This whitepaper details 4 key aspects that make up a present-day mHealth strategy for healthcare organizations.

1. May 2019
Enterprise mHealth
Strategy 2019
White Paper

2. Current State of Mobile Health
The $28 billion global mobile healthcare market is
expected to grow at ~32% to become $189 billion by
2025. Although ~77% of Americans own a
smartphone, only ~25% of providers currently use
mobile for healthcare leading to a tremendous growth
opportunity.
Growth Trends
▪ By 2020, digital twins will exist for potentially
billions of things.
▪ By 2021, 33% of Enterprises will have platforms to
support mobile, web, conversational & AR, VR
development by 2021
▪ By 2022, at least 40 percent of new application
development projects will have AI co-developers on
their team
▪ 25 Billion – Number of connected devices by 2021
▪ 66% of companies doing digital transformation
expect to generate more revenue from their
operations, while 48% predict that more business
will arrive through digital channels.
OVERVIEW (1/2)
1
Technology Applications
IoT / Wearables Monitoring, staff / device tracking
AI
Virtual nursing and advanced
diagnoses
Cloud
SaaS apps and advanced analytics
services
Blockchain Increased security and simplicity
NLP / Voice
Clinical notes and care
coordination
AR / VR Training, rehab and treatment

3. 2
Use Cases
Care Coordination Monitoring Advanced Analytics
Device Type
IoT /
Wearables
Memorial Sloan Kettering
Cancer Center uses activity
trackers to improve prognosis
University of Rochester
medical center uses IoT to
monitor room noise, lighting
and equipment
Hospitals use IoT tags for
patient pathway analytics,
process optimization and
reduction in care time
Medical
Devices
Mayo Clinic uses RFID smart-
beds to sync with Provider
apps and locate medical
equipment
Stanford Medicine uses Apple
Watch to monitor irregular
heart rhythm
Providers use AI powered
insulin and asthma devices to
improve outpatient care
mHealth
Apps
New York Presbyterian has
apps for secure messaging,
medication management and
clinical data
Trinity Health uses a telehealth
platform to monitor patient
vitals & automated alerts to
Providers
AICure App uses AI and image
analysis to identify medication
from images and adherence
patterns
OVERVIEW (2/2)
Healthcare Industry Snapshots

4. 3
▪ Over the past few years healthcare enterprises have
developed large suite of mHealth apps to deliver
variety of healthcare use cases
▪ Mobile still remains a de-facto mechanism for
delivering rapid innovations and disruptions
▪ Enterprises should revisit their mobile strategy for
including but not limited to the following
considerations:
▪ Interoperability with FHIR and support for latest
development techniques like microservices,
containers etc.
▪ Scalability to support IoT and data streaming
apps
▪ Security governance for HIPPA Compliance and
protection of PHI data
KEY CONSIDERATIONS: mHEALTH STRATEGY

5. 4
What does digital transformation mean for
mHealth applications?
▪ The healthcare industry is catching up to the digital
revolution that has disrupted other sectors, mobile
devices along with technologies like AI/ML, Voice,
AR/VR etc. is reshaping patient care
▪ Leading healthcare providers have started
leveraging these technologies for providing
solutions for healthcare uses cases like remote
monitoring, chronic care condition management
etc.
Recommendations: Implementing Digital Trends
Innovation involves
▪ Latest / better technologies
▪ Faster experimentation
▪ Modern marketing
▪ Cannibalization of existing apps
Optimization for
▪ Longer workflows
▪ Fewer bugs, performant
▪ Better standards support
▪ Deeper internal integration
▪ Wider external integration
Best Practices
▪ App analytics
▪ Crash reporting
▪ Improving iterations
▪ Mobile DevOps
▪ Mobile test automation & sustenance
MOBILE ENTERPRISE ARCHITECTURE: DIGITAL TRENDS
Enablers Sources App Catalogs

6. 5
Why FHIR Backend is essential for mHealth
applications?
▪ FHIR supports microservices architecture, enabling
an ecosystem of connected healthcare applications
developed by different vendors
▪ In current healthcare systems, there exists many
legacy interoperability standards like HL7 v2
implementations, CCD documents etc. But, FHIR
makes integrations with legacy systems easier since
it has a well-documented mapping between FHIR
resources and legacy interoperability standards
Solution : FHIR Backend Implementation
▪ The recommended way of implementing FHIR
backend is via a RESTful FHIR server and a FHIR data
model (SMART-on-FHIR, UDMH etc.)
▪ The backend consumes data from two source types:
▪ Non-native: These sources send data in non-
FHIR format i.e. HL7, DICOM etc. and need to be
parsed and transformed
▪ Native: These sources can respond in FHIR APIs
and directly send FHIR payloads
▪ Once the backend data model is fixed, and
ingestion engine and APIs are established, devices
can communicate using standard API responses
Best Practices
▪ Authentication & refresh tokens usage
▪ Using a defined data model
▪ Complying with regulatory requirements
▪ Using profiles to restrict data access
▪ Having a robust error handling mechanism
▪ Implementing transport & rest encryption
MOBILE ENTERPRISE ARCHITECTURE: FHIR BACKEND

7. 6
Why Scalability is important aspect for mHealth
enterprise applications?
▪ With the advent of new technologies such as the
Internet of Things (IoT), artificial intelligence (AI),
machine learning (ML), cloud, analytics etc. Mobile
use-cases are set to grow at a rapid pace which
would need the architecture to scale rapidly
▪ Increase in demand, growing user base, new
business ideas / features incorporation, OS releases,
tech innovations, market trends etc. are few
enablers which would require mHealth app to scale
appropriately
Solution: Scalability Implementation
▪ Adapt containerized microservices model to support
scaling services on demand
▪ Usage of HTTP2 SSE for developing apps which
handle data streaming scenarios
▪ Develop application in cloud which provides option
to pay only for bandwidth in use and is expandable
▪ DevOps matrix to gain insights into release cycles,
rollback, CPU utilizations, etc.
Best Practices
▪ Scalability testing
▪ Traffic manager configuration (routing & health
probe)
▪ Regional pairing
▪ Geo-replication
▪ Security & compliance
▪ Availability considerations
MOBILE ENTERPRISE ARCHITECTURE: DIGITAL TRENDS

8. 7
What does security mean for mHealth
applications?
▪ With the increasing focus on consumerism in
healthcare, patients are taking more control over
their data through mobile applications which has
led to security and privacy concerns of PHI data
during transit and rest
▪ Compliance for healthcare regulatory standards as
well as managing vulnerabilities like unsafe user
session, man-in-the-middle (MITM) attacks, device
risks like unknown device, confidential data leaks,
SQL injection, unaware intrusion etc., have become
essential for m-Health applications
Solution: Security Recommendations
▪ Authentication: App accessible only to the
authenticated users, verification of password policy,
test if no unnecessary permissions are assigned to
the app
▪ Cryptography: Check data encryption algorithms,
strength, key length etc.
▪ Code security: Test if code obfuscation is in place
by prohibiting the app to be decompiled and
reverse engineered
▪ Component analysis: Verify existing vulnerabilities
in the components
Best Practices
▪ Security testing
▪ Encryption
▪ Remote wipe
▪ Auto-lock
▪ Secure password policies
▪ Master device & app management
MOBILE ENTERPRISE ARCHITECTURE: SECURITY

9. 8
Technologies such as the Internet of Things (IoT), artificial
intelligence (AI), cloud, analytics are rapidly disrupting
healthcare business models and driving exponential
growth across verticals.
Digital transformation has enabled healthcare
organizations unlock service improvements across the
clinical value chain and improve operational efficiencies
while driving innovation.
For better part of the decade, healthcare enterprises have
adopted mobile specific use cases that require existing
apps to scale for seamless business workflows, upgrades
platforms and handle more users. But extending mobile
apps without proper architecture results in unsatisfied end
users, untimely retirement of apps and eventually losing
out on competition.
Healthcare organizations need to relook their existing
enterprise mobile strategy to proactively tackle these
issues and build a better healthcare system.
CONCLUSION

10. 9
REFERENCES
▪ https://www.gartner.com/en/newsroom/press-releases/2018-10-15-gartner-identifies-the-top-10-strategic-
technology-trends-for-2019
▪ https://smarthealthit.org/

11. 10
ABOUT THE AUTHORS
Harshal Sawant
Mobile Practice Lead, CitiusTech
harshal.sawant@citiustech.com
Harshal has 13+ years of experience in designing and developing enterprise applications. Additionally, he has
extensively worked on Microsoft and mobile technologies (Xamarin, Android, iOS). He has worked with some
of the biggest companies in healthcare spanning medical imaging, patient portals, personal health records,
and digital health transformations. He is also a certified HL7 v2.7 professional.
Vidhya Jain
Technical Lead, CitiusTech
vidhya.jain@citiustech.com
Vidhya has 8+ years of experience in designing, developing and deploying iOS and Android mobile
applications. She has developed m-Health applications for Referring Providers, Chronic Disease Management,
Patient Engagement and more. She is a Certified AWS Developer with technical expertise in developing and
maintaining applications on AWS platform.

12. CitiusTech is a specialist provider of healthcare technology services and
solutions to healthcare technology companies, providers, payers and life
sciences organizations. With over 3,500 professionals worldwide,
CitiusTech enables healthcare organizations to drive clinical value chain
excellence - across integration & interoperability, data management
(EDW, Big Data), performance management (BI/analytics), predictive
analytics & data science and digital engagement (mobile, IoT).
CitiusTech helps customers accelerate innovation in healthcare through
specialized solutions, healthcare technology platforms, proficiencies and
accelerators. With cutting-edge technology expertise, world-class service
quality and a global resource base, CitiusTech consistently delivers best-
in-class solutions and an unmatched cost advantage to healthcare
organizations worldwide.
For queries contact thoughtleaders@citiustech.com
Copyright © CitiusTech 2019. All Rights Reserved.