While there is plenty of hype (and some good old fashioned chicanery) around mobile health applications, real change will come from system-wide deployments. In most countries, these efforts have failed to reach nation-scale. After some trial and error, Clalit has found success in Israel through what Dr. Bahagon describes as a five layer approach:
1. Personal health Record Layer (what the patient SEES): Medical history, diagnoses, allergies, vaccinations, laboratory results, hospital discharge letters etc. All medical terms are accompanied by explanations with suggestions, called an information prescription (Ix). Each Ix is reviewed by 2 different experts and "translated" into layman''s language by a medical linguistic editor.
2. Personal Knowledge Layer (what the patient KNOWS): Personally tailored preventive medicine and health recommendations, such as mammography and lipid profile screening recommendations, based on sex, age, medical history and previous medical tests. Recommendations are in textual, visual and interactive formats to increase patient engagement. Compliance of users exposed to this layer was 63% higher than for patients informed by traditional means.
3. Personal Health Services Layer (what the patient DOES): Patients carry out their own administrative and clinical self-service, giving patients the ability to refill chronic prescriptions, get medication and refill reminders. Preliminary studies have shown that using mobile medication reminders improves adherence rates by 80-85%. Patients can e-consult a physician or other medical professional either via 1-on-1 asynchronous platform or for pediatrics, by means of real-time video conference. Currently more than 8,000 synchronous e-Visits are done per month, from more than 900 locations, reducing unnecessary ER visits by 47%.
4. Remote Patient Monitoring Layer (personal metrics the patient MONITORS). This layer takes a proactive approach to health promotion and chronic disease management. Sensor infrastructure, paired with mobile apps and wearable bio-sensors, allow remote physical examination, monitoring and broadcasting of various physiological measurements such as physical activity, food intake and sleep patterns.
5. Hybrid Layer (Integrating offline and on-line care). The Hybrid layer brings more medical services to patients in their homes. Some examples:
a. Wireless, vital-sign sensors, transmitting patient data for professional interpretation
b. Home-lab offering comprehensive lab services (such as blood & urine) at the patient''s home
c. Interactive digital pillbox, addressing the issue of non-adherence
At Clalit, applying this Hybrid-Health holistic approach yielded a reduction of more than 15,000 hospitalizations days per year (YOY) in a population of 74,000 patients aged 65-85 years old. The direct financial ROI for this layer was around 350%.
The United States has colossal challenges facing its healthcare system. Obamacare provides explicit incentives for health providers to offer eHealth services. Israel’s experience in digital healthcare can be a valuable reference.