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Making healthcare Mobile First using wearables, the Internet of Things, and mobile

April 07, 2015

Like every industry, healthcare has seen an influx of mobile devices and apps of both the BYO and organization-owned variety. The industry has also experienced rapid change due to a series of government regulations, mandates, and incentive programs, the most notable being the federal EHR incentive program (also known as the meaningful use program) that encourages the adoption of electronic health records and related technologies.

With all these changes and the government readying the next set of requirements for the meaningful use program, it may seem daunting to health IT leaders to also begin proactively planning to implement additional emerging technologies like wearables and other smart devices.

That planning, however, is critical because many of today’s emerging technologies– wearables, smart/connected devices (commonly referred to as the Internet of Things or IoT), and mobile – will likely hit healthcare faster and, at least initially, more dramatically than other industries. They will offer a unique opportunity for healthcare CIOs to make their mark and transform their organizations, but only with planning and preparation that needs to begin today.

Here are several ways that these technologies will be part of the digital health future and where health IT leaders can focus for transformative growth, competitive advantage, better employee satisfaction, and improved patient care.

Note: Although these use cases are specific to healthcare, most also apply to other industries as well and I have noted some of the ways these approaches might be used elsewhere in other settings.

In hospital patient information and tracking

One of the first things to happen during a hospital admission, even just to the ER, is that a printed tag with key information is placed on the patient, making it easy for staff to identify the patient and specific needs. Smart devices and wearables offer new and unique capabilities to this process. Coupled with Bluetooth beacons or another tracking or indoor navigation system, this makes it easy to identify the location of each patient.

A digital tag also allows much more data to accompany the patient, perhaps even including a direct link to his/her electronic record. The ability of the tag to communicate using a variety of technologies – NFC, Bluetooth, Wi-Fi for example – ensures that whether a patient is in his/her room, waiting for a test or scan, or anyplace else that any staff member can locate, identify, and have easy real-time access to any information that might be needed. Such devices can also integrate vital sign monitoring technology and are already emerging in the healthcare-specific wearables field as easier to use replacements for some traditional tethered monitoring systems.
Individually and collectively, these capabilities deliver unprecedented and deeply integrated clinical information, increase ease of use, and can be life-saving in emergencies.

Outside of healthcare, similar tracking technologies have an array of applications including logistics, inventory control, employee safety, and even secure access to facilities.

Hospital navigation

Indoor mapping and navigation isn’t limited to tracking patients. Hospitals are often large and confusing places and finding your way around can be challenging even if you work in one of a hospital’s many units, to say nothing about if you’re a patient or visitor. There are a number of emerging indoor navigation options, many based on IoT, and implementing them can be a boon to patient (and employee) satisfaction and retention, which makes them a powerful competitive advantage.

Deploying a full-scale indoor navigation system may seem daunting despite the value. A good middle ground or first step is to make simple use of beacons deployed on each unit, floor, or near elevators that broadcast a user’s position within the hospital to a consumer-facing app that includes a larger hospital map.

Indoor navigation also has a host of non-healthcare uses like navigating in retail environments, large office or education campuses, theme parks, and sporting/performance venues.

Patient information and engagement solutions for clinical settings

Mobile devices, particularly tablets, provide a unique way to orient and engage patients and their loved ones in a hospital or clinical setting. Fully managed devices can include apps that orient a patient to specific processes, provide interaction with a care team, educate them on their specific condition(s) and path of treatment, allow for easier entry of medical history and other information into an EHR, and provide entertainment.  At their most useful, tablets can enable communication when verbal communication isn’t an option because of illness, injury, or language barriers. As a result, tablets and apps, custom-built or purchased, can be an amazing resource for patients, family members, and clinical staff alike.

A similar approach to tablets and mobile devices applies to any situation where users may share a device or only use a fully managed and provisioned device at a time. This could include education when students don’t get a dedicated device, field service workers, mobile POS in retail, certain sales organizations like car dealerships, or customer service.

Access for loved ones in serious or critical care settings

In many intensive and critical care settings, it may not be possible for loved ones to have direct contact with a patient, particularly in settings like a NICU. This can be challenging for them, the patient, and even the clinical staff on duty. Mobile telepresence technologies and smart glasses like Google Glass can provide proxy access in these situations as well as in situations where loved ones may be geographically isolated. Investing in these patient and family centric solutions can improve patient experience, comfort, and outcomes as well as providing a connection to life outside of the ICU or other serious care units.

The use of telepresence solutions isn’t widespread across many industries, but technologies like Microsoft’s Hololens illustrate their potential in situations like remote service and support.

Patient engagement, education, and wellness

One of the requirements of the meaningful use program is patient engagement, ensuring that provider and patient engage outside of the clinic or office. This can be one of the most challenging requirements because it relies not on the actions of a providers or health IT, but on the actions of individual patients, largely through the use of a patient portal.

Mobile and wearables offer new ways to engage patients, particularly with advent of mHealth platforms like Apple’s HealthKit that can aggregate data from a range of apps and devices. That engagement may take the form of custom patient-facing apps, apps that link to an EHR, or the “prescribing” of public apps.

Developing a mobile/wearable strategy requires investment by a number of stakeholders including IT, clinicians, and health coaches in order to ensure the program is well designed, suited to specific population needs, and is something that clinicians are comfortable with as an engagement tool.  A strategy can vary in scope from something as simple as building a patient/clinician app store to integrating an EHR with available apps and health platforms. In many cases, a strategy can be put into motion using solutions that are already available or can be purchased (and potentially customized) rather than being built from scratch.

As in developing any mobile app strategy, it is best to start with what’s already available and focus on individual processes – something as simple as mobile-based secure messaging, appointment setting/reminders, or other advice-style notifications – that will be easy to implement successfully while offering a broad impact.

Customer engagement is a large focus of many companies, as is developing a mobile apps strategy. Many of the apps strategy approaches, particularly the decision about whether to build or source apps, the fact that many services now include mobile components that can create easy first mobile app success, and how you prioritize app modernization apply to any organization.

Remote patient monitoring

One challenge for hospitals, in particular, is reducing rates of readmissions, which can reduce Medicare payments. One of the best options is post-discharge follow-up, which can be effective as well as labor intensive. Here, mobile, wearables, and IoT strategies can really shine because they provide a form of passive remote monitoring and follow-up that can alert a care team to potential downturns or non-compliance with medications/instructions, allowing a more active intervention. Such systems can also provide telehealth capabilities for interventions and case patients concerns/questions.

Much like a patient engagement strategy, there is a range of possibilities available. In this case, focusing on individual patient populations and their specific outpatient care needs should be the starting point. In some situations, healthcare-specific wearables designed to monitor vital signs may be needed. In others, self-tracking apps for patients or consumer-focused activity tracking wearables may suffice, particularly if they are integrated into a larger health platform. Some situations will also call for other smart devices, many of which will be healthcare-specific like smart pill bottles for tracking medication compliance or devices for fall detection.

While it’s easy to start small with something like a patient-facing app store or some basic app functionality in an engagement strategy, a remote monitoring system needs to be implemented as a whole for each population because of the requisite integration of a range of clinical, information, and payment systems as well as integration with selected or available mobile OSes and devices. Equally important is designing appropriate analytic support for incoming data as well as both clinical and business processes to support needed action before, during, and after discharge.

More information

MobileIron offers a set of resources specific to healthcare organizations including case studies, videos, and other resources.

Ryan Faas

Ryan Faas,

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