Meaningful Use is the phrase used in the 2009 HITECH Act to describe the standard providers must achieve to receive incentive payments for purchasing and implementing an EHR system. The term meaningful use combines clinical use of the EHR (i.e. ePrescribing), health information exchange, and reporting of clinical quality measures. Achieving meaningful use also requires the use of an EHR that has been certified by a body such as CCHIT, Drummond Group, ICSA Laboratories, Inc. or InfoGuard Laboratories, Inc. The term can also apply informally to the process of achieving the standard, for example “How is our practice doing with meaningful use?”
An abbreviation for Mobile Health, mHealth is a blanket label for transmitting health services, and indeed practicing medicine, using mobile devices such as cell phones and tablets. mHealth has large implications not only for newer devices like smartphones and high-end tablets, but also for feature phones and low-cost tablets in developing nations. Many different software and hardware applications fit under the umbrella of mHealth so the term is used conceptually to talk about future innovations and delivery systems.
One of the most exciting trends in modern healthcare can be found at the intersection of two larger societal changes: the shifting demographics of an aging Baby-Boomer population, and the fast adoption of smart mobile devices and mobile application platforms. As robust, secure and intuitive mHealth applications are adopted, patients are more empowered to monitor and share their health data outside of a traditional medical office or hospital setting. As healthcare delivery system already short on providers becomes even more taxed, mHealth applications will allow the system as a whole (patients, caregivers, loved ones, and payers) to navigate health decisions in a more efficient and informed way.
“Boomers view tech-enabled health products as a way to foster control and ongoing independence for themselves, especially in light of the rise in incidence in chronic disease with aging, and their desire to reduce costs. Nearly 56% of boomers show a high willingness to use in-home health monitoring devices in tandem with care of their primary physician.”
What are the advantages of pushing home health medical data from the source to the care provider?
Minimum lag time between data collection and the clinician’s ability to review it.
Reduction in errors associated with human intervention in data entry.
Intuitive and simple interfaces promote active patient involvement and caregiver communication in healthcare management.
Secure sharing of PHI (Protected Health Information) with patient, family members, and approved internal and external stakeholders in health.
Here are just a few of the companies and products available now (or in the near future) that might change your mind about where and how health data is captured and shared. Each of these products automates the capture of health data and the transfer of the data in a usable format to an Electronic Health Record.
Near Field Communications
NFC (Near Field Communications) is a wireless technology that allows for quick transfer of data between two sensors that are fairly close (an inch or two) together. The secure transfer allows for seamless data tracking inside caregivers’ workflow. For example: medical supplies, drugs, injectables and fluids can be fitted with low cost sensors that are swiped past a patient’s sensor to indicate they will be administered to the patient, and then again past the provider’s sensor to indicate a finished procedure, capturing time of administration, dosage, and patient information without slowing down the care to enter this critical data by writing them down, typing them in, or just resolving to remember them for later entry.
Gentag makes the data sensors and applications that manufacturers can use to send data via cell phone to the hospital or physician for seamless inclusion in the electronic medical record (EMR). Monitoring of blood pressure, fever, weight management and urinalysis are just a few of the ways Gentag has improved data capture in healthcare.
iMPak Health makes a cholesterol monitor the size of a credit card that accepts a small blood sample to process for triglyceride levels. The data is uploaded wirelessly to a cell phone that transmits it to a health provider.
Smart Fabrics and Wearable Monitors
Researchers at the Universidad Carlos III de Madrid in Spain developed a fascinating concept for an “Intelligent T-Shirt” that uses sensors woven into a washable fabric to create a hospital garment that does more than preserve the patient’s modesty. The sensors in the fabric can detect and record temperature, bioelectric impulses (for ECG monitoring), as well as the patients location, current resting position, and level of physical activity.
Copenhagen Institute of Interaction Design graduate Pedro Nakazato Andrade has designed a dynamic cast called Bones that collects muscle activity data around a fracture area by using electromyographic (EMG) sensors to report the patient’s progress to physicians automatically. This could reduce the need for follow-up visits and imaging, or change the specifics of rehabilitation.
The Basis Band is a wristwatch-type accessory that monitors heart rate by directing light into the skin to image blood flow. It also uses a heat sensor for skin temperature changes, an accelerometer for recording movement and activity, and sensors for galvanic skin response. The band also gives customers access to a free, web-based health dashboard to oversee the data the device collects and transmits.
There are still some considerable hurdles to full adoption of mobile home health monitoring. Very few patients use only one medical device, so not only do monitoring devices need to work with networked EHR technologies, they have to be integrated with each other to present a comprehensive picture of health to providers and Health Information Exchanges (HIEs). Also, as patients navigate the system of generalists, specialists, and emergency care providers, the possibility of encountering multiple software and hardware platforms will require flexible, integrated solutions that can run on any device. As with any networked application of sensitive data, security and availability are major factors in a success deployment. Unless patients can count on the privacy of their data, and providers can count on the uptime of their software, healthcare systems won’t be able to realize the full benefit of mHealth installations. On top of that, more monitoring of patient health means that there will be even more data to be collected on each patient, and on the population as a whole. While more data means more opportunity for large scale research and analysis for the public benefit, it also means more data has to be secured and protected as a part of the health record, requiring even more security and storage resources. And finally, the Food and Drug Administration will have a large say in the future of mHealth application development through industry regulation. Device makers and application developers will certainly have to work within a governmental framework which will have a large say in the time-to-market of many possible products.
With all that being said, the opportunity to meet the demographic challenges of an already stressed healthcare system with mobile home health monitoring and Electronic Health Records will be one of the major themes of the future of both the heath and technology industries.
For the organized and busy professional on the go, the smartphone has quickly become a necessity on par with a persons house keys, wallet, or purse. The past five years have vaulted the smartphone from status symbol to must-have business tool by bringing data and communication capabilities from your office to the palm of your hand. With decision making and communication tools always at the ready, you can be productive from anywhere you are, and you are freed up to bring information to clients, meetings, and conferences without the hindrance of a laptop.
Physicians, practitioners and forward thinking healthcare organizations are leading the charge to embrace mobile health, often called mHealth, or the practice of patient care supported by mobile devices. A survey conducted at the physician online and mobile community QuantiaMD in May of 2011 found 83% of physicians reported using at least one mobile device and 25% used both a phone and a tablet. Of the 17% surveyed who did not use a mobile device, 44% planned on purchasing a mobile device sometime in 2011. Physicians surveyed reported their top uses for mobile devices as:
Q: Tell us about the process leading up to the creation of Infield and how you decided to focus on a mobile application? Infield has always been devoted to mobile. We were originally in the public health space, but we caught the ”˜Health 2.0’ bug and started looking at the intersection of patients and care providers. We honed in on texting because it includes the 60% of patients that don’t have a smart phone.
Q: Your product is suitable for a large practice or a hospital. Can you describe how a client would use your product for specific populations or health issues or to enhance a service line? A clinic or hospital would enroll its patients into specific strings of messages based on the patient’s condition. For example, hypertension patients would receive a Heart Healthy Tip-of-the-week, while diabetics might receive weekly tips on diet and exercise. Physical therapy patients could receive texts about stretching or light exercise ideas. The goal is to keep the patient close to the provider in-between visits. An additional benefit to the provider is keeping patients on track with appointments and office visits, thereby driving revenue to the provider.
Q: We talked about the client creating the content for the text messages – can you give some examples of text messages that a practice or hospital might send to a patient newly diagnosed with diabetes?
Let’s imagine the texts are coming from Valley General Hospital.
Week 1 text: “An after dinner walk often helps get 20-min of exercise. Join Valley General’s walking club! 800-555-1212. Text STOP to stop” Week 2 text: “Monitors and strips are often covered under insurance or Medicaid. Call us to learn more: 800-555-1212. Text STOP to stop”
Week 3 text: “Dizziness or shortness of breath can be serious. Valley Gen nurse line @ 800-555-1212. Text STOP to stop”
Week 4 text: “Stay on track with your appointments, even if you don’t feel sick. Valley Gen. appt line @ 800-555-1212. Text STOP to stop”
What’s important is that the patient is receiving gentle nudges to adopt a healthier lifestyle, while also receiving contact data to achieve those results. For the provider, the calls to action often result in increased revenue.
Patients can “Text STOP to stop” at any time to stop receiving messages.
Q: What’s the process for connecting the patient with the messages, and who makes that connection? There are two ways. 1. At discharge: the discharge nurse brings up a simple Website that lists the conditions available (diabetes, hypertension, and obesity, for example). He or she chooses a condition, types in a patients phone number, and hits “send’. 2. Self-directed: the patient is handed a business card with instructions on how to self-enroll. “Text HEART to 12345” for English-hypertension. Text “CORAZON to 12345” for Spanish-hypertension.
Q: I was impressed that you offer the service in different languages – which languages are available or can you make any language available upon request? Offering content in multiple languages is crucial to reaching patients who don’t use the Internet or e-mail. For example, young Hispanics are 5x more likely to text than use email in any given day. Infield can offer the content in any language that’s supported on a mobile phone.
Q: I’ve heard of obstetric practices texting pregnant women and giving them lots of support and information during their pregnancy. Are there other success stories about specific populations or specific illnesses or diseases? You’re referring to Text4Baby ”“ a fantastic example of aggregating patients (pre-natal moms) and offering quick snippits of information. In addition, there are recent examples of texting increasing drug compliance and at-home therapy compliance. We’re offering the ability for individual providers to customize the content and offer it to their patients exclusively.
Q: Can Infield handle medication reminders or support group reminders or texts that would be sent on a different time line than 2 messages per week? Yes. We can change the intervals based on what’s best for the patient and the provider.
Q: Could your product be launched in a community to improve the health of an entire community and maybe be supported by a grant? Yes. In fact, we are currently on a number of grant applications to offer health improvement through community health initiatives. We worked with the community centers to meet the grant requirements.
Q: Where do you see mHealth going in the next two years? Can you give us a hint about functionality that your product might have in the near future? The ability for patients to support each other via mobile devices is something we’re very excited about. So, instead of a gentle nudge to improve my health from my doctor, I got one from my best friend or coworker or walking partner. Patients helping each other — one-to-one — is what we’re excited about.
Doug Naegele is president of Infield, a provider of mobile solutions that bring patients closer to healthcare providers. Previously he held positions in healthcare banking, technology development, and drug discovery. The latter, at Vertex Pharmaceuticals, yielded numerous US patents and drug candidates for Hepatitis C and autoimmune disease. Doug holds an undergraduate degree from Harvard University and an MBA from The George Washington University. You can contact Doug here: firstname.lastname@example.org and his company website is www.InfieldHealth.com.
There’s nothing I can say but close your door for 16 minutes and 59 seconds and watch this.
mhealth is short for “Mobile Health” and is medical and public health practice supported by mobile devices, like MP3 players and smartphones. Here’s a link for more info on smartphones, medical applications and other fun stuff from Epocrates.