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Why mobile health first requires governance strategies?

By Kyle Murphy, PhD

Given the increased adoption of smartphones by both providers and patients, mobile health (mHealth) represents an opportunity for compiling and making available more and more health information that can be used to improve the coordination, delivery, and cost of care.

“Obviously, we’re in an age of consumerization,” said Vice Chairman of Clinical Information at the Cleveland Clinic William Morris, MD, FACP, during the second day of the 5th Annual mHealth World Congress. “People are expecting healthcare to be mobile. They’re expected that their health is not just delivered in the four walls of the clinic or the four walls of a hospital, but it’s really going to be ubiquitous. We actually call this pervasive health. It is pervasive.”

For healthcare organizations and providers, the development and use of mHealth presents a series of challenges around ensuring that these mobile apps and technologies are properly vetted and integrated with existing health IT systems and standards.

“When we talk about mobile, everyone says, “I need this app. I need this thing. Build me something,” explained Morris. “The problem is it’s very fragmented. It’s not integrated. It’s not coordinated. It’s not synthesized.”

In order to ensure that innovation leads to integration, Morris and his colleagues at the Cleveland Clinic have emphasized the importance of governance, particularly the adoption and management of strategies that support the development of useful mHealth. “One of the essential pieces for mobile health in the clinic wasn’t sexy technology. It was something as boring as governance,” he observed.

A lack of well-defined rules of the road at the outset could lead to confusion farther down the road. Such was the experience that Morris shared about the proliferation of mobile apps and services that took place at his own organization when strong governance could have made a world of difference:

Why does this all matter in terms of governance is that you need to know what your strategy is, what’s your focus. You need to have standardized content, something as simple as brand or look and feel. About five years ago, we had probably six or seven different Cleveland Clinic apps, and that’s confusing for your patient population and your consumers because you don’t know which one is the right app, which one is being curated and managed — so culling of content — things that I don’t necessarily think of, but it’s very important.

The process of considering governance strategies reveals a whole host of questions and concerns that should be addressed before moving forward with mHealth development and adoption. As Morris noted, the experience of mHealth innovation at the Cleveland Clinic revealed details about supporting mHealth solutions beyond smartphone platform, security standards, and deciding whether to build or buy.

For one, there’s also the matter of supporting for mobile app users. “We introduced a clinical app and lo and behold, we probably didn’t think through who’s going to answer the phone at night when it doesn’t work, so to speak,” explained Morris. “You may perceive that mobile is not [one of] your high-level, critical systems for your hospital, but it certainly for the user becomes essential. It becomes their crutch.”

Another consideration concerns how new technologies will work with existing health IT systems. “The walrus in the room is certainly this modular development scenario,” Morris continued, “you don’t just want to do one-off apps or technology. You really want to build a scalable architecture that you can repurpose both from code standpoint but also from a look and feel. What you really need to do is develop modular components.”

As with other health IT systems, for the potential of mHealth to benefit providers and patients it must be reined in before being allowed to run out of control.

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