mhimss roadmap 3

7/30/2019 mHIMSS Roadmap 3

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3-01mHIMSS Roadmap

New Care ModelsstaNdards aNd

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ROI Payment

3mHealth- Payment,ROI, andReimbursementCOntents

The State o Healthcare: Setting the Stage or mHealth Adoption 3-02

Mobile Business Model Transormation in Other Industries 3-02

Mobility Transorming Healthcare in Emerging Markets 3-04

Mobile Health Adoption across the Globe 3-05

Innovators Driving mHealth in the United States 3-06

The Department o Veterans Aairs Case Study 3-09

Conclusions and Future State 3-12

Authors 3-12

Reerences 3-12
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3-02mHIMSS Roadmap



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Mobile Business

Model Transformationin Other IndustriesIn the last ten years, mobility has transormed the music,

publishing, and gaming industries In 2011, 42% o

games and 32% o music global revenues arose rom

digital sources, while the revolution has just begun to hit

the book and newspaper industries with only 4% to5% o

their revenues coming rom mobile digital downloads In

some countries, like China, this orm o media represents

71% o all music revenues, while in the US it currently

represents 52% This disruption has created great pain

in the music industry with dramatic reductions in USrevenues rom its peak o $15B in 1997 to about hal that

amount ten years later, when downloaded music volumes

eclipsed traditional, non-digital sales volumes The digital

disruption enabled by new technologies has enabled

new players to enter and transorm the market, has

resulted in others becoming larger and more powerul,

while others have gone bankrupt and let the market The

past decade o digital disruption in the music industry

demonstrates seven key lessons regarding payment and

business models that healthcare can learn and apply as

it now goes through its own technological transormationthat requires new payment and business models to

engage patients, consumers, providers, payers, and

pharmaceutical and medical technology organizations

Lesson 1 Digitization o content enables new

business models: As music content became digital

it eliminated physical requirements and barriers to

production, distribution, and consumption This has

allowed content to be bought and sold rom any location,

in a variety o qualities, and at any time, while signicantly

reducing overhead and production costs, as well as

The State of Healthcare:Setting the Stage formHealth Adoption

Necessity for change in the U.S. healthcare system is not an issue but a neces-

sity. The present system is wasteul, ragmented, and limits engagement between

patients and providers. Results o a recent study included estimates o $765B in

excess costs and over 75,000 preventable deaths.1 Inefciency is coupled with ine-

ectiveness, given projections or Medicaid spending to reach $340B in 2020 rom

$159B in 2011, in a system in which 1% o patients consume 15% o resources. 2

Lack o patient engagement in health osters an environment in which over 90%

o chronically ill individuals desire coordinated care, while less than 60% receive

such services.3 (Coordination, integration, communication, and engagement are common themes cited or

improving use o resources, moderating costs, and supporting enhanced outcomes through patient empow-

erment.4,5 Deploying mobile health stands as central in realizing these objectives. Findings o the mHealth

Task Force convened through the Federal Communication Commission elevates these objectives into the

single goal that by 2017 mHealth, wireless health and e-care solutions will be routinely available as part

o best practices or medical care.6 Achieving the goal as with many eorts targeting efciency, eective-

ness, and empowerment in healthcare is not simple or straightorward. A comprehensive approach is

needed to addressing technical requirements across capacity, access, and integration. Equally important is

providing reimbursement, recognizing the value delivered through mHealth. The issue in structuring such

compensation is creating structures that support coordinating care while limiting overall consumption

o services. Meeting the goal or using mHealth requires addressing broader issues in restructuring care

rom volume to value-based. mHealth stands as a means o acilitating this transormation by driving down

waste and ragmentation while realizing the benefts through patient engagement under coordinated care.7


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ROI Payment

eliminating some risk and creating new ones Similarly,

as healthcare data, inormation, and content have

become digital through electronic health records (EHRs),

health inormation exchanges (HIEs), and personal

health records (PHRs), it removes many o these same

physical barriers to enable care anywhere, at any time,

to anyone, with care and services delivered by many

providers across the country and/or around the world

This empowers consumers and providers to employ

mobile healthcare in many orms, such as telemedicine,

telehealth, telecare, and remote patient monitoring, to

increase access to care, improve quality, and decrease

costs A torrent o pilots, trials, and studies has indicated

that this new orm o distant care can deliver, when and

where applied appropriately, equal or better quality careto the patient, by existing and new types o providers,

that payers are willing to pay or to reduce costs while

saving money (by eliminating unnecessary physical

interventions)

Lesson 2 Basic Transactions move to subscriptions;

prior to the emergence o digital music, the music

industry was driven by physical transactions; consumers

purchased CDs albums to create personal music

libraries However, such libraries were dicult to share

and were at constant risk o damage and loss These

pain points were key drivers in the emergence o musicpirating at the dawn o the digital music age Nearly

two decades later, the CD transaction-oriented market

now represents less than 50% o US music sales,

and with this digital transormation we have seen a

powerul move to a new subscription business model

that enables consumers to have access to music without

actually owning it, but instead by owning access to it In

healthcare this is analogous to moving rom a ee-or-

service transaction healthcare system to a capitated one,

where healthcare providers earn a fat ee or an array o

services that looks a lot more like a subscription

Lesson 3 Freemium1 encourages experimentation:

Various new music services and artists have leveraged

the attraction o ree services and songs to get

consumers to experiment and try new things They then

provide additional value-added services that consumers

can purchase We see this as a common payment model

emerging among mHealth apps that provide tness,

wellness, and chronic disease management services as

well as other healthcare-related inormation and tools

Apps such as RestWise and Fitbit provide a basic service

or ree and then charge a monthly or annual ee o $5-

$10 or premium services

Lesson 4 Paid search provides ree services to

consumers: SoundHound and Shazam represent twoexamples o ree paid search services that have enabled

consumers to search music or ree based upon an

advertising model where suppliers pay or the cost o

these services This same payment model has emerged

among mHealth apps like iTriage and ZocDoc that get

hospitals and physicians to pay or a searching service

so consumers can quickly and easily nd healthcare

providers and schedule physical or digital services

Lesson 5 Radio remains but in a customized orm:

Many predicted the end o radio as a result o the digital

music revolution, this has not happened Some o themost successul digital music companies have been

digital radio stations that have transormed the concept

o radio to become a more personalized approach that

enables you to create your own personalized genre that

you can consume on either a subscription basis or by

listening to advertisements like you do with traditional

radio Similarly, many have suggested that much o

primary care might disappear as patients consume more

digital healthcare However, what is emerging is a more

personalized orm o primary care that enables more

fexibility in the use o retail clinics, concierge medicine,

home care, and personally congured digital care, all o

which are greatly enhanced in digital orm

Lesson 6 Greater ragmentation in production

but consolidation in distribution: During the past two

decades the industry saw a signicant change in music

distribution, rom many small, specialty stores like

Tower Records that went bankrupt due to a change in

consumer purchasing habits, to larger big box retailers

like Walmart and Target, which now dominate the

physical distribution channels The industry also saw the

entrance o new and powerul players such as Apples

iTunes, the most dominant in digital distribution, but

also Google and Amazon This led to standardization

in prices, payment, and inormation presented to theconsumer Paradoxically, it also provided artists and

authors more reedom to enter the market with ewer

barriers through sel-published content, where they

could set some o their own prices and terms outside the

constraints o the large record labels This also enabled

new, smaller recording labels to emerge and compete

against the larger houses Digital mobile care looks like

it may ollow a similar path, as telcos, large national and

global retailers enter the market, and new types o digital

providers services emerge that enable smaller practices

to have reach beyond the boundaries o their traditionalgeographic market

Lesson 7 Greater reedom and fexibility in

purchasing: During the 1990s the music industry

phased out the music singles business because it

could make more money on albums However, one o

the most signicant payment changes that resulted

1 Freemium is a business model where a basic level o sotware is

provided, additional eatures or service require an extra ee


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ROI Payment

rom digital music is the unbundling o albums and

enabling consumers to purchase single songs or

$099 Traditional medicine has been structured to

accommodate the physicians and hospitals workfows,

hours, and service bundling to optimize payment through

physical visits Rather than spend a ew minutes having

the physician complete a virtual drug prescription rell

rom his oce, the oce required the patient to physically

come to the oce to get the script relled and picked up;

this ensured that the provider could bill or an oce visit

but wasted the patients time Through digital and mobile

care, such oce visits become unnecessary and the

patient can elect to have a single transaction completed

with no physical visits This is beginning to lead to the

creation o micro-medical payments associated withsmall short tasks

To support the digital music transormation, new laws

have been enacted Copyright and Contract Law, the

Digital First Sales Doctrine, the Fair Use Doctrine, and the

Digital Millennium Copyright Act (DMCA) were all laws put

in place to help support adoption and ensure success

Similarly, the transition to digital mobile technology in

healthcare is being supported by legislation such as

the Health Inormation Technology or Economic and

Clinical Health (HITECH) Act, the American Recovery

and Reinvestment Act (ARRA), as well as the Aordable

Care Act (ACA), all o which support telemedicine, data

analytics, and mobile health services

One key dierence to note when comparing the

changes in digital music to what we see playing out in

the mobile app market the app market is transorming

at lightning speed As the gure at right shows, the

digital transormation o music has been underway or

nearly two decades, while the mobile app market is

barely ve years old Yet the volume o app downloads

eclipsed the iTunes music market in less than two years,

suggesting it is growing at nearly three times the pace Is

this a harbinger that digital combined with mobile could

accelerate the transormation o healthcare and enablemore radical and rapid payment and reimbursement

changes than most players have excepted?

Mobility Transforming

Healthcare inEmerging MarketsAccess to mobile phones and devices is more ubiquitous

when compared to healthcare worldwide. Mobile

penetration in Arica and Asia-Pacifc is expected

to increase by 82% and 98% respectively by 2014.

According to the International Telecommunication Union

(ITU), there are over six billion wireless subscribers; over

70% o them reside in low- and middle-income countries.

Healthcare challenges in emerging markets:

Clinical inormation in papers

Poor inrastructure

Non-availability o trained personnel

Business model

Opportunities Key areas where healthcare

can play big role are:

Monitoring services

Prescription reminders

Wellness management

Physician appointment / rescheduling

Success Stories

China: Qualcomm and LieCare Networks has launched

a 3G mobile health project in the patient monitoring area

targeting patients with cardiovascular disease

Arica: M-Pedigree is developing mobile-based drug

authentication and tracking technologies or developing

nations with an SMS-based system to ght the exploding

appearance o countereit drugs in developing countries

Pakistan: Mobile phones and nancial incentives

is helping a network o private clinics serving poor

communities in Karachi nd twice as many people with
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ROI Payment

planning to pay or more services than providers are

planning to oer The one exception relates to the ocus

o the provider community in using mHealth to realize

administrative cost savings and eciencies: here we

see a much stronger ocus on the part o the providers

in leveraging mHealth to increase their own internal and

clinical productivity This is why we observe providers

adoption o mHealth in the ollowing sequence o

progression:

1. More revenues with no clinical changes: Use

mHealth that increases current revenues o existing

oerings that require no changes in the practice

o medicine Both ZocDoc and iTriage are good

examples o this

2. Administrative cost savings with no clinical

changes: Use mHealth to provide consumers/

patients with text message and email reminders or

appointment, drug adherence, smoking cessation,

etc

3. Administrative cost savings with administrative

workow enhancement: Use mHealth to eliminate

costs and unnecessary steps within the clinical

environment regarding sharing inormation through

EHRs or HIEs, reviewing images, and managing

claims and payment

4. New revenues through new consumer/patientpaid services: Entrepreneurial providers use

mHealth to provide a new type o services like

24/7 doctor or nurse call centers or questions,

inormation, and support, like Teledoc or Walgreens,

which provide new services paid or directly by

the patient and supplemental to the services they

receive rom their traditional provider

5. New services paid or by payers and new

service providers: New market entrants like telcos

and technology companies provide remote patient

monitoring services paid or by a combination o

consumers/patients and payers to keep consumer/

patients healthier in their homes and out o the

traditional providers oces

6. Existing services provided in mobile ormat

with reimbursement: Existing providers deliver

mobile versions o traditional services paid or

through either a ee-or-service or capitated type o

payment model

This progression o services indicates that providers

will rst ocus on making more money the traditional

way by leveraging mHealth consumer/patient marketing

approaches They will then ocus on costs saving return

on investment (ROI) opportunities within their our walls

or with their consumers/patients Some will then begin to

experiment with new services But the actual provisions

o existing types o care through new care models that

require reimbursement will take the longest and be the

most dicult mHealth change or providers to make

The United Kingdom (UK) was one country surveyed

and studied in the PwC/Economist survey and report

that has developed a very aggressive and comprehensive

approach to adopting mHealth Their 3 Million Lives and

Whole System Demonstrator Project both show their

commitment to leveraging this technology in healthcare

and also provide clinical and cost data through pilots and

programs that demonstrate that mHealth actually delivers

better quality and less expensive care, as measured by

ewer emergency room visits, shorter hospitalizations,

and lower mortality rates or patients that use mHealth

Such an approach to healthcare employ the lessons

learned through Lean Six Sigma in other industries,

which is as quality improves, costs go down poor

quality healthcare is much more expensive than high

quality care, and mHealth can enable signicantly higher

quality care at lower costs

Innovators Driving mHealthin the United StatesRealizing innovation in business models or mHealth

requires dening structures that optimize value in use

across care management and patient engagement The

need is or creating operations that provide incentives

that serve to integrate mHealth applications into common

practice or care and wellness The eect is or mHealth

to be seamless and unseen as part o health and caring

Sustainability or the business o mHealth urther

requires enabling the shit to value rom volume-based

care Innovation in mHealth business models provides

a means to support the transition and realize ongoingimprovements in managing outcomes as well as costs

There is dependency as well as synergy between

advancement in models or care and the business o

mHealth

Business models or mHealth capitalize on a simple

act: technology can be leveraged to provide services

better, cheaper, and aster than otherwise available

Consumer demand or mHealth applications provides the

oundation or realizing engagement in care and wellness

among patients The result is the ability or mHealth to

integrate activities end-to-end among all services or

providers and individuals It is the active, proactive link

with the consumer as a patient, regardless o location,

that establishes integration itsel as the nal element in

dening innovation in business models or mHealth

Eectiveness is not a question in dening successul

business models Programs including those rom

WellDoc, DiaBetNet, iglucose, and Glucose Buddy

all demonstrate clinical benets in combining mobile


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ROI Payment

technology into care management or chronic diseases9

Formal clinical trials substantiate the benets in achieving

target levels or glycated hemoglobin levels over one

year10 Nor is eciency a question The Department o

Veterans Aairs (VA) demonstrates the ability or remote

services to support care delivery in a manner not readily

achievable given current physical capabilities Current

conguration o services provides clinical access or

380,000 individuals with an additional 100,000 receiving

ongoing in-home care11 The UKs National Health

Service (NHS) denes ten easy win initiatives leveraging

digital technologies to realize 3B in operational gains

These gains urther support enhancing quality, access,

and value in healthcare services12 Consumer demand

clearly exists Research indicates over 500 mobile healthprojects ongoing worldwide There are 40,000+ health

applications available or download to smartphones

and tablets The orecast is or approximately 250

million people to download a health application in

2012 roughly double the number completing the

activity in 2011 Moreover, estimates or global revenues

rom mobile health applications reach $118B in 2018

compared with $12B in 201113 Innovation or business

models with mHealth build upon the our points o

market advantage:

Eciency Eectiveness

Engagement Integration

One consideration in establishing sustainable business

models is the inter-relationship between these elements

Integration in care builds upon components o eciency,

eectiveness, and engagement Perceptions o eciency

and eectiveness drive consumers toward engagement

Clinical eectiveness results in part by deploying mHealthsolutions that reinorce integration o services through

realizing eciency as well as engagement between

consumers and providers

The implication is that the business o mHealth is

a acilitating technology Mobile applications in health

and wellness provide the capability or real-time, multi-

directional fows o inormation embedded within an

overall process o care That unctionality supports

disease-specic interventions such as chronic care

management or diabetes as well as comprehensive

care through a medical home or individuals with multiple

chronic conditions

A second point is that the our elements are necessary

but not sucient to drive market adoption and use or

mHealth The movement to all-inclusive or risk-based

payment is an essential component in dening the

environment in which mHealth drives nancial return

across participants in the healthcare market providers,

consumers, and payers This change rom ee-or-service

reimbursement to bundles, episodes, or population-

based capitation creates the incentive or all parties

to leverage mobile technology to manage care in an

integrated manner that yields gains in eciency and

eectiveness

The acknowledged act is that volume-based payment

rewards ineciency and poor eectiveness in care

Movement toward value-based payment creates the

incentive structure sucient to pay or using mobile

technology in improving eciency and eectiveness

The ROI or mHealth becomes positive with the need or

providers to account or the costs in poor care delivered

poorly One example is readmission penalties underMedicare The eect is requiring hospitals to reduce

ragmentation and increase coordination, as well as

communication across post-acute activities while building

a sense o vesting in that care among patients

The transition in reimbursement urther supports the

value o an engaged patient as an aware consumer

o health and care The means or active oversight,

communication, and eedback with an individual stands

to reinorce both the eciency as well as eectiveness

realized through integrating mHealth into overall

patterns o care


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ROI Payment

Initiative Cost & Care Quality Years o Data

u.s. ai Fc 14% cin in mncmn (ed) n n c ii;

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hi ai Fc b2009 2011

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Sustainable innovation in business models or mHealth

is maniest through meeting nancial targets or ROI

Meeting the ROI target necessitates addressing actors

across operations, clinical practice, and technology

inrastructure including the ollowing:

See Table 1

Use within closed or at-risk systems currently

provides the strongest case supporting use o mHealth

This applies to gains in clinical eectiveness as well

as operational eciency An example o gains in

eectiveness is integrating mHealth into activities o the

patient-centred medical home Results across several

programs highlight gains in costs savings and clinical

outcomes, as well as quality o care:

See Table 2

Experiences o the VA, Kaiser, and the UKs NHS all

highlight using mHealth to increase operational eciency

These gains apply across administrative unctions (eg,

scheduling, reminders, rells) as well as clinical activities

(eg, pre-assessment, initial assessment, o-site ollow-

up, communicating results)

Less clear are the nancial eects derived through

deploying mHealth in chronic care managed across

open systems or systems not assuming risk or

patient outcomes This observation applies with

care management programs or conditions including

diabetes,14 as well as with eorts targeting adherence

and compliance with medications The latter includes

programs originating through activities in the pharmacy

related to encouraging rells

tb 2

tb 1


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Questions addressing the continuity o results as well

as ROI or patients and sponsors appear open or these

activities A comparable situation applies with mHealth

applications targeting consumers An issue in sustaining

the business model is ongoing value perceived among

users The eect is dening the level o retention versus

churn in securing a positive ROI A related consideration

is the viability o specic applications given the volume

o available options The concern is the eect o noise

across applications in compromising brand identity and

conounding choice by consumers

Closed and risk-based systems appear as currently

providing the best means to ensure sustainability in

innovation or mHealth business models These options

encompass use within systems such as Kaiser, theDepartment o Deense (DOD), VA, and Geisinger The

advantage in use through these organizations is the

ability to internally arbitrage costs against savings in

realizing net nancial eects The ability or mHealth to

lower the rate o ED and urgent care visits may reduce

acility revenue that is more than oset through savings in

health plan costs

Comparable logic applies in deployment under an

accountable care organization (ACO) Internalizing risks

supports using mHealth as the more ecient means to

manage costs as well as clinical outcomes Net gainsaccrue to the program sponsor that also serves as

service provider

The nal application that presently appears as

oering sustainable innovation is use through episodes

or bundles These structures again provide a means

to realize net cost savings as the sponsor bears risk

as the service provider The role o mHealth in driving

eectiveness and eciency supports realizing net savings

required under both structures

Achieving sustainable innovation in mHealth business

models currently appears as requiring unctional and

structural integration Functional elements build upon

delivering eectiveness, eciency, and engagement in

care as well as health management across providers

and patients Structural integration recognizes the role

o mHealth as enabling these gains within the broader

evolution o healthcare rom a volume to value-basedconstruct How this assessment o sustainability under

innovation or mHealth changes depends upon the

overall transormation o healthcare in the US That said,

the inability to sustain mHealth in broader applications or

health and care signals continuing ailure in moving the

system to delivering value or all participants

The Department ofVeterans Affairs Case StudyIn the US, no organization has shown a more powerul

commitment to mHealth adoption than the VA The

second largest government department ater the

Department o Deense, the VA manages a $100B

budget, with 300,000 employees Hal o the budget and

nearly all the employees are part o the Veterans Health

Administration (VHA), which delivers health benets

and services to 83 million patients per year, with 53

million unique patients per year, through 152 medical

centers and 1,400 community clinics As an early and

rapid adopter o mHealth, the VHA represents hal o the

300,000 chronic disease remote monitoring patients in

the US It has awarded contracts or $14B to mHealth

technology vendors or devices and services, and it has

published the most comprehensive studies on the costs

and benets o deploying mHealth and remote patient

monitoring across multiple chronic disease, geographies,

and socio-demographics

The VHA has grown its telehealth and remote patient

monitoring rom an initial program o 2,000 patients in

2003 to over 150,000 in 2012 It provides services to

primarily men between the ages o 50-90 years o age

with specic disease programs addressing diabetes

(48%), hypertension (40%), congestive heart ailure (CHR)

(25%), chronic obstructive pulmonary disease (COPD)

(12%), and mental health (about 5%) Two thirds o these

patients had a single condition, while the remainder had

two or more Hal o these lived in highly rural locations,

while 30% lived in urban locations, and the remainder in

semi-rural areas About 90% o patients oered this orm

o care have eagerly accepted it due to the increased

convenience and control they experience in their care

and patient satisaction or these services is at 86%


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ROI Payment

The annual cost to deploy these programs is $1,600

per patient per year, compared to over $13,000 or

traditional home-based care and over $77,000 or

nursing home care But the key economic benet occursrom the cost avoidance associated with telehealth and

mHealth remote monitoring services that have led to

25% reduction in number o bed days o care and a 19%

reduction in hospital admissions However, the benets

are not the same among all disease conditions, just as

the solutions must dier by type o disease and level o

acuity For example, the reduction in hospitalization or

mental health patients exceeds 40%, while those or CHF

and hypertension range rom 25%-30% and diabetes

and COPD average about 20%

When looking at the cost benet analysis, the VHAhas ound that a $1,600 per patient per annum mHealth

program can enable a call centre nurse or social worker

to predict and prevent expensive emergency department

visits and hospitalizations that can cost in excess o

$16,000 per patient per event When analyzed across

its entire population, and when taking into account the

requent fyers (the 5% o patients that represent 30%

o costs), the VHA nds that a $1,600 investment per

annum or these patients decreases average costs by

over $6,500 per year, producing an ROI o 4:1

The VHAs unparalleled success and breadth in the

application o these technologies has led the UKs

National Health System in their 3 Million Lives and Whole

Systems Demonstrator projects to specically reerencethe VHAs work as the example they wish to ollow in

addressing the same undamental challenges:

1. More patients: Rapidly aging population needing

greater healthcare services

2. Fewer healthcare proessionals: Shortages

o healthcare proessionals, the ratio o health

proessionals to patients declines rom 10:1 to 3:1

3. Insufcient healthcare acilities: Shortage

o hospital or institutional acilities and budget

constraints to build more

4. Budget shortages: Few resources to nancehealthcare services like those provided in the past

5. Complex adaptive system: Deploying

transormational change in a complex system

among diverse, semi-independent, and autonomous

agents (eg, doctors, hospitals, patients)

As Dr Adam Darkin, Chie Consultant or Telehealth

Services at the VHA, has pointed out on many occasions,

the VHA, and all healthcare systems around the world,

have these same challenges, although the VHA began to

experience them and address them earlier than most He

points out that nothing short o a revolution in the deliveryo care will enable us to address these issues, and the

connected technologies we have and deploy through

mHealth can enable us to change workfow, medical

practice, and healthcare economics in such a way that

we can move most o uture healthcare associated with

prevention and chronic disease management into the

home He is quick to point out that those acute episodes

that require hospitals will always need to be in hospitals,

but with 75% o our healthcare costs associated with

chronic disease management, and the act that hospitals

were never designed to manage these diseases, means

that we have a hospital inrastructure that is inappropriate

or managing most o the costs o our systems and

thereore demands a new model and delivery o care

This new model is a home-based mHealth model that

is more consumer-centric, more empowering, pushing

more o the care to the patient and amily members,

and improving outcomes, quality, and satisaction, as

evidenced by the VHA experience, while at the same

time signicantly decreasing costs

DrDarkins points out that the VHAs impressive

achievements have been hard won and required

rethinking the approach to healthcare in a large system

He sees the VHA as a complex adaptive system

that cannot be orced to adopt these new medicalpractices through command and control As a student

o complexity theory he has designed the VHAs system

in a way that enables the emergence o new practices

across the system in an organic manner by providing key

enablers that support the transormation o the system

What the VHA has ound is that merely oering to pay

providers or oering these services does not mean


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ROI Payment

4. Deployment varies by geography and socio-

demographics: As a complex adaptive system, no

one size can t all patients and markets Providers

must be able to construct and deploy telehealth andmHealth on a modular basis so that it can meet the

specic and unique needs o each segment

5. Technology interoperability and integration:

While much o the sensor and monitoring

technology is simple, straight orward, and tried and

tested, the rapid growth o mobile technologies has

dramatically decreased the cost o deployment by

as much as 90% versus the alternatives o just ve

years ago However, providers need technology

support to stitch various new technologies together

so that they can be easily deployed and used togather and integrate data into new clinical services

Only ater placing these enablers in place could local

VHA providers, within the larger complex, adaptive VHA

system, create their own local solutions to address their

individual needs

The VHA continues to innovate the practice o

medicine through mHealth services During the past two

years it has announced the ollowing mHealth initiatives:

Issuing and running IT Innovation Challenges and

selecting the top 26 best IT innovations

Enabling clinicians to use mobile devicesin VHA acilities

Partnering with the Continua Health Alliance to

promote standards or mHealth interoperability

providers will deliver them These enablers must address

the ollowing six barriers to adoption that the VHA has

aced over the nearly decade-long exponential growth o

the system:1. Lack o training in the new paradigm o remote

practice: No medical schools train physicians or

nurses in how to practice care on a distant and

remote basis Providers can be paid to delivery

only those services they know how to deliver The

VHA has trained nearly 10,000 providers around

the US on how to use technologies to augment,

supplement, and in some cases replace their current

practices

2. Validation o clinical and economic efcacy:

Clinicians are scientists, and as such want researchand empirical evidence that this new paradigm

creates greater value than the existing one This

Kuhnian logic has required the VHA to create

the extensive documentation o their structures,

practices, and processes to identiy, quantiy,

and measure the clinical and economic value o

telehealth and mHealth services

3. Data integration with existing digital health

records: Unlike most EHR systems that have an

ability to integrate patient generated data through

remote care, the VHA has anticipated this needand provided the integration o this inormation so

that nurses and social workers can better manage

these patients in a ratio o 150:1 Such an approach

ensured that they can meet the Meaningul Use

Level 3 requirements or patient-generated data

Providing cloud-based services or clinician

collaboration

Opening the VHA app store or clinicians and

patients to download mobile apps Launching a new diabetes mHealth remote patient

monitoring program

Purchasing 100,000 iPads

Issuing a new study showing that remote

monitoring decreases mortality by 45%

Launching a new tele-psychiatry program

Issuing local press releases by regional

VHA providers indicating cost and clinical

benets o mHealth

Eliminating co-pays or mHealth services

Launching an iPhone EHR app Launching home as the hospital program

Upgrading Wi-Fi capabilities

Dr Darkins believes that other public and private

healthcare systems can learn a lot rom the VHAs

experience He is pleased to mention that when they

initially began their remote monitoring programs and

their successes around 2005, people oten said, I the

VHA can do this, then any one can do this But now

nearly ten years since the VHA launched their programs

and others have stubbed their toes trying to replicate

it, he hears a dierent rerain: Only the VHA could dosomething like this He disagrees with both statements

He believes that no system has a choice in adopting

mHealth, that all systems can learn rom the VHA, and

that all can successully develop such programs i they

apply the enablers to overcome the barriers By so doing,

access and quality will improve while costs decline


12/12

3-12mHIMSS Roadmap



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RefeRenCes1 Institutes o Medicine Best Care at Lower Cost: The Path to

Continuously Learning Health Care in America September, 2012

2 Deloitte Medicaid: Whats Its Future September, 2012

3 Institutes o Medicine Communicating with Patients on Health Care

Evidence September, 2012



5 FCC mHealth Task Force: Findings and Recommendations

September, 2012

6 FCC mHealth Task Force: Findings and Recommendations

September, 2012



8 http://wwwpwccom/gx/en/healthcare/mhealth/indexjhtml?WTac=vt-

mhealth#&panel1-19 eHealth Initiative An Issue Brie on eHealth Tools and Diabetes Care

or Socially Disadvantaged Populations July 18, 2012

10 Cluster-Randomized Trial o a Mobile Phone Personalized Behavioral

Intervention or Blood Glucose Control, Diabetes Care 34:1934-1942,

2011

11 Tele-Health: A Better Way Than the Highway VA News Features

September 24, 2012

12 National Health Service Digital First The Delivery Choice or

Englands Population, Transorm 2012

13 Smartphones Health Care Inographic mashablecom, September 26,

2012

14 eHealth Initiative An Issue Brie on eHealth Tools and Diabetes Care

or Socially Disadvantaged Populations July 18, 2012

authORs

Christopher WasdenGlobal Healthcare Innovation LeaderPrice Waterhouse Cooper

David WeirzChie Operating Ofcer

Sleep Trials

health staff lIaIsOn

Thomas Martin, MBAManager

mHIMSS

Copyright 2012

Healthcare Information and Management Systems Society (HIMSS)

The inclusion o an organization name, product or service in this document

should not be construed as a HIMSS endorsement o such organization,

product or service, nor is the ailure to include an organization name,

product or service to be construed as disapproval

For more inormation: www.mhimss.org

Conclusions andFuture State

The unding o mHealth remains a major obstacle to

the successul implementation o mobility-enabled

technologies Other industries and sectors have

leveraged a number o unique approaches to unding

programs These approaches have drastically changed

the landscape or a number o products by breaking up

payments, oering reemium approaches to services, and

even capitalizing on convenience actors well established

in the healthcare industry Suce to say, the route o

insurance payers is setting the stage or the increased

adoption o mobile-enabled devices and applications to

assist with the delivery o healthcare

Adapt best practices or mobile technologies rom

other industries to the healthcare setting

New business models will emerge in healthcare that

share commonalities to other leading industries

Healthcare will embrace mHealth technologies and

solutions to provide better services, cheaper and

aster than other competing eorts

Payers will continue to drive adoption o mHealth

Payers are willing to pay or more services than

providers are willing to oer
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mhimss roadmap 3

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