Wednesday, February 11, 2009

CyLab MRC Mobile Health Workshop: Microsoft's Oren Rosenbloom on the "Copernican Shift" in Health Care

[Image: Oren Rosenbloom addresses attendees]

CyLab MRC Mobile Health Workshop: Microsoft's Oren Rosenbloom on the "Copernican Shift" in Health Care

"Healthcare is undergoing a Copernican Shift, with the consumer now placed at the center of various healthcare programs," says Oren Rosenbloom, Microsoft's Director of Development for Consumer Health Solutions.

"Technology," he added, "has changed expectations."

Rosenbloom spoke of Microsoft's two product offerings, Amalga, a unified intelligence system for hospitals, and Health Vault, a health patient applications information platform.

As an example, he reported on the Cleveland Clinic Home Monitoring Pilot, a Microsoft HealthVault pilot undertaken in cooperation with the Cleveland Clinic.

This pilot addresses chronic disease management in the areas of diabetes, hypertension and heart failure. The short-term pilot follows multiple diseases in the clinical delivery setting, using multiple at-home devices including glucometers, heart rate monitors, weight scales and blood pressure monitors.

Cleveland Clinic hopes to increase clinician efficiency, improve patient outcomes, and deliver a better experience for patients.

Rosenbloom cited the critical questions the pilot is intended to answer:

Can we empower patients/consumers to take an important role in managing their chronic disease ?
Will patient outcomes improve with better data integrity and compliance?
Can clinician efficiency improve by having more reliable and up-to-date data?
Can we improve the quality of a patient visit and reduce the length of appointment time with more integrated physician and patient involvement in disease treatment?
Can we reduce cost by using "off the shelf" home medical devices and leveraging patient's existing home computer and Internet connection?

The Cleveland Clinic Pilot includes 460 patients with hypertension (utilizing one device), 30 heart failure patients (utilizing 4 devices) and 30 diabetes patients (utilizing 5 devices).

The devices used are digital weight scale, blood pressure reader, blood glucose reader, peak flow meter and pedometer.

Rosenbloom shared some observations on the pilot so far:

Patient age factors into success (e.g., heart failure patients are an average of 65+)
Installing software and devices varies across configurations
Device industrial design is greatly lacking
Data integrity even controlled by patient is an issue (digital signatures and auditing history are needed)

In concluding his presentation, Rosenbloom shared some further observations:

Mobile health and technology is still in its infancy
Business models are still insufficient
There are lots of information systems "data islands"
There is increasing desire for patient involvement
There is no substitute for human interaction

To view, Oren Rosenbloom's presentation, click here.

Q&A on Mobile Health Workshop Themes

What is your vision of how mobile health will improve outcomes, reduce costs and/or improve patient (and provider) experiences?

Oren Rosenbloom, Microsoft: Mobile Health by definition will become a necessary component of all healthcare. Technology has created the expectation that you can take your office with you where ever you go and you can communicate with anyone anywhere at any time. Increasingly family health managers interact with their pediatricians, their personal doctors, and the health and wellness providers of their aging and often remote parents via secure/insecure email and cell phones. Similarly, there is a growing trend of healthcare being provided outside the normal confines of the clinical environment with provider visits to the home, increasingly provided as a benefit to employees as a means of reducing trips to the ER and thereby reducing employer costs. And there is conjecture and increasing evidence that outcomes improve when patients are within the comfort of their own environment surrounded by family and friends. My definition of Mobile Health is one where providers and caregivers can remain in contact with their patients where ever the patient and the provider reside. Improving outcomes and experiences, and reducing costs begins by defining the right users and use cases and applying technology, processes and business solutions where applicable. Lots of examples, including 1) Finding your right provider based on your requirements, ratings, social networks, etc., 2) Online scheduling of doctor visits, 3) Online access to a copy of your medical records, 4) Remote monitoring of patient data that is collected, validated, stored, analyzed and shared with providers and caregivers, 5) Improved patient experiences when entering clinical environments via online pre-registration and post-care discharge information available online.

What are the most pressing business, process, organization, cultural and technical issues in mobile health?

Rosenbloom: There are many pressing issues in mobile health.
This is a partial list --
1. Business models are still insufficient. Limited/no incentive for providers to communicate with patients outside the clinical environment because they are not paid to do so.
2. Mobile technology is still in its relative infancy and may not be reliable for mission critical systems.
3. Mobile connectivity is partial at best, especially in North America.
4. Industrial design for many devices is lacking; examples include limited/no suitable cell phones for the elderly, difficulty in configuring monitoring devices and ensuring they remain functional and communicating accurate data.
5. Disparate information systems housing patient data are data islands even within a given hospital.
6. The human touch is still extremely important. Technology will never be a substitute for it.
7. The healthcare system as a whole is one of the remaining service industries that doesn't recognize the "consumer" (i.e. patient) as the most important entity in the system.

What are the best opportunities for collaborative university research, and what is the role of university research in this area?

Universities have the advantage of having a broader time horizon than businesses. I'd recommend collaborating on scenarios that may not have an immediate or obvious revenue model but could result in a disruptive change in how health and wellness is administered.