Smartphone in Health Care

1.AbstractProviding cost effective and efficient health care is, and remains, one of the most pressing challenges facing our nation. Health care has a long way to catch up with other industries in terms of exploiting the new technologies. From just documenting expenses to tracking consumer behavior from just about anywhere in the U.S., smartphone applications (apps) have changed the way many businesses operate.

Now, more industries are turning to these apps to enhance the way customers interact with their products and services. This paper explores the challenges of developing apps for health care industry and how can different sectors of the health care benefit from it. Keywords: IT, Apps, HIT, EHR, Healthcare Exchange,

2. IntroductionInformation technology(IT) has made its impact in every aspect of our daily lives, all industries are now in some ways benefitting and implementing IT solutions to improve their quality of service.

IT in health care means , “Health information technology (HIT) which means an information system for healthcare is defined as “Health information technology provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers.

Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system” (Chaudhry et al., 2006). Having a health care information system will make the health information easily and securely available to those who require it. HIT is making the health care system more efficient and reduce paperwork for patients and doctors, expand access to affordable care and build a healthier future for the nation.

For example, the Inpatient Computerized Physician Order Entry Systems, Electronic Health Records (EHR),Clinical Decision Support System (CDSS) , etc. have proved how beneficial technology can be for the health industry.(Appendix A) One of the latest technological inventions is that of smart phones, these are cellular phones with smart technology.

The smartphones are loaded with variety of features to explore and exploit, from simple word processor to hi-tech camera and videos to social networking and using diagnostic tools , the possibilities are endless. Smartphones are used for increasing productivity and quality of service in business.

According to a study by ComScore, over 45.5 million people in the United States owned smartphones in 2010 out of 234 million total subscribers and by 2011 , 48% of the subscribers in US and Europe will have an internet ready phone. (CamScore) (Appendix B) Smartphones apps not only help businesses improve productivity but can also improve the way customers interact with the product. With such increasing market, it is only true that using smart phones for offering health care services will reap greater benefits. 3. Apps for Health Care

“Medical informatics and healthcare applications have been devoted to the study and implementation of structures to improve communication, understanding and management of medical information and promote public health.

Their main objective is the extraction, storage and manipulation of data and information and the development of tools and platforms that apply knowledge in the decision-making process, at the time and place that a decision has to be made.” (Bichindaritz, 2010) Healthcare sector comprises of hospitals, physicians, pharmacies and insurance companies and then there are the consumers, the public that makes use of these sectors.

When we look at the information exchange between the consumers and the providers we see that most of it is still done in a traditional way. Developing an app for use in health care industry will revolutionize the way information is exchanged and improve services. We will look at each of the sectors and explore the possibilities and benefits of apps for them.

Hospitals have a big market to cater to but also there is a lot of competition. Healthcare organizations that offer a venue for patients to share their positive experiences and personal stories can send a powerful message to consumers who are determining where to obtain their healthcare services. Many hospitals are now using different IT applications to improve their performance, if they can have applications built for use in smart phones they can provide collaborative and efficient care to the patients.

Apps for hospitals can built for the physicians to access patient information and reports and order blood tests etc. The hospital apps could provide patients with information or reminders on medications and appointments, patients can access their accounts to view the post-discharge instructions.

Guide them to the nearest ER and send them general health related information or provide medical consultation, they can provide tools like those on their websites to pick a doctor and make appointment. Hospitals can collaborate with blogs and RSS Feeds to provide an archive of medical knowledge .Some examples of apps used in hospitals are * Atlantic General Hospital in Maryland is now offering outpatient services as an app: wait times for the ER, walk-in lab work and X-ray services.

* Medtronic’s Lenny the Carb Counting Lion children’s diabetes education app: “It’s great for parents (and even adults with diabetes have enjoyed it too), as the app features a guide presenting nutritious food choices with associated serving sizes and carbohydrate values.

* Toronto’s Mount Sinai Hospital developed VitalHub, an in-house app that gives physicians secure, remote access to patient records, test results, vital statistics, and medical literature from its vast internal data network. Using VitalHub allows Mount Sinai’s clinicians to respond more rapidly to patient needs wherever and whenever they arise. * Vanderbilt Medical Center has an app to help anesthesiologists monitor their patients. Physicians have a huge responsibility towards patients as well as hospitals and clinics they work in.

They are dealing with numerous amounts of data every second, be it for entering their hours in a hospital or clinic, or studying patient’s records and reports or looking for medical information and current research. According to a survey by Skyscape, 88% of physicians report that their smartphone is essential for their clinical practice and 87% say that information from their smart phones is influential in their prescription and treatment decisions. Physicians can use apps to communicate with the hospitals, clinics and their patients in case of an emergency.

There are numerous apps in the market that provide knowledge and data on medical care, some even help in continuing education. Examples of apps for physicians are * Anesthesiology i-pocketcards – This app is a clinical reference guide with a compilation of scores, classification, algorithm and dosage information necessary for the Anesthetics environment. * MedCalc (Medical Calculator) – Free – MedCalc is a free medical calculator that gives you easy access to a wide array of medical formulas and scores. Includes detailed information and bibliographic references for each formula.

* Epocrates is a mobile drug reference resource that provides clinical information on thousands of prescriptions and OTC drug products. It features a pill identifier, in-depth formulary information, a drug interaction checker and dozens of calculations (e.g. BMI, GFR). * The mprodserver Medical Devices app is a revolutionary, first of its kind medical device and imaging reference tool that allows medical practitioners to compare, view and obtain detailed information on any type of medical device. Pharmacies can also make use of smart phones by bringing their marketing strategies right into the consumers hands.

They can send alerts to the patients when the refills are due and also inform them about flu shots clinics. The pharmacy locator available makes it easier for people to find that particular pharmacy whatever city they are in and also help in building their brand. Finding a nearby store can give access to specials in that store, product availability, and get driving directions to that store.

Pharmacists are expected to know everything about every drug, they can use the Epocrates app and keep themselves abreast with all the knowledge of medical care. Each pharmacy can offer their in-store promotions or other discounts codes for consumers to use on their phones. The grocery stores/ super stores that have their own pharmacies can also promote their other products through the pharmacy apps.

* Walgreens app offers the scan prescription feature, where just by scanning the prescription it gets ready for pickup at your choice of Walgreens store. One can look up product availability and browse the weekly ad. * The official CVS/pharmacy iPhone App, helps you find the nearest CVS location – store hours (24 hour stores, Drive Thru, Minute Clinic and other services), Order prescriptions and refills, Transfer prescriptions and view detailed drug information on the go.

Insurance companies have still a long way to go in the market of technology oriented services. Insurance companies can offer their services to the consumers/patients , hospitals and physicians. Offering better rates and comparison of plans, providing tools to manage their health care expenses accounts, giving patients a list of doctors in the network and what hospitals offer services they require.

Customers can make claims and update policy information, they can receive policy renewal alerts to renew their policy or ask for another quote. When they develop app for hospitals and physicians the insurance company can offer quick link to claims and faster authorizations. Insurance companies that have offered apps are * Health Net: Offers Health Net Mobile, an app that provides plan details, including subscriber and plan IDs, effective dates, co-pay and deductible information and schedule of benefits.

Provider search, mobile ID cards and details of providers are also available. * Blue Cross Blue Shield of Florida: Florida Blue mobile app provides members with general health information, tools to manage their own health and details about their benefits. Apart from offering plan /account details the app also offers weather related health alerts such as pollen, air quality and UV levels along with tips for managing asthma and allergy symptoms.

* Humana : My Humana also offers the basic services along with comparison of prices for drugs in different pharmacies and its availability. 4. Barriers for Health Care Apps

Though the use of smart phones for health care is increasing , there are many barriers that will slow the progress of adoption. The biggest concern is that of HIPPA compliance for all health care sectors that want to use the internet as media for communication. The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information.

At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. Using internet as a medium to transfer classified information of patients requires high security checkpoints to adhere with federal guidelines.

Apps should be developed in conjunction of security rules that specify a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information. As the challenges grow, so do the risks. Though there will be more information available but the liability of error also increases. The security of data requires state of the art software and malware installed. Data storage is another big concern for hospitals and physicians, it has been estimated that medical data will double every 18 months.

Data must be stored in a centralized, standardized and structured manner to be able to provide information in a timely manner. Choosing the right app is also a big issue for consumers seeking medical advice. Anyone can make and app and put it up in the app store, it is difficult to distinguish the safe, medically credible apps from the less-safe ones. Apps that are accredited from known institutes or government agencies are most credible. Financing the a

5. ConclusionHIT is the fastest growing industry, and there is a lot of scope for new innovations. Smartphones are taking a prominent place among mobile phones that are used to reach the internet. Medical apps are going to become more consumer centric and a majority of population will be using these apps for some form of medical advice.

As of February 2010, there were nearly 6,000 medical apps within the Apple AppStore. Of these, 73% were intended for use by consumer or patient end-users, while 27% were targeted to health care professionals. The future of smartphones looks very bright and so does the app market that is growing like a teenager.

Appendix A: Estimated Annual Benefits from Inpatient Computerized Physician Order Entry Systems, After Full Adoption

Figure 2

Appendix B: Rise of use of smart phones

Appendix C: Categories of apps used in smart phones

REFERENCESRAND Corporation: “Health Information Technology”, Retrieved on June 20th 2011 from http://www.rand.org/pubs/research_briefs/RB9136/index1.html (Online Publication)

http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch7.pdf http://www.ihealthbeat.org/perspectives/2010/social-media-in-health-care-barriers-and-future-trends.aspx http://blog.nielsen.com/nielsenwire/category/online_mobile

Chaudhry, B. Wang , J., & Wu, S. et al., (2006). Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care, Annals of Internal Medicine, 144(10), 742–752. CamScore : “The 2010 Mobile Year in Review”

Isabelle Bichindaritz, Sachin Vaidya, Ashlesha Jain and Lakhmi C. Jain , 2010 “Computational Intelligence in Healthcare 4: Advanced Methodologies” Page 314 http://www.hhs.gov/ocr/privacy/index.html

California Health Care Foundation “How Smartphones are Changing Health Care” By Jane Sarasohn –Kahn . Retrieved on June 26 2011 from http://www.chcf.org/~/media/Files/PDF/H/PDF%20HowSmartphonesChangingHealthCare.pdf