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Get Digital Health to Work For You, Not Create Work

  • Digital health and mHealth facilitates collection of relevant data

  • Data silos and “data noise” divert resources to validate and reconcile data

  • Refined and accurate data is needed to eliminate clinical variation and also proactively manage emerging patient risks

  • The effort to improve health data and mHealth impact is international

  • Clinical variation and social determinants of health explain a lot of the “why healthcare costs too much” internationally

  • We are likely 3-5 years away from making mHealth / digital health work for us

Data Silos and Data Noise

The effort to capture individual level health data and related parameters has produced uneven results. Part of the issue is data capture has been design, which has been uncoordinated, overlapping, and in some cases for poly-chronic patients overly complex. Innovators in the mHealth space are getting to the data by creating applications on consumer devices to capture it. Patient uptake has been slow however. Research into lower than expected patient engagement indicates these innovations and programs were developed with minimal market research or engagement of the consumer as to how the innovation would be valued by the consumer, and without considering the integration and data consolidation question down-stream. The result has been the creation of data silos, with multiple reporting requirements for patients that have unclear or non-transparent utility and a “noise effect” within the collected data. This “data noise” mean more time attempting to reconcile and validate data, and less effort associated with shifting utilization to lower intensity sites across the continuum of care and improving outcomes. The lack of a seamless platform and clinical process has also slowed the efforts to impact consumer preferences and patterns of behavior.

Where do we go from here? The number of applications is already large and growing, and their use is increasing. According to the HIMSS survey, hospitals currently use three or more connected health technologies. Insurance companies are also encouraging the use of care management platforms to encourage wellness and measure healthy behaviors. Interoperability concepts among EHR vendors, with the FHIR standards, is becoming the new industry standard. There is hope that care coordination and consumer interface can be more convenient and more highly valued in the emerging healthcare environment. This more

highly valued landscape collects patient centered data through handheld and related channels that lead to care coordination opportunities prior to admission through telehealth and artificial -intelligence related interfaces. Care management programs use this data as a starting point to shift care utilization to less intensive and less costly components of the care continuum with modified workflows and timely analytics/diagnosis. Additional care management and care continuity planning leverage data sharing and transparency platforms that accelerate physician alignment, patient management and knowledge.

A Global Issue

This is an international effort. Organizations like Areta Health in Southern Africa are also addressing the cost and value question through patient engagement and physician alignment. They appear to be investing in care delivery through specialist hospitals with emphasis on primary care and at-home care. They are balancing data collection, trying to optimize patient education and care management, with utilization of appropriate points of care, but not generate huge amounts of " data noise." Recent articles coming out of Areta discuss pilots around heart disease patients during 2018.

Part of the effectiveness of a program like this appear to hinge on engaging patients by giving them what they want, i.e. in a very service-oriented manner offering “concierge technology.” A survey by CareVision, an eHealth company offering aged care solutions to reduce social isolation among aged patients in Australia, must be “lifestyle enhancing…, [allow patients to] remain independent, stay informed or up to date, provide entertainment and [provide] increased social connectedness…” One example of this in the US is the Allure Group nursing homes in New York who are using OmniVR virtual reality. The goal of “aging in place” in one’s own home is an example of a shift to lower intensity and less expensive sites of care, but relies on a priori knowledge of the home conditions and associated environment that impacts the effectiveness of the patient’s care.

3-5 Years to Go

The effort to reduce costs through lessened clinical variation and increased patient engagement through HIMSS termed connected health technology (mHealth) is an ongoing and international effort. It will take time to address the data analysis and clinical management skills that may not be present in today’s organizations. Education and training will be critical, as will continued efforts to move restrictive legislation and regulations that impair data sharing and create gaps in liability management and risk awareness across a care continuum. As such, we are likely 3-5 years from realizing the vision of a connected mHealth platform that interfaces with individuals and physicians seamlessly, and also generates value-added insights that impact care delivery across the care continuum, including other services like physical therapy and nutrition

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