What are some of my favorite things? “Raindrops on roses” and “whiskers on kittens” definitely make the list. How about the task of combing over a large chunk of new Meaningful Use (MU) proposed requirements? … Not so much… though necessary if one wants to understand how the HIT and mHealth markets will develop.
Will MU grow the market for mHealth technologies? Or, the other way around, will the adoption of mHealth technologies encourage physician compliance with MU?
While skeptics may note that no corner of the HIT Landscape can escape the ‘mHealth hype’ – in all seriousness, mHealth technologies represent an important toolset available to both physicians and hospitals alike as they strive to comply with Meaningful Use. This toolset is especially useful in the hospital setting, where physicians’ compliance is absolutely critical to the hospital’s ability to earn ARRA funds (particularly in smaller hospitals that have a higher percentage of affiliated physicians).
And let’s not forget about those other stakeholders – smartphone-loving, proactive patients, who are not concerned with MU but with gaining access to and control over their own health data, on their own terms within a mobile device that is with them 24/7.
The Stage 2 & 3 Proposed Requirements: A 10,000 Foot View
One thing I noticed while studying these new proposed requirements was that they have been significantly watered-down, as compared to when I first started following MU in 2009. As a result we now see a ‘kinder and gentler’ path towards MU. I won’t list out the details here – John Halamka and Robin Raiford from Allscripts have already posted very helpful summaries of how Stage 2&3 expand upon the Stage 1 final rule.
Overall, from a 10,000 foot view, the new requirements point to the following:
1. More electronic health data capture will be required (no news here).
2. Clinicians will be required to ‘do more’ with this data by using it in advanced clinical processes and by sharing it with other providers, an HIE, and Uncle Sam.
3. There will be an increased emphasis on patient engagement which will involve PHRs, patient education, and stronger patient-physician partnerships.
More Data Capture
Luckily for providers, the Stage2&3 proposals have loosened inpatient and outpatient note capture requirements in an effort to get notes digitized by any means necessary. Notes can be maintained in structured or unstructured forms (scanned-in handwritten paper notes, dictation, etc are all possibilities). With these loosened requirements, physicians will not be driven by MU to document at the point-of-care on their mobile device. Instead, they will have to weigh other benefits, such as the ability to face the patient while taking notes on their touch tablets.
When it comes to discrete data, the story is different. Some physicians have been capturing charge data on mobile devices for more than a decade, avoiding workflow disruption while making sure they got paid. With the current explosion of mobile devices in health care settings, along with improvements in usability, physicians are now poised to move beyond charge capture to capturing the discrete information required for MU (problem lists, demographics, vital signs, smoking status, quality metrics, eMAR data, etc).
Using the Data: Towards Advanced Clinical Processes
Capturing digital health data does no-one good unless it is put to use, and so the Stage 2&3 proposals all expand requirements for advanced clinical processes that use this data, such as: CPOE, drug-drug/drug-allergy checks, eRx, CDS (Alerts), formulary checks, medication reconciliation, and more.
While early clinician adopters are already performing eRx and formulary checks on mobile devices, we are still far away from mission critical clinical processes such as CPOE and CDS moving to mobile on a widespread scale. (We still need to get the desktop versions going!). Currently, few vendors are established in this space, though PatientKeeper has CDS alert functionality built into their platform and is introducing their CPOE App in 2011.
On the other hand, advanced clinical processes such as CPOE and CDS have huge roles to play at the point-of-care. Imagine that while at the bedside, a physician could receive guidance without disrupting the physician/patient interaction – similar to how they now use Epocrates but with data that is much richer and personalized to the current interaction.
Sharing the Data
A health crisis knows no designated time frame, and the ability of physicians to grant access and share patient information with other physicians or with an HIE (at 1am, from their kid’s soccer game, or during hospital rounds), will become increasingly essential. With MU requirements around provider-provider and provider-HIE data sharing, clinicians will increasingly demand access to other provider portals and HIEs via their mobile devices. In fact, HIE vendor Axolotl will be releasing a touch tablet (iPad) app in 2011 for this very purpose.
Patient Engagement Requirements
There are also significant new requirements relating to the ‘Patient and Family Engagement’ MU goal.
These include patient reminders, patient preferences for communication channel, online secure patient-physician messaging, timely electronic access to clinical data, bidirectional electronic self-management tools, and more.
It is easy to see how these requirements can tie-in to the mHealth ecosystem. For example:
* Patients may prefer to be sent reminders via text message.
* Patients may wish to communicate with their doctor through a secure mobile messaging app.
* Patients may also want to be able to access their clinical data and educational resources through an mPHR/mEHR.
But, wait, let’s back up: do patients actually care about their health data? Making the leap that providing an mPHR/mEHR to the consumer would nudge engagement rates upwards (and costs downwards) is just that – a leap. However, this is a topic for the next post…
Summary: MU and mHealth
It is easy to see how many of the evolving MU requirements around data capture, advanced clinical processes, data sharing and patient engagement have a tie-in to the mHealth ecosystem, and how the mobile device will play an increasing role in MU compliance. Hospitals worried about the compliance of their non-employed physicians would do well to look into the mHealth ecosystem for tools that will encourage these physicians to comply — even though deploying HIS-integrated Apps will entail the usual governance, implementation and security costs.