RTI International RTI International is a trade name of Research Triangle Institute. mHealth at RTI International: How Mobile Technologies Are Changing the Practice of Medicine & Public Health Robert Furberg, PhD, MBA; Clinical Informaticist March 16, 2012

RTI International 2 “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.”

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4 “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.”

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6  GE’s Pocket Mobile Echocardiography (PME) device

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9 mHealth describes a broad range of telecommunications and multimedia technologies within a wireless care delivery architecture.

RTI International 10 Continuum of mHealth tools Measurement Sensor sampling in real time Integration with health data Diagnostic POC Diagnostics Portable imaging Biomarker sensing Clinical decision making Treatment Chronic disease management Remote Clinical trials Disaster support/care Global Service Access Remote treatment Dissemination of health information Disease surveillance Medication tracking and safety Prevention and wellness interventions

RTI International 11 mHealth is patient-focused, social, and consumer-initiated.

RTI International 12 Top ten targets for mHealth  Alzheimer’s: 5 million Americans. Wireless sensors can track the vital signs of patients as well as their location, activity, and balance.  Asthma: 20 million Americans. Wireless can track the respiratory rate and peak flow so patients can use inhalers before an attack occurs.  Breast Cancer: 3 million Americans. Women can use a wireless ultrasound device at home and send the scan to the doctor–won’t have to go in for a mammogram.  Chronic Obstructive Pulmonary Disorder (COPD): 10 million Americans. Wireless can monitor FEV1, air quality and oximetry.  Depression: 19 million Americans. Wireless can monitor medication compliance, activity and communication.  Diabetes: 21 million Americans. Wireless can monitor blood glucose and hemoglobin.  Heart Failure: 5 million Americans. Wireless can monitor cardiac pressures, fluids, weight and blood pressure.  Hypertension: 74 million Americans. Wireless can continuously monitor blood pressure and track medication compliance.  Obesity: 80 million Americans. Wireless scales can track weight and wireless sensors can track calories in/out and activity levels.  Sleep disorders: 15 million Americans. Wireless sensors can monitor each of the phases of sleep for quality of rest, detect apnea and track vital signs.

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RTI International 14  The highest level of mobile telephone use is among adolescents, younger adults, socioeconomically disadvantaged populations, less educated young adults, and people who rent or frequently change addresses. (Franklin, 2003; Faulkner, 2005; Koivusilta 2007)  Further, a high level of mobile telephone use is associated with lower levels of self-rated health, higher BMI, and engaging in health-compromising behaviors. (Lajunen, 2007; Koivusilta, 2005)

RTI International 15 Sample CAHIT Projects

RTI International 16 Improvements and Upgrades to AHRQ’s electronic Preventive Services Selector (ePSS)  Client: AHRQ  Purpose:  To refine and expand the Electronic Preventive Services Selector (ePSS) by: 1. Conducting user research 2. Developing new content 3. Recommending new features and processes

RTI International 17 Improvements and Upgrades to AHRQ’s electronic Preventive Services Selector (ePSS)

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RTI International 19 Communication-Focused Technologies  Client: AHRQ  Purpose:  Develop, implement, and evaluate multifaceted, tailored, proof-of-concept intervention delivered through short- message service (SMS) aimed at improving health care quality and outcomes for HIV- positive patients treated in an ambulatory care setting

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RTI International 21 AdherentHe shoots! He scores! Perfect med adherence. Great job! Non-adherentIt’s going to be a great day. This is your med reminder. Sex riskUndetectable is respectable, but your partners are still infectable. Play safe. Substance riskGoing out tonight? Be safe. Party smart. General health and well-beingTake care of yourself today. Eat healthy foods, don’t stress out, get some exercise and sleep well. Social supportWorried about telling friends and family your status? We can help you find the right words. Call HB at Patient involvementAsk your provider questions. If you don’t understand the answer, keep asking until you do.

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RTI International 23 Summary of Findings Among HIV positive MSM, intervention was associated with a statistically significant  increase in knowledge,  change in beliefs,  reduction in risk behaviors,  increase in perceived social support, and  improved medication adherence (self reported and clinical data)

RTI International 24 Improved self-reported adherence Participants Receiving Medication Reminder Messages

RTI International 25 Contact Robert D. Furberg, PhD, MBA Clinical Informaticist Center for the Advancement of Health IT