1. Enterprise mHealth Strategy
David Shiple,
Practice Leader, Advisory Services
November 15, 2012
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© 2012 Divurgent. All rights reserved.

2. Executive Summary
• The explosion of mHealth products is reminiscent of the
dot.com phenomena
– Almost deafening hype, and only a small percentage of the 1000’s of
mHealth products being introduced will make it
• But like the internet, we know mHealth is a game-changer
– So, how do we pick the mHealth winners?
– More importantly, how do we plug the winners into an architecture
that is sound from both a technology and business model perspective?
• DIVURGENT has developed a framework which:
– Outlines various definitions and components of mHealth
– Shows current state of the industry solutions and considerations
– Provides a methodology organizations can use when developing an
enterprise mHealth strategy.
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© 2012 DIVURGENT. All rights reserved.

3. Innovation
West Health Institute’s Sense4Baby
Google – integrated computer & captures the heart rate of the fetus and
eyeglasses; unlimited possibilities: MD mother, and monitors uterus contraction
sees patient chart while talking to a
patient; surgeon sees radiology images
during surgery, etc.
GE Healthcare’s Vscan is a pocket-sized
ultrasound scanner that allows physicians
AliveCor ‘s mobile ECG heart monitor fits onto the
to scan any part of the body by placing the
iPhone and allows patients to monitor their heart
attached wand on it. The wand sends and
health anywhere and anytime
receives sound wave data upon contact
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© 2012 DIVURGENT. All rights reserved.

4. … and More Innovation
GlucoDock by Medisana tracks
EyeNetra’s NETRA-G is part of a portable glucose/insulin levels and charts them
solution to make eye exams affordable and into easy-to-analyze monthly reports
accessible for all - interactively aligns
patterns displayed in the lens and the
software calculates the refractive error
Proteus Digital Health’s Event
Marker, is swallowed and
activated by stomach fluids -
transmits the time, identity,
and characteristics of the
medication taken (and heart
rate, temperature, activity, The Zeo Sleep Manager Mobile
and rest patterns) to a skin tracks sleeping patterns by recording
patch brainwaves as a user sleeps

5. Smartphone Apps
100’s of iPhone applications are available… some downloaded once and
used once, others going viral

6. Power of Social Media
Patientlikeme – Find people with similar symptoms/
conditions; learn from the real-world treatment and
symptoms reports, forum discussions, health
profiles, one-on-one conversations, and more

7. Everyone Wants In
Qualcomm has
announced it will form a
new subsidiary, called
Qualcomm Life, to
manage the
development of the
company's mobile
health platforms. The
new company will focus
on connecting mobile
devices through
machine-to-machine
(M2M) technology.
M2M connects remote-
monitoring devices
through wireless
connections.
Many large companies have entered the mHealth market including
Qualcomm, Samsung, AT&T, Verizon, and Cisco, focusing on not just
“cool apps”, but on the interconnectivity requirements of mHealth.
© 2012 DIVURGENT. All rights reserved.

8. mHealth SWOT Analysis
Strengths Weaknesses
• Huge momentum • Interoperability/ Infrastructure
• Money flowing in from investors • Quality of data
• Technical talent coming in from other • Many patients not engaged
industries • Reluctance of health system to
• Growing acceptance of online living embrace wholesale change
• Smartphones becoming ubiquitous • Reimbursement for e-visits
• Not contending w. large legacy base • MD’s slow to recommend mHealth
• A game-changer toward the 3 Aims products to patients
Opportunities Threats
• Risk-sharing payment models should • May take a while for market to “shake-
give home devices a positive ROI out” and stabilize
• The “high engagement patients”, esp. • Intent of large EHR vendors is unclear
for social media • mHealth may not “move the needle”
• Fast innovation cycles on population health as predicted
• Aligns with aging population • Regulation
preferences • Political environment
• Possibilities are almost limitless
• Developing countries may see most
dramatic increase in mHealth use
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© 2011 DIVURGENT. All rights reserved.

9. Breaking it Down
• Primary drivers are over-
coming distance barriers and
lowering costs of remote care
• Primarily creates a rich care
Telehealth giver experience from a distant
locale
• Video, high-bandwidth, and
Mobile remote nurses/ facilities/
Caregiver vehicles are primary enablers
Devices
• Home electronic devices:
wellness, chronic disease, real
• Within “the four walls”
time monitoring – 100’s in the
• Often smaller, wireless Home Health & marketplace
form factors for EHRs
Wellness • PHRs and Social Networks
• Also mobile imaging, EKG,
• Smartphone and capitation
etc.
likely to be major drivers and
• Depends heavily on
enablers
wireless
Divurgent has focused its mHealth efforts on telehealth, home
© 2011 DIVURGENT. All rights reserved.
health, and wellness
© 2012 DIVURGENT. All rights reserved.

10. mHealth Strategy Methodology
Level-Setting Requirements Strategy / Implementation
Business Business
Telemedicine
Drivers Market Surveys / Receptivity / Model
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
(various constituents)
Healthcare
Remote Monitoring
Consistent Themes
Drivers Standards
Workshop(s)
Technology Technical Implement
Health and Wellness
Drivers Architecture Plan
Vision Vendor
Personal Health Records
Statement List
mHealth EHR / Clinical Decision mHealth
Environment Support Operations
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© 2012 DIVURGENT. All rights reserved.

11. HIE Strategy Methodology
Start-Up Design Strategy / Implementation
Provisional
Governance Data Types
Governance
Imple
Critical Mass Participation
Matching menta
Privacy/ Security Data Sources
Vision / Mission
Funding tio
Who’s In?
Plan
Constituents Technology Workflows Build/ Signup
Letters of h
Financial Model
Commitment Launc
Sustainability
Adoption Plan
Model
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© 2012 DIVURGENT. All rights reserved.

12. mHealth Strategy Methodology
• Healthcare Reform
• Accountable Care Organizations
• Patient Centered Medical Homes
Level-Setting Requirements Strategy / Implementation
• Value Based Purchasing
• Meaningful Use
Business Business
Telemedicine
Drivers Market Surveys / Receptivity / Model
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
(various constituents)
Healthcare • If possible, keep patient “out of the system”
Consistent Themes
Remote Monitoring Standards
Drivers • Capitation means higher ROI on home health
Workshop(s)
• Continued, relentless drive for cost reduction
Technology • Technical
Geographical barriers to care (need for telemedicine) Implement
Health and Wellness
Drivers • Aging population (more “home-bound”) Architecture Plan
• Huge market momentum for mHealth products &
Vision innovation Health Records Vendor
Personal
Statement List
mHealth EHR / Clinical Decision mHealth
•
Environment is the mHealth state-of-the-art?
What Support Operations
• Who is doing mHealth well? What are they doing?
• Where is it the mHealth trajectory heading?
• Can we separate the “hype” from the “real”?
• What do our stakeholders need to know before going into
this strategic process?
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© 2012 DIVURGENT. All rights reserved.

13. mHealth Strategy Methodology
• Smaller, better, faster, cheaper technologies
• Smart phones, Touchpads
• Level-Setting
Expanding wireless / mobile networksRequirements Strategy / Implementation
• Low barrier to entry – stand-alone personal health
applications and devices
• Easy dissemination via Apple, Google, and other markets
Business Business
Telemedicine
Market Surveys / Receptivity /
• Affordability
Drivers Model
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
(various constituents)
Healthcare
Consistent Themes
Drivers Can we Remote Monitoring
craft an overall vision statement Standards
Workshop(s)
that provides:
Technology • An encapsulation of what your Technical Implement
Health and Wellness
mHealth position stands for and
Drivers Architecture Plan
what it will mean to physicians and
Vision our patient community? Vendor
Personal Health Records
• A tagline that sums it all up?
Statement List
mHealth EHR / Clinical Decision mHealth
Environment Support Operations
• How is the market framing
“mHealth”?
• What do we mean when we say
mHealth?
• What’s in / what’s out?
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© 2012 DIVURGENT. All rights reserved.

14. mHealth Strategy Methodology
• What is the health system currently
doing in the telemedicine realm?
• What disease-types / conditions
lend Level-Setting
themselves to Telemedicine? Requirements Strategy / Implementation
• What are the health system’s plans
for future telemedicine investment?
Business
 Within the health system? Business
Telemedicine
Drivers Market Surveys / Receptivity /
 Within the health system ’s Model
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
affiliated providers/
(various constituents)
Healthcare
Consistent Themes
partnerships? Remote Monitoring Standards
• Drivers
How receptive is the medical staff
Workshop(s)
and associated caregivers?
Technology Technical Implement
Health and Wellness
Drivers Architecture Plan
Vision • Who are our mHealth stakeholders? Vendor
Personal Health Records
Statement • What do our stakeholders want? List
• Where do they see the value?
mHealth • EHR / Clinical Decision
What will the patient / physicians pay for? mHealth
Environment • Support Operations
What technologies/products do they use/ are interested in today ?
 Patient
 Clinician
 ACOs
 Investors
• What is there receptivity for future products/ services?
• What are their safety/ security/ privacy expectations?
• Do the parties trust the health system ?
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© 2012 DIVURGENT. All rights reserved.

15. mHealth Strategy Methodology
• Much growth in the mHealth market
including smart pills, sleep studies,
vital Level-Setting
signs, EKGs, etc. Requirements Strategy / Implementation
 Who reads the data?
 Who responds to the data?
Business
 What is captured by the EHR Business
Telemedicine
Drivers
and PHR? Market Surveys / Receptivity / Model
Stakeholder Assessment
•
Market Scan / Education
What is the Interoperability with
Consensus Workshops
(various constituents)
EHRs Healthcare
Consistent Themes
and PHRs? Remote Monitoring Standards
• Drivers
Which modalities are being called
Workshop(s)
for by patients/ physicians?
Technology Technical Implement
Health and Wellness
Drivers Architecture Plan
•
Vision
Is health and wellness a targeted Vendor
Personal Health Records
Statement
program? List
• Is there an existing business model?
mHealth EHR / Clinical Decision mHealth
• Are patient incentives in place?
• Environment
To what extent is the health Support Operations
system’s primary care function
utilizing electronics? Can it be
integrated?
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© 2012 DIVURGENT. All rights reserved.

16. mHealth Strategy Methodology
• Is a PHR and associated strategy for
PHR’s in place? What is it?
Level-Setting Requirements Strategy / Implementation
• What is the alignment with MU stage 2 • The dimensions of mHealth
• What type of PHR is in place - stand- will invariably overlap, e.g.
alone or interactive with EHR?  Remote
•
Business Business monitoring may
What is the current patient adoption Telemedicine automatically upload to
Drivers Market Surveys / Receptivity /
of the PHR? How is the adoption ModelPHR/ EHR and CDS
the
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
(various constituents)
trending?
Healthcare rules and alert may
Consistent Themes
• What role will the PHR play in the Remote Monitoring Standards
ensue
Drivers
Workshop(s)
mHealth strategy?  Common infrastructure
• What role will social networking and
Technology
the interne t play? Health and Wellness Technical shared between
can be Implement
Drivers telemedicine, home
Plan
• Can internet search and social Architecture
health, etc.
networking, and be linked to the PHR?
Vision
Personal Health Records Vendor
Statement List
• What is the current state-of-art use
mHealth
of mHealth and your enterprise EHR / Clinical Decision mHealth
• Presentation of evolving
vendor?
Environment Support Operations
mHealth model
• Does your vendor have an mHealth • Is there a “there there”?
partnership list? • Which constituents are in/
• What is the mHealth connectivity out?
record with your vendor? • What are alternatives?
• How can data fed from mHealth • Can consensus on general
devices being integrated into the business model be achieved?
EHR CDS?
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© 2012 DIVURGENT. All rights reserved.

17. mHealth Strategy Methodology
• Value proposition
• Target market
• Go to market strategy
Requirements Strategy / Implementation
Level-Setting • Consumer relationship
• Activities, resources, personnel
Business • Required core competencies
Business
• Telemedicine
Network/affiliation SWOT analysis
Drivers Market Surveys / Receptivity /
• Sustainability model Model
Stakeholder Assessment
Market Scan / Education
Consensus Workshops
•
(various constituents)
Healthcare 2012-2013 pro forma
Consistent Themes
Drivers • Service offered Monitoring
Remote Standards
Workshop(s)
• High level implementation plan
Technology • Governance model Implement
Health and Wellness Technical
Drivers • Commercialization opportunities Plan
Architecture
Vision Vendor
Personal Health Records
• RMA Platform
Statement • Java ME List
• .Net CF • High-level technical
mHealth EHR / Clinical Decision
• Android SDK mHealth
requirements
Environment •
Support SDK
IOS • Operations
Technical schematic
• Mobile O/S • Role of middleware
• IOS X
• Android
• Role of the HIE
• Blackberry OS • Hardware/ software players
• Network Standard • Mobile platforms supported
• GSM • Security/ Privacy
• CDMS 2000
• W-CDMA
• EDGE
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© 2012 DIVURGENT. All rights reserved.

18. mHealth Strategy Methodology
• Charter
• Scope
Level-Setting Requirements • Strategy / Implementation
Funding/ budget
• Program management
Stratify vendors • Timeline
Business • Those “that matter” • ResourcesBusiness
• Strategic vs.Telemedicine
Market Surveys / Receptivity /
Drivers tactical • Risk mitigation
Model
• Standards embraced •
Stakeholder Assessment
Change management
Market Scan / Education
Consensus Workshops
(various constituents)
Healthcare • Remote monitoring vs. health & •
Consistent Themes
Communications
Drivers wellnessRemote Monitoring Standards
Workshop(s)
• Recommended by the health system
Technology • Vendor track record Technical Implement
Health and Wellness
• Connectivity options
Drivers Architecture Plan
Vision Vendor
Personal Health Records
Statement List
mHealth • EHR / Clinical Decision driven by
Roles and responsibilities mHealth
Environment Support
the defined business model Operations
• Operational plan
• Org chart
• Customer support
• SLA’s
• Vendor management
• Contract management
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© 2012 DIVURGENT. All rights reserved.

19. Contact Information
David Shiple
david.shiple@divurgent.com
617.947.1925
Divurgent
4445 Corporation Lane, Suite 228
Virginia Beach, VA 23462
877.254.9794
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© 2012 Divurgent. All rights reserved.

20. Appendix
Scanadu Scout (pictured), which reads vital
signs from a person's temples; Project
ScanaFlo that can analyze urine; and Project
ScanaFlu, which can test a person's saliva for
cold or flu symptoms. All three devices are still
pending FDA approval before then can be sold
to the public, but the Scout appears to be the
furthest along in development. Scanadu claims
that the device will cost less than $150, and
can record and analyze vital information like
blood pressure, pulse, heart rate, blood
oxygenation, and temperature.
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© 2012 Divurgent. All rights reserved.