nuance mobile health articles

7/30/2019 Nuance Mobile Health Articles

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Advancing themHahecosystem

Mi chg apai, pvi a pa
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C

IntroduCtIon

3 NickvaN TerheydeN,Md:mHealths role inhumanizing healthcare

MobIlIty In ACtIon

Clinicians weigh in onhow their healthcareorganizations are leveraging

mobile technology today, andhow they plan to leveragemobile advancements in thecoming year

5 reid coNaNT, Md:Breakthroughs in workowefciency or the physicianon-the-go

6 TracyBud LawreNce, Md:

Mobile health accessibility,trial & error

Keys to MobIle

suCCess

Industry thought leadersdiscuss which providerorganizations have

successfully adopted mobiletechnology and how mobileis positively impacting

patients and providers alike9 keNNeTh a. kLeiNBerg:

Meet the poster childor successul mHealthadoption

10 eric wickLaNd:mHealth: A great manysmall victories

PAtIent on-tHe-Go

Experts speak out on howpatient-friendly mobiletechnology will revolutionizeour healthcare system

12 regiNahoLLiday:

The voice o patients13 Joseph kiM:

Rules o engagement

14 graviTyTaNk:Patient-centric mobileEMR

PAyers see

PotentIAl In MHeAltH

A look at some of the mostsuccessful mHealth apps on

the market, and how payersare working with patientsand providers to drivebetter outcomes

15MarThawofford:Empowering consumerswith quality healthcareapps

16 Nick MarTiN: Themobile, personal healthintersection

Future oF MHeAltH

Explore the not so distantfuture of mHealth with somof the brightest minds in

healthcare

19 eric TopoL: New era o

medicine unplugged20 peTer ragusa:

The Internet o things

ConClusIon

21 JoNaThoN dreyer: Willmobile virtual assistantspropel the uture omedicine?

Advancing the

mHahecosystemMi chg a pai, pvi a pa

Copyright 2013 Nuance Communications, Inc. All rights reserved. Nuance, and the Nuance logo, are trademarks and/or registered trade-

marks, o Nuance Communications, Inc. or its aliates in the United States and/or other countries. All other brand and product names are

trademarks or registered trademarks o their respective companies.

The conceptof humanizing

healthcare is at the

heart of what we

providers, patients,

payers, developers

and designersarestriving to achieve.

NickvaN TerheydeN, M

cMiO, NuaN
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A d v a n c i n g t h e m

H e a l t h E c o s y s t e m

IntroduCtIon

mHah ihmaizig hahca

Nick van Terheyden, MDCMIO,Nuance

this guide aims o kick-o a coversaio abou how we ca all work ogeher o

humaize healhcare by, frs ad oremos, liseig o each oher. Iside, youll

fd a collecio o isigh rom idusry expers ad hough leaders who share

heir impressios o how each o us, i our ow uique way, ca help improve

healhcare by adopig ad leveragig mobile echology. now is he ime o ake a

ew look a how, as iricae pars o he healhcare ecosysem, we ca collaborae

ad coec healhcare hrough a more persoalized, mobile drive approach.

On a recent work trip, I was reading

the latest edition ofBloomberg

Businessweek. This editions focus was

on design, and one particular quote from

a company called IDEO struck me, this

concept of humanizing healthcare.

I began to think about my own workas a CMIO with Nuance and how thisplayed into the concept o humanizinghealthcare by easing physician rus-tration and struggles associated withelectronic health records.

Capturing the complete patient noteand the discrete details needed to getpaid or the care provided is no easyeatall while educating and engagingthe patient in the care process and actu-al creation o a shared digital record. Ialso thought about the work were doingin the mobile space through advancingvirtual assistants (VAs) or cliniciansand consumers alike; VAs that know youand, in turn, can more readily and intu-itively provide the assistance you need,

when and where you need it most.And the role this next generation

personalized VA will play or doctorswho are acing nothing short o a torna-do o change that threatens their abilityto provide quality, human-to-human

patient care. Then I put on my MD hatand took a trip back in time, revisitingpatient encounters when I too was hard

pressed or time and may have sacri-fced the humanity o personalized carein order to be able to address the sheernumber o patients who needed myguidance. What I realized is thisforfar too long, weve left humanity out

of healthcare.

As I look at where the healthcareindustry stands today, I think the con-cept o humanizing healthcare is at theheart o what weproviders, patients,payers, developers and designersarestriving to achieve. And I think technol-ogy, particularly advances in mobility,can and will play a critical role in thisoverarching eort. For providers, mo-bile technology remains a sacred cow osorts. Some organizations remain earulo initiating a mobile workorce becauseo privacy and security concerns, andinstead remain anchored to their old

ways and methodologies.The tradition o the physician as

dictator and the patient as (an innocent)bystander seems to be hard to let go o.Conversely, many patients today havesimply accepted this model; seeing

themselves as passenger vs. pilot whenit comes to their own health and well-be-ing, not truly considering that everyday

innovations like smartphones and tabletscould enable them to become healthier,and in turn, happier.

Well, this model is surely shiting be-cause o mobile adoption and the wide-spread access to inormation and datathat this type o technology provides.

As this change gains momentum, wereseeing more o our doctors carryingiPad minis; more patients tuning intosel-improvement through a movementcalled the Quantifed Sel (admit it,either you or someone you know ownsa Nike Fuel Band or FitBitI do); andpayers looking or new ways to engageand motivate patients to inject humanityback into healthcares outdated model.

We stand on the precipice o somethingawesome, i in collaboration, were ableto leverage burgeoning innovations toadvance our mHealth ecosystem.

I hope you enjoy this digital guideand that the remarkable contributionsrom some o todays great leaders andinnovators help spur new ideas as tohow mHealth can impact the nextgeneration o healthcare.

NickvaN TerheydeN, Md, cM

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Mii i AciClinicians weigh in on how their healthcare

organizations are leveraging mobile technology

today, and how they plan to leverage mobile

advancements in the coming year


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Medical practice today requiresa broad array o inormation to

be readily accessible at a momentsnotice. Our practice patterns demandit, and our patients expect it.

We are moving rom one patientroom to another, and even onehospital to another more rapidlythan ever, and we need to have easyaccess to inormation and reerencesources while on-the-go. Our patientsare oten attended by amily andriends using their own mobiledevices to check reerence sources,

and they expect the same o theirphysicians.

Practically speaking, we haveound smartphones to be helpuldevices or storage and retrieval oreerence inormation rom a varietyo sources. Particularly helpulare applications and reerencematerials geared toward guidelineso established practices, as well asclinical calculators. Also helpul areapplications that allow physiciansto reerence specifc algorithms thatare critical to patient care but either

cumbersome or complex, such asHIV Needle Stick Risk Stratifcationor Advanced Cardiac Lie Support(ACLS) algorithms.

Moving orward, as aprovider champion or physiciandocumentation solutions thatimprove efciency, I anticipatemy practice will incorporate ourEMR vendors (Cerner) mobilityapplication that is in later stages odevelopment.

As a member o Cerners EDISStrategic Board, I have also beeninvolved in development eedbackloops or this technology and itappears very promising. Withintegration o cloud-based speechrecognition technology, and naturallanguage processing tools to aidproviders with ICD-10 conversioneorts, PC Touch as a mobilityapplication has the potential toincrease efciency and urtherenhance the availability o data tobusy physicians and healthcare

teams.As many o us have ound in

the non-clinical moments o ourlives, or learned rom our children,texting can be completed much moreefciently by leveraging cloud-based

voice recognition technologies.I have actually ound that leveragingmy voice and the microphone orsearches, navigation apps, and manyother purposes has increased mymobility productivity signifcantly.This same technology can beleveraged in our medical practice,

and then some. One key to thiswill be the linkage o the mobileworkow with the desktop-basedworkow that is not likely to becomeextinct anytime soon. It is the easyentry o text via speech that makestexting so much more efcient onmobile devices. And it is that, inaddition to the critical linkage othat inormation to the EMR, that

will provide the breakthrough inworkow efciency or the physicianon-the-go.

As many o us have ound

in the non-clinical moments

o our lives, or learned romour children, texting can

be completed much more

efciently by leveraging

cloud-based voice recognition

technologies.

Breakthroughs in workfow eciencyor the physician

On-the-GoBy Reid Conant, MD, FACEPEmergency Physician and CMIO, Tri-City Emergency Medical Group

President and CEO, Conant and Associates, Inc.

reid cONaNT, Md, FaceP
http://www.tcemg.net/http://www.conantandassociates.com/http://www.conantandassociates.com/http://www.tcemg.net/http://www.nuance.com/for-healthcare/index.htm


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Since 2007, Henry Mayo NewhallMemorial Hospital (238-bed,

not-or-proft community hospitaland trauma center) has been trans-

orming patient care with technologythrough its digital hospital initiativecalled iCare.

We believe the achievement o a

digital hospital is critical to theimplementation o patient saetyinitiatives that will improve thequality o patient care delivery. And

we are excited about what the utureholds or mobile technology both inthe workplace and rom the patientperspective.

We currently use MEDITECHselectronic health record or ourinpatient physicians. Our doctors caneasily and efciently monitor labora-tory results, vital signs, radiology andconsultation reports, as well as other

important items o clinical relevance.Our IT department has done an ex-cellent job o supporting this tool bysupplying physicians with iPads andbudgeting or smartphones.

CPOE and voice-enabled

physician documentation

We are also live with ComputerizedPhysician Order Entry (CPOE) and

voice-enabled physician documenta-tion in our Emergency Departmentand Womens Unit, and will be going

live throughout the entire hospital insummer 2013. With this transition,mobile devices will likely be heavilyintegrated into the daily physician

workow. We anticipate a very highutilization rate as adoption gathersmomentum.

Tablets: lesson learned

We have had difculty integrat-ing a mobile platorm into the EDsetting as most physicians still preera desktop environment. We did,however, make the institutional erroro purchasing many tablets that wereelt to add to the efciency o theED physicians. The end result wasa product that was difcult to log

on to, hard to navigate and only hada battery lie o nearly our hours.These qualities were enough to doomthe tablets to an eternity o non-use.

We will use this lesson learned inmobile technology deployment byincreasing the engagement o ourclinicians in mobile device selection.

Patient portals

Part o our MEDITECH upgrade(as well as an integral part o ourpush or Meaningul Use Stage 2attestation) will be the MEDITECH

patient portal. We hope to integratethis portal into the current mo-bile-driven liestyle o our patients.This portal will allow patients to viewand manage their health inormationand medications, make and cancelappointments, and pay their bills. Pa-tients will be able to enter this securesite rom their mobile device, allow-ing or anytime, anywhere accesso their personal health data.

Speech recognition and

smartphones

Future iterations o MEDITECHwill certainly be mobile-riendly with

attention paid to unctionality, easeo use and improved user interaces.I see a time in the not-so-distant u-ture where clinicians at Henry MayoNewhall Memorial Hospital are per-orming CPOE and creating narrativedocuments using speech recognitionon their smartphones.

Fortunately, at our acility, we havean extremely supportive IT depart-ment and a CIO who is ready to takeour medium-sized community hospi-tal to the next level with technology.The uture is coming, and coming

quickly. An integral part o thatuture will be mobile health acces-sibility. We plan to be ready or thismovement, as should any hospitalthat is looking to stay competitive.

The uture is coming, andcoming quickly. An integralpart o that uture will bemobile health accessibility.

Tracy Bud LawreNce, M

Mobile health accessibility,

trial& errorBy Tracy Bud Lawrence,MDHenry Mayo Newhall Memorial Hospital
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K Miscc

Industry thought leaders discuss

which provider organizations have

successully adopted mobile technology andhow mobile is positively impacting patients

and providers alike


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The more

personal theconnectionbetween thedata and therecipient,the better.

mHealth:

A great manysmall victoriesBy Eric WicklandEditor,mHIMSS

The true power o mHealthlies in its malleability. Ahealthcare provider can

develop and oster an mHealthproject or program that works well,and another provider might well takethat concept and tweak it because it

would otherwise not work or himor her. In its ideal state, its not aone-size-fts-all solution or somethingthat a provider should struggle toadopt or adapt to. Ater all, at atime when providers are struggling

with so many mandates, crises andconcerns, they wont ock to some-thing that requires a lot o work ontheir end.

So WatIS Workin Ot Tere?At this time, in this environment, thefeld o mHealth is seeing a greatmany small victories, rom the atherin Maryland whose brain-damagedson gets his physical therapy throughan online program that connects hisTV to a rehab center an hour awayand specialists hal a world away,

to the community health center inAlaska thats monitoring patients viahome-based telehealth networks, sav-

ing the time and expanse o a longdrive, helicopter or dogsled ride.

Its all subjective. Diabetics areusing mobile devices that track theirblood sugar and other vital signsand automatically transmit themto their doctors, enabling thosedoctors to spot warning signs andintervene beore a crisis develops.Doctors and public health advocates,meanwhile, are using text-messagingprograms to reach out to mothers-to-be, smokers, people dealing withdierent addictions, encouragingthem and directing them to resourcesand pertinent inormation. The morepersonal the connection between thedata and the recipient, the better.

In other instances, mHealths chiebeneactor is the clinician. Smart-phones and mobile devices are beingused in hospitals rom New Hamp-shire to Hawaii to help the nurse ordoctor conduct rounds, view dataand make quicker and better deci-sions. Telehealth technology is being

adoptedby physicians who have certainspecialties and want to help peo-

ple beyond easy-driving distance.Theyre putting their talents outthere, available to anyone with asmartphone or tablet, and fnding anew way to conduct business.

Its important to remember thatthe healthcare industry as a wholehas to view mHealth not throughthe time-honored lens o the bestpractice, but with an eye towardindividuality. We can talk all we wantabout the success o the telemedicinenetwork in Georgia or Ontario, orthe BYOD platorm in San Diego, or

the text messaging program in NewOrleans, but that doesnt guaranteethat the same project or platorm will

work everywhere. There are so manyvariables.

It All Comes Down to MD Workfow

A doctor who fnds the time duringhis day to communicate online withpatients, dispensing a ew prescrip-tions and diagnoses, will be success-ul. However, i he or she loses tracko other patients in the process,or cant fnd the revenue stream tosupport that platorm, then successis short-lived. Finding a balance isthereore critical.

So where are the successes? Every-

where, in all sorts of environments,

and measured individually. Eventually,

theyll become commonplace, and

well stop celebrating them, or at the

very least regarding them as unusual

or above the norm. And in time, we

may not even notice the little m in

front of Health anymore.eric wickLaNd
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AlThOugh the health careindustry is about deliveringcare to patients, most con-

sumers are only in the presence o acare giver a small percentage o thetime. As such, the ability o a caregiver to treat them, educate/inuencethem and monitor them has at leasthistorically, been quite limited. Butthat is changing. The changes arebeing driven by a number o majororces.

First, the health care industry

itsel is being transormed to asystem based on outcomes, not

volume. Providers are going to bepaid on managing the health o theirpatients, not just on how many pro-cedures they perorm. Providers arethereore more motivated to have pa-tients become more educated abouttheir health and conditions, ollowtreatment recommendations andmake healthier choices. Additionally,providers are looking to touch theirpatients more oten, but in a waythat keeps costs, time and resourcesin check.

Second, patients themselves arebecoming more motivated to beengaged with improving their ownhealth. While they might be makingpoor choices when it comes to eatingtoo much or not exercising enough,they are taking an increased interestin seeking out health care inorma-tion, particularly over the internet,including inormation about medicalconditions, medications, the bestdoctors and hospitals, etc.

Third, the modern world (andeven parts o the underdeveloped

world) is rapidly adopting mobiletechnology. Advances in smart-phones, wireless networks, GPS-based locationing technology, etc.,are providing consumers with thekind o inormation access that

would have been hard to imagineeven 10 years ago.

Taken together, these three orcesare driving health care in the direc-tion o mHealththe use o mobiletechnologies to connect providersand patients and to enable andengage consumers and their amilies.Examples o mHealth include pro-

vider/patient messaging, lab reportviewing, patient education, appoint-ment scheduling, and tele-health.

A great example o a hugelysuccessul health care organizationis Kaiser Permanente. Their com-prehensive approach to patient careand their use o modern electronicmedical records, portals and mobiletechnology has led to a system withhigh loyalty o providers and pa-tients. The majority o KPs members(millions) access the patient portal,and increasingly are able to do so

with mobile technologies such assmartphones and tablets.

Some would argue that becauseKPs providers are employed, theycan be orced to use such technolo-gies to interact with patients.However, there are many healthsystems in the country and provid-ers are in higher demand than everbeore. KPs physicians choose tostay with the system, as do KPsmembers. Such high adoption ohealth inormation technology to thisdegree is still rare.

As to the uture, the increaseduse o remote-home monitoringequipmentand in particular mobileequipment that travels with thepatient, that can provide inorma-tion to providers and their patientsto detect problems and recognizeprogress will strengthen the bondsbetween providers and patients evenurther, leading to higher loyalty andhealthier patients.

Meet the poster childor successul

mHealthadoptionBy Kenneth A. Kleinberg, FHIMSSManaging Director o Research and Insights

The Advisory Board Company

The majority of

Kaiser Permanentes

members (millions)

access the patient

portal, and increasingly

are able to do so with

mobile technologies

such as smartphones

and tablets.

Kenneth A. Kleinberg,

The Advisory Board Company

keNNeTh a. kLeiNBerg, FhiMSS
https://healthy.kaiserpermanente.org/html/kaiser/index.shtmlhttp://www.advisory.com/https://healthy.kaiserpermanente.org/html/kaiser/index.shtmlhttp://www.advisory.com/http://www.advisory.com/https://healthy.kaiserpermanente.org/html/kaiser/index.shtmlhttp://www.advisory.com/https://healthy.kaiserpermanente.org/html/kaiser/index.shtmlhttp://www.nuance.com/for-healthcare/index.htm


10/22

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Pai o-h-GExperts speak out on how patient-riendly

mobile technology will revolutionize our

healthcare system


11/22

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A d v a n c i n g t h e

m H e a l t h E c o s y s t e m

We are striving toward a future

of better healthcare for all with

assistive tech in every back

pocket in America.

th

vic fpai

By Regina Holliday,Artist, Speaker & Blogger atRegina

Hollidays Medical Advocacy Blog

In the school year 2007-2008,my son was struggling and

had recently been diagnosed withan Autism Spectrum Disorder. Heunderwent tests, including an assis-tive tech assessment, to determine

which accommodations would be

needed. Based on the fndings o theassistive tech team, he would needmany costly interventions. He wouldneed access to a laptop or computer.He would need a larger deault ont.He would beneft rom some type ospeech recognition sotware, as hiskeyboarding skills were very slow.

As the team listed item ater item,I knew the school system wouldstruggle to provide even a quartero the devices my son would need.

Appropriate accommodations were

almost unattainable then, but todayvirtually all my sons requirementscan be provided by the iPhone in myback pocket.

2013 is a very dierent landscapein both education and health. Whilesome institutions, organizations andindividuals still lumber about usingtools and technology more appro-priate or yesteryear, quite a ewpatients have embraced the possi-bilities o mobile health via tablet

or smartphone. I a patient logs onto their patient portal and does notunderstand a word or term, it takesonly seconds to copy and paste thattext into a search feld. I a patient issearching or the best path to reachthe closest hospital there is an appor that. And why settle or closest?Services such as Yelp provide insightthat a hospital fve more miles awaymay have much better care.

The voice o patients is becom-ing louder as the tools o mobiletechnology become omnipresent. Nolonger must the hospitalized patientendlessly press a call button waitingor someone to come to his or heraid. Ater a ew tries, the e-patientcan call the ront desk or help, emailcustomer service to complain andtweet their displeasure. Meanwhile,patients are accessing their inor-mation more rapidly as acilities andinsurers are oering patient portals.Here the data is pushed out to the

patient and the patient has the abilityto respond via email but not amend.Some organizations are embracingthe Blue Button concept and allow-ing patients to download some or allo their available data.

This is a great step orward ordata access, because now patientscan utilize that data set with thefltering resources o third-partyapps.

Do you see what this

means? Now any healthcitizen with access toa smartphone has theability to monitortheir health andguide their care likeno other gener-ation in history.Even someonelike my son,

who strugglesdaily, candictate a

note to himsel. He has an endless li-brary o defnitions to understand hiscondition with a device that allowshim to magniy the text with a swipeo his fngertip. Can you imagine

what a great equalizer this is? Weare striving toward a uture o betterhealthcare or all with assistive techin every back pocket in America.

regiNahOLLiday
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12/22

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Rules of

engagementBy Joseph Kim, MD, MPHPresident,MCM Education

Founder,MedicalSmartPhones.com

Healthcare providers (HCPs)are becoming so busy that it

is more difcult than ever to trulyconnect with the patient. Primary

care providers only have 10 minutesor each patient encounter. Medical

specialists may take more time witheach patient discussing very complexissues, but patients have a verydifcult time retaining some o the

key pieces o inormation that areoten communicated during theseencounters. Thereore, there areseveral key ways that HCPs can usemobile technology and portals toengage with their patients:

heat edcationEven though patients may be comb-ing the Internet to fnd answers tohealth questions, they want to learnrom their HCPs. Nurses are oten theront-line clinicians who are answer-ing clinical questions, but they can-not be the ones to provide medicaladvice. Physicians are oten too busyto answer the myriad o questionsthat get asked by patients. Mobiledevices and health apps can be highlyinstrumental in educating patientsabout broad health promotion topicsor ocused disease-specifc topics.For example, as patients check inor their visit, they may get handed atablet that has an interactive healtheducation app that produces tailoredmultimedia content based on how

the patient may answer three simplescreening questions related to diet,exercise, and sleep. Or, a patient mayget prescribed a mobile health app

to learn more about diabetes care,proper eating, and the importanceo exercise. As patients interact withsuch apps and web portals, they maylog their progress, enter specifc datapoints, and receive tailored eedbackrom their HCPs during their next

visit. Mobile apps are making it eas-ier than ever to educate patients andto keep them engaged about theirongoing disease management.

Medication aderencePatients oten have difculty with

medication adherence. This is espe-cially true among patients who takemultiple medications or in the olderadult population. Mobile technology,health apps, and web portals can beused eectively to improve adherenceto complex drug regimens. We nowhave reminder apps that can be builtinto mobile devices. Family membersand riends can also track whethertheir loved ones are taking their pillsand reinorce proper behavior by call-ing, emailing, or texting with a dontorget your pill message or with agood job taking your medicationstoday compliment. HCPs can alsotrack patient behavior and reinorceor remind patients to maximize ad-herence. Without proper adherence,diseases can worsen and lead to a

variety o burdensome complications.Thereore, it is in the best interest opatients, amily members, and provid-ers to improve adherence to medica-tions treating chronic conditions.

SstainabebeaviormodifcationsPatients oten need ongoing motiva-

tion to manage their health condi-tions. Whether they are trying to lose

weight or quit smoking, theseconstant reminders are criticalto sustainable behavior changes.Mobile apps and web portals thatleverage an online social communitycan provide the necessary socialsupport to keep patients motivated.In some cases, adding a ew basicelements o gamifcationsuch asincentive points, ranking order, orother types o positive eedbackcan signifcantly boost levels o

motivation. This is one o the reasonswhy we see increasing momentum inthe quantifed sel (QS) movement

where patients are using wearabletracking devices to monitor theirsteps, their ftness, their sleep, orany other type o physical activity.They are sharing these stats onsocial platorms and participating incontests to earn bragging rights andto improve their health. HCPs canencourage the use o these types otechnologies to keep their patientsmotivated to live a better andhealthier liestyle.

a patient may get prescribeda mobile health app to learn moreabout diabetes care, proper eating,and the importance of exercise.

JOSePh kiM, Md, MPh
http://www.mcmedu.com/http://www.medicalsmartphones.com/http://www.medicalsmartphones.com/http://www.mcmedu.com/http://www.nuance.com/for-healthcare/index.htm


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Patients are currently lacking

a clear orm o communica-tion when it comes to their

total health picture. We have manyresources to interpret and consider

when it comes to medical advice:recommendations rom our doctors,lab results and support on medicalorums rom others with similarconditions. Putting all those channelstogether is nearly impossible itson the patient to decide what pieceso the puzzle to connect, interpret itsmeaning, and how to act.

It all eels impersonal and daunting,especially considering that actively

monitoring your health might happen to

coincide with a serious health state.

A monotype electronic medicalrecord stands in stark contrast tothe personal and emotional qualityo a concerning health condition. Bycontrast, while in good health, thepresentation o the EMR does noth-ing to motivate a patient to maintainor improve their liestyle.

For something as complex as our

ongoing health, patients need a ro-bust, understandable view o the in-terconnected aspects o their health.The data in these EMRs is incredibly

valuable, but patients overwhelm-ingly dont have the health literacyto interpret them. By creating ameaningul, personal view o thisdata, patients can be empowered totake control o their health.

Medical records technically dotheir job fne as a discrete piece oinormation the problem is that

theyre designed or doctors andtheyre almost never presented incontext to each other. They quick-ly scan histories o medications,conditions, and lab results to makesure theyre treating their current

patient appropriately. Regularpeople, patients, get no value romtheir medical records. Theyre ull o

jargon, dry, non-intuitive, and just asnapshot o historical inormation.Unortunately, this is where a troveo rich medical data lies.

This can become the North Stardesigning

a health record that actually empowers

people to take control of their health.

I we were to design a solutionaround this, we should start with

identiying the problem and the goal.The problem isnt to create a mobile

version o a medical record, its tohave critical inormation at hand inan emergency, or to improve patientcompliance, or to help people im-prove their health.

For patients, a tablet can providea much more interactive experiencethan mobile phone, because theormat supports rich, exploratoryinteraction and presentation. Beau-tiul visualizations, diagrams and

interactive models can give patientsa picture o their health as it relatesto their body over time, and with re-lation to all aspects including recentlab results, current and past medi-cations, a history o medical events,

and other important drivers like dietand exercise.

A mobile app is a means to an end,not an answer in and o itsel. Mobiledevices, or example, are the perectplatorm or here-and-now inorma-tion, quick reminders, things thatcommunicate at a glance. While youmay be able to access your entiremedical history on a mobile device,there really isnt a situation when

youd want to do that.

On the other hand, mobile devices provide

the opportunity to make EMRs more a part

o our day to day lives.

Mobile interaction is likely tobe ocused around the immediatemoment. What medication do I needto take now? Wheres my doctorsappointment? It may be less import-ant to access ull lab results on amobile device, and more benefcial tohave an app communicating with apatient-acing portal with centralizedinormation.

Team that was Awarded Best Overall

Design in the 2013 Health Design

Challenge, sponsored by the

Ofce o the National Coordinator or

Health IT. The team ormed as a result o

their day job connections at gravitytank.

Top Row, let to right: Dene Civelekoglu,

Stephen Menton, Amy Seng

Bottom Row: Justin Rheinrank, Amy

Guterman, Kunal Bhat

Patient-centric mobie EMRBygravitytank

The problem isnt to create a mobile version oa medical record, its to have critical inormation

at hand in an emergency, or to improve patient

compliance, or to help people improve their health.
http://www.gravitytank.com/http://www.gravitytank.com/http://www.gravitytank.com/http://www.gravitytank.com/http://www.nuance.com/for-healthcare/index.htm


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dvancingthe

mHealthEcosystem

Pa s Piai mHah

A look at some o the most successul

mHealth apps on the market, and how payers

are working with patients and providers todrive better outcomes


15/22

1 5



Empowering consumers withquality healthcare apps

By Martha Woord,Vice President, Head o CarePass,Aetna

More and more people, across alldemographic segments, are turn-

ing to mobile devices to fnd healthinormation and make health caredecisions. A 2012 Pew Internet studyound that 19 percent o smartphoneusers have at least one health-relatedapp on their phonea number that issure to increase in the coming years.

In this new health care environ-ment, consumers are defning quality

in terms o convenience. Our researchshows that more Aetna members arelooking to manage their health usingtheir smartphonetracking theirexercise and eating, getting healthinsurance inormation on the go, andfnding a nearby doctor or pharmacy.

We are striving to meet our memberswhere they are with resources andinormation that help simpliy andimprove their health care experience.

The Aetna Mobile app puts ourmost popular online eatures at ourmembers fngertips. With the app,

Aetna members can fnd a localdoctor, view their Personal HealthRecord, learn about their coverageand benefts, and more. They caneven use their smartphone as their

Aetna ID card.

Better Apps. Better DecisionsUnique, innovative apps can also helpconsumers and health care provid-ers make better, smarter and saerdecisions. One example is iTriage,one o the most popular health andftness apps with more than 8 million

downloads. iTriage allows users toresearch their symptoms, fnd a med-ical provider that best serves theirneeds, and book appointments allrom their smartphone. iTriage is oneo several resources that we are usingto help connect health care providersand patients with powerul, personaltechnology.

We will continue to create new appsthat meet consumer needs. However,

we are also ocused on helping peoplemanage their health by making the

apps they already use work togeth-er more eectively. In 2012, welaunched the CarePass platorm,

which allows consumers to keep us-ing their avorite health and wellness

apps and seamlessly integrate theirdata and insights to one location.

Access to Persona DataAn important component o em-powering consumers is to make iteasy or them to access their data.Now eaturing 19 market-leadingpartnersincluding iTriage, FitBitand MapMyFitnessthe CarePassplatorm is creating a personalizedexperience or consumers to managetheir whole health, rom getting care,to staying well.

Building upon the CarePassplatorm, we recently launched anapp called Passage, one o thefrst health and wellness apps in thenew Microsot Windows 8 store.Developed in collaboration with Mic-rosot, the Passage app transorms adull workout routine into something

visually exciting by transporting usersto places like London, San Franciscoand Paris. A person using the Passageapp can unlock real-time picturesposted to Instagram; hidden gemrestaurants with reviews rom Yelp;street view images; insider traveltips; and interesting acts rom theselocations based on their progress onthe virtual route.

uneasin CreativityAetna is also engaging developers todrive better outcomes rom mHealth.Last year, CarePass launched aDeveloper Portal that oers uniquedata services, encouraging developersto unleash their creativity and buildinnovative solutions that drive con-

venience or consumers. Consistentwith the U.S. Department o Healthand Human Services (HHS) opendata initiative, we strongly believethat making valuable public and pri-

vate health data available to talenteddevelopers increases the chances odeveloping apps that can truly changethe health care experience.

We will continue to work withconsumers, health care providersand developers to create mobilehealth solutions that meet theirdiverse and unique needs. Weare committed to making it assimple as possible or individu-als to pick up a mobile deviceand manage the complexitiesassociated with seeking, getting

and managing their health. We believeempowering consumers can improvethe entire health care system andresult in health care delivery that ismore convenient, connected and costeective.

MapMyFitness is a trademark of MapMyFitness, LLC.

FitBit is a trademark of FitBit, Inc.

Microsoft and Windows are either registered trade-

marks or trademarks of Microsoft Corporation in the

United States and/or other countries.

We strony beieve tat makin vaabe pbic and private

eat data avaiabe to taented deveopers increases te

cances o deveopin apps tat can try cane te eat

care experience.

MarThawOFFOrd
http://www.aetna.com/http://www.aetna.com/http://www.nuance.com/for-healthcare/index.htm


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dvancingthe

mHealthEcosystem

The mobile,

personal healthintersectionBy Nick MartinVice President, Innovation Research & Development, UnitedHealth Group

Mobie tecnooiesare changing the way health care

is consumed and delivered in America,paving the way or greater consumerengagement, reduced costs and betterpatient outcomes. The trend is beingdriven by the growing prevalence osmart phones and tablets, which haveempowered consumers to take chargeo their health like never beore.

Many Americans, 53 percent, dontcurrently use consumer electron-ics to access important health careinormation, options and services.However, more than 60 percent orespondents anticipate increasingtheir use o consumer technology or

just these purposes during the nextyear, according to a survey conduct-ed by ORC International on behalo UnitedHealthcare. The surveysresults suggest the public is startingto realize how technology and con-sumer electronics can help them learnmore about health, empower them totake better control o their individualhealth, and even simpliy the entirehealth care system.

So what mobile technologies arestarting to change the health caresystem? Here are a ew examples ohow mobile technologies are currentlyintersecting with personal health:

heat acievementSmart phones are also allowing

consumers to more easily track,evaluate and compare their eortsto exercise more, improve their dietsand promote overall wellness. Thesemobile health apps eature coaching,relevant and personalized content,and connection to social networks.Some tools even let people createtheir own health challengeswithriends, co-workers and otherstohelp achieve health and ftness goals.

These tools can also incorporatewireless trackers that include accel-erometers to more accurately count

how many steps a user takes andan altimeter to track stairs climbed.The devices also calculate how manycalories are burned. The inormationcan even be uploaded wirelessly to theindividuals Personal Health Record,enabling people to track their prog-ress and share the results with theirphysician.

Other new tools are also helpingpeople more eectively track andmonitor their chronic conditions.For instance, new technologies nowenable diabetics to use their mobilephones to monitor their blood glucoselevels. By automatically uploadingthese readings to an online portal andto healthcare providers, diabetics canaccurately and conveniently managetheir condition.

heat system naviationSome o the most useul mobile appli-

cations related to health enable peopleto more eectively navigate the healthcare system. For instance, United-Healthcare oers Health4Me, an iPho

and Android app that enables people tdo everything rom check claims andaccount balances, locate nearby urgencare acilities and ERs, and quickly co

nect to the health plan. The app also eables people to access an experiencedregistered nurse 24 hours per day/sevdays per week or advice regarding ankind o medical question.

This tool, along with other newonline systems, enable people to comparison shop or health care servicebased on both cost and quality. Histoically, patients oten didnt know howmuch their medical care actually cos

with the bill arriving months atertreatment. These new tools now en-able consumers to create side-by-sidquality comparisons or specifc treaments at specifc acilities, allowingpeople to place just as much emphason quality as they do price.

As consumers continue to take amore active role in their health and

well-being, mobile applications havenearly limitless potential. Theseinnovations are enhancing the healthsystem and helping people take morcontrol o their personal healthtrends that will help create a happieand healthier America.

NickMarTiN

60% o respondents anticipate

increasing their use o

consumer technology or health

care inormation, options and services.

These new tools now enable consumers to

create side-by-side quality comparisons or

specifc treatments at specifc acilities
http://www.unitedhealthgroup.com/main/Default.aspxhttp://www.unitedhealthgroup.com/main/Default.aspxhttp://www.nuance.com/for-healthcare/index.htm


17/22

1 7



F f mHahExplore the not so distant uture o mHealth

with some o the brightest minds in healthcare


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dvancingthe

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New era o medicine

unpluggedBy Eric Topol, MDChie Academic Ofcer,Scripps Health,Proessor o Genomics,Scripps Research Institute

Author, Creative Destruction o Medicine

Within the next 5 years, there willbe a undamental shit or who

accesses and owns medical dataand inormation. Although this is

presently in the doctors domain, andhas been or medicines long histo-ry, the biggest single advance willbe the about-ace to true consumerempowerment. The empowermentterm related to health has beentossed around or many years datingback to the 1990s, especially sincethe internet provided considerablemedical inormation or consumersto access. But what is dierent nowis that an individual will not just bereading about population level data,but will be seeing real-time smart-phone display o his or her own dataand inormationdata that in manycases was not even obtainable untilquite recently.

We are just beginning to see the signso this in 2013 with new smartphoneadds and apps that capture data onphysiologic metrics such as bloodpressure, blood glucose, and heartrhythm, along with imaging or suchconditions as skin cancer and middleear inections. Sensors or lung unc-

tion, mood, eye pressure, movementdisorders, brain waves and hundredso medical metrics are in clinical useor testing. The technological progress

that has been made in innovatingand developing such hardware isremarkable, having only started in thepast ew years. Now all vital signs, in-cluding blood pressure, heart rhythmand rate, blood oxygen saturation,respiratory rate and body tempera-ture can be continuously monitorednon-invasively. In my own practice ocardiology, I am seeing patients whoI would never have been predicted tobe data-driven but who are clearlyexcited about having their own med-ical data on their own smartphone.This has enabled many patients tosel-diagnose not only that their hy-pertension is inadequately controlled,but the precise link to their activitiesas returning to work on Mondaymorning, or an evening phenomenondue to a medication wearing o. Andthats just with intermittent bloodpressure measurements that requirethe individual to tap start on thephone screen.

How about when such measure-ments are being captured seamlessly

during sleep and stressul situa-tions? But this is just one example osmartphone-DIY medicine. It is nottruly do-it-yoursel. Yet having onesinormation can be integrated with-the unique insights o the individualor a dierent and rereshing modelo partnering with ones physician.Thats a whole new look.

This is not just about sensors but

also about DNA sequence. Whileit is possible to obtain ones wholegenome sequence today, it still costs$4,000-5,000 but that is widelyanticipated to drop to ~$1,000 bythe end o this year. But like sensorphysiologic data, imaging data, andsequence data, its all about the algo-rithms and transorming it to useulinormation and knowledgeto beeminently understandable, enlighten-ing and actionable. It means taking

large data sets or any given individ-ual and extracting all the meaningulinormation. Like developing thehardware, this, too, is moving alongat an extraordinary velocity.

Once all relevant medical data

or any individual can be obtainedand ully processed, displayed andarchived on ones mobile device,

we have reached a new plateau ohealthcare, a new dimension o knowthysel that might not have beenimaginable a ew years back. Re-ecting newound and well-deservedpower and authority, the individual

will be driving i and when, and withwhom, the inormation will be sharedThats what were in store or in theera o unplugged medicine.

eric TOPOL, Md

We have reached a new plateau

o healthcare, a new dimension o

know thysel that might not have

been imaginable a ew years back
http://www.scripps.org/http://www.scripps.edu/http://creativedestructionofmedicine.com/http://creativedestructionofmedicine.com/http://www.scripps.edu/http://www.scripps.org/http://www.nuance.com/for-healthcare/index.htm


19/22

1 9



The Internet

o thingsConvergence o mobile technologies,web-based sotware, low-power, low-cost hardwareand connectivity will usher in a new era o healthcare

By Peter Ragusa, MD, MPHCEO and Co-Founder, VoiceHIT

Developer o theBetter DayHealth Platorm

As the healthcare industryand governments around the

world struggle with the risingcost o healthcare, many are lookingto the uture to address todays prob-lems. As they do, what they are fnd-ing is that, in the next fve-10 years,mobile devices, connectivity and theconvergence o currently-emergingtechnologies will spur the growtho patient-centered treatment plans,collaborative care and populationmanagement.

These trends in innovation will bethe primary drivers in decentralizingpatient care away rom the clinicand hospital while improving qualityand lowering overall costs. They also

will enable us all to realize the longsought-ater benefts o technologyin healthcare. Advancements in thisdirection are already underway. Aspatients begin to engage with provid-ers over the internet, mobile devicesand connectivity are transormingthe way people view and managetheir health.

Today, patients are using smart-phones and online tools to stayconnected and inormed. Over 80percent o U.S. consumers searchor health inormation online, andone-third o all smartphone userstrack their diet or exercise activities.

Additionally, patients and provid-ers are using social media in new,creative ways. PwC reports that athird o Americans now use socialmedia sites, such as Facebook andTwitter, to seek medical inormation

and to track and share symp-toms. Providers are increasinglyusing social media to reach theirpatients and interact with theirpatient communities.

As social media matures,were likely to see smaller,customized social communitiesemergeorganized by providerorganization, disease, geogra-phy or a mix o these actorsand others. These will connectpatients to patients, patients to

providers and providers to eachother. Accordingly, paymentmodels will also emerge that in-centivize collaboration and helpto ensure patient engagement, as

well as continuity o care, improvinghealth and lowering costs.

Convergence o mobile technolo-gies, web-based sotware, low-power,low-cost hardware and connectivity

will usher in a new era o health-care. This convergence will occuras the so-called Internet o Thingsbecomes a reality. Consumers are

increasingly using sel-tracking mo-bile health devices and smartphonespaired with health apps to monitorkey indicators. These unobtrusivedevices and apps collect poweruldata and provide rolling evalua-tionsalerting patients to changesin their health based on biometricand sel-initiated assessments thatcan monitor everything rom locationto mood to blood glucose to bloodpressure, weight, sleep and physicalftness level. For example, Microsot

and Ford are working on a car thathas a ketone detector in the dash and

will proactively alert a diabetic driverto pending problems.

Like the Ford example and others,new advancements in connectedhealth technologies will mean thatpatients no longer have to rely onofce visits to assess their health.Rather, these technologies will work

in concert to alert them proactively.As consumers take control o theirown health and technologies movetowards convergence, emerging andgrowing market orces will spur onthe mHealth ecosystem to produceproducts and services that empow-er both providers and the patientsthey serve with tools that will enableproactive care management similarto web-based banking and socialnetworksonline, in the cloud, romany device and anywhere, anytime.

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A

s noted in the contributions in this guide, the uture

o a quality, efcient healthcare system rests on ourability to press industry players to embrace collaborationand push or the creation o a connected ecosystem where

rom patient to payermHealth technology acts as theember to spark ongoing innovation.

Today, we, as consumers, havegrown accustomed to experiencingthe power o mobile technology. Astechnology has evolved, its begun

to take on an increasingly intuitiverole in the orm o mobile devices,televisions, laptops and cars thatlisten and understand our requests.

With this evolution in mind, Ivebeen thinking a lot about what amobile virtual assistant could meanor clinicians. In todays healthcaresetting, ar too much clinician timeis spent on administrative tasks that

while important, pale in comparisonto the signifcance o their main job

duty ensuring the health and well-being o actual people. But, whati we could help clinicians tackleadministrative and other day-to-day

duties by enlisting the power o aeet o mobile virtual assistants thathelp clinicians simpliy interactionsand address data-entry headaches

with electronic health records(EHRs); or provide real-time insighton the next patient, including vitalsand medications; or even promptthem or more inormation whenthe record does not contain thelevel o detail needed to ensurefrst-rate care?

Overall, the everyday consumerunderstands the power o a mobile

virtual assistant. In act, a recentconsumer-ocused survey ound that

more than 60 percent o respondentsare interested in using a virtual assis-tant on their phone and o those whoare currently using mobile virtualassistants, more than 80 percentound them useul. To simply pick up

your smartphone and ask it to movea meeting, present local movie times,call your mother, or set a reminder tosend your car payment all o theseactions provided by a mobile virtualassistant just make lie easier.

Building o these consumer fnd-ings, Nuance also recently conduct-

ed a similar survey with clinicians.Nuances 2013 Virtual Assistants inHealthcare Survey ound 79 percento clinicians surveyed spent morethan 15 percent o their day onadministrative, non-direct careduties. Moreover, one-out-o-threespend 30 percent or more o theirday on these duties. Clearly, theirtime could be better spent.

Wi mivia aiapp h ff mici?

By Jonathon DreyerDirector o Mobile Marketing,Nuance

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a via p i chg ha

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pa a w a pai surVey resPondent

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http://www.nuancemobilelife.com/mobile-personal-assistants-are-the-new-digital-wingman-infographic/http://www.nuance.com/http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3F4h8tm00twn10et5http://www.mediafire.com/view/%3Fmyfiles%23http://www.nuance.com/http://www.nuancemobilelife.com/mobile-personal-assistants-are-the-new-digital-wingman-infographic/http://www.nuance.com/for-healthcare/index.htm


21/22

2 1



As the healthcare communitylooks or ways to modernize healthcareand improve patient care andengagement, mobile technology will

increasingly take center stage. While Iwont go as ar as Vinod Khosla and saythat technology will eventually replace80 percent o doctors, I will say thisthe healthcare system and the mannerby which we provide patient care todayis broken and technology can helpreconfgure the pieces back together tocreate a more efcient, patient-centricsystem. In order to address deep-seededissues that continue to inuse complexityinto healthcare, I believe we need to dothree key things and mHealth will playan important role in each:

Doctors believe that by 2018,

virtual assistants, powered by

clinical language understanding,

will drastically change how

physicians interact and use

electronic health records.8 i10

th K r f AigHahca Cm

thgh mHah:

1Identiy ways to streamlinecommunication and cooperationacross the various involved parties.

2Leverage what we know works romconsumer use o mobile devices &apps and adapt these solutions toft the healthcare realm.

3Create and adopt intelligenttechnologies that help reinventoutdated, unnecessary processesand approaches to patient care andclinician job duties.


22/22

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dvancingthe

mHealthEcosystem

Hw hik mHah

ca hp aica cmpxi

a fh hmaiz hahca?

Ci h cvai a

F h Hah f It.
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