Industry-First Exclusive: Cleveland Clinic Medical Informaticists Share their Perspectives on the mHealth Journey (Part Two)

Nov. 26, 2013
On Nov. 18, Colin Konschak of Divurgent, a healthcare management consulting firm, and David Levin, M.D., CMIO of Cleveland Clinic, and William H. Morris, M.D., director of clinical informatics at Cleveland Clinic, announced the public of their new book, mHealth: Global Opportunities and Challenges. Drs. Levin and Morris spoke exclusive to HCI’s Mark Hagland prior to the book’s release, to share their perspectives on the global mHealth journey. Part two of a two-part series.

On Nov. 18, Colin Konschak of Divurgent, a healthcare management consulting firm, and David Levin, M.D., CMIO of Cleveland Clinic, and William H. Morris, M.D., director of clinical informatics at Cleveland Clinic, announced the public of their new book, mHealth: Global Opportunities and Challenges, published by Convurgent Publishers.

As articulated in a summary online, the authors explain that mHealth: Global Opportunities and Challenges provides the ultimate coverage of all aspects of the burgeoning mobile health arena. It integrates issues around the clinical, policy, and technical aspects of mHealth to highlight the potential this transformative technology holds for healthcare systems throughout the world.”

As the authors further note, readers will “read about what works and what doesn’t’; the barriers to full integration; and the strategies that companies like Aetna, AT&T and Intermountain healthcare employ, as well as organizations like USAID and countries like Zimbabwe, are utilizing.”

Shortly before publication, Drs. Dave Levin and Will Morris spoke exclusively with HCI Editor-in-Chief Mark Hagland regarding their objectives for the book, and their perspectives on where the mHealth phenomenon is headed. Part one of this two-part series was published on Nov. 18 Below are excerpts from part two of the interview. This is the second and final part in this two-part series.

What does the term “pervasive health IT,” as you use it in the book, mean?

David Levin, M.D.: It’s about removing time and space as barriers to effective healthcare. We want to remove bricks and mortar as barriers. Today, people have to [physically] come to the healthcare system. And that’s a barrier. The notion of pervasive computing is actually pretty old. I started by looking at some of the literature in the late 1990s, and it wasn’t a great leap to see how those concepts apply to healthcare. So “pervasive IT” means removing time and space as barriers, virtualizing healthcare, and it’s alive and dynamic, and everything is connected, communicating, and smart.

William H. Morris, M.D.: And “pervasive” also means managing risk well and making prevention effective. And in order to do that, it has to be an omnipresent ecosystem and neural network, or otherwise, you’re just maintaining the status quo.

Levin: Health and wellness expert Dee Eddington has said this: you’ve got to keep the well, well, and prevent the sick from getting sicker. And I think Will is exactly right. I’ve got a little app on my iPhone, and it’s essentially a pedometer, and that’s nice. But you know what’s really cool? It sends me a text message saying, here’s what you did yesterday, and here’s your record for the month. And that does two things for me. First, it guilts me because I did fewer steps yesterday. But more importantly, it makes it sticky. But what’s lacking is the connection to the EMR. That would create a pervasive environment.

Morris: And I have an app for running. It knows what other people are doing as well as you. So your PR for this segment was just broken by this other guy. And we do pedometers. And I would love to see that Will Morris has the record today for steps at 12,000, but Joe Schmoe in environmental services is coming up on you. So that’s a kind of gaming. And we’re actively trying to create things at the Clinic. And gaming around diabetes control is pretty compelling. And the ultimate is actually having it try to drive down your premiums.

What are some of the key things that CIOs and CMIOs should be thinking about right now, with regard to all of this?

Morris: I think that they need to be cognizant that we’re still in a very nascent phase, and they need to galvanize their clinicians and patients to advocate and want the ability to communicate with the other groups of stakeholders. And they need to help put pressure on government and vendors to break down the technology barriers. The barriers are being broken down. And they need to actively prepare for the day when data is liquid and moving around. It’s going to happen; it has to happen.

Levin: And most folks know this is coming. And the reimbursement model is shifting, but it’s shifting in a discontinuous and irregular manner, and depending on what you’re doing, the scenario is an economic win or loss. So start out asking, how do I optimize what I have today? Because typically, we’re finding that people have only gotten part of the juice out of the orange. So are there workflow improvements and new functionalities that involve a smaller investment for a good return?

But that’s not enough, and you’ve got to start making a couple of bets, and they need to be really strategic. Because otherwise, you’re going to be caught flat-footed. I think there will be several discontinuities. So that’s what we’re doing, we’re picking a couple of areas, and we see some of our initiatives as pilots, or the pioneers going out to see what the frontier might look like. And we can tell who those people are, because they’re coming back with arrows in their backs.

Do you think that some healthcare IT leaders are afraid to make mistakes, as they begin moving down this important path?

Levin: Right, some are, but I think that it’s a very dangerous strategy to take a wait-and-see approach to all of this; you’re at high risk for getting run over later. So I think you’ve got to look in your environment for some existing opportunities. I’ll give you two concrete examples. We’re very interested in having patients put their own data into our systems. Now, we’re interested in clinical data and outcomes, but maybe someone more cautious might say, can I have patients schedule themselves? To me, that’s a win under any kind of reimbursement.

And there are some risks in trying to make that work, but there are some clear wins, too. And to take another good example, per clinical activities, and more of an ACO [accountable care organization]-type experience, if you have a self-funded employee plan or large employer you work with, use that as your test bed. That’s an economic environment that looks like the future. So I think that there are some clever ways that allow you to manage risk in an acceptable way.

Where are you both on a scale of optimism to pessimism, with regard to moving forward on the mHealth journey as a healthcare system?

Morris: I’m highly optimistic, highly. I’ve been at the Clinic for seven years, and even a year ago, I look back, and it’s a completely different culture now, with new technology. Vendors are really having hard conversations with us about interoperability. I think it’s past the point of no return in terms of the energy. There’s no longer activation energy, it’s pure work. I’m not naïve about the fact that we have a lot of work to do. And physicians are experiencing what technology is, it’s basically a replication of a paper record and hasn’t transformed practice yet, and we need to transform practice and care delivery. But there’s so much momentum.

Levin: I agree with Will; this is a classic Stockdale Paradox. The Stockdale Paradox involved is that we’ve got to face the facts. This is about disruption of 20 percent of the U.S. economy. And we lack some of the basic standards. You referred to telecom and banking; they got together to create standards, and that’s sorely lacking in healthcare. Yet the other part of this that makes this a Stockdale Paradox, is that we are very optimistic about the future. This is going to happen; there’s simply no plausible alternative to get to where we need to get to.

So there will be a lot of false starts, lots of agony and bodies in the ditches, or roadkill, but we’re going to get there. And we are optimistic. That’s a lot of the reason we wrote the book. We see what you see: we think we’re at an incredible inflection point. I’ve been in this field for 30 years. And for 15 years, I’ve said, it’s going to have to get worse before it gets better. And it’s finally gotten bad enough. So it’ll get better. It’s a lot like a roller coaster: there are thrills and there are chills. But it will happen.

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