mHealth: Integration, networked systems will drive better care
CHICAGO—After 30 years of advocating for EHRs, “It’s disappointing where we are at this point,” said C. Peter Waegemann, vice president of mHealth Initiative, during his keynote speech at the mHealth Initiative Conference March 30-31.

Despite the growing acceptance of EHRs, 100 percent adoption isn’t close, and “we will not be there for some time to come because we have not looked at the issues which can be solved with m-health. EHRs have many benefits, [but] there’s one big problem—it takes substantially longer [to use them],” Waegemann said.

Where does m-health fit in the EHR adoption equation? Mobile health elements—smartphones, wireless devices and the networks that support them—can improve documentation at the point of care and speed information to the clinician and into the EMR, personal health record (PHR) or anywhere it’s needed, he said.

More people now own mobile phones than televisions or PCs, according to Waegemann. “It’s all getting to the point where the small device we are carrying is really the computer of choice,” he said. “We have become really dependent on this mobile phone; it changes our lives more than we anticipated even a few years ago.”

The rise of the mobile phone and its expanding capabilities might ultimately be what drives m-health to greater acceptance, but its use in healthcare is still far from ubiquitous, he said.

Home monitoring systems and PHRs are still “minor” clinical tools in most cases. “Why? Maybe we’re waiting for better-than-voice applications,” Waegemann said. Nevertheless, “it’s irresponsible in 2011 not to make it possible, for very little money, to connect IT to [physicians], so they can care for patients.”

In addition, although there are thousands of mobile phone apps available, healthcare app use is still low, he added. “You have to wonder how many of them are used? Sixty to 70 percent of users might download an app once, then just leave it. It’s so low-cost, it doesn’t really matter.”

If clinicians may not quite be ready to utilize m-health, “where’s the leadership?” asked Waegemann.

“We are getting into the second generation of iPhones and apps. Now you are getting systems from integrators, now you’ll see much more implementation than we have seen before. My prediction is within next two or three years, you’ll see more real-world implementers—the ones who provide EMRs, HIT systems—integrate m-health solutions, and it’s going to make all the difference,” he said. “Hopefully, we’ll have systems where the patient can be integrated. … We need to create an overall system where everything is networked. We have too many people trying to find their own way.”

Mobile health can enable new methods of clinician communication, better healthcare and lower costs through better communication systems, but pagers are still the internal communication method of choice at most hospitals. “Why doesn’t an organization send messages via smartphones? We’re still talking about budget issues. [However,] the money needed to create a communication system should not be an issue when the same hospital spends millions on a CPOE system,” said Waegemann.

"There is a major disconnect: People don’t know that m-health can be a low-cost solution and very effective," he continued. "Some people predict that your credit card will be outdated in 2012, and you will be using your mobile phone for payments wherever you are. We need to get to that point in healthcare." For example, a patient should be able to check into a hospital or doctor’s office from home as easily as he or she can book a flight.

“Strategy has to be an ecosystem, and the ecosystem needs key stakeholders to really understand what needs to be done,” said Waegemann. “How can we get physicians to understand that communication-enhanced healthcare is really where we need to get to? We need to look at systems integration.”

Human integration must also occur: Waegemann suggested “networked clinicians [with access to] fully operational networks wherever they are. Networked patients have to be given the right tools for their healthcare issues.” Networked payor systems are also important, he said, “so a physician and patient can question immediately what is to be charged, what is to be paid and what will be reimbursed.”

In spite of the obstacles, Waegemann said he believes an m-health-powered, "more participatory" healthcare system is on the way.