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How Mobility, Apps and BYOD Will Transform Healthcare The mobile health movement has legs, but it won’t hit its

stride until physicians and patients connect with each other.

Before that can happen, reimbursement models must

change. IT must also address BYOD and select smart app

strategies. Here’s a path forward for healthcare pros who

want to take advantage of mobility advances.

By Ken Terry

R e p o r t s . I n f o r m a t i o n We e k . c o m

Presented with

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CO N

TE N

TS

TABLE OF

3 Author’s Bio

4 Executive Summary

5 Consumer Mobile Health Apps Abound

5 Figure 1: Use of Tools by Doctors

to Collaborate With Peers

6 ‘FDA Effect’ Hinders Chronic Disease Apps

6 Figure 2: Use of Tools by Doctors

to Collaborate With Patients

7 Figure 3: Mobile Devices Used by Doctors

8 Home Monitoring Evidence Mounts

8 Figure 4: Reasons Doctors Use

Mobile Devices

9 Provider-Focused Applications

9 Figure 5: Types of Tablets Used by Doctors

11 Figure 6: Security-Related Challenges:

Healthcare Providers

12 Next Step: Connecting

With Patients

12 Figure 7: Applications Hosted in the Cloud:

Healthcare Providers

14 Related Reports

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InformationWeek Reports’ analysts arm business technology decision-makers with real-world perspective based on qualitative and quantitative research, business and technology assessment and planning tools, and adoption best practices gleaned from experience. To contact us, write to managing director Art Wittmann at [email protected], content director Lorna Garey at [email protected], editor-at-large Andrew Conry-Murray at [email protected], and research managing editor Heather Vallis at [email protected]. Find all of our reports at reports.informationweek.com.

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H o w M o b i l i t y , A p p s a n d B Y O D W i l l T r a n s f o r m H e a l t h c a r e

Ken Terry, the author of the book Rx For Health Care Reform (Vanderbilt University Press, 2007), is a former senior editor at Medical Economics magazine. Terry, who has received several journalism awards, now blogs regularly for InformationWeek Healthcare and also writes for Hospitals & Health Networks, iHealthBeat and Medscape.

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The tsunami of mobile device use has the potential to transform healthcare, experts say, but it will take time. So far, mobile health has had a much bigger effect on the work habits of physicians than on the care they provide to patients. That could change, however, as new reimbursement models emerge. “If you can imagine a world in which physicians and hospitals are paid based on the outcomes of patients, some of

these technologies may be very integral to them getting paid and enabling them to do the right thing for the patient,” says Dr. Mohit Kaushal, chief strategy officer and executive VP of business development for the West Wireless Health Institute. John Moore, founder and CEO of Chilmark Research, agrees. Referring to mobile health apps designed to engage pa-

tients in their own healthcare, he says, “A lot of healthcare institutions are starting to look at these applications and how they might be deployed within the context of getting patients to better self-manage their care. As providers take on more of the risk in these new reimbursement models, they’re going to give these tools to their patients and say, ‘We want to you use this to help you take better care of yourself and track your care over time.’ ” Many consumers, of course, are already using standalone mobile health applications to track their fitness, wellness, ex-

ercise and diet, and some are utilizing apps created for people with chronic conditions such as diabetes and hyperten- sion. But the potential for the latter apps will be limited until providers are ready to receive, process and act on the data. While definitions of mobile health usually include mobile devices, home monitoring can be viewed as part of the

same trend. This is a form of remote patient monitoring, just as mobile health apps are when they’re connected to a provider office. Also, home monitoring will always be required for certain patients, especially elderly ones. Nevertheless, a recent IMS Health report forecast that 80% of the remote monitoring market will be mobile by 2016. The third big division of mobile health is provider applications. These include reference and rounding apps for physi-

cians, iPad-native electronic health records, wireless medical devices in hospitals, and administrative applications that replicate the billing and appointment-making functions of a hospital’s patient portal. Little of this is revolutionary. But the increasing ability of providers to do clinical work on their mobile devices, coupled with the potential to communicate directly with patients’ smartphones, is laying the groundwork for much bigger changes in the future. Here’s how to prepare.

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EXECUTIVE

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Somewhere between 20,000 and 30,000 mo- bile health apps are available to consumers today. The vast majority of these applications are aimed at people who want to track their fit- ness or wellness activities or look up healthcare information on their smartphones and iPads or Android tablets. For example, there are apps that record how far you walk or run, how many calories you burn or how many hours you sleep. You can use other apps to weigh yourself or check your blood pressure. A whole new category of social gaming apps enables users to compete with family, friends or online bud- dies on losing weight or increasing exercise. Users can also share health information with one another and create online communities. Among the best-known examples of mobile

health apps designed for people with chronic diseases is WellDoc’s DiabetesManager. In this application, users enter blood glucose read- ings and other data into their smartphones. They receive feedback, either on their mobile phones or on a website, from a “virtual” expert

who coaches them on managing their condi- tion and provides tips on diet, exercise and other lifestyle factors. A trial of DiabetesMan- ager showed a decline in HbA1c of 1.9% among the WellDoc app users, compared with

0.7% in the usual care group. Other apps allow patients to monitor their

colitis (WellApps), alert them to allergy-pro- ducing conditions (SDI) and graph their blood pressure. In addition, Worcester Polytechnic In-

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To what extent are clinicians in your organization using the following tools to collaborate with peers?

69% 24% 7%

46% 33% 21%

21% 43% 36%

20% 37% 43%

7% 28% 65%

6% 23% 71%

Widely used Used on limited basis Not used

Email/secure messaging

Portal or website

Videoconferencing

Instant messaging

Social media (online medical forums, Facebook, Twitter, etc.)

Internal wiki

Base: 337 respondents working at a doctors’ practice, hospital, healthcare center or other healthcare provider Data: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012

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Use of Tools by Doctors to Collaborate With Peers

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Consumer Mobile Health Apps Abound

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Figure 1

July 2012 6

stitute researchers recently developed an app to detect atrial fibrillation through changes in skin color. WPI also has created a diabetes app that tracks weight and blood sugar levels, alerts patients when they’re off track and uses smartphone cameras to photograph incipient foot ulcers. While diabetes apps account for a large por-

tion of the available chronic disease apps, Ben Chodor, CEO of Happtique, a company that catalogs and sells mobile health apps, says he has seen a big increase in mobile apps for other conditions, including rheumatoid arthri- tis, cardiovascular conditions and even Crohn’s disease. Still, he admits apps aren’t available for every chronic condition—and there’s a reason for that.

‘FDA Effect’ Hinders Chronic Disease Apps Why do relatively few mobile apps target

patients with chronic diseases? One reason is that the Food and Drug Ad-

ministration must approve any software appli- cation that is intended for medical treatment. The FDA has OK’d some mobile health appli-

cations—including WellDoc DiabetesMan- ager—and it issued a guidance document last year on how it might regulate this area. But ob- servers say that more clarification is needed to assure entrepreneurs that chronic disease apps are safe to invest in. Meanwhile, they note, the wellness/fitness market is booming.

Chronic-disease patients are more aware of mobile health apps than most people are, and many have tried them. But according to a re- cent PricewaterhouseCoopers report, their participation tends to fade after a few months. Dr. Joseph Kvedar, founder and president of

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To what extent are clinicians in your organization using the following tools to collaborate with patients?

30% 35% 35%

23% 35% 42%

5% 73%22%

4% 16% 80%

4% 9% 77%

2% 8% 90%

Widely used Used on limited basis Not used

Email or secure messaging

Portal or website

Videoconferencing

Instant messaging

Social media (online medical forums, Facebook, Twitter, etc.)

Internal wiki

Base: 337 respondents working at a doctors’ practice, hospital, healthcare center or other healthcare provider Data: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012

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Use of Tools by Doctors to Collaborate With Patients

FAST FACT

62% of doctors used iPads or

other tablet computers, and

81% had smartphones,

according to a pair of

Manhattan Research surveys.

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the Center for Connected Health at Partners HealthCare, suggests that people with chronic diseases need to know that their providers are paying attention to the data they’re generat- ing. He cites a CCH diabetes program in which patients were given a glucometer and a wire- less device to upload data so they could get feedback from a diabetes educator. “The more data they uploaded, the better

their outcome,” Kvedar says. “And the more they knew the nurse educator was looking at their data, the better the outcome. So there’s a feeling from patients that this home moni- toring stuff is fine as long as the doctor’s pay- ing attention to it.” Unfortunately, most physicians are not yet

ready to pay attention to either mobile or home monitoring data. For one thing, they’re not getting paid to do it—a problem that should recede, observers say, as the health- care system moves toward value-based reim- bursement. Second, the typical clinical work- flow is not set up to receive and act on monitoring data, even if it’s pre-sifted. Third, doctors don’t have a lot of faith in patient-

entered data, because patients can make errors and may put in data that makes them look better, Kvedar says. “We don’t have much credence in self-

entered data here at the Center for Con- nected Health,” he states. “We believe that

data should be sensor-derived and automati- cally uploaded whenever possible.” Dr. Mohit Kaushal, chief strategy officer and

executive VP of business development for the West Wireless Health Institute, agrees, noting that automation prevents errors and elimi-

Research: Accountable Care Organizations

As healthcare providers consider whether to participate in the Centers for Medicare and Medicaid Services ACO program, many IT executives wonder whether it’s doable. Our expert analyst offers a blueprint for success.

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Which mobile computing devices are doctors in your organization using for medical purposes?

Mobile Devices Used by Doctors

Laptops

Smartphones

iPads or other tablet computers

Other

Our doctors don’t use mobile devices for medical purposes

Note: Multiple responses allowed Base: 337 respondents in January 2012 and 357 in December 2010 working at a doctors’ practice, hospital, healthcare center or other healthcare provider Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals

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78% 74%

69% 61%

66% 45%

1% 3%

11% 14%

Figure 3

July 2012 7

July 2012 8

nates the burden of entering data. “Take a [digital] weight scale, for example,” he says. “If it’s Bluetooth-enabled, when somebody steps on that scale, the data is automatically trans- mitted rather than the patient having to self- enter it.” What this means is that home monitoring

devices that use automated sensors, such as digital scales and blood pressure cuffs, have an edge over mobile monitoring apps in get- ting physicians’ attention. But there’s one big exception: garments with monitors imbedded in them and sensor “patches” that attach to the skin, both of which can automatically transmit data about vital signs. Powered by the miniaturization of wireless

connectivity, wearable monitors have gener- ated a respectable business in the fit - ness/wellness area. There are signs that the use of wearables may expand into the chronic disease field, as well. For example, the Mayo Clinic has partnered with Preventice to develop a wearable device that monitors ir- regular heart rhythms. Sensor patches can be applied to the body,

Kaushal says, “to monitor physical parameters, and we can’t feel the patch. Using heart failure as an example, you can monitor whether there’s fluid in someone’s lungs, where some- one is decompensating before they feel unwell. That data is captured and moved around, and the hospital and the physician can intervene earlier.” He cites a San Diego

company named Corventis that makes a patch to monitor cardiovascular health.

Home Monitoring Evidence Mounts Home telemonitoring has been around for

more than a decade, and there’s growing evi- dence that it can improve outcomes and lower costs. A Veterans Health Administration

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For what purposes are your doctors using mobile computing devices?

Reasons Doctors Use Mobile Devices

To access patient data

To communicate with other healthcare providers

To access decision support and other business intelligence applications

To communicate with patients

For all their computing needs; it’s their only computing device

Other

Note: Multiple responses allowed Base: 297 healthcare provider respondents at organizations where doctors use mobile computing devices Data: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012

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82%

62%

47%

33%

19%

2%

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Figure 4

July 2012 9

study a few years ago, for example, found that a combination of care coordination and home monitoring reduced hospital bed days by 25% and hospital admissions by 19%. More recently, a study by the Geisinger Health Plan showed that a home monitoring program for patients with heart failure cut readmission rates by 44% compared with a control group. Besides the traditional telemonitoring of vi-

tal signs, new applications and devices are helping seniors “age in place” at home. Mo- tion-sensing technologies used in video games, for example, are being deployed to track people’s movements in their homes, while sensors in beds monitor their pulses and respiration rates. To monitor medication adherence, a company named Proteus inserts tiny wireless chips in pills that send out data when the medications are ingested, says Kaushal. However, a lack of provider reimbursement

continues to hold back home monitoring as well as mobile health apps, says Chuck Parker, executive director of the Continua Health Al- liance, which represents, among others, device

manufacturers that make the monitoring equipment. “It’s difficult to fit home monitor- ing into a fee-for-service system, where a physician or other provider gets paid for everything they do,” Parker points out. Nevertheless, he believes this will all change

if and when providers begin to be paid for keeping costs down and improving out- comes. At that point, he says, “it becomes much more apparent that you need to do home monitoring to keep the patients out of expensive care settings like hospitals. So the

shift to the accountable care organization model is driving significant interest in home monitoring. As those organizations mature, they’ll be driving the demand.” As for the incorporation of mobile apps into

healthcare, Parker says it’s inevitable. “It will have an impact at some point, because it will allow better interaction with an informed con- sumer, and physicians will start looking for that data from mobile apps on a regular basis,” he says. “Eventually, you’ll start to see a shift— probably in the next tree to five years—where

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Which tablet(s) are in use by doctors at your organization?

Types of Tablets Used by Doctors

Apple iPad

Windows-based tablet

Android-based tablet

Other

Note: Multiple responses allowed Base: 222 healthcare provider respondents at organizations where doctors use tablet computers Data: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012

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83%

48%

36%

3%

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they’ll begin to look at that data coming into their system and interact with it on a more continuous or real-time basis.”

Provider-Focused Applications Physicians are among the biggest users of

mobile devices. A pair of Manhattan Research surveys recently found that 62% of doctors used iPads or other tablet computers, and 81% had smartphones. Only about half of the doctors who have

tablets say they’ve used them at the point of care, and far fewer are using them to look up electronic health records. The vast major- ity of physicians use their iPads and Android

tablets to view reference materials, access drug information and prescribe electronically. Nevertheless, hospital administrators and

CIOs are seeing a tremendous demand from physicians to use their personal mobile de- vices at work. While many hospitals have been

slow to respond to the “bring your own de- vice” (BYOD) trend because of security con- cerns, conversations with healthcare leaders indicate that they’re trying hard to meet their medical staffs’ needs. Neal Ganguly, VP and CIO of CentraState

Health System in Freehold, N.J., says that BYOD is still in an early stage at his facility. Most of his staff is bringing in tablets and smartphones, and the hospital has enabled email access on the smartphones. In addition, CentraState is in- troducing computerized physician order entry and piloting the use of iPads in the initial group of doctors who are doing CPOE. Meanwhile, the hospital has noticed that

some physicians and nurses are texting each other in a work context. While CentraState doesn’t want to stop that if it has a clinical benefit, Ganguly is looking for some way to encrypt the messages. He’s already using the AirWatch mobile device management system to lock down devices and wipe them if they’re lost or stolen. Both Ganguly and Dr. Craig Horton, VP of

medical affairs at Meadows Regional Medical

Center in Vidalia, Ga., say that physicians no longer want to go near desktop computers. Meadows Regional is using a rounding pro- gram called PatientKeeper that has native ver- sions for iPads, iPhones and Android phones, and most of the doctors have adopted the system for use in the hospital, Horton says. When Meadows Regional got Patient-

Keeper five years ago, he recalls, many doc- tors had Palm or Windows Mobile devices; while some used the connection that Patien- tKeeper provided to look up hospital records in their offices, few were using it on rounds. That changed dramatically, however, after iPhones appeared. Now most of the doctors use Patient Keeper in the hospital to keep track of lab and culture results, X-rays and consults, he says. “This has been a significant change in the

workflow, and it has replaced the doctors’ phone call to the nurse asking her to look this or that up for him or what happened to a lab result,” he says. “Nurses are more productive as well.” Paul Brient, president of PatientKeeper, says

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Hospital administrators and CIOs

are seeing a tremendous demand

from physicians to use their

personal mobile devices at work.

July 2012 11

he has seen several distinct growth periods in the adoption of mobile devices during his 10 years with the company. After Palms, Brient noted, there was the Treo smartphone and the BlackBerry. But today’s smartphones and tablets are something different. “We’re seeing penetration rates go up signif-

icantly among physicians,” he says. “And the things you can do with these devices are so much broader. We’re bringing PACS images down to iPads and even to iPhones. “For doctors, it’s no longer a question of

whether you use mobility, but of how you use mobility,” he says. Besides the security issues, the biggest ob -

stacle to the full use of mobile devices right now is technological. Smartphones are too small to view electronic health records comfort- ably, and none of the leading vendors has yet made a high-end iPad- native EHR. One problem with using a non- native EHR, Ganguly says, is that if you use the touch screen to click or type, it’s easy to make an error. Still, there are workarounds: At Partners Healthcare in Boston, clinicians are able to view information in their

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How significant a challenge will each of the following security-related issues pose to your organization over the next 12 months? Please use a scale of 1 to 5, where 1 is “not significant” and 5 is “very significant.”

Security-Related Challenges: Healthcare Providers

Note: Mean average ratings Base: 337 respondents in January 2012 and 357 in December 2010 working at a doctors’ practice, hospital, healthcare center or other healthcare provider Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals

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2012 2011

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Figure 6

July 2012 12

EHR on their mobile devices, using a specially designed presentation layer from InterSystems. Also, many hospital IT departments allow EHR access through an iPad by means of a Citrix thin client approach, al- though the security and managea- bility of virtualization doesn't nec- essarily make up for a less-than- stellar user experience. We discuss this issue in depth in our report on anywhere, anytime application delivery.

Next Step: Connecting With Patients A growing number of hospitals

are trying to connect with patients on their mobile devices, but in a very limited way. For the most part, says John Moore of Chilmark Re- search, they’re providing access to a mobile personal health record or portal and doing some simple transactional processing.

In other words, they’re taking the services they have on their pa- tient Web portals—such as online bill paying and appointment requests—and transferring them to a mobile platform. Tellingly, Moore adds, most of the money for these projects comes from hospi- tals’ marketing departments. Few hospitals or physician prac-

tices are yet using mobile health apps for what Moore calls “care provisioning”—which means giving patients mobile apps specifically de- signed to help them manage their health. There are several reasons for this—and not all of them have to do with reimbursement. “Health IT departments are busy

with other things; for instance, they’re trying to put in a workable EHR system,” he says. “Second, they’re focused on physician enablement on the mobile side— they’re trying to enable their clini-

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Which applications does your organization host or plan to host in the cloud?

Applications Hosted in the Cloud: Healthcare Providers

Note: Percentages reflect a response of “currently hosted,” “planned within the next three months,” “planned within the next six months” or “planned within the next 12 months” Base: 192 healthcare provider respondents in January 2012 and 184 in December 2010 at organizations using or planning to use cloud computing services Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals

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July 2012 13

cians to connect to their EHR on their iPad. Care provisioning is just sitting on a stack of priorities.” Chilmark has released a new report, how-

ever, predicting that this won’t be the case for much longer. The firm’s reasoning is that the burgeoning accountable care organiza- tions will have an urgent need to contain costs by improving population health, and there’s no way they can do that without en- gaging patients. “This use of mobile health [for care provi-

sioning] is very small and inconsequential right now,” Moore says. “But over the next two or three years, it will pick up steam. Then, with the ACO payment models coming into full swing in 2015-2016, everything really begins to pop.” By 2017, Moore predicts, this sector of mobile health could be worth $1.1 billion. Kaushal foresees a convergence among

health IT, mobile devices, and healthcare de- livery. Instead of just focusing on moving data around, he says, providers are looking for solutions so they can get paid in an out- comes-based world. “Mobility is an integral

part of that solution, but it’s not a solution in itself,” he says.

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