Deloitte Report Mobile PHR (mPHR)

8/6/2019 Deloitte Report Mobile PHR (mPHR)

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The Mobile Personal Health Record:Technology-enabled self-careForeword

Engaging consumers to live healthier lives and adhere toevidence-based treatment plans using technologies thatenhance self-care is central to controlling costs in the U.S.health care system. Realizing this goal entails leveragingfamiliar technology with incentives for consumers andproviders to manage preventive, chronic and post-acutecare. The personal health record embedded in mobilecommunication devices – mPHR – is the “killer app” thatmay change the game for providers, consumers and payers.

In this issue brief, we offer a perspective on the convergenceof personal health records and mobile communicationdevices, and examine the barriers and opportunities toaccelerate their use by health care industry stakeholders.

Paul H. Keckley, Ph.D.Executive DirectorDeloitte Center for Health Solutions

The case for convergence: PHRs and MCDs

The U.S. health care system in the coming years will beincreasingly challenged to manage and reduce costs. In 2010,health care is expected to account for 17 percent of the U.S.gross domestic product (GDP); it is anticipated to increaseat two percent above the economy’s growth rate. 1 Treatingchronic disease accounts for more than 70 percent ($1.7trillion) of the total $2.4 trillion in U.S. health care spending.2,3

Technology can help consumers – particularly thosewith chronic conditions – monitor and manage theircare to improve outcomes and decrease costs. Mobilecommunication devices (MCDs) such as cell phones,smartphones and other mobile tablet PCs are relativelyinexpensive, portable technologies that can collectenvironmental and patient-entered information andtransmit it via the Internet to a personal health record(PHR). Combined with actionable decision support, theMCD-PHR combination, or “mPHR,” can analyze aggregatedata to activate mobile, patient-speci c output such asmedication reminders, healthy habit tips and medical billreminders. Consumers who access such information anddecision prompts from a portable communication device inan outpatient setting can make informed health decisionsusing fewer health system resources. Consider:

• Twice as many Gen X and Y consumers want to access andmaintain their PHRs using a mobile device than do BabyBoomers and Seniors – indicating that younger generationsare more likely to manage their health using MCDs.4

• Fifty percent of consumers want a personal monitoringdevice to alert and guide them to make improvements

in their health or treat a condition.5

• Approximately six out of ten consumers (57 percent)want to access an online PHR connected to theirdoctor’s of ce.6

Produced by the Deloitte Center for Health Solutions

Issue Brief:

1 “Health Spending Projections Through 2019: The Recession’s Impact Continues,”Health Affairs ,February 4, 2010.

2 Financial and Health Burdens of Chronic Conditions Grow, Tracking Report No.24, Center forStudying Health System Change, April 2009.

3 “Healthcare Spending Increase to Set Record in 2009,” Health Affairs , February 24, 2009.4 2010 Survey of Health Care Consumers: Key Findings, Strategic Implications, Deloitte Center

for Health Solutions, May 2010.5 Ibid6 Ibid


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Although mPHR systems are in early-stage development,pilot projects demonstrate their potential to improveoutcomes and reduce health system utilization. For example,at the Cleveland Clinic, diabetic and hypertensive patientswho used smartphones to transmit vitals to their PHRreduced their number of doctor’s of ce visits as compared topatients who did not track readings. 7 Austrian investigatorsfound that congestive heart failure (CHF) patients, whotypically require extensive hospitalization, had fewer andshorter hospital stays when they used an mPHR system totransmit vitals, medication information and health status totheir physicians.8 Similarly, researchers at Kaiser Permanentein Colorado discovered that 58 percent of hypertensionpatients using mPHRs lowered their blood pressure tohealthy levels within six months, compared to 38 percentreceiving conventional treatment. 9

Four major barriers

Despite these promising pilots, widespread application ofmPHRs faces four major barriers:

• To maximize utility as a monitoring/care managementtool, mPHRs must integrate relevant patient data acrosssites of care to provide an appropriate set of prompts,alerts and reminders that align with evidence-basedself-care. Ideally, the mPHR will also tap data from theconsumer’s health insurance plan to provide real-time,localized information about treatment option costs (e.g.,diagnostic tests, therapeutics) to direct consumers towardappropriate, lower-cost options. Currently, no widelyaccepted, single technical standard among both PHRsand electronic health records (EHRs) exists, limiting theusefulness of mPHRs to integrate data and movementthrough different care providers. 10 Furthermore, onlyone-third of doctor’s of ces use a basic EHR, furtherlimiting both integration and portability. 11Glossary of Key Terms

Personal Health Record (PHR) – An electronicresource storing health data maintained in a secureand private environment by the consumer.

Mobile Communication Device (MCD) – A cellulartelephone with built-in applications and Internet access.

mPHR – Term for mobile PHR systems that utilizeMCDs to access one’s PHR.

Electronic Health Record (EHR) – An electronic

record providing consumer health informationmanaged by the provider.

Fifty percent of consumers want a personalmonitoring device to alert and guide themto make improvements in their health ortreat a condition.

7 Boutros R, M.D., Lazuta G, Harris CM, M.D., et al.Case Study Conducted by the Cleveland Clinic and Microsoft Corporation Using Technology to Manage Chronic Disease, HIMSS, March2010.

8 Scherr D, Kastner P, Kollmann, A, Hallas A, et al.Effect of Home-Based Telemonitoring Using Mobile Phone Technology on the Outcome of Heart Failure Patients After an Episode of AcuteDecompensation: Randomized Controlled Trial. J Med Internet Res 2009, 11(3): e34.

9 “Findings of Home-Based Monitors and Online Coordination,” American Heart Association’s 11th Scienti c Forum on Quality of Care and Outcomes Research in Cardiovascular Disease andStroke, Kaiser Permanente Colorado, May 2010.

10 Heubusch, K. "IT Standards for PHRs: Are PHRs Ready for Standards? Are Standards Ready for PHRs?" Journal of AHIMA, 79, no.6 (June 2008): 31-36.11 “Physician Of ce Usage of Electronic Healthcare Records Software,” SK&A, A Cegedim Company, February 2010.



• Consumer demand for PHR-accessible data is not yetstrong. Only 10 percent of American adults currentlyuse a PHR;12 when polled, 61 percent of Americanssaid they do not believe they need a PHR, potentiallybecause they do not see the bene t. 13 However, severalstudies suggest that patients do better when they tracktheir condition on a PHR. For example, a CaliforniaHealthcare Foundation study revealed that PHR users feltthey had a better understanding of their care; 14 morethan 50 percent of these consumers believed they knewmore about their condition and their treatment; 15 and40 percent believed that it led them to ask their doctora question they may not have asked before. 16 PHRs alsoincreased these consumers’ association with their healthcare providers, particularly low-income consumers, whobelieved they were more connected to their doctor. 17

• While privacy is still a concern, consumer sentiment isslowly changing. Once consumers start using a PHR, fearsabout privacy and con dentiality noticeably diminish.18

• Providers have historically voiced concern over liabilityand data integrity of PHRs.19 Today, more providers areoffering pre-populated PHRs to their patients to viewtheir medical history, access test results, email theirphysicians, re ll prescriptions, schedule clinical visitsand keep track of personal data such as diet, sleep andexercise. The barrier for providers lies in making thelegal medical record distinct from the patient-entered

data, both technically and operationally. 20

12 2010 Survey of Health Care Consumers: Key Findings, Strategic Implications, Deloitte Center for Health Solutions, May 2010.13 “Consumers and Health Information Technology: A National Survey,” California Healthcare Foundation, April 2010.14 Ibid15 Ibid16 Ibid17 Ibid18 Ibid19 Robeznieks, A. “PHR Data Overload, Legal Liability Concern Docs,”Modern Healthcare, May 21, 2007.20 Fahrenholz, CG, Buck, SL. “PHRs and Physician Practices,” Journal of AHIMA, 78, no.4 (April 2007): 71-75.



Five accelerators

Five accelerators position mPHRs as the self-caremanagement platform of the future (Figure 1):

Figure 1: mPHR Accelerators

Trend Description Impact

Greater EHRadoption byhospitals, physiciansand allied healthproviders

• Federal and state government-created incentives suchas the HITECH Act and the American Recovery andReinvestment Act of 2009 (ARRA) are incentivizingproviders to adopt health IT. 21

• Due to the HITECH Act, more physicians are expectedto adopt EHRs over the next ve years.

• Capital provided under the stimulus act slightlyobviates the monetary constraint to install an EHR.

• Adoption could improve information exchangebetween an EHR and PHR.

• Adoption could enable a consumer to access

longitudinal medical data across the consumer’shealth experiences.

Increasingregulatoryclarity aroundstandardizationof health records,privacy protectionsand provider liability

• The Continuity of Care Document (CCD) standard,which exchanges basic patient care information(demographics, medications, allergies, labs,immunizations, etc.), is gaining recognition amongfederal agencies.22

• Third-party personal health platforms, such as Microsoft’sHealth Vault and Google Health, are developing auniversal PHR format.23 Due to these companies’ sizeand in uence, they are attracting notable partners andincreasing acceptance of this format.

• Regulators are nearing privacy and security standardsto better de ne ways for consumers to control theirhealth information. 24

• Government agencies might prefer CCD-complianthealth IT tools, thus increasing the format’s adoption.

• Consumers could download their provider data intotheir mPHR system.

• Consumers would not be tied to a provider- orpayer-supplied PHR.

• Consumers would have access to their informationand de ne with whom (providers, family members,etc.) to share it.

• As pilot programs illustrate mPHRs’ usefulness viaimproved outcomes, providers’ liability concernsmight lessen.

• Efforts enhancing provider-consumer connectivity(without exposing providers to liability), wouldmost likely be led by the Center for Medicare andMedicaid Innovation.25

© 2010 Deloitte Development LLC. All rights reserved.

continues on next page

21 H.R. 1 – 111 th Congress: American Recovery and Reinvestment Act of 2009. (2009).22 Heubusch, K. “IT Standards for PHRs: Are PHRs Ready for Standards? Are Standards Ready for PHRs?” Journal of AHIMA, 79, no.6 (June 2008): 31-36.23 Google.com and Microsoft.com.24 Heubusch, K. “IT Standards for PHRs: Are PHRs Ready for Standards? Are Standards Ready for PHRs?” Journal of AHIMA, 79, no.6 (June 2008): 31-36.25 H.R. 3590 – 111 th Congress: Patient Protection and Affordable Care Act. (2010), Section 3201.



Figure 1: mPHR Accelerators

Trend Description Impact

Increasing MCDcapacity andfunctionality

• 1 GHz processors (like those in home PCs) arereplacing the typical 500 or 600 MHz processors inmost MCDs.26

• Sensors that can detect and analyze the user’senvironment will soon be embedded in most MCDs. 27

• The emergence of ultra-compact processors thatboost performance while drawing less battery powerfurther enhance the functional capabilities.

• Mobile Internet data speeds are improving astelecommunication providers are piloting new wirelessnetworks with mobile data speeds comparable tohome or work networks. 28

• Larger processors could enable mPHRs to support ever-more complex data input from medical devices, furtherintegrating mPHRs into patient care.

• Sensory capabilities could transform the MCD froma transmission solution between the medical deviceand PHR to a direct medical device, supporting itsincreased applicability in care management.

• Faster data transmission could enable mPHRs to bea real-time monitor of consumer health status andprovide timely alerts to and from the doctor.

Decreasing cost ofMCDs (scalability)in tandem withpayer incentivesfor their use

• The original iPhone cost $599 at its 2007 launch;market saturation is driving device costs down. 29

• Price points for service plans are likely to beembedded in insurance premiums and offset byimproved consumer adherence (lower health costs).

• 45 million people in the U.S. have a smartphone. 30 Smartphone sales in 2009 increased year over year by27 percent, making it the fastest-growing segment ofthe mobile devices market. 31

• Bio-monitoring devices are currently provided at nocost by some health plans and employers. MCDs couldbe a cost-effective alternative. 32

• Care management organizations might provide MCDsat no cost to consumers for targeted disease-speci cpopulations.

Increasingconsumerism inhealth care

• As health care costs rise, employers are likely tocontinue to shift costs to their employees. Forexample, the average premium for a family healthinsurance plan purchased through an employerdoubled between 2000 and 2009. 33

• One-third of employers are reducing costs byincentivizing employee tness, wellness and diseasemanagement initiatives.34

• The Patient Protection and Affordable Care Act of2010 (PPACA) is likely to incentivize consumers whoparticipate in wellness and preventive care.35

• On-demand, transactional mPHR applications, such asco-pay and formulary reminders, would help consumersmake cost-effective choices at the point of care.

• Integrating wellness and disease managementapplications on MCDs may show incremental nancialbene t to those who use mPHRs to manage theirhealth and health care costs.

© 2010 Deloitte Development LLC. All rights reserved.

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26 Miller, M. “Smartphone Processors Getting Smarter,” PCmag.com, February 22, 2010.27 Brandon, J. “The Future of Smartphones: 2010-2015 and Beyond,” Digitaltrends.com, February 16, 2010.28 Zibreg, C. News release: “AT&T doubling 3G data speed to 14.4MBps for 250 million Americans by the year’s end,” Geek.com, May 17, 2010.29 Walmart.com, May 24, 2010.30 February Market Share Report, ComScore, April 5, 201031 “Competitive Landscape: Mobile Devices, Worldwide, 2Q09,” Gartner, August 2009.32 Deloitte interviews with select Fortune 500 companies, 2009-2010.32 2010 Top Five Total Rewards Priorities Survey, Deloitte Research, February 22, 2010.34 Ibid35 H.R. 3590 – 111 th Congress: Patient Protection and Affordable Care Act. (2010).



Immediate opportunities

The mPHR has immediate utility in several areas wheremanaging prevalent health problems currently show

suboptimal results. Examples include:

• Obesity: Microsoft is piloting the MyLife for WindowsMobile Phones application, which leverages integratedMCD cameras, accelerometers and microphones toinput a user’s physical activity to Microsoft’s PHRHealth Vault.36 “The dream,” according to Eric Chang,Microsoft’s director of technology strategy for Asia,“is that a user could photograph each meal with theirphone, and have the application return data such ascaloric content, food group and allergy informationfor each item.”37 In the future, consumers could use anMCD with integrated biosensors to longitudinally trackactivity and align them to diet and exercise goals in theirmPHR. Also, with greater Internet operability, consumerscould share data with their social network to gain peersupport, advice and motivation.

• Post-acute care: At some point, patients with anmPHR might be discharged from a hospital soonerthan before because of an enhanced ability to monitorprogress without being in the hospital. For instance,Kiwok combines a smartphone, decision supportsoftware and an electrocardiogram (ECG) sensor tomonitor non-hospitalized chronically ill CHF patients.38 The product detects when patients may bene t fromchanging diet, increasing exercise, decreasing stressor changing medications. It alerts the medical team ofabnormal readings and recommended changes to theconsumer’s treatment regime.

• Home care: In the future, patients may be able toavoid or delay moving to nursing home and long-termcare (LTC) facilities by using an mPHR. For example,Control4 and CloseBy Network together offer a solutionthat combines sensor technology embedded in thehome to monitor the elderly and alert caregivers anddoctors to changes in status via their cell phones. 39 They can receive instant alerts via email or text whenspeci ed sensors are triggered or if normal behavioralpatterns change. Patient health information also can becollected and imported to a PHR.

• Asthma: As MCDs continue to integrate environmentalsensors, they could measure an asthmatic patient’simmediate surroundings for triggers such as smog,pollen or other allergens and use an mPHR to issue

alerts.40

It is also possible to link the mPHR to devicesthat monitor the patient’s respiratory metrics, creatingalerts when the condition is sub-acute.

• Diabetes: Dexcom uses a biosensor inserted into theskin to continuously monitor blood sugar levels andtransmit that data to an MCD, which distributes it tothe mPHR and the provider’s EHR. The medical teamcan then adjust insulin doses accordingly. If readingsdrop too low, the device sends an alert to the user’sand provider’s cell phones.41

At some point, patients with an mPHR mightbe discharged from a hospital sooner than beforebecause of an enhanced ability to monitorprogress without being in the hospital.

36 MyLife for Windows Mobile Phones, Microsoft Research, Microsoft.com.37 Fletcher, O. “Microsoft e-Health Research Taps Xbox, Mobile Phones,”PC World, February 8, 2010.38 “Cool Vendors in Healthcare Providers, 2009,” Gartner, Industry Research ID Number: G00166283.39 Montgomery, L. “New Health Technology Lets Elderly Stay at Home,”Electronic House, February 25, 2010.40 “Cool Vendors in Healthcare Providers, 2009,” Gartner, Industry Research ID Number: G00166283.41 Mendosa, D. The Dexcom Continuous Sensor, DiabetesHealth.com, September 1, 2006.



Looking ahead

The mPHR shows great promise as an optimal platform forengaging consumers in self-care. The mPHR enables health

management programs for conditions across the continuumthrough monitoring, real time decision support, educationand the collection of aggregate data for trend analysis.The impacts and implications for stakeholders are clear:

• For consumers: Better care and lower costs via accessto real-time information that is useful in “teachablemoments” when diagnostic and therapeutic decisionsare made. These therapeutic interventions create aninterdisciplinary care environment that directly involvesthe patient.

• For hospitals and physicians: A mechanismto coach consumers to make better judgmentsabout their care and to align provider incentiveswith optimal patient outcomes. mPHR is likely tobe a key component supporting accountable careorganizations and medical home initiatives.

• For life sciences companies: A platform fordemonstrating value (ef cacy and effectiveness) oftherapeutics and diagnostics within the context of aninformed consumer population. If consumers agreedto share information, the consumer-reported databaseunlocks potential for manufacturers to learn moreabout product use.

• For health plans: Lower costs associated with feweradmissions and emergency room visits, avoidabledrug-drug interactions, avoidable over-use of medicationsand increased use of self-care/over-the-countertherapeutics in treating common chronic conditions.Health plans will have a new platform to fully enablehealth and disease management programs.

With growing recognition among policy makers, healthplans and providers that the key to reduced health carecosts and improved population-based outcomes is moreeffective consumer self-care, the mPHR is positioned as anatural progression of technological capabilities to helpachieve this desired future state.



Authors

Paul H. Keckley, PhDExecutive Director

Deloitte Center for Health [email protected]

Bianca ChungManagerDeloitte Consulting [email protected]

Contributors

Michelle Hoffmann, PhDSenior ManagerDeloitte Center for Health [email protected]

Acknowledgements

We wish to thank Jennifer Bohn, Kerry Iseman and the manyothers who contributed their ideas and insights during thedesign, analysis and reporting stages of this project.

Contact information

To learn more about the Deloitte Center forHealth Solutions, its projects and events, please visit:www.deloitte.com/centerforhealthsolutions.

Deloitte Center for Health Solutions555 12th Street N.W.Washington, DC 20004Phone 202-220-2177Fax 202-220-2178Toll free 888-233-6169Email [email protected] http://www.deloitte.com/centerforhealthsolutions


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Deloitte Report Mobile PHR (mPHR)