Upward mobility

The promise of mHealth technology is almost limitless. The tricky part is figuring out the best and most effective ways to unlock it.
By Mike Miliard
01:00 AM
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Everybody uses mobile devices, but no one is still quite sure how to make the most of them.

That, to varying degrees of more-or-lessness, is the upshot of the most recent HIMSS Analytics Mobile Technology Survey, which for the past three years has taken the pulse of an industry still coming to terms with the benefits and risks of mobile technology.

As providers try to get a handle on how best to put wireless technologies to work, HIMSS polled them in 2013 on six areas of focus: new care models; technology; ROI and payment; legal and policy implications; standards and interoperability; and privacy and security.

Broadly speaking, they represent "the six areas to consider as you roll out an mHealth implementation strategy," says David A. Collins, senior director, mHIMSS.

The results of the survey show just what a multifaceted thing the still-new phenomenon of mobile technology in healthcare represents. Some organizations clearly have a handle on what they want from it and how they plan to get there. Others are still finding their way. 

On the policy front, for instance, just more than half of providers – some 59 percent – said they had a mobile plan in place; 29 percent said they were in the process of putting one together. Where they did exist, most policies had to do with data security. When it comes to securing devices, however, there's still a mishmash of strategies, with use of passwords the most common.

But privacy policies are easy, relatively speaking. It's where and how to use mobile devices for care delivery that many providers still seem to be tossing around ideas. Pharmacy management – medication reminders or medication reconciliation – remain popular, but still, just more than one-third of providers thought mHealth tools would "substantially or dramatically" impact care – a decrease from the two-thirds that thought so just a year ago.

Does that represent a steep decline in confidence that these tools can get the job done? Or is it just a recognition many providers are still unsure just how do it?

Responses to HIMSS' questions about interoperability are illustrative of the different clinical approaches. Most organizations said their clinicians had the ability to access clinical systems via a mobile device, most often over the Web, using virtual private networks.

The numbers are similar for notifications from remote monitoring tool, with more than half of respondents reporting getting alert in their EMR/clinical system. As for more comprehensive data, just 22 percent said that three-quarters of the data captured by mobile devices was integrated into their EMRs.

Providers were fans of the enhanced access to patient data – especially the ability to view it remotely. But most were still vexed by cost issues, with majorities pointing to funding limitations as the top hurdle to wider mobile adoption at their organizations.

Perhaps that's why more and more organizations are starting to closely track the money spent on these tools: roughly half of respondents formally measure  return on investment related to mobile technology, and one-third of respondents evaluate the total cost of ownership as it relates to their mobile strategy, according to HIMSS.

"Not too many people are measuring ROI yet, as well as total cost of ownership," says Collins. "That's a gap – one that kind of aligns itself with the gap of the number of people who don't have a mobile technology policy in place."

Which is no particular surprise, after all.

"It reflects on the fact that mobile is still relatively young. And people are still grappling with it," he says. The challenges are many and varied, and most facilities are still experimenting with what works best for them: BYOD, whether they're going to build apps in-house or outsource them, how to deploy within and outside.

All in all, it points to one big fact: well-thought-out policies are crucial. "It's pretty important to have something like that in place before you try to integrate mobile into the overall system," says Collins.

Were there any surprises when compiling this most recent survey, or when parsing the results?

One was that apps are starting to get a little more traction, within provider organizations, and most respondents say they have plans to launch new apps, he says.

Another had to do with the types of technology, and the fact that there's "more of a rise in the use of tablets – specifically medical tablets, he says. "I think people are starting to see the portability and flexibility of that technology."

In-hospital, clinicians said they were most likely to use mobile tools for accessing patient information, 69 percent, such as labs or imaging, or clinical decision support at 65 percent, according to the HIMSS survey.

But it's outside the hospital walls, post-discharge, that the tablets and apps seem, lately, to be really starting to find favor.

More than one-third of respondents said they provider at least one app for patient or consumer use.

One recent phenomenon is especially interesting.

"Mobile discharge kits seem to be really starting to take off," says Collins. "You discharge the patient with the tablet, with the pulse oximeter, with the scale. They have information at their fingertips regarding what meds they're on. They can engage with their provider remotely. That seems to be providing a lot of value – satisfaction-wise and financially – both to providers and patients."

Programs like those have seen success at Geisinger Health System, CHRISTUS Health, Hackensack Alliance ACO and beyond, he says, clearly showing there's a trend in the value and use of the technology."

The payers are noticing too. As pointed out in a 2013 Chilmark Research study, big changes in technology and payment strategies means insurance companies are making the most of mobile technology – both to enable outreach to high-cost populations and market themselves to potential new post-Affordable Care Act customers.

On the provider side, health systems and ACOs are "saying, 'It's literally cheaper for me to buy this technology and give it to patients than it is for us to eat the cost, manage their chronic care and have them readmitted with these high costs in an inpatient setting,'" says Collins.

And while mobile tools have long enabled telemedicine for patients in rural areas hours away from the nearest hospital, "now you're starting to see more localized use, with the new technology," in the interest in keeping high-risk patients healthy.

"They're trying to get a handle on chronic disease management," says HIMSS Analytics/directory/analytics" target="_blank" class="directory-item-link">Analytics Executive Vice President John Hoyt. And so you see a redoubled focus on weight gain, diabetes: Bluetooth-enabled scales that send data back to providers, even new insulin pumps with their own IP addresses.

"They're sending data to the cloud," says Hoyt. "Not the EMR – because it's too much data, it's like every 10 seconds – but I was at a Stage 7 visit at OSU, at the endocrine clinic, and they were looking at data."

They noticed, for instance that a young person's blood sugar went up before dinner: "'You're getting dinner a little too late, can you move it up?'" says Hoyt. "They're looking at the data on her pump from the cloud, and then can download a summary of the data to Epic."

If clinicians are still grappling with how best to deploy mobile tools in-hospital, this sort of use for remote care management looks to be making big advances.

"We will continue to increase (mobile usage) inside the hospital walls, just for efficiency's sake," says Hoyt. "But the real impactful use is outside, between visits."

"Remote patient monitoring is huge, and we're going to see an explosion there," says Collins. "It's going to impact the baby boomer population all over the world."