Health IT glossary

CIO.com's health IT glossary provides definitions and information for many terms used in the complex field of healthcare-related information technology and management systems.

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Health IT glossary: Mobile health and telehealth

Apple HealthKit. A mobile data aggregation platform, HealthKit is interfaced with some widely used EHR systems. Patients can send their mobile data to HealthKit, view it there, and authorize sharing of the data with their providers. Healthcare organizations have begun to use HealthKit in different ways. For example, Cedars-Sinai is asking patients to tell their physicians what they’re interested in using the data for. Duke Medicine, in contrast, is focusing on specific conditions, starting with heart failure. Duke has connected HealthKit with the mobile app for its patient portal. When a doctor wants to monitor a patient, he or she sends that patient a message saying that HealthKit is available. The patient can then authorize access to the data on his or her smartphone, and the physician pulls it into the EHR.

BYOD (Bring Your Own Device). Since the advent of smartphones and tablets, more and more clinicians have been bringing them to work. BYOD has created concern among hospital administrators because of its security risks. Some healthcare systems allow doctors and nurses to use only hospital-supplied mobile devices when they are on the hospital campus. Others allow people to bring their own devices but prohibit them from storing protected health information on them. Nevertheless, clinicians have discovered that the easiest way to get one other’s attention quickly is by texting their colleagues. To address that trend, a growing number of hospitals have adopted secure texting systems.

eICU and telestroke. Both of these terms refer to the use of remote monitoring technology to provide appropriate staffing to understaffed areas of community hospitals. In an eICU setup, a critical care specialist in an academic medical center or a remote monitoring center can track patients in another hospital’s intensive care unit, using both monitoring data and remote cameras. Some organizations have used this strategy to reduce costs and improve patient outcomes. Telestroke systems allow neurologists to diagnose strokes remotely in time to order life-saving “clot buster” medications. The neurologists review and interpret CT brain scans that have been stored and forwarded, and they examine the patient via videoconferencing. In some systems, robots with cameras wheel up to the patient’s bed, allowing the examining physician to make more accurate observations.

Mobile health. Mobile health, also called mHealth, encompasses mobile devices and applications used in healthcare. In this context, mobile devices include smartphones and tablets, as well as add-on devices. In some cases, smartphones can be converted into medical devices, such as an ECG or a stethoscope. Alternatively, they can be used in combination with add-on devices such as glucometers that transmit data via Bluetooth to a smartphone app. The overwhelming majority of mHealth apps are designed for wellness or fitness, such as diet and exercise apps. Consumers use most of these by themselves, but some apps allow users to share information with friends and family. Apps for monitoring chronic diseases have yet to gain much traction, mainly because most physicians are not yet willing to review the data. But some physicians are beginning to prescribe mHealth apps to their patients.

[Related: Can you trust your healthcare app?]

Mobile-native EHRs. Some vendors provide either full mobile-native EHRs or apps that supply limited EHR functionality. One vendor’s mobile app, for example, allows doctors to retrieve visit notes, view diagnosis and medication lists, write prescriptions, and send secure email. The small screen size of smartphones and the clumsiness of onscreen keyboards are barriers to mobile EHRs. But speech recognition ameliorates the keyboarding issue in some of these EHR versions. Although there are mobile-native EHRs for Android tablets and smartphones, physicians favor iOS devices.

Remote patient monitoring. Remote monitoring can be done via mobile apps or with home monitoring equipment. Nevertheless, most pilots of this technology have focused on home monitoring. Remote monitoring has been shown to have health benefits for patients with congestive heart failure (CHF), and many hospitals are interested in using it to prevent CHF patients from being readmitted. Some healthcare systems and health plans are also investigating the use of home monitoring in treating chronic diseases such as hypertension and diabetes as part of population health management. As noted earlier, most physicians are still not ready to accept data from mobile chronic disease apps. Few of these apps have been tested or approved by the FDA. Moreover, clinicians need better screening mechanisms to filter relevant data from the mobile data streams.

Secure messaging. Patient portals can be used for secure messaging between physicians and patients. This technology, which goes back 15 years, usually requires patients to visit the portal to view their messages; in some cases, they may receive emails saying that a message from their provider is waiting for them. Patients can also use portals to ask questions about their health conditions, their care plans, or how to take their medications. Some physicians have discovered that patients don’t always check their messages on the portal, so they send them text messages.

Telehealth.Telehealth, sometimes called telemedicine, encompasses virtual visits, remote patient monitoring, and educational and support applications. There is a lot of overlap between telehealth and mHealth; however, telehealth includes home monitoring of health conditions, as well as online consultations and support materials that can be accessed on desktops and laptops with Internet connections. None of this has yet joined the mainstream of healthcare. But it is believed that the shift to value-based reimbursement will change that by paying doctors for non-visit care. Some experts predict that telehealth will change how healthcare is delivered. Not only will it reduce the number of unnecessary office visits, they say, but it will also allow doctors to monitor their patients’ health continuously.

Virtual visits. Remote consultations, as noted earlier, have been growing rapidly and no longer just involve patients and physicians in rural areas. In recent years, many health plans and employers have contracted with telehealth services that provide 24/7 access to physicians via phone or video chat on smartphones and desktop/laptop computers. These can be combined with photos of relevant portions of the body. While the medical establishment opposes allowing doctors to diagnose and prescribe remotely to people they’ve never met, some healthcare organizations have quietly begun offering virtual visits to their own doctors’ patients.

Wearable sensors. One of the fastest growing areas of mHealth, wearable sensors track everything from activity to vital signs such as heart rate, metabolic rate, and heart rhythms. These sensors may be imbedded in wrist bands, chest patches, or other kinds of devices. Consumers use these wearables and their associated apps mostly to track their own health, but they could also be used for continuous monitoring of people with chronic conditions. As with add-on devices like glucometers and digital blood pressure cuffs, some wearables use Bluetooth to connect with smartphones. The consumer can then view the data and/or upload it to a data center in a healthcare organization.