mHealth: The Future of Provider-Patient Engagement

These days, I spend a lot of my time on my (so called) smartphone or ubiquitous tablet. I saw a video this past weekend about how we were not smart due to our dependence on (anti) social media while our phones were (I liked that a lot).

While I was in Los Angeles, on a project some years ago, managing the development of specialty clinical notes, the neurology physician I was with at the time, asked me why could we not have the notes on her tablet rather than on the laptop. The functionality that we wanted was not quite possible then, so we continued with our project with the laptop or desktop in mind then.

In today’s world and possibly in the future, this is even more relevant a question as both physicians and patients are more in tune with their mobile devices than they are with any other gadget around. We take pictures, we check our bank account, we send simple emails (sometimes with attachment) and I chat with someone eight thousand miles away in an instant.

I remember a HEMOC physician told me that he received pictures from his patients on his personal phone and also used his “AOL” account to email them, outside of his provider mandated email address. While this was “unusual”, (i’m being polite) it is definitely something that needs to be kept in mind as we move towards a more mobile and connected patient-provider interaction life. Since I already engage with my physician on a portal online, my next easy access would be my smartphone app. Like other individuals, I am also on the go and want to make sure that I am connected at all times (yes, most of us are unfortunately tied to our devices with an invisible umbilical cord).

We keep hearing about BYOD and by now, many provider organizations have developed a policy for BYOD, while the smaller organizations still lag behind. Last week, the American Telemedicine Association had a trade show in Baltimore, MD. For anyone interested in the Tele-Health, Telemedicine areas that is a fast growing initiative in several provider organizations, they should attend this show to get a perspective on the many different solutions for this type of patient engagement. One of the options was interaction directly from your “smartphone” app from your healthcare provider (I just updated the app I use and it had face to face call functionality with my provider, which I thought was very impressive indeed).

While I am a traditionalist at heart and know that what the HEMOC physician in Los Angeles who said that he felt it was insulting to his patients to have a PC in the room, the march of technology, possibly in ways that are less intrusive, will continue if there is a market, which I am sure there will be. As each new generation and iteration of healthcare specific devices becomes available in the market, you will see a much more symbiotic relationship between physician and their technology over the next few years. We are still only in it’s infancy and will look back on this time as we did mainframes and punch cards.


The Tide is HIE, but we’re moving on…

CCD Example
CCD Example found online

Ok, so I was a “Blondie” fan in the 80s, I mean, who wasn’t really? During a breakfast meeting with some healthcare leaders on Friday, we discussed the need for an HIE and what it would mean to executive leaders in the region if they pulled out of the local healthcare information exchange when Meaningful Use requires that not only do you need to be interoperable with another healthcare provider organization that has the same electronic health record you have installed, but one that is different from your EHR as well that you can interface with. What is the need for an HIE then if CMS stipulates that you need to do this in order to attest to MU 2 anyway? In a HIMSS document, they mention that while working with Stage 1 objectives and measures, “an organization should keep in mind that future rule making around Stage 2 and Stage 3 requirements will include HIE capabilities”.

Many healthcare IT executives wonder whether it is worth the money to pay an HIE to follow their patients and make sure that CCDs or Continuity of Care Documents can initiate (see the generic example I found on the left). As of now, if my healthcare provider wants me to go to get a blood test, and the lab that I have gone to is the same one close to my house for the last 12 years (currently owned by a different provider in this day and age of acquisitions and integrations), I am happy that half a day after I get my blood drawn, I have the results on my smartphone app. A far cry from when I had to wait for days without knowing the result and that too, if my provider got it, saw it and then mailed it or faxed it to me (or I asked to come in to meet him for an appointment, pay co-pay, review the result with him, he makes a copy and then I took that copy home and filed it in my healthcare folder). Fewer trees cut down, less wait, less suspense. Patient Engagement at it’s finest.

As was noted in a Government Health IT News article, many of the measures in MU stage 3, such as sharing care summaries and care plans, rely on health information exchanges and while exchanging data remains expensive, with the core problem being standards, for data, transport and identification of patients. With underlying costs for long term interface development, support and maintenance remaining high, not to mention safety issues and the inability to have secure data when moving between different standards and processes at each care delivery provider.

We are getting to be more educated about our healthcare as patients and consumers of healthcare and we want to be. I watched CNN’s GPS with Fareed Zakaria on the April 20th episode and he discussed the study in which the US was found to be ranked #16 in terms of Social Progress by noted Harvard scholar (and committed Capitalist Michael Porter). America ranks poorly by a team that Porter has put together. Fascinating GPS episode and a must watch. It takes social aspects, community and your quality of life in a country and captures it in a framework that measures social progress in quantitative terms. In Health and wellness, the US ranks 70th and we spend more money in the world than many other countries. Access to information and communication, we are behind Jamaica at 23. These numbers surprised me. The penetration and access to information (like the mobile telephone subscriptions, we are 83rd) and we do better at access to basic knowledge at 39th (behind Cuba). Something to think about.


Your Smartphone App will see you now! Has Telemedicine come of age?

Welcome to 2014 and the future of healthcare IT.

My blog has been about how to make understanding healthcare and the information and technology that surrounds it as easy to understand as I can make it! Whether you are from IT, healthcare or an interested stakeholder as only a patient can be.

One of the areas that has taken on new life is telemedicine. Formerly reserved for the likes of NASA or inter-governmental assistance such as helping far away earthquake disaster victims get medical attention, telemedicine is taking on new life due to the pervasiveness of smartphone and secure messaging technology.

An article recently published about how patients are using an application on their smartphone to be able to find a community physician, securely communicate with them, share photos of an injury for instance and then get advice, such as scheduling an MRI for a potentially broken ankle, from the comfort of their homes.

One question that comes to mind is how will these patient encounters get billed (or will there be a certain number of “free encounters”) before a claim get generated? How will patients react to being billed for these encounters as this will relate directly to the patient experience and patient engagement initiatives?

This is the next frontier of healthcare IT.

Welcome again to 2014!

Mobile Health Security. It’s finally here!

Let me check my phone and get back to you. I’m sure everyone knows it’s so much more than a phone now. It’s an alarm in the morning, the main form of media that you read with your first cup of coffee; your organizer as you see what you have in store for you during the day and your recorder of memories that you will treasure for a lifetime. With everything happening on a mobile device; from taking pictures of checks to deposit in a bank to reviewing details of your office visit in your medical record app, the question about security of your mobile device in a healthcare setting was bound to be raised.

BYOD policies have been developed over the last few years in order to take into account the loss or theft of devices in a healthcare setting and the consequences they have for a care delivery organization. The ability to auto wipe devices after a certain number of tries is a necessity and care providers may not like the thought of their device losing all of it’s data, but in terms of what the risks of continuing to have that information on the device and the fact that 4 character or digit passwords could be breached after 9,999 attempts is something that care organizations must have a mitigation plan in place. Too many times, the headlines talk about data breaches and the possible compromise of hundreds, if not thousands of medical records due to a provider organization not properly planning for such loss of devices; mobile or otherwise.

Secure messaging as well comes into this environment. There are many organizations now that need to leverage the benefits of secure text messages between the provider and patient and between providers as well. The ability to have secure and confirmed delivery, the data behind it to show how many patients leveraged this form of communication, the audit chain of the messages and last but not least, compliance with HIPAA is what secure messaging communication requires to overcome the regulatory and practice challenges at healthcare provider organizations, with the HIPAA Omnibus rule from September 2013 also added to that regulatory mix. The ability to be more in tune with your patients through this form of communication and be able to engage faster with them brings positive strides to patient engagement metrics.

Ultimately, being able to provide great patient care through technological advances such as practical and timely mobile health solutions is what healthcare information technology teams should collaboratively strive to accomplish.

One week to go for CSO HIMSS Spring Conference 2013

Please make sure that you plan on attending the CSO HIMSS Spring Conference for 2013 titled “Meaningful Use: The Practical Approach”. We have great speakers and a wonderful location, thanks to our hosts, UC Health for allowing us to use The Drake Center facilities in Cincinnati. Please register at to participate.

We have topics covering Infrastructure, Reporting, Patient Engagement and ICD-10. See you there!

Martinis and email…

I was with a colleague traveling to a customer in Wisconsin and finished the day and were walking through the airport wondering how to find a place to eat, access email and debrief from the day’s activities when the need for, well, you guessed it…”martini’s and email came up” (we actually never got to the martini’s, just for the record). There is nothing more acute for busy, traveling executives than the loss of that connectedness we take for granted in our society these days.

I write this as I listen to my (second) favorite Dire Straits song, Money for Nothing (my favorite is Walk of Life, but that’s a whole other blog entry). A great song that exemplifies the 80s. A lot of people don’t realize that Sting had such a great impact on this song, singing the introduction and chorus in falsetto; most people only credit Dire Straits and Mark Knopfler for this. This was the work of a collaboration and that was what made the song great (plus everyone wanted money for nothing and MTV those days).

I bring up collaboration as I was priviliged to live up to my recent award as a Fellow of HIMSS by connecting the IT departments of two healthcare networks that make a significant impact on our community and having them collaborate and share information to make their initiatives better, faster and cheaper to execute. I truly believe that Ohio can be #1 in Healthcare and Healthcare Information Technology. We have been able to put men in space and on the moon. I’m sure we can collaborate our way to successful initiatives and make sure that we conserve and make use of our available resources appropriately in order to maintain lower costs of operations for our healthcare providers and hopefully pass those savings on to our patient population.

With aspects of the Affordable Care Act coming into force soon, true collaborative environment will be required and our communities will be tested soon. “Fiscal cliff” not withstanding,  our nation has it’s share of challenges ahead for it and I intend to find a way to bring our communities together to continue the great American adventure. Collaborate, collaborate, collaborate. On December 23rd, 1783, George Washington came back after defeating the British and voluntarily resigned his commission. This was a first in recorded human history. Don’t you want to be a part of that unselfishness? I know I do.