Participatory Health Waegemann M Hi091809
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Transcript of Participatory Health Waegemann M Hi091809
Copyright 2009 mHealth Initiative Inc. Boston.
Participatory Health: The New Game in Town
C. Peter WaegemannExecutive Director, mHealth Initiative“One of 20 Most Influential People in Healthcare”(HealthLeaders)
I’m a new kind of person – I’m a
Mobile Computer Person• Wireless Voice Communication• Texting• Email• PDA Functions: Calendar, Notes, Contacts,
Clock, Weather, Search Functions• GPS• Lifestyle Functions: Yoga, eBooks, Music,
Transportation, Banking, Identification, Networking, etc.
Trends of Our TimesTrends of Our Times
Consumers do the workConsumers do the work–– Bank tellersBank tellers–– Travel agentsTravel agents–– CheckCheck--in counters at airportsin counters at airports
Making Information Available to AnyoneMaking Information Available to AnyoneFrom Sporadic to Continuous CommunicationFrom Sporadic to Continuous CommunicationSocial NetworkingSocial NetworkingTechnology: from Big to Small Technology: from Big to Small From Forced Legacy Systems to From Forced Legacy Systems to ““Easy Use Easy Use SystemsSystems””From From ‘‘AuthorityAuthority--centriccentric’’ Systems to Wiki Systems to Wiki EconomicsEconomics
Participatory HealthParticipatory Health
Active Participation of Active Participation of –– PeoplePeople–– Healthcare providersHealthcare providers–– Wellness providersWellness providers–– Public healthPublic health–– Health plans and payersHealth plans and payers–– Pharmacies, labs, othersPharmacies, labs, others
Active Participation of People
••Are encouraged to become active Are encouraged to become active participants in their wellness and health participants in their wellness and health mattersmatters
••Change their life styleChange their life style
•• Keep a personal health recordKeep a personal health record
••Spend personal resources on living Spend personal resources on living healthierhealthier
••Research and learn about relevant health Research and learn about relevant health topicstopics
•• Be involved in cost issues for their Be involved in cost issues for their healthcare and participate in healthcarehealthcare and participate in healthcare--related cost decisions.related cost decisions.
Whether healthy or ill
• Patients• Consumers • Children• Adults• Seniors
Healthcare ProvidersHealthcare Providers
Medical NetworkingMedical Networking–– All provider typesAll provider types–– Pharmacies, labs, etc.Pharmacies, labs, etc.–– Public HealthPublic Health–– Health plans and payersHealth plans and payers–– Professional networking within your Professional networking within your
hospital or clinichospital or clinic
Three Generations of HIT
1Computer-based Patient Records
Document Imaging
Practice Management Systems
EDI Messages
CHINs
1970-1997
2eHealth
5 eHealth Systems
RHIOs
PACs
CPOE
Medical Communities
EMRs
1998-2009
3
Participatory HealthConsumers
New Communication
Participants’ Coordination
mHealth
Ecosystem Interoperability
New Financial Systems
Workflow, workflow, workflow
2010-2020
What is e-Health?E-Health
1Electronic
Administrative Systems
2Electronic Financial Systems
3Electronic
Clinical Systems
4Electronic Research Systems
ElectronicImaging Systems
ElectronicHealth Record
Systems
ElectronicPharmacySystems
Electronic Medical Record
Systems
Document Imaging-based
System
5E-Public Health
Systems
Population Health
Environmental Health
Caregiver Health Processes
Safety: Terrorism Alert and DefenseHealth Promotion
PACs
What is mHealth?♦ Communication-enabled new ways to communicate with
patients and people– Disease management– Effective Care Processes
♦ Allowing people to research health topics– Physicians– People
♦ People and patients to share experiences– From “Summary at Visit to ODLs”
♦ Mobile computing at the point of care♦ Affecting change in the healthcare system
mHealth
Change in Workflow
Wireless Communication and Computing Devices
People’s Involvement in
Health
New Financial System
New Systems: Decision-support and
SPCs Trust and Ease of Use
Problem #1
Patients often see their clinicians only periodically and for short periods of time. They need to remember all health symptoms and health related events (observations of daily living – ODLs) within a very short visit that may be emotionally laden.
Types of Communication
1. Patient to provider (pre-engagement)a. General inquiryb. Appointmentc. Insurance coverage or cost
2. Provider-patient interactivelya. Appointment confirmation/reminderb. Reason for visit: Agendac. Referrals and other care management
communication, e.g. ‘How r u?’
d. Other3. Patient education
Text Messaging• In general, fewer than 5% of adults are
currently able to communicate with their providers electronically
• When asked, 62% of adults stated that electronic communication would influence their choice
• 75% stated they wanted to schedule appointments electronically
• Harris Interactive: Feb. 8, 2007• 50% of 12 to 24 year olds send or receive
text messages• Ipsos: 2007
Credit: Renee McLeodCredit: Renee McLeod
Text Messaging• Appointments• Medication reminders• General inquiries• Administrative questions• Non-healthcare related communication• Health promotion• Patient-initiated communication
– Need to reschedule appointment– Need for prescription refill (?)
Problem #2
Physicians and other practitioners cannot memorize all formularies, guidelines, protocols, health plan instructions, or all of new developments in the scientific body of medicine.
Accessing Information at the Point of Care
Patient health informationInsurance eligibility informationCare decision support information
FormulariesGuidelines and protocolsDisease management informationAccess to scientific body of medicineOther
Cell Phone as Information Resource at the Point of Care
FormulariesGuidelines and protocolsDecision supportTelemedicine guidelinesPatient’s comments re WebPatient directives
Problem #3
Physicians and other practitioners often provide patient care without knowing what has been done previously and by whom, resulting both in wasteful duplication and in clinical decisions that do not take into account critical data related to patient health.
The Race for The Race for InteroperabilityInteroperability•OSI Level•Microsoft•Object Management Group (CORBAmed)•DICOM/RSNA: EHI•HL7•ASTM E31•Google•Others
EHR
Structured Data Elements – Not Documents
1. Too much information
2. No uniform arrangement
3. Interoperability Composite Clinical Dataset
EMR
Structured Data Elements – Not Documents
Clinical Basis Dataset
Insurance
Provider Interoperability PHR
Patient Card
Cell Phone
1. Too much information
2. No uniform arrangement
3. Interoperability
For over 2,000 years, the patient was rarely informed about the
medical circumstances. Disease details were left to doctors. As recently as 1965, patients were not allowed to see medical books in publicly funded
libraries
HIPAA gives the patient the right to a copy of the medical record
1999-2000
Internet opens up
health information
13 million Personal Health Records
Dot.com bubble bursts
Concern over Internet reliability
2007-2008
Health 2.0:
Disease-specific Communities
2002-2006
Patient support groups develop
Professionally guided disease communities will support new research. guidelines and protocols
7 million PHRs10 mill. PHR-Lites3-4 mill. PPPs
2010
20% EMR Implementation
Interoperability through
ecosystemsCCR-based
PHR Developments
Personal Health Record on the Phone
• Interoperability through the patient• After the smart card, USB, CD experiences• Can use any phone• Current projects
Using the CCR as the base, a clinician can now dictate or record through speech recognition – or with keyboard or stylus
This opens up a wide range of workflow options at the point of care
As such recordings will be integrated over the next 18 months with online protocols (new and existing), a new process of electronically enabled care will emerge
Problem #5
Is there a way of disease management that is more effective and reduces costs?
Answer: Communication-based Disease Management
Disease Management Applications
Wonders of better communicationCurrently focused on
DiabetesAsthmaDermatologyPreventive care in pregnancySmoking cessationHypertension
30 patients random assignmentIntervention (n=15) received cellphone software with real-time feedback of blood glucose levels, displayed medication regimens and requested additional data needed to evaluate diabetes management.Average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients.
Quinn, CC, Clough, SS, Minor, JM, Lender, D, Okafor, MC, Gruber‐Baldini, A. WellDoc Mobile Diabetes Management Randomized Controlled Trial: Change in Clinical and Behavioral Outcomes and Patient and Physician Satisfaction. Diabetes Technology & Therapeutics. June 1, 2008, 10(3): 160‐168.
doi:10.1089/dia.2008.0283.
Changing Communications within HospitalsChanging Communications within Hospitals
Nurses use mobile technologyNurses use mobile technology67% of nurses carry two or more mobile 67% of nurses carry two or more mobile communication devices communication devices Spyglass Consulting, 2008 Spyglass Consulting, 2008
88% of nurses had three phone numbers 88% of nurses had three phone numbers Ascendant Systems, 2008Ascendant Systems, 2008
Nurses are mobile*Nurses are mobile*Walk an average of Walk an average of 3 miles (up to 5) per shift(up to 5) per shiftregardless of racetrack, corridor, or radial design facilityregardless of racetrack, corridor, or radial design facility
Spend Spend 31% of shift in the of shift in the patient roomSpend Spend 38% of shift at the nurses stationof shift at the nurses stationSpend Spend 24% on the unit and on the unit and 7% off the unitoff the unit
Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State University
* Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3):25-34.
University
NursesNursesNurses need access in real time; they Nurses need access in real time; they spend spend 35% of shift in documentation*of shift in documentation*
3% in the patientin the patient’’s rooms room81% at nurses stationat nurses station15% on the unit15% on the unit1% off the unit1% off the unit
Smart phones can be HIPAA compliantSmart phones can be HIPAA compliantSmart phones access the secure serverSmart phones access the secure server
Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State UniversityUniversity
* Hendrich, A, Chow, M, Skierczynski, BA & Zhenqiang. L. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3):25-34.
Professional Communication
Preferred communication channels for lab, pharmacy etc.Colleagues
Specialty-specific communities
Administrative Applications
Wide range of applicationsProvider – Patient applicationsStaff communicationWith others
Text v. emailRFiD: Asset management
InventoryPatient Flow
Financial Applications
Charge capture Providers accessing eligibility infoProviders sending billsPayers in active communication with patients and providersOnline real-time adjudication
Emergency Care in Participatory Health
Not starting with a “blank sheet”Potential need for record locator systemSubstantial cost reductions expected
TapChart increases Productivity
♦By using TapChart and Palm mobile devices SDMSE, has returned more ambulances back in-service to the community, in excess of 16,500 hours
♦Without having to actually add additional units to the streets
What It Takes to Save a Life
♦Mobile communication♦Care software♦Integration into IS♦Change
Example for eHealthcare of the Future
Population Health Communication in Participatory Health
Reporting of disease outbreaksInstructing patients BioterrorismSurveillancePopulation notificationsOther
Future solutionsFuture solutions
Hospital policies need to reflect the Hospital policies need to reflect the constant change in technologyconstant change in technology
Understand what you can police and monitorUnderstand what you can police and monitorCell phones have cameras and recordersCell phones have cameras and recorders
Policies must apply to everyone and everyone Policies must apply to everyone and everyone needs to help enforce needs to help enforce Healthcare facilities (hospitals, ambulatory Healthcare facilities (hospitals, ambulatory care, etc.) must work with healthcare care, etc.) must work with healthcare educatorseducators
Credit: Renee McLeod, Arizona State Credit: Renee McLeod, Arizona State UniversityUniversity
What is mHealth?Bringing the power of the Internet to the mobile userPatient/consumer to control and manage their essential health data on mDeviceNew communication vehicle for care communicationNew applications using disease management applications at the point of careMethods to create interoperability in healthcareEnables integration of all healthcare participantsInteroffice wireless connectivity is a commodityMuch different and bigger than telemedicine or “wireless hospital applications”
PeterPeter’’s Visions VisionPhone identificationPhone identificationPrePre--service automated checkservice automated check--ininPrePre--service communicationservice communicationCare applets guide the clinicianCare applets guide the clinicianRealReal--time financial bill submissiontime financial bill submissionRealReal--time adjudicationtime adjudicationAdditional fee services by providerAdditional fee services by providerContinuous care communicationContinuous care communication
What does this mean for What does this mean for Providers?Providers?
Restructuring is unavoidableRestructuring is unavoidableSolutions are not limited to new technologiesSolutions are not limited to new technologies
Prepare staff for Participatory HealthPrepare staff for Participatory HealthCreate a mHealth strategyCreate a mHealth strategyBalance Solutions and EffectBalance Solutions and Effect
HurdlesHurdles
InteroperabilityInteroperabilityConfidentialityConfidentialityStandardsStandardsCoordination of ParticipantsCoordination of Participants
Wishing You a great time at this seminar and a happy transition into the era of
participatory health and mHealth
C. Peter [email protected]