eHealth Second, mHealth First (Part 2) 2/14/12

I wrote a post last week about why developing for health on mobile, before web, often makes sense for consumers. I did not intend to make it seem like Mobile First is always the right strategy, but, I do think any product developer should weigh the value of starting with mobile when building health services for consumers.

I think increasingly the Mobile First will be the right decision, but not in all instances. Decisions on whether to build Mobile First for consumer health products will be based primarily on the type of service being offered, its intended use, and the associated population. I don’t think I clearly articulated this in my last, post so I wanted to clarify.

The other area that I don’t think I was totally clear on was the power of mobile as a hub to integrate data from sensors and biometric devices. I got several e-mails about this specifically and I agree with all of them – the power of mobile devices to collect data automatically and transmit it for analysis and reporting is huge. Thanks for the responses.

This week I wanted to lay out the reasons why a Mobile First development approach works so well for providers. Mobile health is very broad these days and the differences between mobile for consumers and providers are sizable. The same characteristics of mobile devices and usage exist but the applicability and value for providers are very different than for consumers.

When I say providers I mean all clinical providers, not just physicians. Look at the success companies like Voalte and PatientSafe have had over the last several years selling mobile products to hospitals for use by nurses. I’d say they’ve had more success selling mobile into the enterprise than companies selling mobile tools for docs. This might be because both Voalte and PatientSafe have a dedicated device approach so their wins are more easily identifiable than a win by a health app developer.

Either way, healthcare providers are a mobile workforce, whether it is a nurse moving room to room or floor to floor in a hospital or ambulatory office or a physician moving between multiple offices, hospitals, or surgery centers, not to mention moving around within each of those locations.

I remember working with a family doc in med school that delivered a ton of babies. He’d constantly be calling the hospital in between office patients to get updates on his laboring patients. AirStrip is addressing this specific need.

Or take my wife, who attends lecture every morning at one location and then goes to 2-3 locations throughout the rest of the day. At each location she is rarely off her feet, moving from patient to patient. Or investor I used to work with, a retina surgeon who worked out of eight office locations (he was rural and was aggressive in building and maintaining his referral base.) covered four hospitals, and spent two days a week at an ASC.

I’m sure everybody gets the point. It boils down to the fact that physicians generally need tools at — or as close as possible to — the point of care (POC.) The problem is that the POC is always moving, and that is why mHealth is so powerful for providers.

Certain aspects of clinical work, like laborious EMR documentation, will likely not be as efficient over mobile unless speech technology becomes super fast and accurate or EMR documentation requirements are reduced. Even if somehow either or both of these things happen, providers will likely still want to sit down from time to time at a computer and not spend 100% of there time entering and consuming info over mobile. And that is why an integrated approach of web and mobile still makes sense (more on that at the end.)

OK, specifically what makes Mobile First a key strategy for providers.

Mobile devices are individual. As with consumer health, security and privacy are big concerns. Providers are busy, only getting busier with reimbursement reductions, and do not want to spend time waiting to log into a shared terminal.

I remember a CIO telling me once how he was so excited to introduce a new badge authentication system that would pull up virtual instances from the last login of a provider, speeding up the average login from over a minute to under 10 seconds. He said within a couple of weeks physicians were complaining about the new reduced login wait and wanted to see if it was possible to do proximity logins so that as a user approached a terminal the login process would start, reducing the time from sitting to login. I remember seeing a demo video of a company that was doing this in healthcare.

This shows the power of mobile, with certain security requirements added in, to speed the workflow of providers. You can think of mobile devices like proximity logins. Providers can start while walking and be logged in before they sit down. The other issue is that sometimes desktop terminals are hard to find, especially during rounds when all teams are looking to get access to them. Mobile helps with this too.

Mobile is location aware. For provider tracking in facility, much like RFID (Awarepoint) and visualization tools (Intelligent Insites), I wonder how accurate you could get with smart phones? Could you leverage the iOS hardware from Voalte or PatientSafe to track nurses and devices? I guess you could just attach an RFID tag to the iOS devices and it would probably be cheaper. What other value can you think of in tracking providers?

Devices are limited in screen real estate. I wrote something that specifically applies to this last week when I covered the story on meridianEMR’s new mobile app. The mobile app presented a full, unstructured encounter note on the mobile screen, making it almost unusable, or at least far from being mobile-optimized.

I’m betting that most providers, and specifically urology providers (meridian is a urology-specific EMR), look for certain things in old encounter notes most of the time. Instead of presenting the full note, why not present these certain things up front instead of making them scroll to find them? And search on mobile is not as good as a workstation, so don’t count on that. I realize providers want access to the whole note, so why not give that access? Just make it an extra click the minority of the time they need it.

This is the same with any application, not just EMRs. Epocrates doesn’t just put a huge drug reference database on a mobile screen as a scrolling entry for each med. It formats it so it’s usable by clinicians. VisualDx is pretty good at this too.

Devices are always present. This ties to the fact that the POC is a moving target. Creating tools that are usable over mobile makes the time spent between rooms and facilities more valuable, making providers more efficient and happier that the pile of stuff they need to do doesn’t all build up to the end of the day. Also, being able to check in quickly on a patient vitals, telemetry, or other monitor while on the go is very valuable.

Minds and paper have limits. It takes a lot to be a clinician. Dosing calculators, recent evidence, drug interactions, coding/billing, patient lists, various templates, contact info, and on and on are all required at different times throughout the day. Some of these are addressed with mobile apps, some with web apps, and some are done with a mix of note cards, paper, and memorization. Create dynamic mobile apps to solve some of this and I think you’ll have success.

Obviously I’m a little prejudiced in my thinking that Mobile First is typically the right approach with providers, much more so than with consumers. The one caveat is EMRs, which I think require a desktop — or preferably web — component first. Mobile makes a ton of sense for prescribing and data access, but documenting and visualizing individual patients and cohorts of patients requires more than a smart phone and usually more than a tablet, which is why EMRs require an integrated approach. E-prescribing, drug reference, and specific POC tools, like calculators, do not.


Travis Good is an MD/MBA involved with health IT startups. More about me.


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