By Melissa Fox, COO, Acenda Integrated Health

On August 6, 1991, the World Wide Web was thrust into the public spotlight for the first time with the launch of a fledgling website by Tim Berners-Lee. Though the internet was actually invented in 1969, it was only used to allow computers to communicate with each other. Until Berners-Lee invented a way for users to search for and access information, the practical application of the medium had not been fully realized.

However, there was slow adoption of the game-changing invention, which was promoted with lofty language. For example, an advertisement from 1993 explained, “The WWW project merges the techniques of information retrieval and hypertext to make an easy but powerful global information system”.

Though the project’s original purpose was relevant, it didn’t achieve widespread acceptance until the public not only understood the purpose but was able to consistently access and personalize its usage according to individual needs.

This is the challenge — yet opportunity– which confronts designers and producers of mHealth apps.

According to IQVIA Institute, mHealth market size doubled between 2015 and 2019, with global growth expected to reach $102 billion by 2023. Increased smartphone usage has helped fuel this growth as well as widespread adoption by health and fitness companies. However, though there has been significant product expansion and proven cost savings related to incorporating mHealth into care management, adoption by the wider public has not been consistent – especially for highly vulnerable populations who tend to be more significantly affected by chronic illness.

To address this clear gap between the innovation of mHealth and its consistent utilization by the individuals who would be helped the most, the industry should follow the example of the internet and 1.) Normalize 2.) Personalize and 3.) Deliver.

Though mHealth has been in existence for several years, there is no anchor message that grounds the public’s overall benefit. There are over 318,000 mobile health apps, many of them offering differing benefits, access levels, and usability. Essentially, each app has to individually “make the case” regarding its connection to the overall healthcare continuum. Normalization is occurring in certain areas, such as the usage of patient portals, but even that is a low bar considering the Government Accountability Office has reported that 90% of providers offer portals, yet only 30% of patients use them.

To normalize mHealth, it may be necessary to adopt messaging which focuses on how the app connects to the healthcare continuum vs. messaging, which touts the tech functionality (a la 1991 WWW). This approach may help individuals shift from thinking of mHealth as peripheral to their healthcare, and instead begin to proactively search for apps which will integrate with their overall care processes.

Next, it’s extremely important to engage the patient voice in the development and delivery of mHealth. A research study from the University of Michigan Medical School and Brigham and Women’s Hospital found that many of the available apps may benefit a narrow subset of individuals, but the apps had little relevance or impact on outcomes for the vast majority of users. Other studies have shown that low-income, non-white ethnic and racial groups, and older populations also have much lower adoption rates for mHealth, though their health needs tend to be greater and they would benefit even more from using the apps. Incorporating patient input from the target populations will help ensure the app not only addresses patient needs, but also their level of engagement. Lastly, apps must consistently deliver on their brand promise of easy access, relevance, and contribution to healthcare outcomes to p

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Health care institutions have traditionally focused on sick care, which means that we serve most of our patients through our physical locations and when they need us. The role of technology traditionally has been around what the institutions want vs. what patients need.

As tools such as Telehealth, AI, automation, RPM, and Mobile Health take center stage, the need for integration of Human-Centered Design is now necessary. Simply plugging in software or digital tools is not enough since they do not take the user perspective into account. Enabling seamless digital journeys into health systems requires us to solve the right problems that consumers face in the current traditional model.

Focusing on the reality of what health care looks like today and solving for the ideal experience through the lens of the consumer will ensure that we find the true problems that need to be solved. How do we bring convenience, speed, accessibility, and choice to the forefront? What is the experience in health care that people will expect or be delighted by? How do we support sick care and spotlight preventative care? How do we build relationships with consumers beyond one-time visits, with holistic care in mind? How do we get into their doors vs. only asking them to come to ours?

At Hoag’s Digital Organization, we start defining the problem/s vs. simply going after what everyone says is the next big health tech.

Digital will be central to answering the above questions, especially as we focus on where it fits into a unified health care journey. It is the reason we need to design a digital ecosystem that is interoperable and offers services like virtual health, choice of care, speed, and accessibility to top doctors in the nation while leveraging foundational technology tools like telemedicine, mobile, and AI. These need to be part of the toolkit that creates a best-in-class health journey for consumers. Instead of interactions based on Hospital IT systems and EMRs, we need to focus on guiding our patients through an experience where physical, virtual, and digital journeys are employed at the right moments to create lifelong partnerships.

How does Human-Centered Design play into this? At Hoag’s Digital Organization, we start defining the problem/s vs. simply going after what everyone says is the next big health tech. We take those problem statements, ideate, and co-create with physicians, consumers, and patients on the ideal experiences to solve them. We are not just plugging in technology but ensuring that any digital tools we bring in, design, or build fit the problem solution.

One example of this is our focus on mothers. The pregnancy/parenting market is already very saturated with digital offerings, but this demographic is responsible for making many health decisions across their entire family unit. To better understand if there was an opportunity here, we immersed ourselves with this consumer segment.

From survey studies to in-depth user research sessions, we set out to understand if there were gaps in the marketplace. Through that research and time spent with this group, we unlocked key insights around parts of the women’s health journey that were missing, and areas they were struggling with. With those insights, we started to design products from their perspective outwards vs. simply finding ways to solve with the systems tied around the hospital. We wanted to design around those systems but with an eye on what the experience truly needed to be for us to solve the problems that the moms had identified. Those ideation sessions led to a deep understanding of the journey women have with health care systems and we found the areas that, if improved, would have the most positive impact on their experience with us as a health care organization. We were no longer only focused on highlighting the services we provide. Instead, we were also focused on designing experiences and digital tools that would help the moms have a deeper relationship with us and drive improved health outcomes.

These concepts and products are digital-first solutions, and central to their success is the human connection and expertise that providers bring to the table. Technology is intertwined into that journey as the mechanism to enable that dialogue and care provided. It is deeply tied to solving the problem from the consumer/patient point of view vs. strictly the organization’s. We accept the foundational value of EMRs but understand that winning the relationship with consumers is not about “logging into your patient portal” but more tied to serving up the experience you need at the moment in a seamless way that thinks about you, the person trying to get answers.

The process of going deep with our patients who are mothers and co-designing solutions with them and our physicians allowed us to build digital products that can stick in the marketplace. The digital strategy is centered around being the patient vs. assuming for the patient. That way, we are designing experiences and building digital solutions that are less about what we want and more around what the end-user wants.

In closing, I’ll leave you with this “We spend a lot of time designing the bridge, but not enough time thinking about the people who are crossing it.”

– Dr. Prabhjot Singh, Director of Systems Design at the Earth Institute

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COVID-19 has a significant impact on all industries and mainly healthcare. Many lives were lost and hospitals and healthcare workers had to deal with unprecedented situation dealing with the new virus. This pandemic forced everyone adopt to new ways of delivering care in a safe and cost-effective manner. COVID-19 became the Chief Transformation Officer in healthcare to provide care virtually using telehealth technology.

Though telehealth technology has been in the industry for over a decade, adoption has been slow for various reasons. However, pandemic forced everyone to offer care virtually to provide continuous healthcare to the patient population and to stay competent in the highly competitive healthcare market.

With big tech companies such as Amazon, Apple, and Google investing more in healthcare delivery, the healthcare market is becoming more competitive. Once big tech companies expand healthcare services through joint ventures with hospitals and health systems and with price transparency and restriction on surprise bills regulations patient population will be able to browse online and shop for the best healthcare provider less expensively instead of walking into an ER or Urgent Care Facility. At the same time, this is a great opportunity for innovative healthcare organizations to create a new line of business as telehealth hubs to provide telehealth on-demand care 24/7 by forming joint ventures with other tech and healthcare organizations.

1) Recent trends in mobile applications used in healthcare

• Pandemic forced everyone to implement and use mobile for various use cases such as Telehealth, integrating wearable devices with mobile apps to track health conditions, pre-visit registration paperwork completion and check-in prior to arrival, access patient charts, lab results, and radiology reports from anywhere, etc.
  
  
• Apps for healthcare organizations: inventory management, secure texting, etc.
  
  
• Apps for healthcare professionals: Telehealth, remote diagnostics.
  
  
• Apps for patients and family members: Health tracking apps, fitness/wellness, monitoring of chronic conditions such as diabetes, blood sugar, women’s health apps.

2) Recent trends in virtual technologies used in healthcare

• Virtual healthcare is changing from telehealth visits to more interactive consumer/patient-driven technology.
  
  
• New solutions for contactless care are evolving. Patients can enter all information via mobile phone or from home.
  
  
• Advanced analytics and BI tools, targeted focus on groups of high-risk patient population will be possible to send alerts via text, mail, etc to encourage getting vaccines, attend virtual health webinars, etc.
  
  
• The evolution of 5G broadband internet into the healthcare space will enhance the overall user and physician experience.
  
  
• As virtual care expands, it will provide more opportunities to work remotely for Clinicians and Support Staff.

Though telehealth and virtual care were in place for over a decade, adoption was very low because of lack of awareness, confusion in charges for patients, and reimbursement for healthcare organizations for in-person care vs virtual care.

3) Common adoption and operational challenges in deploying mobile applications and other virtual health tools in healthcare.

• Though telehealth and virtual care were in place for over a decade, adoption was very low because of lack of awareness, confusion in charges for patients, and reimbursement for healthcare organizations for in-person care vs virtual care.
  
  
• Other challenges:
  1. Lack of broadband and smartphones in low-income communities.
  2. Lack of regulatory enforcement
  3. Lack of incentives or subsidies to promote telehealth technology implementation.
  4. Security
  5. Interoperability
  6. Patient language
  7. Technology support for patients
  8. EHR integration
  9. Big data from discrete systems: How to consolidate and analyze data from remote monitoring and wearable devices in a physician friendly manner.

4) How to address the adoption and operational challenges in mobile applications and other virtual health tools?

• Incentives or grants to invest in mobile clinics and provide smartphones to low-income families.
  
  
• Evaluate reimbursement models, come up with some standards for care provided for in-patient vs virtual, and implement new incentives for organizations who meet some percentage of virtual care and penalties who don’t meet standards. Similar to the ARRA meaningful use initiative that helped promote EHRs implementation and adoption at most of the healthcare organizations.
  
  
• Invest in cybersecurity infrastructure and services.
  
  
• Lack of interoperability among disparate systems and different healthcare organizations is one of the major reasons for duplicate tests and higher cost of healthcare. EHR vendors and healthcare providers should break the barriers and share data for better patient care. Operationally this may be difficult in highly competitive Urban Areas, but if CMS defines some standards and rules regarding data sharing requirements, this should be possible.

5) How mobile health applications and other virtual health tools are transforming the healthcare industry?

• Proactive monitoring and real-time alerting via apps if there are any infectious disease outbreaks in certain parts of the world and precautions to be taken, so everyone is better prepared.
  
  
• Healthcare becomes more retail with virtual care and mobile apps. Patients can browse through and check for healthcare providers in a region, consumer ratings, cost estimates, any promotions, etc., just like online shopping.

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None of us will forget the chaos that COVID-19 unleashed on our daily lives and routines. For years to come, humanity will study the immeasurable impact on our physical health, emotional wellbeing, and socioeconomic disparities and how these factors will change the face of healthcare for good. Of the countless tragedies this plague thrust upon us, one thing it did in a positive way was foster innovation. Particularly in healthcare, an industry that needed a figurative – and literal – shot in the arm.

Technology has long played a role in healthcare, from the first EKG transmitted by telephone in the early 1900s to today’s explosion of mobile apps, online visits, and mHealth solutions. Factor in emerging high-tech like AI, and our dependency on the digital ecosystem for quality and efficiency becomes even more apparent. Everyday technologies like smartphones and step trackers have become conduits for digital engagement, uniting patients and caregivers across geographic boundaries. High-demand, high-volume specialties such as behavioral health and dermatology are primed for growth in a market that is quickly adapting to this new paradigm in healthcare delivery. It is time to adapt our practices to those of what a consumer-savvy population expects: convenience, access, choice, value, and a positive overall experience. Instead of being compared to the clinic down the street, we are now being compared to Amazon.com.

I classify telehealth technologies into five general categories:

Interactive Video tends to be the most familiar use of technology in healthcare. Simply real-time audio/video interaction between the patient and care provider, or among two or more providers. This is key to programs such as telestroke, where visually assessing the patient’s motor skills and facial expressions are vital to performing the physical exam and remote diagnosis. Synchronous interactive video is most useful in cases where the onsite care team cannot provide emergency specialty care.

Store and Forward technologies are characterized as being asynchronous, meaning the exchange and evaluation of medical information does not necessarily occur in real-time. Specialties such as radiology and dermatology leverage this medium to receive non-emergent information for remote diagnoses and extend their expertise to areas where related services may be limited.

Remote Patient Monitoring, or RPM, can occur asynchronously or in real-time, as is the case with programs like teleICU. RPM typically involves the transmission of data, such as vital signs or blood glucose levels, which is then used to evaluate the condition of the patient. This may allow for corrective actions in-between regular office visits to assist with the management of a chronic illness such as CHF or diabetes. It also serves as the cornerstone for many home health programs and is increasingly more prevalent in wearable technologies.

mHealth, short for mobile health, represents the practice of medicine supported through mobile technology. This encompasses the use of telecommunication and multimedia tools such as smartphones, wearables, and remote monitoring devices. Practical applications include mobile devices to collect clinical data, deliver health information to caregivers, real-time monitoring of vital signs, and direct provision of care. The explosion of mHealth is evidence of the shift in traditional care delivery models to more consumer-driven and patient-centric.

Predictive Analytics / Artificial Intelligence (AI). The difference between predictive modeling and AI, or machine learning, is that predictive models depend on past data to foretell future events. On the other hand, AI not only uses historical data, but also makes assumptions about the data without applying a defined set of rules. This allows the software to learn and adapt to information patterns in more real-time. The utility of predictive analytics is well-suited for detecting the onset of sepsis, for example, where the data can lead to a predictable result. AI, however, is better suited for rapid detection of an anomaly, such as a large vessel occlusion in the brain, where the dataset may be incomplete.

Telehealth is creating disruptive innovation, compelling healthcare systems to adopt new delivery models to assure long-term sustainability.

Technology deployed effectively can address fragmentation, create value to reduce cost, drive innovation, and improve quality and satisfaction. Still, technology itself does not constitute a strategy. It is an instrument to gather data in the form of interactive video, image capture, electronic diagnoses, vital signs, and much more. But to be effective, data must become actionable information for the care team because the most relevant information combined with the right action at the right time almost certainly leads to better care.

Telehealth is not new to us. But demand for telehealth solutions is growing rapidly. We now face unprecedented competition in a rapidly changing healthcare marketplace. Telehealth is creating disruptive innovation, compelling healthcare systems to adopt new delivery models to assure long-term sustainability. Now more than ever, our ability to connect with patients is literally in the palm of our hands. The healthcare industry is flooded with tools and technologies that facilitate ease of access, convenience, choice, and remote monitoring capabilities. Boosted by a shift in consumer preference, there is little question that technology will remain a central component to nearly any telehealth strategy.

And yet, the traditional house call, known so well for generations of patients and doctors alike, is making its comeback by way of technology. Ever since the advent of radio in the early 20th Century, people have envisioned how advances in communication and technology could be applied to the practice of medicine. Today it is quickly evolving as a mainstream component of the care continuum, to the extent that the term “telehealth” should and will fade away. After all, it is simply health care enabled by technology.

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The COVID-19 pandemic has been devastating to healthcare organizations on many levels. If there is to be even a tiny silver lining to a pandemic, the pandemic engendered rapid adoption of consumer-based tools that often were spoken about a lot, but not adopted on a widespread basis. One of the most compelling examples is the rapid adoption of “virtual visits” (often also known as “telehealth”) wherein a doctor conducts his/her exam “virtually” over a secure video link with the patient without the need for the patient to visit the doctor and potentially get exposed to COVID. Due to the public health emergency, Medicare waived a lot of their restrictions on the use (and reimbursement for) of virtual visits and healthcare providers pivoted in very short order to conducting the vast majority of their visits through this new paradigm. Even visit types that one would think would be particularly tricky to do effectively met with success, such as physical therapy visits. As restrictions on in-person visits eased somewhat as the pandemic progressed, providers did move back increasingly to seeing their patients in offices, albeit with new processes to minimize the time in waiting rooms and in the presence of other patients or staff.

Urgent Care centers also took advantage of mobile tools that would allow patients to see how long they would have to wait to see a practitioner, which was a great patient satisfier.

The early stages of the pandemic proved that practices can indeed provide effective care through virtual visits, though virtual visits’ popularity scaled back quite a bit over time. Providers found that they were more comfortable with an in-person model, though many still offer the virtual visit as an option. There were concerns in the provider community that some commercial payors, and eventually Medicare once the public health emergency is lifted, would either no longer pay for these visits or would pay at significantly reduced rates. The uncertainty about reimbursement and the extra technological steps and occasional glitches pushed many providers back, at least in part, to their traditional models of care.

One area where virtual visits have sustained a great deal of popularity is in the Urgent Care center realm. Urgent Care centers found that they could handle a significant percentage of the cases coming to them through virtual visits, thereby freeing up in-person slots for those who had more acute illnesses or injuries. Urgent Care centers also took advantage of mobile tools that would allow patients to see how long they would have to wait to see a practitioner, which was a great patient satisfier.

As patients found themselves locked down for months in their homes with the pandemic, they came to adopt mobile technology tools in the healthcare space and expected that these tools would be user-friendly and easy-to-navigate just like their Amazon experience always has been. Given the intrinsic complexities of healthcare involving things like third-party insurance requirements, prior authorizations, approval requirements from providers, availability of particular providers, and many other things, attempting to replicate an Amazon experience was always going to be a very tall order. But the realities on the ground with the pandemic spurred many providers (and electronic health record vendors) to offer and refine new “patient portal” tools such as pre-registration, collecting medication, allergy, and other clinical information online prior to a patient’s visit so as to minimize the amount of time a patient had to be in a potentially infectious environment. While still a work-in-progress, these improved patient portal functions have had a positive impact and have been adopted by patients and families at levels not previously seen prior to the pandemic. These new consumer-facing technologies were designed to work well both in a traditional desktop computer environment as well as a mobile phone environment. The success of these initiatives has led to a broader concept in healthcare which is being called the “Digital Front Door”. What the Digital Front Door concept aspires to do is to provide different “channels” through which a patient can communicate with their healthcare provider (and, likewise, their provider can communicate with them). The Digital Front Door envisions provider/patient communication happening not only by phone, but also by text, by “Chatbot”, through the provider website, and, again, through a much improved “patient portal” user experience. The access by telephone would still have a role in the Digital Front Door, but with a much-improved experience, minimizing hold times and several transfers to different extensions, and improving upon the lengthy “call trees” that patients often encounter. 

With mobile phones being so prevalent, even among elderly people, texting has become a tool that providers are eager to leverage. Whereas many people don’t answer calls from numbers they don’t recognize (or, even worse, hospital phone numbers are often flagged as “potential spam”), people do open text messages and act upon them. People are increasingly used to communicating with businesses through their cell phones (and not necessarily by voice) and are deriving a lot of value from choosing how they wish to engage with their healthcare providers. This is a relatively young technology, but one with a lot of promise and one that, if properly deployed, can act as a compelling competitive differentiator for providers in their respective communities.     

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It’s not the patient’s portal
It’s your digital front door. 

The patient portal is a reflection of your organization’s strategy on patient engagement.

This shift in thinking tripled my organization’s patient portal use in less than one year.

Patient portals were first used in the late nineties by a few large healthcare organizations but took off with the meaningful use criteria of CMS’s EHR incentive program. The incentives included in the program jump-started the adoption of EHRs by independent practices and hospital systems. The program required thresholds for the use of basic functionality. This included messaging, visit summaries, and access to laboratory results. Providers rushed to meet these goals to receive the incentives, but very few could increase user adoption numbers.

Most organizations treat the list of portal features mandated by MU as a to-do list. If an organization hits each item, they consider the portal “done” and move on to other things.

The common reasons patients were not engaging the patient portal would not shock the average person.

1. Websites were clunky and difficult to navigate; and
2. Portals lacked basic functionality.

Since the nineties, web design has come a long way. Now, most portals are much easier to navigate and include mobile apps. The second reason, lack of functionality, however, should make you rethink how to view your organization’s patient portal.

Most organizations treat the list of portal features mandated by MU as a to-do list. If an organization hits each item, they consider the portal “done” and move on to other things. Despite this “done” mentality, EHR vendors continue to add functionality to their portals that customers can (and should) adopt. For example, the platforms can support scheduling everything from visits to procedures. Patient-generated data from wearables can be entered and viewed by a patient care team. Because the portal is considered finished, however, organizations are slow to or do not adopt these new functionality. If healthcare providers saw their patients more like consumers, a shift would take place in functionality and improve user adoption and satisfaction. 

Friction, in the consumer sense, identifies how hard it is for a customer to get what they want from a digital interface. Why does Amazon have a “1-click to buy” button on their app? It makes it much easier for me to impulse buy toys for my kids. If I had to click through four screens and re-enter my password each time, I might abandon my purchase and invest my money wisely. 

Organizations that remove unnecessary friction will do better. This became clear to our organization over a year’s worth of patient portal steering committee meetings. We had a dedicated patient advocates and IT representatives meeting monthly to discuss our portal because we were stuck at around 12% activation and use. Repeatedly, the group made recommendations to offer canceled appointment slots to a waitlist of patients and online self-scheduling of office visits, but the operational engagement was not there.

The reasons made sense but mainly revolved around changes in our practices’ long-established workflows that were mainly telephone-based. It was only after getting buy-in on the concept of patients-as-consumers did the operational areas come on board. Unsurprisingly our portal numbers are now over 40%.

Patients, like consumers, have come to expect interactions with your system to be on their devices and for those interactions to be easy. These may seem lofty goals, but a few key pieces of functionality will help you get there.

1. Registering for an account: Many organizations require an initial patient visit before a patient may access the patient portal. A registration code and instructions are given to the patient after the initial visit with the organization. Unfortunately, this makes the portal an afterthought. Most portals allow a patient to create an account prior to a visit. Organizations should take advantage of this functionality to do pre-visit planning, paperwork, and communication. Yes, patients may make mistakes when entering demographics or insurance information. They may even create duplicate records if they forgot they have an account, but these mistakes can be fixed on the back end. Getting patients in your digital front door is worth the hassle.

2. Scheduling office visits: Giving patients the freedom to schedule their appointments is almost sacrilegious to the medical community. Physicians and office staff want to retain control over the flow of patients into the office. This is 100% understandable and has merit. Leaving gaps for emergencies or preventing a patient from jamming a 1-hour annual physical into a 15-minute sick visit prevents havoc from being wreaked on the flow of an office.  The reality is that very few of these fears come true with some careful planning and system monitoring.

3. Access to medical records: Viewing test results is a long-standing feature that most organizations adopted due to MU. The federal government pushed this feature to a new level with information blocking rules that went into place this year. It used to be commonplace to block test result release for days or even weeks. Now, delaying test results is considered information blocking. The new rules include office and hospital notes and all of this data needs to be available to patients in almost real-time.
   
   Just because this functionality is on, however, doesn’t mean it is promoted. Trusting patients to see their medical records and understand it feels like a giant leap to most health care organizations. Our organization shares over 35,000 notes a month. Patients viewed roughly 15% of them with no complaints to our patient advocacy department. In fact, we received multiple compliments on how helpful patient data was to patients and families. There is a growing body of medical literature to support this. Check out Opennotes.org to learn more.

4. Make your app a one-stop-shop: App development is an area that most hospital systems do not think that much about. They take their portal as their vendor created it. Think about using it for Wayfinding within your facilities. Give your patients educational material that comes from a trusted source. A health system near us did just this. They created an app and embedded several different apps, including their patient portal. The end result is a seamless experience for the patient and their families.

Patient engagement is shifting towards seeing patients as consumers. Offer them a friction-free portal experience and they will use it to their benefit and yours.

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Mobile health, or “mHealth,” has received an increasing amount of attention recently in connection with approaches to combating the COVID pandemic. mHealth, as defined by the National Institutes of Health (NIH), is a relatively simple concept: the delivery of healthcare services via mobile communication devices. In reality, this simple definition may mask a rather complex interplay between patients, providers, payers, policy, and the underlying infrastructures that support the health of populations.

To address equity, mHealth solutions should be designed by diverse product teams that focused on an expanded customer experience discovery process.

mHealth includes a relatively broad set of solution types. These solutions range from mobile applications focused on health care engagement or intervention to wearables that track specified data points to connected devices that are purpose-built to extend data collection beyond traditional healthcare settings. This set of mobile solutions has generated a market that is projected to grow rapidly. Currently estimated to be a global market of almost $55B, mHealth is expected to grow 20-30% annually over the next five years. This accelerated growth will likely shed a spotlight on critical challenges that the mHealth market will need to address.

Design

Design is a fundamental component of mHealth. Well-designed mHealth solutions can lead to impressive outcomes. However, poor design is not only problematic itself but leads to exacerbation of the other challenges of mHealth, including quality, privacy, data management, and access. Three of the more important considerations for mHealth design include:

1. Consumer focus – mHealth solutions should be designed with user interfaces and user experiences (UI/UX) that mirror design features in non-health mobile applications. The UI/UX for mHealth applications should not reflect the underlying complexity of healthcare delivery but should aim to simplify experiences.
   
   
2. Improve health – mHealth solutions should be relentlessly focused on the end goal of improving health. Features that are not proven to ultimately improve health should be reassessed. It is also critical to avoid the “killer app” syndrome where there is a solution looking for a problem.
   
   
3. Integration – mHealth solutions are often deployed within complex healthcare environments and well-designed solutions will not expose that complexity to the end-user. However, it is still important that these solutions are designed to integrate into the larger health ecosystem.

Data management

The volume of data generated from mHealth solutions is staggering and consistent with the idea of “big data.” Wearable devices are capable of sharing continuous data over expended periods, while connected devices are designed to provide multiple data points in settings much more diverse than the typical medical office or hospital. A core challenge is navigating the signal-to-noise ratio of mHealth-generated data. Solution architects may look to design features that improve the signal-to-noise ratio and/or develop underlying machine learning algorithms that manage large mHealth data sets to provide actionable information.

Privacy and security

The generation of significant amounts of data through mHealth solutions is promising but also poses a privacy risk. The devices themselves can be targeted as well as the flow of data from source to destination. Potentially more challenging to address is the ability of seemingly anonymized mHealth-generated data to be traced back to individual contributors. Leadership at the Digital Medicine Society recently noted that just six days of step counts are enough to uniquely identify an individual from amongst 100 million other people. mHealth data generation and distribution should be treated with the privacy and security afforded to research-grade health data and will likely require additional protections unique to mHealth.

Quality

mHealth solutions have a unique role amongst other mobile applications in that their goal should be to promote and improve health. Therefore, mHealth solutions must consider the added dimension of healthcare quality to their design and implementation. There is increasing concern that poor quality mHealth solutions are being deployed and used. Both the quality of the content as well as software functionality have been cited as ongoing concerns. These issues can lead to poor outcomes, including sharing misleading educational content or incorrect diagnosis. To address these challenges, mHealth solutions should be evidence-based, validated, and engage experts in the development and designs of the solutions.

 Equity

Like other digital health tools, mHealth has the potential to exacerbate current health inequities or help address disparities. Unintuitive and complex mHealth solutions that do not consider the increasing diversity of mHealth users may differentially harm patients who are already disadvantaged in the current healthcare ecosystem. To address equity, mHealth solutions should be designed by diverse product teams that focused on an expanded customer experience discovery process. The design should also consider diverse environments of use, including device types, bandwidth, disabilities, and digital health literacy, among other considerations. Additionally, underlying algorithms should be explicitly designed to address and overcome bias. The growth of digital health solutions, including mHealth, has accelerated recently. It is now clear that mHealth will increasingly become a core component of healthcare engagement and delivery. In order for the growth of mHealth to coincide with a parallel increase in health outcomes, the challenges of design, data management, privacy and security, quality, and equity will need to be addressed.

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The longstanding problem of asset monitoring was brought into stark relief by the COVID-19 pandemic, which created critical shortages of respirators and other equipment in beleaguered ICUs. To address the crisis, several hospitals turned to Claro Enterprise Solutions (CES), a global technology services company, and its IoT-enabled Real-Time Location Services (RTLS) platform.

CES’ RTLS approach enables hospitals to tag and track mobile equipment anywhere within a facility. Data-collecting sensors, AI-powered video analytics and beacons identify and monitor the location and movement of assets. Staff can issue a query via a mobile phone, tablet, or computer to quickly identify a device’s precise location. This allows faster access to equipment, improved quality of care, cost savings from reduced inventory and maintenance costs, and theft prevention.

Assets are tagged with low-cost QR codes and beacons, bypassing the need for more expensive RFID-based solutions. Geo-fencing defines zones within a facility, and when an asset such as a mobile ventilator crosses a geo-fenced border, an alert is issued identifying the asset as well as the precise location of the breach. AI-enabled video analytics track assets in motion, as well as identify the type and location of stationary assets, and track data on asset utilization and maintenance history.

Speed and ease of deployment are critical benefits. The solution integrates with existing video surveillance data streams and is deployed on an independent secured network infrastructure which does not encroach on existing hospital information systems. In one instance, CES implemented the entire system in a nine-floor hospital facility in seven working days.

An Evolving Healthcare Landscape

Apart from equipment monitoring, the COVID-19 pandemic has accelerated several existing imperatives related to digital innovation within healthcare. For one thing, the pandemic has driven expanded use of telemedicine and remote visits, as well as bandwidth-intensive applications and graphics. This, in turn, has fueled demand for flexible, zero-touch provisioning of network connectivity. Video conferencing for distance consultation and training is being increasingly utilized, particularly by smaller hospitals in isolated areas.

Budget pressures have intensified, as hospitals were forced to curtail non-essential (and revenue-generating) procedures to focus on providing care for COVID patients. This has resulted in a significant financial impact and underscored the need to optimize operations and reduce costs, especially among mid-sized and regional hospitals, which were already facing the prospect of acquisition by larger providers.

The issue of siloed data is a longstanding barrier to optimized healthcare quality and operations.

Comprehensive Range of Offerings

Launched in 2018 as the U.S. subsidiary of America Movil, a leading international provider of integrated telecommunications services, CES is positioned to address the challenges of today’s healthcare landscape. Leveraging a robust partner ecosystem, the company has developed a “Right-Sized Technology Integration” model that scales up from a granular level to deliver enterprise-level, end-to-end solutions to businesses of any size.

A comprehensive portfolio of offerings features Managed Network Services, Cloud Services, Cybersecurity, and Digital Business Services, which comprise capabilities around IoT and AI (including RLTS), collaboration, Extended Reality, and end-user services. In addition, CES focuses on aligning its offerings to specific industry requirements, including those of healthcare. “We’re committed to delivering tailored solutions that address the specific requirements of a customer,” says Jorge Rodriguez, President and CEO. “Achieving that objective means we need insight into the customer’s strategic priorities, objectives and pain points. That, in turn, requires industry expertise across different sectors.”

CES’ Managed Network Services capabilities, for example, are ideally suited to healthcare requirements around rapid and flexible deployment, high-bandwidth performance and transparency and oversight, as well as the modernization of obsolete legacy technology. This functionality enhances patient access to care portals and facilitates collaboration between care team members in different locations. In addition, high-bandwidth connectivity supports the burgeoning use of wearable devices, as captured patient information needs to be immediately accessible to healthcare providers for analysis.

Network connectivity is also essential to connecting the disparate dots in the healthcare delivery value chain. “The issue of siloed data is a longstanding barrier to optimized healthcare quality and operations,” says Rodriguez. “Seamless sharing of patient care and financial data between different insurers, providers, and facilities requires a transformational approach that leverages technology, process improvement, and a design thinking mindset.”

Security is obviously a critical priority for healthcare providers, and CES solutions address both traditional firewall environments as well as virtual software-defined perimeters. End user training and awareness programs keep employees alert to continually evolving cyber risks. Such initiatives are especially important for remote workers who are managing HIPAA data from their home offices, and who are a prime target of phishing attacks. 

Quality Customer and User Experiences

CES’ Digital Business Services capabilities focus on enhancing collaboration and customer and user experiences. That focus is exemplified through a recent CES partnership with Talkdesk, a leading contact center technology provider, to deliver a solution designed specifically for healthcare providers. When COVID-19 vaccines first became available, healthcare provider contact centers were inundated with inquiries from anxious consumers seeking information on vaccine options, availabilities, and scheduling. Talkdesk’s vaccine administration solution is designed to manage extremely high call volumes, simplify scheduling and proactively engage with recipients and address basic vaccine questions and concerns.

As a value-added reseller, CES enables easy integration with out-of-the-box and custom applications in the customer’s environment, along with a wide range of advanced functionalities such as workforce and quality management and compliance with industry standards.

Focusing on Problems, Delivering Results

Doctors, nurses, and administrators increasingly rely on mobile devices to communicate, collaborate, and deliver care. And because different roles within healthcare require different levels of mobile functionality, tools and capabilities must correspond to individual responsibilities. CES’ Workspace Services – a component of the Digital Business Services suite – include mobile device management capabilities that align different levels of mobile functionality and security to different user personas. This ensures that every employee has the functionality they need to do their job, while avoiding situations where the hospital or provider pays licensing and maintenance fees for software that sits idle.

Adaptability and acceptability, meanwhile, are critical. Healthcare workers – particularly physicians – can be notoriously technology-averse, and many innovative and expensive tools gather dust in hospital storage closets. As such, innovations must be aligned with existing practices and processes, and the design and development process must focus on the user experience as a starting point.

“Technology solutions have to deliver results and solve problems,” says Rodriguez. “That requires working with customers to understand how they operate, and then applying the right tools to drive positive outcomes. In the case of healthcare, that means improving the quality of care and the efficiency of operations.”

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At the nexus of Healthcare and Technology emerges solutions aimed to improve patient outcomes and satisfaction, while making the jobs of clinicians safer and more effective. The primary driver of these solutions is to address industry-specific challenges faced by these populations. One such solution at the convergence of Health and Tech that is beginning to show signs of maturity is Telehealth—the remote delivery of healthcare services over an audio and visual telecommunications platform.

We are experiencing an exciting time for Health Tech, as a whole. We are seeing climbing rates of adoption of digital health tools among consumers, including wearables and Telehealth applications. New players are emerging in the healthcare industry leveraging technology to bring new delivery models to consumers. State and Federal legislators are discussing ways to reduce barriers to Health Tech innovation, while encouraging industry leaders and new players to look toward solutions like Telehealth, as the new norm.

From a technological viability standpoint, we are more capable of delivering Telehealth effectively in multiple healthcare settings than ever before. I serve as Chief Information Officer for Consulate Health Care, a national leading provider of senior healthcare services. Our talented team of Health Tech pros and vendor partners are currently implementing Telehealth in a controlled test group of our Skilled Nursing Facilities.

Telehealth platform integration with legacy e-health record systems and single application sign-on capabilities helps to streamline utilization by cutting down on the amount of time it takes for clinicians to become familiar with new technology platforms.

We are seeing the industry’s most advanced wireless internet networks provide seamless, two-way interaction through high-resolution cameras and crisp, clear VOIP communication. We are integrating our Telehealth platforms with electronic patient recordkeeping systems to send and receive information quickly and securely, while allowing Telehealth clinicians to monitor the status of patients in real-time. In other words, the technology needed for effective Telehealth platforms already exists.

While technological capability is an essential element to industry-wide adoption, it is not the only element. The healthcare industry at large has a significant amount of work to do as it relates to policy making, security, education and talent development, as well as overall trust and adoption among patients and clinicians.

These barriers are similar to circumstances occurring in other emerging technology trends, such as Future Mobility or Blockchain—where the technology fueling these trends already meets or exceeds the needs of the consumer, but overall adoption remains moderate at best due to a lack of governance and policy, infrastructure, security and overall consumer trust.

Healthcare providers looking to offer Telehealth solutions to their patients must treat training and development with the same regard as tech implementation. At Consulate, we view this as a culture-changing initiative to meet and exceed the needs of our patients, while improving the employee experience and work-life balance of our clinicians and physician partners.

Let’s face it—in today’s healthcare environment, clinicians are busy—making tech implementation and culture-change challenging, at any scale. This reality constitutes the “make it easy” approach essential to successful team implementation. Telehealth platform integration with legacy e-health record systems and single application sign-on capabilities helps to streamline utilization by cutting down on the amount of time it takes for clinicians to become familiar with new technology platforms.

Another barrier to address is onsite and remote physician team integration. While Telehealth physicians engage patients remotely through an audio/visual platform, at its core, the technology introduces new groups of physicians to existing clinician teams. Onsite care teams and Telehealth clinicians have to learn how to effectively trust each other and work together to leverage the platform’s full capacity.

While it is up to the individual clinician to be adaptive and open-minded when it comes to learning, and actually using new patient care technology platforms, it is the responsibility of provider organizations to ensure their care teams have the knowledge, resources, infrastructure and accountability measures in place to ensure platforms like Telehealth are utilized to their fullest capacity.

Part of training and education is helping onsite and remote clinicians, as well as ancillary staff understand the evolving administration and payer management ecosystem. On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a rule that updated the Medicare Advantage program by allowing plans to include “additional telehealth benefits” as part of Medicare basic benefits starting in 2020. The plan requires that providers comply with applicable licensing requirements and laws for the state in which the patient is located and receiving care. This is important for care teams to know and comfortably communicate to support staff and consumers, as Telehealth become a more widely-adopted resource.

As we have seen in the past, integration and culture-change initiatives will converge to promote Telehealth as a trusted resource among care teams, over time. This trust will extend to the patient community, as care teams demonstrate familiarity and ease of access. Additionally, increased accessibility to physician-led care helps to ensure quality outcomes and patient satisfaction—helping consumers become more comfortable and accepting, or trusting, of Telehealth. Consulate’s Skilled Nursing Facilities with Telehealth offerings are already showing decreases in un-necessary patient readmissions to hospitals and emergency rooms visits due to extended access to physician-led care.

As trust builds between onsite practitioners and remote physicians, care teams will have more resources to treat patients, helping to cover patient care needs over long periods of time and shift changes—aiding to offset physician burnout through a balanced, team-oriented approach to quality care.

As the technology continues to develop and converge with consumer electronic mobile devices, future applications of Telehealth show signs of increased scalability and utilization among patients and clinicians—bringing its value to more hospitals, long term care and skilled nursing facilities, as well as assisted living and home care environments. Tech integration working in congruence with team implementation will bring Telehealth into more health care delivery models faster, helping more patients and communities benefit from its power.

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When I was a kid, I was convinced that we would be beaming up as Scotty had shown us, instead of flying or driving. I was also certain that we would be using a Tricorder for diagnosis and treatment. For non-Star Trek Geeks, a tricorder was a multifunction hand-held device useful for data sensing, analysis, and recording, with many specialized abilities which made it an asset to crews aboard starships and space stations as well as on away missions. With the explosion of technology in health care, especially with wearables, we are so close to the tricorder becoming reality. Today, one can get in touch with one’s doctor by clicking a button on a phone; apps and platforms regularly augment and facilitate health care decisions. Diagnosing heart rhythm abnormalities like atrial fibrillation or sleep apnea using wearable or managing diabetes using patient-generated data does not even raise an eyebrow.

During this last decade, the near-universal adoption of electronic health records (EHRs) provides us a unique opportunity to study diseases and develop new epidemiological models of disease control and prevention. Wearable technology and artificial intelligence: the new frontiers have the promise of combining data collected within EHRs and patient-generated data especially patient-reported outcome measures (PROMs) and truly impacting the practice of medicine.

As we enter 2019, access to smart technology continues to increase. An estimated 90% of American adults have access to a cell phone or have a family member or friend who has one. 64% of American adults have a smartphone. One in six (15%) consumers in the United States currently uses wearable technology, including smartwatches or fitness bands. With the smartphone revolution, an increasingly powerful new set of tools are being available to patients and physicians: phone attachments that can diagnose an ear infection or track heart rhythms, promote weight loss, predict falls and improve quality of life and safety amongst patients with movement disorders via sensors in their clothing, to apps that can monitor and possibly treat mental health. These tools have the ability to reduce our use of doctors, cut costs, speed up the pace of diagnosis and give more power to patients. Imagine if we could eliminate the need for patients to sleep in a lab overnight to diagnose and treat sleep apnea, or were able to titrate insulin doses for all our patients using smart devices.

The challenge facing physicians, medical educators, patients, developers, and system leaders is how to convert thousands, even millions of data points of information into knowledge.

I regularly invite my patients, in my practice, to use wearables and apps to monitor their diseases and symptoms, with the caveat that they are not validated and current evidence requires me to verify findings by applying the standard tests. Over the years, I have seen a significant activation of my patients and the ability for shared decision making and improved compliance. The proliferation of smart devices brings the opportunity to revolutionize and augment the practice of medicine.

The success and proliferation of the wearable market and the adoption is however, significantly hampered by the payment structure of the healthcare industry. Currently, most wearables are still in ‘test or pilot’ stages and are currently directly marketed to patients as wellness products. Some barriers in adoption include a lack of studies on validity and reliability compared to standard tests. The good news is that many companies are testing these products and FDA approvals for wearables continues to increase.

There is a paucity of information and a clear pathway for the dissemination of information to physicians regarding the efficacy of the technology. There is a significant need for education of physicians and other clinicians about innovative technologies and the impact on diagnosis and treatment. Traditional venues and modalities of learning used by physicians: continuing education events, journal articles and journal clubs and conferences have a remarkable paucity of information that is readily available for physicians. I have yet to see a standard “Updates in Technology” section as a standing agenda item on a medical conference agenda.

Another barrier towards ready adoption of technology is general fatigue and apathy felt by the clinicians towards new technology. EHRs have contributed significantly to the burnout epidemic within healthcare. The lack of usability of the EHRs and data platforms, need for multiple sign-ons and inability of patient portals to be truly useful prevents the conversion of data from these diverse sources into actionable information or knowledge. As a result, there is a trend amongst developers of bypassing front line physicians and clinicians with the hope of luring systems or insurers into adopting this technology. The problem with this approach is that the front line clinicians are still needed to act on these data sets, given the current health care delivery system. Our current system does not reimburse clinicians for time spent on innovation and the use on non-patient facing encounters. Medicare has provided a glimmer of hope with some of the new payment codes for chronic care management announced in 2018.

The challenge facing physicians, medical educators, patients, developers, and system leaders is how to convert thousands, even millions of data points of information into knowledge. The health care technology revolution especially with wearable technology, coupled with the use of artificial intelligence and machine learning, is here and has great promise, but currently is in its nascency. In order for this technology to live up to its promise, there has to be a significant redesign of our health care system to value innovation and the cognitive effort needed to transform health care.

Innovation and learning labs and genius bars in clinics and hospitals are sprouting all across the country to help act as catalysts to expedite the speed of change. The tricorder (or alternatives) will be ubiquitous soon!

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