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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
Presented with
Report ID: S5310712
July 2012
$99
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TABLE OF
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Author’s Bio
Executive Summary
Consumer Mobile Health Apps Abound
Figure 1: Use of Tools by Doctors
to Collaborate With Peers
‘FDA Effect’ Hinders Chronic Disease Apps
Figure 2: Use of Tools by Doctors
to Collaborate With Patients
Figure 3: Mobile Devices Used by Doctors
Home Monitoring Evidence Mounts
Figure 4: Reasons Doctors Use
Mobile Devices
Provider-Focused Applications
Figure 5: Types of Tablets Used by Doctors
Figure 6: Security-Related Challenges:
Healthcare Providers
Next Step: Connecting
With Patients
Figure 7: Applications Hosted in the Cloud:
Healthcare Providers
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How Mobilit y, Apps and BYOD Will Transform Healthc are
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Ken Terry
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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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SUMMARY
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EXECUTIVE
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How Mobilit y, Apps and BYOD Will Transform Healthc are
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 patients 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, exercise and diet, and some are utilizing apps created for people with chronic conditions such as diabetes and hypertension. 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 physicians, 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.
July 2012 4
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Consumer Mobile Health Apps Abound
Somewhere between 20,000 and 30,000 mobile health apps are available to consumers
today. The vast majority of these applications
are aimed at people who want to track their fitness 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 buddies 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 readings and other data into their smartphones.
They receive feedback, either on their mobile
phones or on a website, from a “virtual” expert
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who coaches them on managing their condition and provides tips on diet, exercise and
other lifestyle factors. A trial of DiabetesManager 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-producing conditions (SDI) and graph their blood
pressure. In addition, Worcester Polytechnic In-
Figure 1
Use of Tools by Doctors to Collaborate With Peers
To what extent are clinicians in your organization using the following tools to collaborate with peers?
Widely used
Used on limited basis
Not used
Email/secure messaging
69%
24%
7%
Portal or website
46%
33%
21%
Videoconferencing
21%
43%
36%
Instant messaging
20%
37%
43%
Social media (online medical forums, Facebook, Twitter, etc.)
7%
28%
65%
Internal wiki
6%
23%
71%
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
R
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FAST FACT
62%
of doctors used iPads or
other tablet computers, and
81% had smartphones,
according to a pair of
reports
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 portion 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 arthritis, 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.
How Mobilit y, Apps and BYOD Will Transform Healthc are
Figure 2
Use of Tools by Doctors to Collaborate With Patients
To what extent are clinicians in your organization using the following tools to collaborate with patients?
Widely used
Used on limited basis
Not used
Email or secure messaging
30%
35%
35%
Portal or website
23%
35%
42%
Videoconferencing
5%
22%
73%
Instant messaging
4%
16%
80%
Social media (online medical forums, Facebook, Twitter, etc.)
4%
9%
77%
Internal wiki
2%
8%
90%
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
R4290312/24
Manhattan Research surveys.
‘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 Administration must approve any software application that is intended for medical treatment.
The FDA has OK’d some mobile health applireports.informationweek.com
R
cations—including
WellDoc DiabetesManager—and it issued a guidance document last
year on how it might regulate this area. But observers 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 recent PricewaterhouseCoopers report, their
participation tends to fade after a few
months.
Dr. Joseph Kvedar, founder and president of
July 2012 6
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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 generating. He cites a CCH diabetes program in which
patients were given a glucometer and a wireless 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 monitoring stuff is fine as long as the doctor’s paying 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 healthcare system moves toward value-based reimbursement. Second, the typical clinical workflow 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-
How Mobilit y, Apps and BYOD Will Transform Healthc are
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 selfentered data here at the Center for Connected Health,” he states. “We believe that
data should be sensor-derived and automatically 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-
Figure 3
Mobile Devices Used by Doctors
Which mobile computing devices are doctors in your organization using for medical purposes?
2012
2011
Laptops
78%
74%
Smartphones
69%
61%
iPads or other tablet computers
66%
45%
Other
1%
3%
Our doctors don’t use mobile devices for medical purposes
11%
14%
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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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 transmitted rather than the patient having to selfenter 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 getting 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 generated 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 irregular heart rhythms.
Sensor patches can be applied to the body,
reports.informationweek.com
How Mobilit y, Apps and BYOD Will Transform Healthc are
Figure 4
Reasons Doctors Use Mobile Devices
For what purposes are your doctors using mobile computing devices?
To access patient data
82%
To communicate with other healthcare providers
62%
To access decision support and other business intelligence applications
47%
To communicate with patients
33%
For all their computing needs; it’s their only computing device
19%
Other
2%
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
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 someone 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
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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 evidence that it can improve outcomes and
lower costs. A Veterans Health Administration
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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 vital signs, new applications and devices are
helping seniors “age in place” at home. Motion-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 Alliance, which represents, among others, device
How Mobilit y, Apps and BYOD Will Transform Healthc are
Figure 5
Types of Tablets Used by Doctors
Which tablet(s) are in use by doctors at your organization?
Apple iPad
83%
Windows-based tablet
48%
Android-based tablet
36%
Other
3%
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
manufacturers that make the monitoring
equipment. “It’s difficult to fit home monitoring 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 outcomes. 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
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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 consumer, 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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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
Hospital administrators and CIOs
of care, and far fewer
are seeing a tremendous demand
are using them to look
up electronic health
from physicians to use their
records. The vast majorpersonal mobile devices at work.
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 devices at work. While many hospitals have been
reports.informationweek.com
How Mobilit y, Apps and BYOD Will Transform Healthc are
slow to respond to the “bring your own device” (BYOD) trend because of security concerns, 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 introducing 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 program called PatientKeeper that has native versions 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 PatientKeeper five years ago, he recalls, many doctors had Palm or Windows Mobile devices;
while some used the connection that PatientKeeper 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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3.5
3.4
Bolstering HITECH Act compliance
Bolstering security for participation
in health information exchange
3.5
3.4
3.5
3.4
Encryption
Bolstering HIPAA compliance
3.5
3.4
3.6
3.5
Bolstering fraud-identification capabilities
3.6
3.6
Training staff on existing policies and enforcing them
Securing mobile devices
3.8
3.6
3.8
3.7
Protecting against data breaches, hacking
Ensuring patient data is secure and
privacy requirements are adhered to
1 Not significant
3.8
3.7
Very significant 5
he has seen several distinct growth periods in
the adoption of mobile devices during his 10 Figure 6
years with the company. After Palms, Brient
Security-Related Challenges: Healthcare Providers
How
significant a challenge will each of the following security-related issues pose to your organization over the
noted, there was the Treo smartphone and the
next 12 months? Please use a scale of 1 to 5, where 1 is “not significant” and 5 is “very significant.”
BlackBerry. But today’s smartphones and
2012
2011
tablets are something different.
“We’re seeing penetration rates go up significantly 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 obstacle to the full use of mobile devices right
now is technological. Smartphones are too
small to view electronic health records comfortably, 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
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Note: Mean average ratings
that if you use the touch screen to click or type,
Base: 337 respondents in January 2012 and 357 in December 2010 working at a doctors’ practice, hospital, healthcare center or
other healthcare provider
it’s easy to make an error. Still, there are
Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals
workarounds: At Partners Healthcare in Boston,
clinicians are able to view information in their
R
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61%
58%
Other clinical applications
Picture archiving communication system (PACS)
Financial (including insurance-related apps)
Clinical decision support
Computerized physician order entry (CPOE)
47%
47%
51%
56%
56%
58%
58%
59%
63%
50%
R
Storage
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 Research, 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- Figure 7
tient Web portals—such as online Applications Hosted in the Cloud: Healthcare Providers
bill paying and appointment Which applications does your organization host or plan to host in the cloud?
requests—and transferring them
2012
2011
to a mobile platform. Tellingly,
Moore adds, most of the money for
these projects comes from hospitals’ marketing departments.
Few hospitals or physician practices are yet using mobile health
apps for what Moore calls “care
provisioning”—which means giving
patients mobile apps specifically designed 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
R4290312/32
Note: Percentages reflect a response of “currently hosted,” “planned within the next
EHR system,” he says. “Second, 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
they’re focused on physician using or planning to use cloud computing services
Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals
enablement on the mobile side—
they’re trying to enable their clini59%
57%
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, although the security and manageability of virtualization doesn't necessarily make up for a less-thanstellar user experience. We discuss
this issue in depth in our report on
anywhere, anytime application
delivery.
How Mobilit y, Apps and BYOD Will Transform Healthc are
E-prescribing
reports
60%
61%
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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, however, predicting that this won’t be the case
for much longer. The firm’s reasoning is that
the burgeoning accountable care organizations will have an urgent need to contain
costs by improving population health, and
there’s no way they can do that without engaging patients.
“This use of mobile health [for care provisioning] 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 delivery. Instead of just focusing on moving
data around, he says, providers are looking
for solutions so they can get paid in an outcomes-based world. “Mobility is an integral
How Mobilit y, Apps and BYOD Will Transform Healthc are
part of that solution, but it’s not a solution in
itself,” he says.
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