Abstract In today’s world, the era of innovation is growing at a fierce pace; without limitations information technology can prove to be as harmful as it is helpful. This is especially applicable to the healthcare industry. The idea of paperless files is the way of doing business in the future. However, papers containing life and death implications such as medical records have been a hot topic for close to a decade. Even though, the American population may be ready for it, there are multiple regulatory guidance at the federal level, which must be addressed such as security and patient confidentiality.
Currently mobile (m) health is the current trend for patients to access their healthcare needs. The public and private sectors are competing for their share of the market when it comes to mHealth. This paper discusses two healthcare organizations leading in this effort, the Veterans Affairs and Sentara. Key words: Electronic (e) Health, Mobile (m) Health, personal health record (PHR) Mobile Health: What is the Holdup? The internet coupled with mobile technology era is pushing our demand for information to be readily available in the palm of our hands. This mentality is affecting all industries of the U. S.
to include the healthcare industry. This paper will explore and evaluate innovative uses of mobile (m) Health and emerging technologies to build synergistic mediums in the healthcare industry. MHealth is a progressive topic pushing the limits on how to access healthcare going forward. There are many factors for the drive of mHealth initiative due to the affects by healthcare stakeholders. An overview of the mHealth initiative will be discussed as it applies to government policy and regulatory agencies, the healthcare network today and future demands, as well as leading hospitals in the mHealth revolution.
Mobile health, commonly known as mHealth is ‘the use of wireless communication devices to support public health and clinical practice (Barton, 2012). Mobile devices are handheld in nature and include mobile phones, personal digital assistants, patient monitoring devices, and other wireless devices. The Internet has introduced us to electronic (e) health, which influences the delivery of healthcare. Subsequently, mHealth applications are receiving increased attention largely due to the global penetration of mobile technologies.
Mobile technology will offer patients the ability to remotely evaluate, access, and monitor their electronic health record (EHR). The EHR is gradually replacing the paper medical records with electronically stored information using information technology (IT) applications (Shi & Singh, 2012). These two mediums of health information exchange are emerging rapidly, but at different rates. The challenge for the healthcare community is meeting the EHR and mHealth government requirements during implementation stages in order to meet the demand of the patients, doctors, and insurance companies.
Americans have a much higher expectation when it comes to medical technology; if it is available; they want it and are willing to pay for it (Shi & Singh, 2012). Government Strategy The public sector has gone mobile, and experts say the government should redouble its efforts to become mobile-friendly. The current administration is pushing for a mobile government. In May 2012, the Office of Management and Budget released the “Digital Government: Building a 21st Century Platform to Better Serve the American People” strategy.
It requires agencies to convert priority citizen services to a mobile platform in the next year (Weigelt, 2012). So where does this apply to healthcare organizations across the country? The answer would be simpler if healthcare fell under the government’s role such as in a national health system (NHS), national health insurance (NHI), or even a socialized health insurance (SHI) (Shi & Singh, 2012). However, our health care system is fragmented producing a “disjointed incrementalism” approach to healthcare reform (Shi & Singh, 2012).
The term-disjointed incrementalism is applicable to the information technology (IT) world, as well. The mHealth movement is here and ready, but some obstacles will have to be addressed in the areas of federal mandates, strategic goals, and security. Government Policy In order to understand how we arrived to our current state in mHealth, we must understand what national policies and agencies are in place to manage the technology revolution from the past and of today. Former President George W.
Bush first established the Office of the National Coordinator for Health Information Technology (ONC) in 2004 where the funding was $32. 8 million (Ong, 2012). This agency was the beginning of establishing an EHR across the U. S. , however, the growth and implementation was marginal due to capital and maintenance constraints (Ong, 2012). Our current administration enacted the American Recovery and Reinvestment Act of 2009/Health Information Technology for Economic and Clinic Health Act of 2009 (ARRA/HITECH) in order to give the public incentives to establish an electronic health record using the “meaningful use” guidelines.
Today HITECH appropriates $2 billion to that office and up to $27 billion in Medicare and Medicaid incentives for meaningful use of the EHR (Ong, 2011). This revolution will create between 45, 000 and 50, 000 new jobs in the health information technology (IT) industry over the next five years (Ong, 2011). The HITECH Act defines three components of meaningful use, the first is the use of a certified EHR in a meaningful manner for example electronic (e)-prescribing. Second, demonstrate the use of a certified EHR technology for electronic exchange of health information to improve quality of healthcare.
The third is use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by Department of Health and Human Services (HHS) (Ong, 2011, pg. 10). The Centers for Medicare and Medicaid Services (CMS) is the office who can certify hospitals for the “meaningful use” incentives (Ong, 2011, pg. 10). Healthcare Network Progress Now that the government has subsidized the healthcare system with substantial incentives the hospitals progress adopting an EHR has increased significantly, but not at the rate projected.
The advances in health IT that were promoted in the 2009 ARRA seemed in doubt as reactions to the proposals ranged from confusion to outright resistance. The eventual impact of the proposals was unclear and many parts of the U. S. health industry, particularly providers, pushed back against the costs and complexities involved in implementing them (FCW: Insights Health IT, 2012). However, 2011 was the year when the commitment to using health IT finally solidified. At the beginning of the year, a survey by the Office of the National Coordinator for Health IT (ONC) found that four-fifths of U. S.
hospitals and over 40 percent of office-based physicians said they would take advantage of federal incentives for the adoption and meaningful use of certified EHRs (FCW: Insights Health IT, 2012). “It’s been known for some time that EHRs could improve patient care while lowering costs,” said David Blumenthal, who was the national coordinator for health IT, “But adoption by health care providers had remained stubbornly low. ” However, the survey showed “We are seeing the tide turn toward widespread and accelerating adoption and use of health IT,” he said. Later figures for the program showed the adoption trend continuing.
Participation in the meaningful-use incentive program jumped 30 percent in August, 2011, to 90,000 providers from the 77,000 recorded in July, 2011, according to the Centers for Medicare and Medicaid Services (CMS) (FCW: Insights Health IT, 2012). Security At the federal level, agencies are rapidly working on securing the wireless networks. The National Institute of Standards and Technology (NIST) an agency of the U. S. Department of Commerce is taking part in the testing standards for certification of developing security technology and guidance while conducting research on usability with other federal institutions (Ong, 2011, p.4).
The NIST is currently undergoing a complete revision of its security guidelines as it pertains to all mobile devices for both organizational provided and personally owned devices. The scope of mobile computing has broadened significantly, since the last publication of this document in 2008. One of the first challenges is addressing the definition of what constitutes as a mobile device. In the article, New Mobile Security Guide Catches Up With Smart Phones, by William Jackson, he states, “Features are constantly changing, so it is difficult to define the term” (Jackson, 2012, pg. 6).
The new guidelines include redefining features of mobile devices. These features include, “At least one wireless network interface with the internet, a built in storage data with the ability to with the ability to synchronize local data with a remote source, an operating system that is not as full featured as that for a personal computer (PC), and the availability of third-party applications” (Jackson, 2012, pg. 6). The same security measures required to assure confidentiality, integrity and availability of data for a PC are required for mobile devices to include additional wireless threat countermeasures.
Patient Confidentiality As healthcare networks continue to develop in hospitals all over the U. S. there is a growing concern for network and patient security. The Health Insurance Portability and Accountability Act of 1996 (HIPPA) took steps to protect patient privacy and security. HITECH extends that protection further with specific guidelines as it pertains to the process of health information exchange. The overall message is to ensure that certified EHRs must be able to “protect electronic health information” as required by HIPPA (Ong, 2011.)
However, due to the stringent HIPPA fines under the HITECH Act more organizations digitizing patient records, are seeking financial rewards under the meaningful use program, yet they are not placing an emphasis on security. According to Mac Millan, chairman of the Healthcare Information and Management Systems Society (HIMSS), “It’s little surprise that security continues to be a concern for healthcare organizations,” (McGee, 2012). “There’s a combination of different forces at work – healthcare organizations have lots on their plates,” says McMillan.
“These organizations are upgrading their EHRs to certified products for meaningful use, joining health information exchanges, dealing with ICD-10 conversion and figuring out if they should become an Accountable Care Organization (ACO),” says McMillan. The Department of Health and Human Services website listing large HIPAA privacy breaches and lawsuits are in the rise for privacy and security data incidents as well, this can be harmful to a hospital’s reputation, let alone any fines, legal fees, penalties or judgments that might end up being paid.
Among indirect costs of data privacy and security breaches for healthcare organizations is the loss of patients who choose to go to another provider (McGee, 2012). Mobile Market The need for a mobile landscape is here, estimations calculate that over 85% of the world’s population is now using a commercial wireless signal, with over 5 billion mobile phone subscriptions (Barton, 2012). Today over 46% of American adults own a smartphone device (Federal IT Consulting, 2012).
By the end of 2012, the number of mobile-connected devices will exceed the number of people on earth, and by 2016, there will be over 5 billion mobile broadband subscriptions globally (Federal IT Consulting, 2012). By 2015, more Americans will access the Internet via mobile devices than desktop personal computers (PC) (Federal IT Consulting, 2012). As of March 2012, 50 percent of U. S. mobile subscribers downloaded applications, which was up 2. 4 percentage points from the previous year (Federal IT Consulting, 2012, pg. 7).
The top marketplaces for mobile applications are Google Play, Apple Applications (App) Store, Blackberry App World, and Windows Phone Marketplace (Federal IT Consulting, 2012). Mobile Market Strategy Recently the Department of Defense (DOD) Deputy Chief of Information Operations (CIO), Robert Carey, stated, “Mobility is key to the future of DOD; we’re not chained to our desks anymore. ” The department rolled out its strategy on 15 June 2012, which identifies IT goals and objectives to leverage the power of mobile devices.
The strategy focuses on improving three key areas: wireless infrastructure, mobile devices and mobile applications (Tuutti, 2012). While implementing a strategic strategy for an EHR, the healthcare industry is already falling behind as a new demand is already taking place, a mobile personal health record (PHR). A PHR is an electronic, universally accessible, life-long health information resource for individuals to make health decisions (Ong, 2012). The healthcare industry is researching this new demand by reviewing current trends in the market for mHealth.
Gartner Study A study, done by the Gartner Research Company, an IT advisory and research company, outlines the Gartner’s Hype Cycle for telemedicine to assist healthcare stakeholders to make better-informed decisions when it comes to the revolution in healthcare and technology. The hype cycle defines technology, provides a justification for its purpose and adoption speed, and user advice. It also provides a benefit rating and an assessment of the technology’s market penetration and relative maturity.
All of these attributes serve to position the technology on the hype cycle, as well as provide input into the associated Priority Matrix (Gartner 2012, pg. 4). The priority matrix is a companion to the hype cycle graphic, which maps a technology’s benefit to its time to maturity. The priority matrix generates from the benefit rating and time to plateau values for each technology. The priority matrix provides an easy to read format and answers basic questions such as: How much value will an enterprise get from a particular technology and when will this particular technology mature to deliver that value (Gartner, 2012, pg.9)?
See Figure 1 for the latest Gartner Hype Cycle. The hype cycle describes Mobile (m) Health an umbrella term for the use of mobile devices in healthcare. The mHealth industry health monitoring, data collection, delivery of healthcare information to clinicians and patients, supports for diagnosis and treatment, and facilitation of education and research. Furthermore is explains mHealth to be similar to ehealth in that it is a broad and nebulous concept that emphasizes the means (mobile technologies), not the end (actual use of technologies in healthcare delivery) (Gartner, 2012).
The business impact of mHealth is difficult to assess since the concept is in its infancy and rapidly developing. The rapid growth in mobile connectivity worldwide, a rush of new mobile healthcare applications, new devices such as tablet computers, and ongoing global physician shortages will boost the adoption of mobile solutions in healthcare, but only if some complex and fundamental problems are overcome. These include business and financial incentives; technical and human infrastructures for data analysis, storage and response; and regulatory and legal frameworks (Gartner, 2012, pg.27).
Successful mHealth Organizations The two healthcare organizations leading the effort in mHealth the private and public sectors are the Veterans Affairs (VA) and Sentara Healthcare. In April 2012, the VA launched the posttraumatic stress disorder (PTSD) coach smartphone app, intended to help military personnel and veterans learn about and manage symptoms that commonly occur after people suffer trauma. It provides information about PTSD and lets users track their PTSD symptoms, enabling them to link to both public and personal sources of support.
It also teaches users helpful strategies for managing PTSD symptoms on the go. Tools like this are imperative to help reduce catastrophic trends such as suicides among members of the military and veterans, the rate of which has increased more than 50 percent since 2001 and for which PTSD is thought to be a leading cause (Federal Computer Weekly, 2012). Judging by the response, it is also something that will be quickly taken up by service members.
Approximately, 5,000 people downloaded the app in the first month of its launch, within two hours of it going live, a veteran had called the Veterans Crisis Line using information provided through the app and was provided an appointment at a local VA medical center (Federal Computer Weekly, 2012). The app is the first in a series that VA and DOD intend to produce to help service members and veterans manage their readjustment challenges and to get assistance (Federal Computer Week, 2012). Veterans are using the applications to learn more about their symptoms and gain a little more awareness about further needs. Breathe2Relax is a good example.
It contains videos and psycho-educational material where users can learn more about why “proper” breathing helps with stress reduction. They can see a scan of a human body and learn how deeper diaphragmatic belly breathing can help all sorts of the body’s systems (Corrin, 2012. ) These mHealth apps prove to be highly effective for the veteran community. Sentara Healthcare is a not-for-profit, integrated health care system, recognize nationally for its accolades in the IT medical revolution (Ong, 2012). In 2010, the organization achieved stage 7, the highest level of the HIMSS Analytics EMR Adoption Model (EMRAM) (Ong, 2012).
Sentara created MyChart, which is a web-based tool that provides secure access to your physician and personal medical information. The app is currently available on Android, Blackberry, and iPhone operating systems. This app allows patients real-time access to medical information about all the hospitals and physicians as part of the Sentara network. The app is intended for patients to view lab results, renew prescriptions, schedule appointments, communicate with physicians and staff through secure encrypted means, as well as view other family member’s personal information.
Many testimonials stated the sharing of information was very important to them. For example, one person was able to view monitor his mother’s appointments and result with her approval by a proxy access setting approved by her and the hospital staff. Another interesting feature of MyChart is the ability to print a health information card for patients to carry with them at all times. The information is limited to basic information such as allergies, blood type, or chronic conditions, which would come in handy, in case of a medical emergency for first responders. Sentara’s mHealth improves access while providing transparent
PHR for it patients. Conclusion The rapidly changing healthcare landscape is shifting toward a new paradigm for improving the access of healthcare by way of mHealth. Digital patient records, health information exchanges and analytics are some of the key technology efforts being pursued by many healthcare providers. The federal government has made significant strides in adopting a new medical model for delivering healthcare using the Internet; however, there is still a lot of work to be done before a full standardization of an EHR can be adopted using meaningful use certification.
Government agencies will continue to invest resources in order for the healthcare industry in both the private and public sector in order to continue advances using technology. Stakeholders are progressively overcoming the barriers of implementing such networks, but now face additional security requirements. The mobile market is gaining acceptance by healthcare providers across various specialties. Healthcare organizations are working to incorporate innovative health networks with wireless architecture.
Gartner is a leading IT consultant agency providing both the public and private sectors invaluable research in order to appropriate proper funding for IT infrastructures. The VA and Sentara Healthcare represent healthcare organizations successfully incorporating mHealth with their secure network. Their implementation models are first-class reference points, for the remaining healthcare organizations to adopt as their networks become operational. Appendix Figure 1. Gartner Hype Cycle for Telemedicine 2012. This graph illustrates the mobile health monitoring innovation hype cycle.
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