The mHealth Symposium in Dublin was an eye-opener for me, as it brought to light the reality that there are some universal challenges in mHealth, but there are also some big wins in mobile integration in countries outside of the US. I believe a lot of the credit needs to be attributed to these countries having national health systems in place, where the health system draws the line and implements the technology. To me, this is very analogous to US hospitals which have had success with EHR systems, i.e., when the leadership draws a line in the sand and states that this is the new way we are doing business and practicing medicine.
One such example is Croatia, located in the heart of Europe on the beautiful Adriatic coast bordering Italy, Slovenia and Hungary. Regarded as an ecotourism hotspot, the nation with an estimated population of 4.4 million is also one of the most digitally integrated countries in the EU.
Similar to the US, chronic disease, obesity and an aging population is taking its toll on the overall health within the European population. Those healthcare demands are driving innovative changes that take advantage of the digital savvy population.
Croatia is unique in that the national health insurance fund is a key driver of the eHealth strategy development and implementation for the entire country as it is considered the most basic, cost-effective tool population health tool. During the mHealth Symposium, the director of the Croatian Institute for Health Insurance, Dr. Siniša Varga, provided some examples of the digital health capabilities the State health insurance fund has established for all nationals:
- ePrescribing – 137,000 prescriptions are issued dailyeReferrals
- 8,483 referrals are issued monthly
- eBooking operations for all hospitals
- eWaiting lists with national interconnectivity for all general practitioners, hospitals, labs and specialists
So, what does the Institute have in the cue for mHealth? Piloting mobile technology with crucial chronic disease areas to include COPD, CHF and diabetes. The Institute is also developing and deploying process changes and implementing mHealth platforms within the national IT system while opening the platform to industry applications and devices. In the words of Dr. Varga, “Health IT is the basis for a chronic disease management program implementation and long term success in optimizing healthcare outcomes. mHealth is a step towards a patients self-care and a technology enabler for new patient-centric healthcare services.”
The University of Pittsburgh Medical Center (UPMC) was also present in Dublin to share their insights on the value of mHealth in bending the cost quality curve of healthcare delivery. You might be wondering why UPMC was in Dublin. Well, it was UPMC Italy, and Dr. Giovanni Vizzini, Department of Medicine - Transplant Hepatology Unit of ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione) who presented “How to deliver high-specialty care at home after liver transplantation: A sustainable approach.” The presentation focused on various remote care implementations including remote monitoring of vital signs, tele-visits (by videoconference to the patient’s home) and educational support for patient/family. The cost quality benefits were impressive – a six day reduction in length of stay for home-monitoring patients and the cost of home monitoring at 7 Euro per patient/day as opposed to the cost of a day in the hospital at 1,000 Euro/day. These numbers are an obvious win!
Come with me now to a place where you can experience the midnight sun and the Northern lights – yes, we are talking on top of the world, about as far north as you can go! Eirik Årsand, PhD, research scientist at University Hospital of North Norway shared his experiences from designing apps for patients with diabetes over a period of more than 10 years. So, what’s so significant here? The user-involvement in the design. After all, the power of mHealth really comes into play when it involves you and me, “the patient”, playing an active role in our own healthcare! Specifics on how to integrate feedback from users into design included:
- Recruiting and involving users early
- Listening to users’ needs and suggestions
- Having open discussions around the possibilities and techniques available
- Utilizing quick prototyping through iterationsTesting in real settings without the fear of modifying the previous design due to test results
- Building on the test results to further improve designs
Mobile technology is becoming the great equalizer, increasing access to care, decreasing costs, improving quality, and engaging the patient as part of the overall solution. Ubiquitous has truly found its home!