Enterprise mHealth StrategyDavid Shiple,Practice Leader, Advisory Services
1© 2012 Divurgent. All rights reserved.
November 15, 2012
• The explosion of mHealth products is reminiscent of the dot.com phenomena – Almost deafening hype, and only a small percentage of the 1000’s of
mHealth products being introduced will make it
• But like the internet, we know mHealth is a game-changer– So, how do we pick the mHealth winners? – More importantly, how do we plug the winners into an architecture
that is sound from both a technology and business model perspective?
• DIVURGENT has developed a framework which:– Outlines various definitions and components of mHealth– Shows current state of the industry solutions and considerations– Provides a methodology organizations can use when developing an
enterprise mHealth strategy.
© 2012 DIVURGENT. All rights reserved.2
Executive Summary
© 2012 DIVURGENT. All rights reserved.3
Innovation
GE Healthcare’s Vscan is a pocket-sized ultrasound scanner that allows physicians to scan any part of the body by placing the attached wand on it. The wand sends and receives sound wave data upon contact
West Health Institute’s Sense4Baby captures the heart rate of the fetus and mother, and monitors uterus contraction
AliveCor ‘s mobile ECG heart monitor fits onto the iPhone and allows patients to monitor their heart health anywhere and anytime
Google – integrated computer & eyeglasses; unlimited possibilities: MD sees patient chart while talking to a patient; surgeon sees radiology images during surgery, etc.
… and More Innovation
GlucoDock by Medisana tracks glucose/insulin levels and charts them into easy-to-analyze monthly reports
EyeNetra’s NETRA-G is part of a portable solution to make eye exams affordable and accessible for all - interactively aligns patterns displayed in the lens and the software calculates the refractive error
Proteus Digital Health’s Event Marker, is swallowed and activated by stomach fluids - transmits the time, identity, and characteristics of the medication taken (and heart rate, temperature, activity, and rest patterns) to a skin patch
The Zeo Sleep Manager Mobile tracks sleeping patterns by recording brainwaves as a user sleeps
Smartphone Apps100’s of iPhone applications are available… some downloaded once and
used once, others going viral
Power of Social Media
Patientlikeme – Find people with similar symptoms/ conditions; learn from the real-world treatment and symptoms reports, forum discussions, health profiles, one-on-one conversations, and more
Everyone Wants InQualcomm has announced it will form a new subsidiary, called Qualcomm Life, to manage the development of the company's mobile health platforms. The new company will focus on connecting mobile devices through machine-to-machine (M2M) technology. M2M connects remote-monitoring devices through wireless connections.
Many large companies have entered the mHealth market including Qualcomm, Samsung, AT&T, Verizon, and Cisco, focusing on not just “cool apps”, but on the interconnectivity requirements of mHealth.
• © 2012 DIVURGENT. All rights reserved.
8© 2011 DIVURGENT. All rights reserved.
mHealth SWOT AnalysisStrengths
• Huge momentum• Money flowing in from investors• Technical talent coming in from other
industries• Growing acceptance of online living• Smartphones becoming ubiquitous• Not contending w. large legacy base• A game-changer toward the 3 Aims
Weaknesses
• Interoperability/ Infrastructure• Quality of data• Many patients not engaged• Reluctance of health system to
embrace wholesale change• Reimbursement for e-visits• MD’s slow to recommend mHealth
products to patients
Opportunities
• Risk-sharing payment models should give home devices a positive ROI
• The “high engagement patients”, esp. for social media
• Fast innovation cycles• Aligns with aging population
preferences• Possibilities are almost limitless• Developing countries may see most
dramatic increase in mHealth use
Threats
• May take a while for market to “shake-out” and stabilize
• Intent of large EHR vendors is unclear• mHealth may not “move the needle”
on population health as predicted• Regulation• Political environment
© 2011 DIVURGENT. All rights reserved.9
Breaking it Down
Mobile Caregiver Devices
Telehealth
Home Health & Wellness
• Within “the four walls”• Often smaller, wireless
form factors for EHRs• Also mobile imaging, EKG,
etc.• Depends heavily on
wireless
• Home electronic devices: wellness, chronic disease, real time monitoring – 100’s in the marketplace• PHRs and Social Networks• Smartphone and capitation
likely to be major drivers and enablers
• Primary drivers are over-coming distance barriers and lowering costs of remote care• Primarily creates a rich care
giver experience from a distant locale• Video, high-bandwidth, and
remote nurses/ facilities/ vehicles are primary enablers
Divurgent has focused its mHealth efforts on telehealth, home health, and wellness
© 2012 DIVURGENT. All rights reserved.
10
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
© 2012 DIVURGENT. All rights reserved.
11
HIE Strategy Methodology
Provisional Governance
Matching Funding
Letters of Commitment
Sustainability Model
Who
’s In
?
Governance
Privacy/ Security
Technology
Financial Model
Adoption Plan
Criti
cal M
ass
Parti
cipa
tion
Build/ Signup
Launch
Implementatio Plan
Start-Up Design Strategy / Implementation
Constituents
Visi
on /
Mis
sion
Data Types
Data Sources
Workflows
© 2012 DIVURGENT. All rights reserved.
12
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• What is the mHealth state-of-the-art?• Who is doing mHealth well? What are they doing?• Where is it the mHealth trajectory heading?• Can we separate the “hype” from the “real”?• What do our stakeholders need to know before going into
this strategic process?
• Healthcare Reform• Accountable Care Organizations• Patient Centered Medical Homes• Value Based Purchasing• Meaningful Use
• If possible, keep patient “out of the system”• Capitation means higher ROI on home health • Continued, relentless drive for cost reduction• Geographical barriers to care (need for telemedicine)• Aging population (more “home-bound”) • Huge market momentum for mHealth products &
innovation
© 2012 DIVURGENT. All rights reserved.
13
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• Smaller, better, faster, cheaper technologies• Smart phones, Touchpads• Expanding wireless / mobile networks• Low barrier to entry – stand-alone personal health
applications and devices• Easy dissemination via Apple, Google, and other markets• Affordability
Can we craft an overall vision statement that provides:• An encapsulation of what your
mHealth position stands for and what it will mean to physicians and our patient community?
• A tagline that sums it all up?
• How is the market framing “mHealth”?
• What do we mean when we say mHealth?
• What’s in / what’s out?
© 2012 DIVURGENT. All rights reserved.
14
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• Who are our mHealth stakeholders?• What do our stakeholders want?• Where do they see the value?• What will the patient / physicians pay for?• What technologies/products do they use/ are interested in today ?
Patient Clinician ACOs Investors
• What is there receptivity for future products/ services?• What are their safety/ security/ privacy expectations?• Do the parties trust the health system ?
• What is the health system currently doing in the telemedicine realm?
• What disease-types / conditions lend themselves to Telemedicine?
• What are the health system’s plans for future telemedicine investment? Within the health system? Within the health system ’s
affiliated providers/ partnerships?
• How receptive is the medical staff and associated caregivers?
© 2012 DIVURGENT. All rights reserved.
15
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• Much growth in the mHealth market including smart pills, sleep studies, vital signs, EKGs, etc.
Who reads the data? Who responds to the data? What is captured by the EHR
and PHR?• What is the Interoperability with
EHRs and PHRs?• Which modalities are being called
for by patients/ physicians?
• Is health and wellness a targeted program?
• Is there an existing business model?• Are patient incentives in place?• To what extent is the health
system’s primary care function utilizing electronics? Can it be integrated?
© 2012 DIVURGENT. All rights reserved.
16
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• What is the current state-of-art use of mHealth and your enterprise vendor?
• Does your vendor have an mHealth partnership list?
• What is the mHealth connectivity record with your vendor?
• How can data fed from mHealth devices being integrated into the EHR CDS?
• Is a PHR and associated strategy for PHR’s in place? What is it?
• What is the alignment with MU stage 2• What type of PHR is in place - stand-
alone or interactive with EHR?• What is the current patient adoption of
the PHR? How is the adoption trending?
• What role will the PHR play in the mHealth strategy?
• What role will social networking and the interne t play?
• Can internet search and social networking, and be linked to the PHR?
• Presentation of evolving mHealth model
• Is there a “there there”?• Which constituents are in/
out?• What are alternatives?• Can consensus on general
business model be achieved?
• The dimensions of mHealth will invariably overlap, e.g. Remote monitoring may
automatically upload to the PHR/ EHR and CDS rules and alert may ensue
Common infrastructure can be shared between telemedicine, home health, etc.
© 2012 DIVURGENT. All rights reserved.
17
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• RMA Platform• Java ME• .Net CF• Android SDK• IOS SDK
• Mobile O/S• IOS X• Android• Blackberry OS
• Network Standard• GSM• CDMS 2000• W-CDMA• EDGE
• Value proposition• Target market• Go to market strategy• Consumer relationship• Activities, resources, personnel• Required core competencies• Network/affiliation SWOT analysis• Sustainability model• 2012-2013 pro forma• Service offered• High level implementation plan• Governance model• Commercialization opportunities
• High-level technical requirements
• Technical schematic• Role of middleware• Role of the HIE• Hardware/ software players• Mobile platforms supported• Security/ Privacy
© 2012 DIVURGENT. All rights reserved.
18
mHealth Strategy Methodology
Business Drivers
HealthcareDrivers
Vision Statement
mHealth Environment
Mar
ket S
urve
ys /
Rec
eptiv
ity /
St
akeh
olde
r Ass
essm
ent
Telemedicine
Remote Monitoring
Health and Wellness
Personal Health Records
EHR / Clinical Decision Support
Cons
ensu
s W
orks
hops
(v
ario
us c
onsti
tuen
ts)
ImplementPlan
Level-Setting Requirements Strategy / Implementation
Technology Drivers
Mar
ket S
can
/ Ed
ucati
on
Wor
ksho
p(s)
Business Model
Standards
Technical Architecture
VendorList
mHealth Operations
Cons
iste
nt T
hem
es
• Roles and responsibilities driven by the defined business model
• Operational plan• Org chart• Customer support• SLA’s• Vendor management• Contract management
Stratify vendors• Those “that matter”• Strategic vs. tactical• Standards embraced• Remote monitoring vs. health &
wellness• Recommended by the health system • Vendor track record• Connectivity options
• Charter• Scope• Funding/ budget• Program management• Timeline• Resources• Risk mitigation• Change management• Communications
© 2012 DIVURGENT. All rights reserved.
David [email protected]
Divurgent4445 Corporation Lane, Suite 228Virginia Beach, VA 23462877.254.9794
Contact Information
© 2012 Divurgent. All rights reserved.19
Appendix
© 2012 Divurgent. All rights reserved.20
Scanadu Scout (pictured), which reads vital signs from a person's temples; Project ScanaFlo that can analyze urine; and Project ScanaFlu, which can test a person's saliva for cold or flu symptoms. All three devices are still pending FDA approval before then can be sold to the public, but the Scout appears to be the furthest along in development. Scanadu claims that the device will cost less than $150, and can record and analyze vital information like blood pressure, pulse, heart rate, blood oxygenation, and temperature.