mHealth in Acute Care:Where are We Now?

Where (Might) We Be Going?

Megan L. Ranney MD MPH FACEPDirector, Brown EDHI

@meganranney / @brownedhi

Our patients want mHealth:

Ranney, Choo, et al Annals of EM 2012

95% have SMS-capable cellphone45% have smartphones (rapidly growing)67% use social media (rapidly growing)90% interested in tech-based platform to improve their health

Patients are trying mHealth:

http://www.pewinternet.org/Reports/2012/Mobile-Health/Key-Findings.aspx

Once enrolled, people use it!

- mHealth interventions have been shown to be acceptable and result in high engagement even in the highest risk groups

• adolescents• Spanish-speaking diabetics seen in the ED• schizophrenics

Monitoring, Surveillance, Dx

Care coordination/delivery

Patient engagement & behavior change

Where is the evidence?

Are they safe and private for my patient?

How does it affect our workflow?

How do I know they’re good?

Do they exist for my OS?

Do they exist for my disease?

She doesn’t even look at my data!

1. Privacy/Confidentiality

https://www.privacyrights.org/mobile-medical-apps-privacy-consumer-report.pdf

prviacy

But….

1. Design well

http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Patient_Apps/IIHI_Patient_Apps_Report.pdf

Need to use…

2. Create evidence

Emerging evidence in our field…

Emerging evidence in our field…

3. Optimize the ethics

Privacy Security

Trust Autonomy

Justice

4. Make it matter in “real life”

“Brown’s Emergency Digital Health Innovation (EDHI) program exists to facilitate the creation and deployment of effective, evidence based digital health tools in the acute care setting.”

www.brownedhi.org@brownedhi

@meganranney@brownedhi

www.brownedhi.org

• Sheck, A. (2014) Special Report: Putting an End to Super Users Slipping Through the Cracks. Emergency Medicine News, 36(1), 12-13.

• Stokes-Buzzelli, S., Peltzer-Jones, J., Martin, G., Ford, M., Weise, A. (2010) Use of Health Information Technology to Manage Frequently Presenting Emergency Department Patients. Western Journal of Emergency Medicine, XI(4), 348-53.

• Stranges E, Uscher-Pines L, Stocks C. Emergency Department Visits and Hospital Inpatient Stays for Bicycle-Related Injuries, 2009: Statistical Brief #135. 2012 Jun. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK99792/

• Unger, L. (2013) Program offers aid to ER ‘super-utilizers’ to cut costs. Courier Journal. April 15, 2013. http://www.courier-journal.com/article/20130413/PRIME01/304140036/Hospitals-target-emergency-room-super-utilizers-cut-down-costs?nclick

• U.S. Department of Health and Human Services, Health Information Technology and Quality Improvement. What is mHealth?

• Ranney ML, Choo EK, Wang Y, Baum A, Clark MA, Mello MJ. Emergency department patients' preferences for technology-based behavioral interventions. Ann Emerg Med. 2012;60:218-27 e48.

• Fox S, Duggan M. Mobile Health. Pew Internet and American Life Project. Washington, DC: Pew Research Center; 2012.

• Kumar S, Nilsen WJ, Abernethy A, Atienza AA, Patrick K, Pavel M, et al. Mobile health technology evaluation: The mHealth Evidence Workshop. Am J Prev Med. 2013;45:228-36.

Bibliography

• Arora S, Peters AL, Burner E, Lam CN, Menchine M. Trial to Examine Text Message-Based mHealth in Emergency Department Patients With Diabetes (TExT-MED): A Randomized Controlled Trial. Ann Emerg Med. 2013.

• Head KJ, Noar SM, Iannarino NT, Grant Harrington N. Efficacy of text messaging-based interventions for health promotion: A meta-analysis. Social Science & Medicine. 2013;97:41-8.

• Patient Apps for Improved Healthcare: From Novelty to Mainstream. Parsippany, NJ: IMS Institute for Healthcare Informatics; 2013.

• Heron KE, Smyth JM. Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15:1-39.

• Georgiou A, Prgomet M, Paoloni R, Creswick N, Hordern A, Walter S, et al. The Effect of Computerized Provider Order Entry Systems on Clinical Care and Work Processes in Emergency Departments: A Systematic Review of the Quantitative Literature. Ann Emerg Med. 2013.

• Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Beynon M, et al. Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial. Age Ageing. 2013;42:501-8.