In late August, researchers in the Global Institute for Emerging Healthcare Practices at the Falls Church, Va.-based CSC, released a new white paper entitled “Harnessing the Value of mHealth For Your Organization,” which looked at the proliferation of next-generation smart mobile devices, and the implications of mobile device adoption among physicians and other clinicians in U.S. patient care organizations.
In that report, Fran Turisco, research principal in the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices, and Mike Garzone, chief technology officer for CSC’s U.S. Health Delivery Group, examine the recent acceleration in clinician adoption of mobile health (mHealth), and the challenges facing CIOs, CMIOs, and other healthcare IT leaders, as they react to an adoption curve that is in most organizations outstripping strategic planning for mobile health.
There are many aspects of this landscape of opportunity and challenge, and Turisco and Garzone delve into the broad range of implications involved. As they note, “Opportunities and challenges abound with mHealth and they are always increasing—enough to overwhelm many organizations. However, having completed the strategy and roadmap, ‘mHealth-ready’ organizations are equipped to tackle their highest project projects.” And as they emphasize, “[S]uccessful mHealth projects require much more than simply introducing new technology. There needs to be a program or process that incorporates the solution, and this can involve business and care processes, changing roles and responsibilities, and adding support services for device and application management and user support (Help Desk).”
Recently, HCI Editor-in-Chief Mark Hagland spoke with Fran Turisco regarding the report and its implications. Below are excerpts from that interview.
With regard to your report, how should the CIO, CMIO, vice-president-clinical informatics, and other healthcare IT leaders, be thinking strategically about the issues you and Mike Garzone illuminated?
I think the CIO needs to think about some of the big areas, as discussed in table 3 of our report (“Key mHealth Strategy Questions”). They need to ask, what do you want to do with mobility, and what is already being done with mobility? Are the doctors walking around already using the ePocrates dose calculator, or chatting with their patients via different apps? What are they using technology for already, and what do you see as your organization’s direction per mobility? One of the major elements under healthcare reform is all this stuff around the concept of accountable care—with small ‘a’ and small ‘c.’ And in terms of that broader concept of accountable care, it’s all about connecting the points of care, which fits in really well with the mobile health concept. And mobile health can be the preferred mode for expediting coordinated care.
So where is your organization moving in terms of this broad concept of accountable or coordinated care, and what’s already happening now in terms of devices? And iPads are the number-one device of choice right now. And you need to come up with an overall strategy; you need an overall program that encompasses governance and policies and procedures. For example, are you going to adopt a specific sanctioned platform? A lot of the apps work on Android and IOS. And are you going to prioritize requests?
Our feeling is that because what this offers is much more than technology—obviously, you’re building your governance and your support, and you’re deciding on what apps to use and how they’ll be used in the organization. And logically, you’ll want to begin by taking a project that picks off the low-hanging fruit. So if you’re concerned about Medicare patients being readmitted in 30 days, you set up a program to do address that issue. And that means there will be a technology component to it; there will be different workflows; and if you use an app, you’ll teach the patient to use the app; you’ll support the app, whether it’s used in the home or truly is mobile and is in the patient’s pocket—those kinds of things.
So we see organizations coming up with a mobility strategy, mobility governance, mobility infrastructure. And those different elements may be somewhat separate now, but they should ultimately be integrated. The typical situation we’re seeing involves a mixed picture. For example, we talked to the leaders at one particular hospital, and they had figured out which devices to allow, and had developed a policy around that. Their policy was that clinicians could bring in any devices they wanted, but that they had to hand each device to IT so the IT people could [implement encryption and security on that device].
And they had developed a few apps, but they were all siloed, and weren’t connected yet to the clinical information system. They had a Citrix view into the clinical information system, but the mobile apps that they had created weren’t yet integrated into their clinical system. So for example, there might be a dose calculator or an image viewer—but the apps weren’t integrated into the overall clinical information suite.
And that’s where things are going. And that’s what the paper said, which is that these tools are cool and neat, but the longevity of use comes from the integration, so that summaries can be created for physicians and patients, for example. So that’s where we’re at right now, is that we’ve got thousands of apps doing different things—but those apps have to be integrated into core clinical information system development for truly accountable care and sustainability of use.