mHealth: Think outside the system
CHICAGO—It takes collaboration and ease of use—not monolithic systems—to build effective mobile health, according to Andrew Barbash, MD, medical director of neuroscience and virtual care services at Holy Cross Hospital in Silver Spring, Md.

“My primary area of interest is really looking at how we can just be more efficient at doing what people need,” Barbash told his audience at the mHealth Initiative Conference, March 30-31. "At the end of the day, the problem isn't the technology, the problem is our workflow. Probably the biggest revolution coming about in mobile health is the fact that ... things can now be done on whatever device, wherever you need to, with very high-speed connectivity."

The telecommunications industry is driving that new mobility: "The Verizon and AT&T salespeople are now selling bandwidth, they’re not selling cell minutes,” Barbash said. As they develop uses for the bandwidth they’re selling, “they’re beginning to understand more about the industry they’re affecting,” he added.

Clinicians must be empowered to use these new capabilities because “in order to serve our patients, we need to serve ourselves. And in order to serve ourselves, we have to stop being dependent on enterprises and institutions and organizational IT structures that were not designed to meet our individual needs, they were designed to meet the needs of their firewalls,” said Barbash. "If we understand what our accountabilities are, I think clinicians can drive a lot of change here … including aligning with what consumers need us to do as well.”

Having telecom companies move into the industry means more powerful devices and better connections. “I can walk into any hospital, any government institution anywhere, and I can get the same speed of connectivity with my own device, with my own passwords and my own applications, and I can communicate and collaborate with other people wherever they are [and] whenever I want to. I don’t have to ask anybody’s permission to collaborate and communicate and do what I need to do with my own tools as efficiently as I need to. That is a total game-changer for healthcare.”
‘Availability management’
To show what is possible using current tools and services that were not necessarily designed for healthcare, Barbash connected eight people in five states in three time zones during a demonstration at the mHealth Initiative event. However, getting a virtual group together isn't the tough part, he said.

“The challenge was, we had to focus first on availability management,”  that is, knowing who is available and to what degree.

There are mobile apps available that show whether a colleague is online, but also whether he or she is using an iPhone or a PC. If that colleague were at a PC, "there’s a reasonable chance I can do a web meeting. I’d send a screen-sharing link, we can get into a [virtual] meeting, broadcast the screen and encrypt it. What’s not HIPAA-compliant about an encrypted session between two known people, where one has complete control over what the other person is seeing?” Barbash said.

“Knowing that someone’s available, [and] knowing how available they are ... is a huge enabler to being able to efficiently get work done,” he said.

Ultimately, “we can educate ourselves how to leverage these tools, we know the telecom industry is serving up the devices and the bandwidth, we know that there are companies that are out there building better, faster, simpler tools that completely begin to match the human workflow process.” Mobile health will happen when clinicians put that knowledge to use, Barbash added.