John mentioned in an earlier post, “Is the mHealth hype justified?” how the word ‘mHealth’ has acquired a broad, unwieldy set of definitions. The mHealth term is now practically useless (except as a buzzword). In my research to date, I have learned not to approach an interviewee by asking if they want to chat about ‘mHealth’ anymore, lest they start talking about telehealth monitoring or wireless embedded devices.
In this post I’ll muse on this bite-sized topic, which falls under the umbrella of ‘mHealth’: What is the business driver for physician mobile app use in the enterprise?
The same old physician recruiting/retention story
As we all learned in ‘US Healthcare 101’, physicians are THE critical drivers of revenue for the enterprise. Doctors generally determine where a patient is hospitalized and what treatment that patient receives during their stay. (Note: this is also true for integrated payor-provider settings. Top-notch doctors offer a competitive advantage to HMOs when employers and groups are deciding which plans to offer their members).
Given these incentives, it is no wonder that Hospital CIOs are responding to physicians’ needs for mobility. In interviews this week with McKesson and EffectiveUI (who designed the Airstrip OB iPhone app for GE Healthcare), we heard over and over again that when it comes to mobility, the doctor is not a partner, the “doctor is a client”.
In another example of the doctor-as-client, Ajay Misra, CEO of MobileIron, recently wrote a brief report on his findings from talking to ten hospital CIOs: ‘Mobility in Healthcare: Results from the Road’. Misra, noted that these CIOs were essentially running to keep up with the physicians’ mobility demands –that their IT departments were providing mobile access to doctors even to the detriment of privacy/security, stating that: “‘no’ is usually not an option”.
Beyond doctor retention…towards better patient care
Misra’s report also describes a strong business driver on the part of the CIOs to ‘Offer best patient care’. Now, talking about quality of care is not to be taken lightly and a dissertation could be written on whether or not physician mobile access could improve patient care – and what affect this will have on a hospital’s bottom line.
Not opening that can of worms right now, what we do know is that physicians surveyed for PricewaterhouseCoopers’ Healthcare Unwired report mentioned the following:
1. They don’t have enough information at the point of care to make informed and timely decisions.
2. They (especially specialists) want to access information when/where needed. (Specialists are most interested in accessing EMRs wirelessly while primary care physicians are most interested in e-prescribing).
If doctors think they need mobile information access, then they probably do. Will it help them make more informed decisions, improve patient care, and save the US healthcare system from itself? Will hospitals experience increased brand equity due to higher quality metrics, fewer never-events, quicker discharges, lower malpractice insurance, higher re-imbursements from payors, … ?
Or…will the benefit to hospitals be more in terms of patients’ perception of quality of care? When they see their doctors tapping away on iPads, patients may come to believe that they have arrived at the forefront of medical technology and quality, whether this is the case or not.
Reality Check
Keeping our feet firmly planted on the ground:
Reality Check #1: Hospitals mostly gain from better patient care but perverse incentives mean that fee-for-service doctors do not (until we reach bundled-payment and Accountable Care Organization utopia).
Reality Check #2: Complexities abound on just what level of data and what interface to provide the physician on their mobile. It is also possible to make the clinician less productive and provide a lower quality of care through the wrong granularity of data and/or a lousy interface.
Reality Check #3: There is also the complexity of managing smartphones and the apps therein, especially within a large hospital enterprise. How does the CIO effectively manage the multitude of apps that may reside on a portable device, insuring continuity, upgrades, physician satisfaction and ultimately privacy and security of sensitive patient health data?
In Closing
It is too easy to boil down hospitals’ investments in mobility into a doctor retention story. The ROI models are more straightforward this way, but the really interesting stuff is around providing better care. Can investments in mobility move the needle on quality metrics defined by CMS, private state-based payors, The Joint Commission, … etc? If so, only a small part of the battle is won. As upcoming bundled payment contracts are defined, payors will still have to be convinced that hospitals’ investments in mobility are worth paying for.
Mobile tech will be transformative when it replaces the current technology (the ubiqutous hybrid of 3-ring binders and clunky desktops). Until then, it’s just “one more thing.” The problem, as always, is the software. You just can’t do it right with Citrix running desktop software or with a web-based UI, at least not in my field–emergency medicine–where seconds count. When the iPad or whatever is the chart itself, then it becomes not mHealth, but just practicing medicine. The way we were meant to, looking our patients in the eye like we used to before point-and-click laid waste to our workflow.
Brian – I have heard your exact sentiments from clinicians at the front-line of medicine, and also from vendors eager to sell usable software solutions to providers.
From what I am hearing, it is all about the cost of security and compliance. In order to minimize lag-time, data has to be stored on the smartphone/tablet. This means that providers have to pay for (or upgrade) their mobile device management solutions, and make sure that they comply with HIPAA’s rules for encrypting and transferring PHI on the device.
At this point in time, Citrix and web-based access is cheaper and less risky…hindering the clinician’s workflow nevertheless.
(Also, some data (images) are too large to be stored on the mobile, meaning that network access over the carrier network or wi-fi is needed regardless.)
Hi Cora,
Before you write off mHealth as just a buzzword check out this definition:
“mHealth is the leverage of Mobile, the newest Mass Media, to improve Health”
Explanation:
http://3gdoctor.wordpress.com/2010/03/22/the-definition-of-mhealth/
David, I prefer your definition over the paragraphs at Wikipedia. I hope consensus can be reached on what the term really encompasses. Until then, I’ll limit my use of ‘mHealth’ during interviews as I usually end up getting sidetracked to a discussion of, ‘what is mHealth?’
Cora,
Why restrict mhealth to such a limited definition to telehealth monitoring or wireless embedded devices?
I beleive consumers are the drivers during this transformation of health care and they will define mhealth not the “experts.” This is such an emerging industry and therefore we all must watch and see how innovation defines mhealth before we place restrictions on it’s definition. The definition does need some clarity like a diagnosis, meet certain criteria, affortability, mobility, remote, secure, privacy compliant, interoperable….
The Healthcare Unwired report on physician feedback as you pointed out mentioned that physicians:
1. Don’t have enough information at the point of care to make informed and timely decisions.
2. Want to access information when/where needed. (Specialists are most interested in accessing EMRs wirelessly while primary care physicians are most interested in e-prescribing).
By applying these two criteria will broaded the definition of mhealth to include the remote digital and mobile App PHR that will empower consumers and physicians.
Hi Gerald, yes physicians and consumers are driving – no incentives needed here for physicians to adopt mobility.