Karen Rheuban, MD, serves the University of Virginia Health System as professor of pediatrics (pediatric cardiology), Senior Associate Dean for Continuing Medical Education and director of the UVA Center for Telehealth. She is a fellow of the American College of Cardiology, the American Academy of Pediatrics and the American Telemedicine Association and serves as a board member of the Center for Telemedicine Law. She chairs the boards of Virginia Medicaid and the Virginia Telehealth Network and is past president of the American Telemedicine Association. She is also a trustee of the Swinfen Charitable Trust, an international charity that supports the delivery of store and forward telemedicine services to underserved patients through their providers.
David Cattell-Gordon is the director of the University of Virginia Office of Telemedicine, where he also serves as the director of Community Engagement and Rural Network Development. He is also a faculty member in Public Health Sciences and the School of Nursing and co-director of The Healthy Appalachia Institute. A community organizer by training with advanced degrees in divinity and social work, he is a member of the American Telemedicine Association and the National Association of Social Workers and a board member of the Northern Neck & Middle Peninsula Telemedicine Consortium.
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. We have been operating a telemedicine program at UVA for more than 20 years and have seen, especially over the past five years, a steady move away from fixed endpoint capabilities to more flexible and less costly desktop and mobile resources. This year we will continue to see greater use of telemedicine using mobile platforms. Tablets and smartphones have become an increasingly ubiquitous technology for managing everything from chronic disease to health education to emergency care. Much of this has paved the way for direct to consumer telehealth services and the integration of secure video-communications and diagnostics on smartphones.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. Mobile devices of every kind for healthcare will continue to rapidly expand over the next three to five years to include smartphones, tablets, sensors and peripheral devices that securely replicate or augment in-person care and move health information onto secure clouds and into integrated EHRs.
Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?
A. The most significant breakthroughs we are witnessing fall in the realm of integration of video-based services with remote monitoring tools, peripheral devices, mobile apps and big data management – all within the EMR. The evidence has demonstrated that an integrated approach improves access and clinical outcomes and lowers costs. In addition, the inclusion of a broader range of health professionals in this technology-enabled workforce paradigm (including EMS providers and community health workers) offers promise to align with the triple aim of improved access, quality and lower costs.
Q. What mHealth tool or trend will likely die out or fail?
A. The mHealth trends that we believe ultimately will not succeed are siloed direct-to-consumer models based on telephone-only or online-only services outside the medical home. We risk over-prescribing of antibiotics and other medications, and misdiagnosis leading to harm to the patient and to greater antibiotic resistance.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. The most surprising advance we are seeing is not just one device but the remarkable integration of multiple platforms and mobile apps. For instance, a patient can now use a smartphone to make a video call through the patient portal into the EHR, have the physician reply within Epic, with the patient providing health data via an inexpensive home-based peripheral device that feeds into the medical record. This model, along with greater data analytic capabilities, represents a remarkable confluence of efficient, cost-effective, personalized medicine with preventive care and population health.
Q. What's your biggest fear about mHealth? Why?
A. Our biggest concerns are twofold. The first concern is security. As more and more folks enter this market, there are massive amounts of PHI moving between locations, stored in the cloud and managed with different levels of control and encryption - and a major security breach will have a deep impact on the industry. The second is to ensure that direct-to-consumer telehealth services do not further fragment care but, rather, are provided in the context of integrated delivery models. Consumers have driven this demand; we need to ensure it is of the highest quality.
Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?
A. The answer is, of course, all of the above. The consumers will drive how and when they are seen, industry will push more and more affordable and secure devices and healthcare will respond in the context of reducing costs and readmissions by supporting the process. The stakeholders that will win in this environment are those willing to integrate multiple modalities to enable care.
Q. What are you working on now?
A. We have several remarkable projects in the works, including: the use of tablets in the back of ambulances to conduct the NIH stroke scale to hopefully reduce the door-to-needle time for treatment of ischemic strokes; the integration of peripheral devices into the direct-to-consumer market and unique locations such as schools; the inclusion of IM functionality within telemedicine capabilities; the use of mobile and fixed VTC capability for the management of special pathogens; and the integration of video-conferencing into the patient portal of our Epic EHR.
Previous episodes in our mHealth master series