The intersection of mHealth and meaningful use

While the use of mHealth devices is not explicitly outlined as a key component of meaningful use, a number of changes to the core measures may drive HIT vendors to develop some technologies associated with the mHealth movement. With the release of Meaningful Use Stage 2 (MU 2), the mHealth community should turn its attention to supporting and advancing these new objectives and measures.

The mHealth community has not necessarily found a niche within the promulgation of meaningful use, but perhaps the release of new metrics may serve as a genesis for new ideas and opportunities for the mHealth and HIT communities to interact on a more “meaningful level.” Mobile devices have become increasingly powerful tools for communication and education, two major objectives of the meaningful use policy. While privacy and security concerns and barriers remain present throughout the industry, the opportunity to engage patients via mobile devices should be considered at this intersection of mHealth and meaningful use.

Patient Engagement

Caregivers represent an opportunity to engage and educate both patents and family members and placing the patient first has become a battle cry for many. But how do we engage the direct community that supports patients all around the world? During his keynote address at HIMSS12, Farzad Mostashari, the director of the Office of the National Coordinator for Health IT, referred to this simply as “the meaningful use of meaningful use.” While the objectives of meaningful use remain consistent, the community needs to remain open to the idea an opportunity to support individuals located at the point of care but not necessarily the focus of care.

The second opportunity for mHealth to assist meaningful use requirements is in the area of patient engagement. The HITPC has recommended moving HER-enabled, patient-specific education into the core measures. Again, an opportunity presents itself to the mHealth community to engage patients in local and national mHealth initiatives through the recommendation of certain mobile related educational and preventative technologies. Patient preference for communication also represents the opportunity to associate mHealth and mobile technologies with the need to understand how patients desire to interact with health professionals including the ability to dictate where information is directed. The proposed changes to meaningful use patient engagement metrics increases the recordation of patient preference for communication medium to 20 percent of patients. Again, the opportunity to target individuals with a preference for communication through mobile devices presents itself. While determining the granularity of device capabilities may be difficult, the potential to engage patients with innovative mobile health solutions is again present.

Health Disparities

The old management saying goes to the effect of “You can manage what you measure.” Proposed rules for Stage 2 will increase recording patient demographics from 50 percent to 80 percent of patients. While all hospitals should know the demographics of the populations they serve, collecting a larger percentage of patient demographic information coupled with increased data granularity requested by the IOM Health IT and Patient Safety Report will yield opportunities to target “at risk” populations with mHealth initiatives to reduce health disparities.

Future changes to Meaningful Use could leverage potential market-driven solutions to implement mHealth as a strategy for reducing health disparities. The combination of clinical decision support or care plans with the capability to recommend certain mHealth applications based on patient demographics would trigger the recommendation of local or nationally supported programs. A number of proposed changes could bolster mHealth initiatives – more specifically, the suggestions contained in the HITPC recommendations regarding the use of alerts to users who can act, presented at a relevant point in clinical workflow, coupled with the recommendation regarding the integration of CDS with EHRs. While the tracking and recommending apps would require some integration and maintenance of local or national initiatives, there is certainly a need for a coordinated approach to providing patients with up-to-date information and prevention strategies throughout the care delivery process, which may or may not include the recommendation of health prevention based apps as a component of these suggested changes.

In summary, Mostashari’s anecdotal story during his HIMSS12 keynote about searching for an app during a recent doctor’s visit may have provided a clue as to the location of the intersection of mHealth and meaningful use. It lies somewhere beyond a piece of paper containing the requirements for MU2. The community as a whole, whether from a patient’s perspective, physician’s perspective or caregiver’s perspective, will ultimately influence the role of mHealth in patient care. Engaging in the idea of mHealth as a component of meaningful use is just a start but the community as a whole remains responsible for adhering to the rules of the road.

Is your organization using MU2 objectives as a platform for mHealth patient engagement and education? Please leave a comment describing your approach to the “meaningful use of mHealth in meaningful use.”