EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Five Considerations in Starting an mHealth Program

Five Considerations in Starting an mHealth Program | EHR and Health IT Consulting |

Engaging patients in their care through the use of mobile devices, also known as mHealth, is one of the biggest healthcare technology trends of 2015. But what exactly should your medical practice be doing to get involved?

That's a question that Chanin Wendling, director of the division of applied research and clinical Informatics at Geisinger Health System, explored during her presentation, "Active Patient Engagement: mHealth as a Tool for Interaction," at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago.

Wendling said health systems that want to get more involved with mHealth must adopt the right perspective first.

Don't get lured in by a mobile tool just because it is exciting and cutting edge, she said. Instead, consider whether the tool will provide value to your patients and providers.

"You need to look at this technology in that same context of hiring another physician or buying another medical device — what is this going to accomplish for you?" she said.

For Geisinger, Wendling said the value of mHealth is improved patient engagement that leads to better outcomes and lower costs. That's "a very strong business rationale," she said.

Here are five of Wendling's other suggestions for practices hoping to form a successful mHealth program:

1. Define the objectives. If you don't have an end goal, it's difficult to determine how to get started. Wendling said that before embarking on an mHealth project, you should first define your objectives. At Geisinger, those mHealth objectives include helping patients understand their health, helping them be better prepared for patient visits, and helping them control their health conditions.

 2. Determine how fast you want to move. Just because the health system down the street is using a particular mobile tool, that doesn't mean it's the right tool for your practice. Similarly, just because that health system is rushing to adopt mobile tools, that doesn't mean your practice needs to do so.

"You can be a follower" and let others figure it out first, said Wendling. "The key is to think about where you want to be, what's important for your specific organization, what [you] value, what kind of patients do you have, and what kind of business measurements you have..."

3. Assign project management responsibilities. Before embarking on an mHealth project, make sure you have identified the appropriate staff to lead it. Also, make sure you provide them with adequate time and resources to be successful, said Wendling. "I believe that if something is important you dedicate resources to it."

4. Determine what projects to pursue and what tools to use. When determining what type of mHealth project to pursue, consider your desired outcomes and what tool might increase the likelihood that you will achieve those outcomes. Possible mHealth Tools include patient portals that can be accessed via a mobile device or app, mobile apps, text messaging, and so on.

5. Consider the patient perspective. Regardless of what tools you decide to use and what project you embark on, keep the patient's perspective at the forefront of your decision-making, said Wendling.

Think about what a patient would prefer in relation to the tool. For instance, it might be helpful to offer a medication reminder through both a mobile push from an app and from a text message so the patient can choose what will work best for him. Also, consider whether the mHealth solution best suits patients' needs. For instance, it might be helpful to enable patients to choose what time of day they receive medication reminders, rather than having all the patients receive the reminders at the same time.

Some methods Wendling recommended to get patient feedback regarding mobile device design and deployment include:
• Ask clinicians to share feedback they receive from patients. 
• Conduct a survey on your patient portal and offer an incentive to those who complete it, such as a gift card. 
• Discuss mobile devices with patients when they come in for visits.
• Ask your patient advisory council for input (if you have one).

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How the Connected Revolution Impacts the Medical Industry

How the Connected Revolution Impacts the Medical Industry | EHR and Health IT Consulting |

The connected revolution is the ongoing change in how our devices connect everyone to the world around us. Whether mobile devices or tablets connect a person to other people or other devices, it’s helping people solve problems, improve existing processes and make more of an impact in their prospective industries.

The healthcare industry is in the process of widespread changes at the moment due to the impact of the connected revolution. Both healthcare facilities and professionals utilize a variety of tools to help perform their everyday duties, which are now connecting with apps on mobile devices and tablets to offer more utility to service providers and patients alike.

According to the 2nd Annual HIMSS Mobile Technology Survey released in December, the percentage of medical professionals using apps to actively engage in direct patient care has grown in the past year in several key areas, including: collecting data at the bedside (45% compared to 30%); using bar code readers on mobile devices (38% compared to 23%); monitoring data from medical devices (34% compared to 27%); and capturing visual representation of patient data (27% compared to 13%).


200+ Companies Surveyed

A survey in 2012 of 200+ healthcare institutions and organizations also confirmed the adoption of mobile devices and the buy-in for the connected ecosystem:

  • 44% have enabled physicians to prescribe medications, order exams, and change charts, compared to 15% previously
  • 53% have implemented EHR access on mobile devices compared to 18% last year
  • 41% use text message reminders, compared to 24% in the previous survey
  • 29% use wireless monitoring technologies, compared to 15% previously

The global mobile healthcare market is estimated to be valued at $6.6 billion this year and is expected to reach $20.7 billion by 2018. Connected devices bring in about 80% of the revenue in 2013, as compared to medical apps.

Connected devices are broken up into different categories like multi-parameter trackers, cardiac monitoring, diabetes management devices and other devices like sleep apnea devices, and respiratory monitors, all of which can be synced with the connected ecosystem.

Connected cardiac monitoring devices are the most profitable and useful devices in the market, followed by diabetes management devices, and multi-parameter trackers. The highest growth will be witnessed by the diabetes management devices due to the increasing global needs of the diabetes population as a whole.

It’s extremely obvious that the healthcare industry will continue to transform the way in which medical professionals interact with patients and vice versa. This change will continue to impact more areas of medicine at a quicker pace with every passing year. It’s time to start understanding how this will affect your work as a healthcare professional and how the medical facility you work at will evolve.

Here’s how the medical industry is impacted by the start of the connected revolution:

1. Increased Patient Safety:

With the development of apps for mobile devices that help to better synch the information and tools used at medical facilities, patients are able to help manage aspects of their own health more effectively and therefore, be much safer.

Patients will continue to have more access to medical information to better understand their own health, warning signs of different ailments and access to your complete medical history from your phone.

By ensuring all records and paperwork is done digitally, patients will have a more clear understanding of what their medical needs are, what documentation they need to complete after a visit to a physician or a hospital, what to take note of in regards to their health and more, all from the convenience of their app synced with the information and systems at a medical facility.

When each patient has a clearer understanding of their own medical conditions, when to seek treatment and how to handle their health from the information on a mobile device, they are a more healthy person than they were before having access to this knowledge and understanding of how to use it to be safe.

These devices will also synch more effectively to ensure that patients are properly monitored over time from the hospital bed, from home, at the doctor’s office or wherever they may be. This is important because if something were to go wrong, these devices will alert the proper medical professional to ensure they can provide the best services possible as soon as possible. This technology for monitoring patients has existed for years, but now it is more robust and efficient with this added layer of functionality.

2. Reduced Medicare Fraud:

It is estimated that there is $60 billion dollars in Medicare fraud every year. By connecting all the systems and tools already in place for filing claims, billing and patient history related to Medicare, it’ll be easier to prevent and detect fraud.

By setting up a fraud detection and prevention system that lives across the different devices medical professionals use on a regular basis, as well as patients, it can help save money, time and the effort of both medical professionals and the larger community as a whole.

These apps can sync with existing medical tools to track all Medicare transactions in real time to ensure they are accurate and occurring with all the proper permissions inline with pre-existing procedures. Increasing the speed at which fraud is detected can help ensure that individuals are identified and money is returned to the right person before it is too late.

The time and money saved by these efforts can go towards finding more creative ways to reduce the cost of Medicare and improve patient health overall.

3. New Revenue Generators:

When a mobile phone or tablet is connected with other medical devices in a healthcare facility it creates a new source of data to interpret about the functions of these tools and how their use is beneficial. The new sensors and devices created within this connected ecosystem will generate more data than ever before.

With this medical data eventually comes the need for data analysis and management, which creates new companies and service providers offering to manage this influx of data brought about from the connected revolution. Service providers and medical facilities can utilize this data and offer it for sale to others, bringing in additional income.

Obviously, this wouldn’t be patient specific information, but anonymous data to help shine light in patterns of usage and the success rate for different tools, systems and other medical technologies when it comes to treating patients.

Lastly, this vast amount of data will continue to be helpful when it comes to creating new apps and devices for healthcare purposes that are better informed due to this new source of information.

The more actionable data that can be pulled from a medical procedure the better, offering deep insights on how the process can be improved to be more beneficial to patients and healthcare professionals alike.

4. Improved Patient Interaction:

The ecosystem of connected devices has already improved patient’s interactions with medical professionals and facilities and will continue to do so for the future. Today appointments and referrals can be found and booked through many different app offerings that both the patient and healthcare facility have access to across devices.

This takes a lot of the hassle of booking appointments with a healthcare provider for patients and finding the right referral to offer your patient as a medical professional. This ecosystem of accessible information helps everyone save time and avoid frustrations, which leads to a more effective interaction for both the patient and healthcare provider.

These apps can integrate with every part of many different medical processes like getting prescribed medication, which can all be documented and completed via an app.

This way the medical professional can send through the approved prescription, the patient can review and send this prescription order to the pharmacy of their choice and then be alerted as to when their prescription is ready to be picked up. This can streamline the process allowing for better service and more accuracy when it comes to providing the service to patients.

5. Accessibility of Care:

The connected revolution will successfully help make healthcare more accessible for everyone across the United States and the world. Many people don’t live in a metropolitan area or have access to a nearby doctor. With the use of the right app or other form of technology that is a connected part of the healthcare ecosystem, services or consultations will eventually take place for patients remotely.

There are many concerns with this approach of course, but on a case by case basis there is certainly instances where this could be the right technique to properly administer services to a patient. Each patient and doctor should decide when it is and isn’t the right to interact remotely and when it is or isn’t time to have an in person consultation.

The consolidation of healthcare information about a patient or larger medical discipline can also help ensure that a patient is well educated about what type of care they have the opportunity to receive, what questions they should be asking and an understanding of their medical history and how it may conflict with another medical procedure.

This information can quickly be accessed by either the patient or healthcare professional across different devices quickly and easily, giving the patient access to better care than they would typically receive if each person’s time was being spent sorting through paperwork in a binder containing all of the necessary medical information on their medical history.

According to CITE World, healthcare providers remotely monitored 308,000 patients worldwide for congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and mental health conditions in 2012. This number will continue to soar as the technology become more readily available and the idea of remote medical care becomes more mainstream for patients across the world.

- See more at:

Via eMedToday, Jérôme Buisson, dbtmobile
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Could mHealth Apps Be a Reprise of the EHR?

Could mHealth Apps Be a Reprise of the EHR? | EHR and Health IT Consulting |

While your humble correspondent continues to delight in the emerging science of “mHealth” as a newly minted start-up Chief Medical Officer, he ran across this interesting article on risk and patient safety.

Authors Thomas Lewis and Jeremy Wyatt worry that “apps” can lead to patient harm.

They posit that the likelihood of harm is mainly a function of 1) the nature of the mistake itself (miscalculating a body mass index is far less problematic than miscalculating a drug dose) and 2) its severity (overdosing on a cupcake versus a narcotic).  When you include other “inherent and external variables,” including the display, the user interface, network issues, information storage, informational complexity and the number of patients using it, the risks can grow from a simple case of developer embarrassment to catastrophic patient loss of life.

In response, they propose that app developers think about  this “two dimensional app space” that relies on a risk assessment coupled to a staggered regulation model.  That regulation can range from simple clinical self assessment to a more complex and formal approval process.

What’s clear to your correspondent is that hidebound mainframe entities like the Food and Drug Administration are no match for the app “ecosystem“.  Rather than try to formulate a one-size-fits-all “not function as intended” model like this, maybe it should triage its oversight using the Lewis and Wyatt framework.

In addition, I agree with Lewis and Wyatt that safety is also a function of clinician input.  Docs and nurses can assess possible mistakes, their downside severity and the impact of all those variables.

I couldn’t have put it better myself:

“…. many app developers have little or no formal medical training and do not involve clinicians in the development process and may therefore be unaware of patient safety issues raised by inappropriate app content or functioning.”

Without the insights of seasoned real-world doctors and nurses, apps could end up with the same safety issues that are plaguing electronic health records, many of which were also developed with little regard to physician or nurse input.

In other words, just because it’s a “health” app doesn’t mean its necessarily so.

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