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Medical Apps: To Come From A Hospital, Not An App Store?

research2guidance.jpgIn the future your medical apps might come from your hospital, not your app store. So says a recently published report by Research2Guidance, a mobile technology research company based in Germany. In their report, titled “Health Market Report 2010-2015″ the market researchers came to the conclusion that the dominant mode of application distribution in the future will be from doctors, hospitals and other care providers.

The report also painted a bullish picture of healthcare app adoption, estimating that the number of users of mHealth apps on smartphone phones will reach 500m by 2015. However, the revenue from this sector will still be driven mostly by device sales and through provision of services, rather than by paid downloads.

The report preview shows it to be organized into three “dimensions”: a) The smartphone market, b) The current state of the mHealth market & c) mHealth outlook to 2015. One would imagine that the last portion will be the most avidly read read as the numerous stockholders in mHealth — telecoms, device makers, insurance and pharmaceutical companies, hospitals and entrepreneurs jockey to position themselves in this rapidly-evolving land grab.

In this outlook section, Research2Guidance tries to predict what new business models and revenue sources may develop in the next five years,  the growth of specific types of applications and to identify future potential businesses. While iMedicalApps does not have access to the complete report, the research methodology as described to us by one of the authors was an online questionnaire conducted during Summer 2010. There were a total of 231 companies involved in mobile health, with global reach. Some of these companies included: AT&T, Bayer, Ericsson, IBM, Nokia, Nuvon, Sapient & Sprint. The report release has been covered by other medical sites, including MedHealthWorld and MobiHealthNews.

What struck us is the prediction that app distribution in the future will be done mostly by providers of healthcare, rather than teleccom and device vendors. This prediction seems logical, although difficult to imagine presently in light of the wild success of Apple’s app store and the rush of other vendors trying to imitate it.

What Apple accomplished was hiding the complexity of application installation from the user. Along the way, the problems of software distribution (all publishers instantly had global reach) and security from viruses and rogue applications were (mostly) eliminated.

While this was a revolution for consumers and led to the dawn of the current age of smartphnoes, it is nevertheless not adequate in the realm of health information technology where isolated data stores are dead ends. In particular, the ability to reference clinical evidence, prescribe medications or communicate with other providers is of greatly diminished value unless all parties have simultaneous access to the same patient record.

Some of the exciting future developments in tying together medical apps will probably come from the Direct Project which allows email-like secure communication among healthcare providers, and the Health Accelerator Apps Network, which is laying the foundation for a web of interconnected applications and data stores.

Therefore, it makes sense that in the future hospitals and other provider networks will be the ones to develop and distribute networked apps for their providers. These powerful apps will be an extension of physicians’ “desktops,” extending our tools from hospitals and offices seamlessly onto mobile devices. If we are lucky, these future apps will have built in APIs or hook for secure  communication with a broad network of innovative applications built by tomorrow’s entrepreneurs, that further enhance and extend their functionality. And then maybe we can remember the present age of data silos as a temporary aberration.

*This blog post was originally published at iMedicalApps*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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