mHealth Harnesses Care Improvements


At the latest mHealth Summit, Maryland Physician learned about a variety of unique partnerships that are employing mobile devices to improve care.

At the fifth annual mHealth Summit in December 2013, keynote speaker Rick Valencia, senior VP and general manager of QualComm Life, predicted, “By 2020, we’ll need 1,000 times the bandwidth we have now, and everywhere we go we’ll be connected. With 6.8 billion mobile connections, mobile is more prevalent than electricity or running water.”

Valencia’s comments are in line with the many mind-boggling statistics on mobile technology, including:

  • More than 80 billion apps were downloaded in 2012
  • The number of mobile devices will exceed the number of people on the planet in 2014
  • The wearable device market will hit $1.5 billion this year
  • The mHealth market will be worth $30 to $60 billion by 2015

What’s more impressive, however, is the fact that mHealth is beginning to move beyond big numbers, gimmicky devices and interesting apps to make an impact on health and healthcare delivery. At the summit, the focus was slowly shifting to applying mobile devices to improve patient and population health, though data on results is in its infancy.

“There has never been a more exciting time to be an entrepreneur or investor in the mobile health and wellness space,” said Rich Scarfo, VP, Events at HIMSS Media, and director of the mHealth Summit.

Another key-noter, Steve Case, CEO of Revolution and former CEO of AOL, observed, “What’s happening here is health, not healthcare. It’s happening outside healthcare’s walls.”

Esther Dyson, considered the most active healthcare angel investor, added, “mHealth is creating a new industry, not transforming an existing one.”

Partnerships Provide Remote Monitoring of High-Risk Patients

To use mobile devices to transform health, new partnerships between technology companies, insurers, health providers, universities and government agencies are forming. In one example, the American Heart Association has teamed up with Qualcomm Life on a Connected Heart Health initiative that uses wireless technologies and evidence-based care plans to improve post-acute outcomes for patients with cardiovascular disease.

Another example of a healthcare-focused technology company that has joined with physicians and patients is Alere™ Connect. They have partnered with the George Washington Hospital to secure a $1.9 -million Innovation Grant from the Centers for Medicare and Medicaid (CMS) that funds research led by Susie Lew, M.D., medical director for the Acute Hemodialysis Unit. Dr. Lew’s project investigates how video and real-time, continuous remote monitoring may improve patient access to care, treatment adherence and health outcomes for patients on peritoneal dialysis, a home-treatment option for renal failure.

In this program, Alere Connect’s remote monitoring technology will help identify dialysis patients who are having issues in near-real-time, to permit early intervention rather than waiting for them to be in crisis. The team predicts the new model will reduce overall hospital days and save approximately $1.7 million.

The cloud makes much of this remote connectivity possible. Alere Connect’s CEO, Kent Dicks, said, “Our goal is a total solution. We develop remote health-monitoring devices that securely and automatically transmit health information from patient homes to our CloudCare platform, where the data is downloaded to provider EMRs.”

Alere Connect also has partnered with over 10,000 physicians to provide home International Normalizing Ratio (INR) monitoring services to 100,000 patients taking warfarin, providing a real-time option that is safer and more convenient than monthly monitoring in a clinic.

Another model that uses mobile devices to remotely monitor and manage high-risk patients was developed at CHRISTUS St. Michael Health System in Texarkana, Texas. In 2010, it launched a Care Transition intervention program to reduce hospital readmissions of high-risk patients (e.g., diabetes, hypertension, myocardial infarct and pneumonia), whose readmission rates are higher than average.

Luke Webster, M.D., chief medical information officer, noted in his presentation, “Patients are able to learn and apply new self-care skills to help them assert a more active role during care transitions.” The pilot program decreased per-patient costs from $13,000 to $1,200, and average readmission rates from 1.43 to 0.20. The health system plans to expand this program in 2014 and begin using telehealth to reduce patient transfers from smaller hospitals to tertiary centers.

MedStar Institute for Innovation’s Virtual Visit solution provides a similar program, offering remote monitoring and management of high-risk patients with chronic diseases using QualComm’s 2net Platform and Hub. The platform can capture and deliver medical device data to integrated portals or databases from nearly any wireless medical device, for storage in a secure, interoperable system.

Improving Patient Engagement in the Hospital

Hospitals also are using mobile devices within their walls to better inform and guide patients.

David Cook, M.D., anesthesiologist at Mayo Clinic, described how his team piloted the use of tablets and an app called “MyCare” in post-surgical care to improve patient communication and health. Patients recovering from cardiac surgery and other procedures received a tablet loaded with an instructional video and a personalized care plan. The plan included both educational modules on what to expect and daily ‘homework,’ such as how much to walk each day.

Cook’s team coupled patient feedback with data from FitBit to monitor pain levels and progress in daily activities. Establishing protocols allowed ancillary staff to take appropriate interventions without requiring physician input. The program reduced hospital stays for some patients, and patients liked knowing what to expect and being able to track their progress. Surprisingly, the 80-year-olds mastered the devices as well as younger patients did.

PatientPoint® and Miami Children’s Hospital® (MCH) won Microsoft’s “Innovation in Patient Engagement” prize based on MCH’s use of the PatientPoint Care Coordination Platform 2.0. The program integrated data from tablets used at more than 40 check-in points across the hospital with the MCH Admissions-Discharge-Transfer (ADT) systems to reduce waiting times and to provide educational information.

Following on this success, MCH is focusing on population health and care coordination. It takes data from health plans, EMRs and patient self-reporting to create a more robust health record. Using tablets, secure messaging, mobile apps and interactive voice response (IVR), MCH can reach out to noncompliant patients before they arrive in the physician’s office, and automate followup to increase medication and care-plan compliance.

Far-Flung Partnerships

In a partnership that spans the seas, German company Boehringer Ingelheim, United BioSource Corporation (a subsidiary of Express Scripts) and Healthrageous launched a SMART Study involving employees at more than 10 major U.S. corporations. This Institutional Review Board -approved research project is testing a digital diabetes self-management program. Participants received a personalized action plan with health behavior improvement goals, a wireless glucose meter transmitting data to clinical monitors, and HbA1c at-home test kits. The impact will be measured through medical claims data and self-reported biometric health measures.

Physician, Pharmacy and Insurer Partnerships

In January 2014 Baltimore-based WellDoc received $20 million in funding from Merck GHI Fund to continue commercializing its FDA-cleared mobile application and program for Type II diabetes, called BlueStar. The company will stop marketing its first major product, Diabetes Manager (described in our March/April 2011 issue).

BlueStar must be prescribed by a physician and purchased through a pharmacy. The app links to WellDoc’s Automated Expert Analytics System to deliver various motivational, educational and action-oriented messages to the patient’s mobile device at the same time that it provides physicians with regular updates and clinical decision support tools. With the new funding, WellDoc can market BlueStar to a growing number of payers, pharmacy benefits managers and physicians. Participating insurers covers the technology.

mHealth clearly is only at the beginning of its maturation process. But it has moved beyond early mobile app use to support an ecosystem of providers, payers, health technology firms and health information systems that are connecting to improve patient care.

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