RTI International m Health at RTI International How

RTI International m. Health at RTI International: How Mobile chnologies Are Changing the Practice of Medicine & Public Health Robert Furberg, Ph. D, MBA; Clinical Informaticist March 16, 2012 RTI International is a trade name of Research Triangle Institute. www. rti. org

RTI International “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. ” 2

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RTI International “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. ” 4

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RTI International § 6 GE’s Pocket Mobile Echocardiography (PME) device

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RTI International m. Health describes a broad range of telecommunications and multimedia technologies within a wireless care delivery architecture. 9

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

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

RTI International Top ten targets for m. Health § § § § § 12 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 FEV 1, 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 § 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) 14

RTI International Sample CAHIT Projects 15

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

RTI International Improvements and Upgrades to AHRQ’s electronic Preventive Services Selector (e. PSS) http: //epss. ahrq. gov/PDA/index. jsp 17

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

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RTI International 21 Adherent He shoots! He scores! Perfect med adherence. Great job! Non-adherent It’s going to be a great day. This is your med reminder. Sex risk Undetectable is respectable, but your partners are still infectable. Play safe. Substance risk Going out tonight? Be safe. Party smart. General health and well-being Take care of yourself today. Eat healthy foods, don’t stress out, get some exercise and sleep well. Social support Worried about telling friends and family your status? We can help you find the right words. Call HB at 773388 -8865. Patient involvement Ask your provider questions. If you don’t understand the answer, keep asking until you do.

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RTI International 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) 23

RTI International % of Participants Improved self-reported adherence 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% Baseline 81% 62% 53% 38% 23% n=21 Missed dose in past 7 days n=17 Forgot to take medication Participants Receiving Medication Reminder Messages 24 Follow-up Notes: All differences are statistically significant. Differences between baseline and follow-up participants are due to loss at follow-up or missing data. Smaller n's reflect SMS sent only to those nonadherent at baseline. Slept through dose time

RTI International Contact Robert D. Furberg, Ph. D, MBA Clinical Informaticist Center for the Advancement of Health IT 919. 313. 3726 rfurberg@rti. org 25