Back to the Future: mHealth is the 21st Century House Call
Thursday, September 15, 2011
By Chris LaPage
With Healthcare, one thing you can count on for certain is that it typically trails other industries by at least a decade in terms of the latest trends. While other sectors started moving away from file cabinets and towards electronic records in the early 1990s, the health industry is just starting to see significant uptake of electronic health records. However, it seems that many healthcare organizations are intent on following the latest trends towards utilization of mobile electronic devices, or mHealth. Indeed, many health care organizations are utilizing custom mobile applications to turn smart phones and other devices into personal health assistants.
Mobile devices are being used to remind patients on strict prescription regimens to take their medication at the appropriate time of day. Two-way videoconferencing available on smart phones allows patients to conveniently consult with physicians, nurses, pharmacists and other health professionals. In other words, mHealth is the modern-day equivalent of physician house calls that were standard in the early days of western medicine. In a sense, it can be considered a return to patient-centered care, where treatment and related follow-up are organized in a way that is most convenient for the patient. In fact, mHealth devices improve upon the historical house call as high speed data transmission allow health care to be requested and delivered very rapidly.
While there are a plethora of potential projects to be explored in the mHealth arena, uncertain reimbursement and payment models will likely temper growth in the area. Providers will be slow to engage patients through mobile devices until the legal and business impediments are addressed. Public programs like Medicare and Medicaid account for the bulk of spending on health care delivery.
As we saw with telehealth, laws will need to be passed to address licensure concerns (health professional licensure occurs at state level unlike mHealth which recognizes
no such boundaries) and update payment models to reimburse care provided over mobile devices. In addition, providers will need to address mHealth reimbursement models with private payers through contract negotiations.
While we wait for the legal issues and business models to be worked out, the federal government is beginning to demonstrate they recognize the value in mHealth initiatives. The National Institute of Health (NIH) recently announced three grant programs to fund mHealth projects, "mHealth Tools to Promote Effective Patient-Provider Communication, Adherence to Treatment and Self Management of Chronic Diseases In Underserved Populations." While all three program have the same title, they each use a different NIH grant mechanism to distribute funding. The R01 program indicates that it is a true research grant, with the NIH looking to fund projects resulting in the development, testing and comparative effective analysis of interventions that incorporates mHealth Tools to encourage patient-provider communications, promote treatment adherence and improve self management of chronic diseases. Similar to other NIH funding, applications are submitted by an individual (principal investigator) on behalf of an organization. Since they anticipate both large and small projects, there is no ceiling or floor on funding requests under the R01 program. The R03 mechanism is utilized for small, self-contained research projects in the mHealth arena with a limit of $100,000 over a two-year project period. The R21 mechanisms supports exploratory and developmental mHealth projects, with an award ceiling of $275,000 over a two-year project period. All three NIH opportunities are authorized through 2014, with multiple deadlines to apply each year.
While the mHealth-specific NIH opportunities represent a strong signal that the government recognizes the value of mHealth, these projects can also be funded through traditional grant funding available on an annual basis. mHealth initiatives are fundable through opportunities available each year to improve health care delivery in rural areas, promote chronic disease management in outpatient and home-based settings, and utilize technology to improve care. Thus, health care providers that see the value of mHealth and want to explore applications need not wait for the removal of legal impediments or development of new business models. Instead, they can begin work immediately on various grant applications to fund their mHealth project.