Going mobile: Providers deploy apps and devices to engage patients and cut costs

Nurse Anita McCole loves Bluetooth-enabled scales for monitoring patients' weights at home. The devices wirelessly transmit the weights of congestive heart-failure patients to a mobile receiver or smartphone, which sends the daily readings to McCole, a case manager at Geisinger Health Plan, Danville, Pa. The computerized system, made by AMC Health, automates what once was a less reliable, labor-intensive process of getting heart-failure patients to track and report their weights.

Combining the wireless scales, voice-response communications, mobile devices and data-analytics technology into Geisinger's case-management program led to a reduction in the 30-day hospital-readmission rate of 44%, a 38% drop in 90-day readmissions, and an 11.3% reduction in per member per month costs over five years, said Doreen Salek, director of population management partners at Geisinger Health Plan and co-author of a study on the program published this month in the journal Population Health Management. These savings produced more than a threefold return on Geisinger's investment in the technology.

“Before, we had to rely on patients weighing themselves at home and calling in,” McCole said. With the wireless scales, “their weights come right through to my computer. I can monitor their trends and see if their weights go up or down.”

Deborah Bolster of San Antonio is delighted that she can connect with her doctors at the San Antonio Orthopaedic clinic through athenaCommunicator Mobile Patient Portal using her new iPhone 6 Plus. The portal links her to the practice's electronic health-record system, developed by Athenahealth, Watertown, Mass.

“My physician now is monitoring a condition I have in my left leg,” she said. “I saw him last Wednesday, and he ordered an MRI and also asked me to keep in touch with messages through the portal to see if my condition has changed. In fact, it had. I've sent him two messages, which would allow him to know more than he would if I showed up” in his office.

“Every single day I get messages from my patients,” said Dr. B. Christian Balldin, a surgeon specializing in sports medicine at the 25-physician San Antonio Orthopaedic Group, where Bolster gets her care. Having a mobile tool to communicate with a patient and get feedback, Balldin said, is “instrumental in providing good care for that patient. I wish 100% of my patients would do stuff online. I really do think it improves patient care.”

Balldin's wish soon may come true. McCole and Bolster can use mobile devices, patient-engagement mobile applications, and wireless networks to make connections today because their respective healthcare organizations were early adopters of mobile patient-engagement technology. Many other providers and patients are joining them.

“We're beyond the innovator stage,” said Dr. Kevin Fickenscher, chief medical officer at AMC Health, New York. He sees a “tsunami” coming in how U.S. healthcare providers use telehealth communications to improve outcomes.

An important driver of mobile patient engagement is providers' and insurers' shift to performance-based payment, including accountable care. “If you fully take in what ACOs have to do—manage patients (who are) not in front of them—then you're immediately drawn to (these) tools,” said Dr. Joe Smith, chief medical and science officer at West Health, a San Diego-based not-for-profit that promotes mobile healthcare technology.

One major obstacle, though, is insurance payment for services offered through mobile devices' patient-engagement apps. Payment remains “a patchwork,” as private insurers lag behind public insurers, said Nathan Lacktman, a partner at the law firm Foley & Lardner, who specializes in telehealth. “I have some clients that are able to negotiate payment for telehealth services from some payers,” he said. But without states requiring payers to cover these services, “you won't see any meaningful telehealth adoption.”

Nevertheless, a survey of 57 healthcare leaders by Foley & Lardner found that 52% of their organizations have systems that enable real-time interaction between patient and providers, and 39% have mobile-health programs using patient-driven apps and portals.

In July, there were 173 million Americans with smartphones, up 3% since April, according to a recent survey report by comScore, a Reston, Va., digital research firm. That's 71% of the population age 16 or older, census bureau figures show. Demand for mobile-health services that engage patients outside the hospital and doctor's office—broadly described as telehealth—is growing rapidly, too.

Smith said diabetics in particular have rapidly adopted digital glucometers and are “already comfortable dealing with information about themselves and acting on it.” But there are other patient populations as well that are eager to take advantage of mobile technology to improve their health and increase the convenience of their healthcare.

“There are these highly energized communities, like the diabetes community, that will show what's possible,” he said.

HHS' Office of the National Coordinator for Health IT is developing a 10-year health IT interoperability road map, due early next year. A draft released in October set as a milestone that by 2017 to 2020, people will be routinely “accessing and contributing” to their electronic health-record information. The ONC is considering requiring EHR developers to add application programming interfaces to their systems, a technical enhancement that would promote linking mobile apps to their EHR systems. Those requirements could come as soon as 2017.

But even without government inducements and widespread participation by private insurers, lots of money and effort already is pouring into the development of mobile patient-engagement systems. Almost every week, new companies are being launched to develop patient-engagement apps, and more established ones are cutting financing deals.

Last month, COR Medical Technologies, Houston, a 1-year-old mobile app developer, launched CORcare, a diagnostic and decision-support mobile app for cardiologists. The app covers 160 heart and vascular conditions. It offers “anything you need to know about myocardial infarction,” said Dr. Vincent Friedewald, its founder and CEO.

While CORcare is primarily intended for clinicians, patient engagement is built into the program. “Any information about a disease-specific file can be sent via a secure e-mail to the patient on their iPad or (other device), and the physician can get a message right back,” Friedewald said. “The key is to get the patient actively engaged, not just to fill their prescriptions, but to do something back.”

In October, Jeff Arnold, founder of WebMD, announced he had signed up CHE Trinity Health, a 86-hospital Catholic healthcare system based in Livonia, Mich., as a partner in his latest venture, ShareCare, which he describes as a Web-based health and wellness-engagement platform. Now called Trinity Health, the organization hopes to use Sharecare to extend the reach of its hospitals' names, services and brands throughout the communities they serve, said Scott Nordlund, Trinity's executive vice president of growth, strategy and innovation development.

In September, former Allscripts CEO Glen Tullman launched Livongo Health, a cloud-based service that runs off a mobile app. It monitors diabetic patients' glucose levels and provides other supports. Tullman's investment firm, 7wire Ventures, also has a stake in Zest Health, the developer of a mobile-health app. It enables consumers to link to a self-diagnosis tool, speak with a nurse or other care manager about a medical problem, schedule an appointment, and pay the provider at the point of care.

Michelle Candelaria, developer of post-acute services for two Dignity Health hospitals in San Bernardino, Calif., said she's always on the lookout for sharp new mobile patient-engagement technologies. A participant in this year's Modern Healthcare survey on the Most Important Mobile Medical Applications, she named InQuicker, a Nashville company whose eponymous app helps patients expedite emergency-department visits.

The app asks for basic personal data, insurance information, and symptoms. “That comes over the app to a charge nurse who triages it and messages back the patient,” Candelaria explained. The return message includes an appointment time, so the patient can wait in greater comfort at home if the emergency department is backed up. One woman came in by appointment with her son and was in and out of the ED with a prescription in 20 minutes, Candelaria said. With ED wait times being advertised on road-side billboards, the system helps her hospitals effectively compete. “We have to have those amenities to draw in the patients we want to attract,” she said.

There still are plenty of providers that aren't yet using mobile patient-engagement apps, but they better start catching up because these tools have the potential to greatly improve the patient experience and outcomes, said West Health's Smith. While the use of these tools won't go mainstream immediately, he said, “however long it takes won't be fast enough.”

Florida State Rep. Gayle Harrell, a health IT consultant who sits on the federal Health Information Technology Policy Committee that advises the ONC, said it might be too soon for the government to require insurers to pay for services offered through mobile devices and apps. First, there needs to be a solid infrastructure in place and carefully crafted definitions of covered services.

“What I would prefer to see happen is the private sector and insurance companies realize the potential of this, and I think we're starting to see that,” she said. “It's going to be a very good method for providing care, particularly in rural areas and in specialties when you have difficulty in getting access to care.”

Follow Joseph Conn on Twitter: @MHJConn