Making Care Mobile:

Shifting Perspectives on theVirtualization of Health Care

www.pwc.com/ca

CIO Connect BreakfastJune 11, 2013

Agenda

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2

Key Trends Shaping Healthcare

Making Care Mobile: Study Highlights

PwC

3 A Possible Future…

4 Moving Your Organization Forward

Slide 2

Key Trends Shaping Health Care

PwC Slide 3

Health Care in Canada: We are Tracking Four KeyInnovation Trends

Focus on “Frequent Flyers” (Health Links) as a Solution to Integration

• The 1% who account for a third of healthcare dollars

• Create more efficient and accountable care paths

• Integrate and standardize care; more efficient usage of resources

Activity-Based Payments (QBP)

• Identify the leading practice treatment pathways for specific diagnosis

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2

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• Identify the leading practice treatment pathways for specific diagnosis

• Funding based on that pathway and a fixed prices for services model which allows for innovation

• Allows funder to pay for what they want (and not what they don’t want)

Digitization Continues and Morphs into mHealth

• eHealth is currently providing little or no core support for hospital system upgrades

• Fast-changing environment threatens centrally planned models

• mHealth is a huge new factor in the last three years

Continued Model of Care: Innovation shifts to Virtual Care

• Advances in technology are enabling “care anywhere” networks

• Smart phones and tablets are being used as an educational platform in Medical School

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Slide 4

Making Care Mobile: Shifting perspectiveson the virtualization of health care

Highlights and Key Findings

PwC Slide 5

Making Care Mobile: Shifting Perspectives on the Virtualizationof Health Care

• Report explores Canadians’ attitudes towards pertinentissues in the health care industry

• Provides analysis of what citizens expect decision makers tokeep in mind when thinking of the future of health care inCanada

Goal of the report

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Canada

• What improvements are citizens looking for in health care?

• What channels are citizens using to access health care andinformation now, and in the future?

• What innovations are citizens ready to use that can makehealth care delivery more efficient?

• What are the future possibilities in health care delivery?

Key Questions

www.pwc.com/ca/virtualcare

Slide 6

Nearly 2,500 Canadians helped us address the central question:“What does the future of health care delivery look like?”

• 2,413 Canadians participated over 3 week period

Methodology

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• Research was conducted through interactive online‘Choicebook’ where respondents:

• Learned about vHealth and mHealth

• Explored important questions related to key issues

• Reviewed advantages, disadvantages and trade-offsinvolved in scenarios

• Thought through and identified what services theywould like to use in the future

www.pwc.com/ca/virtualcare

Slide 7

Mobile devices and virtualization of care make it possible to provideand receive health care treatment and preventative services outside oftraditional care settings.

Mobile health and virtual health tools may include:

• remote patient monitors

video conferencing

Making Care Mobile

PwC

• video conferencing

• online consultations

• personal healthcare devices

• smartphone or tablet apps

• wireless access to patient records and prescription applicationsusing a cellphone, smartphone or wireless tablet

Slide 8

vHealth and mHealth are related, but different

PwC Slide 9

What are Canadians Saying?

• Canadians are aware of the challenges andgrowing demand facing our health caresystem

• Canadians are gaining comfort interactingonline, and see mHealth solutions as a way toaddress concerns

Perspectives on our Healthcare System...

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address concerns

• Overall, respondents are satisfied with healthcare quality they receive

• However, respondents indicate that there arekey areas for improvement related toimproved access to health care providersthrough the use of more moderncommunication channels

Slide 10

Canadians are interested in mHealth tools that canimprove access to a doctor and health information…

34%34%of patientsreport that

What would be the main motivation for youto use mHealth services and applications?

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report thatconvenientphysicianaccess wouldmotivate themto adopt amHealthservice or app

Slide 11

… such as apps for secure access to personal health info,scheduling & communication with health care professionals

70%70%are interestedin apps that

Which of the following mHealth apps/serviceswould you be interested in using?

64

70

Apps or services that help me schedule medical appointments

Apps or services that help me securely access my healthinformation, such as lab results or immunization history

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in apps thatprovide secureaccess topersonalhealthinformation(such as labresults)

7

31

41

44

48

50

63

64

No Answer

Apps or services that help me manage my own wellbeing bygathering data automatically

Apps or services that help me securely access a familymembers health information, such as lab results or

immunization history

Apps or services that work with my medical devices to senddata on my condition to my doctor

Apps or services that help me manage my own wellbeing

Apps or services that gather general information onhealthcare, such as illnesses or medications

Apps or services that help me communicate better with healthcare professionals

Apps or services that help me schedule medical appointments

Slide 12

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Most Canadians would use secure email for non-urgent health concerns

79%79%of patientsindicate that

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indicate thatthey woulddefinitely , orprobably, usesecure emailfor non-urgenthealthconcerns

Slide 13

There is latent demand amongst Canadians formobile-enabled prescription renewal services

83%83%of patientssurveyed

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surveyedwoulddefinitely, orare likely to,use onlineprescriptionrenewalservices

Leading the Way: More than 50% of Walgreensonline prescription refills done through mobile device(vs.10% three years ago). Walgreens is refilling oneprescription per second on a mobile device.

Slide 14

Virtual assessments via apps are good options inthe right situation…

52%52%of patientsindicate that

15%

20%

21%

36%

None of the above

You use an app for an initial assessment

You send it to your doctor using an app

Doctor takes the photo and communicates withdermatologist

Canadians were comfortable with virtual mole assessment appscenario – although, at this time, most prefer doctor-controlled option.

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indicate thatfaster access tocare is theprimaryappeal ofvirtualassessment

1%

8%

No answer

Not sure

Slide 15

... Canadians told us they are ready for virtualmonitoring for chronic conditions…

79%79%of Canadiansindicate that

Most Canadians indicated they would be comfortablehaving a chronic condition monitored virtually...

36%

43%

10%

5%

4%

Yes, definitely

Probably

Not likely

Definitely not

Not sure

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indicate thatthey arecomfortablewith virtualmonitoring forchronicconditions

4%

2%

Not sure

No answer

... and 62% of caregivers indicated that virtual healthcare would help them to provide care for someoneelse (e.g. parent/ child)

Slide 16

… And virtual visits for post-surgical follow-up.

54%54%of Canadiansindicate that

24%

43%

17%

11%

5%

Yes, definitely

Probably

Not likely

Definitely not

Not sure

The majority of Canadians indicated they would becomfortable having post-surgical follow-up visitdone by video conference.

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indicate thatvirtual visits,homemonitoring,and virtualwards are goodcare deliveryoptions

5%

0

Not sure

No answer

Slide 17

Canadians want more opportunity to engage in their healthcare – the convenience of virtual monitoring offsetsconcerns related to risk of exposed personal data.

46%46%of Canadians

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of Canadiansrankedconveniencehigher thanprivacy whenconsideringvirtualmonitoringtrade-offs

Respondents expect privacy to be addressed as tablestakes. However, privacy concerns must be balancedwith innovation in service delivery.

Slide 18

Doctors and patients all over the world not only believe thevirtualization of health care is coming, but that it willimprove the delivery of care when it does.

PwC

For the Canadian health care sector to remain competitiveas a leader in medical services, new delivery methodsneed to be explored and implemented

Slide 19

A Possible Future…

PwC Slide 20

We need to construct the Apps Formulary

Take 2 Apps and

Tech RxApps Pharmacy not Apps Store

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Take 2 Apps andCall Me in theMorning

Apps Formulary

AliveCor Cardiac

Withings Blood Pressure

bant Diabetes

Pain Squad Pain Mgmt

MyIBD Crohn’s Disease

UK (Cambridge Healthcare): “Europe’s First Health-App Store” developing certification process for apps itsells.US (Happtique): market-leader in health appspublished set of standards to certify apps operability,privacy, security, content reliability

Slide 21

We need a process and standards for selection,and a taxonomy for regulation of apps

Front ofStore

Over theCounter

Criteria for evaluation include:

• Operability

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Counter

Prescription

ControlledSubstance

• Operability

• Privacy & Security

• User Data Safeguards

• Functional Validation

• Clinical Efficacy

Slide 22

Front of store apps are mHealth ‘vitamins’ thatsupplement a healthy lifestyle

Front ofStore

Over theCounter

Fitness and Health• Fitbit

• Nike+ Fuelband

• MyFitnessPal

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Prescription

ControlledSubstance

• Sleep Cycle Alarm Clock

Wayfinding Apps• BC Health Service Locator App• Hamilton Health Sciences App• Alberta Health Services App

Slide 23

Fitbit –Helps you achieve your fitness goals

Front ofStore

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Fitbit – Flex

• Measures data such as the number ofsteps and distance walked, stairs climbed,calories burned, activity duration andintensity as well as sleep quality.

Slide 24

Health services apps to enhance patient experience

Hamilton Health Sciences App Front ofStore

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BC Health Service Locator App Alberta Health Services App

Slide 25

Front ofStore

Over theCounter

• My Heart&Stroke Health <30 Days

• MyNetDiary• Medication Reconcilliation

(MyMedRec)Withings (blood pressure tracking)

Over the counter apps may be dispensed after anassessment of the patient's needs

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Prescription

ControlledSubstance

• Withings (blood pressure tracking)• Masimo – iSpO2 Device• Mood Watch• Education Apps

Slide 26

Withings– Blood Pressure Monitor

Over theCounter

WithingsBlood Pressure Monitor

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Blood Pressure Monitor

• Monitors blood pressure andheart rate

• Attaches directly into anyiOS device

• Allows users to viewmeasurements, graphs andtrends over time

Slide 27

Masimo – iSpO2 Device

Masimo – iSpO2 Device

Over theCounter

PwC

• Accurate noninvasivemeasurement of bloodoxygenation, pulse rate andperfusion index

• Connects to any iOS device• Allows users to view

measurements, graphs andtrending over time

Slide 28

Patient / client / family education apps provide astandardized, yet tailored experience

Over theCounter

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Education Apps

• Standardized, customizable approach to client/patient education inreal-time or asynchronous manner

• Teach-out, follow-up, triggered instructions for self-care

Slide 29

Prescription apps: plan of care written by physician orother health professional

Front ofStore

Over theCounter

Supported self-management• Diabetes – bant• Mental health - Lawson SMART

record• Asthma – breathe• MyIBD

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Prescription

ControlledSubstance

• MyIBDPost-surgical patient follow-

up

• QoC

PHR / test results viewing

• Wellx

• MyChart

• InstantPHR

Slide 30

Lawson Supportive Mental AssessmentRehabilitation and Treatment (SMART)

Lawson SMARTRecord

Prescribed

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Record

• Created for LawsonHealth ResearchInstitute, the LawsonSupportive MentalAssessmentRehabilitation andTreatment (SMART)record is an example ofa customized mentalhealth PHR, built usingthe instant PHR (iPHR)Toolkit. Slide 31

Wellx

Prescribed

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Wellx

• Allows patients to easily and securely connect with their healthcare provider• Receive lab results• Refill prescriptions

Slide 32

breathe – Improved asthma control

Self

Management

Improved

Asthma Control

Improved

Health

Outcomes

Prescribed

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QoC Health Software

Prescribed

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QoC Health Software

• Allows doctors tocommunicate with andmonitor their patients’progress as theyrecover from surgery.

Slide 34

Controlled apps: require close supervision ofmanagement and use

Front ofStore

Over theCounter

• Diagnostic testing and follow-up (m-CARDS)

• Remote Patient Monitoring(GE, Telus)

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Prescription

ControlledSubstance

(GE, Telus)

• Electrocardiograms

• Ultrasounds

Slide 35

Mobile Cardiac Arrhythmia DiagnosticService (m-CARDS)

ControlledSubstance

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m-CARDS

• Auto detect/ auto send wireless Event Loop Recorder (ELR) transmits ECGthrough BlackBerry Smartphone

• patients are taught to self “hook-up” using video instruction

Slide 36

AliveCor– iPhone Electrocardiogram

ControlledSubstance

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AliveCor

• Instant, portable electrocardiogram (ECG) rhythms• Cleared by the FDA for sales in the USA to licensed medical professionals and

prescribed to patients

Slide 37

MobiSante – MobiUS

ControlledSubstance

MobiUS

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MobiUS

• Cleared by the FDA in 2011,accurate and inexpensiveSmartphone-based ultrasoundimaging system

Slide 38

Moving Your Organization Forward

PwC Slide 39

Health care leaders should have four coreplanning assets for mHealth in 2013

Point of View on BYOD

Develop organizational point of view onBYOD based on review of currentoperating environment, organizationstrategy, IT strategy, and mHealthreadiness assessment.

Mobile StrategyRoadmap

mHealth opportunity matrix and high-level strategy roadmap with prioritizedopportunity areas for organization acrosskey stakeholders segments (characterizedby value proposition, high-level cost-benefit, and/or implementation effort).

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MobileStrategy

Mobile ApplicationInventory

Inventory of all applications – currentmobile apps and those that may bemobilized in future – leading to alignmentof IT infrastructure with organizationalstrategic objectives. A critical step tomaximize return on IT investment.

benefit, and/or implementation effort).

Apps Formulary

Health care organizations need a deliverysystem to direct patients/clients to apps.Develop and publish an apps formularythat provides physicians and staff with listof applications for their clients/patientsthat have been approved for use.

Slide 40

Thank you

Will Falk

Managing Partner, Healthcare

416.687.8486

william.f.falk@ca.pwc.com

@willfalk

Mark Casselman

This content is for general information purposes only, and should not be used as a substitutefor consultation with professional advisors.

© 2013 PricewaterhouseCoopers LLP, an Ontario limited liability partnership. All rightsreserved.

PwC refers to the Canadian member firm, and may sometimes refer to the PwC network. Eachmember firm is a separate legal entity. Please see www.pwc.com/structure for further details.

Mark Casselman

Director

416.687.8480

mark.casselman@ca.pwc.com

@markcasselman