By Jane Sarasohn-Kahn. Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system.

Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act and estimates that 80% of existing hospital IT applications will be affected by the regulation. Hospitals will be spending about $120 billion to meet the adoption and meaningful use provisions of the Act. This equates to $80,000 to $100,000 per hospital bed. ARRA incentive payments will cover roughly 20% of this cash outlay, meaning that $60-80K won’t to covered.

But McKinsey says, “Hold on!” There are ways to recoup the spending gap between HITECH incentives and cash-out-of-the-hospitals-budget. McKinsey’s research calculates that optimizing labor, reducing adverse drug events and duplicate tests, and adopting revenue cycle management can help the average hospital save $25,000 to $44,000 per bed each year. That gets to the $40 billion in annual savings when multiplied across all hospital beds in the U.S.

In operational terms, the savings accrue through:

• Managing inpatient beds more efficiently using equipment-scheduling software
• Optimizing the use of clinical equipment
• Determining optimal staffing
• Reducing administrative waste
• Reducing adverse drug reactions through computerized-physician-order-entry (CPOE) which cost $8,000 to $15,000 per bed each year (up to $3 million for a 200 bed hospital)
• Managing the revenue cycle by billing unbilled services, equivalent to 0.4% of hospital services, or $4,000 per bed.

Jane’s Hot Points: The McKinsey team rightly points to three critical success factors for maximzing health IT investments that the most wired, effective hospital-adopters have learned: get critical buy-in among clinicians and hospital execs early in the HIT adoption process; ‘radically’ simplify health IT architecture; and, elegantly plan and execute.

It’s the implementation phase in health IT adoption that so often gets short-shrift. McKinsey notes that Canada’s hospital system devoted 30% of its entire budget to change management. That’s a big number, but it’s also where rubber meets road: a capital outlay of $N million is the easy part of HIT adoption. The follow-on implementation resources, both in terms of sheer dollar volume and labor/staffing, along with disruption of clinical workflow, is the hard part. But getting to meaningful use will require no small amount of implementation effort in the form of evangelism, education and training, and ongoing assistance and support.

Originally posted on The Health Care Blog on August 18th.

Did you miss Disruptive Women bloggers Indu Subaiya, Jane Sarasohn-Kahn, Trisha Torrey, and Regina Holliday this week on the Real Women on Health! Radio series? Or did you hear them, but want to listen again? If so, you can listen to the podcasts now available.

By Pamela Cipriano. On July 13, 2010, the clock started running for eligible providers, hospitals, and critical access hospitals, to become meaningful users of certified electronic health records (EHR). Under the direction of the Secretary of Health and Human Services, the Centers for Medicare and Medicaid, together with the Office of the National Coordinator for Health Information Technology (ONC) released the final rules that lay out the first two years of requirements for eligible professionals to qualify for incentive payments included in provisions of the American Recovery and Reinvestment Act of 2009 through the HITECH act (Health Information Technology for Economic and Clinical Health).  View the press conference led by Secretary Sebelius.   (Disruptive Woman Regina Holliday, spoke at the press conference)

Seven months and 2000+ professional and public comments later, the final rules lay out a three phase graduated approach of requirements for demonstrating meaningful use of certified EHRs.  Since not one stakeholder group is wholly enamored with the rules, they are more than likely equitable and balanced.  Listening to the feedback, the ONC made a number of changes from the proposed to the final rules, taking into account concerns about the speed and scope of implementation of criteria to qualify as a meaningful user.  Groups across the industry gave faint praise as they acknowledged the greater flexibility in the final rules and an easing of some of the requirements.  The phased approach lays out the goal for Stage 1 as capture of data in coded format, Stage 2 exchange of information with emphasis on guiding and supporting care processes and coordination, and Stage 3 improving outcomes by focusing on decision support with improved access to comprehensive patient data.

With quality at stake, the meaningful use incentives tie payments to achieving advances in health care processes and outcomes.  The payments are intended to help accelerate use of HIT. Fortunately there is already broad agreement that populating data into EHRs, using electronic prescribing, reviewing and sharing data across providers and settings, and reporting on quality measures has a positive effect on care.  Dr. Don Berwick, newly appointed Administrator of the Centers for Medicare and Medicaid, emphasized that the new rules define the use of EHRs that is “meaningful to care and to people,” emphasizing the direct improvement in patient safety, transparency, and access to data resulting in better, safer, and more reliable care for everyone.  Certified EHRs help providers know more about their patients, make better informed decisions, and reduce costs of care.  Electronic systems can reduce potential for errors, and enable consumers to work with their providers to coordinate and manage their care.     (more…)

By Robin Strongin. It didn’t receive much attention in the context of oil wells being capped and financial services legislation being passed, but the Federal Communications Commission (FCC) took a step last week that could make a profound difference for Americans who live in rural parts of the country.

The FCC voted unanimously to have the federal government pay a greater share of broadband Internet costs for rural health care providers, and the commission also expressed its intent to subsidize the construction of broadband networks.

Why is this important?  Over the past 25 years, according to the Center for Health Transformation, over 500 rural hospitals have shuttered their facilities.  And, while 25 percent of the U.S. population lives in rural areas, only about one in ten doctors base their practices in sparsely populated areas, creating a serious physician shortage.  For many, it’s an economic hardship to drive a few hundred miles to see a specialist.  Broadband access can bridge those distances and help physicians and rural patients share vital information.

The FCC has a $400 million annual spending cap for rural health care telecommunications programs, but it wasn’t spending all of that money.  So, now it will pay 50 percent of monthly broadband charges for eligible health providers, instead of 25 percent.

It’s not a lot of dollars in the grand scheme of federal outlays, but if it can help bring quality health care closer to those living in America’s wide open spaces, it’s one of our nation’s better investments.

By Mary Grealy.  An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds.  But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

On June 8th, in conjunction with Health 2.0 Goes to Washington, we held a Disruptive Women breakfast on the topic of Health 2.0. For highlights, read our summary and watch the video below.

By Sheryl Flynn.  Earlier this week, the American Heart Association (AHA) announced a new partnership with Nintendo of America.  According to their website (www.activeplaynow.com), the AHA and Nintendo are working together to promote physically active play as a part of a healthy lifestyle. This is the first time that the AHA has partnered with the video game industry to help consumers discover how video games that incorporate movement can be beneficial to health.  According to their “Healthy Lifestyle Tips” they encourage everyone in the house to enjoy active-play video games together and when the weather prevents outdoor activities- they encourage hosting an active-play video game tournament in your living room. 

 Today, according to AHA’s press release- They are not supporting playing all video games in an effort to promote a healthy lifestyle- only the Nintendo games such as WiiFit™ Plus and Wii Sports Resort™ software for the Wii are supported by the AHA.  The AHA’s logo will be found on these products beginning this summer. 

 The AHA is “trying to reach people where they are.”  They suggest that if you don’t move at all- move some.  If you move a little, move a little more.  In essence, if you go outside and play sports or are already active- they are not suggesting that you come inside and play video games- rather, they are trying to get those people who play video games (or are otherwise) mostly inactive- to start doing something active.  They figure, if you like playing video games and typically play video games with your thumbs while surfing the couch- perhaps you could get a little exercise by playing active video games. They are targeting the “no physical activity” group and trying to get them to move!

So, as one would expect- there is controversy over the two companies working together.  Some people believe that both Nintendo and the AHA see a significant return on their partnership investment.  But the AHA has suggested that this is not the case.  Nintendo has contributed $1.5million to AHA to fund a prevention platform aimed at informing Americans about heart disease and stroke prevention.  Another important consideration to keep in mind is that Nintendo is not the only “active-play” video game company out there.  Sony PlayStation released the “EyeToy” years before the Wii and it offers many hours of fun, active gaming as well.  The EyeToy is fun because you can see a video projection of yourself in the game, rather than controlling an avatar as with the Wii games. Microsoft plans to release Project Natal later this year- these games will also offer hours of active gaming fun! There are a number of other off-the-shelf gaming devices that promote active gaming- the consumer should be encouraged to seek the game that would be most fun for them. 

Perhaps most exciting, however, is the Innovation Summit that the AHA intends to host.  With $350,000 support from Nintendo, the AHA will bring together “Thought Leaders” in the area of health care, research, physical activity, fitness and video gaming to look at the synergies and potential benefits of active-play video games and physically active lifestyles.  Now that is exciting!  Finally!  The game industry, researchers and health care industry all together in one room to envision the future!  Wow!

The World Health Report 2008, from WHO, entitled “Primary Health Care Now More Than Ever” acknowledges the need to improve health systems for all through a Primary Health Care (PHC) reform. The report cites Brazil among other countries as good example of successful implementation of PHC policies and emphasizes the role of integrated health information systems as instrumental to achieving this reform.

It is impossible to deliver high quality health services to hundreds of thousands or millions of people without robust processes. That doesn’t mean taking away the human nature of health care. It means that it is possible to put methods in place that can, with the strong support of technology, organize health care delivery, support promotion and prevention, improve services quality and extend its reach. That IS eHealth.

In general, eHealth only makes sense if it supports a Health System. An example I’ve been closely involved with is SIGA SAUDE system in Sao Paulo city. SIGA SAUDE is São Paulo city’s integrated health information system. It is in operation since 2003, and today is present in all 700 health care facilities, with 14 million people in its database, processing 45 thousand scheduling requests a day. SIGA SAUDE implements all the business rules of the Brazilian National Health System, from family and community care, to surveillance and patient flow management.  The system reflects our country’s experience of using a national health system heavily focused on PHC and its long tradition of developing health information systems, now in the move to an integrated architecture.  Thirty years ago, we started developing several health information systems to deal with specific health issues, leading to 200 different systems that did not talk to each other. From 1999 on, we made the decision to move to an integrated health system to support the nation health system comprehensively. The basic premise is that information should be collected only once at the point whre it is generated and from that shared in the network.

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The following guest post on the subject of drug adherence is written by Julie Murchinson, Founder, Health 2.0 Accelerator and Managing Director with Manatt Health Solutions.

The tools are coming! The tools are coming! For a while now, tools to manage drug adherence have been developed, many designed to enable the patient to self-manage in the context of and in collaboration with the health care system from a specifically designed device or heavy application. Patient adoption, however, has been slow and the vision for self-management of drug adherence not yet reality. But recently from the budding Health 2.0 space, we are seeing tools built on more accessible web and mobile platforms that allow patients to manage when and where they want to with their mobile device (e.g. iPhone, Blackberry, cell phone). So, in much the same way many people’s lives have changed as a result of being able to use Facebook or Twitter, or read the Washington Post from their phones on the bus or out at lunch, patients who have previously required proximity to their home device or desktop to log medications taken can now not only track on their phone what they take from their pill box, but also take advantage of glow cap or smart label technologies that can technically interact with a phone-based mobile application.

It was one thing when the Brazilian government was sending text messages to remind women to take their birth control pills (which, by the way, has been highly effective), but we are in a new age of both passive and active patient engagement with mobile platforms. There are iPhone accessible apps like Polka and TheCarrot.com that enable patients to schedule and track their medications taken along with a number of other health topics including sleep, exercise and mood, among others. Medic8Manager provides an iPhone solution that goes a few steps deeper on drug adherence for managing scheduled medications with reminder functionality, refill tracking, missed dose alerts, as-needed meds and discontinued medications. A similar application in development from Informediq even uses the tagline, “enabling healthcare anywhere”. While some products are typically used solely by patients without involvement required from a physician or other caregiver, we are starting to see more user-friendly tools that originate from the physician-patient care process, while allowing for more consumer-friendly adherence tracking, a good example of which we are seeing from the new AdhereTx product. The next step in innovation can be seen from eMedMobile which facilitates a phone working with “smart labels” on prescription medication bottles that store drug data and send alerts to caregivers when a drug is missed.

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I’ve always been someone who (pretty much) does what I’m told. When my parents or a doctor told me “Take your medicine”, I complied. However, I remember a number of years ago when I was taking an antibiotic for a bad kidney infection; I started to feel better and I wondered why I should continue to take the drug. It wasn’t until someone explained to me that by not taking all the medication, or even skipping a few pills, the bacteria-causing infection could become resistant to future antibiotic treatment – they’d be bigger, “badder”, bacteria. This tidbit of information made perfect sense to me and I’m pleased to report that today, I take all my medications as prescribed, even when I might not have any symptoms.

Based on my personal experiences, I was very surprised to learn what an extreme problem drug adherence is to the health care system. It appears that many, many people are not listening to their health care professionals about taking their medicine as they should.

Before looking at possible solutions to this national epidemic, let’s identify a few reasons patients don’t take, or sometimes, even fill, their prescriptions. One common reason is a lack of understanding about the disease or diagnosis for which the prescription was written. Other reasons may be concerns about the drug’s effectiveness, fears related to medical side-effects, lack of belief that they can control the disease, or like me with the antibiotic, they stop taking the medication because they are feeling better and don’t realize the side effects of not taking all of the prescription. It seems to me that many of these reasons for non-adherence can be addressed if people were provided with more information about both their medical conditions and how their medications can be of benefit.

One possible emerging solution to this information/education problem is the application of healthy games – multimedia experiences that are fun and deliver health benefits. Healthy games hold the potential for many benefits, including improving health literacy, physical fitness, cognitive fitness, condition management and motivating behavior change (like increasing the likelihood of drug adherence).

iConecto, a company working to empower personal health and organizational performance though healthy games, gaming technologies and social media, has collected the largest database of healthy games for consumers and professionals. In addition, iConecto is tracking the evidence and experience of the benefits of these games. Currently, there are over 35 documented studies which show that well-designed games can help engage and empower consumers health behaviors leading to higher treatment regime adherence, better overall health, and more clarity in communication with others about their conditions. These clinical studies have focused on a variety of areas, including cancer, asthma, diabetes, cystic fibrosis, exercise/weight loss and brain games. This blog post will focus on a few examples related to improving drug adherence through the use of healthy games.

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As the President and CEO of the American Academy of Nursing, I am very interested in the direction and potential of HIT. Of course, the issue of meaningful use is at the center and of tremendous importance. But the definition as it currently stands does not go far enough.

What follows are recommendations put together by a working group of the Academy’s technology and informatics experts for The Department of Health and Human Services.

To Meet the Needs of Patients, the American Academy of Nursing
Says we need to go Beyond Meaningful Use

The American Academy of Nursing (AAN) is an advocate for improved patient safety, cost-effective care management of acute and chronic conditions, and the effectiveness of nursing and interdisciplinary care. The Academy strongly supports health care reform that goes beyond the prevention, diagnosis, and treatment of disease to include assisting persons to manage their own and their family’s health as well as possible. Such reform must capitalize on the contributions of all health care disciplines. This aggressive approach to broad health care reform will only be achieved and sustained if information systems are collaboratively designed by the “meaningful users” to address data elements that reflect the work of all health care disciplines.

The AAN recommends that future electronic health records (both EHR’s and PHR’s) not only provide for documentation of the services provided by all disciplines but also address the shifting of care from acute and ambulatory care settings to home and community-based settings. To achieve its intended role in health care reform, comparative effectiveness research (CER) must include accurate data collection and data exchange, address health as well as illness content, and be interdisciplinary versus physician-centric.

To assure meaningful use of health care information and information systems by all health care disciplines, the AAN therefore respectfully requests the following:

1. The “Meaningful User” Definition should specifically include advanced practice registered nurses (APRNs), registered nurses (RNs), and other interdisciplinary health care clinicians as providers, particularly in hospital settings, but also in most ambulatory and home care [or community-based] settings where the nurse may collect key demographic data, conduct the initial screening, and support implementation of the medical regimen, and whose documentation will largely determine if the overall encounter meets the various mandatory guidelines for effective and efficient patient care. In creating the definition of “meaningful user”, CMS must include all essential contributors to the care episode documentation if those contributions provide critical evidence of the effectiveness of care.  (See Sample Definition Matrix at end)

2. The “Meaningful Use” definition should include inpatient documentation by nurses and other patient care providers. Likewise, ambulatory care including community and home based settings where nurses and other key patient care providers deliver services that will impact the quality and outcomes the care should be included in the definition. The use of the EHR by nurses and other key providers is essential in supplementing and expanding the meaningful use by physicians. In the majority of situations, especially in the inpatient sector, physician design of the EHR and the population of the information fields will be incomplete and the data collection not comprehensive without the meaningful involvement and contributions of nurses and other key providers.

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The day before my daughter Elise’s 15th birthday, the new iPhone went on sale.  My birthday was 4 days later.  So Elise figured out we should buy each other an iPhone to mark our big days.  She planned (and saved) for months.  She spent weeks talking to friends, researching apps on line, planning for such accessories as protective covers, and educating herself on how to maximize her minutes.

When the big day came, we made our way to the Apple store and stood shoulder to shoulder with hundreds of others waiting on a very long line.  Two and a half hours later we were invited, actually escorted, in to the store by an extremely friendly, knowledgeable young man who stayed with us during the entire purchase transaction.

He answered tons of questions (mine, not Elise’s…she already knew everything), politely reviewed various functions with me (Elise was extremely patient during this process), and made great suggestions about which plan was best for us.

While we were waiting on line, I looked around at the people waiting with us–we were an extremely diverse group–and wondered (a) Why in the world were we all willing to wait hours to buy a telephone, a very expensive telephone?  (b) How did the folks at Apple get us to this point? and (c) What lessons could we take away and apply to health care?

Here’s what I came up with:

Cool. The iPhone is not your mother’s rotary dial wall phone.  The engineers and creative types figured out how to make a very uncool, but necessary, object not only aesthetically pleasing, edgy, and fun, but useful, convenient, and easy to use.  They stimulated demand.

Now if the Apple  folks could only do for colonoscopies what they did for telephones.  I am only half joking.  How do we make taking care of ourselves and our loved ones cool?  How do we make boring, sometimes not so pleasant preventive measures cool and edgy?

Hospitals are scary places–while some newer facilities have made efforts to look more appealing (open atriums with green trees, brighter colors and lighting), many are dark, smell strange, are old and creaky, have tons of frightening tubes, machines, noises, and for most people are places to be feared and avoided.

What amenities can be added to make it harder for patients to find excuses not to get that mammogram (valet parking, anyone?), not to go for that follow up, not to just give up and leave after waiting for two and a half hours in the waiting room (Elise and I waited that long–and the friendly folks at Apple handed out water, and updated us on our progress).  The only water I could find in my local hospital emergency room last week (when we were there with my son) was a nasty water fountain that had stuff in it that would make a petri dish cringe.  There were vending machines with chips, candy and soda, but it was broken.

Service. Imagine for a minute that when you enter a clinic, doctor’s office, or hospital, you are accompanied by a knowledgeable, helpful, pleasant individual who can speak to you in a non-condescending, judgmental manner, in language that you understand.  Someone who can help you navigate a complex system of decision making.

Quality. Pretty obvious attribute.  Quick–think Mayo, Cleveland Clinic, Johns Hopkins.  What is it about these institutions that people think of when asked to list “best” hospitals.  How do you (should you?) rate different doctors? Nurses?  Most people buy the iPhone because they believe they are buying a high quality product.  How can we be sure we are buying high quality health care?

It’s interesting when you look at the literature.  Quality is defined in many different ways by health care professionals and by patients.  Sure there’s overlap.  But in addition to better health outcomes, living longer and better–patients highly rank items such as convenience, hours of operation, waiting times, and location as quality indicators.  Apple stores have better hours than most clinics and physician offices.  My dog’s vet has better hours than most doctors.

Value. Why was a 15 year old willing to save her hard earned money for an expensive phone (and why was I willing to pay not insignificant monthly charges) for the iPhone?  Because we thought it was worth it.

If only we could figure out a way to get people to see that it’s worth it to exercise, eat healthy, get annual check ups, not smoke… and get that colonoscopy.

EAST COAST.  In and around the DC Beltway, there is a tremendous amount of excitement when it comes to Health Information Technology (HIT).  Lots of mainstream IT vendors, trade associations and HIT gurus are licking their chops.  Policy wonks, legislative aides and administration appointees have been diligently debating the thorny issues of the day: privacy, security, standards, and meaningful use.

WEST COAST.  In and around Silicon Valley, there is a tremendous amount of excitement when it comes to Health Information Technology (HIT). Lots of software engineers, health 2.o entrepreneurs, and venture capitalists are licking their chops.  IT experts,  computer intelligensia, and bleeding edge developers have been diligently innovating the thorny issues of the day: privacy, security, standards, and meaningful use.

East meets West.

Policymakers and legislators are talking about the promise of increased efficiencies and cost savings. And meaningful use.  HIT innovators are talking about the right to personal health data and personal health records.  And meaningful use.

Lots of people are talking about meaningful use.  Here’s what the Department of Health and Human Services’ Office of the National Coordinator’s website has to say about it:

The American Recovery and Reinvestment Act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR).  These incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare.

The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

Informed clinical decision making must include the patient.

But who’s talking about meaningful use for today’s patients, the future HIT generation?

What we have here is a teachable moment:  If we are really serious about meaningful use, it must be meaningful for the patient.  Not just for health providers.

• How do we make sure the public (patient and caregivers) are well informed?
• What, if any, consumer protections may be necessary (ie, a misdiagnosis is inadvertently entered in an electronic health record–who, how does that correction get made–everywhere in cyberspace?)
• How do we insure that all people–the disabled, those who don’t speak English–will be able to meaningfully use HIT?

My suggestion:  As we make the transition from paper to electronic records let’s have the National Coordinator, working with patient, consumer, and provider groups develop a HIT LIST–a plain English (with translations as needed) document explaining what electronic records are, why they are meaningful/useful to patients, along with a consumer check list of questions patients should ask. If I were putting this together, I would also include where to go for help (both online and offline).

Ideally, patients need to receive this HIT LIST before they are sick.

This month, Disruptive Women welcomes Andre Blackman, Health Communications Analyst at RTI International, a non profit research organization, as our July Man of the Month.

Andre Blackman has an extensive background associated with science, technology and public health, conducting research in institutions such as the Naval Research Lab, NASA and WESTAT. This merging of technology and health has proved helpful in his current work in Health Communications.

Andre is very passionate about the role of new media, mobile technology and other emerging technologies as it relates to health communications and public health in general. You can find his thoughts on the intersections of health and technology through his blog, Pulse + Signal and via Twitter.

The past few years have seen a significant increase in the use of emerging technologies to improve public health all around the world. From grassroots initiatives empowering citizens in low-resource areas to making sure consumers get the healthcare they need – changes are happening for the better. This article will aim to look at a specific area of the ‘citizen empowerment’ – the application of SMS (Short Messaging Service – or texting) and mobile phones in public health.

With the onset of social tools such as social networking sites (Facebook, Myspace, etc.) and real time information hubs such as Twitter, we are exposed to numerous ways to stay connected to each other. Our mobile devices are equipped with applications that allow us to do a myriad of things – many of which focus on entertainment and productivity. Another very important part of our lives is maintaining good health and the mobile phone is making strides in that area. mHealth is the term that has been coined to describe the interaction of mobile technology with the improvement of health.

mHealth is exploding onto the scene as the next big technology boon for public health – the main reasons this is true are twofold: ease of implementation and relative low cost of operation/maintenance. This is especially true in the developing world and in low-resource areas where technology options are relatively sparse. The use of SMS has become a tremendously powerful way for health clinics in Africa to communicate with their community health workers who are traveling to villages to tend to patients. Imagine the ability to significantly reduce fuel consumption and get real time data on medical adherence in a world where it make take several weeks to get this information.

All of that from a technology that for many of us in the developed world may take for granted.

A few months ago I presented this information at the North Carolina Division of Public Health – here is the presentation that touches on the basics of mobile technology and how it can be applied to the public health landscape. It is by no means comprehensive but gives a good idea of where things are and thoughts on where things can go in the near future.

Private sector organizations such as Voxiva have been taking the lead on mobile initiatives, especially in health. Nonprofit organizations and local health departments have also been dipping their toes into the use of SMS technologies to get health information out to residents. The government has also become a supporter of mHealth initiatives and the Centers for Disease Control and Prevention (CDC) continues to innovate in this area. Several weeks ago, I wrote about a hypothetical situation in which public health could benefit from a mobile application called The Extraordinaries, which uses the free time of consumers to volunteer their time for good.

From a recent article on mobile communications in health via Mobileactive.org:
“Mobile provides a fantastic channel for communication,” said Erin Edgerton, senior social media strategist at the CDC. “It’s always on, always with you and provides personal access to information.”

I heartily encourage you to begin exploring this venue of health communications and figure out how you or your organization can integrate strategy with mobile technology.

Additional Articles/Resources:

Mobile Active – a great starting point for learning about using mobile technology for social impact. Contact them with any questions

PopTech – Can Your Cell Phone Change Lives? My article on mHealth

Texting4Health – conference and newly published book

ISIS initiative – sexual health information/STD prevention through SMS technology

Heart disease is the number one killer of women. The problem is, women have different symptoms then men — so they often don’t realize they’re having a heart attack. The Queen of Hearts Foundation is co-hosting a women’s wellness seminar in Atlanta June 2 and 3 at the Crowne Plaza Hotel Atlanta Perimeter At Ravinia – (Address is: 4355 Ashford Dunwoody Rd NE, Atlanta – (888) 444-0401)

If you’re in Atlanta, the cost is only $10 — and it could save your life.

Queen of Hearts co-founders, Katy Atterbery and Carmen Perez, talked to Disruptive Women’s Wendy Grossman.

DW: Did you know each other before you started the foundation?

KA: We met while volunteering on a project regarding women and heart here in Atlanta in 2004. We formed the foundation in May 2005, and got our 501C3 status in July 2008. Carmen is the daughter of a man who has had open-heart surgery. And I, of course, am a multiple heart attack survivor.

DW: I read that you had several heart attacks in a week.

K.A.: I had three heart attacks in a five-day period.

DW: And you didn’t know you were having a heart attack?

K.A.: I had no idea. I had symptoms for six to eight months and ignored them. I was busy doing other things. I had a burning sensation in the pit of my stomach, a pain in the side of my neck, and a pain in the shoulder blade. Women symptomize differently than men (visit qohf.org and click on symptoms).

I never had a pain in my chest; I never had a numb left arm. I felt lousy, my skin tone was gray, I saw dots in front of my eyes. When I had the first heart attack, on Nov. 13, 1997 (a week after my 54th birthday) I was misdiagnosed as having an anxiety attack in the ER and they sent me home.

DW: Wow.

KA: I drove myself — which was a really stupid thing to do — but I didn’t know what was wrong. The second heart attack I had while co-chairing a fundraiser at my son’s school that Sunday night (Nov. 16.)

I wouldn’t let my husband take me back to the hospital because they told me nothing was wrong. I saw my internist that Monday who told me that I was over 50 and probably had acid reflux. He gave me a prescription for an upper GI series and said he’d call in a couple days. That night, I suffered a major myocardial infarction — which is a heart attack. I was throwing up and in excruciating pain.

My husband carried me back to the ER. Our son, Christopher, was a senior in high school and he had the flu. He was sick in bed and my husband — who traveled for business every week, by God’s gift was home that Monday. If he hadn’t been home, my son would have come upstairs that morning and found me dead. Because I never would have got to a phone, and he never would have heard a cry for help.

At the hospital, I lost consciousness and lay for over four hours with them insisting it was my gallbladder, before they called a cardiologist.

It wasn’t until the cardiologist did the cardiac blood enzyme test they knew I had a heart attack. (That is a blood test that detects the presents of certain enzymes your heart produces when under attack.) I was unconscious. They did a heart catheterization and a angioplasty and put a stent in my lower and anterior descending artery. The interesting thing is, 11 years ago when this happened, stents were brand new. So I have a surgical steel coil that is now embedded in the wall of my artery. (more…)