mHealth, mEHR and mPHR Current Solutions

Shepherdstown 10 January 2010Mobile health (mHealth) solutions are revolutionizing health care delivery around the world in both developed and under developed nations. Today there are over 4 billion mobile devices in use around the world - 64 percent of them are in the hands of people living in emerging market economies. Innovative mHealth projects utilizing mobile phones and other wireless and hand held devices are powering the collection and use of health information to diagnose, treat, and educate people in even the most remote corners of the world. See http://www.unfoundation.org/global-issues/technology/mhealth-alliance.html. This article attempts to pull together relevant information and examples about the development of mHealth to date, with an emphasis on mobile Electronic Health Record (mEHR) and mobile Personal Health Record (mPHR) solutions. The article also highlights selected issues of concern and offers a set of recommendations to senior management of healthcare organizations on next steps to take with regards to mHealth technologies and solutions. In the coming decade, mHealth will dramatically change the daily clinical practices of many health care providers and the lives of their patients.

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Background

There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve health care services. Since 2005, the United Nations Foundation and Vodafone Foundation Technology Partnership has funded the use of wireless communications to advance global health and disaster relief work, and to further public discourse about how wireless technology can address some of the world's toughest challenges. Governments, companies, and non-profit groups are already developing mHealth applications to improve health care and consequently save lives. These new mobile applications, bypassing the fixed-line solutions, are creating new pathways for sharing health-related information. Several studies prepared by Vital Wave eConsultants for the Technical Partnership should be read - see "The Opportunity of Mobile Technology for Healthcare in the Developing World" at http://www.vitalwaveconsulting.com/insights/articles/mHealth.htm

Another study in the MIT Press Journal, "The Case for mHealth in Developing Countries" at http://www.mitpressjournals.org/doi/abs/10.1162/itgg.2009.4.1.103?cookieSet=1&journalCode=itgg states that "individuals around the world are already using mobile technologies to access health services and information and that health professionals are formally and informally integrating mobile technologies into public health and clinical activities". The author, Patricia Mechael, also writes, "As mobile phones and other mobile devices become part of everyday life, people become better equipped to respond to emergencies, consult with peers and health professionals about health issues as they arise, and access health services that are increasingly being delivered through mobile phone based systems".

Definitions

  • eHealth - involves the delivery of health‐related services utilizing the full spectrum of information and communication technologies.
  • mHealth - is the term for a subset of eHealth referring to the delivery of health‐related services via mobile communications technology such as cell phones, personal digital assistants (PDA) and other wireless devices. mHealth applications include the use of mobile devices in accessing, collecting and/or delivering a wide range of community and clinical information to practitioners, administrators, researchers, and patients.
  • mEHR - is the term for mobile Electronic Health Record (mEHR) systems that utilize wireless, mobile devices to collect, process and display medical information to providers from a particular health care organization's health information systems.
  • mPHR - is the term for mobile Personal Health Record (mPHR) systems that utilize wireless, hand held devices to access, collect, process and display an individual's personal health information.

We are seeing a major sea change at work. Smartphones, health apps, implantable technologies, wearable systems and other mobile solutions are going to bring about changes we may find hard to imagine. This is a real movement. Cerner, CPSI, Eclipsys, Epic, GE Healthcare, McKesson, Meditech and Siemens have all been steadily expanding their footprints in the mobile health information technology space. http://www.mobilehealthwatch.com/blog/cracking-mobile-health-market

Some recent other articles by the authors on some of these emerging, mobile technologies previously published in Virtual Medical Worlds include:

Marketplace Examples

The following are some highlights on mHealth based on a quick scan of news items during the past year.

mHealth Solutions

EpiSurveyor is now the most widely adopted open source mobile health software in the world. This free software package, can be downloaded onto hand held mobile devices. EpiSurveyor enables full cycle data collection from surveillance of diseases affecting populations, to evaluating treatments, to monitoring the success of treatments in preventing outbreaks and improving health. See www.hoise.com/vmw/09/articles/vmw/LV-VM-05-09-18.html

WebMD Health Corporation recently launched Medscape Mobile, a free medical application for physicians. Medscape Mobile provides physicians with Medscape's industry-leading medical information in a convenient mobile format that can be accessed on demand using an iPhone. Medscape Mobile includes the most comprehensive drug information, clinical reference tools, medical news and continuing medical education. See www.hoise.com/vmw/09/articles/vmw/LV-VM-08-09-35.html

AllOne Mobile will be providing injured American soldiers access to case managers and other military personnel to monitor and stay in touch with service members through personalized mobile communications. Information received from soldiers will help personalize and monitor daily care. Initially, AllOne Mobile's platform is anticipated to support the rehabilitation needs of up to 10,000 returning soldiers in a phased implementation over the next year. AllOne Health has been built to provide fast, reliable, and secure mobile health care information solutions. See www.hoise.com/vmw/09/articles/vmw/LV-VM-04-09-16.html

OnCare, developed using Gearworks' Appmosphere platform, represents a new set of wireless carrier-delivered mobile business applications. Deployed on BlackBerry and other low-cost, mass-market mobile phones, OnCare allows home care and hospice organizations to economically increase productivity, ensure compliance and improve outcomes, saving $300 per aide per month through reduced costs, increased visits and capturing missed interventions. See www.hoise.com/vmw/08/articles/vmw/LV-VM-11-08-11.html

Finally, several new hardware products developed for the mHealth market include Panasonic's Toughbook H1, the first fully-rugged mobile clinical assistant (MCA) and Tangent's new point-of-care MCA, Medix 10T, a state-of-the-art tablet PC.

mEHR Solutions

During 2008, SigmaCare implemented its mobile EMR system in 19 nursing homes (4167 beds) in the New York metropolitan area. The system allows health care providers to access resident medical records and document activities, treatments, vital signs, and notes at the point of care using handheld and portable devices. SigmaCare reportedly attained extremely high user adoption rates across the nursing homes. See www.hoise.com/vmw/08/articles/vmw/LV-VM-02-08-13.html

Working with a middleware product like the Navara Mobility Suite allows an EHR system to become mobile with virtually no development time because the applications have already been created and are continuously updated to work with new software and hardware. Since Navara's solutions work with any Smartphone like BlackBerry or iPhone, integration requires no changes to existing applications. See http://www.navara.com/en/work_order_software/mobile_healthcare

Practice Fusion is launching mobile EHRs in early 2010. It is one of their most requested features. They will be coming out with cross-platform (e.g., iPhone, Android, Blackberry) mobile solutions in the Spring of 2010 says the CEO of PracticeFusion. See http://www.practicefusion.com/

According to MobileHealthNews, Apple and Epic Systems are teaming to pilot test a mobile EHR solutions. In particular, Stanford Hospital & Clinics in Palo Alto, CA, has started a trial with Apple and Epic to test software that will let medical staff access patient charts on Apple's iPhone. See http://mobihealthnews.com/4952/apple-epic-team-up-for-mobile-ehr-pilot/

Allscripts Remote was demonstrated at HIMMS in April 2009. The application enables physicians to access and control an Allscripts Electronic Health Records (EHR) directly from their iPhone. The application's capabilities include access to real-time patient summary information, communication to local hospital emergency rooms, ePrescribing, and real-time access to other information, including medical history, lab results and medications. See http://mobihealthnews.com/1246/himss-another-allscripts-ehr-iphone-app/

Several of Canada's largest home care agencies are using MedShare for BlackBerry to increase administrative efficiency and to support their health care workers with access to patient information, diagnosis, risks, service plans and clinical documentation tools. MedShare's central Electronic Home Care Record (EHCR) integrates with the agency's existing billing and scheduling software. Once connected, the patient information is extended into a longitudinal EHCR and made available on mobile devices like the BlackBerry and/or tablet computers. See http://www.prweb.com/releases/2009/10/prweb2970274.htm

mPHR Solutions

Aetna is working to connect a range of health apps to its online personal health record (PHR) portal so its patients can track their activity and then send that data up to their Aetna PHR. Aetna has more than 19 million customers covered by its medical insurance plans. See http://mobihealthnews.com/3737/aetna-connecting-mobile-apps-to-its-phr/

AllOne Mobile will soon be connected to Microsoft HealthVault personal health record (PHR) system enabling subscribers to share health information about themselves and family members with physicians, hospitals, emergency care facilities, and other trusted third parties. AllOne Mobile will help consumers and their families to do things on their mobile phones such as: view and send insurance information; track prescription drugs; catalog allergies; send health information, including a family health history, to a physician; and access health tips to better manage chronic conditions. See http://wireless.sys-con.com/node/879455

According to a 2008 report on mHealth by Chilmark Research, there are already a number of health apps on iTunes split between PHR-light apps and more robust mobile PHR products like MyLifeRecord, iChart EMR from CareTools, and Epocrates. See http://chilmarkresearch.com/2008/07/23/mobile-health-and-the-iphone/

Project HealthDesign's Common Platform Development Environment (PHD-CDE) allows you to develop and test new personal health applications. The use of smartphones to host health applications is compatible with the platform model Project HealthDesign promotes for PHRs. Blackberry, Symbian, Palm, and Apple devices, among others, support application services, with an increasing number of health applications. See http://projecthealthdesign.typepad.com

Issues

Privacy & Security

Some of the questions that should be asked include the following - Are the consequences of using cell phones or other mobile devices to store or access EHRs fully understood? Could the use of cell phones to access and display a patient's medical record cause any harm? Imagine if your medical records were lost or misplaced. It could impact the care you receive, especially in an emergency situation. Again, while there are concerns about privacy, the ability to securely access a patient's medical records via cell phone and other mobile devices could benefit both physicians and patients in many conceivable scenarios. Use of available access control, encryption, VPN, and other technologies, coupled with effective policy and procedures, should resolve many of the privacy and security concerns related to the use of mobile technologies. Check out "The Challenge of Managing Portable Devices" on the AHIMA web site at http://campus.ahima.org/audio/2009/RB042109.pdf

Costs & Benefits

According to a paper by RAM Mobile Data, it is understood that implementing an electronic health records system can help an organization cut costs, improve quality of care, and enhance patient safety. However, implementation of mobile EHR and PHR solutions can result in an even bigger return-on-investment (ROI). For example, "If a doctor accesses a patient record from a PC, that's a certain dollar savings", says Yves Neidlinger, National Channel Manager for Navara. "If the doctor gets that same information from an iPhone or Windows Mobile Device, that results in an additional savings." See http://www.navara.com/en/work_order_software/mobile_healthcare

For more detailed information on the ROI for PHR and EHR systems read the following articles previously published in Virtual Medical Worlds.

Triple Tree has also released an excellent report in September 2009 entitled "Wireless & Mobile Health" that addressed many of these issues and challenges in more detail. See http://www.triple-tree.com

Recommendations & Next Steps

Mobile technologies will contribute significantly to the revolution in health care over the coming decade and will change the daily business practices of health care organizations and enhance how they provide patient care. They will also start to be used and dramatically impact the lives of everyday citizens. The following set of recommendations is presented on possible next steps for large health care provider organizations to take:
  • Consider establishing a multi-disciplinary mHealth Technology working group under the umbrella of your health IT steering committee that is guiding your eHealth investment strategies.
  • Monitor and obtain lessons learned from the growing body of mHealth technology projects and reports.
  • Consider becoming actively involved in selected mHealth research and development (R&D) efforts that relate to innovations in delivery of health care by providers and ready access to health information by patients.
  • Conduct Cost/Benefit Analyses (CBA) and Return On Investment (ROI) studies of mHealth solutions before making any major commitment by your organization.
  • Investigate changes in clinical practices and business processes that your organization may need to make in anticipation of implementing and using a range of new, innovative mHealth solutions.
  • Consider providing guidance to patients on their potential use of smart phones or other mobile devices to access and store emergency medical information and personal health records.
  • Recognize that applications utilizing mHealth technologies will begin to mature very rapidly and widespread usage to occur during this decade.

References/Links

Authors

Peter J. Groen, Associate Director, Shepherd University Research Corporation (SURC) - http://www.shepherd.edu/surc/cosi/ - groenpj@cs.com

Douglas Goldstein, CEO & eFuturist, iConecto Inc. - doug@iconecto.com


Peter J. Groen, Douglas Goldstein

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