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mHealth must be usable for patients, integrated with EHRs: Q&A

By Jennifer Bresnick

- As patients continue to adopt mHealth technologies like wearable activity trackers, home monitoring equipment, and smartphone applications tailored to chronic disease management and health research, patient-generated health data (PGHD) is becoming ever more prevalent, detailed, and useful for healthcare providers.  But every new technology has its problems, and the explosive proliferation of telehealth tools is no exception.  From teaching seniors to use monitoring devices to developing strategies to integrate data into a provider’s already-complicated workflow, mHealth is a much more complex proposition than it may initially seem.

Manu Varma, Vice President of Strategy and Development for Philips Hospital-to-Home, sat down with EHRintelligence to discuss some of the challenges involved in bringing healthcare to the patient on his or her own terms.

What are some of the most significant obstacles when trying to bring remote monitoring and telehealth into the home?

We are at a point where people are going to start thinking about the amazing impact these technologies have on care coordination and the ability to bring patients from more expensive settings to less expensive settings.  And that, to me, is really exciting.

But one of the big issues is trying to help educate patients, especially the elderly ones, about how to use these tools.  I’m sure you listen in the news about all these cool gadgets that are coming out but you know what?  They are not really designed for that elderly patient, and they’ve struggled with that.

The things that we’ve built are designed to be really simple, and they’re kind of sophisticated in their simplicity.  That’s primarily because we need them to be able to support this kind of elderly patient.  I would say that when I first saw these things, I was a little bit intrigued because I’m definitely not in that population cohort and these solutions looked a little bit less “modern,” for lack of a better word.  But, actually, they’re designed to be ultra-simple.  That’s what makes them usable by this elderly population.

Now, that said, you actually have to have some people out there in the field helping these populations.  You cannot expect them to receive a package and start using these tools right out of the box.  We send installers to homes of these patients, and these patients are coached for a little while.  The installer knows how to set everything up to make sure the data is coming back to our cloud, and makes sure that the user understands the regimen they need to follow. And that’s an important part of the solution we’re able to bring to bear.

Providers have been struggling with the idea of patient-generated health data and how it should be used.  How can remote monitoring be integrated into a provider’s EHR workflow in an effective way?

With our solutions, providers are able to log into our system remotely, and when they log in they see their patients and they’re able to do whatever needs to be done.  The EHR situation is an interesting one.  Basically, EHR developers don’t want to get into the world where they take device data directly and interpret it, because that falls under FDA’s purview.

But we, as a medical device company, as a company that has decades of experience dealing with FDA and those kinds of regulations, we are able to do that.  So, as of now, the standard way of working this is that there is a dedicated care team for watching these types of patients, and they are using our system to see this information.

It can interface with the EHR.  We absolutely understand EHRs are critical and we build upon that.  We leverage that investment from the health system.  The primary care provider also gets to see the information in the EHR, but it comes via our system, and the automated components of decision making and critical analytics happen in our system because that requires FDA regulation.

Will wearable devices become mainstream for patients?  How will providers integrate this data into their care plans?

I think these devices can really serve two purposes.  Number one, they can detect information and help us predict things that are about to go wrong.  If you’re a COPD patient  and your activity really declined over the last week, well, maybe you’re not doing too well.  And, certainly, the wearable technologies are also becoming sophisticated so they can go beyond just activity monitoring.  They may be tracking respiration data, and your respiration data is giving hints that something bad is about to happen.  So that’s one way it could be valuable.

Another way it could be valuable is for motivation.  I’ve used the Fitbit and it does kind of motivate you.  I can take a look at my data and see, “Oh, instead of 10,000 steps, I only did 8,000.  Maybe I should go for a walk to catch up.”  And so if you think about the overall health of the patient, it can help you catch exacerbations and it can help motivate the patients.

We want to bring those kind of things to bear into our programs.  I think it’s going to make a difference, but as of now there is no definitive study that proves that they are perfect or they really have a huge impact.

The most interesting part for me is how quickly some evolution is happening in that space.  A year or two ago, people were putting out trinkets and an application on the side with it. And that works for consumers because, maybe as a consumer, you just want to keep track of one or two activities and that’s good enough for you.

But it doesn’t work that way for healthcare.  In healthcare, if your provider has to actually do something with information, they don’t want one application for activity, another application for respiration, and another application for surveys.  It has to sit in one place.

I think people are recognizing that integration to the provider community is really important, and you need to move away from what I would call single proposition devices or single proposition software. Your software needs to integrate with different devices.  And that’s absolutely what we do today and what we intend to continue doing in the future.



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