Mobile health is an ever expanding field, and shows great promise for delivering care to remote patients. In this presentation at the ATA 2012 conference, Dr. Robert Ciulla demonstrates the potential for mHealth to improve care availability and how T2 is supporting that goal.

1. Mobile Apps in Clinical Settings
American Telemedicine Association
29 April 2012
Robert Ciulla, Ph.D.
National Center for Telehealth & Technology
Joint Base Lewis-McChord, Tacoma, WA
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2. Interview with the Father of Cell
Phones
• 2011 ATA Opening Plenary: NY Times’ David
Pogue interviews Dr. Martin Cooper

3. Life-Altering Mobility
• Wharton School biggest “life changers” of past
30 years:
– Internet, PC/laptop, mobile phones, email, DNA
sequencing
• From 2008-2010 mHealth consistently outpaced
forecast growth and revenue
– mHealth apps will continue on a steep growth
curve as increasingly mobile technologies disrupt
the market
– Mobile apps are the single-biggest digital channel
since the ‘90s and the Web

4. 1973… 2012
• Mobile broadband subscriptions: 200 million in
2008 to 1.2 billion in 2011; projected to reach
3.8 billion by 2015
• 2011: U.S. mobile health market at $718m
• March 2012: 46% of American adults own
smartphones – up from 35% in May 2011
• By 2013, more users will connect to the Internet
via mobile devices than PCs.
• By 2013, 500m people will use mHealth apps

5. Health Care Survey
• 2011-2012 survey of U.S. & int’l health IT
– 85% support use of personal devices by
physicians and hospital staff
– 83% report their hospital supports
clinician use of iPads in next 24 months
– 60% reported their hospital supports
electronic medical record mobile apps
– 50% of hospitals to upgrade mobile
health capabilities

6. What is Mobile Health (mHealth)?
• “The practice of medicine and public health,
supported by mobile devices.”
• “The delivery of healthcare services via
mobile communication devices.”
• “Umbrella term for wireless devices that are
used in healthcare. It includes mobile
monitors worn by patients as well as
smartphones that physicians and nurses use
to obtain and disseminate information.”

7. If We Build It, Will They Use It?
• Hong Kong physicians
– Pragmatic, less concerned with ease-of-use
and more interested in usefulness
– Expressed concerns about the compatibility of
the technology with their practices
• Australian/Indian cross-national study
– Tech acceptance is more likely when it
supports clinical management
– Barriers to use must be minimized

8. Mobile Issues
• Physicians using mobile devices for
patient care aren't connected to practice or
hospital IT systems
• Physician concerns about privacy and
security when adopting mobile health tools
• Hospital networks need more bandwidth to
support rapid exchange of data.

9. Getting Authentic(ated)
• Authentication systems:
–Something you know (password)
–Something you have (ID badge,
keycard)
–Something you are (biometrics)

10. More Mobile Issues:
Is It A Medical Device?
• Food and Drug Administration (FDA)
• Health Insurance Portability and
Accountability Act (HIPAA)/ file-
sharing

11. If We Build It, Will They Know
How to Use It
• Technology: what’s your comfort level?
• Data are as good as human input allows
• Applications: bugs, crashes (what if: lab
results appended to wrong record)
• Using both paper and electronic
systems

12. Current Uses in
Behavioral Health
• Various disorders (developmental, cognitive,
substances, mood, eating, sleep)
• Informational, assessment, track/graph,
interactive tools, self-monitoring prompts
• Mobile apps’ many other capabilities:
– Calendars, file-sharing, therapist audio-recordings, date-stamp
homework assignments
– Real-time audio/ video coaches (telehealth)
– Global positioning system (GPS)
– Wearable sensors (biofeedback)
Luxton et al. – mHealth for Mental Health: Integrating Smartphone Technology in
Behavioral Healthcare. Professional Psychology: Research and Practice. 2011, Vol.42, No.
6, 505-512.

13. If We Build It, Will They Know
How to Use It in a Clinical Setting
• Online workbooks
• Telehealth
• Mobile applications

14. Online Workbooks

15. Telehealth

16. Mobile Apps

17. Technology “CPGs”
• A “how-to” instructional manual
• What is a mobile application?
• Clinical practice benefits
– Availability, access to critical
resources, communication,
evidence-based content,
assessment, tracking, remote
monitoring, flexible encounters/
bridge
• The “bipersonal field”/ asynchrony
• Charting mobile communications
• Storage of transmitted data
• Practical exercises

18. T2 Mood Tracker
Self-monitor, track and reference
emotional experiences over a period of
days, weeks and months.
Features:
- Self-rating on pre-populated categories
- Full note adding
- Graphed results
- Fully customizable categories
- User-set reminders for self-rating
- Send results to providers (upcoming)
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19. LifeArmor
Currently in beta version (soft release)
A multi-topic application derived from
AfterDeployment.org to provide the
user with knowledge and tools to cope
with the many challenges faced by
today’s service members.
Features:
- Multi-topic resource guide
- Self-assessments of topic symptoms
- Ease to manage, customizable views and
favorites
- Manage symptoms with coping tools
- Video resources on topics
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20. mTBI Pocket Guide
Clinical Practice Guidelines for
treatment of mTBI
Features:
- Quick results with coding guidance
- Symptom management lists
- Summary of clinical recommendations
- Patient education resources
- Clinical tools and resources
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21. mTBI Co-occurring Conditions
Toolkit
Co-occurring Conditions Toolkit:
Mild Traumatic Brain Injury and
Psychological Health
Features:
– Guidance to primary care providers
on the assessment and
management of patients
– Synthesizes information from the
following VA/DoD CPGS: mTBI,
PTSD, depression, chronic opioid
therapy and substance use disorder
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22. Provider Resilience
Deploying Summer 2012
Currently field testing downrange
Self-care tool for health care providers
who work with service members and
who may need support in coping with
burnout or compassion fatigue
Features:
- Quick dashboard view
- Graphing to track resilience progress
- Tools to assist increasing resilience
- Inspirational value cards
- User-set reminders to update
assessments
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23. Provider Education

24. Service Delivery in the
21st Century
• The (very) educated consumer.
• Social networks
• Participatory Medicine / Patient-Centered
Medical Home
• Consumer-centric
• Security / privacy
• Informatics (the “measured life”)
• The virtual “clinical setting”
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25. Next Generation
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26. Mobile Trivia
• 70% of people sleep with their cell phone;
90% of “digital natives” (under 30)
• There are more mobile phones in the
world than toothbrushes.

27. Contact Information
Robert Ciulla, Ph.D.
Chief, Population & Prevention Programs |P3|
National Center for Telehealth and Technology |T2|
Joint Base Lewis-McChord, Tacoma, WA
robert.ciulla@us.army.mil
To view or download a copy of this presentation, visit
www.slideshare.net/t2health
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