Overcoming Cloud-Based Mobility Challenges in Healthcare

Overcoming Cloud-Based Mobility Challenges in Healthcare

July 17, 2012 2:00 pm

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A free educational webinar on Overcoming Cloud-Based Mobility Challenges in Healthcare with Rich Mendis, Co-Founder and CMO of AnyPresence and April Sage, Director of Heatlhcare Vertical and Marketing at Online Tech.

When: July 17, 2012 @ 2 P.M. ET (see recording below)
Who: Rich Mendis, Co-Founder and CMO of AnyPresence and April Sage, Director of Healthcare Vertical and Marketing at Online Tech.
What: Overcoming Cloud-Based Mobility Challenges in Healthcare

Description: Smartphone and tablet devices are out-pacing PCs as the primary means for accessing email and internet. In fact, by 2015 it's estimated that more U.S. Internet users will access the Internet through mobile devices than through PCs or other wireline devices. While many organizations realize they must embrace the mobile channel to keep their customers and employees engaged, becoming mobile-enabled has historically been complex and cost-prohibitive.

In addition to standard challenges like platform fragmentation and hidden costs of maintenance, healthcare organizations face even more scrutiny by the FDA and must adhere to HIPAA compliance standards set forth by the Department of Health and Human Services. As daunting as it may sound, the path to mobility for healthcare is already within reach.

During this session, April and Rich review the common challenges associated with mobile enablement, and introduce the new technologies that are empowering healthcare providers to securely engage their patients and practitioners through the mobile channel.




View slides (PDF).

April: Today we’re going to talk about overcoming cloud-based mobility challenges in healthcare. With no further adieu, let me introduce Richard.

Richard: Thank you, April. Hi, everyone. This is Richard Mendis speaking to you from northern Virginia in Reston just about 30 minutes outside of Washington D.C.  Thank you very much for joining today. Let’s go ahead and dive right in. My background, as April mentioned, has been software industry. I’ve worked at companies like SAP, Oracle, and Siebel Systems. I’ve also done some startups and am pleased to be working on an interesting new company that specializes in cloud-based mobile platforms. In case any of you would like to reach me after the presentation, my email address is remendis@anypresence.com.

As April mentioned and as you probably gathered from the agenda in the email, we are going to be covering a wide variety of topics in this presentation. I’m going to start by kind of talking about some general mobility trends from a consumer perspective and kind of focus on why this is important. We’re not building mobile apps for the sake of it, but it’s in response to specific trends in the market and specific expectations that consumers have, so we’ll talk about that. We’ll then dive into some of the healthcare specific challenges and opportunities that are out there, talk about what’s going on with respect to mHealth or mobile health applications, some of the business challenges that customers face when attempting to determine what apps to build or how to roll them out. We’ll also cover HIPAA and FDA regulatory issues that are on the forefront of anyone’s mind if you’re in this particular space.

April has a wealth of experience in this industry and will pitch in as well. Finally, we’ll wrap up with some of the technology challenges that are out there and some of the options you have when you decide that you want to roll out mobile apps to build mobile apps for healthcare and start looking at the different options and what might be the best approach for you.

With that, let’s go ahead and get started. The kind of high-level overarching theme around what’s driving mobility today, if you kind of look back historically at what the consumer experience has been when working with businesses, healthcare providers, insurance companies, pretty much anyone who has to provide customer service to customers, in the 80’s and prior to that, paper bills and the phone and letters was your primary mode of communication between a consumer and a company. Then in the 90’s you had automated instant or interactive voice recognition, which automated a lot of the telephone conversations that you might have with a person.

Finally, and to great relief to many consumers, the Web caught on and you had websites that provided some self-service capabilities. Now at the beginning of 2010 and onward, we’re starting to see an embracement of simple mobile apps that provide some self-service capabilities. What’s happened on the consumer side in consumer technology in the household during the same period is you had the first millennials and the baby boomer’s children being born in the early 80’s.  These folks grew up with personal computers and cell phones in the household.  Internet subscription was almost a default or de facto for many people, especially North America. Laptops and netbooks started becoming very prevalent in the 90’s. As they went through adolescents, they grew up with social websites like YouTube, Facebook, Twitter, LinkedIn, and others.

The games that they played were constantly connected to the web. Finally, you had the advent of iPhones and Android devices in the late 2000’s followed by fantastic mobile devices with form factors like touch screen tablets and a much faster ubiquitous Internet connectivity. So these folks have grown up with this fantastic technology. Now when they either work at or interface with companies, there is a huge expectation gap between what they’ve experienced growing up in their life and what technologies the companies and businesses they work with offer them.

So you’ll hear a lot of themes in the market today around social collaboration, gamification, push based information, and this concept of mobile first, which is the principle of saying most of the consumers that I’m going to be working with are going to be interacting with me through a mobile device primarily. So how do I best serve or optimize the channel for that experience? I think this is a good backdrop as we start diving into talking specifically about what’s going on in healthcare and mobility and why it’s important.

A few overall statistics – I’m sure some of you or many of you have seen this data perhaps from different sources. What’s happening in terms of adoption for mobile devices is simply breathtaking and staggering in terms of the speed at which this technology is being adopted. There are a variety of different estimates by it, but generally speaking the consensus is by around 2015 it’s expected that more U.S. based Internet users will access the Web from mobile devices than through PC’s or other traditional wire line devices.

Just as though you can’t imagine not having a website for a company today, pretty soon you’re not going to be able to imagine not having a mobile optimized version of that website to the majority of visitors who are going to be hitting that site. We often get asked by prospects and customers about whether this particular trend is only applicable to a certain demographic. Is it only, say, the affluent side of the society that can afford these smartphones?

What’s interesting is if you look at the data, the statistics actually show completely the opposite. The fastest growing demographic segments for smartphone users are either households of six people or more, which typically are the mid to low income households, or households of income under $25,000.  There are multiple reasons for that, but some of the biggest are it’s a lot less expensive today to get a subsidized smartphone with Internet connectivity from a carrier than it is to have a desktop or laptop with a more expensive Internet plan from a residential provider.

So what you’re seeing here is that this phenomenon of smartphone adoption and mobile-based Internet access is not something that’s limited to a certain subset of the demographic, but is in fact embraced by all demographics throughout the country. Just as an FYI, it’s fascinating to see how quickly this market is changing from an adoption perspective and who is using which smartphone version. You can see here this data is recent as of the end of last year. I wanted to show the chart because it goes back to 2005, and you can kind of get a feel here for what you guys have clearly been seeing where traditional market share leaders like Symbian and RIM are now relegated to a very small minority of market share.  In many cases, they’re irrelevant.

Apple and Google Android have certainly taken over the lion’s share of the market. What we expect to see is that Microsoft, with the launch of the surface tablet and Windows 8 later this year, will probably see a bit of growth in their segment. What’s also been happening over the course of the last 12 to 18 months is HTML5 has taken off in terms of being supported on mobile devices and desktop browsers. The capabilities of HTML5 today are such that the experience provided to a user or consumer on a mobile device with an HTML5 site is in many cases on par or as good as the features provided through a native app developed for either iOS or Android.

Certainly, there is a long way to go to support a variety of different features that the phones provide using HTML5, such as camera and microphone access, but those are well-specified within the standards. I think we’re going to see, over the course of the next 12 to 18 months, a lot more support and richer, very interactive apps than games even developed on HTML5, which is great for those of you who are going to be experimenting or developing mobile apps. There is certainly no good reason not to initially start with an HTML5 version of that mobile app and then branch out to other platforms as needed, based on your requirements.

There are a variety of statistics here, but I think one of the important statistics to point out is there is a company called Keynote Services that did a survey of consumer preferences for services related apps – of mobile apps that provided access to consumers who are interacting with or doing business with service providers – and well over 60% of those consumers surveyed said that they preferred to have mobile web apps versus a native app that they’d have to download and install on their device.

If you think logistically with your own experience, you probably don’t want to have to download an app for every single service provider that you interact with.  It would be much easier and seamless if you could just go to a web browser, Google for that service provider, and have a nice usable experience with that person’s website on your mobile device.



April: So, Richard, let me ask you a quick question here. I know, having worked in the interactive industry for a while, that it’s always been a significant challenge to try to create a website or some type of Internet application that will play nicely across many different browsers. It seems like this problem is exponentially exacerbated with mobile apps because we’ve got dozens of phones with all different sizes, all different resolutions, and they’re obsolete within 12 months. So we have this growing demand working its way both to the younger crowd and to the older crowd at the same time – all these different types of users, all of these different types of phones. It seems like one of the big challenges of what we’re looking at is getting consistency and getting a workable interface on hundreds, potentially more, different types of platforms.

Richard: You’re absolutely right, April. For those of you who may be from the development world or have been in the development world for some time, what this mobile development space looks like is like back in the client server days where you had to actually develop an application for every platform you wanted to support. In the early 2000’s and up to now, when Web apps came out and were embraced more broadly, you had a little bit or respite from that. Now with mobile platforms and the rapid pace of change within those platforms, it certainly feels like we’re back in the old days of client server development.

Having said that, there are plenty of tools now on the market that reduce the pain of having to maintain and manage multiple versions of a mobile app across different platforms or even if you’re only rolling out a mobile website using HTML5, ensuring that it scales and is responsive to fit across a wide variety of different form factors, from smartphones to tablets. Later on in this presentation, I’ll cover some of the different development approaches, and we’ll talk about what some of the other early adopter industries, such as those in finance and hospitality, have learned from their experience and how they’re solving some of these challenges today.

So key takeaways from this section kind of introducing the concept and the trends: Consumers have expectations now for richer more proactive interactions with businesses through the mobile channel. Mobile devices are either becoming or will soon be the primary way for consumers to reach businesses and providers on the Web. This applies to all consumer demographics. There are about two to three dominant mobile platforms, and we can expect that for the next 18 to 24 months at least.  However, HTML5 is becoming kind of the lowest common denominator platform and a good viable entry point for companies who want to experiment or roll out mobile apps as a starting platform to get going with.

All right. With that behind us, I think we’ll dive into the meat of things now and talk about what some of the mobile opportunities, trends, and challenges are specific to healthcare providers. It’s a fascinating time to be in this space. For any of you who are tasked with figuring out for your organization or for your customers how to go to market in this space and tackle it, I think you couldn’t have asked for a more interesting job or a better time to do it. It’s expected that by the end of this year, it’s estimated that about 44 million mobile health-related apps will have been downloaded.

About 13,000 consumer health-related iPhone apps will be available by this summer, so literally now in the iTunes app store. About half of those are expected to be clinical type iPhone apps targeted for physicians to help them in their daily interactions with patients. Again, this is not forecast but actually numbers as of today.



April: Wow, that’s amazing.

Richard: It really is staggering to see these numbers. Thirty percent of physicians are currently using smartphones and tablets to treat patients. That obviously covers a wide variety of services, but I also saw a statistic the other day that said about 80% of physicians have a smartphone device that they use either for personal or work use, compared to about 50% of the overall consumer market. Clearly, the adoption among physicians for these types of apps is huge. We’re talking not just about the opportunity for consumers to interact with these apps but also physicians.

Mobile health apps are exploding. Let’s take a look at the corresponding mobile readiness, if you will, of healthcare providers. We know the consumers are eager to use mobile apps to get better information about their health, and physicians are eager to use mobile apps to help them in their clinical practice. What about hospitals and healthcare providers embracing mobile apps or mobile websites to better serve their customers? On this front there is some traction but perhaps not as much as we’d like to see. In the fall of 2011, I think this is a survey of marketing professionals within the healthcare provider segment. About 34% have rolled out mobile apps to their consumers, patients, visitors, etc.  About 38% have a mobile-enabled website.

So, not bad. Certainly, a little bit better than some of the industries we’ve seen that are late adopters but a lot less than we’d like to see. I think there is a fantastic opportunity here for healthcare providers, hospitals, and other folks in that segment to be able to, at the very least, ensure that they have a mobile optimized website to serve the needs of patients, visitors, referring physicians, and other entities, donors, etc. that may be interacting with the hospital through what is more commonly going to be the mobile Web channel.

With that in mind, assuming that everyone buys into the fact that this is an important critical trend and that in the future, more and more people are going to be hitting your website through mobile devices – by the way, you don’t have to guess. You can go and ask your webmaster for some statistics and see what that is. My guess is if you’re a healthcare provider of any size, typically that’s going to be in the double-digit percentage and growing significantly over the next few months.

If you look at kind of what the top challenges are to building a mobile strategy.  I’m not sure why developing a strategy was a response here. That seems obvious. Identifying and prioritizing business cases and then choosing the platform of technology of no surprise are kind of the top two items. Now, this particular survey was sent to a broad variety of industries. I would kind of categorize in the security healthcare specific challenges such as HIPAA compliance and FDA regulation.  

In this particular presentation, we’re going to address these three topics from a challenge perspective. How do you identify and prioritize business cases? How do you choose which platforms and technologies to support? What are the specific healthcare challenges related to HIPAA compliance and FDA regulations?  By the way, you’ll notice at the bottom of this list is user adoption, which clearly indicates there is no expectation that the adoption of mobile apps is going to be a challenge. If there was ever an opportunity to position a “if you build it they will come” scenario, I think this is it.

In terms of determining what scenarios to support if you are a healthcare provider, my suggestion is you look at things in a multi-dimensional fashion. One potential way to do that is by looking at both scenarios for your patients but also physicians and across two dimensions of financial or productivity benefits and then brand value benefit to the organization. For example, for the patients, from the financial and productivity benefits, the ability to reach more patients or prospects through mobile channels, reducing the service wait time. So being able to provide pre-registration forms, check in, check out, and other productivity enhancing scenarios. Be able to provide proactive alerts, reminders for medication. Follow on visits for post-op care, etc. A lot of interesting scenarios that can be done from that perspective.

On the brand value benefit, being able to provide as much content as you can with respect to preventative care, providing the convenience to patients of mobile access, and providing them, to as much a degree as possible, access to their information or health records through this mobile channel, for example, leveraging initiative such as the Blue Button program.  I think these are just a few high-level examples of domain areas or scenarios that you can tackle from a patient’s perspective.  Depending on what your specific needs are, depending on the demographic of the types of physicians that you have or the make up of nurses versus practitioners, there’s a variety of different productivity and brand value for employee engagement scenarios that you can also consider at the same time.

For example, giving physicians easier access to data through mobile smartphones or tablets, providing process-based clinical apps that streamline the process that they’re going through today perhaps through a lot of paperwork. From an employee engagement perspective, supporting personal devices that pretty much all physicians and nurses have today and providing a better user experience as an employee that’s interacting with the organization. You can kind of in these four quadrants pick and choose based on your constituents what you think makes the most sense. Perhaps as one method of prioritizing the business case, you can rank these different scenarios across two dimensions, the financial or productivity benefits, taking into account the cost to build that scenario, as well as the cost-savings and then the brand value benefit on another access.

It’s not going to be perfectly scientific, and we’ll talk in a little bit about how certain companies are measuring return on investment of these mobile scenarios. You can start to plot different scenarios here on this quadrant and then identify perhaps scenarios that are ranked with lower financial benefit and lower brand value benefit or ones that you can de-prioritize, and scenarios that have a dual benefit perhaps are ones that you should tackle as low-hanging fruit.  Then pick and choose your scenarios accordingly.

Again, it’s certainly not a race against anyone else. I think healthcare providers, while there is certain degree of competition amongst each other, I think more importantly to present the best experience for your consumer. Being able to put together a phased approach where you pick a prioritized set of business processes that you want to mobile enable and then roll out over a period of time over a series of different releases is certainly a viable approach.

With respect to some of the features that are currently offered by most healthcare providers who have rolled out a mobile website, you see some of the data here. So the ability to find a doctor or physician obviously is something that’s probably highly requested by consumers but also relatively easy to provide, showing a calendar of events at the hospital allowing consumers to request appointments, and the list goes on here. I think this is a great example of scenarios that could be relatively easy to enable on a mobile website or mobile app, depending on your desire, but at the very least a mobile website so that as consumers are searching more frequently for mobile devices and finding websites, you’re presenting them with a mobile-optimized version of your website to be able to easily perform the most commonly requested functions, such as finding a doctor or requesting an appointment.

In terms of how these organizations are currently measuring return on investment, I thought it would be interesting to share some statistics on this.  Clearly, increased patient volume is the number one driver or benefit to this.  The return on investment is so clear that even if you were to spend six figures to put out a simple mobile website, even if you get one additional new patient a month, it will easily pay for itself many times over.

So there has been a very clear response, at least amongst the healthcare providers we’ve spoken to, that the return on investment has been a no-brainer here with respect to at least having a mobile optimized website. Many organizations are now, because of that positive benefit, looking to make significantly more investments and getting into looking at the return on investment, not just from an increased patient volume perspective but improved productivity for their employees within the organization and improved experience for patients pre, during, and post care.

All right. The next issue that we’re going to look at from a challenge perspective is HIPAA compliance and FDA regulation. I’m going to hand it over to April at this point to cover the HIPAA compliance aspect of the challenge.



April: Thanks, Richard. I’m just going to share these from the perspective of a business associate. Certainly, everyone will want to consult with their healthcare attorneys and HIPAA compliance specialist. These are a few things that have come to our attention as we’ve been working to fulfill our responsibilities to protect PHI and the healthcare industry. I don’t think anyone is surprised by the fact that mHealth is bringing an incredible amount of opportunities our way.  As Richard pointed out, the adoption rate is expected to be phenomenally high.  Already we’re seeing a huge adoption rate.  Next slide.

The interesting thing about the small portable devices is they’re incredibly convenient, and they’re also incredibly prolific and easy to lose, easy to misplace, easy to have taken. While we have endless opportunities in the mHealth space, we also have now endless end points that we need to secure. We’re seeing a lot of healthcare CIOs really taking an innovative approach to security, creating profiles that allow them to manage the security of many different types of devices within one or very small number of security profiles. So this is a very interesting potential for the development of these applications.

One thing that is taken into consideration when deciding if you’re going to create a mobile app that someone will download and install or if you’re going to do one that serves a website where if there is a security issue, it can be patched and remedied immediately. Next slide.

I think that the big realization here is that protecting PHI is a responsibility of not just the healthcare providers but also of all the business associates. We’re seeing that a majority of the records breached did involve a business associate. HHS and OCR are certainly taking steps to extend the chain of trust from the covered entities to the business associates. We really need to make sure that vendors are working together with the covered entities to make sure that no matter where PHI goes that it’s secure, available, and private. Next slide.



Richard: April, just to clarify, a business associate is really anyone in the supply chain, if you will, of the healthcare provider who is assisting with these types of solutions, correct?
April: That’s correct. Our understanding is that a business associate is anyone who may be storing or transmitting or processing the PHI information. I think in the early hours of the HHS wall of shame and people starting to get worried about these penalties, there was perhaps a tendency to look the other way and assume that not knowing was going to be an acceptable answer or claiming conduit. It’s not really our patients. It’s not really our data. Therefore, we’re not really a business associate. It’s pretty clear that OCR certainly does not take that position, so it’s proving to be less and less favorable for anyone to make the claim that they’re not a business associate.

Really, if you want to look at doing business in a win-win way, you want to make sure that you really understand the provisions of the HIPAA security rule and what your healthcare clients are up against and the standards they need to meet if you’re really truly going to serve that industry well.

So this is just a statement that was released recently by David Holtzman. He’s from the Information Privacy Division in OCR. He went so far as to state within the last few weeks if you use a cloud service – and the majority of the mHealth apps are served on a cloud platform – it should be your business associate. If they refuse to sign a business associate agreement, don’t use the cloud service.  This is very encouraging because the hope is that this will prompt both the covered entities and the business associates to really up their game and pay attention to HIPAA compliance. Hopefully, in the end that will drive the number of breaches down. Next slide.

The place where we were encouraged to start and are hoping that all business associates will embrace this is to really take a very close look at the HIPAA security rules. If you’re hearing 164.308, 164.310, and 164.312 and trying to figure out why IP address that might be, then you might want to re-read the HIPAA security rules. Those numbers identify the administrative, physical, and technical safeguard that are intrinsic to the HIPAA security rules. The very first one on the list and the foundation of all HIPAA compliance is conducting a risk assessment and creating a risk management plan.

As in all things software, it’s really tough to audit your own stuff. If you are the one who programmed that app, it’s really tough for you to QA your own stuff.  When we’re talking about medically-related apps, you could even say that it’s dangerous to do so. When we take that to heart, we wanted to invest in having an independent opinion on our level of risk for HIPAA compliance, and we’re hoping that that becomes more standard in the industry. Next slide.

Just for fun here, Richard, I’m going to launch a really quick survey here to see if any of our attendees are using medical apps in a healthcare setting, so we’ll put this up here just for a couple of minutes, and we’ll share the results with all of you at the conclusion of the webinar. If you take just a quick second, let us know whether you’re currently using any medical mobile apps. Then we’ll turn it back over to Richard.



Richard: Again, I’m certainly not a lawyer. You could have an entire webinar on the topic of FDA regulations of mobile healthcare apps. This is a new area. I think, in fact, April’s organization has run one of these before. I think we refer to it later on.  This is a very interesting development. There has been talk about the FDA regulating mobile apps, and what they’ve done now is they’ve actually proposed the draft regulation that proposes to oversee mobile apps that are either used as an accessory to an FDA regulated medical device or apps that transform a mobile platform into a regulated medical device.

Now, those are the technical definitions. I put together the Rich Mendis abridged version of assessing whether you’re subject to regulation or not. Again, as a disclaimer, please do obtain appropriate legal advice. I’ve also linked directly to the current draft of the regulation, which is ongoing and actually open for comments if you’re interested in commenting. Generally speaking, your mobile app may be subject to regulation if it’s connected to a medical device to display results. So it’s a physical accessory to a mobile device and displaying results from it. If it serves as an accessory of any kind to a regulated medical device – for example, there could be a medical device that’s capturing information, storing it on the cloud or a data center, and then your medical device takes that information directly and presents it – it could be subject to regulation.

If the app takes patient data or input and has some sort of algorithm that interprets that input and provides a recommendation for use in clinical decisions, it could be subject to regulation. Finally, if it uses some of the device features directly of a smartphone to gather data for a diagnosis, it could also be considered and FDA-regulated mobile device. These are kind of the general statements. I think how I would categorize this in kind of general statement is if the app takes in data gathered directly from a patient or monitoring device, provides information about it, it could be regulated, or if it takes in data, interprets that data, and provides suggestions for diagnosis or some sort of curative suggestive, it could be subject to regulation.

Now, that’s actually pretty narrow if you consider the wide variety of different types of mobile apps that are out there from a healthcare perspective today. For example, apps that are considered outside of regulatory scope – for example, apps that provide reference content, so something that provides information from a textbook or frequently asked questions or other healthcare-related content, apps that provide suggestions related to general health and wellness.  Again, generally speaking, if it’s providing preventative suggestions or guidance versus curative suggestions or guidance, you’re generally considered to be safe.

For example, the many different mobile apps and accessories that track how fast you run, how much you lost, how frequently you wake up at night, those are generally considered to be related to general health and wellness as opposed to for clinical decisions and diagnosis. Also, all of the apps related to automating office operations within a healthcare provider or a health insurance provider – for example, billing, administrative, check-in, patient registration, apps that are patient spacing for productivity, for example, reminders. These types of apps are generally not considered subject to FDA regulation. The mobile website, for example, for healthcare providers to help people find physicians, schedule appointments, etc., are not subject to regulation.

Finally, apps that function or supplement electronic or personal health record systems are also not subject to regulation. Even though the FDA is talking about regulating these apps, realistically speaking, the scope of that regulation applies really to apps that are acting or supplementing the existing regulated mobile medical device. There are a lot of scenarios where you don’t have to worry about it. Now, if you do feel that you are subject to regulation, again, keep in mind that this regulation is in draft form. There are different FDA requirements based on the device classification. In many cases, you’re typically a class three medical device. There are specific applications you can file to be approved. If not, there are other options or different pathways to figure out how you get regulation from the FDA.

You’ll certainly have to work with an organization that can walk you through this process and consult your lawyers, but it’s not an insurmountable path. Certainly, I’d be surprised if for most healthcare providers, any of their apps fall into this classification. Key takeaways from this section: there is an explosion of mobile health of mHealth apps, but there is still an opportunity for healthcare providers to build patient spacing or physician spacing self-service apps and mobile websites. There are multiple potential business benefits to do so. HIPAA compliance and FDA regulation may apply, but there are plenty of guidelines and options on the HIPAA compliance side to make sure that your vendor is okay with signing this business associate agreement to ensure that they are providing you the best option for data protection and transmission. Then from an FDA regulation perspective, ensuring that if you do fall into one of these regulated devices, that you follow an appropriate procedure and file for the appropriate registrations.

With that, we’re going to move on to the final topic, which is the technology challenges. This one, again, is something that you could dedicate a whole discussion to, but I’m going to kind of cover the highlights, and then we’ll open it up for questions.  Some of the mobile enablement challenges today from a technology perspective is there is significant mobile fragmentation.  If somebody says, “Look, I just want to go roll out a mobile app for the Android platform,” that sounds a lot easier said than done because when you look under the covers as to what specific Android app forms you want to support, you’re going to find extreme fragmentation in terms of which versions are available or being used by consumers in the market today.

There are new devices and new operating systems being rolled out.  In many cases, if you want to roll out an app that works on multiple platforms, such as Android, iPhone, and let’s say HTML5, you typically would need specialized development skill sets for each platform.  There are also nuances of mobile design itself.  You’re not simply trying recreate the experience that you get on a desktop and shrink it down to a mobile device.  You want to go through specific design patterns and apply best practices around mobility guidelines to ensure that it’s a positive experience and a productive experience when somebody is using your mobile app.

Finally, building it once is just the tip of the iceberg.  You’re going to have to maintain it on an ongoing basis, add features to the application, troubleshoot it, etc., and so your total cost of ownership, it’s important not to measure that just based on the initial cost but also on the ongoing deployment and maintenance of that mobile app.  There are three are four main approaches to doing this in the market if you wanted to develop a mobile app.  You could outsource it to a services firm, which gives you a lot of flexibility and low impact to your [inaudible 00:42:06] organization but has a high total cost of ownership over time.

You could outsource it to a mobile solution vendor.  This is somebody who may already have an app built specifically for the scenario you’re looking at, which will help reduce the cost significantly.  Then as you branch out to other requirements, you’re going to have to go find someone else to build new capabilities.  You can custom build the app in house, which gives you complete flexibility and control.  If you’re custom building it, again, it requires a lot of resources, time, and cost.  You can learn from some of the experiences of the early adopter businesses in other industries, and what they’re doing today is they’re adopting what’s called a mobile application development platform.  In some cases, it’s called a mobile enterprise application platform, which allows them to define the app once using a simpler easier to learn drag and drop environment and then it automatically deploys the app across multiple platforms automatically.

This gives you a lot more flexibility in terms of managing the development of the app and more control, but it requires a lot less IT resources and overall cost of ownership.  It’s expected that within a couple of years 40% or more of the Fortune 1000 will have deployed mobile application development platforms because of the immense benefits associated with it and the importance of mobile apps for multiple scenarios within a company.

Some of the problems that these mobile app development platforms help solve are the ability to assemble once and deploy to many devices.  They include a lot of the mobile best practices.  As you build or assemble an app in the platform, there are a lot of inherent [inaudible 00:44:00] best practices.  They provide a lot of stability to integrate with existing data sources within the organization.  It helps also reduce the cost then and time and resources involved in maintaining and deploying that application once you’ve completed the initial version.

Key takeaways here: There is device and version fragmentation within and across mobile platforms that could result in unforeseen costs.  However, these costs are manageable and maintainable through this new kind of market space, if you will, of mobile enterprise platforms that help reduce the total cost of ownership over time, especially as you have multiple mobile projects that you’re working on and maintaining simultaneously.  With that, we’re at about a quarter or 10 to the hour.  I’m going to pause here and open it up for any final comments from April or questions.

April: Richard, I’m going to address a couple of the questions that were submitted during the presentation.  One is a very perceptive question that healthcare or HIPAA compliance requires 100% availability of patient medical records.  This is a really important part of HIPAA compliance that I think a lot of people are not aware of.  Most people focus on the privacy and security of protected health information.  If you look at the three core tenants of HIPAA compliance, availability is one of those three.  The good news is that cloud affords a very unique potential for accomplishing the high availability.

We can actually accomplish warm site disaster recovery architectures that were simply not affordable and very difficult to maintain, even a few years ago with a traditional server model.  Any time you have a natural disaster, no matter what form your medical records are in, whether they’re paper or whether they are in the cloud, it is absolutely essential that you have an off site backup of all of those records.  Being able to connect clouds together and synchronize that data incrementally day to day is a very important strategy for making sure that that availability is maintained.

For healthcare providers, you want to look to the natural disasters that are intrinsic to your area and find out for your specific area how far away you would need to have an off site disaster recovery facility and make sure that that’s on a separate power grid so that in the event of a natural disaster, even though there may be issues of re-establishing connectivity, at least those records are up to date and at the ready for anyone who is able to connect online.  Excellent question.

Richard: April, I would add one thing to that.  If you are evaluating mobile development platforms along those same lines, ensure that the vendor provides you with the flexibility either to deploy into the cloud or to give you the ability to take the run time application and back end and host it in your own private data center or cloud as an option.  I think it’s important to make sure that you pick a vendor who will provide you with both options.


April: Any other questions out there?  I know we had a similar question here about EMR implementation, about the availability of the patient record.  I think that we touched on that.  Thank you for joining us.  Rich, if you would, we can share with everyone the upcoming webinars.  In August, we have two great webinars that are scheduled.  On August 7th, we will have Chris Mitchell, a member at Dickinson-Wright who is a specialist in intellectual property specific to the medical and healthcare space.  Chris will give us an overview on the most important things to keep in mind when we’re talking about protecting intellectual property for medical devices.


On Tuesday, August 14th we’ll be joined by Tom Gomez. He will share with us how he used cloud based technologies to achieve meaningful use on a $0 budget. Tom has done some amazing things in the free clinics at Florida. I know you’ll all be anxious to learn how he has managed to do what he has done. Thanks, everyone for joining us. It was a pleasure having all of you. If you have any further questions, we will post contact information for both Rich and myself at www.onlinetech.com/webinars, and we’ll send all of you a link to a recording of this webinar as soon as we have it posted for you. Thanks again. Thanks, Rich.

Richard: Thanks, April. Thanks, everyone.


rmendis headshotRichard Mendis, Chief Marketing Officer and Co-Founder of AnyPresence

Richard Mendis is the Chief Marketing Officer and Co-Founder of AnyPresence. Before co-founding AnyPresence, Richard spent over 16 years in the software and information services industry. Most recently, Richard was Vice President of Solution Management at SAP, where he led product management of SAP’s carbon and energy management suite. Richard joined SAP through the acquisition of SaaS startup Clear Standards, where he was co-founder and CMO, responsible for marketing, product management, and business development.

Before that, he was Vice President of Marketing at Current Analysis, a leading competitive intelligence firm in the mobile telecommunications sector, where he launched the company’s web commerce channel. Richard has held senior roles in product management, sales consulting and professional services at Siebel Systems, and worked at software development startup Saratoga Systems.

Richard is a member of the Society for Healthcare Strategy and Market Development (SHSMD) of the American Hospital Association. He holds a Bachelor of Science in Computer Science from the University of Toronto.


April Sage, CPHIMS, Director Healthcare Vertical, Online Tech 
April Sage has been involved in the IT industry for over two decades, initially founding a technology vocational program. In 2000, April founded a bioinformatics company that supported biotech, pharma, and bioinformatic companies in the development of research portals, drug discovery search engines, and other software systems.

Since then, April has been involved in the development and implementation of online business plans and integrated marketing strategies across insurance, legal, entertainment, and retail industries until her current position as Director Healthcare Vertical of Online Tech.

Contact:  asage@onlinetech.com

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