Physician/patient tele-health care management using an integrated EHR/patient smartphone platform.

1. Physician mobiLink
Physician/patient tele-health care management
using an integrated EHR/patient smartphone platform
Nicholas Ivon
Clark & Daughtrey Medical Group, P.A.
Copyright © 2011 Allscripts Healthcare Solutions, Inc. 1

2. Solution Overview
 High Level Solution Description:
• Real time disease management between provider and patient.
• Patient uses their smartphone to track, manage, and record self obtained
results of physician prescribed self-management plans and goals. All result
data is maintained in EHR.
• Direct physician/patient secure communication.
 Healthcare/Business problem addressed:
• Proactive disease management directly integrated to physician EHR provides
real time data monitoring, notification, and alerting.
• Eliminates costly home tele-health equipment and home visit setup/training.
• Enhanced case management tools to reduce hospitalizations, manage high risk
patients, and help patient educate patient in good disease self-management.
 The application developed addresses the following category:
 Applications that improve management of high cost chronic diseases.
 Innovative approaches to addressing value-based care imperatives.
 Both
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3. Usability and Design – Workflow Overview
• Using EHR provider orders self management disease plan. Provider can adjust hi/low ranges and goals
and required frequency of data capture within the order to meet patient specific needs. e.g. Weight
EHR every morning no clothes, set alert for gain of >= 2 lbs over 24 hours or 5 lbs over 120 hours, sets weight
Order goal and tardy sensitivity. Orders can be preconfigured with defaults and adjusted as desired.
• Patient downloads Dragonfly Physician mobiLink smartphone application and authenticates with provider
office with patient demographic elements and the EHR order number. Patient receives ordered plans and
Patient for each can review history, goal, launch educational resources, and enter self acquired data. Patient can
Enrolls also send and receive secure communications with physician/office.
• Patient entered data is transmitted immediately to EHR as patient recorded result. Dragonfly refreshes
data and patient can see all in-office and self recorded values in chronological order and compare
against goal. Out of range values or conditions alert the patient to call the physician office and trigger
Data priority tasks within EHR, configurable for EHR users and/or teams as the EHR permits.
• Dragonfly Physician mobiLink constantly monitors for tardy patient self recorded data per order
specification. If patient is tardy an application push notification is sent reminding patient to record data,
Monitor and tasks are generated within EHR, configurable for EHR users and/or teams as already configured.
• The patient or the physician/office may suspend or close a self management disease plan. Suspended
plans can be reactivated by either party, whereas closed plans must be re-ordered by the physician.
Suspension, reactivation, or closure of a plan triggers a message to the patient and tasks within EHR as
Care already configured.
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4. Usability and Design – Architecture Overview
Physician Practice Allscripts Patient
EHR Dragonfly Physician mobiLink supports Andriod
or iOS smartphones, comprising 87.8% of the
Allscripts Enterprise EHR or Allscripts Pro global smartphone market.
EHR.
Dragonfly mobiLink Coordinator
Middleware communicates between EHR and Patient
Smartphone. Dragonfly mobiLink Coordinator uses the
Allscripts Unity SDK to monitor disease plan orders, read and
file results, generate tasks, and provide communication with
patient’s Dragonfly Physician mobiLink smartphone application.
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5. Usability and Design – A Deeper Dive
• The Dragonfly mobiLink Coordinator user
interface allows for administrative management
of task assignment, orders management,
• Orderable items are setup in EHR and Dragonfly mobiLink message and push notification management.
Coordinator with matching order codes.
• Orderable items in EHR are setup with additional questions for
goal value, low value alert, high value alert, and tardy hours
indicating sensitivity before generating alerts for tardy patient
data entry, allowing physician to set patient specific care plans.
• Dragonfly mobiLink Coordinator monitors and manages all
active orders within EHR with these codes and facilitates all
communication and integration between the EHR and the Patient.
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6. Development Stage
 Development stage as of the Phase 1 Submission Date:
 Idea
 Prototype
 Code development in progress
 Code complete
 Code complete, tested and approved by Allscripts.
 Dragonfly mobiLink coordinator and the Dragonfly Physician
mobiLink smartphone application are currently under rapid
development. Both are about 25% complete.
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7. Integration Description
 Dragonfly smartphone application written in Titanium Studio by Appcelerator for a
single codebase and hosted by Appcelerator Cloud Services for pre-built services
and extended future capability.
 Dragonfly mobiLink Coordinator uses many Allscripts Unity SDK calls:
• GetDictionary • GetTaskList
• GetOrderHistory • GetUserAuthentication
• GetPatient • GetVitals
• GetPatientCDA • MakeTask
• GetPatientDiagnosis • SaveAdminTask
• GetPatientFull • SaveCED
• GetPatientList • SaveNote
• GetPatientProblems • SaveResult
• GetPatientSections • SaveTask
• GetProvider • SaveVitals
• GetProviders • UpdateOrder
• GetTask
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8. Go to Market Plans
 Dragonfly Physician mobiLink provides constant monitoring of high risk patients without a 3rd
party and directly interfaces both the physician and the patient in a more convenient and efficient
manner for both parties.
 Very attractive for physician practices working in or going to ACO and other risk based models.
5% of patients are responsible for half of all healthcare costs. Close monitoring of high risk
patients reduces hospitalizations and readmissions thus saving significant dollars, while
encouraging patients to adapt better self-management skills.
 Adult U.S. smartphone penetration is over 50% and rising. Smartphone ownership will surpass
80% by 2015, proving to be a natural way for patients to communicate.
 Addresses 2011 PCMH 4A and MU Stage 2 core objectives 12,13, and17.
 Proposed price models are modest at either $500.00 per physician/year for unlimited patient
enrollments or $10.00/month for active patient enrollments for unlimited self-management plans.
 Current tele-health solutions involve setting up expensive equipment at patient’s home that
communicate back to the tele-health hub for monitoring. Captured data is not available to
physician EHR. Companies specializing in tele-health monitoring charge a single disease plan
around $200.00 month per patient.
 With Dragonfly Physician mobiLink, patient does not have to be home to record results.
 Dragonfly Physician mobiLink will be implemented at Clark & Daughtrey Medical Group.
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9. Video Demonstration
 Please preview this video demonstration of what Dragonfly Physician
mobiLink offers here: https://vimeo.com/58853893
 The video presentation demonstrates the value that patient self-management
tools have to offer, and how this solution provides a fluid and natural work
flow integration for both physician practices and patients in this new
smartphone world.
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10. Why this solution should be selected!
 Physician practices are finding patient care management programs to be labor intensive and costly
programs to implement, but critical to providing excellent yet economical care required by ACO and risk
based care models which are the only financially viable payment models of the future.
 Today, patient disease self-management plans and patient data recording tools are limited to paper and
web based portals which are not integrated into the physician practice EHR. This requires the patient to
bring in their recorded data on the next visit, or clinical staff to access one more portal for patient self-
management tools, and manual entry for the patient data to get into EHR. This is an inefficient process
that does not allow close monitoring of the patient by the physician practice.
 Tele-health companies sell their disease care management programs to insurance carriers, integrated
health groups, and physician practices, which require expensive digital equipment that transmits data to
a “hub” that is monitored by the tele-health company. One disease process starts at around
$200.00/month per patient. While expensive, it is cheaper than having a risk-based patient admitted to
the hospital. It is so critical to closely monitor high-risk patients that some larger integrated health
groups have setup their own tele-health programs.
 Using smartphone equipment patients already have, along with inexpensive at-home testing equipment,
this solution provides a huge breakthrough in disease self management that allows physician practices
and patients to work closely together using the same tools they already use every day. Data is shared
by both parties effortlessly and constant monitoring allows for serious situations to be identified and
actions taken early before it’s too late.
 There isn’t a physician/patient centric disease management system available today that so tightly bring
together the physician and patient while providing an intuitive, customary, and familiar workflows.
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