• Cognizant Reports
U.S. Healthcare: Mobilizing Care and Claims
Mobility has forever changed how healthcare is delivered. The desire for improved productivity, lower costs and higher quality care is prompting providers and payers to adopt enterprise-wide mobility strategies. The goal: greater efficiency, self-empowerment and a healthier population.
Executive Summary Finding innovative ways to improve clinical as apps that deliver remote diagnostics and outcomes is of great importance to payers, diagnoses in locations where it is either too expen- providers and consumers alike, and mobile sive or impractical for caregivers and patients to technology is at the center of this pursuit. While be proximate. cost reduction and improved outcomes ultimately require process and technological changes at On the payer side, mobile apps will increasingly multiple levels, mobility is seen as having the enable patients to more conveniently monitor potential to transform healthcare practically claim status. By empowering patients, payers will overnight and in novel ways — that is, if security reap cost savings that they can pour back into and privacy challenges are appropriately tackled core business activities and contribute to the with an enterprise-wide mobility policy. Only then overall healthcare industry’s mission of saving can better, cheaper and more efficient delivery of lives. healthcare become possible. However, to improve consumer care and com- Our research shows that healthcare organizations fort, providers and payers must embrace that are able to bring together disparate data as enterprise-wide mobility strategies that protect part of an overall mobility and connected health data privacy and prevent security lapses, hack- effort will forge ahead. ing and malware. Also, healthcare organizations must first figure out how to co-exist with and The pervasiveness of mobile devices is forcing extend legacy systems and processes to accom- the industry to adapt to changing operational modate the ever-evolving capabilities of mobile needs, as well as the lifestyle requirements and OS platforms and devices. This requires an imme- expectations of a growing portion of the diate fix that will only take shape once standards population. Moreover, the continued pressure to are codified and followed, enabling healthcare cut costs will drive development of new mobile organizations across the ecosystem to achieve remedies across the healthcare industry, such long-awaited operational cost relief.
cognizant reports | july 2012 Mobile Device Ubiquity Physicians are also using these measurements The number of smartphones and other mobile to decide whether professional intervention is devices in use globally is growing astronomically. necessary. Approximately 900 million tablets will have been purchased by 2016, which means approximately As the average age of populations around 12% of the world’s population will own a tablet. the world rises, the demand for primary-care Smartphone purchases are expected to grow at a physicians is also increasing; as a result, the CAGR of 14.5% between 2010 and 2016.1 delivery of care will likely become more difficult and expensive. Moreover, it will not always be According to a 2011 survey by the Healthcare possible for the patient and physician to be in Information and Management Systems Society the same location at the time of an emergency. (HIMSS), nearly 89% of physicians in the U.S. use Advancements in mobile, wireless and other tech- a mobile device, as do 32% of patients surveyed nologies will enable remote patient monitoring by HIMSS (see Figure 1).2 and diagnosis to help address such emergencies. Remote patient monitoring will solve the issue of The mobile applications market in the healthcare proximity, while mobile technology can ensure industry was estimated at $100 million in 2010 the delivery of flexible care outside the traditional and is projected to reach $1.7 billion in 2014.3 In healthcare setup. 2010, 63% of U.S. physicians used mobile health, or “m-health,”4 apps, which is projected to reach Healthcare providers already use mobile devices 100% in 2013 (see Figure 2, next page). such as smartphones and tablets to examine, consult, diagnose, treat and follow up with Healthcare's Increasing Use of Mobile patients. Payers use mobile devices for insur- Historically, patient care was delivered at ance premium payments, collecting and process- particular locations and at particular times. ing claims data, locating physicians, providing However, with the ubiquity of mobile devices, directions to low-cost retail clinics and managing this is set to change. Both baby boomers and care for customers. Consumers use mobile appli- millennials are embracing mobile technology cations for wellness and fitness management, as that provides immediate feedback and guidance well as accessing information, such as locating on their health.5 Increasingly, even the elderly doctors and clinics (see Figure 3, page 4). are using home monitoring devices for chronic or co-morbid health conditions. This allows Telehealth’s Growing Popularity them to monitor their vital health indicators and Telehealth’s7 acceptance as a safe and effective take control of their own health management.6 way to deliver care is growing. According to
Use of Mobile Devices by Professional Groups
Physicians 89%
Non-Physician Clinicians 84%
Healthcare Executives 70%
Administrative/Support Staff 62%
Patients 32%
None of the Above 3%
Other 3%
Source: HIMSS Survey, October and November 2011 Base: 164 HIMSS members Figure 1
cognizant reports 2 “The World Market for Telehealth: A Quantitative Physicians deploy solutions for health informa- Market Assessment, 2011 Edition,” by InMedica tion exchanges, e-prescriptions and comput- and IMS Health, the global market for telehealth erized order entry. Other applications include is expected to reach $1 billion by 2016 and could real-time location systems, patient scheduling jump to $6 billion by 2020. Consequently, the and patient check-in and check-out systems.9 number of individuals using telehealth through Previously, doctors were passive recipients of mobile devices is bound to rise (see Figure 4, information gleaned from product information page 5). brochures, manuscripts, sales representatives and journals. Now, the sources have changed Tracking Health Indicators in Real Time to e-details, blogs, mobile apps, Twitter, portals With the advent of mobile devices, patients now and social networks. All the stakeholders in the have the ability to monitor their health indicators current context — doctors, patients and care- by the second and contact their physician with givers — are digitally connected. any concerns. Patients mainly track weight, vital signs, calorie intake, sleep patterns, etc. in real Mobility has four key advantages: time (see Figure 5, page 6).8 • Access to EMR for viewing and entering Companies such as Medtronic provide mobile real-time patient data, information shar- applications (running on Apple iOS devices) that ing and consultation. Making EMR systems help clinicians access data, such as cardiac device accessible through mobile devices results in diagnostics and patient data, directly from their 60% faster documentation of vital signs and mobile devices, thus connecting cardiac device 83% less data being transcribed manually.10 patients to their clinic and physician from any • Faster insights, leading to speedier location. decision-making. • Reduced time spent managing records, Early Success in Improving Healthcare improved data capture, reduced errors and Many organizations in the healthcare industry improved quality of provider interaction with have implemented clinical and administrative patients. mobile solutions. On the clinical side, key solu- • Ability for patients to view their own tions include imaging, medication administration records and seek help as needed.11 and electronic medical record (EMR) systems. On the administrative side, organizations are using Drivers in the Payer Industry inventory management, financial analytics and Mobility drivers for business-to-business (B2B) personal contacts or calendars. and business-to-consumer (B2C) are widely divergent. In the B2B context, medical claims
U.S. Physician Adoption of Smartphone and Apps
100%
80%
60%
40%
20%
0% Dec. 2008 Dec. 2009 Dec. 2010 Dec. 2011 Dec. 2012* Dec. 2013*
No smartphone Have smartphone, no content app use Have smartphone, use content apps
Source: Chilmark Research * Projected Figure 2
cognizant reports 3 processing is inherently suited to benefit from One beneficiary will be rural health collectives,13 mobility. Mobile data entry with the right which will increasingly gain access to this critical built-in error correction and validation reduces data through cloud services. The healthcare errors and the need for adjudication at the payer provider setting is subject to large volumes of end. Mobility can help in the sales process, as data and processing needs, such as imaging, well. With real-time information available through real-time health information, prescription details mobile devices, there is a direct impact on and comprehensive analyses of medical condi- incremental revenue. tions. An epidemic or a natural disaster would necessitate robust and flexible storage and In the wellness and care management link in the systems in the healthcare setting.14 value chain, mobile-enabled remote sensors will help deliver care at a lower cost in a non-hospital According to research by Markets and Markets setting, directly impacting the bottom line. In the (M&M), approximately 32% of healthcare facili- B2C context, better mobile solutions will broaden ties surveyed already use cloud applications. Of the customer base and attract demographic those not yet in the cloud, 75% intend to be there segments considered less costly to serve (i.e., over the next three to five years.15 younger and more educated populations). Inter- active exercise trackers and basic guides about Healthcare organizations that have imple- calorie intake will help payers in wellness and care mented or are implementing cloud solutions have management. Once these systems are integrated realized annual average savings of up to with healthcare records and with healthcare 20%. Cloud usage for medical applications is providers, there will be a multiplier effect on predicted to grow at a CAGR of 18% through the industry as a whole.12 2015. The key benefits of cloud-based services for healthcare organizations include: Impact of Emerging Technologies Cloud-based services are being used in the • Service is provided and paid for on demand. healthcare industry to exchange medical, • Network access to all computing resources financial and other sensitive data across health- is persistent. care information exchange (HIE) networks. • Interaction with the service provider is minimal, As business processes are transformed to reducing required management effort to support mobile devices, the intersection of near-zero. mobility with cloud will become an important factor in IT strategies.
Telehealth Markets
Professional Core Telehealth HIE Traditional Healthcare and Telemedicine Robotic telepresence EMR/EHR Tele-imaging Tele-pharmacy Simulation/Training Sleep apnea Remote video Mobile consultation telemedicine Mobile health ECG monitoring software Mobility/Tablets Remote vital signs Customer Focus Mobile Information Medication dispensing Diabetes monitoring gathering and delivering PHR Activity monitoring Patient portals Fitness apps PERS Consumer/Non-Healthcare Wellness systems Approaching Telehealth Wellness apps Health coaching Consumer Information Communication Healthcare Technologies Industry Focus
Source: “Telehealth Defined, Explained and Explored,” Frost and Sullivan, 2011
Figure 3
cognizant reports 4 Challenges Implementing Mobility and security concerns are adequately addressed A major source of concern among patients and (see Figure 6, next page). the medical community is the potential for “doctor distraction” resulting from the use of Hospitals are increasingly feeling the constraints mobile devices. Instances of doctors making of outdated wireless networks. An adequate personal calls during surgery, nurses checking IT infrastructure is required to support expand- airfares during surgery and technicians texting ing volumes of healthcare data within hospitals. while operating bypass machines have been Managing the large quantity of actionable data, reported.16 Ensuring responsible use of mobile securing patient data and managing interoper- devices by healthcare professionals is crucial. ability are among the challenges that hospitals Friction between younger and older physicians need to overcome. can also result from their differing understanding and use of technology.17 A Roadmap To address the security challenges, a comprehen- The security of mobile devices in healthcare orga- sive policy for all employees and contractors who nizations is also a potentially tricky area. A lost or use mobile devices should be developed. Hacking stolen mobile device costs more than any other and malware infections must be handled using type of data breach. A study by the Ponemon application control and patching. Integration of Institute found that 62% of lost or stolen mobile various technologies and applications with legacy devices contained sensitive information.18 It is, systems is a must. Universal standards should be therefore, important for healthcare organiza- developed and regulations put in place to ensure tions to devise an enterprise-wide mobile security privacy and security. strategy. Myriad data sources and technologies, as well as Methods that can enhance security include mobile legacy systems, generate fragmented data. To device management (MDM) solutions with remote create operational efficiencies, this data needs device wiping, mobile application management to be integrated as part of the overall mobility (MAM) with application-level security and policy and connected health effort, although a lack of features, encryption of mobile devices and anti- standards in how to do so remains a challenge. theft technology. Consumers will increasingly A comprehensive strategy encompassing plat- demand a healthcare setting where their privacy form, applications, approaches and users is,
World Market for Telehealth: Subscribers by Disease Condition Number of subscribers
600,000
500,000
400,000
300,000
200,000
100,000
0 2010 2011 2012* 2013* 2014* 2015*
CHF Chronic obstructive pulmonary disease Diabetes Hypertension
Source: InMedica, August 2011 * Projected Figure 4
cognizant reports 5 Health Indicators that Consumers and Physicians Want to Track
70%
60%
50%
40%
30%
20%
10%
Weight Vital Calories/ Exercise/ Sleep Blood Acid Digestive signs fat physical patterns sugar reflux/ health consumed activity indigestion Physicians Consumers
Source: PwC Health Research Institute (HRI) Physician and Consumer Survey, 2010
Figure 5 therefore, critical. Otherwise, the switching costs captured in real time with built-in error checking, for embracing enterprise mobility will make the it will save time, which is of critical importance. transition prohibitively expensive. The management of infrastructure, data storage and applications can be entrusted to an external Apart from the security challenges, healthcare partner, and the entire package can be used on a organizations must also address usability require- pay-per-use model. This will free up resources to ments, technical challenges, battery issues, failed focus on the most critical activity for a healthcare transmission, synchronization issues, network provider — saving lives. issues, device breakdown and input adaptability. Recommendations Paper-intensive processes should be reduced To successfully identify and adopt mobility to maximize efficiency gains. If the data is solutions and benefit from the value that
Consumers Seek Privacy, Security
Attributes that would cause consumers to select one hospital over another if cost, quality and access were equal
Clear privacy/security policies 30%
Online consultations 28% with doctor
Other, such as doctor 20% recommendations, location
Electronic health records 17%
Social media presence* 5%
*Has a blog, uses Twitter, Facebook or YouTube to communicate and engage with patients Source: PwC HRI Consumer Survey, 201119 Figure 6
cognizant reports 6 mobility can bring, organizations need to devote • Decide on an appropriate mobility strategy, time and resources to visioning and planning. based on the organization’s business and tech- This will provide the necessary foundation nological maturity and operational objectives. for strong execution. Without this prepara- • Assess the various mobility solutions that can tion, healthcare organizations will not get the be deployed and process changes required to envisioned value from their mobility investments. meet these overall objectives. • Work with a partner that understands the Our recommendations for healthcare organiza- full spectrum of mobility technologies and tions looking to make the enterprise mobility leap implications, including mobility trends, data include: security, systems integration, application • Establish a mobility center of excellence or development platforms, etc. similar working group.
Footnotes 1 Patrick Thibodeau, “Expecting a Recession, Gartner Urges ‘Creative Destruction’,” Computerworld, Oct. 17, 2011, http://www.computerworld.com/s/article/9220914/Expecting_a_recession_Gartner_ urges_creative_destruction.
2 Angela Dunn, “Only 38% Have a Mobile Policy: HIMSS Releases Survey, Launches MHIMSS,” Hl7 Standards, Dec. 15, 2011, http://www.hl7standards.com/blog/2011/12/15/only-38-have-a-mobile- policy-himss-releases-survey-launches-mhimss/.
3 Brian Dolan, “By 2014, $1.7 Billion Market for Mobile Apps in Healthcare Enterprise,” MobiHealthNews, Nov. 22, 2010, http://mobihealthnews.com/9581/by-2014-1-7b-market-for-mobile-apps-in-healthcare- enterprise/.
4 The Global Observatory for eHealth (GOe) defines mobile health, or “m-health,” as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices.
5 Julee Thompson, “Providers and Patients are Embracing Mobility,” HealthcareITNews, Sept. 30, 2011, http://www.healthcareitnews.com/news/providers-and-patients-are-embracing-mobility.
6 ibid.
7 The delivery of healthcare at a distance using electronic means of communication, such as remote monitoring of patient health conditions and transmitting this information to clinicians.
8 HRI commissioned an online survey in the summer of 2010 of 2,000 consumers and 1,000 physicians regarding their use and preference of mobile technologies in the U.S.
9 “Provider’s Perceptions: Mobility in Healthcare, 2011,” Billian’s HealthDATA and Porter Research, August 2011, http://www.ciosummits.com/media/pdf/solution_spotlight/porter_providers- perceptions.pdf.
10 “Using Mobility to Improve Patient Interactions,” Sybase, 2011, http://m.sybase.com/files/Data_Sheets/ Sybase_Better_Patient_Interactions.pdf.
11 “Mobility Advantage: Health Care Made Easier, 2011,” Sybase, 2011, http://m.sybase.com/files/ White_Papers/Sybase-Mobility_Advantage-Health_Care_Made_Easier_wp.pdf.
cognizant reports 7 12 “Health Insurance Mobility: Myriad B2B and B2C opportunities for Payors Throughout the Value Chain,” Everest Global, Inc., 2011, http://www.everestgrp.com/wp-content/uploads/2011/08/POV- HC-Payer-Mobility-December-2011.pdf.
13 Rural health associations focused on the health of people in the vicinity.
14 Srinivasan Sundara Rajan, “Challenges and Solutions for the Healthcare Industry in Cloud Computing,” Cloud Computing Journal, Jan. 24, 2011, http://cloudcomputing.sys-con.com/node/1685234.
15 Barbara Filkins, “Cloudy with a Chance of Better Healthcare: Security and Compliance Fundamentals for Protecting e-Health Data,” SANS, September 2011, http://www.sans.org/reading_room/analysts_ program/arcsight-ping-healthcare.pdf.
16 Matt Richtel, “As Doctors Use More Devices, Potential for Distraction Grows,” The New York Times, Dec. 14, 2011, http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for- distraction-grows.html?pagewanted=all.
17 “Mobile Health Technology Trends for 2012,” The Mobile Enterprise, Jan. 25, 2012, http://www.rapid- valuesolutions.com/blog/mobile-health-technology-trends-for-2012-3/.
18 “Seven Tips for Securing Mobile Workers,” Ponemon Institute, May 2011, http://m.softchoice.com/cms/ brands/sophos/pdf/sophos_seven_tips_securing_mobileworkers_4.pdf.
19 PwC’s Health Research Institute commissioned an online survey of 1,000 U.S. adults in fall 2011.
References “Trends for the Mobility-Enabled Healthcare Enterprise and Security Threats, Vulnerabilities, and Countermeasures,” Booz Allen Hamilton, HIPAA Conference, May 2011, http://csrc.nist.gov/ news_events/HIPAA-May2011_workshop/presentations/day1_HIPAA-conference2011-secure- mobile-and-wireless.pdf.
“Achieving Better Patient Care and Efficiency through Mobility in the Age of Healthcare Reform,” MedTech, 2011, https://secure.logmeinrescue.com/Common/Pdfs/MedTech_wp.pdf.
“Healthcare Unwired, New Business Models Delivering Care Anywhere,” PricewaterhouseCoopers, 2010, http://www.pwc.com/us/en/health-industries/publications/healthcare-unwired.jhtml.
Authors Yuvaraj Velusamy, Researcher, Cognizant Research Center Sanjay Fuloria, Senior Researcher, Cognizant Research Center
Subject Matter Experts Suresh Ganesan, Assistant Vice President, Cognizant Life Sciences and Healthcare Patricia Birch, Vice President, Cognizant Business Consulting, Healthcare Practice Jeffrey Wallace, Assistant Vice President, Cognizant Mobility Business Development Head
Design Harleen Bhatia, Creative Director Suresh Sambandhan, Designer
cognizant reports 8 About Cognizant
Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 140,500 employees as of March 31, 2012, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world.
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