Combining the advantages of both mobile health and clinical decision support can achieve improvements in patient-centered care and healthcare organization operations.
In the past decade, the application of healthcare IT (HIT) systems to improve the quality of care, patient outcomes and access to care has grown exponentially. Concurrently, mobile health – defined as the use of wireless technology to deliver healthcare services at a distance – is being leveraged to improve the delivery of care between patients and caregivers. Simultaneously, new broadband wireless technologies such as fourth-generation (4G) long-term evolution (LTE), broad availability of low-cost and versatile wireless devices, use of interoperability specifications (i.e., HITSP and HL7) and improved system user interfaces are dramatically lowering barriers to adoption. Although clearly an exciting time for taking advantage of mobile health, the abundance of new wireless technologies and approaches can be confusing. This article explores an approach that combines the workflow advantages of both mobile health and clinical decision support (CDS) to achieve meaningful improvements in both patient-centered care and healthcare organization (HCO) operations.
Leveraging mobile health with the right technology
One of the most promising areas of mobile health is intelligent wireless networks combined with CDS. Together, these create a real-time, context-rich environment for clinical decision making at the time and point of care. The healthcare delivery system is now realizing that CDS strengthens many value propositions underpinning meaningful use (MU). When the performance of healthcare delivery systems is scrutinized, the coupling of CDS with mobile health is one way to achieve improvements in patient outcomes and care quality while supporting value-based purchasing, pay for performance and accountable care organization (ACO) mandates.
Fortunately, there are an increasing array of CDS and mobile health solutions available. The former are fairly mature in terms of their systems design and architecture (i.e., knowledge- and non-knowledge-based CDS). Similarly, there is a wide variety of standards-based wireless archetypes that an HCO may use so that clinical services are delivered in a secure, private, seamless and transparent manner. For example, a proven industry technology is IEEE 802.11x Wi-Fi. The latest version, 802.11n, provides high capacity and quality-of-service metrics that make it very attractive for localized applications, such as bedside monitoring, real-time location services (RTLS) and patient identification (i.e., RFID). However, the localized nature of Wi-Fi makes scaling and extensibility a challenge. An obvious example is providing seamless and transparent data services beyond the physical coverage area of the Wi-Fi system. Moreover, workflow challenges are introduced when considering that clinicians and patients are mobile beyond the four walls of the HCO.
Transcending Wi-Fi limitations
One way to solve this issue is to use a commercial wireless network consisting of base stations (including small cells) and distributed antenna systems (DAS) technologies. When these are deployed as an overlay to Wi-Fi, HCOs are able to transcend the limitations of Wi-Fi by bridging service to any wireless device, independently of the wireless network (subject to the networking policies and procedures of the HCO). By adding role-based management, a unified wireless solution that is managed by the HCO is achieved to support highly resilient and reliable mobile health CDS operations. That is because in this model, the wireless networks seamlessly transport clinical transactions and other data flows between the HCO’s CDS and/or enterprise service-oriented system.
Fortunately, the commercial wireless industry has developed packet-based mobility gateway (MoGW) solutions that provide role-based management of wireless services, including mobile devices management. These solutions achieve true continuity of connectivity between patients, clinicians and the healthcare enterprise and are transparent to users. Additionally, when artificial neural network (ANN) methods are used for MoGW transport management, data flows between people (patients and clinicians), devices (machine-to-machine biometric sensors) and things (enterprise service-oriented architectures) can be intelligently managed and automated.
Consider the following scenario: It is Saturday evening, and Bob, an elderly patient with a history of congestive heart failure, walks into the emergency department complaining of chest pain. After evaluation by the attending staff, Bob is found to have a mild arrhythmia and is admitted for evaluation and treatment. An RFID wrist bracelet is assigned for identification and tracking purposes, and Bob is also given a mobile heart monitor capable of working with both Wi-Fi and commercial cellular systems. His biometric readings are continuously polled (and logged in the hospital’s electronic medical record or EMR) using the hospital’s Wi-Fi system. Additionally, suitable alerts and triggers are configured in the hospital’s CDS should anything out of the ordinary occur.
The next morning, no episodic events of importance are found, and Bob is discharged with guidelines electronically transferred from the CDS to his smartphone. Bob keeps the mobile heart monitor and leaves the hospital knowing that he is still being monitored. However, his monitoring is now handled through a commercial wireless network. Should a vascular condition re-develop, the CDS is able to alert Bob and the attending physician for interventional care. This reduces the likelihood of a more serious event because interventional care is more timely and immediate. Hence, the probability of an improved patient outcome is achieved. A secondary benefit is the potential for reducing unnecessary re-admissions, helping to reduce costs.
While this example is simplistic, technology exists today to support these mobile health capabilities. However, additional considerations should be weighed before an HCO implements an intelligent wireless network like this, including:
- Costs: Who finances the acquisition and service for such wireless technology systems? Will costs be borne solely by the HCO via service plans, or will they be shared between the HCO and other stakeholders, such as a DAS company or the wireless carrier?
- Maintainability and service-level guarantees: Who will ensure that clinical (i.e., medical-grade) wireless transactions meet minimum availability requirements? What are the agreed-to response times to an HCO when service is interrupted?
- Security and privacy: How will HIPAA compliance be maintained in terms of safeguarding privacy and maintaining security of data transactions across the entire network, particularly given the broad and diverse types of wireless devices available?
A promising future
Implementation and operation of a mobile health solution that combines CDS with intelligent wireless networking offers HCOs several benefits. These include:
- Operations management improvements realized by greater workflow efficiencies, which increase productivity and efficiency of care, thereby lowering the provider costs of care;
- Heightened intervention and access to care, improving HCO compliance to value-based purchasing, pay for performance and similar initiatives (i.e., ACO);
- Knowledge sharing and medical informatics data management, supporting research and use of evidence-based medical practices;
- Real-time care that leverages domain knowledge of a CDS with a clinician’s heuristic knowledge;
- Better patient satisfaction given that access to care is virtual and in real time, with a secondary benefit of lowered patient cost of care since unnecessary travel to an HCO may be obviated;
- Greater HCO differentiation by early solution adopters. For instance, utilization of mobile health with CDS to offer progressive disease management (i.e., intervention); and
- Increased patient safety, outcomes and quality of care via the process improvements provided by mobile health and CDS combinatorial delivery.
Additionally, beyond available grants and incentives via federal programs, initial costs for intelligent wireless networks as well as for CDS systems continue to decrease, while the available pool of solutions providers and integrators is increasing. Given the supply-side challenges of meeting the burgeoning demand for healthcare services that are affordable, equitable, cost effective, timely and accessible, HCOs are well positioned to benefit from implementing this solution.
About the author
Eric Abbott is director of product management at ExteNet Systems Inc. For more on ExteNet Systems, go to www.extenetsystems.com.
