World of mHealth and Predictions for Tomorrow (Part 2 of 2) – 9/17/11

Last week I wrote a post covering mobile health solutions from payers and big pharma, two of the major players in the mobile health space. Today I’m going to continue with the state of mHealth with retail pharmacies and health systems. After that, I’ll try and see if can come up with some coherent thoughts to tie it together. It’s really not easy because of the range of activities in the mobile health space.

Retail Pharmacy

Retail pharmacy is a huge and important part of healthcare delivery in the US. Providers prescribe and consumers consume tons of prescription medications worth about $300 billion each year, or close to 13.4% of total healthcare spending. Pharmacies offer flu shots and urgent care to take advantage of the facilities they already have and try to get more people through the doors.

Additionally, medication therapy management (MTM) is seen as a viable and high-impact way to reduce costs and improve care for patients. Pharmacists are perfectly suited to deliver this kind of care, ideally in a documentable way that gets added to the patient record (PHR, HIE, mobile app?) so that other providers have access to it.

I covered retail pharmacy attempts at mobile consumer health apps in my post about Walgreens Mobile. Walgreens is far ahead of the other retail pharmacy chains in terms of mobile tools for consumers. It has apps for all major mobile platforms, does text notifications when refills are ready, and even does "Refill-by-Scan" if you take a picture of the bar code on the pill bottle.

I’m sure the other retail chains, several of which already have mobile apps, will catch up to Walgreens soon enough to start offering services people need. Namely, the ability to order refills and get pick-up notifications over mobile.

One feature I’m a little surprised I haven’t seen from retail pharmacies is medication reminders like those offered by GreatCall. The biggest challenge from my perspective is that users must manually enter information about medications and schedules. I have to assume that retail pharmacies could easily and automatically load medication schedules into a mobile app or into a reminder service. This would certainly be a nice offering for lots of consumers, especially if adherence reporting, like GlowCaps reports (pictured above, was provided.

Maybe pharmacy and prescription data will become more readily available as a higher percentage of prescriptions are electronically sent. I’m sure Surescripts will love that. Until then, retail pharmacies have a rich set of patient data that is valuable both to providers and patients and could easily be made available over mobile.

I’m not aware of any retail pharmacy apps for providers. The one app that I’ve used is called Generics. This is not from a retail pharmacy, but aggregates retail pharmacy generic medication program information. Providers, and presumably patients, can find good cheap alternatives for meds. I’ve seen providers look up generic medication lists for patients online, so this at least makes that process more convenient.

I’m not sure what else a retail pharmacy would offer a provider other than maybe information about patient medication lists (since medications can be prescribed by different providers) or the ability to get patient adherence info based on refill data. I’m sure this would open up lots of security issues around patient data.

Health Systems

Health systems have a lot to gain by effectively using mobile technology to engage consumers. They can do anything from answering questions about hours and locations to helping improve self care. I covered mobile apps from healthcare orgs pretty extensively in a post a few months ago. The key functionality of these apps then and now seems to be basic facility information, such as provider directory, addresses, and phone numbers. Some offer emergency room wait times and pre-registration, though this is not the average app. Of course there is iTriage, which is starting to do scheduling and registration.

Newer offerings, like the one from Ohio Health, attempt to create a tailored experience for patients, linking them to providers and semi-customized data. Ohio Health is focused initially on pregnancy, with a nice timeline in which you can feed relevant patient education. The design of the Ohio Health app is interesting in that it is built around patient relationships with providers (pregnant patient and OB, for example). The data entry is manual and based on user-entered dates. I’m curious to see how this evolves to more general and chronic care as well as linking mobile app users to medical records.

EMR vendor Epic has MyChart Mobile that is a mobile PHR for patients with lab results, medication information, and appointment schedules. It seems like more and more health systems that are using Epic and MyChart are starting to roll out MyChart Mobile. I think the key will be integrating this with some self-care tools (reminders, evidence-based education, relevant health classes) to make it more than just an mPHR, thus avoiding the fate of Google Health.

I’d also consider appointment booking services, like that of ZocDoc, as a health system, or provider, mobile health tool for consumers. It serves as a mobile interface between consumers and provider schedules, assisting to link healthcare supply to healthcare demand.

The topic of health system mobile apps for providers is a devoted post in and of itself. They include different form factor devices and functionality for secure messaging, accessing patient records, RFID asset tracking, barcode scanning, vitals recording (outside the EMR), patient alarms, coding, and a bunch of other functions that I’ll devote more time to in another post.

How / Does it come together?

Unfortunately I don’t see there being a convergence of mobile health offerings from all the different stakeholders. Each group is trying to target key users — providers and consumers. With both, organizations will want to brand the app for themselves and not roll up functionality into a broader app. At least you can group icons now, at least on iOS. In fact, I had a group of about six apps that I used daily  when I was working in the hospital. They were mostly reference and medical calculators because I didn’t have mobile EMR access.

Healthcare consumers will likely end up with whatever their health provider, payer, and/or pharmacy tells them to use. The one caveat might be those mobile health developers that are working through employers, which seem to be a potentially viable business model for mHealth, and those organizations like Kaiser that are the provider, the payer, and the pharmacy all rolled into one.

I think there is potential for HIEs, if they can start aggregating good amounts of data, to offer consumers access to good, personalized medical and provider info. HIEs may be able to create linkages to pharmacies for refills as well and offer the pharmacists the ability to enter relevant patient information back into the HIE. While HIEs are at it, they could do provider scheduling as well. All of this would require exceptional and unprecedented deal-making for an HIE, something I doubt is even possible. I think they first need to figure out how to keep the doors open.

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

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