Searching For Evidence Of mHealth Effectiveness

Compiled by Scott Westcott, Contributing Writer

The growing prevalence of mHealth technology promises a new dynamic between patients and caregivers, as well as better health outcomes and cost-efficiency. Yet challenges remain in the effort to get both patients and providers on board.

Healthcare is going mobile at an increasingly rapid rate as both providers and patients are realizing the benefits of mHealth technology.

A recent market study of the global mHealth market conducted by Transparency Market Research projects the mobile market will grow to more than $23 billion by 2020, up from $5.79 billion today. Driving the growth? The rapid proliferation of smartphones, increased availability of high-speed telecommunication networks, and rising awareness of the advantages of mHealth at a time when consumers are looking for ways to better manage chronic diseases, and healthcare providers are seeking to enhance operational efficiencies and patient engagement.

Providers are rolling out telehealth programs designed to connect themselves and patients, as well as offering technology allowing patients to play a more active and ongoing role in their own care. Recently Reena Pande, M.D., Chief Medical Officer, AbilTo (a behavioral healthcare provider), and cardiologist, Brigham and Women’s Hospital, and Hargobind Khurana, M.D., Senior Medical Director of Health Management at Banner Health, shared their insights on how the mobile movement is changing the way providers and patients interact, while also creating cost-efficiencies and better outcomes.

Q: How are you leveraging mHealth at your facility?

Pande: We are leveraging it in multiple domains across the healthcare delivery system, from telemedicine to remote monitoring to digital therapeutics. Creative utilization of mHealth technologies has the power to improve patient access, spark patient engagement, and reduce overall cost of care across many different treatment domains. I have seen innovative technological applications such as telehealth significantly improve medical outcomes, reduce hospital readmissions, and bring affordable, accessible care to those unable to access care through traditional delivery methods.

Khurana: At Banner, we are committed to a telehealth program that relies on mobile technology to engage patients to improve their health and quality of life, while also reducing costs. In 2013, we partnered with Philips Healthcare to launch our Intensive Ambulatory Care program that aims to improve patient outcomes and care team efficiency while preventing high-risk patients from entering acute care. Patients are provided with an electronic tablet and can connect via an audiovideo platform with caregivers. For patients with multiple chronic conditions, we have initiated an at-home telehealth pilot program. Patients in the program can respond to questions and transmit blood pressure and heart rate daily.

As a result, we are able to intervene before problems worsen as well as determine if a patient needs to go to the hospital or if the situation can be monitored and treated at home. We have a mobile health team that goes to the patient’s home to connect in person and build bonds with the patient. Across the larger Phoenix area, we identify patients for the program based on need and their healthcare utilization history. We are finding there is significant savings from meeting the needs of patients earlier — before they show up at the hospital.

Q: What barriers are you experiencing as you use mHealth to improve care delivery, and what are you doing to overcome them?

Pande: Thankfully, we are slowly but surely lowering the barriers across the healthcare continuum, but barriers to acceptance and implementation indeed still exist. For example, state and federal regulation for telehealth delivery and reimbursement are still being clarified. State licensure regulations still limit the ability to provide care across state lines even though the technology makes it quite simple to do so. Second, financial barriers persist, including the need to clarify who pays for digital technology — provider, payer, or patient — and by what payment mechanism. Third, data integration can be a challenge with many disparate data sources insufficiently integrated to allow optimal collaboration of care.

Khurana: Going into the program, we thought one of the key challenges would be acceptance of technology by elderly patients, but we’ve found that has not been the case. We have many elderly patients who are tech-friendly. They understand the idea of audio-video interaction — most likely they have already interacted that way with grandkids — so it is a technology they are pretty familiar with. We ask our patients to use the tablet every day to answer some questions and record blood pressure and heart rate. Th ere are barriers in the sense there can be some early resistance to this — similar to if a patient has to take medicine every day and complains about it. Yet they are much better at complying once they understand the importance of keeping up with it. It is like anything in healthcare; the patient and their families need to see the benefit before they fully get on board. It’s also a learning process for our healthcare team. In a traditional healthcare office setting, you expect a patient to reach out to you and hope they show up for appointments. With telehealth, there is an ongoing interaction that can be initiated by patient or caregiver — a different model than people are accustomed to — but the added benefits are clear.

Q: In what ways are you extracting actionable intelligence from your mHealth initiatives, and how is your analysis of this data driving actions?

Pande: Many healthcare entities record comprehensive data about their patients’ medical history, ongoing treatment, and clinical outcomes. For a large institution — such as a health plan, hospital, or provider group — the data can be leveraged to impact population health initiatives, evaluate quality of care, and ultimately lower total healthcare spend. Data can also be tremendously advantageous in helping us target high-risk individuals and ensure they receive the right treatment at the right time. But on the individual level we have to constantly reevaluate whether the data collected actually leads to meaningful change for the patient and translates into real clinical outcomes. In order to improve outcomes for individual patients, as well as the larger population, it is often necessary to stop for a moment, reassess, and refine treatment modes and methods in order to achieve optimal clinical results.

Khurana: We rely on algorithms to help us identify patients whom we need to focus on based on change in symptoms or vitals information. Our population health tool indicates which patients we need to work with immediately out of the 600 patients enrolled in the program. The data helps point to the patients who need immediate medical attention or who are trending in the wrong direction. If they are, we are alerted and can take prompt action.

Q: What results have you seen from your mHealth initiatives to date?

Pande: Technology allows us to get more high-quality care to more patients at the right time. Disruptive healthcare technologies have proven to increase access to care and optimize patient engagement, resulting in clear improvement in clinical outcomes. Health data analytics platforms allow better understanding of patient populations and guide refinement of treatment programs. Remote monitoring devices improve chronic disease management and medication adherence. Technologies that capitalize on the mobile delivery of care, including both medical and mental healthcare, allow more patients to get the care they need and deserve.

Khurana: We continue to achieve measurable results. As part of the telehealth pilot, we assessed results of 135 patients after six months of being engaged in the program. Thanks largely to lower hospitalization rates and fewer days in the hospital, we saw overall cost-of-care decline by 27 percent, and acute and longterm care costs decline by 32 percent. There was also a 45 percent reduction in hospitalizations, which was driven primarily by fewer ED (emergency department) visits. We have been able to capture anecdotal stories about how, prior to the program, patients who were experiencing a problem and had a need to connect with a healthcare provider would go to the ED. When an elderly person comes to the ED, there is a very high likelihood that person will get admitted to the hospital. However, with more frequent contact, you might be able to off er reassurance that, based on symptoms and vitals, a visit to the ED isn’t immediately necessary, and then continue to follow up frequently and monitor the situation. By being able to provide that extra attention, we are able to do things we couldn’t have done in the past and reduce healthcare costs in the process.

Q: What needs to be done to accelerate progress and extract more actionable intelligence from the data being captured?

Pande: Real progress will come when we recognize that technology alone is not the answer, but instead it’s the marriage of data and technology with a human touch that will truly be magical. Let’s face it — the last decade of healthcare has seen an explosion of digital technologies geared at replacing providers. But simply having a device or solely collecting data does not equal change and does not equal better care. Helping patients take data and translate it into actionable intelligence and meaningful change in behavior is the progress we need.

Khurana: While there has been progress, the technology needs to become even more mobile and even more accessible. We now have to give patients a tablet, and that can be a bit of a production. We should be able to get to the point that we simply give them an app and they can then connect and interact via their smartphone. Everything is going mobile these days because it is easier to use. Healthcare has consistently been slow to move in that direction. The other point is we need the ability to better understand data in ways that are actionable. In healthcare, we are not used to getting all this data from patients, and now the question is how do we easily analyze and take action based on that flow of information? We always wanted more data; now what do we do with it?

Q: What aspects of healthcare will be most impacted by embracing mHealth?

Pande: While all of healthcare stands to benefit from embracing mHealth, the most neglected areas stand to benefit the most, and behavioral healthcare stands at the top of the list. Behavioral health issues and medical health issues often coexist and lead to poorer outcomes and greater cost of care. Access, stigma, and variable quality are all barriers to patients getting needed behavioral healthcare. Technology has the capability of substantially improving access, quality, and outcomes in behavioral healthcare that will no doubt improve the lives of millions of patients nationwide and reduce billions of dollars in medical cost and lost productivity.

Khurana: I think the fact that there will be more focus on patient needs will have the biggest impact. Right now, healthcare remains provider-centric, but technology and other factors are moving us toward a patient-centric model in which patients expect information and care when they want it, where they want it, and how they want it. Th e whole concept of “the doctor will see you now” is shifting to “the patient will see you now.” With mobility, we are going beyond the boundaries of what’s expected and what we can do.

Q: What advice would you offer to a healthcare facility looking to increase the way it leverages mHealth?

Pande: I say just do it, but be smart and be thoughtful, and choose those tools that are demonstrated to improve access, quality, and outcomes. Don’t be swayed by gadgetry. Ensure that mHealth tools are truly translating into actionable behavior change and meaningful clinical outcomes. And do not forget that in healthcare, the synergy between data, technology, and humanity has the greatest potential to have an impact on a massive scale.

Khurana: First and foremost, understand what the technology you are using is capable of and what it can do to improve patient care and reduce costs. It is important to understand the technology’s limitations as well, so you have clearer expectations of what can be accomplished. Also, make sure you are hiring the right people who are comfortable with mobility and working in a virtual environment. It is not the traditional model, so there are certain skills and certain training needed to make sure the technology is being leveraged effectively. Caregivers need to be thinking about how they come across on video and asking questions such as, “Do we need to examine the patient, or can we make a decision without an exam?” I see these issues as modification of skills that we already have. It is just a matter of having the willingness to learn and go beyond your limits of what you are accustomed to in caring for and interacting with patients.