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Transforming Healthcare with mHealth Solutions August 2011
1.
Transforming Healthcare with mHealth
Solutions The Opportunities, Efficiencies, and ROI of Mobile Technology August 2011 Copyright © Galvin Consulting and Technology Coast Consulting
2.
Transforming Healthcare with
mHealth Solutions 2 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 TABLE OF CONTENTS Executive Summary....................................................................................................................5 Target Audience .........................................................................................................................8 Background and Methodology ...................................................................................................9 Current State of Mobile Technology in Healthcare Organizations............................................10 mHealth Market Trends.......................................................................................................10 Mobility to Quell the “Perfect Storm” ........................................................................................... 10 Bring Your Own Device (BYOD) ..................................................................................................... 11 Physicians at Forefront of Mobility Adoption ................................................................................ 11 Healthcare Ecosystem Embraces Mobility..................................................................................... 12 Healthcare Organizations Increasingly Provide Standardized Mobility Support.............................. 12 Accountable Care Organizations Increasingly Important ............................................................... 13 Growth Data.........................................................................................................................15 Sources of mHealth Growth.......................................................................................................... 15 Mobile Product Roadmaps and Healthcare IT Investments......................................................16 Mobile Application Technology Market Segmentation ............................................................19 Enterprise Applications..................................................................................................................... 19 Small and Medium Business Applications.......................................................................................... 20 Consumer Applications ..................................................................................................................... 21 Healthcare Transformation through Mobility ..........................................................................21 Innovation ........................................................................................................................................ 22 Efficiencies ....................................................................................................................................... 25 Improved Patient Outcomes ............................................................................................................. 27 Mobility ROI ..................................................................................................................................... 29 Technology Overview...............................................................................................................34 Mobility Vendor Business Models..................................................................................................... 34 Form Factor/Hardware ..................................................................................................................... 37 User Preferences vs. Developer Preferences..................................................................................... 40 Application Type: Native, Web, Hybrid and HTML5 .......................................................................... 41 Mobile Enterprise Application Platform (MEAP) Vendors........................................................43 Single Platform MEAPs..................................................................................................................... 43 Multi-platform MEAPs ...................................................................................................................... 44 Rising Niche Mobile Developers........................................................................................................ 46 Packaged Healthcare Applications .................................................................................................... 47 MEAP Technology Differentiators ..................................................................................................... 51 Mobile Device Management (MDM) Vendors..........................................................................56 Why MDMs are Important in Healthcare Mobility............................................................................. 56 MDM Vendors’ Views of the Healthcare Market ............................................................................... 57 MDM and Security in the Healthcare Setting..................................................................................... 60 MDM Features of Special Interest to Healthcare Customers.............................................................. 65
3.
Transforming Healthcare with
mHealth Solutions 3 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 MDM Vendor Profiles ........................................................................................................................ 68 AirWatch ...................................................................................................................................... 68 McAfee......................................................................................................................................... 69 MobileIron.................................................................................................................................... 70 Motorola Solutions ....................................................................................................................... 72 SAP............................................................................................................................................... 74 Zenprise........................................................................................................................................ 75 Regulation and mHealth Product Development.......................................................................79 Policies and Procedures............................................................................................................81 Internal Battles for IT Resources ..............................................................................................83 Healthcare Mobility Pain Points and Technology Solutions .....................................................85 Looking to the Future ...............................................................................................................89 The Future is Now............................................................................................................................. 89 Federal Regulation Nudges mHealth Forward.................................................................................... 89 Extending the Value of Legacy Healthcare Equipment and Devices.................................................... 90 Remote Care Expected to Expand...................................................................................................... 90 mHealth to Reach New Markets........................................................................................................ 91 Viral Mobility to Combat Viruses....................................................................................................... 92 Recommendations and Conclusions.........................................................................................93 About the Analysts ...................................................................................................................95 License......................................................................................................................................96 No Unauthorized Distribution ..................................................................................................96 Disclaimer.................................................................................................................................96 Contact Information .................................................................................................................96
4.
Transforming Healthcare with
mHealth Solutions 4 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 LIST OF TABLES Table 1: Overview of mHealth Use Case Findings Across the Healthcare Continuum Table 2: Mobility Platform Features Relevant to Healthcare Settings Table 3: Native, Web, Hybrid and HTML5 Applications Table 4: MEAP Profiles by Application Type and OS Support of Native Applications Table 5: MEAP Focus on Healthcare Table 6: MEAP Development Approach and Security Features Table 7: MDM Focus on Healthcare Table 8: MDM Security Offerings Table 9: MDM Features of Special Interest to Healthcare Customers Table 10: Considerations for Implementing Mobility Policies and Procedures Table 11: Sample Reimbursement Policy Matrix Table 12: Healthcare Mobility Pain Points and Technology Solutions LIST OF FIGURES Figure 1: Where mHealth Can Offer Promise Figure 2: ACO Synergies with mHealth Solutions Figure 3: Growth Opportunities Figure 4: Mobility Enterprise-Friendly Progress Figure 5: mHealth Solution Providers and Application Categories Figure 6: Doctor and Dentist Offices Benefit from Mobile Applications Figure 7: Profiled Innovations Figure 8: Profiled Efficiencies Figure 9: Improved Patient Outcomes Figure 10: Mobility ROI Figure 11: Before Selecting a MEAP Figure 12: Before Selecting a MDM Figure 13: New Regulation Figure 14: Current Regulation
5.
Transforming Healthcare with
mHealth Solutions 5 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 EXECUTIVE SUMMARY Mobility in the general workforce is expected to increase at an unprecedented rate in the coming years, both in the United States and overseas. Mobility in the healthcare sector will mirror that trend as healthcare providers, insurers, consumers, and government leaders all search for ways to increase efficiencies, lower costs, and improve patient care. Many healthcare professionals are looking to new mobility technologies as a way to solve some of the industry’s most pressing problems. These thought leaders believe society is on the cusp of dynamic change in the way healthcare is both provided and consumed. Mobilizing healthcare employees, as well as extending enterprise applications to customers, requires a significant commitment and the redirection of vital resources. To the discomfort of some legacy healthcare application developers, it may mean rethinking the value of the current enterprise roadmap against the potential ROI gains of mobility initiatives. After all, not all projects can be green-lighted. Theoretically applications that deliver the most value to the widest audience should take precedent - or so most CIOs would like to believe. There is no guarantee that the disruptive invasion of mobile initiatives will drive value in healthcare organizations. But if the concept of mobility does not challenge the healthcare IT status quo, which one could argue needs to be challenged regardless, then it is hardly disruptive. Nevertheless, we believe mobility in healthcare has the potential to transform – indeed, has already begun to transform – the medical arena. This study includes the latest research on the healthcare industry's mobile successes as gauged by two fundamental measurements, revenues and costs. Given the sensitive nature of healthcare, we parse these topics into relatable, human metrics. The research is highly attentive to the sensitivities of enterprise budget considerations as well: Revenue opportunities come in many forms. Had we only looked at hard data, this would have been an easy point to miss. In speaking to our subject matter experts, we uncovered the subtleties of how putting patients first is not only good medicine, but good business. More to the point, we reveal how healthcare organizations are harnessing emerging mobile technology to create new markets and forge deeper patient/provider relationships too. We explore how the unique characteristic of mobility allows a cross-section of healthcare providers to expand beyond traditional healthcare management objectives. The combined “stickiness” of a mobile app and the intensely personal nature of mobile device interaction create the perfect opportunity for customer intimacy and loyalty. Cost efficiency: We chose to focus on the healthcare vertical precisely because of its well- publicized cost management issues. If mobility has a valid value proposition for lowering costs and improving productivity, one could not ask for a better testing ground than healthcare IT. Healthcare workers were mobile long before anyone thought of “mobility” in terms of smartphones and tablets. But mobile healthcare solutions have a long and expensive history of being proprietary, and often inconvenient. This study focuses on the new generation of mobility. Specifically, we explore how the marriage of smartphones and
6.
Transforming Healthcare with
mHealth Solutions 6 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 tablets with apps and mobile Web enables progressive operational changes, improves information accessibility and increases data accuracy in healthcare systems. Mobility ROI: Any seasoned technology research analyst will attempt to derive or extract some measure of an implemented technology’s Return on Investment. Most seasoned technology analysts acknowledge that organizations do not make this an easy job for those analyzing a technology’s value to the business. We pressed our subject matter experts, who in many cases were responsible for allocating significant portions of their enterprise’s budget, to articulate their expectations of tangible returns. A major focus of every interview was to identify where healthcare organizations are seeing material productivity gains and tangible savings resulting from mobility investments. Healthcare mobility goes beyond delivering information efficiently. Healthcare is an industry that has particular form factor and information delivery needs. For this study we reached out to leading mobility developers and their users to understand which devices, mobile operating systems and mobile application platforms are preferred in healthcare settings. The technology analysis of the report goes on to address infrastructure requirements. Primary research for an earlier study, Smartphones in the US Enterprise, revealed a wide gap among enterprise managers regarding their knowledge of enabling mobile technology. This study profiles the leading technology used to build mobile applications (Mobile Enterprise Application Platforms, or MEAPs) and manage the applications and partnered devices once deployed to end-users (Mobile Device Management or MDM). “mHealth” is a relatively new term that describes an organized system of mobile devices used to collect community and clinical health data, either via mobile devices or integrated medical- based peripherals. The collected healthcare information is delivered to practitioners, researchers or patients, real-time. Innovative Uses of Mobile Technology in Healthcare features cutting-edge mHealth achievements from diverse healthcare entities, ranging from start-ups to established medical institutions. We address how mobilized patients, caregivers, physicians and rehabilitation providers are changing the way medicine is provided and received, as well as the major players enabling these new innovations and efficiencies in healthcare. Table 1 encapsulates the primary research findings uncovered through interviews with healthcare providers and executives, insurers, pharmaceutical industry representatives and mHealth solution developers. mHealth solutions described in the table are featured throughout the study.
7.
Transforming Healthcare with
mHealth Solutions 7 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Table 1: Overview of mHealth Use Case Findings across the Healthcare Continuum User mHealth Solution Benefits Hospitals Electronic Health Records, Health Information Exchange Telehealth/remote care Patient self-registration using tablets Bar code scanning Accessibility of patient data; reduction in procedures and tests; fewer medical errors Improved patient access to physicians; increased billable hours Lower administrative costs; faster service Improved supply chain efficiency/accuracy; increased productivity; lower risk of compliance breaches Doctors, Nurses Electronic Health Records, Health Information Exchange Telehealth/remote care Peripheral devices integrated into mHealth solutions Accurate and timely feedback to patients; ease of coordinating remote providers; streamlined consultations Regular patient monitoring; increased productivity; reduced travel time Real-time updates of patient data; ability to offer “untethered” care outside of traditional settings Insurance Companies Consumer self-help apps Ease of locating specialists and services in network; lower costs with drug cost-comparison shopping; increased consumer usage of plan benefits; better management of medical expense accounts Suppliers Mobile apps replace paper-based forms; bar code scanning Increased accuracy and lower costs; compliance- certified apps meet regulatory requirements Community-based retail stores use mobility to improve ACO care coordination Pharmacies Drug reference and drug interaction apps Mobile access to back- office systems Real-time access to data to advise doctors and patients on drug therapies and associated risks Enables pharmacists to interact with patients “in the aisles” with access to real-time patient data Drug and Medical Supply CRM Mobile CRM apps for “detail” sales representatives More efficient and accurate order processing; improved compliance in sample distribution; digital signature capture Federal Agencies Electronic Health Records, Health Information Exchange Ability to identify and catalog worldwide epidemiologic trends Consumers Symptom checker Apps with integrated peripheral devices Telehealth/remote care Social engagement-based solutions Insurance benefit apps Interactive apps to identify appropriate care providers Accurate and timely feedback of health data; rapid throughput of test results to providers Improved care/lower costs through home healthcare Greater emphasis on patient-centered care; reduced isolation of convalescing patients Increased knowledge of cost/benefit trade-offs
8.
Transforming Healthcare with
mHealth Solutions 8 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 TARGET AUDIENCE Innovative Uses of Mobile Technology in Healthcare serves a multi-faceted audience within enterprise, operational, end-user and public agency settings. The research results and analysis target enterprise managers and executives tasked with mobilizing workers in hospitals, healthcare organizations, rehabilitation clinics and other healthcare settings, specifically: Regional healthcare operation managers can learn about significant savings realized by small-to-medium operations that successfully deployed mobile applications. Mobilized healthcare providers including physicians, nurses, technicians, and all other caregivers in the healthcare continuum that wish to leverage smartphones and tablets for improving productivity and patient care will find the study highly relevant. Healthcare-focused executives at insurance companies, federal and state health regulatory agencies, healthcare industry organizations, and groups with a vested interest in improving patient outcomes and lowering overall healthcare costs, can learn how mobility enables efficient workflow processes. Enterprise vendors selling mobility solutions to the healthcare industry, including both products and services, can translate the study into a guide to the key drivers, opportunities, efficiencies and ROI healthcare end-users seek, both today and in the future.
9.
Transforming Healthcare with
mHealth Solutions 9 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 BACKGROUND AND METHODOLOGY Primary and secondary research for this study took place during April – July 2011 and included interviews with healthcare IT executives, physicians, nurses, and other healthcare providers. Additionally, qualitative research findings were gathered through the use of an online survey tool, from participation in Webinars and online forums, and from live discussions at industry events. Report contributors included CXOs, VPs, directors and managers. Participants were represented from marketing, sales, technology, and business analyst perspectives and provided both tactical, as well as strategic feedback regarding their organization’s healthcare mobility technology. Respondents represented hospitals, insurance companies, pharmaceutical companies, pharmacies, healthcare IT, healthcare education, telecommunications providers, mobile enterprise application platform vendors, mobile device management vendors, back- office vendors and their partners, end-users, industry experts, and healthcare entrepreneurs. End-user research targeted North American and European based hospitals, providers, and vendors with at least several thousand employees. Over 50 percent of respondents had over 5,000 employees in their organizations.
10.
Transforming Healthcare with
mHealth Solutions 10 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 CURRENT STATE OF MOBILE TECHNOLOGY IN HEALTHCARE ORGANIZATIONS mHealth Market Trends Many experts agree that mobility has the potential to play a key role in the changing healthcare market. It’s a real force – a global trend and a revolutionary movement, according to many observers. The investments chasing the healthcare mobility market have the attention of many healthcare executives and traditional enterprise vendors, many of whom are trying to understand how mobility can impact their business. We offer the following perspective: A cardiologist we spoke with recounted a key moment from a statistics course he attended several decades ago. His statistics professor framed the role that data should play in medical practice. Paraphrasing, the professor began the lecture with: “Here is all you need to know about statistics for the rest of your career: If it always happens, you need to know it. If it sometimes happens, you should know it. If it never happens, you don’t need to know it.” After this brief statement, the professor ended the lecture, making a lasting impression on his students. The cardiologist agreed with his professor's basic premise – trends are only important if they impact doctors’ daily routines. Indeed, the nascent market of mHealth is showing strong signs of ubiquity. A February 2011 report authored by Pyramid Research found that more than 200 million mobile health applications are used by doctors and patients today, and more than 600 million medical apps will be available by 2012. (Source: Pyramid Research) Members of the healthcare community we interviewed believe mobility will pervade most healthcare settings at a pace that will challenge those tasked with harnessing it. Mobility’s impact is only expected to accelerate as the burden for improving patient care and lowering medical costs shift to those providing, and receiving, healthcare. Below we describe trends around smartphones’ and tablets’ expanding roles in healthcare settings. Mobility to Quell the “Perfect Storm” According to one physician, the United States and many developed countries are positioned at the center of a “perfect storm” in terms of needing mobility tools to help solve healthcare issues. In the United States, there has been a monumental push for healthcare reform. Although controversial, many experts agree that the healthcare system as it currently exists is unsustainable. In addition, the worldwide economic downturn has led to fewer resources being available for managing patient needs. A February 2011 report authored by Pyramid Research found that more than 200 million mobile health applications are used by doctors and patients today, and more than 600 million medical apps will be available by 2012. (Source: Pyramid Research)
11.
Transforming Healthcare with
mHealth Solutions 11 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 A chronic shortage of workers, many of whom are “burnt out,” is only expected to worsen as budget cuts decrease medical provider compensation. Demographics play a key role, as many developed countries have an aging population with high levels of chronic disease too expensive to manage long term. Finally, there is increasing pressure from federal authorities to adopt Electronic Health Records (EHRs) and a Health Information Exchange (HIE). Bring Your Own Device (BYOD) As mobile technology moves into the healthcare setting, one of the key drivers of this movement is the push from consumers demanding that their personal mobile devices are supported by healthcare IT departments. Industry experts generally agree that it is very common in healthcare settings for individual-liable devices to enter the work place. Physicians lead the category of healthcare professionals who procure and use their own tablets or mobile phones for patient care. Patient-facing shift workers, such as nurses and technicians, are more likely to work on corporate purchased mobile devices that move within, but do not leave, the healthcare facility. Physicians at Forefront of Mobility Adoption Government funding to implement EHRs into medical practices is a catalyst driving doctors to embrace mobile technology. The American Recovery and Reinvestment Act of 2008 provides up to $44,000 per physician under Medicare or up to $65,000 over 6 years, under Medicaid. Most respondents reported, however, that mobility technology is infrequently, if ever, being used in EHR deployments at this point in time. Nevertheless, it is doctors who are bringing mobile devices into hospitals and other extended healthcare settings, demanding access to hospital networks and applications. Physicians have embraced tablets more readily than smartphones due to tablets’ superior form factor, such as a larger screen size and longer battery life. Apple’s iPad, in particular, is viewed as especially well designed Where mHealth Can Offer Promise A shortage of workers places higher productivity demands on current healthcare professionals. Aging populations with chronic disease levels require careful monitoring. Higher operational costs necessitate leveraging existing enterprise investments to the fullest extent. Drivers of mHealth Adoption Hospital staff bringing personal devices to work. American Recovery and Reinvestment Act which provides $44,000-to- $65,000 per physician. Physicians are ardent adopters of tablets and find new uses for them on the job. iPad mania: According to a February 2011 study by Aptilon, 79 percent of physicians prefer the iPad, compared with 12 percent of doctors who prefer a Windows-based tablet and nine percent who prefer an Android device.
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Transforming Healthcare with
mHealth Solutions 12 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 for the healthcare setting and has been adopted by many physicians. According to a February 2011 study by Aptilon, 79 percent of physicians prefer the iPad, compared with 12 percent of doctors who prefer a Windows-based tablet and nine percent who prefer an Android device. Executives at SAP agree with other industry observers who report widespread usage of tablets in the healthcare mobility market. Company representatives report they are seeing an especially large deployment of iPads and Samsung Galaxy tablets within the healthcare setting. Healthcare Ecosystem Embraces Mobility Point-of-care providers such as physicians, nursing staff, emergency response teams, hospital “Innovation Centers” (centers that focus on best practices, technology testing, prototyping, product evaluations, safety, training, and simulations), and pharmacies are fueling strong demand. Peripherally there is marked interest in mobile technology from clinicians, support staff, and outreach coordinators, as well as healthcare students, executives, field sales representatives, human resources managers, information technology workers, marketing employees, strategy personnel, and finance/administration employees – essentially all facets of the healthcare ecosystem. Healthcare consumers are a forceful undercurrent in the mHealth market, as the thousands of healthcare apps downloaded by millions of users attest. Healthcare Organizations Increasingly Provide Standardized Mobility Support Recently, many healthcare organizations have begun to offer a standardized program of support for mobile devices, as opposed to accommodating “one-off” requests by individual doctors. This was an informal, but prevalent trend that emerged when mobile devices were just emerging in hospitals and healthcare settings. According to one leading MDM vendor, it is only very rarely that organizations do not have some sort of policy in place currently that is either providing the device itself or providing support for the device at an institutional level. Some organizations that do not purchase mobile devices for employees are providing grants or reimbursements that allow users to choose their own device. “Behaviorally we’ll support whatever the doctors want. Some people on my staff question this because there are so many devices to support. Why do we support any device? It was a political decision. We’re a small community and there is little competition. It took us a long time to convince doctors to implement EHRs; we didn’t want to put up a wall to discourage their progression to use and adopt more technology. iPhones and Android-based phones are used most often. We don’t endorse one over the other. We put out instructions for those devices we’ve tested.” VP, Information Technology, Non-Profit Hospital Group in Florida
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mHealth Solutions 13 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Accountable Care Organizations Increasingly Important In addition to an influx of new devices and device types, new organizations are emerging to support changing healthcare needs. One type of organization that is increasingly mentioned as a harbinger of future healthcare is an Accountable Care Organization, or ACO. Although some vendors confessed confusion around ACOs, noting that ACOs are a “new idea, a gray area” with requirements that are still not well understood, physicians reported that ACOs are expected to move care to a more community-based model, avoid the use of expensive emergency services, engage in better continuity and coordination of care to prevent more serious complications, decrease variations in care, and demonstrate better outcomes, including no re- hospitalization within 30 days of discharge. Nowhere is this example more prominent than the home healthcare category. Independa, a developer of mobile technology to enable home healthcare, is one example. Using Independa’s mobile solution, transition from an aged individual's place of residence to the next stage in long term care, such as a nursing home, can conceivably be delayed. Care managers of individuals with healthcare conditions can enlist Independa’s interactive “Angela” platform to monitor and manage a patient’s care. The complete Angela solution consists of an intuitive Windows-based touchscreen tablet designed for the in- home care provider or patient, and Web service for the care manager to establish thresholds, reminders and alerts. While health and safety information is collected within the cloud-based application, having Angela provides additional visibility and flexibility in remote care, above and beyond the inherent and significant benefits of social engagement. For example, thresholds can be presented to the care recipient for behavioral change considerations, or medication compliance can be offered much more visually using the touchscreen format. ACO Synergies with mHealth Solutions Like mHealth, ACOs have the potential to become “game changers” due to their promise of improved coordination and continuity of care. ACOs are expected to drive care to a patient- centered home healthcare. ACOs will promote better communication and coordination between providers, including primary care, specialists, pharmacists, and therapists, as well as the patient. ACO initiatives will drive the integration of health information, including electronic health records, health information exchange, and decision support. According to an executive at Johnson Controls, “Fully realized ACOs and their outreach will need to be fueled by mobility.”
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mHealth Solutions 14 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 If aged individuals have a blood pressure condition their adult children want to proactively manage, medication reminders and blood pressure level thresholds can be established via the Angela Web service. The patient or care provider can confirm medications are being taken and blood pressure readings are in a normal range using Angela. This functionality can be extended to a number of health management scenarios and categories of patients. Mobile solutions such as Angela engage care managers with care receivers, promote good health management habits and help families avoid preventable acute scenarios. Importantly, ACOs will also need to decrease medical errors, an objective that will be facilitated with the use of EHRs and integrated decision support. For example, a doctor who orders an inappropriate medication for a patient due to an allergic reaction would see a pop-up message alerting him or her to the likely adverse effects and suggesting an alternative. Likewise, a duplicate test that has been ordered for a patient would also trigger a pop-up message, alerting medical staff to the unnecessary test, thereby saving money and avoiding unnecessary radiation exposure for the patient. As care increasingly moves to the community and patients’ homes and ACOs attain a greater status and presence, some observers believe that mobile technology will be more critical in these venues, and not necessarily in large hospital settings. As this happens, the need for monitoring technology is expected to increase for acute care issues, as well as chronic diseases. Indeed, acute care and chronic disease management are an increasing focus for retailers throughout many communities. In January 2011, for example, Walgreens announced that, through its pharmacy, health and wellness services, it is also becoming a “critical component of new accountable care organizations by expanding opportunities with health systems.” CVS and Walmart are expected to be major players in this market as well, providing pharmacy and retail medical expertise to improve ACO care coordination. An IT Director with a pharmaceutical wholesaler agrees about the importance of mobile devices in the emerging ACO environment. He notes that “ACOs will be a primary concern for our pharmacy customers, especially hospital and alternate care facilities. As these organizations are formed, it will become increasingly important that we provide solutions that cross organizational divides.” And let’s not forget the consumer. The spirit of ACO has permeated the healthcare end-user, according to insurance provider Humana. As a greater proportion of healthcare costs have shifted to consumers, patients have become more conscientious about medical cost management. They look to their insurers to validate that they are using their healthcare benefits to their full advantage. Common patient inquiries include in-network provider searches, generic or alternative dosage prescription options, medical spending account management, and urgent care locator. Humana studies consumer trends closely and has designed a self-service mobile app called “MyHumana” based on customer service usage patterns.
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mHealth Solutions 15 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Growth Data When discussing mobility in the healthcare market, observers and experts use terms such as “explosive” and “exponential” to describe the projected growth in devices, applications, and software. Physician demand for smart devices, particularly tablets, is expected to drive this growth, but other healthcare workers are also pushing for increased mobility, particularly given the dual goals of improved patient care and lower costs. Research reflects mobile health initiatives becoming a significant part of overall healthcare IT budgets. An InfoWorld article published in May 2011 cites a study by RNCOS. The study estimates healthcare IT spending in the United States is expected to reach $40 billion in 2011. Of that, the mobile health market is estimated to be worth $2.1 billion at the end of 2011, or 5.3 percent of total healthcare IT spending. Multi-billion dollar budgets notwithstanding, healthcare is considered by many to be a laggard in terms of adoption of new technologies. The healthcare industry earned this reputation because it is risk averse – technology in healthcare must first be fully proven before IT leaders will adopt it into a healthcare setting. Indeed, many observers point out that progress in healthcare mobility has required a push from the federal government to adopt technology from other verticals and take these technological advances into the healthcare setting. Sources of mHealth Growth There is some disagreement over the impetus for the current sense of urgency regarding mobility in healthcare. Some observers believe the growth in mobility is coming from the bottom up, as consumers bring devices into healthcare organizations and increasingly use personal-liable devices in a professional setting. Moreover, as consumers become increasingly comfortable with technology, they will recognize that they do not have to physically be in a doctor’s office but When examining growth opportunities, Motorola Solutions believes there are two distinct categories of hospitals that are looking to mobilize their workforce: Large, 300+ bed hospitals, which have first generation voice (such as legacy telephony infrastructure) and point solutions, and have purchased single devices. This type of organization typically purchases a team solution in which there is interoperability of different devices, such as a voice-over-wireless LAN handset, VOW LAN phone (voice in/out of hospital), or a dual phone that works on wireless cell phones. After having had voice for a few years, these customers want to move from a point strategy to a more complete strategy centered around voice. In essence, they want an end- to-end communications strategy. <300 bed hospitals, which have typically had some type of mobility, such as a hybrid of different devices, but not a comprehensive strategy. For smaller organizations, cost is the biggest hindrance in terms of an end-to-end mobility strategy.
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mHealth Solutions 16 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 can have care brought to them, through mobility devices and telemedicine. Projections indicate that over one third of all smartphone holders worldwide, or 1.4 billion people globally, will be using mHealth solutions within the next five years, according to research2guidance. As this happens, providers will realize that the whole world is their market, with healthcare organizations reaching out to patients in different time zones and on different continents. Other industry experts believe the impetus is more top down, as health care organizations, insurers, and the federal government all push to make dramatic changes, primarily as a way to lower costs. Corporate growth emanates from multiple directions. Pyxis Mobile, a MEAP vendor, sees strong demand in the drug and medical device manufacturer market. Pharmaceuticals developers are putting mobile applications in the hands of their sales representatives at the point of data collection, resulting in more efficient order processing and higher data accuracy. Reduced administration is enabling more face-time between pharmaceutical sales representatives and their base of physicians. At this early stage of healthcare mobilization, growth and usage patterns will continue to take form. However, to believe that the growth of mobility is haphazard or accidental is a misconception. Market success, especially where technology is concerned, is incidental – a means to reducing costs or improving patient care. An increasing demand for mobile solutions in healthcare settings signals that mobile solutions work, and work well. MOBILITY PRODUCT ROADMAPS AND HEALTHCARE IT INVESTMENTS Conversations with mHealth buyers and sellers highlight how mobile technology product development can impact healthcare IT purchasing trends – and vice versa. There is palpable excitement about the growth of mobility in the healthcare vertical, including widespread device usage and an explosion of healthcare applications. Future medical practitioners are being indoctrinated into the realm of mHealth. Through informal polling, Epocrates estimates up to 70 percent of medical schools now have a mobile device requirement or recommendation for medical students. Mobile technology is being integrated into students’ training in anticipation of future digitized healthcare practices. Enterprise managers’ concern over security and patient privacy had deterred mass adoption of new MOSs until very recently. Officials at McAfee report that they have seen an accelerating ramp of greater numbers of healthcare organizations using mobile devices since 2010, with the inflection point being the introduction of the iPhone 3GS in mid-2009, which allowed data-at-rest encryption. Other MDM vendors point to the launch of iOS 4 as the watershed moment when compliance- conscious IT managers allowed iOS devices into their enterprises.
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mHealth Solutions 17 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Security Managers viewed iOS 4, with deeper support of Exchange ActiveSync, as proof of Apple’s commitment to corporate users’ needs. Exchange policy settings such as password creation rules, expiration, and history; disabling camera usage; and requiring manual synchronization while roaming to reduce roaming fees removed iOS’s multiple barriers-to-entry within many conservative enterprises. Apple’s consumer device was finally ready for healthcare markets and, as a result, CIOs and CISOs could no longer deny healthcare staff requests for iPhones. Instead, the focus turned to questions about scaling and ensuring compliance. The pent-up demand led to unprecedented market growth, especially for iOS devices. Good Technology analyzed usage patterns among thousands of its enterprise customers from January 2011 to March of2011. The study showed that iOS devices represented just under 70 percent of new devices activated by Good Technology during this period. Healthcare organizations had the second highest iPad adoption rate, contributing to nearly one-quarter of all iPad activations by the end of March 2011. MDM providers generally agree that the US market is moving toward a 100 percent smartphone penetration level, including in the healthcare vertical. According to McAfee’s VP of Mobility David Goldschlag, “The same way everyone has a cell phone, everyone will soon have a smartphone. Penetration will trend toward 100 percent. Once everyone owns a smartphone, the job of the enterprise will be to open the network in a controlled way. Governance will be indifferent to ownership. As such, enterprises get the benefit of mobility without bearing the cost of mobility.” Consider for a moment how 100 percent smartphone penetration might be divided among mobility technology vendors. Apple’s demonstrated sensitivity to mobility policy control in regulated industries was a calculated success. Apple’s strategy allowed iOS to win market share in many healthcare enterprises, even as Android’s rate of growth outpaced iOS for the last quarter of 2010. Mobility Enterprise- Friendly Progress iPhone 3GS introduction allowed data-at-rest encryption. iOS 4 support of Exchange ActiveSync includes policy settings such as password creation rules, expiration, and history; disabling camera usage; and requiring manual synchronization while roaming to reduce roaming fees. Android has improved security for email and vendors have formed partnerships with NitroDesk; SAP offers applications with its SQL Anywhere mobile database and synchronization technology. Third party communication framework vendors, such as OIS, provide interoperability among distributed objects. This alleviates custom integration between disparate Android devices with other devices and back-end systems.
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mHealth Solutions 18 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Android’s consumer-centric product roadmap is welcomed by third parties that see economic advantages in buffering Android’s perceived sub-standard enterprise functionality. In February 2011, SAP announced initiatives to improve Android’s security for email, in partnership with NitroDesk, and applications with SAP’s SQL Anywhere mobile database and synchronization technology. Android device manufacturers have aligned interests in improving Android’s corporate reputation. This is evidenced by Samsung’s and SAP’s joint program to deliver Afaria Advanced Enterprise Security (AES) for Android to Samsung Galaxy S devices. There are unanticipated entrants in the pure-play mobility market. Companies such as Objective Interface Systems (OIS) are responding to the unmet enterprise needs that Android’s consumer market fixation presents. OIS develops cross-industry communication software with a strong niche in military defense and avionics systems – envision F15 fighters engaged in dog- fights while collected data is transmitted to central command. OIS felt its experience in providing secure, high-performing communication frameworks and integration platforms for “failure is not an option” systems could address numerous Android MOS enterprise pain points. For example, there is disparity between Android’s smartphone and tablet operating systems, with further MOS variation among Android’s device manufacturers. OIS's ORBexpress allows developers to write one set of core logic that facilitates secure communication from Android apps to corporate applications and enterprise networks. Because ORBexpress is designed to provide interoperability among distributed objects, both connected and Wi-Fi or Bluetooth remote medical devices are also easily integrated. There is no incremental adaptation required for different device or MOS versions. While Google focuses on captivating the mobile consumer market to promote its search marketing and mobile ad model, organizations such as SAP, Samsung and OIS are staking their product development on ensuring Android’s B2B success. At present, Apple’s iOS enterprise roadmap appears to be resonating with healthcare IT purchasers. Later in the “Mobility Vendor Business Models” section we address Microsoft’s and RIM’s bold new technology investments and implications for healthcare organizations. Healthcare IT purchasers that understand how a mobility vendor’s product roadmap aligns with their internal IT strategy can help ensure a cost- effective, compatible long-term fit. “The same way everyone has a cell phone, everyone will soon have a smartphone. Penetration will trend toward 100 percent. Once everyone owns a smartphone, the job of the enterprise will be to open the network in a controlled way. Governance will be indifferent to ownership. Enterprises get the benefit of mobility without bearing the cost of mobility.” David Goldschlag, McAfee VP of Mobility
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mHealth Solutions 19 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 MOBILE APPLICATION TECHNOLOGY MARKET SEGMENTATION Mobile applications are emerging as one of the highest growth areas within the healthcare mobility market. According to a director at a US-based hospital, “The most significant mobile healthcare projects we are working on are new health applications. We have multiple projects that will enable mobile access to applications (including new mobile applications), security applications that support mobile clients, and updates to existing applications to support them.” Executives at McAfee concur, noting “It’s all about applications and helping to make data more useful in more places while controlling the data.” An executive at MobileIron also agreed, adding that all healthcare organizations have a need for mobility applications. Usage areas include rehabilitation care, inventory control, and instructions to and from patients and instructors. Unlike the broader app market, app sales are not the only primary revenue source. Solution providers for mHealth applications see growth in the adjacent markets of Bluetooth or Wi-Fi enabled medical devices, sensors and point-of-care solutions that feed data to healthcare apps. In fact, the mHealth peripheral market could reach beyond professional healthcare settings. A Mobile Executive Business Lead for MyHumana believes the market has a strong desire for biometric device compatibility with mHealth consumer apps. And as the mobile market has proven, solutions providers are quick to respond. Enterprise Applications In May 2011, Ford Motor Company reported that it has been working with WellDoc, Medtronic, and SDI Health to create a prototype system to monitor health issues, such as asthma and congestive heart failure, while driving. If a driver is in danger, the system can display and transmit alerts using Ford’s SYNC in-car mHealth solution providers believe there are two primary categories of applications: B2C (Business-to-Consumer): Peripherals will allow healthcare workers to take metrics, such as weight and blood pressure, and send readings via a network provider. There are many ways mobile devices become part of a patient's life and allow patients to be much more proactive in managing their health. In one study hemophilia patients with smartphones uploaded and sent wound pictures to their doctors. When used in this way, the device becomes very personal. B2E (Business-to-Enterprise): Mobility applications replace paper forms using a convenient form factor. B2E applications allow greater access to patients when medical providers are on call or otherwise out of the office. TeleNav, developers of mobile solutions for remote workers, estimates that organizations can save $100/form by substituting mobile workforce management solutions to enter, validate and transact patient data, instead of relying on manual data entry processes. Speed is an added benefit as front and back-end processes are no longer separated by time and distance.
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mHealth Solutions 20 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 connectivity capabilities, transmitting information via Bluetooth and downloading data from the cloud. The SYNC platform also uses AppLink to allow drivers to access smartphone applications via voice commands. Ford is reportedly exploring other healthcare tools, including applications that would allow drivers to find the nearest medical provider or pharmacy. Using a medical application for iPhones and Android devices called “ResolutionMD Mobile,” doctors in Europe have started using mobile devices to determine if a patient suffered an acute stroke. With the use of compression technology, images can be transmitted over the Internet then streamed to a mobile app or Web browser, where doctors can manipulate the brain-scan imagery. Results found that doctors reach the same diagnosis using a mobile phone as they do when using conventional technology in 94 percent of cases. The Food and Drug Administration is currently considering approval for this application in the United States. When deploying healthcare applications, larger organizations tend to have more sophisticated IT organizations and larger headcount, resulting in more in-house application development. Smaller organizations that may be later in the adoption process or lack the technical sophistication or headcount may prefer instead to partner with outside vendors. Small and Medium Business Applications Small-and-medium sized hospitals are using applications in healthcare mobility. For example, an IT executive responsible for the mobility strategy at a collection of small hospitals in Florida stated that her organization is working with its EMR vendor to have native iPad applications built for doctors to order directly from their tablets or smartphones. Doctors can request additional and selective lab orders, in their office or while they are traveling. If a physician is alerted by the nursing staff about a follow-up item, Doctor and Dentist Offices Benefit from Mobile Applications MacPractice, based in Lincoln, Nebraska, introduced an iPad application in May 2011 that allows patients to electronically enter their medical information directly into an iPad. “Clipboard” comes in four different versions: MD for physicians DDS for dentists DC for chiropractors 20/20 for eye doctors After a patient enters his or her information, the data is automatically sent to a doctor’s practice-management application and electronic health records. Patients can also read and sign HIPAA privacy forms on Clipboard. Key benefits of the system include: Fewer data-entry errors Less time spent by patients and staff inputting information The ability to schedule future appointments The option of printing insurance forms Electronic claims filing
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mHealth Solutions 21 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 that doctor can launch an application, review the vital statistics and notes, and add items. In the near term, this IT executive is taking a simplistic approach, avoiding complex programming that “won’t work on tablets currently” due to synchronization issues of pulling information from different third-party databases. In the future, however, the hospital is evaluating Windows-based applications on tablets with different operating systems and different capabilities. Consumer Applications WebMD is a classic case study in consumer demand directly shaping technology. WebMD stood as a symbol of new possibilities and consumer empowerment in the dot.com era. WebMD organized, explained and presented complex medical concepts, making the daunting topic of health far less mysterious to millions of healthcare recipients. WebMD’s popularity skyrocketed because the more consumers learned, the more they wanted to know. WebMD’s popular Symptom Checker, which provides actionable information, speaks to the depth of understanding that today’s sophisticated healthcare consumer expects. Mobilizing healthcare content is the natural progression in meeting consumer demand. The Android mobile app launched in May “helps consumers in their decision-making and health improvement efforts by providing 24/7 access to mobile-optimized health information and decision-support tools, including WebMD's Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings.” Humana confirms strong influence of consumer preferences, adding that consumers not only want what they want, but they also eschew irrelevant information. The motivation is once again economics. Consumers are under increasing financial pressure to share the burden of managing their own health. Consumers, like insurers, recognize the potential savings of commoditized medical care for low-risk health issues such as common colds and minor cuts and sprains. Mobile applications allow consumers to make informed choices before spending their valuable healthcare dollars on medications and services, potentially saving thousands per household and billions on an aggregate basis. HEALTHCARE TRANSFORMATION THROUGH MOBILITY Study participants cited several organic benefits from introducing mobile technology into healthcare settings. Innovative mHealth solutions have created new business models, expanded existing markets, or lent a competitive edge to otherwise “old tech” organizations. Healthcare professionals described important productivity gains resulting from the real-time accessibility and interactivity of healthcare data. We found the most compelling use case themes centered on improved patient care/patient outcomes. Regardless of the benefit – innovation, efficiency or quality – healthcare professionals ranging from physicians to operations staff acknowledge mobility’s tangible benefits. No less important
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mHealth Solutions 22 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 are the “soft dollar” benefits, such as reduced frustration from data inaccessibility; lower rates of “burn out” stemming from inefficient processes; greater awareness of global shifts in diseases (such as the 2009 H1N1 pandemic flu); and a conveyed sense of empowerment from being well informed. Innovation When the terms “cutting edge” and “healthcare” are paired, one typically thinks of breakthroughs in disease treatment, such as extending the life of cancer patients. One might also imagine progressive diagnostic equipment, predictive tests or futuristic medical devices like a bionic limb. Rarely, if ever, does healthcare IT earn a reputation for being innovative. Mobility is quickly changing the perception of IT’s ability to catalyze innovation in healthcare settings. Healthcare innovation will allow medical providers to access information at the point of care so they can make well-informed decisions for their patients. While the existing infrastructure does a poor job of supporting this, the post-2015 generation of medical records will be fully-digitized to support continuity of care. Mobility is already playing a key role in the federal EHR mandate. For example, mobility will allow doctors to see what other providers or care givers are doing for, or prescribing to, patients. Medical progress notes will be viewable by all caregivers. In essence, the consumer becomes the central figure of the coordinated care team. Hospitals and physicians are already starting to extend Protected Health Information (PHI) access to employee- owned devices. According to the director of a large, US- based hospital, “We will be doing this using new mobile security applications that can enforce device-based security.” Other hospital executives are also extending PHI access to personal devices, while also ensuring that strong security measures are in place. According to one executive, “We’re requiring device encryption for downloaded data.” Another stated, “We are utilizing a Profiled Innovations Insurance: MyHumana’s User Interface design prompts insured customers to consider the affordable option of Urgent Care as an alternative to an Emergency Room visit. Home Healthcare: Independa incorporates social engagement features in its home healthcare mHealth solution to reduce the isolation and stress often experienced by elderly and infirm patients. Personal Mobile Health App: Integrates biometric and sensor data into a personal health management mHealth solution. Encourages use of mobile technology to manage personal health goals.
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mHealth Solutions 23 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 variety of security solutions to encrypt the data being sent to devices as well as being able to track and wipe the devices if lost. Agreements with users are being initiated so they understand the risk.” It is understandable that hospital executives are tentative about introducing consumer mobile devices into their conservative, regulatory-centric organizations. As mentioned earlier, there is an anti-professional perception that affixes itself to staff using smartphones, and to a lesser degree tablets, in healthcare settings. Yet we observed that the marriage of consumer habits and healthcare data is where impressive innovations are taking place. Why? Because consumers like, or more accurately demand, instant results from their technology. Smartphones help consumers navigate, save money, learn, organize, communicate and manage their time. Why should healthcare providers and patients expect any less from their mobile experience? MyHumana, a recipient of the first Appy Award for “Best Medical App,” blends consumer usage patterns with mobile conveniences. The innovative component can be found in the app’s ability to potentially influence healthcare consumption patterns. For example, if a Humana customer is traveling and in need of immediate medical care, the MyHumana app can list local Urgent Care facilities, leverage the phone’s GPS to provide directions and tap the search engine for the facility’s phone number. According to a Humana representative, “Urgent Care visits, when right for the patient, help employers keep benefit costs down. In some cases the ER is the right place to go. When a consumer needs immediate help, Humana wants that consumer to have the Urgent Care finder accessible to determine if that's the best option.” Not coincidently, the Urgent Care finder is prominently positioned within the UI. MyHumana’s Urgent Care locator serves up a relatively affordable healthcare service option that consumers might otherwise overlook. In the future, the MyHumana app will go a step further by offering a symptom checker. Consumers will be presented with a range of options such as doing self-care, going to urgent care or going to the hospital. MyHumana’s formulary for innovation – relevant, timely information plus consumer choice – is simple, but effective. A Senior Manager with TeleNav sees the market awakening to the possibilities mHealth promises in home healthcare. “The whole mobility movement has been right around the corner for seven years. There is a preponderance of workers not using mobile technology to the fullest extent. Organizations that were early adopters of mobile were influenced by Nextel, which served the market well. Some healthcare organizations are excited about smartphone capabilities, some have great trepidation. If the company puts the device in their employees’ hands, will the employee go from work time to Facebook time?” Perhaps the better question is whether the combination of mobility, social networking and healthcare is a positive or negative influence. The answer may depend on the application of these technologies. Independa, a technology start-up focused on the home healthcare market, developed “Angela” with the dual focus of combining mobility and social engagement synergies. Independa’s
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mHealth Solutions 24 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 founder explained that social isolation is a common issue for infirm or elderly individuals. Loneliness can cause house-bound patients to become depressed, sometimes leading to self- neglect. Additionally, isolation can be a major source of stress, potentially exacerbating existing health conditions. Once again, UI plays a key role in “stickiness.” The lighthearted and engaging aspects of Angela, such as photo and video access to friends and family, are featured alongside appointment and medication reminders. Independa presents responsible health management features evenly with enjoyable daily interactions, subtly conveying that these categories are equally important. We explored subject matter experts’ opinions of future innovation. These individuals pointed to integration of biometric and sensor data with mobile applications. Healthrageous, a mobile healthcare app developed on the Pyxis Mobile MEAP platform, is designed to accept input from a range of biometric devices. Healthrageous combines individuals’ biometric data with their predetermined preferences and guides users to better health management through goal setting, action plans and community support. Integration of data from heterogeneous healthcare devices is a natural progression of technology and supports federal EHR initiatives. However the noteworthy organic change is occurring at the social, rather than technological, level. Individuals are gradually sharing every aspect of their personal lives with these small but powerful devices and increasingly depending on them for managing their time, money, and now health. We observe investments supporting mHealth innovations to grow or maintain market share. Mobile healthcare technology promotes consumer empowerment and creates new channels for selling goods and services. For example, one individual interviewed for this study who developed consumer mobility technology that helps to safely resolve emergency healthcare situations, pointed to increasing numbers of consumers “shopping around” for healthcare “deals” due to increasingly high healthcare deductibles. These consumers are bypassing insurance companies and going directly to health care providers. Humana, which insures millions of individuals, is working to ensure their consumers and prospects are getting the most value from their existing insurance policies. According to a Humana executive, there are over 25,000 visitors to Humana’s mobile web services each month, many of whom are interested in purchasing insurance. Humana is determined to foster these relationships: “We want to assure our members have what they need, when and where they need it. We want them to have Humana at their fingertips.” Efficiencies
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mHealth Solutions 25 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Our discussion of efficiency is addressed with two important segments in mind – what it means to healthcare workers, and what it means to consumers. The stressful nature of helping unwell patients makes any efficiency a welcome addition to healthcare settings. Just as healthcare workers feel the pressure of providing for their patients’ needs, patients can easily feel lost in an ecosystem that is frequently characterized by discontinuous providers, processes and paperwork. Consumers are often left to weave elements of their personal health management plan together. Mobility’s growing role in collecting and imparting information is changing how healthcare providers and patients interact. Healthcare workers are a zealous base of mobile technology adopters, having discovered that significant productivity gains can be achieved using mHealth solutions. Instead of sitting in their offices tethered to a desktop computer, physicians now move freely throughout the hospital environment, using their tablets to review MRIs, X-rays, and other patient data with the patients and patients’ families, in locations that are convenient to all parties. Patient information can be easily referenced from disparate online medical enterprise applications, databases and other resources. When a MEAP solution that supports integration is used, the physician has the experience of interacting with a composite mobile application, even though there are several underlying data sources. The National Health Service’s (NHS) University Hospitals Birmingham (UHB), based in the UK, is at the forefront of uniting critical patient information and then presenting time-sensitive data and images to geographically separate collaborative teams. NORSE, UHB’s Neurological On-call Referral System, leverages BlackBerry devices to provide emergency room doctors with real-time assistance from UHB’s neurological specialists. The system connects the neurological center of excellence with the consulting physician. Case notes and patient history are shared between the NHS and UHB medical teams to accelerate the speed of diagnosis and treatment. Profiled Efficiencies Hospitals: Unite critical patient information, then present time-sensitive data and images to geographically separated collaborative neurological and trauma teams to rapidly diagnose and treat head-injury victims. Data Administration: Tablets are used to enlist patient assistance in completing hospital admissions data. Tablets also allow physicians and hospital staff to update patient records at the point of care. Pharmacies: Tablet and smartphone pharmaceutical apps will bring back-office functionality to hospital and retail pharmacists, allowing them to interact more with hospital staff and patients.
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mHealth Solutions 26 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Efficiency was a key consideration in designing NORSE. NHS used Webalo’s mobile development platform to quickly develop the system, without adding any additional IT development or operations staff. NHS is able to create new healthcare apps within short timeframes – days or even hours in some cases. Like the mobility contagion affecting the entire healthcare industry, mobile application development tools are increasingly being viewed as a means to greater productivity in healthcare settings. Data input is a key area where mobile technology is expected to create greater efficiencies. Tablets are also being given to patients to complete registration and admittance forms. For example, Tara Cares, a support organization for nursing, senior living, and assisted-living centers, replaced its manual system of collecting patient and resident data with Windows Mobile-powered HP devices and device management software SOTI MobiControl. Tara Cares staff can now enter patient and resident data into the devices and upload the information in real time over wireless networks to a back-end server. Because mobile devices can be used to capture patient data initially without the need for cumbersome and duplicate paper forms on subsequent visits, the use of this technology is also expected to reduce errors because it does not need to be re-entered by administrative staff at healthcare organizations. As the VP of Information Technology at one US hospital stated, “I would like to see mobile technology as the main conduit for clinicians entering the necessary [patient] data. I hope more clinicians see mobile devices as they do their stethoscope or IV Pump - as a tool to take care of the patient.” Medical data processing is transforming due to mobile technology and is viewed by the industry as a very positive paradigm shift. Instead of physicians typing notes or scheduling follow-up care after their daily rounds with patients, providers are using mobile devices to update patient information at the point of care. Experts state that physicians with mobile devices who enter the information into the mobile app immediately, whether in the patient’s room or right outside the patient’s room, have a much higher chance of being able to document the information without interruption, leading to more accurate, timely and comprehensive notes. In the pharmaceutical arena standardized mobile devices are replacing a cadre of proprietary and expensive mobile-to-mobile (M2M) devices, many of which have single-use functionality. Pharmaceutical wholesalers that support independent, retail chain and hospital pharmacies have a patchwork quilt of legacy and acquired systems. These vendors are moving toward industry-standard solutions that are platform agnostic. According to one industry executive, Instead of sitting in their offices tethered to a desktop computer, physicians can now move freely throughout the hospital environment, using their tablets to review MRIs, X-rays, and other patient data with patients and patients’ families, in locations that are convenient to all parties.
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mHealth Solutions 27 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 “Because the mobile revolution is taking place in the consumer world, pharmacy buyers and consumers are bringing their personal devices, and their expectations about what these mobile apps can do for them. Vendors want to link into Android, iOS, RIM, and Windows.” Sweeping productivity gains will continue as mHealth solutions deliver back-office system functionality to patient-facing pharmacists and healthcare providers. Healthcare professionals view these productivity gains in human terms as well, noting that their improved work capacity translates into the gift of time with their patients. A US hospital director reports that physicians estimate they save 30 minutes each day doing rounds as a result of mobility devices; clinical staff have estimated similar savings for numerous departments. TeleNav has received feedback from its clients stating that home healthcare professionals are often able to see one additional patient per day and can focus their time with each patient on their health concerns, instead of paperwork. According to one physician who is heavily involved in telemedicine, greater efficiencies will take place due to greater adoption, better advances, increased confidence about security, and timely responsiveness. Rapid responsiveness has been a double-edge sword in terms of data overload for healthcare workers. Users need to learn to balance responsiveness with data overload. In general, however, most observers agree that providing a more timely response adds value. Improved Patient Outcomes Healthcare apps can provide critical checks and balances in scenarios where rapid decisions can lead to tragic mistakes. mHealth solutions deliver more precise results. For example the integration of bar code scanning into healthcare apps can ensure that the correct amount and frequency of medicine dosages are administered. We observe mobility facilitating rapid throughput of Improved Patient Outcomes Bar Code Scanning: Integration with healthcare apps for accurate dosing. Rapid Throughput: Coordinated diagnostics are aggregated from remote physicians and test centers via mobile devices for faster diagnoses. Pharmaceutical Substitutions: Mobile apps recommend alternative brands and dosing to lower cost of drug therapies. Telemedicine: Mobile applications, displaying images and test results, facilitate remote doctor/patient interaction.
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mHealth Solutions 28 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 patient follow-up care. For example, women with a suspicious finding on a mammography will spend time waiting for follow-up readings. The patient may also need an ultra-sound, which could take several days for testing and interpretation. A biopsy may then be ordered, which takes additional days to read. In total, a patient may wait many weeks to find out if the results are suspicious for breast cancer. In contrast, a project done by the Arizona Telemedicine Program showed that the amount of time from a suspicious finding on a mammography to completing all of the testing and procedures could be accomplished in less than eight hours, providing answers to patients rapidly and accurately. Using an “ultra-rapid breast care process” (URBC), the process bundles telemammography, telepathology, and teleoncology services and provides input from virtual physicians in each of these fields. Diagnostic elements have been refined to ensure accuracy, speed, and integration with multi-disciplinary care management plans. Results are available to the oncologist or surgeon for immediate discussion with the patient by mobile phone or via video conferencing. Telehealth rapid breast care patients prefer telephone (including mobile phone) contact by the clinician or oncologist for immediate results. The service is has been commercialized by UltraClinics, a company created by the University of Arizona. Physicians prescribing medications to their patients understand patient involvement is good health management. Due to soaring drug costs, patients will often forego, dilute or otherwise modify their medications. Recognizing that medication lapses can result in preventable emergencies and exacerbate chronic conditions, pharmaceutical and medical community leaders have taken steps to make medications affordable. Humana is using its mobile app to engage patients in this process. MyHumana can suggest generic alternatives, dosage variations and substitutions to prompt pharmaceutical consumers to ask their doctors or pharmacists about affordable drug alternatives. Patients who previously felt they only had two options – risk their finances or their health – are able to have a meaningful dialog with their providers about affordable drug therapies. MyHumana can also provide price comparisons of the same drug across multiple retail or mail-order pharmacies. For patients in developing countries, smartphones and tablets are expected to add a whole new dimension to how people access health services and information in general. With telemedicine, for example, patients and their providers are doing much more than just teleconferencing, they’re actually sharing information, including knowledge and best practices that are evidence- based. Mobile devices are enabling these types of interactions. Many doctors believe that the use of mobile technology in healthcare will result in better access to services, leading to better health outcomes and – if done correctly – more affordable healthcare. This is due to the fact that there will be better Many doctors believe that the use of mobile technology in healthcare will result in better access to services, leading to better health outcomes and – if done correctly – lower costs.
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mHealth Solutions 29 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 continuity of care, better surveillance, and earlier detection of problems so that expensive and serious complications can be prevented. There will also be less hospitalization and lower rates of re-hospitalization, along with a decrease in the use of emergency services as consumers are empowered to play a decisive role in their own health management. Mobility ROI Some healthcare organizations report that they are not being required to demonstrate mobile return on investment as stringently as they are in other areas of information technology. Bypassing ROI modeling is sometimes the case where emerging technologies are concerned, because there are few, if any, established benchmarks. A VP of Information Technology at a US hospital, for example, noted that “Demand is such right now that we don’t see the normal objections to budget requests.” Other organizations reported that having the support and financial backing from line of business units can be even more important than demonstrating tangible ROI. Seasoned managers competing for IT resources know that the blank check mentality wears off once emerging technology becomes established technology. In fact, MEAP and MDM vendors interviewed for this study commented that operations-oriented mobility RFPs are seen in decreasing numbers. According to these vendors, the recent enterprise customer initiatives are strategic, sweeping and almost always involve IT. The heightened visibility and growing importance placed on mobilizing workforces is putting mobility squarely in competition with other IT initiatives. Therefore, healthcare mobility evangelists will have to form compellingly high ROI models. For that reason, we present different business cases that mobility project sponsors are using when trying to secure resources for their mHealth projects. Administrative costs: Real-dollar savings are difficult to prove, but offer the most persuasive argument for mobility projects. Labor is among the largest outlays Mobility ROI HARD DOLLAR BENEFITS Reduced administrative overheard Reduced physician travel time Increased physician billable hours Less wasted inventory Fewer redundant procedures SOFT DOLLAR BENEFITS Greater accessibility of information Lower frustration due to inefficiencies More engaging patient interactions Improved patient safety due to data timeliness and accuracy VARIABLES THAT IMPACT ROI MOS of devices deployed Mobile application type MEAP vendor selection MDM vendor selection Ability to leverage other current IT investments Future enterprise strategy
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mHealth Solutions 30 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 for any healthcare organization. Patient data can be captured and maintained at the point of care, eliminating the need for medical transcription and administrative resources. Budgets for back-office staff can be reallocated to patient-facing staff. Billable hours: The average physician can repurpose 130 administrative hours each year by using a mHealth solution. This translates into an annual savings of $10,010 per physician. This time can be redirected away from administrative duties to engaging with patients or collaborating with other medical professionals. Marginal increases in patient interactions directly contribute to higher patient satisfaction ratings and more physician billable hours that increase hospital revenues. Travel: Travel costs can be reduced for employees who can communicate via voice, data, and video instead of physically traveling to other locations. The iPad’s superior graphics and crisp resolution earned the device praise among early adopters of image-intensive practices such as radiology, cardiology, orthopedics, obstetrics and neurology. Physicians’ reclaimed travel time can be used to see more patients, thereby generating additional revenue. Supply Chain: Following labor, inventory is a second major category prone to inefficiency. Mobile supply chain solutions improve inventory accessible without contributing to excess inventory carrying costs. A Motorola Solutions executive interviewed for this study stated that typical excess inventory in healthcare is between 25 and 50 percent. This individual added that there are many hard dollar savings currently taking place within the healthcare supply chain, some as a direct result of mobility technology, such as automating the healthcare products receiving process and tracking medical supplies through the delivery process. Eliminating redundant procedures and tests: Hard dollar savings are also evidenced by the reduction in waste, including unnecessary visits to the Emergency Room if a closer and less expensive urgent care facility could be found, as well as redundant diagnostics tests. One Hard dollar savings: Equipping physicians with mHealth solutions can directly increase hospitals’ top line revenues, while reducing administrative overhead. --Average annual US physician salary: $200,000 --Average weekly US physician salary: $200,000/52 weeks = $3,850 --Average US physician hours worked per week: 50 hours --Average US physician hourly rate: $3,850/50 hours = $77 --Average daily time saved from mHealth solution: 30 minutes --Average daily cost saved from mHealth solution: $77 x .5 (30 minutes) = $38.50 --Average annual cost saved per physician: $38.50 x 260 workdays/year = $10,010 VP, Information Technology, Non-Profit Hospital Group in Florida
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mHealth Solutions 31 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 physician recounted the story of a patient who avoided an unnecessary X-ray after a pop-up menu on his tablet alerted the doctor to the fact that the patient had had the same test several weeks prior to that appointment. Preventing waste in the healthcare colossus is clearly a win-win for everyone. Soft dollar savings: Some healthcare IT experts feel that mobility ROI is often perceived in soft dollar improvements for clinical work, which is measured in terms of worker productivity gains over a period of time. Operational performance can benefit from timely and accessible patient information. Medical staff are less frustrated and less prone to burn- out from inefficient processes. Physicians can have more meaningful conversations with patients using data and images displayed on tablets. While difficult to measure, high- functioning healthcare organizations are better prepared to safely and effectively care for patients, a key goal for most hospitals. For example, instead of spending valuable time relaying patient status updates to an incoming shift of nurses, critical patient data can be generated in a report using an EMR application. Competitive advantage: ROI is often one of perception: If hospitals fail to embrace new technology, there is the possibility that they will be viewed as resistant to change and unsophisticated. At the “C” level, hospital executives feel they are risking their competitive edge if they are not viewed as early and aggressive adopters of mHealth solutions. Financial Implications: The financial penalties of a compliance breach are also very costly, as are devices that are being supported but that are unused and sitting in a “desk drawer.” Mobile Device Management vendor Zenprise noted, for example, that one customer using its Mobile Manager solution found that it was spending $180,000 annually on devices that had not been used within the past six months. In this instance, the Zenprise customer was paying for devices that were not being used, illustrating the point that, in order for mobile device management to be cost effective, users needed to actually use their devices. Overall, we found a high interest level in ROI calculations, both by vendors and by providers. According to one executive at a pharmaceutical wholesaler, “Getting real financial support will be difficult unless we can quantify and justify the benefits that mobility will bring.” Users and providers alike strongly suspect that mobile device usage in this industry delivers healthy, if not tremendous, returns on investment. From vendors’ perspectives, many Mobile Device Management vendors admit that their ROI calculations are done at a high level across many different industries, and not for specific verticals. One executive at an MDM who had recently completed an industry-wide ROI study stated his belief that ROI in healthcare is not different from other industries. Instead, ROI has more to do with the scale and size of the organization. Determining accurate ROI figures is dependent upon “Getting real financial support will be difficult unless we can quantify and justify the benefits that mobility will bring.” IT Director, Pharmaceutical Wholesaler
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mHealth Solutions 32 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 the Mobile Operating Systems and device types, mobile application, and mobile development and management technology used. One must also consider the healthcare operation or department and the role of the individual using the mHealth solution. Additionally, accurate ROI figures are dependent upon the time frame to realize the ROI and composition of the technology investments currently existing in the enterprise. TECHNOLOGY OVERVIEW MOBILE ENTERPRISE APPLICATION PLATFORM (MEAP) VENDORS
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mHealth Solutions 33 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 TECHNOLOGY OVERVIEW MOBILE ENTERPRISE APPLICATION PLATFORM (MEAP) VENDORS MOBILE DEVICE MANAGEMENT (MDM) VENDORS
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mHealth Solutions 34 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 TECHNOLOGY OVERVIEW In examining mobility in healthcare, many experts report that the technology is fundamentally horizontal. At the same time, however, the technology garners favor from vertical industries based on application development environments, mobile operating system stability and security, availability of hardware form factors, application distribution ecosystems and third party support. Some verticals may not need encryption at all or to a significant extent, while others, including healthcare, will require significant levels of encryption. In contrast, healthcare does not require data controls at the level that a trading system at a bank requires. In essence, there is a layering of tools within each vertical, and within that a layering of configurations. When selling solutions to specific verticals, vendors need to promote their offerings in a vertical manner, in essence “verticalizing” what are essentially horizontal technologies. According to a senior executive at McAfee, “Companies should be as vertically-focused as possible.” Mobility Vendor Business Models Arguably, there are four industry giants – Apple, Google, Microsoft and RIM – that dominate the mobile space. By dominate, we mean impact almost every mobility decision a healthcare organization will make. Apple, Google, Microsoft and RIM are regarded foremost as mobile operating system (MOS) developers. But each company’s span of influence is much broader than its MOS and should be considered in the full context of how it can influence healthcare objectives. For example, Apple and RIM are the exclusive designers of the hardware devices that run their MOSs. They also share a common philosophy of a closed architecture that disallows variations of the MOS. Apple and RIM exercise unilateral control of their respective customers’ experiences. Since March 2011, however, RIM seems to be embracing the wider world by creating a run-time application to support Android apps on RIM’s PlayBook and QNX-based BlackBerry smartphones. Google’s Android is an open system that permits Android developers to take liberties with the UI, as well as integrate applications, peripherals and proprietary systems without relying upon Android-provided APIs. The various Windows platforms, though flexible from a UI configuration and back-end integration perspective, have become less malleable over time as Microsoft asserts tighter controls on the user experience. This direction is expected to continue with successive Microsoft MOS releases. According to an interviewed software engineer WP7’s closed architecture is a welcome sign to IT professionals. The WP7 OS runs managed applications, meaning CPU cycles are strictly controlled through the OS, not the memory or The WP7 OS runs managed applications, meaning CPU cycles are strictly controlled through the OS, not the memory or hardware. Microsoft’s OS design and new certification process stand in the way of users installing anything malicious, unlike with previous Windows Mobile versions where phones could become unstable from installing third party applications.
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mHealth Solutions 35 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 hardware. Microsoft’s OS design and new certification process stand in the way of users installing anything malicious, unlike with previous Window Mobile versions where phones would become unstable from installing third party applications. Microsoft, the grandfather of the mobile tablet industry, first launched the Windows Tablet PC Edition approximately one decade ago. Windows Mobile and Windows CE were replaced by Windows Phone 7 (WP7), and effectively sunsetted since the new smartphone operating system does not support any pre-WP7 applications. Windows 7 supersedes Windows CE and Windows Mobile for supporting tablets and other mobile devices, including ruggedized devices. Hospitals and other patient settings have collective fortunes invested in Microsoft’s mobile solutions and do not take the prospect of porting to net-new mobile operating systems lightly. Like Google, Microsoft relies on third party hardware manufacturers such as Dell, Fujitsu, HP, HTC, LG and Samsung, to develop the hardware that runs its various MOSs. It is incumbent upon Google and Microsoft to not only win end-user favor, but technology partner mindshare, in order to be commercially successful. Healthcare IT purchasing departments have more options and arguably greater negotiating power when shopping Android and Windows-based hardware. But the complexity of choosing among dozens of hardware form factors cannot be disassociated from this perceived buying power. The mHealth apps that currently, or will in the future, exploit the strengths and weaknesses of each MOS and form factor are a key dynamic unto themselves. There’s the question of how mobile apps are created. Once again we observe Android handing over control to third party Mobile Enterprise Application Platform (MEAP) providers entirely. While many of the MEAPs we profile support BlackBerry, iOS and Windows platforms, RIM, Apple and Microsoft left little to chance and offer their own MEAPs. All four vendors entrust mHealth application development to their partner community. Microsoft has a longstanding stake in the healthcare sector with HealthVault, an online individual health management system. Google Health is a similar service that incorporates apps and information sharing. In June 2011 Google announced that it will retire Google Health in January 2012 because the service “didn't scale as we had hoped.” Healthcare organizations should consider the meaningful investments mobile vendors have made in understanding and serving their markets. Widespread adoption of Android and iOS devices has ignited a flurry of mHealth development. Research reveals that consumer favorability is not the only consideration. Developer motivation plays an undeniable role. The popularity of Android devices has attracted many to the Android developer program but has failed to satisfy developer support expectations. The Android apps are especially susceptible to piracy and have overall more technical support issues due to the open nature of Android’s development platform. Android developers also inherit direct responsibility for billing issues, a task that Apple buffers for its developers. Developers should consider healthcare file app size limits and distribution options, which not only vary by app market, but change frequently as well. If remote downloads are the only options that may constrain developers that wish to embed large video files into the healthcare app.
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mHealth Solutions 36 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Mobile Device Management (MDM) has traditionally been the domain of third parties. RIM, through the acquisition of Ubitexx in May 2011, will offer an MDM solution. Ubi-Suite will work in conjunction with the BlackBerry Enterprise Server to manage and secure iOS and Android devices, excluding push technology and setting IT management policies. Microsoft has enterprise server, security and endpoint management solutions that can conceivably be repurposed for Mobile Device Management. The pervasiveness of Microsoft applications in enterprises is often a key selling point, because organizations are able to leverage their current license investments for multiple uses. What the above analysis implies, but is up to each healthcare organization to empirically confirm, is that there is no clear winner among Apple, Google, Microsoft and RIM. If one vendor had a clear advantage, there would not be four multi-billion dollar behemoths contending for mobile market share. Each platform must be considered in the context of the organization’s current enterprise investment and future mobility strategy. Table 2 summarizes the relative characteristics of each vendor’s platform, or business model, that many healthcare mobile technology purchasers consider when developing a mobility strategy. Although many of these categories could be applicable to other industries, primary and secondary research reveals that these are the variables particularly relevant to healthcare settings. A caveat: The Mobility Platform Features Relevant to Healthcare Settings Table is based on a best-efforts basis at the time of publishing. The analysis is based upon all operating systems provided by the vendor currently in commercial use. In the case of Microsoft, this includes Windows Mobile, WP7 and Windows 7 for tablets. IT managers and other interested parties should check with their mobile device vendors for specific features and functionalities in which they are interested.
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mHealth Solutions 37 Copyright © Galvin Consulting and Technology Coast Consulting August 2011 Table 2: Mobility Platform Features Relevant to Healthcare Settings Feature Apple Google Microsoft RIM MOS is consistent from smartphone to tablet, promoting ease of development, deployment, administration and 3 rd party support. ● ○ ○ ○ MOS is standardized across all smartphones and does not vary by hardware device manufacturer. ● ○ ● ● Offers a tablet with a large screen size for which many mHealth applications are optimized. ● ● ● ◓ Open architecture allows UI customization for specific patient categories such as aged or sensory impaired. ○ ● ◓ ◓ Multiple hardware vendors drive competition and drive down hardware costs. ○ ● ○ ● Supports Microsoft Exchange ActiveSync security features for pass code protection and remote wiping, which are imperative for healthcare devices. ● ◓ ● ◓ Offers open architecture for back-end integration without relying exclusively on provided APIs. ○ ● ◓ ○ Flash support for playing medical tutorials, healthcare videos, etc. ● ● ● ● Operating System works on healthcare-specialized ruggedized devices. ○ ● ● ○ Provides Bluetooth and Wi-Fi support to connect to medical devices and sensors. ● ● ● ● Has a Mobile Enterprise Application Platform (MEAP). ● ○ ● ● Has a Mobile Device Management solution. ○ ○ ◓ ● Leading in the consumer market. ● ● ○ ○ Form Factor/Hardware Many of the discussions for this report focused on form factor – making sure that the device being used in the healthcare setting is appropriate for the task at hand. Observers generally
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