Care Coordination and Interoperable Health IT Systems Unit 9: Expanding Access with Technology Lecture a – Introduction to Mobile Health Technologies Welcome to Care Coordination and Interoperable Health IT Systems, Unit 9: Expanding Access with Technology. This is lecture a - Introduction to Mobile Health Technologies.   The component, Care Coordination and Interoperable Health IT Systems, is an overview of how interoperable health IT systems are organized to support care coordination services. This unit, Expanding Access with Technology, will cover the topics of mHealth and Telehealth in regards to their use in the coordination of care. This material (Comp 22 Unit 9) was developed by Columbia University and The University of Texas Health Science Center at Houston, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Numbers 90WT0004 and 90WT0006. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Health IT Workforce Curriculum Version 4.0

Expanding Access with Technology Lecture a – Learning Objectives Objective 1: Name and describe three mobile health (mHealth) technologies (Lecture a) Objective 2: Describe a real world scenario in which a mHealth technology is used to achieve better coordination of care (Lecture a) Objective 3: Explain ways in which mHealth data can be used by clinicians (Lecture b) Objective 4: Identify access to telehealth solutions in a variety of settings (Lecture c) Objective 5: Compare models of telehealth systems (Lecture c) Objective 6: Evaluate populations served with telehealth tools and services (Lecture c) The objectives for this Unit: Expanding Access with Technology, Lecture a are to: Name and describe three mobile health (mHealth) technologies. Describe a real world scenario in which a mHealth technology is used to achieve better coordination of care. Health IT Workforce Curriculum Version 4.0

Some Definitions: mHealth Provision of health-related services using mobile telecommunication and multimedia technologies (mHealth Alliance, 2010) Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, and personal digital assistants (PDAs) and other wireless devices (World Health Organization, 2011) This introductory lecture will provide a high-level perspective on the use of mobile health technology to expand access to care for the purposes of care coordination. We will begin by defining the term mobile health or “mhealth.” mHealth is defined as the provision of health-related services using mobile telecommunication and multimedia technologies. This definition is from the mHealth Alliance. The World Health Organization defines mHealth as the medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices. Health IT Workforce Curriculum Version 4.0

mHealth: Additional Definitions Data from mobile apps and sensors To inform health care decisions and / or treatments To drive communication and connect patients and providers Health interventions delivered using mobile technologies: Prevention Treatment Behavior change Synonymous with: Digital health eHealth Telehealth In addition, mHealth may refer to data from mobile apps and sensors. These data can be used to inform health care decisions and/or treatments. These data can also be used to drive communication by connecting patients with their providers. The term mHealth is also used to refer to health interventions delivered using mobile technologies for prevention, treatment or behavior change; all important components in care coordination. Sometimes mHealth is used synonymously with digital health, eHealth and telehealth. Since mHealth is quickly blending into healthcare workflows, it characterizes the patient’s ability to use their mobile devices to access healthcare – whenever and wherever they want it. Since mHealth is ‘blending’ into healthcare workflows, it characterizes the patient’s ability to use their mobile devices to access healthcare – whenever and wherever they want it. Health IT Workforce Curriculum Version 4.0

mHealth Tools Pager Phone Calls Website Video Smartphone Tablet Portal / personal health record (PHR) Email SMS (short message service) messaging Physiological sensors Glucometer Blood pressure cuff Connected devices Bluetooth scale Wearables / trackers Electronic pill boxes The use of mHealth tools has expanded from the basic pager, phone calls, website, video smartphone, tablet, portal or personal health record and email to now more sophisticated forms of mHealth that include communicating via SMS or Short Message Service. SMS is a text messaging service component of phone, Web, or mobile communication systems. SMS can be used to communicate appointment reminders or to facilitate quick correspondence between the patient and the provider. Advanced mHealth also includes the collection of physiological sensor data from glucometers or blood pressure cuffs and the use of connected devices such as a Bluetooth scale or wearables and trackers such as Fitbit. The use of electronic pill boxes with SMS messaging is also a new mHealth development. Although organizations are excited to innovate in this area and deploy many different tools to patients and families, this rapid proliferation of independent mHealth tools presents a challenge in the presentation of a coordinated, patient-centered health IT tool to the patient. This is an important piece to note during the education and training of clinicians and patients. Moving forward, it will be important to integrate data from various devices, tools and applications to enable patients with multiple health issues to manage all of their care under in one place. Health IT Workforce Curriculum Version 4.0

Using Mobile Phones for Health Consumers use Mobile phones in Three ways for Health The mobile web for understanding symptoms, researching available treatments, and learning about a disease Mobile apps for tracking symptoms and for understanding and managing conditions SMS (text messaging) for medication reminders, talking to a healthcare provider and getting a refill With the growing list of devices, it is important to understand the uses for such devices and how they can be leveraged in care coordination activities. Digitas Health found that consumers use mobile phones in three ways for health: one, it is used to access the mobile web for understanding symptoms, researching available treatments and learning about a disease; two, it is used to access mobile applications for tracking symptoms as well as understanding and managing conditions and three, the mobile phone is used for SMS text messaging for medication reminders, talking to a healthcare provider and getting a prescription refill. Digitas also showed that people that use mHealth tools are more engaged in health, more likely to follow medical advice and be more proactive about treatments. Health IT Workforce Curriculum Version 4.0

mHealth Functions Wellness support Communication Health coaching Chronic care management mHealth tools have been developed to support the continuum of health. Tools that support wellness are aimed at tracking food and exercise such as My Fitness Pal and Map my Fitness. Luminosity, Yoga Studio and Calm were developed to support the brain and the mind/body connection. There are also tools to support sleep such as Twilight or Up from Jawbone. In the area of communication, there are a number of messaging tools to communicate health information when it’s needed most and to streamline the patient-provider communication. mHealth tools are used for appointment requests and reminders and to share lab results so that patients can view in a timely fashion. They can also be used to document and communicate personal information such as current health profile and insurance information to avoid mistakes and obtain the most current, up-to-date data. Tools such as Voice and Echo developed by Cipherhealth can record voice communications so that patients and families can review instructions in their own time since generally patients and families receive a lot of information all at once during healthcare visits. Health coaching and telehealth activities can also be accomplished by using mHealth tools. Omada Health and Noom Health have tools that offer the use of a health coach that can monitor patient use and provide real time support and feedback through the application. Teladietician can be used for video nutrition consults from any mobile device. There are also a number of tools to support the management of chronic diseases. Glucose Buddy can be used to monitor glucose levels, exercise and nutritional intake. Noom Health delivers the National Diabetes Prevention Program with a health coach via a mobile application. And the Use Inhalers application supported by the COPD foundation provides instructions on how to use an inhaler. Looking at ways patients are using such mHealth tools will guide the best ways to apply mHealth for care coordination. Health IT Workforce Curriculum Version 4.0

mHealth Potential Benefits 9.1 Figure (Tiase, V., 2016) In the context of care coordination, mHealth tools have the potential be powerful in the enhancement of patient-provider engagement. And while there is little scientific evidence supporting the effectiveness of mHealth, many organizations view it as a way to improve current healthcare services by informing and engaging patients in their healthcare. It is also worth noting that the degree to which mHealth apps will add value to the patient-provider relationship will vary with patient readiness to make behavioral changes and their willingness to communicate with providers. However, in a systematic review done by Aranda-Jan et al, researchers found that in Africa, mHealth projects, in general, demonstrated positive health-related outcomes. Another systematic review by Gagnon et al found that healthcare professionals believe that their relationships with patients are improved with the use of mHealth tools. As more mHealth tools are put to use, it will be important to closely examine the potential intended benefits. Refer to Component 25 for more information on Patient-Provider Communication and Patient Engagement. Refer to Component 25 for more information on Patient-Provider Communication and Patient Engagement. Health IT Workforce Curriculum Version 4.0

Care Coordination Activities Avoid readmissions Schedule follow-up visits Reinforce education Shared decision-making Refill medications Support adherence and compliance The functions and capabilities of mHealth tools offer the opportunity to support a number of care coordination activities: Readmissions may be avoided with enhance communication methods. Patients and families have the ability to send questions to the provider or quickly schedule an outpatient visit which could potentially avoid an unneeded inpatient admission. With the messaging of appointment reminders and the ability to schedule or reschedule electronically, mHealth tools can assist with the scheduling of follow up visits or rescheduling of visits. mHealth tools can provide easy-to-access educational materials which can answer critical questions and assist with shared decision making as well as overall adherence and compliance. mHealth tools can provide an easy way to received medication refills, which can contribute to increase medication compliance. There are many opportunities for mHealth to benefit care coordination activities. Evaluation of such mHealth interventions will be important to fully understand the impact of mHealth tools. Health IT Workforce Curriculum Version 4.0

Patient / provider communication may be enhanced with mHealth tools Unit 9: Expanding Access with Technology Summary – Lecture a – Introduction to Mobile Health Technologies mHealth is the use of mobile apps and digital health tools for health and health care Patient / provider communication may be enhanced with mHealth tools The use of mHealth applications spans the continuum from wellness to illness, but may be useful in the support of care coordination activities This concludes Lecture a, Introduction to Mobile Health Technologies, of Unit 9: Expanding Access with Technology. In summary, mHealth is the use of mobile apps and digital health tools for health and health care. Patient and provider communication may be enhanced with mHealth tools. The use of mHealth applications spans the continuum from wellness to illness but may be useful in the support of care coordination activities. Health IT Workforce Curriculum Version 4.0

Unit 9: Expanding Access with Technology References – Lecture a Azumio Inc. (2012). Glucose Buddy (3.7.0) [Mobile application software]. Retrieved from https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=294754639&mt=8 Calm.com. (2016). Calm: Meditate & relax with guided mindfulness meditation for stress reduction (2.6.3). [Mobile application software] Retrieved from https://itunes.apple.com/us/app/calm-meditate-relax-breathe/id571800810?mt=8 Cipherhealth. (2016). Echo Care Instructions [Computer software]. Retrieved from https://cipherhealth.com/echo/ Cipherhealth. (2016). Voice Follow up Calls [Computer software]. Retrieved from https://cipherhealth.com/voice/ FitBit Inc. (2016). Retrieved from www.fitbit.com Gaiam, Inc. (2016). Yoga Studio (3.2.1) [Mobile application software]. Retrieved from https://itunes.apple.com/us/app/yoga-studio/id567767430?mt=8 Jawbone. (2016). UP by Jawbone (4.17) [Mobile application software]. Retrieved from https://itunes.apple.com/app/apple-store/id916240764?mt=8 Lumos Labs, Inc. (2016). Lumosity Mobile (7.3) [Mobile application software]. Retrieved from https://appsto.re/us/yY9zI.i  MyFitnessPal.com. (2016). Calorie Counter & Diet Tracker by MyFitnessPal (6.17) [Mobile application software]. Retrieved from https://itunes.apple.com/us/app/calorie-counter-diet-tracker/id341232718?mt=8 Noom, Inc. (2016). [Computer software]. Retrieved from www.noom.com No Audio. Health IT Workforce Curriculum Version 4.0

Unit 9: Expanding Access with Technology References – Lecture a (Cont’d – 1) Omada Health Inc. (2016). Prevent [Computer software]. Retrieved from https://omadahealth.com/ Teladietitian Inc. (2016). Retrieved from https://teladietitian.com/ Under Armour. (2016). Map My Fitness – GPS Workout Trainer for Fitness, Step and Activity Tracking (16.4.0) [Mobile application software]. Retrieved from https://itunes.apple.com/us/app/imapmyfitness/id298903147/?mt=8 Urbandroid Team. (2016). Twilight (6.3) [Mobile application software]. Retrieved from https://play.google.com/store/apps/details?id=com.urbandroid.lux&hl=en Aranda-Jan, C. B., Mohutsiwa-Dibe, N., & Loukanova, S. (2014). Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC public health, 14(1), 1. Digitas Health. (2012). The m.Book. Retrieved from http://mdot2012.digitashealth.com/mbook_2012_digitashealth.pdf Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS med, 10(1), e1001362. No Audio. Health IT Workforce Curriculum Version 4.0

Unit 9: Expanding Access with Technology References – Lecture a (Cont’d – 2) Gagnon, M. P., Ngangue, P., Payne-Gagnon, J., & Desmartis, M. (2016). m-Health adoption by healthcare professionals: a systematic review. Journal of the American Medical Informatics Association, 23(1), 212-220. mHealth Alliance. (2010). Economics of eHealth. Retrieved from http://mhealthknowledge.org/resources/economics-ehealth Silva, B. M., Rodrigues, J. J., de la Torre Díez, I., López-Coronado, M., & Saleem, K. (2015). Mobile-health: A review of current state in 2015. Journal of biomedical informatics, 56, 265-272. World Health Organization. (2011). mHealth: New horizons for health through mobile technologies. Retrieved from http://www.who.int/goe/publications/goe_mhealth_web.pdf No Audio. Charts, Tables, and Figures 9.1 Figure: Tiase, V. (2016). mHealth potential benefits. Used with permission. Health IT Workforce Curriculum Version 4.0

Unit 9: Expanding Access with Technology Lecture a – Introduction to Mobile Health Technologies This material was developed by Columbia University and The University of Texas Health Science Center at Houston, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Numbers 90WT0004 and 90WT0006. No Audio. Health IT Workforce Curriculum Version 4.0