Patient engagement has the power to educate patients, change behavior, improve outcomes, reduce readmissions, and reduce cost associated with health care. In an article that was in Government Health It, Five Road Blocks of Patient Engagement.
Emerging technologies like mobile health applications and wireless sensors can turn road blocks into speed bumps. The associated cost with hospitals and providers using EMR’s are still there but by 2014 those accepting medicare who do not want their reiembursment rate cut by 3% are required to use EMR’s. EMR’s are an important part of the process to transfer and integrate health data obtained by mobile devices and other peripherals device during the patient engagement.
How will patients become engaged in this process?
Patients who use connected mobile health applications have the ability to have them personalized to fit to their needs. Working with a health care professional, a care plan is designed specifically for the patient with educational information, gaming, reward programs, leader boards, and business rules that alert and remind patients to adhere to the health plan. The customized health application and health plan linked to wireless sensor will reduce the burden of data input and increase the accuracy of the data.
The health data from the mobile application transmits the information into the cloud which cleanse and reformats the data to be compatible with EMR’s. This information flows safely from the secure cloud into the EMR where the health provider can access the information in a web portal.
The use of technology is the key to patient engagement. The technology must not be a stand-alone but be connected with the ability to communicate with many devices, platforms, and EMR’s. Technologies that works in a multi-modal world means all of the patients devices that they choose have access to their health information and health plan. Wither they use a mobile phone, web t.v., web-portal, connected car or tablet, their health information can be accessed.
The organizations culture will need to adopt a business strategy that focus on care outside of the doctors office. This require a higher level of communication between the patients and their health provider. Connected mobile health applications can help capture accurate health data in real-time and create a communication channel. Once the data is captured health care professionals can have data driven conversations with patients about their current health behaviors and the patients progress with in their health plan. Thus creating both a relationship between the patient and the health care provider and a support channel for patients to improve outcomes. If the patient support network is not developed with in organizations culture, improving health outcomes for patients will continue to struggle. To prevent any additional burden to the healthcare professionals these technologies should fit seamlessly into their current work flow.
The creation of a personalized applications with a customized health plans designed specifically for each patient is painless process done though a web portal. The custom profiles and health plans created for the patients applications, gives health care outside the office a personal touch. To keep patients active and involved in their health plans an approach based off achievements helps patients be engaged with a higher frequency. Applications with benchmarks, health videos, reward programs, gaming, leader boards, adherence reminders and alerts features keep the patient engaged. This engagement will help patients recognize bad health behavior and be rewarded for healthy behavior which leads to better health outcomes.
“Pharmaceutical companies should remember that patient engagement means customer loyalty.”
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Remote Patient Monitoring
Reason # 5 (countdown)
Care Plan Implementation
Care plans are personalized health programs that can be developed in a web portal by a health provider with the individual needs of their patient. Once the plan has been developed the health provider can push the plan though the cloud to the patients mobile device. The patient can access the customized care plan though their mobile application. The care plan than becomes a guide with benchmarks for the patient to improve their health. Once the patient engages the plan though the application, their health care provider as well as the patient can monitor the progress of the health plan as it is executed. For the plan to be effective it must have workflows and business rule based triggers in the event that the patient is not adhering to the plan. If the rules are triggered it will push out an alert or notification to the patients healthcare provider. The health provider now has the option to make an appointment, give new instructions, or send education by video, email, or text. The intervention of the non adherence to the health plan can help prevent health problem in the future.
Integration to Healthcare System
Integration of physiological and behavior data that has been collected during the patients care plan needs to flow back to health providers health records. The integration process from the application should work in several formats and transfer the data seamlessly.
For example, information collected from a body worn ECG heart monitor will be integrated back to a ECG monitor station and or the health providers EMR. It is done though a cloud based service layer. The open backend allows the information to be integrated and cleansed to the format of the health providers current system. The information from the cloud can now be combined with the current patients record. The data obtained was format and cleansed to the providers current format. The health care provider can now read accurate data obtain from the ECG about their patient.
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Compile Health Behaviors and Marketing Informatics
Reason #6 (countdown)
Sensor integration is a key element in developing an effective mobile health application. Sensors can help ease the burden of data entry and improve the quality of the health data by reducing human error. Peripheral sensors are coming on hard and strong in the health care market, with blue tooth and other wireless capabilities. With a host of new sensors being built everyday and old sensors upgraded a mobile application must be built to accept the new technology with out re-writing the entire application. Creating the front-end of the application with plug and play capabilities that allow new and strong sensors to be add as needed will help minimize the cost of application maintenance and rebuilds in the future.
What kind of value can integrated wireless sensors create?
Sensors can create tremendous value for collecting and recording health information while keeping a high standard of accuracy. The cost saving value can be looked at in two ways; how sensors can help prevent catastrophic health conditions and how they can alleviate the financial burden in the health care system. To demonstrate the cost saving we will this example. A body worn ECG sensor is subscribed to a patient named Joe who has been having symptoms of AFIB. Joe can where a band-aid sized wireless sensor thought his daily routine. The sensor is constantly transmitting his heart data to his mobile health applications that has business rules in place to alert his health provider when an irregular heart rate is occurs. The business rule is triggered only 5 days after the patch his been worn, the health provider contacts the patient and sets up an appointment. At the appointment the patient is diagnosed with a high risk of heart failure and surgery is needed to prevent a catastrophic health problem.
Joe is now a post op cardiac patient; the sensor is put back on the Joe the day he is released from the hospital. In this case the patient is released two days early because of the wireless body worn sensors can accurately monitor the patients health from his home. From the comfort of Joe’s home he can finish his bed rest while still being monitored. Joe’s doctor has recommend Joe to continue wearing the body sensor for another two weeks to prevent any kind of re-occurrence and re-admission to cardiac center. During these two weeks Joe has returned to work and his everyday normal life with out the burden of a monitoring center and with the reassurance that his health is still being monitored.
In the scenario described above wireless sensors has added value in several ways. The first way is in an early diagnosis of the patient preventing a catastrophic health failure, the remote monitor and early release from the cardiac monitoring center has saved a substantial amount of money for the Hospital and the patient, and lastly the burden of the monitor center was eased by wireless remote monitoring.
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Care Plan Implementation and Integration to Current Health Care System
Reason #7 (countdown)
Managed Behavior Change
Mobile applications can be one of the most powerful tools for tracking behavior change, delivering education, and engaging patient though benchmarks and reward programs. Patients can track their health information by inputting data directly, peripheral sensors, or by transferring information from a web portal. During this process patient my achieve goals or reach benchmarks that could go otherwise unnoticed. In the first stage of the benchmark process the application will recognize good behavior and unlock new educational health videos. These videos are part of the patient support network and will help the patient reinforce healthy choices and nurture behavior change. As the patient continues their sucessful behavior change they can be rewarded while still reinforcing the good behavior though incentive programs. Pharmacies and pharmaceutical company’s can offer point programs that can be redeemed for store credit, discounts to drug prescription, or coupons to other products that the pharmaceutical company manufactures. Creating rewards based challenges with in the health application keeps the patient engaged and motivated to succeed in their healthier behavior change.
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Reason #8 (countdown)
Can personalized application reinforce positive health outcomes?
In past blog entries we discussed how reminders, alerts, and custom health plans help improve health behaviors. Now I would like to discuss how personalize health application can be effective for individual patients and how a customized applications can help the patient reach their health goals.
Our patient Joe is a diabetic but he also suffers from hypertensive. On his smartphone he has two individual health applications that do not communicate with one another. The first application is his diabetes app and the second is his hypertensive app. He opens the apps separately and records his health information accordingly into each application. Both applications have vital information but this information may be hard to compare and contrast because the two applications do not communicate.
How can we record health data for two, three, or even four diseases and still be able to paint an acute picture about a patient’s health? The answer is simple, applications will have to be customized and personalized. We can do this though the front-end of the application using the plug and play model. (discussed in pervious blog) Lets take Joe’s diabetes application and add a few widgets and sensors. First widget we will add is the hypertensive widget, this allows blood pressure to be tracked and inputted into the diabetes app. Joe finds it to be a hassle to manually enter data about his blood pressure and his glucose data, so Joe can simply pair blue tooth blood cuffs and a blue tooth glucose meter to his application. Now the information from the cuffs and the glucose meter is transmitted directly into the application. Joe has now decided to really take his health seriously and has started to jog. He wants to record his heart rate into his diabetes application. With a reusable band-aid sized heart monitor patch he can track his heart rate though out his entire exercise routine. The last thing Joe wants to do is track his weight, sure he could download another application and manually enter his weight, or he could add another widget to his application that tracks his weight using a Bluetooth weight scale.
Personalizing applications by add widgets and sensors to record data and track a patients health, reduces the burden on the patient and increases the accuracy of the data.
What to do with all the data?
Joe can access all his information he collected in his diabetes app from a web portal. Including his glucose level, blood pressure level, heart rate, and his weight. He chooses to create a graph showing the effects of jogging on his health. The results are very encouraging for Joe. It shows that the exercise from jogging has lowered both his glucose and blood pressure level, his heart rate has started to decrease during his workouts, and he has lost 14 pounds.
The use of connected apps with widgets and peripheral sensors creates valuable health data for patients and healthcare providers that analyzed in dashboards and help patient understand their health and reach their benchmarks.
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Managed Behavior Change
Reason #9 (countdown)
We live in a Multimodal world, with hundreds of devices to choose from that can access the Internet from anywhere at anytime. With all the choices patients may choose to use a computer, smartphone, web TV, tablet, or any internet capable device to access their health information from the cloud. Lets take a look at a scenario where a patient use the wide range device choices to his advantage.
Patients name is Joe and he is a diabetic, Joe finds himself at home and wants to create his diet plan. Creating the diet plan on 3.5-inch mobile phone does not make sense when he can use his computer. So Joe uses the more convenient web portal and designs his diet plan for the month. He can now push this information to the cloud, where the information can be accessed from his smartphone, tablet, or web tv. Joe finds himself at his favorite restaurant, while at the restaurant Joe wants to up date his calorie intake and his sugar level in his diet plan. The best method at this time would be his mobile devices, so Joe updates his information and sends it to the cloud. After dinner Joe comes back home and sits down on his couch. His mobile phone alerts him that there is an educational health video that his certified diabetes educator (CDE) has prescribed him. Once again the small 3.5-inch screen of his mobile device is not the preferred medium to watch the video so he turns on his web tv and accesses his educational health video from the comfort of his couch on his big screen tv.
Mobile health application maybe a really neat novelty, but they may never be effective in producing better health outcomes if the application does not communicate in a multimodal world. Harnessing the power of cloud technology and connecting patients to their health information across all platforms at anytime and anywhere is what makes a health application an effective tool in improving health outcomes.
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Reason # 1
Improved health outcomes and healthy behavior change are the end goals of connected mobile health. Though out this series “Why Connected Mobile Health Applications Over Stand-alone Applications”, I explained the advantages of a connect applications over stand alone applications that does not communicate outside of the application, link to peripheral sensors, or process information back to an EMR.
Listed below is 10 reasons
To improve health outcomes of patients all 10 of these reasons or a combination of them are necessary to achieve behavior change and provide better outcomes. The advantages to using a platform that incorporates this strategy is;
Patient that use mobile health to track their health behaviors, symptoms, or medication create data that is used to diagnosis conditions early or intervene with adherence issues. For the patient this could mean lower cost of health care from avoidance of a more serious condition or prevention of a catastrophic event. For life science companies it means that your marketshare has an opportunity to grow significatly. Developing effective applications that become an everyday useful tool in a patient life creates tremendous value for brands and a direct marketing channel. The behavior data collected not only helps to improve outcomes but can be a very effective channel to market, fine-tune messaging, and collect real-time market data.
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Reason #10 (countdown)
There is no question that patient support is critical in improving the health outcomes and promoting healthy behavior change in patients with chronic diseases. Chronic diseases put extraordinary pressure on the healthcare system with annual cost for diabetes at $174 billion/year and heart disease/stroke at $432 billion/year. Patients with chronic diseases have fewer options, receive lower quality care and face sharp increases in health care cost.
The patient support network can be made up of a family health manager (FHM), which is a family member that takes charge of the family’s health. It could come from the patient’s health care professional (HCP), or a certified diabetes educator (CDE). But how do you connect all of the patient supports into a network that works seamlessly? Smartphones can play a major part of creating an effective patient support network and instilling behavior change. Lets look at how a diabetes application can improve health outcomes though a patient support network.
The FHM, HCP, and CDE are connected into the diabetes application though a customized set of business rules. One set of rules can be as simple a reminder from the application to the patients via SMS notifying the user (lets call him Joe) did not log an entry for their daily dosage of medication. If this this reminder goes unanswered than the application can elevate the situation to an alert to the FHM. The FHM will receive a SMS, Email, or a pre recorded voice mail alerting them that Joe did not record their medication. The FHM can than reach out to Joe and ask him if he forgot to take his medication or if he just forgot to record it into his diabetes application. Business rules can also be in place that trigger notifications to Joe’s health care provider, which informs the provider that the patient has not taken their medication for several days or the patient can receive coaching, educational information, and health videos from his CDE.
Now we have recorded the information about Joe’s health behavior, what can we do with it? At Joe’s next doctors appointment his health provider can access the information though a secure web portal and have data driven conversation with dashboards, charts and key indicators about the Joe’s behavior and health. The data recorded provides greater insights and accuracy about Joe’s health and behavior. The health provider can a create care plan that fits the needs of Joe to encourage better health outcomes.
Next blog entry:
Mobile application connected to a multimodal world
Reason #3 (countdown)
Compile Health Behaviors
Compiling accurate data about a patients health and behavior creates tremendous value for both the patients outcome and the useful information for the health provider. The data will help change unhealthy behaviors, reward good behavior, give greater insights on patient progress, reduce recovery time, lower readmission, produce better outcomes, reduce cost and help prevent a catastrophic event.
Marketing data obtained from the target audience with in the application is more accurate, current and relevant. The real-time data that is collected can be used to create targeted messaging to the audiences. Targeting the market though E-commerce, coupons, texts, and loyalty reward programs can be implemented and analyized in real-time.
For example a coupon campaign is launched and when each coupon is redeemed the information is available in real-time to analysis. Traditional marketing can be costly to obtain such metrics and have a lag period that may render messaging useless. Another example is rewarding patients with healthly behavior though a reward program. Utilizing a company’s current reward program and enhancing them though a mobile application with a direct and captive channel to the patients. Allows positive reinforcement of healthy behavior choices when patients reach benchmarks in their health plan.
Next Blog Topic;
Mobile health has exploded in the past few years with over 5,820 medical, health and fitness apps available for smartphones today according to Mobihealthnews.com. In a recent report Frost & Sullivan market says the mobile health market (mhealth) earned revenues of $230 million in 2010 and is estimated to reach $392 million in 2015. So how does a mhealth application stand out of from the endless amount of application in the app store? How can an mhealth application improve the current data flow of the healthcare system? Is the Current stand-alone application model going be able to integrate into the current health information flow?
For an mhealth application to add true value for patient, providers, and improve outcomes they will need three connections.The front-end connection, the back-end connection, and the service layer connection.
The front-end connection integrates sensors and other data gathering technologies.The front-end should be built with the notation that new sensors will enter the market, old sensors will be upgraded, and other information sources will feed data to the application. When building the front-end it should be built as generic as possible, creating the front-end into a cost effective plug and play model. This will prevent your company from paying for a new version of the application to be completely re-written.
The second connection is the back-end connection, to be effective in the current flow of health care information the applications needs to be integrated, cleansed, and reformatted to the providers current format i.e. in house EMR, ECG monitor station, or nurse call center.
The final Connection is the service layer; the service layer must be a secured HIPAA compliant cloud based connection. The service layer connects patient to provider, web portal to mobile device, patient to the care plan management program, application management dashboard and gives the patient the ability to personalize the application.
In order for an mhealth application to create true value, engage the patient and improve health outcomes. The application will have to connect patients to provider, data sensor to the providers current health information data format, have a cloud based data storage that can be accessed from a multitude of devices, and be a safe and secure HIPAA compliant access.
Look for my next series of blog posting we will dive deeper into “What Makes a Health App Effective” and 10 reasons why connected apps are the future of mhealth