Mobile health: Staking a path from advisement to ownership

In 2018, can we all agree that the acute onset model of health care doesn't work out so well? Avoiding preventive care and annual doctor visits in favor of waiting to go to the doctor until something  happens to you can  trigger an emergency room visit and a potentially preventable admission to the hospital. This is not an optimal way to achieve any of the Triple Aim initiatives: improving health, quality and reducing cost.

As we strive to attain these goals, we examine our current mobile-health environment. The National Institute of Health states:

"....Numerous apps are now available to assist healthcare providers with many important tasks, such as: information and time management; health record maintenance and access; communications and consulting; reference and information gathering; patient management and monitoring; clinical decision-making; and medical education and training."

Make no mistake: This is good. Really good. Even with all this digital progress, much more work needs to be done before we lay claim to shared electronic health data. For example, we often still ask patients for their list of medications when they come to the emergency department (ED). This can be risky, particularly for the elderly Medicare population and yet a post-discharge physician will often have all relevant information available at their fingertips. How can we make sure patient information is available to all providers at all points of care?

We need to leverage this opportunity to coordinate care. It is wonderful that more information is recorded in EHRs and healthcare apps, but a key challenge is the need to coordinate care so adverse events and acute onset can be avoided. The objective is to transform information into a workflow that represents actionable next steps eliminating the downstream need to run to the ED, which in turn eliminates the need for observation and/or admission. 

It is a step in the right direction for the physician or a care coordinator to get a text or phone call if the patient is not taking their meds, but let's think about the next step. The truth is, providers need to know even more information about the member’s risk status as it may necessitate a change in their clinical pathway. Is their heart rate elevated? Are they feeling stressed? What other symptoms, if any, are present?

Some of this work is already in progress. These apps are touching on care coordination processes, but invariably in a niche patient segment because mainstream adoption hasn’t yet been achieved. The central theme of these initiatives is to push technology coupled with intelligent workflow. Mobile technology offers the opportunity to shift the information paradigm in health care, leveraging technology to work a healthcare issue from identification to closure.

Here’s what the future could look like for patients with chronic conditions:

Vitals are checked (and perhaps more ...) through a scanner on the shower door in the morning. Errant values are communicated to the PCP with relevant escalation depending on the specific vital being tested, deviation from history, co-morbid conditions and patient history (just discharged yesterday?). Patient receives instructional next steps via text and reviews recommendations with care.

For members on targeted medications:

A medication monitoring device is deployed to ensure compliance. Non-compliance is escalated as in the process above, depending on a number of factors, including social determinants. Is the patient elderly? Do they show signs of dementia? Do they live alone?

Not just sharing information, but using that information to take steps toward solving the problem.

Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.