Interview: Kaiser CMIO on mHealth opportunity

By Brian Dolan
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Kaiser Permanente"There is a growing awareness of the opportunity that mobile has for healthcare," Dr. John Mattison, assistant medical director and chief medical information officer (CMIO), Kaiser Permanente Southern California told MobiHealthNews in an interview at HIMSS 2010 in Atlanta last week. "When we spoke last December, that much was clear. What has not gotten recognition is that mobile health can have a significant economic impact on the healthcare economy and healthcare reform. That awareness will hit in the next six to eight months," Mattison said.

That's just the awareness of mobile health's economic potential, of course. Mattison does not believe the economic impact of mobile health will actually register for at least two years -- two to four years for the U.S., he said.

"When you look at drivers for healthcare costs in the U.S. for the past 15 to 20 years you can find lots of cost drivers," Mattison said. "These have been well-documented and incorporated into the healthcare reform talks that are ongoing. What has been underrepresented as cost drivers is three things: Getting enough sleep, eating healthily, and exercising regularly."

Mobile extends wellness and healthcare's reach

"The advantage of mobile health," Mattison said, "is that your phone is with you 24/7 where you work and play. Patients spend more than 99.95 percent of their lives outside of our clinics and hospitals. That's where their lifestyle decisions are made. Mobile health enables healthcare and -- more importantly -- wellness to extend its reach where people live, work and play."

The conditions driving much of the healthcare spending today, including obesity, diabetes, hypertension, coronary disease, kidney failure and others are largely caused and affected by lifestyle decisions rather than medical choices, Mattison said.

"Our efforts as an industry to direct healthy lifestyles has been a notable failure," Mattison said. "Look at the prevalence of childhood obesity. Look at the prevalence of diabetes across the entire population. We are getting better at spending more and more money on things that shouldn't had happened in the first place."

Don't forget sleep

As noted above, sleep deprivation was among the three biggest cost drivers Mattison pointed to as being underrepresented in the healthcare reform talks and healthcare talks in general.

"Sleep deprivation is one of the biggest drivers of obesity in this country," Mattison said. "You've stayed up too late before -- just think about how you ate the next day. All 'comfort food,' right? There is an epidemic of sleep deprivation but in addition to that epidemic is a sedentary lifestyle. Sleep deprivation is as under recognized as a part of poor health as so many other wellness related behaviors. Mobile health is one common pathway that addresses all of them."

Kaiser Permanente to co-create a "symphony of apps"

"What I am working on is symphony of apps that brings to bear the behavioral models, incentive models and information therapies into one single construct," Mattison said. "[Kaiser Permanente] has always been founded on wellness and disease prevention: Recently our EHR helped us to make strides in wellness, but I believe that mobile is going to be the biggest accelerator for wellness that has ever come along, because of the basic presence of cell phones. People are mobile and phones are mobile -- it's convenient."

Mattison said that KP's mobile health plans has universal support across Kaiser Permanente and while KP does have the resources to do everything themselves, they won't. Kaiser has a track record of using open source and APIs, according to Mattison. Expect KP to build some of the mobile health apps they plan to offer but their partners will build others. Mattison said that KP's mobile offerings will serve the two masters of wellness and chronic disease management, but the care provider aims to shift the burden of its efforts to wellness and disease prevention.

What doesn't work for mobile health?

"Which are the attractive dead ends for mobile health? That's a good questions," Mattison said. "There are a number of them out there. I think the big one is relying exclusively on information therapy. If information therapy worked then why doesn't McDonald's sell a veggie burger? Why doesn't Burger King sell more veggie burgers than hamburgers? Yes, information therapy is necessary, but it's not even close to sufficient. Everybody knows that certain foods are unhealthy, but it hasn't translated on a population level. Information therapy won't work on an individual level if it's in isolation. It needs to be a part of -- not of all of [a mobile strategy]."