The healthcare IT (EHR and interoperability modules) and mobile health (or mHealth) industries are traveling on similar paths. They are both technologies in evolution that are sorely needed. EHRs have been mandated by health reform legislation. MHealth is still seen as an interesting curiosity by most. Therein lies the difference. Both will ultimately be here for the duration and dare I say, change healthcare the way it is delivered for a very long time.
EHRs are getting a lot of attention, good and bad. The technology has been mandated by health reform and is therefore viewed in an adversarial manner by many providers, mostly physicians. The mandates of Meaningful Use are driven by lofty goals, some obtainable, some definitely not as of now, and some need long-term follow up to evaluate. Theoretically, they will decrease medical and medication errors, lead to better outcomes at decreased cost in conjunction with ICD-10 coding and ACOs (as envisioned by the powers that be), and lead to better patient education and compliance via patient portals or PHRs. Financial incentives are being paid for adopters, and fines will ultimately be levied for non-adopters. Most of the press regarding the benefits of EHRs is really seen in online social media, websites from EHR companies, or financial analysts.
Healthcare professionals have their noses to the grindstone and are still busy implementing or finding the money to do so. They therefore have no time or not enough experience to tout the benefits of EHR or interoperability with Meaningful Use. Certainly excellent case studies are seen and presented at conferences sponsored by HIMSS or IT companies themselves. But is this too self-serving? We await presentations at medical society meetings to truly, as scientists that physicians are, to make a judgment. Certainly medicine is following commercial industry in getting wired, and it has taken way too long. Perhaps it is the yet unmet goals that have non-industry proponents waiting. Healthcare IT needs proponents such as physicians to get ‘grass roots’ providers excited about, not intimidated by the technology. Security breaches are making headlines and are not helping. There is no perfect EHR system and therefore the buyer needs to vet the vendor’s match to individual needs, something that is not well appreciated. The technological mandates for Meaningful Use cannot all be met, some of the reasons for delaying implementation of Stages 2 and 3. The shortfalls of EHRs cannot, and should not, take away from the potential benefits. If the technology is not fully implemented, the goals will not be reached. For by definition, interoperability means interacting with many providers, labs, officials, and others. SO let’s stop the bickering, realize EHRs are here to stay, and do everything we can to mobilize and look like we care about our patients more than the discomfort of changing the way we’ve delivered healthcare for centuries. Thought leaders and early adopters should step forward and discuss in non-commercial forums how IT has improved the way they deliver care and/or how patients perceive such.
Mobile health is a different story. It is now associated with those cute icons we have on our cell phones and offering to give us free yoga lessons, take our pulse if we are jogging, or anatomy diagrams for medical students. MHealth is a movement that goes way beyond technology. There are many proponents of mHealth that are very active in spreading the word. Again, this is done primarily through channels that involve the companies themselves or people involved in the embryonic industry in some way. Large scale scientific studies have not been performed. The technology has many of the same goals as EHRS: achieve better outcomes and decrease healthcare costs. Mobile health is different, however, insomuch as it will ideally be more patient-centric and therefore more motivating to the patient (or person in the case of preventive medicine). The healthcare provider will not be a passive participant, but the patient will be front and center and the technology will be more of a tool to the patient than EHRs are (at least until PHRs reach their full potential and likely beyond). Mobile health will conceivably actually increase interaction between patient and provider, decreasing the need for face-to-face communication. Mobile health is not mandated, and is first being reimbursed for certain services. It is on the government radar, prompting determinations by the FDA as to which platforms require FDA approval. So the word is at least trickling to stakeholders. Mobile health is more than technology, and this differentiates it from EHRs. It is borne out of both necessity (shortage of physicians, cost of care, cost of development of standard medical technology) and a growing movement of participatory medicine.
I look forward to both EHRs and mHealth having success. They are certainly not mutually exclusive and have goals that are similar. They will undoubtedly compliment each other and work well together. We need clinical studies to convince those that will then carry the torch to show fellow scientists, stakeholders, and the public that these technologies need support by all. Let’s not rely on the industries themselves to be the biggest cheerleaders, providing an impression of self-servitude.
By Dr. David Scher