1. Tackling the Tsunami: Building an mHealth
Strategy
David Lee Scher, MD, FACP, FACC, FHRS
Director, DLS Healthcare Consulting, LLC
digitalhealthconsultants.com
Clinical Associate Profess or Medicine
Pennsylvania State College of Medicine

2. “The most valuable commodity that I know of is
information”. –Gordon Gekko, “Wall Street”

3. What is mHealth?
Diverse application of wireless and mobile
technologies designed to improve health
research, health care services and health
outcomes .

5. Pew Internet/CHCG Surveys

6. Developments Supporting mHealth
Adoption
• Implementation of electronic health records
• Release of FDA Guidance on Mobile Medical
Apps
• Growth of Patient advocacy (Health 2.0,
Quantified Self movement), Social Media
• Wearable sensor and remote monitoring
technology development

7. Why is mHealth Good for Patients?
SOMETHING MUST BE DONE to IMPROVE HEALTHCARE
Promotes patient engagement (self-management)
Provides educational resources and content development
Improves doctor-patient relationship
Creates personalization of healthcare -> ?better outcome
Convergence of many technologies -> simplification,
convenience
• Supports caregivers’ mission
•
•
•
•
•
•

9. Which Mobile Apps Patients Want Their
Doctor to Have
• 42%: An app to see their test results.
• 33%: App connected to remote monitoring
devices.
• 30%: Access to patient health records via
mobile device.
• 13%: Didn’t think apps would help improve
care at all.
Source: 2012 Ruder Finn mHealth Report

10. • GENERAL HEALTHCARE AND FITNESS
–
–
–
–
–
Fitness & nutrition
Health tracking tools
Managing medical conditions
Medical compliance
Wellness (traditional and corporate)
• MEDICAL INFORMATION
–
–
–
–
Reference
Diagnostic Tools
Continuing Medical Education (CME)
Alerts and Awareness
• REMOTE MONITORING, COLLABORATION, AND
CONSULTATION
– Remote monitoring (safety)
– Remote Consultation
– Remote Collaboration
• HEALTHCARE MANAGEMENT
– Logistical & payment support
– Patient health records

11. Facts About Health Apps*
• 97,000 mHealth applications are listed on 62 full
catalog app stores.
• 15% are designed for healthcare professionals (CME,
RPM, healthcare management).
• 42% of apps: Paid business model.
• Top 10 mHealth apps generate 4 million free and
300,000 paid downloads per day
*Research2guidance, 3/13

12. Barriers to Adoption of mHealth
• Incomplete regulatory guidance
• Lack of reliability, security/privacy
• Lack of mobile strategy by providers (BYOD, M2M
integration), payers
• Lack of smart phones by older, chronically ill pts
• Lack of business models
• Lack of proven reimbursement, return on
investment
• Physicians’ fear of high volume useless data

13. Clinicians:
“Not
medically
sound”
>90,000
medical
apps/programs
Consumers:
<1/10 of
apps used
more than
once
Business:
“Doesn’t
make me
money”
From Megan Ranney, MD

14. Remote Patient Monitoring

15. Attributes of Ideal RPM
• Provide continuous surveillance with
only actionable, trending data
• Unobtrusive
• Interoperable with other devices and
EHR/portals
• Have associated robust analytics with
clinical decision support

16. Mobile Cardiac Monitoring

17. Diabetes

18. Transdermal Patch w/Continuous
Glucose Monitoring

19. Blood Pressure Monitoring

20. Pulmonary Monitoring

21. Complete Vital Sign/GPS Monitoring

23. Sensors: MEMS
•
•
•
•
Implantable Sensors
Wearable Sensors
Biochemical sensors: glucose, pulse ox
Positioning sensors

24. Wearable Physiologic Monitoring

25. Footwear Sensors

26. mHealth: Smart Phone Capabilities

28. Medication Adherence Apps
•
•
•
•
MyMedSchedule
Mymeds
RxMindMe
GloCaps

29. Proteus Digital: The Ultimate Adherence App

30. Role of Social Media in mHealth
• SoMe is mobile
• Patients use smartphones for health
information
• Patient-centered companies emerging
• New market/business model for Pharma and
med device companies

31. Social Media: Critical Role inmHealth
Strategy

32. 4/6 Most Used Mobile Apps are SoMe-Based*
*GlobalWebIndex, 2013

33. SoMe and Healthcare
Online patient support groups
– Clinical trial recruitment
– Peer and caregiver support
– Disease specific education
– Healthcare navigation
– Convenience
– Anonymity

34. mHealth and Clinical Trials

35. Advantages of Mobile Clinical Trials
• Recruitment of patients via social media
• Real-time adverse event reporting
• Bidirectional patient-provider interactions
eliminate visits
• Easier communications among all trial
stakeholders (regulators, sponsors, investigators)
• Facilitates medication adherence (reminders, pill
sensors)
• More efficient data collection, reporting, auditing
• NO MORE FAXES!

36. Healthcare is still working in silos in
many European countries
Hospital Care
Physician Care
Emergency Care
Outpatient Care
No cross-border workflows, processes, no data exchange and access
Absence of legal and regulatory frameworks, e.g. for liability
Missing health-economic validation and bench-marks
No incentives for providers, payers and patients to use mHealth
© Rainer Herzog, HealthActiveConsulting

37. Regulatory agencies and policy makers
Food & Drug
Administration
(FDA)
USA
Office of the
National
Coordinator
(ONC)
USA
Medical
Device
Directive
(MDD)
EU
CE Quality
Mark
EU
• National / international standard protocols for e-/m-Health
• Security and privacy of data
• Data integrity, availabilty and auditability
• Risk management

38. A Strategic Framework for Hospitals and Health Systems
Present and Future State of mHealth
New Care Models
Technology
ROI and Payments
Policy
Privacy and
Security
Standards and
Interoperability
www.himss.org/mobilehealthit/roadmap

39. New Care Models: Healthcare in
Transition
•
•
•
•
Acute care  Chronic Disease Management
Aging at Home
Hospital Readmission Prevention
Caregiver Involvement

40. mHIMSS Roadmap
• ROI/Payment: Addresses financial aspects of mobile tech
adoption
• Legal & Policy: FDA mobile medical app Guidance
• Standards & Interoperability: Types of networks,
communication patterns, standards above and below the
network layers, network/storage tradeoffs, syntax and
data, app standards, Blue Button Interface
• Technology: Factors to consider in app development
• Privacy & Safety: Current state and future considerations

41. What is the Best Measure of the State of
Adoption?
The HIMSS Mobile Technology Member Survey,
2013
Released February 26, 2014

42. HIMSS Survey: Respondent Profile
• 62%: IT professionals
• 27%: Responsible for developing the
organization’s mobile tech policy
• 38%: Member of committee responsible for
developing the organization’s policy on mobile
tech
• 22%: Responsible for implementation and
operation of mobile tech

43. Highlights of 2013 HIMSS Mobile Tech
Survey
• Prioritization of Mobile Technology:
Average score: 5.25
• Maturity of Mobile Technology Environment:
Characterized at 3.95, increased from 3.33 in
2012
• Impact of Mobile Technology on Patient Care:
33%: will substantially or dramatically impact
patient care, decreased from 2/3 in 2012

44. Takeaways From HIMSS Survey
Mobile Technology Policy:
59% have mobile tech policy, 29% in
development.
App Development:
Apps within their organization likely to be developed
by third party.
½ plan to expand app usage.
Barriers to Mobile Technology Use:
#1= Funding

45. Significance of the Survey
• Identifies the decision-makers
• Identifies market penetration more
accurately than industry analysts
• Identifies pain points of mobile tech
adoption
• Useful for developers, analysts,
healthcare enterprises, IT vendors

46. Challenges
• Increase awareness and mobile tech by older
consumer/patients
• Need filtered actionable data/alerts
• Full connectivity with EHRs
• Clinical efficacy studies
• Interoperability among apps and platforms
• Complete, reasonable and appropriate regulatory
requirements
• Funding for mobile strategies (private, public)

47. Questions?