Mobile healthaug4 snyder

Mobile Health - Overview
Recording Health Monitoring Data SV Forum Mobile Internet SIG

August 4, 2011
© David M. Snyder, 42TEK, Inc., 2011 www.42tek.com 1

This Evening
✤ iHealth & MedApps Examples
✤ Mobile Health Overview - David Snyder, 42TEK, Inc.
✤ Setting the context
✤ Tracking Personal Health - Rajiv Mehta, Bhageera, Inc.
✤ Self-Quanti cation & Tonic iPhone app
✤ Dr. Justin Graham, Chief Medical Information Oﬃcer, NorthBay Healthcare
✤ The Healthcare Practitioner’s Perspective
✤ Panel Discussion/Questions & Answers


Setting the Stage
✤ Healthcare Issues, including costs ✤ Regulations & Standards

✤ Healthcare IT ✤ Reimbursement

✤ Staying Healthy & Treating Illness ✤ Market, including obstacles

✤ Chronic Illness ✤ Technologies & Use Cases

✤ Systems and Processes ✤ Privacy & Security

✤ Electronic Health Records ✤ Interoperability

✤ What is Mobile Health? ✤ Companies


What Is Mobile Health?
✤ No single de nition, but the main focus seems to be the use of
telecommunications devices to (a) collect monitoring data outside of traditional
clinic or hospital settings, (b) transmit such data from a remote location to a
doctor or other healthcare professional, or to an electronic health record
system, and (c) provide remote access to health care data and references.

✤ “m-health,” “remote monitoring,” “mobile health,” ...

✤ Telehealth seems to be about doctor (or other healthcare provider) interacting
with a patient, or consulting with a medical colleague, via phone, video, email,
text, etc.

✤ Telemedicine seems to be about conducting medical procedures via a
telecommunications link. For example, remotely controlled robotic surgery.

MedApps

✤ http://www.medapps.com/HealthPAL.html ✤ http://www.youtube.com/watch?v=GiV239PR0R4&feature=player_embedded#at=18


Healthcare Issues
✤ $2.7 Trillion/year = one-sixth of US GDP and growing
Complica)ons
from
chronic

✤ Aging population, with associated needs disease
account
for
~75%
of

US
healthcare
spending
Smith,
Joseph,
Iden%fying
Unmet
Public
Health
Needs
and

✤ Chronic illness accounts for ~75% of costs Facilita%ng
Innova%on
in
Medical
Device
Development,

6/24/2010.

FDA
Public
Workshop

✤ Reactive, not proactive model - costs more once you are ill
Remote health monitoring
has the potential to reduce
✤ Potentially not enough healthcare professionals the demand on primary
care providers by allowing
chronically ill patients to
✤ Inertia and regulatory obstacles monitor and manage
conditions at home.
Sarasohn-Kahn, Jane, The Connected
Patient: Charting the Vital Signs of Remote
Health Monitoring, February 2011


Healthcare IT Trends
✤ Shifting from paper to electronic records

✤ Smaller and more portable devices with increasing computing power

✤ Convergence of clinical engineering and IT networks

✤ “Business intelligence” analytics to see patterns in data


Complex Landscape


Staying Healthy & Managing
Illness
✤ Exercise ✤ Medication

✤ Diet ✤ Therapy

✤ Sleep ✤ Physical observations

✤ Community ✤ Analytical measurements


Consumer Goods
✤ What used to be found only in hospitals is now on the shelves in Frys.


Chronic Illness

✤ Major chronic illnesses where remote monitoring can help

✤ Chronic Obstructive Pulmonary Disease

✤ Congestive heart failure

✤ Diabetes Taking medicines as
directed, careful monitoring,
and doing the right things in
•reminders
✤ Hypertension terms of diet, exercise, and
•monitoring devices
sleep can help prevent
•tracking tools
people from getting sicker.


Data That Doctors Want


Connecting Devices is Just
Part of the Picture
Electronic
Health
Record

Is intervention needed?

What sort of follow-up
is required?

Source for Image: Identifying Unmet Public Needs and Facilitating Innovation in Medical Device Development, June 24, 2010
Joseph M. Smith, MD, PhD [EHR added] - http://www.fda.gov/downloads/MedicalDevices/NewsEvents/WorkshopsConferences/UCM221033.pdf


Electronic Health Records
✤ Large focus in recent healthcare legislation - federal incentives to doctors and
hospitals to implement

✤ Growing provision of access to patients and authorized family members

✤ Various Personal Health Record initiatives, like Microsoft HealthVault and
Google Health

✤ Health Information Exchanges being built to support interoperability
between organizations (e.g., Kaiser Permanente and Veterans Administration)

✤ Growth in automatic input of monitoring data in EHRs - including from
mobile health devices


Interoperability

© David M. Snyder, 42TEK, Inc., 2011 www.42tek.com IHE = Integrating the Healthcare Enterprise 15

Parts of the Puzzle
Patient Payer
Family Regulator
Design Caregiver Vendor
Development People Provider Supplier
Testing
Documentation Devices
Implementation Process Technology Environment
Maintenance Interfaces
Support Computers
Replacement Policy Telecommunications
Discontinuance
Don’t underestimate the potential
Statutes & Regulations need for work ow changes when
Organizational Policies technology changes

Regulations
✤ Food & Drug Administration (FDA) regulates medical devices

✤ Medical Device Data Systems rule in February 2011

✤ Draft Guidance on Mobile Medical Applications in July 2011

✤ FCC/FDA Joint Meeting on Life Saving Wireless Medical Technology in July
2010


Standards
✤ IHE PCD (Integrating the Healthcare ✤ HITSP IS77 (Remote Monitoring
Environment Patient Care Devices Interoperability Speci cation)
Domain)
✤ ICE (Integrating the Clinical
✤ IEEE 11073 (Point of Care Medical Environment)
Device Information)
✤ IEC 80001-1 & ISO 14971 (risk
✤ HL7 (Health Level 7) management)

✤ MD FIRE (Medical Device Free ✤ IEC 60601 (medical electrical
Interoperability Requirements for the equipment design)
Enterprise)
✤ IEC 62304 (medical software design)
✤ HITSP TN905 (Common Device
Connectivity)

Regulatory Drivers

Source: Health Information Technology Standards Panel Report on HITSP/TN905 – Safe? Eﬀective? Say what?!, January 26, 2010, Todd Cooper


Reimbursement
✤ “The ATA* said HHS should waive “...broad adoption [of remote
ve current Medicare rules that health monitoring] will require
‘contain major, arbitrary barriers three fundamental shifts in the
to Accountable Care way health care services are
Organizations.’ They include:” structured and paid for — namely,
“restriction on paying for videoconferencing except in
rural counties”
changes in reimbursement from
“...restriction of Medicare payment for "store-and-
insurers, a new service model for
forward" telehealth services, such as transmission of
medical images to federal demonstration programs in
providers, and greater
Alaska and Hawaii” engagement by patients and
“Restrictions on what types of telehealth services
Medicare covers” consumers in managing their
“Bans on originating telehealth communication from own health.”
certain locations, including a patient's home, hospices, Sarasohn-Kahn, Jane, The Connected Patient: Charting the Vital
and some dialysis facilities...” Signs of Remote Health Monitoring, February 2011
“Restrictions on Medicare paying physical therapists,
occupational therapists, and speech- language
pathologists for telehealth services”
* American Telemedicine Association
Versel, Neil, ACO Rules Limit Patient Telehealth Options, Information Week, April 29, 2011


Medical Device Data Security
✤ HIPAA Privacy & Security:
✤ Con dentiality (only authorized users)
✤ Integrity (precise, accurate, and complete - not altered or destroyed)
✤ Availability (accessible when and where needed)
✤ Data at Rest: on devices; on computers; on servers
✤ Data in Motion: wired and wireless communications channels; storage media
being transported (CDs, DVDs, USB drives)
✤ Roles: who has access to what and what are their security obligations?
✤ “Business associates”
✤ Authentication: key management and updating roles/access

Home Health Security
✤ Less controlled environment than healthcare provider facilities

✤ Less sophisticated users with less training and experience

✤ The more connected things become, the more vulnerabilities there are

✤ Finding the balance between security and ease-of-use


Market for Mobile Health

✤ Estimates vary, but the
numbers are in the
billions of dollars

Source: http://mobihealthnews.com/04-15-10-mhealth-predictions-verizons-new-mhealth-platform/


Examples

✤ Blood Pressure Tracker ✤ Practice Fusion

✤ Digi t ✤ Runkeeper

✤ Heart Rate ✤ Sleep Cycle

✤ Heartwise ✤ Tonic

✤ iHealth

✤ MedApps

Blood Pressure Tracker


Heart Rate
✤ Uses camera lens and ash on
back of iPhone 4

✤ Simple app - no export


Sleep Cycle Alarm Clock


Information Sources
✤ http://www.mobilehealthwatch.com/

✤ http://mobihealthnews.com

✤ http://www. ercemobilehealthcare.com/

✤ http://www.mobilehealthcomputing.com/

✤ http://www.mhealthupdate.com/


David Snyder
President
42TEK, Inc.
www.42tek.com
david@42tek.com
http://www.linkedin.com/in/dmsnyder


Mobile healthaug4 snyder

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