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Industry-First Exclusive: Cleveland Clinic Medical Informaticists and Authors Discuss the Global mHealth Journey

November 18, 2013
by Mark Hagland
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David Levin, M.D. and William H. Morris, M.D. of the Cleveland Clinic share their perspectives on the global mHealth journey

On Nov. 18, Colin Konschak of Divurgent, a healthcare management consulting firm, and David Levin, M.D., CMIO of Cleveland Clinic, and William H. Morris, M.D., director of clinical informatics at Cleveland Clinic, announced the publication of their new book, mHealth: Global Opportunities and Challenges, published by Convurgent Publishers.

As articulated in a summary online, the authors explain that mHealth: Global Opportunities and Challenges provides the ultimate coverage of all aspects of the burgeoning mobile health arena. It integrates issues around the clinical, policy, and technical aspects of mHealth to highlight the potential this transformative technology holds for healthcare systems throughout the world.”

As the authors further note, readers will “read about what works and what doesn’t’; the barriers to full integration; and the strategies that companies like Aetna, AT&T and Intermountain healthcare employ, as well as organizations like USAID and countries like Zimbabwe, are utilizing.”

Shortly before publication, Drs. Dave Levin and Will Morris spoke exclusively with HCI Editor-in-Chief Mark Hagland regarding their objectives for the book, and their perspectives on where the mHealth phenomenon is headed. Below are excerpts from that interview. This will be the first in a two-part interview. The second part of the interview will be published soon.

Gentlemen, you’ve produced a very important new book in this very important arena. Was part of your purpose to produce a textbook-like resource for healthcare leaders, as they lead their organizations forward in this area?

David Levin, M.D.: Part of the vision of the book was that we wanted to create a guide that people could go to and begin to see the whole landscape. At the same time, we wanted it to be accessible, so we had to balance putting in enough detail to be credible, but engaging for people.

How far along are we on the mobility journey, as a global healthcare system? Is it a bit like the human journey around the discovery of fire, then tools, then machines?

William H. Morris, M.D.: My perception is, we have fire—we have the core elements. So we’re well on our way on two things, in healthcare, towards pervasive health IT. And you need two things: the first is a purely electronic infrastructure; you can’t be paper-based, obviously. And we’re well on our way on that one. Where we’re not quite as far is in making the data liquid and easily transferable. And we have to work through the issues of security and privacy and data standards. The challenge is making it liquid now.

The other key piece on the clinical side is in terms of the culture. And though clinicians would like data to be liquid, that’s not how healthcare is organized right now. So something as seemingly obvious as an open medical record, that’s not a technological issue, but a cultural issue: making the record accessible to patients—there’s a cultural barrier there. So it’s one of culture, and I think we’re about 50 percent over the hump. Once the data is out there and you can personally view your data at home or on a mobile—I think we’re about 50 percent there. So we’re not in our infancy, we’re well underway, and I see parallel efforts in both those areas daily, and things are moving at a very rapid pace. Six months ago, we were barely talking about an open record, for example, but that’s changing quickly.

Levin: I agree with everything that Will has said; we have fire now. But you can get burned with fire, too. We’re seeing all kinds of really crappy apps; we’re seeing stuff that is not secure; we’re seeing stuff being pushed into the workflow that’s not going to work. I was doing a presentation recently to people from another health system, and I asked them, are the guys trying to sell you apps showing up? And they all raised their hands. There are a lots of well-meaning technologies, but poorly executed. The core infrastructure is being put in place, and culture, we’ve got to work on that; but what actually what works, what will stick, that remains a very open question.

And part of the theory of this book is that there are these three things driving this perfect storm of things. One is mobility, which goes far beyond smartphones, towards a vast array of streaming data. The other two drivers—one is rising consumerism. And the third driver is the coming transformation of how we get paid to do what we do. Classically, it’s defined as the conversion from a volume-based to a value-based system.

And that’s so important because that begins to realign the economic incentives, so that all of a sudden, thinking about giving a patient a tablet to help them avert a readmission actually begins to make business sense.

Where are doctors  in practice, in all this? My own personal physician, Dr. X, simply feels oppressed by all the demands on him that are forcing him to use an electronic health record and other clinical information systems. If he were forced right now to engage directly with patients via mobility, he’d really be upset.