

Changing Communications within HospitalsChanging Communications within Hospitals

Nurses use mobile technologyNurses use mobile technology67% of nurses carry two or more mobile 67% of nurses carry two or more mobile communication devices communication devices Spyglass Consulting, 2008 Spyglass Consulting, 2008

88% of nurses had three phone numbers 88% of nurses had three phone numbers Ascendant Systems, 2008Ascendant Systems, 2008

Nurses are mobile*Nurses are mobile*Walk an average of Walk an average of 3 miles (up to 5) per shift(up to 5) per shiftregardless of racetrack, corridor, or radial design facilityregardless of racetrack, corridor, or radial design facility

Spend Spend 31% of shift in the of shift in the patient roomSpend Spend 38% of shift at the nurses stationof shift at the nurses stationSpend Spend 24% on the unit and on the unit and 7% off the unitoff the unit

Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State University

* 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.

University

NursesNursesNurses need access in real time; they Nurses need access in real time; they spend spend 35% of shift in documentation*of shift in documentation*

3% in the patientin the patient’’s rooms room81% at nurses stationat nurses station15% on the unit15% on the unit1% off the unit1% off the unit

Smart phones can be HIPAA compliantSmart phones can be HIPAA compliantSmart phones access the secure serverSmart phones access the secure server

Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State UniversityUniversity

* 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.

Professional Communication

Preferred communication channels for lab, pharmacy etc.Colleagues

Specialty-specific communities

Administrative Applications

Wide range of applicationsProvider – Patient applicationsStaff communicationWith others

Text v. emailRFiD: Asset management

InventoryPatient Flow

Financial Applications

Charge capture Providers accessing eligibility infoProviders sending billsPayers in active communication with patients and providersOnline real-time adjudication

Emergency Care in Participatory Health

Not starting with a “blank sheet”Potential need for record locator systemSubstantial cost reductions expected

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

What It Takes to Save a Life

♦Mobile communication♦Care software♦Integration into IS♦Change

Example for eHealthcare of the Future

Population Health Communication in Participatory Health

Reporting of disease outbreaksInstructing patients BioterrorismSurveillancePopulation notificationsOther

Pharma/Clinical TrialsClinical trialsPatient feedback systems

Future solutionsFuture solutions

Hospital policies need to reflect the Hospital policies need to reflect the constant change in technologyconstant change in technology

Understand what you can police and monitorUnderstand what you can police and monitorCell phones have cameras and recordersCell phones have cameras and recorders

Policies must apply to everyone and everyone Policies must apply to everyone and everyone needs to help enforce needs to help enforce Healthcare facilities (hospitals, ambulatory Healthcare facilities (hospitals, ambulatory care, etc.) must work with healthcare care, etc.) must work with healthcare educatorseducators

Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State UniversityUniversity

What is mHealth?Bringing the power of the Internet to the mobile userPatient/consumer to control and manage their essential health data on mDeviceNew communication vehicle for care communicationNew applications using disease management applications at the point of careMethods to create interoperability in healthcareEnables integration of all healthcare participantsInteroffice wireless connectivity is a commodityMuch different and bigger than telemedicine or “wireless hospital applications”

mHealth Community

Participatory healthmHealth implementation

More: www.mhealthinitiative.org

PeterPeter’’s Visions VisionPhone identificationPhone identificationPrePre--service automated checkservice automated check--ininPrePre--service communicationservice communicationCare applets guide the clinicianCare applets guide the clinicianRealReal--time financial bill submissiontime financial bill submissionRealReal--time adjudicationtime adjudicationAdditional fee services by providerAdditional fee services by providerContinuous care communicationContinuous care communication

What does this mean for What does this mean for Providers?Providers?

Restructuring is unavoidableRestructuring is unavoidableSolutions are not limited to new technologiesSolutions are not limited to new technologies

Prepare staff for Participatory HealthPrepare staff for Participatory HealthCreate a mHealth strategyCreate a mHealth strategyBalance Solutions and EffectBalance Solutions and Effect

HurdlesHurdles

InteroperabilityInteroperabilityConfidentialityConfidentialityStandardsStandardsCoordination of ParticipantsCoordination of Participants

Wishing You a great time at this seminar and a happy transition into the era of

participatory health and mHealth

C. Peter Waegemannp.waegemann@mhealthinitiative.org