Health care is moving away from a long-standing center of gravity in which most activity has involved provider and patient together in close quarters, exchanging information face-to-face, giving and receiving care and then going their separate ways.

A steady, inescapable shift toward provider responsibility for people's overall health has stimulated the need for constant awareness of their health status and the ability to track and treat across a continuum of care, including the home. With that comes the need to create, receive and be prompted to action by data and instructions on devices within and outside of care settings. In other words, going mobile.

Mobile health care, or mHealth, has proliferated in the broad sense. It can mean any use of mobile devices and the applications specifically written for them to advance the use of information for a health purpose independent of location. For health care chief executives, the problem is that the vast majority of the tens of thousands of mobile apps identified as mHealth "sit in the fitness and wellness space; they don't go particularly deep into health care," says Harry Greenspun, M.D., senior adviser on health care transformation and technology to the Deloitte Center for Health Solutions.

"The real promise of mHealth is moving into utilizing it for sharing information, for care coordination, for meaty consumer engagement, and also analytics, particularly as we move into a value-based reimbursement environment," says Greenspun.

In that environment, the right information has to land in the hands of the right people at the right time, "to avoid unnecessary expenditures, to make better decisions, to have decision support delivered at the right moment," he says. "And also to use these devices to capture that the right people did the right things at the right time — to know who's responsible for either good treatment or bad treatment, who's providing good adherence or bad — and also what's working, to identify how things are improving."

Global estimates of mHealth growth look impressive, with one market forecast by research2guidance in March 2013 stating worldwide it will hit $26 billion by 2017, and another by PricewaterhouseCoopers LLP in July 2013 predicting a nearly sixfold increase to $23 billion by 2017. Of that PwC estimate, however, all of North America accounts for 28 percent of the total. And much of what's marketed is geared to a narrow target in isolation from an overall provider clinical and IT strategy.

"I think too many people look at this as, 'We're going to put some more apps in,' and that's it. It's so much more than that," says Daniel Garrett, who leads PwC's health care IT practice. "It's not just about providers' figuring out how they're going to introduce mobile phones and remote connectivity to the household, or better patient and physician connectivity. It's also about how they fundamentally prescribe and deliver health care."

Those fundamental needs are starting to compute with health care leaders amid the noise of app proliferation and patient/consumer-oriented mHealth growth, says David Collins, who heads up mobile health activities with the Healthcare Information and Management Systems Society. "The traditional hospital/health system space is catching up. I think they're seeing the value of mobile." With the meaningful use incentive program moving into the second stage of requirements, mHealth will be tapped for the requirements emphasizing communication between provider and patient, he adds.

The pace of clinical IT adoption generated by that program has created greater readiness for mHealth and the logic for it as a next step in automation, says Garrett. "The medical record phenomenon created by meaningful use got everybody to a digital space, a foundation level of digitizing our personal records and our medical records. The next layer is to put more out there and to distribute that data, aggregate it and then put it into the points of delivery in the health care process, and mobile is a perfect way of doing that."

"Professionals are on the fly; they're always on the move," says Rob McCray, president and CEO of the Wireless-Life Sciences Alliance. "That means at any given time, you need information or some communication with somebody else who isn't there, or a data source that isn't in front of you." Used as part of the IT plan, for time-sensitive alerts and other data-critical moments, "mobile systems contribute to the ability to ensure that when the information is available, the decision will be made."

Patients in the Loop

Any mHealth strategy has to make sure to loop in the patient, to meet consumer demand as well as extend the continuum of care. "Hospitals and health systems have to embrace mobile health to satisfy their patients. People just expect a certain way of transacting with a health care provider — and with the world in general," says McCray. Now that managing their own health information is possible, more consumers will want to go down that path with their providers, he says.

Patients are coming to expect a doctor to be able to find out what's going on with their care, which sometimes would have to be accessed remotely, says Greenspun. "And they expect to be able to share this information with people they need to share it with, because they're having those experiences outside of health care. So expectations are rising rapidly."

Mobile health applications feed patients' quest for wellness and the tracking of personal health information that goes with it, says Collins. Besides sharing such data through social media, patients will want to share it with their providers, which leads to how they organize to receive streams of outside information into electronic records.

That's a lot of extra data coming in, but "if we can get them engaged and tuned in to monitoring their conditions and helping us monitor their health," Collins says, "that's so much that the doctor is [currently] missing between periodic visits."

The Business Case

As health care providers step back to weigh how mHealth figures into care delivery, heavyweights in other health care sectors are driving the market into new areas of deployment. "There's a huge pressure from the payer sector around performance out of their dollars, and they're chipping in ways to use mHealth to better address and better serve their members," says Garrett. "And suppliers are beginning to give (payers) opportunities to serve their constituents."

It's a "logical rollout" for health plans, pharmaceutical firms and medical device companies, he says. "The payer community in general has been in search of more value for their members, more 'stickiness' (keeping members loyal), and also looking for a better way to add value to the provider networks. And this is certainly a platform and a technology to do that."

Strategies for drug and device-makers are moving from simply manufacturing to "treating the overall disease state, trying to get into everything from adherence to the whole consumer experience," says Garrett. Becoming service-based and engaging consumers in their health can show a higher level of results for their offerings, "because they're not just selling insulin to a diabetic, they're going to take on the whole disease."

Providers should take note of the business case, around retained members and reduced costs resulting from wellness and prevention, especially as they take on risk or launch their own health plans, Garrett says. There's also an opening to integrate mHealth efforts of other sectors into their own care processes.

Getting into the market: mHIMSS Roadmap

The Healthcare Information and Management Systems Society's mobile guide covers 6 areas:

1 | New Care Models: Illustrations of how mobile health apps are utilized in the shift of care from the acute to non-acute institutions and the home. For example, new mobile health technologies use remote patient monitoring and vital-sign sensors to manage elderly people with chronic diseases in their homes.

2 | Technology: Factors to consider for developing mobile medical apps, and incorporating person-generated health data into existing systems.

3 | ROI and Payment: Financial aspects of adopting mobile app technologies, with examples of successful programs.

4 | Legal and Policy: A practical and informative perspective of recent Food and Drug Administration guidance pertaining to mobile medical apps.

5 | Standards and Interoperability: Types of networks, communication patterns and standards that figure into implementing mobile health applications and incorporating them into existing IT.

6 | Privacy and Security: Expert overview of the current state for mobile apps, as well as future considerations. It includes guidance to app developers as well as health care enterprise users.

Source: mHIMSS Roadmap, second version, released Dec. 9, 2013

About the series

As health care moves rapidly toward a value-based delivery model, a greater emphasis will be placed on care coordination. We must ensure that patients not only get the right care at the right time in the right setting, but also that every part of the delivery system is connected and understands that a patient's need will be critical going forward. Information technology will be instrumental in making sure that these connections take place.

H&HN, with the support of AT&T, created Connecting the Continuum to explore how hospitals and health systems are addressing the care continuum in their strategic and operational plans. In 2014, the series will examine the growing use of mobile technologies to drive performance improvement.

Each month, we will examine such topics as health information exchange, mobile health and transitions of care. Follow the series in H&HN, H&HN Daily and on our website.

Connecting The Continuum