CEO Tim Vasko's Speaks at the national conference on m-health

Dec 12-14, 2005, San Diego, California

Emerging Mobile Healthcare Technologies :

From cell phones to iPods, Bluetooth to GPRS, the wireless Electronic Medical Record and e-Prescribing will connect the patient, physician and pharmacy in an open web that may surprise you. Understand how a world of health care that increases availability, and reduces cost is rapidly emerging. This session will lead you through today's technologies that are learning how to deliver compliance to chronic care over the wireless neural network. Learn about the virtually unlimited space, that is evolving, where healthcare is delivered electronically in a connected, mobile and un-tethered world.

Opening of Speech

"Concerns about care for the elderly are running high this week as the fifth White House Conference on Aging takes place in Washington, D.C. Issues that are high on the list include Alzheimer's disease, shortages in caregivers, shortages in geriatric physicians, and questions about how programs such as Medicare and Social Security will be funded."

America's Health Insurance Plans Industry News

Consider for a moment, time: "Suppose time is a circle, bending back on itself. The world repeats itself, precisely, endlessly... . In the world where time is a circle, every handshake, every kiss, every birth, every word, will be repeated precisely." As so stated by Alan Lighman in his book Einstein's Dreams. We consider the inevitable circle and relativity of time to the existence of each of us in this life.

When we contemplate time, we contemplate the inevitable nature of our relative relationship with life and communication. It reminds me of the television ad for a popular cell phone, "time for sale, you can buy time..." where busy people show up to “buy some time” to add minutes to their hectic day. From any one person’s perspective, time might seem exceedingly slow or fast, depending on their circumstance.

A patient, with a case of montezuma’s revenge, is in Mexico racing from his hotel room to the Farmacia, knowing that he can get any medication without a prescription. He does not, however, know which one is safe considering his heart medication.  In his time between restroom stops, he has little time to think about which medication he will need that is safe.  Time, to him, seems both short on the one hand and eternal on the other.

In San Diego an aging patient sits in a park, leisurely watching people pass by, lost in time gone by.  She feels a tingle, in her hip, that slowly increases and begins a ringing that reaches her ears and brings her fully to the present.

In a Canadian hospital, an emergency room is crowded with patients - waiting with injuries and illnesses, ranging from cracked heads to violent stomachs. They wonder why they must wait.  To them time is crawling at a snail’s pace.  What is the delay? Each person’s need is immediate, yet for all waiting, the clock seems to have ceased movement.  With the touch of a button this changes.

In a London Hospital triage clinic, a harried nurse receives a code. A doctor rushes to stabilize an elderly American’s floundering heart.  Time rushes before him as his unconscious patient lies silent, out of time.  The doctor reaches for a syringe, to make his injection, but pauses.  He glances quickly at the screen, laying on the bed, to confirm that the injection will be safe.  No adverse medication interactions will worsen the situation.  He proceeds, and the heart slowly begins its timed rhythm toward recovery.

In 2005, 500 billion text messages were sent over mobile devices globally. 220 billion of those were sent in China alone. An estimated 31 billion emails were sent, daily, in 2005. An estimated 60 billion will be sent in 2006.

Information travels in at a velocity equal to the speed of light; communication has become data, from voice bits and bytes to SMS messages. It is more precise, and more rapid than ever before in history.

Our perspective of timed demands and needs for information, have become as broad as what we choose to type in any web browser.  200 million unique searches are currently made each day, through search engines: starting with Google, which handles 51% of search traffic. North American search queries are outpaced, globally, at a rate of 5 to 1.  From the general to the specific: 1to1 pharmaceutical query of medications. The delivery, of information, is as time sensitive - relative to the circumstance we have for the use of the information:

Most people have at least a vague idea of the basis for Einstein’s theory of relativity (E=MC2): which changed our perspective of how the nature of time and the speed of light are relative. Today’s digital and wireless information, are part of that light stream of data bits that has changed our perspective on how we can get, use and become aware of information: critical information that relates to our health.

Consider this paradigm of information as the neural network of mobile technology that is shaping the possibility of how the relative nature of communication, information, and data today, affects all with a stake in health care.

The probabilities of need, along side the possibilities for use, will continue to unfold through the use of an un-tethered network - that is linked through the world wide web we’ve created on a growing global basis.

Mobile technology, for health care, is a time portal: connecting the world wide web to the patient, physician, pharmacist and health care providers of information and services.  The mobile health technologies are nodes, into this machine, that deliver information from a global network to the proper recipient. Information is delivered at a 1to1, private and secure basis: at the proper time, with proper relative speed, and pointed information. This is the paradigm that does not yet exist, but that is forming as we explore the uses and deployment of mobile technologies in health care.

Our mother or grandmother, visiting the beach for that leisurely afternoon, needs a nudge which is pre-programmed into this network to remind her to reach in her purse and take her heart medication.

Doctor Lambert, at the Churchill London Clinic, is glancing at a screen that has returned information from the patient’s record of medications. This information was returned after sending a query to the server, from the patient’s cellular phone, that returned a security code for the doctor’s authorized network to display the need for medication information instantly.

These scenarios are repeated in this circle of time.  Information relationships through wireless delivery in different variances, for varying medical and health related situations, millions of times a day, precisely, endlessly, in an ever growing demand for information. Our personal health information, is tethered only by the device we carry with us, wherever we go, secured by its messaging capability at any level. Each level is dependant on who we are, and how we use this information.

Today, not all of this yet exists, but the platforms of technology are more than capable for a full scale rollout of M-Health technologies. 

When we consider mobile technology, we must consider the elements of that technology: the need for what it can and might deliver safely and securely. It can not be questioned that we are an increasingly mobile world, whether that mobility comes from travel, or e-commerce.  Patients are driven to purchase medications from other countries, (Canada, the UK, Europe) in an increasing environment of parallel trade that is leveling medication costs for out of pocket expenses.  Yet pharmacists and doctors need consolidated patient information, when the need for prescribing or treatment arises.  This is the challenge of the EPR, which can be partially answered by mobile technologies.

We have evolved in our knowledge of how medical care and compliance are linked.  And so too, have we changed our thoughts about how our devices, evolving from a desktop to a cellular phone, are needed and of use.  Consider a chronic care patient, suffering from COPD and Heart disease, who is made certain to remain on medication to avoid a trauma room visit through the use of a cellular call or SMS message.

We carry our health with us, good or bad, wherever we take our bodies.  We can’t leave our bodies at home.  Through use of cell phones, Blackberry’s, and other handheld devices, we can carry our medical records along with us - as a wireless link into the neural network of information, the web, and the EPR.

Mobile technologies, in health care, are ultimately web based software technologies.  

Health care’s mobile technology is about:

• The  information and users or stakeholders of the information
• The time or relative immediacy of delivery
• For the process and use of the data

When we consider mobile technology in a practical sense, the deployment of methods according to a 1to1Mobile health (“M Health”) delivery to each user, we might refer the information delivered in “little packets” of information or “Quanta” as first described by Max Planck’s theories back in 1900.

Early focus, on M Health, has been in the area of telemedicine (where phones and fax machines were first deployed 30 years ago).  Next came pagers, for health care practitioners. Wireless technology is based on a paradigm of care providers and the need for information. 

More recent deployments have been across wireless GSM and GPRS platforms, (based on wireless technologies) that span the areas of emergency health care: telecardiology, teleradiology, telepathology, teledermatology, teleophtlalmology, teleoncology, and telepsychiatry and e prescribing. Additionally, health telematics applications, enabling the availability of prompt and expert medical care, have been exploited.  The provision of health care services at understaffed areas like rural health centers, ambulance vehicles, ships, trains, airplanes, and patient home monitoring.

We now must expand the context: the relationship of available data and services through wireless devices as it relates to a larger group of stakeholders in health care; namely, the Patient, Physician and Pharmacist.

Our deployment of wireless technology truly begins to take shape if we consider the elemental foundations of information delivery, on a 1to1 basis, relative to needs of the stake holders. This adds a new dimension to our technology, and to our thinking of what M-Health is and can be.

Looking at the paradigm, from a global perspective, we must consider the free flow of information and medications - that has begun on a global scale, driven by technology.  From this macro perspective, we can narrow our focus to North America, and consider the largest consumer of health care services: the elderly. Seniors represent a sector, of health care consumers, that will continue to grow for the several decades. By 2030 one in five Americans will be age 65 or older.

Broken down, this category is comprised of two main groups of stake holders:

1. those that need care
2. those that care for them:  the seniors who are our parents, and those of us that are baby boomers who are caring for our aging parents

In this category of stakeholders, the patients and the family, similar concerns and different needs exist. 

As Senior Citizens, my parents (both in their mid 70’s) wish to live free from assisted living for as long as possible. Empowered by mobile technologies, they may be more able to do so.  Through low cost and effective help, from wireless technologies (that assist them with connectivity) to health care centers, as they travel, and reminders for their medication and appointments, benefits, and emergency connectivity, their list of M-Health needs differ from mine.

In my case, I would not only want access to the medical records and contacts for my parents, but also the indicators of needs or compliance that they are using. Are they missing reminders (in the case of mild Alzheimer’s)?  I may want to be on the list of “care-watchers” that have profiled sets of information - that increase my ability to help my parents by linking me with their health profile, doctors and benefits.  This could all be handled more easily, for me as a traveling professional, on a wireless basis.

Similar elements might apply to my University age son and daughter, and finally extend into my own health care: though the personal need and consumption, I currently have, is relatively small.

Why a mobile record? Because the flexibility of an SMS, or mobile web application, is far greater than a desktop/laptop computer.

A cellular phone or Blackberry, is far more private and portable.  The “push awareness” technologies remove the user’s need to remember, amongst a myriad of other responsibilities, the things that are profiled as important and or critical.
 
Thus, reminders, profiled meds, refills, reorders, benefits, locations of care, appointments, and critical or emergency care are the relative pieces of information that I or my care providers have access to through M technologies.

Accordingly, physicians have other uses for M Health technologies: where e-prescribing, access to the EPR of patients, and their medications, monitoring, case management, telemedicine are all available.

Another stake holder, the pharmacist, has access to: my EPR of medications, and personal formulary, linked to my prescription coverage plans (private insurance, Medicare Part D, a balance on my Medical Savings Account).  All of this information is accessed because my handheld device is wired for security into this critical database for the filling of prescriptions.

By continuing with a focus on stakeholders, it is easy to see that the use of M-Health technologies continues to evolve the standards, and best practices, for privacy and safety that are increasingly complex – and of increasing concern between governments, medical providers, and pharmaceutical boards.
 
While we can not be positive that every patient will have access to M-Health tools, it is an increasing probability that through technologies (such as VOIP, IVR and of course, the web) most every patient will be able to profile and establish a medical record of some sort.  And this is what is taking place to drive the M-Health evolution that is based on stakeholder process and use of information.

In M-Health we have scratched the surface.  We have push technology such as blackberry and SMS.  We have the application of that technology as is relative to: the use of information, the time sensitivity, and relationship to each stakeholder’s use of information, and the M-Health connectivity.

The specifics, of how this is deployed, need to be no more limiting than the realization that this is a web based, XML, based technology set - linked through the stakeholder and their processing of information.

Mobile Health care is all relative to what our physical needs are, as we move throughout our lives.  What starts on a cell phone, in a patient’s purse, may spur a life saving critical care SMS to a web server that holds the key to medication interactions. 

We must expand our thinking to link all stakeholders, based on need, (from the hospital, doctor, and health care provider, and pharmacist, to that of the additional stakeholder at the center of care, the patient).  The delivery, of that information in a mobile world, will be based on the time our relationship has, to the circumstance of call for, and or receiving (via request or push), the information at hand and the processes (such as e-prescribing) needed.

The M-Health, like the E-Health systems, will never be finished. They have, in fact, scarcely begun.