Healthcare Mobile Information Flow
Victor Camlek
VP Market Intelligence
Thomson Reuters Healthcare & Science
March 2011
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1
Headline News:
The capabilities of mobile technology are
greatly influencing the practice of medicine
TODAY!
As the technology matures there is potential that a huge
amount of workflow content may become available
for use over mobile devices.
What will this continue to mean for STM Publishers and
their customers?
Healthcare: Converging Mobile Markets
mHealth
Telemedicine
Mobile Devices
Mobile Solutions for
Interactive Data
Management
Mobile Content
3
mHealth Definition
• mHealth
– The practice of medical and public health supported by mobile devices
– Sub-segment of e-Health
– The use of mobile devices in collecting community and clinical health
data; delivery of healthcare information to practitioners, researchers, and
patients; and, real-time monitoring of patient vital signs, and direct
provision of care (Telemedicine)
mHealth gets into the actual practice of medicine, which is one
of the reasons that it has been embraced by the World Health
Organization as a way to manage healthcare in third-world
countries.
4
Telemedicine Definition
• Telemedicine
– An application of clinical medicine where medical information is
transferred through interactive audiovisual media for the purpose of
consulting, and sometimes remote medical procedures or examinations
– Includes two concepts
• Real time (synchronous) and store-and-forward
• Home Health (asynchronous)
– Mobile devices may or may not be used
• Mobile telehealth: provision of medicine via a mobile unit
• Services may involve mobile technology used by a mobile vehicle associated to
a medical facility
Telemedicine includes some mobility and is often mentioned
within the context of the mobile market. However it involves the
connection of at least two points to either perform or monitor
patient care.
5
Mobile Content Definition
• Referential healthcare-related content
• May include:
– Disease monographs
– Drug-related content
– Order sets
– Protocols
– Social networking content
• Electronic Medical Record(EMR)/Electronic Health Record(EHR)
• The ability to combine referential and patient-related data creates a
mobile solution
The capability for content to be delivered over a mobile device
combined with interaction with patient-related data represents a
current market in which various companies participate.
6
Mobile Solutions for
Interactive Data Management Definition
• Mobile Solutions for Interactive Data Management
– Solutions that permit users to achieve mobile access to data from
Hospital Information Systems (HIS) using at least one data presentation
format
– Solutions must possess a data access layer that obtains and
deconstructs information from disparate HIS systems, and repackages
the information around a patient object
– Provides a mobility platform for interactive data retrieval and
transmission
This is the core space where STM content providers may be
interested in serving.
7
Healthcare Mobility and STM Publishers
Content
Workflow
Platform
Devices
mHealth
Telemedicine
•
•
•
•
•
•
• EHR
• Charge
Capture
• Patient Index
• CPOE
• Order Sets
• Rounding
• Scheduling
• Patient Alerts
• Lab Data
• Financial/
Billing Mgmt
• Performance
Mgmt Software
• Diagnostic
Imaging
Ability to stage,
re-configure and
message data
from an HIS or
source system to
a variety of
devices
• Handheld
PDA’s
• Smartphones
• iPod Touch
• iPad
• iPhone
• Android
• Windows
Mobile
• Net books
• Mobile Carts
• Mobile
Diagnostic
tools
• Workstations
• Patient
Monitoring
devices
• Mobile
telemedicine/
telecare
devices
• MP3 players
for mLearning
• Laptop
computers
and desktops
• Data collection
software
The use of
medical
information
exchanged from
one site to
another via
electronic
communications
for the health
and education of
the patient or
healthcare
provider and for
the purpose of
improving patient
care.
Telemedicine
includes
consultative,
diagnostic, and
treatment
services
Referential
Drug Data
Clinical
Journals
News
Guidelines
STM Content Space + Workflow Data
STM Opportunity
Content Enablers
Adjacent Areas
8
This market is in an early stage
Healthcare Mobility and STM Publishers
Content
Workflow
Platform
Devices
mHealth
Telemedicine
•
•
•
•
•
•
• EHR/EMR
• Charge
Capture
• Patient Index
• CPOE
• Order Sets
• Rounding
• Scheduling
• Patient Alerts
• Lab Data
• Financial/
Billing Mgmt
• Performance
Mgmt Software
• Diagnostic
Imaging
Ability to stage,
re-configure and
message data
from an HIS or
source system to
a variety of
devices
• Handheld
PDA’s
• Smartphones
• iPod Touch
• iPad
• iPhone
• Android
• Windows
Mobile
• Net books
• Mobile Carts
• Mobile
Diagnostic
tools
• Workstations
• Patient
Monitoring
devices
• Mobile
telemedicine/
telecare
devices
• MP3 players
for mLearning
• Laptop
computers
and desktops
• Data collection
software
The use of
medical
information
exchanged from
one site to
another via
electronic
communications
for the health
and education of
the patient or
healthcare
provider and for
the purpose of
improving patient
care.
Telemedicine
includes
consultative,
diagnostic, and
treatment
services
Referential
Drug Data
Clinical
Journals
News
Guidelines
STM Content Space + Workflow Data
STM Opportunity
Content enablers
Adjacent Areas
9
Mobile Devices Definition
• Mobile Devices
– Traditionally “Pocket-sized computing devices,” typically having a display
screen with touch input or a miniature keyboard
– The definition is evolving as larger mobile devices appear (iPad, Net-books)
– Not all of these devices can access all public or proprietary mobile networks,
however, as they develop more will be able to include direct mobile access
• Mobile Devices may include:
– Smartphone
– Mobile computer/Mobile cart/Mobile monitor
– Personal digital assistant/enterprise digital assistant including the Blackberry
– Digital still camera (DSC)/Digital video camera (DVC or digital camcorder)
– Portable media player
– e-book reader
– Pager
– Personal navigation devices
– iPad (as of 2010)
Confidential – Do Not Distribute
Advances in mobile device technology
are fueling mobility as a growing medical
application
10
Relevant Handheld Devices
BlackBerry
Palm
Nokia
Windows Phone
Android Phone
Motion computing,
mobile computer and
mobile cart
iPod Touch
iPhone 4G
iPad
NetBook
11
Confidential – Do Not Distribute
Market Dynamics:
• Worldwide mobile device sales to end users equaled 1.6 billion units in 2010,
a 31.8 percent increase from 2009
• Smartphone sales to end users were up 72.1 percent from 2009 and
accounted for 19 percent of total mobile communications device sales in
2010
• Worldwide mobile phone sales to end users reached 32.7 percent growth in
the fourth quarter of 2010, with sales of 452 million units
• Gartner forecasts worldwide mobile application store downloads to reach
17.7 billion downloads in 2011, a 117 percent increase from an estimated 8.2
billion downloads in 2010
• According to the MDsearch Smartphone Survey, 53% of physician
respondents own a smartphone and 63% of those physicians are using
mobile medical applications
• EMR vendors have begun to offer remote access to EMRs via smartphone
applications (Example: Epic Systems partnership with Apple announced in
2009 for a mobile EHR pilot)
•
Confidential – Do Not Distribute
Source: Gartner Research; 'Forecast: Mobile Application Stores, Worldwide, 2008-2014'
Mdsearch: and Mobile Health Q1 2010 State of the Industry. Mobilehealthnews,
2010 report
12
STM Participants: Early Signs of Differentiation
• “Large healthcare publishers such as Hearst Business Media, Reed
Elsevier, Thomson Reuters, and Wolters Kluwer have a portfolio of
products that support clinicians, healthcare providers, and payers
along the healthcare workflow. These products are still evolving as
the technologies mature.”
• “The main components include traditional reference and journal
content; teaching and training applications (particularly for nursing).”
• “The most highly competitive area is in clinical decision support
tools, where order sets and drug reference databases are the most
common product.”
• “There will be increased focus on content integration with work-flow
needs and just-in-time delivery driving competitive features and
pricing. As much of the evidence as possible should be embedded in
content-based software.”
Source: Outsell, Inc., Growth Trends in the Market for Clinical
Decision Support Tools, June 2010
13
HC Mobility: Notable Service Providers
Referential Content and
Analysis
Clinical Workflow
Sources
• UnBound Medicine
• TR Clinical Expert
• Medicine Central
• Patientkeeper
• Evidence Central
• Global Care Quest
• ePocrates
• Dr. First
• Lexi-Comp
• IQMax
• Dynamed
• Theradoc Expert
Systems
• Diagnosaurus
• Skyscape
• Up-to-date
• Tarascon Pocket
Pharmacopia
• TR Micromedex products
• MedAptus
• Zynx, First DataBank
• Pharmacy OneSource
(Sentri7)
• MedMind (CareFusion)
• Premier Safety
Surveillor
• Cogon Systems
• CureMD
• Elsevier – First Consult
14
Confidential – Do Not Distribute
The Concept and The Potential
• Today:
– All relevant information derived from a patient encounter
may be documented and transmitted to a mobile device
– However, previous information documented in various
medical records will not be readily available until there is
additional progress creating EHRs (Electronic Health
Records)
– The available data may be combined with value-added
referential content delivered to a mobile device at the
point of care
©2008 Thomson Reuters
• Tomorrow:
– Even more information will become consistently available
at the point of care and for use during ongoing treatment
15
Thomson Reuters CLINICAL XPERT AGGREGATES PATIENT DATA
FROM THE HOSPITAL AND DELIVERS IT DIRECTLY TO CLINICAINS
16
CLINICAL XPERT ADDRESSES HOSPITALS’ CLINICAL AND
BUSINESS CHALLENGES…
• Enhances clinician efficiency
• Champions informed decision at the point-of-care
• Address CMS and Joint Commission initiatives
• Identifies high-risk patients quickly via clinical surveillance
• Promotes patient safety and reduces medical errors
• Reduces lost or inaccurate charges (CX Billing)
• Facilitates clinician communication
• Improves physician satisfaction and relationship with the hospital
• Creates competitive advantage for recruiting clinicians
• Serves as an HIS downtime solution, providing uninterrupted access to
patient information when the HIS is not available
17
©2008 Thomson Reuters
Clinical Xpert Solutions
Solution
Attributes
CareFocus
Generic surveillance tool capable
of supporting any clinical area
Clinical Xpert Navigator
Rounding, Mobility and Tracking
to support clinicians across
locations when managing patients
Pharmacy Xpert
Intelligent dashboard, pharmacy
specific surveillance, quality
drug/disease content, department
management reporting
18
Pharmacy Xpert Product Description
• Pharmacy Xpert consists of three primary components
• Xpert design to support
pharmacy decision support
• Links to HIS systems
• Patient specific drug
interaction checking, IV Index
and calculators
Pharmacy
Application
•
•
•
•
Micromedex
Content
Drugdex
Diseasedex GM
Drug REAX
IV Index
• Pre-built pharmacy
profiles
• Patient data
• Real-time surveillance
Clinical Xpert Foundation
• Mobility
• Integration with any HIS
19
Clinical Xpert: Value Proposition
• Patient Safety/Improved Outcomes:
– Real time patient surveillance to:
• Manage patient specific drug therapy effectively
• Identify patients at risk
• Improved cost management
– IV to PO proactive conversion
– Antimicrobial therapy management
– ADE (Adverse Drug Events) prevention
• XPert software:
– ‘Just what I need to know’ – targeted, relevant information needed to
make optimal decisions
– Evidence-based surveillance and recommendations
– Intelligent user design anticipates information needs
©2008 Thomson Reuters
• Technology ROI
– Works with any HIS system
– CCOW (Clinical Context Object Workgroup)(context management)
compliant
– Implementation resource requirements minimal
– Infrastructure designed to support multiple Xpert systems
20
Business Model Issues
• Solutions include two components:
– Software needed to access, manage and transmit the
data
©2008 Thomson Reuters
– Content, including referential content available via
subscriptions, tailored to meet the needs of the mobile
device customer
21
Business Model Issues
• Costs associated with HIMS data conversation
• Technology challenges
– Data access layer capabilities
– Messaging layer to devices
– Mobile device platform strategy
• End-User issues
– Who is the actual customer (Institutional Providers, Physicians,
Pharmacists, others)
– Willingness-to-pay
– Quality assurance
• Regulatory issues
– Privacy
– Data Integrity
22
Business Model Options
• Software model:
– Perpetual lease
– Maintenance
– Updates
• Capital investment
– Requires institutional
participation
– Includes subscription to
content
• Subscription-based
• Suitable for content
• Transaction-based
• Less likely
• Sponsorship
• Provides service to
organizations
• Advertising
• Less likely
• App Store for download
• Shells are available to
enable usage by those with
institutional access or
“skinny” versions of content
23
Technical Issues
• Technical Options
– Web-based approach
• Quickest approach
• Not a complete solution (no off-line capability; can use
various device features)
– Vendor Specific (You pick the winner or sink the cost)
• Works within capabilities of specific device/platform
• Some platforms have limitations (Apple does not permit Flash
and 3G usage; it avoids apps that impact network resources)
©2008 Thomson Reuters
– Hybrid Digital Platform
• Permits service to multiple device platforms
• The issue is choosing the right platform
• Recommended Reading: “Building Applications for the Mobile
Web, Best Practices,” at Thomson Reuters Legal, 10/28/10
24
Challenges Moving Forward
• The path to the highest quality solution sets will
require additional progress in electronic health
records (EHRs)
– Interoperability challenges
– Data standardization challenges
– Adoption challenges (perhaps overcome in the US by
Meaningful Use requirements)
• We are at an early phase that could be the
beginning of a path to even greater benefits based
upon the ability to access and utilize a very high
volume of existing data that will become available
as EHRs are fully adapted for use in mobile
devices.
Hospitals with EHRs (%)
U.S. Hospital EHR Adoption Forecasts
100
80
2014
85
90
2015
2016
40
40
20
12
0
2009
Hospitals with EHRs (%)
2013
65
60
20
75
80
2010
2011
2012
100
80
60
Any
Basic
40
Advanced
20
0
2009
2010
2011
2012
2013
2014
2015
2016
*Hospitals in this instance are considered to be acute care, non-federal hospitals; baseline penetration rates are derived from an analysis by Jha, et al in Health
Affairs (October 2010) based on the March-September 2009 AHA health IT survey (N=3101); forecasts modeled based on primary and secondary research with
health care CIOs
Source: Frost & Sullivan
U.S. Physician EHR Adoption Forecasts
100
81
80
85
89
74
Physicians (%)
66
57
60
41
44
49
35
40
29
20
18
17
17
21
24
0
2001 2002 2003 2004 2005 2006
2007 2008
2009 2010
Year
*EHR = any EHR with basic or advanced capabilities
2011 2012 2013 2014 2015 2016
Conclusion
• Mobility is already providing important services to
healthcare professionals
• Moving forward, there should be increasing
adoption of EHRs by 2016
• The combination of widespread EHRs plus more
advanced wireless device features should have a
profound effect on the level of information that will
be available and useful at the point of care
• Future business models will need to account for
higher amounts of data available at the point of
care, along with the software investment required
to access data from various systems
28