Three issues jumped out at us from the recent “mHealth + Telehealth World” conference in Boston.
1) Telehealth versus mHealth Implementations: While telehealth is well-established and accepted by traditional providers – hospitals, clinics, etc. – their road to mobile health is unfolding slowly.
2) Transparency: Medical data transparency and patient empowerment is likely to profoundly influence the future of medical information and care.
3) mHealth Consumer Engagement: Mobile health is clearly being driven by consumer apps and an over-riding issue is how to get “engagement” of consumers (which may also be described under the headings of consumer “compliance” or “incentives”).
1. Telehealth versus mHealth Implementation
Numerous presenters from leading medical institutions highlighted their established uses of telehealth tech. For example, Massachusetts General Hospital (MGH) maintains that three out of five face-to-face visits could be replaced by virtual visits. The MGH Innovation Labs reported on a remote visit project with 50 patients enrolled to date.
Wisconsin-based Marshfield Health System, with 75 sites, states that it has 90% rural areas and has used telehealth programs regularly. The VA with 32 million patients in rural areas uses telehealth including store and forward capabilities, including for teleretinal and teledermatology patients. It has one million patients using secure messaging.
While the enthusiasm for telehealth was noticeable, the same providers reported being at an early stage with mobile health implementations. Marshfield stated that they recommend some consumer apps to patients. MGH questioned whether there is an ROI to hospitals from mobile apps. An MIT representative also questioned whether doctors who use data from “nonregulated devices” could be at risk. (However, Mercy Telehealth observed, “It’s data you didn’t have before.”) Boston Children’s Hospital commented that mobile solutions are coming about as hospitals “apply consumer technologies to medicine.”
An outstanding example of a hospital moving boldly ahead in the mobile health area was Cleveland Clinic (2,200 physicians and scientists 5,800 nurses). Stating frankly that their purpose was to “liberate data from EMRs” (electronic medical records) systems, the Clinic has developed mobile apps with a major effort from its in-house IT staff. They observed that the EMR providers “need prodding” to develop API infrastructure to allow the data accumulated in the mobile apps to be integrated.
Transparency involves the issue of release of medical data to patients and the means of making the data available. It is linked to the underlying issue of patient “empowerment,” suggesting that patients can get more of a say in their treatments and even have information that allows them to make more informed choices of treatment alternatives.
A number of very cogent observations were offered about transparency. A representative of Mobiquity, (a firm that advises on, designs and develops mobile solutions for enterprises) stated that giant EMR providers “used to think they owned the data.” He pointed out that companies like Google and Apple were among those leading in the direction of Personal Health Records, which enable consumers to do what they wish with their own data.
In a far-reach presentation, Dr. John Mattison of Kaiser Permanente emphasized “person centricity” in healthcare data. He stated that Kaiser are “big advocates” of OpenNotes (a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.) Mattison spoke of “reciprocal transparency.
The VA presenter pointed to the organization’s Summary of Care App which allows vets and their caregivers to view parts of their VA EHR on a mobile. This includes access to the notes from their visit to a physician. He stated that patients “forget 70% of what occurred in a session with a doctor.”
3) mHealth Consumer Engagement
There was a general recognition that mobile health apps, services and solutions are coming and that the principal driver is the consumer market. This led to recurrent discussion of the question of how to engage patients, so that they maintain usage of mobile capabilities on their own.
Speakers pointed out approaches to encouraging engagement (or consumer “compliance”) that work – and some that don’t work. An MGH speaker referred to the fact that sometimes technology limitations are impeding patients’ usage – they may have out of date mobile devices. He suggested engaging the patient in the development process.
A speaker from Duke stated that they have used chat rooms, although there is a risk of misinformation spreading through the chatroom. Marshfield’s speaker pointed out in using chatrooms it is important to avoid monitoring of discussions. She also asserted that engagement with new mobile capabilities could involve changing some “core beliefs” of patients and that it was good to have health coaching and family or social network support available for the patient. Marshfield has observed the high rate of abandonment of mobile fitness apps among users (1/4 reportedly only use once and 80% drop out after 10 days) and believes that users need immediate and positive feedback.
Insurance provider SeeChange Health, whose business is premised largely on using innovation to promote healthy practices among their insured, observed, regarding client engagement, that premium rebates “don’t work.” They pointed to other techniques, including cash equivalents, such as gift cards, or deposits to health savings accounts and also lottery type awards. The VA pointed to a mobile app that gets vets to join teams in their branch, which set health goals and receive points for team success.
A Note About the Conference. This three-day event gave an excellent view of the actual state of adoption of mHealth and Telehealth, particularly among healthcare institutional providers and professionals and the issues involved in both areas. It also covered related issues, such as the state of regulation and reimbursements for telehealth and mHealth.