Integrating #mHealth in the health care process #3

Today’s subject I’m writing about is related to what I consider implies to square the circle, on the issue that concerns me in this post: “The integration of the #mHealth into healthcare processes in hospitals”.

In the first two posts on this subject I spoke about the #mHealth project we launched a few months ago in the Hospital. We are working on a particular treatment process, the diabetes, and since my last post till now, we have continued to advance and mature the steps slowly towards our final goal.

The current project situation challenges us to close the circle, and try to connect two dimensions, patient’s and professional’s dimensions virtually and forever.

Two dimensions which until now have always been connected to the physical level, in the outpatient clinic, emergency room, hospital day … Where the doctors are sharing information with patients regarding their health, complex information for the receiver (patient and / or familiar), who receive it in a very delicate emotional state at times, which greatly limits their ability to understand.

mHealth Cloud Relationship 2 Dimensions

The connection of these two realities, the healthcare professional and the patient goes beyond an App integrating information with a hospital information system. Giving access to the patient to his information in his medical history, agenda visits to the doctor or the results of diagnostic tests, etc, is an objective as well.

The challenge is that all this information flow safely and naturally between the two dimensions. There should be a meeting point where everything will be integrated, organized, prepared to be accessible to every user, whatever is the dimension he belong to. They must be able to access such information at any time and anywhere…

“Because ultimately, the information is unique, the owner is the patient and recipients are multiple professionals.”

At this point I want to refer to a post I posted 10 months ago about our Intranet, which on May 26, 2015 completed its first year.

In that post I talked about the implementation of the Digital Strategy of Hospital Clinic, and the relationship between the Intranet and the Web.

Knowledge Sphere Dimension ENG

Our Web is what I dare to describe as the cornerstone of the project, because from a strategic perspective, this should be the connection platform for both dimensions I just mentioned.

Our new Web is where we want to make available to society in general, our knowledge of health, identify each of the diseases we treat, the various moments that patients go through, and prepare appropriate information to their expectations.

We are convinced that the need for information and how it is to be presented at each time, is very different for a person who’s just been diagnosed with diabetes, than for a diabetic with 20 years of experience living with his disease.

They are diametrically opposite profiles that require very different approaches. And it is between these two extremes, where we find different moments throughout the care process, where we identify how these needs are different from each.

About how we are working on the content we will provide to our visitors in the future Hospital Health Portal, I will write in a later post.

We are working a methodology side by side with health care professionals, based on this concept that I’m describing, about the moments throughout the care process, and information needs, taking into account important aspects such as language, formats or even emotions

Finally, to achieve our objective of integration of the #mHealth in the daily clinical practice we must land the projects and approach them more to everyday reality.

We’ll NEVER take advantage of the full potential that this new technology gives us, if we don’t incorporate it from the strategic level in the organizational approaches, and obviously if we don’t invest resources and efforts on this landing.

In response to what “Speaking of health blog” explains in his latest post about e-Health: It’s a matter of Projecte or Strategy talking about Health 2.0 European Health Congress 2015. From our point of view, we understand that this should be encouraged and supported inescapably from the highest management level.

Health 2.0

To conclude today’s post, expose that to achieve squaring the circle implies to go through successfully achieving our goals in the different issues on which we are working and we aspire to connect:

  1. The Health Portal content = Information available to everyone, didactic and pedagogical, but with different levels of information according to each patient’s time in the process.
  2. The Patient Portal content = Information for our patients and their needs throughout the care process, operational, practical and to help, facilitate and improve your experience as a patient in our hospital.
  3. Transactional information to share with our patients (HCE, Agenda tests, results, diagnostic information processes…).
  4. The integration of information generated by patients and their mobile or wearable devices.

Only when these four aspects have been solved, connected and systematically integrated and ubiquitously accessible by those who need to meet their health-related needs, we’ll think we’ve started to take advantage in an efficient and integrated way into the healthcare processes all the potential that #mHealth already offers.


Google Analytics and e-Health a very promising relationship

With today’s post I will open a new subject on which I try to write on, and on which, so far, few have dared to do so.

After learning the full potential of Google Analytics (GA) offers us, especially in terms of e-commerce / online shopping is concerned, I can think of other dimensions in which this analytical capability that gives us this tool can provide and lots to our sector.

2 ideas:

  1. Use web analytics to certain highly prevalent chronic diseases and to find the way to relate the consumption of information about their illnesses with their visits to existing healthcare services first level (Devices Emergency and Primary Care Centers).
  2. Aim the tool to analyze whether the information provided by the hospital through its Health Portal impact on the reference population of the territory and access to the system.

In relation to these two ideas, I wish to consider to what is currently happening in the field of e-commerce, and as shops on line monitor their traffic, track URLs (URLs tracking) and identify user profiles and buying habits for tuning the most of their marketing campaigns, whether through SEO or SEM.


And I wonder … Why not use these same tools to work on improving health in our territory?

That is, on one hand, and related to the first idea, analyze the traffic it receives from the hospital the web to identify health issues that concern people who visit us. If you know Med Line Plus, is a good example of what I want to explain. When you visit their website, one of the things you see is a Cloud Tag of the most viewed topics. This gives you an idea of where the “trending topic” health at that time. For example, in September with the theme of Ebola, the label with this name was by far the largest.

MedLinePlus Cloud Tag

Following this logic, when we launch our Web Portal of Health, we intend to work with web analytics to identify disease outbreaks based on visits to our site, and location. The next step is to link these results with concrete actions on the territory, in coordination with primary care.

On the other hand, for some time I have been thinking how to apply the SEM to improve health in our sector. Initially when I was told to do SEM from the hospital, I thought there was no point, even though, after analyzing it calmly, I saw that it might be another way to invest in health and prevention, to anticipate the consequences of a disease not detected time.

Investing for ads about preventing a disease or detect it early, or how to identify symptoms, surely impact in improving the health of the population and indirectly reducing cost of care treatment in most acute phases.

Definitively, everything I said in this post, I can explain it in financial terms, which ultimately are largely those rules governing the world.

We propose that by investing in a Web Portal for Health, as well as in SEO and especially in SEM, and measuring their return on impact on health, like for the economists is the Return On Investment (ROI), we can name it as the Return on Health or ROTH.

It is therefore essential to work and exploit the full potential we see with Google Analytics, and focus it to measure this ROTH and show how it is worth to invest in prevention from quality-oriented information to patients and users of our hospital or any hospital wherever you are.

HIV care process from Telemedicine to # mHealth

In this post I want to share with you an example of a healthcare reality which is taking advantage of all the potential of new mobile technologies on which I speak since I started this blog, for a long time.

I recently had the opportunity to learn in detail how is organized the process of care for infected patients by human immunodeficiency virus (HIV) in the hospital where I work, the Hospital Clínic of Barcelona.

“The Clinic is the referral hospital for a large part of the city of Barcelona, specifically for Integral Health Area of Barcelona Esquerra, comprising a total of 4 municipal districts with a population around 500,000 inhabitants”

I can assure that this care process is one of the pioneers in implementing new technologies on patient care, and therefore allows me to illustrate and argue in this post, something that I’ve been thinking and now want to share with you about #mHealth.

“I think it’s already clear that #mHealth is the natural evolution of telemedicine, hence probably many healthcare processes have been supported in the latter, naturally will evolve towards a virtual dimension relying on Apps, Mobile Websites or Responsive Websites, and substantially will improve access for end users, allowing them the gift of ubiquity and almost total connectivity.”

HIV care process

Nowadays, HIV infection, which is the cause of acquired immunodeficiency syndrome in humans, is considered a chronic disease, thus requiring prolonged follow-up time of those who suffer.

This disease can be diagnosed from different levels of care, primary care, specialty care or hospital care or from non-governmental organizations related to it.

When a patient is diagnosed with HIV in our care area, it is referred to the Hospital Clínic where makes a first visit with a specialized nurse. She is responsible for making the debut process. It is a patient oriented education visit in the management of their disease, which opens the clinical history, and where the steps to follow are very protocolised. The visit ends up with the demand of, following the protocol, the established medical tests ahead of the visit to the doctor 15 days later.

With the medical tests results, the doctor visits the patient previously to begin treatment and monitoring in the Day Hospital. Once it is considered that the patient is already autonomous in managing their disease (after 2 or 3 visits), the possibility to include the patient in the process of virtual monitoring through the platform of virtual Hospital is considered.

Schematically the process would be something like this:

HIV Assistential Workflow

It’s at this moment when everything starts changing, from now on the patient goes into another assistential dimension, allowing it to have the support of a multidisciplinary team of professionals and to access information about their pathology, or even if the patient need it, he can get in touch with other patients to share their concerns, questions, etc …
The communication between hospital and primary care is essential in the management of chronic patients. So far in our country, the care of HIV-infected patients has been performed only in hospitals.

However, patients have new needs (simplification and integration of care) and health systems too,  having to cope with an annual increase of 10% in new patients.

According to these premises, with political approval and mimicking what was done in other chronic diseases, the Shared Care Unit of HIV-infected patients (SCU) in chronic stage of their illness (most of them) was created by the Hospital Clínic’s infections service and three primary care centers from the Integrated Health Area fo Barcelona’s Eixample Esquerra (CAPSE Les Corts, Casanova and Borrell).

The SCU’s physicians (both primary care and specialty care), rely on the Virtual Hospital, a computer system through which all of them share the same electronic records and relevant information for patients.
Between 2005 and 2007, a prospective case control study was performed during 1.5 years with 30 patients, with results regarding clinical parameters similar to hospital standard control. This unit has been expanded to other primary care teams in Barcelona as are the South Raval, and is planned to do the same in the 4 centers also within the AISBE.

Web Pacienten Hospital Virtual VIH

From Telemedicine to #mHealth

The Virtual Hospital, in addition to health care activity that supports, also allows developing activities such as Teaching and Research.

For Teachers standard platform is used for online sessions with different health centers territory if possible. If not, the medical team moves to the center for clinical meeting in person.

In terms of research, the database on which the program activity develops, enables the approach of research by providing a significant amount of information.

In terms of usability, the Virtual Hospital provides professionals 96% of the information they need about the patient on one screen, making it possible to access 100% of the information by opening additional tabs.

Briefly it is about a Shared Care Unit focus on patients with HIV, where different levels of care are coordinated through the Virtual Hospital System. This is additionally complemented by the possibility of face to face visits if estimated necessary.

Usually, the patients included in this process are visited twice with their referring physician at the primary care level, and another visit with a physician at the hospital level annually.
Being able to visit patients virtually by hospital specialist, has a very positive impact on productivity thereof, attending a volume of patients near the 20 patients in two hours of consultation.

The final objective of this new healthcare dynamic so innovative, is aimed at helping these patients to keep a good control of their disease, which otherwise would impact negatively on their health and those around them.

What I just explained is a reality that has been operating in the Integral Health Area of Barcelona Esquerra since 2010, which can be defined as pure Telemedicine.

However, as expected, this medical team is still working to improve daily this care process, and they are actually working on the jump to #mHealth, which obviously involves the development of a APP focused on patients involved and followed through the Virtual Hospital, empowering them with the ubiquity and the 24/7/365 accessibility and providing them in the near future, the possibility to carry wherever they go, their the Vitual Hosptial’s team ;-D.



Right Care Values

I want to share with you a video in which production have participated professionals from my hospital .
I think it is a good resource, more oriented to professionals and students, but it can help many patients to understand that when it comes to assisting people to solve their health problems, NOT ALWAYS MORE IS BETTER.
Here you have a video of seven minutes which sets out the arguments and provides tools and resources for those who want to incorporate it into their clinical practice.
By the way, the video is in Catalan but subtitled in English and Spanish.

4 key issues about the evolution of the Mobile Health (#mHealth) in 2015

Once more it has arrived the time of writing the end of 2014 and 2015 opening post, the traditional post of trends or key issues from a blogger’s point of view who enjoys writing and sharing it with everyone.

As far as I’m concern, over 2015 Mobile Health (#mHealth) will experience significant changes in 4 aspects closely related, within the context of public health in which we are in Spain:

One aspect that will highlight this evolution is the process of integrating information generated from patients through their mobile devices (Smartphones, Wearables, Laptops …) related to their diseases. The definition of key indicators by healthcare teams will be very important in this process, which will open new dimensions of improving both the quality and capacity of public hospitals with the same resources available aspect.

Integracion mSalud en PA

  • Beyond the physical dimension:

This integration will precipitate a phenomenon that until relatively recently it could seem complex to achieve. This is approaching the assistencial process and knowledge of doctors working in health centers beyond the physical structures of the Hospital. The integration of #mHealth into hospital’s Information Systems will mean that the surveillance which is subjected a patient in a hospital, can be made, somehow, remotely and ubiquitous to certain patient profiles.

  • Improved productivity and quality of care:

This integration of information will enable, without an increase in resources available to hospitals, without increasing the workload of professionals and with the same number of care hours, a greater number of people indirectly assisted without the need of coming to the hospitals and healthcare centers, because they will be monitored by their reference centers in return for a single thing … their commitment and engagement.

  • Web Analytics will work for health:

Web Analytics is a relatively new field, the first application has been doing in the field of e-commerce.

However, the great potential that it hoards, opens endless possibilities if we apply to our sector, aimed at improving the relationship with our reference population and health campaigns are directed towards her goals, nevertheless we could point to more ambitious goals which I expect to write about all along 2015…

Finally and to close the post I think it is important to clarify that these trends I just shared with you are clearly framed in a context of public health, which I consider to be the most benefited from the arrival of #mHealth to our sector.

I think the private sector in this regard must still wait to see how this new dimension of providing healthcare will fit with their business model. However, I think there are already many opportunities to apply the #mHealth in both sectors, with the only difference of the results it can be expected in each case.

Happy new year and I hope 2015 will surprise us on #mHealth related issues :-P.

The Clinic will create the first Public Hospital’s Health Site

Last November 26th was a very special day for me due to two reasons. Personally because I turned seven years working in the Hospital Clínic of Barcelona, for me the best of Spain in many ways, and where I have the opportunity to participate in important projects for the hospital itself and the public health system.

Professionally, because that day it was presented one of the projects in which I participate and that will set a turning point in the digital world and access to health information by Latin citizenship worldwide.

This project is the Hospital Clinic’s Health Site powered by an alliance between the Hospital Clínic of Barcelona and the BBVA Foundation, which began its gestation at that moment and plans to see the light throughout 2015.

Logo ABC Logo Atlas Agencia Logo El Logo La Informacion

Besides everything said in the press, I want to emphasize something that I see is very innovative in the digital world.

The main objective of this project is to provide quality information to any Latin citizenship wanting to improve their knowledge about their health.

Quality information generated by a team of professionals whose job is precisely to solve those problems, and also will worry about sharing their knowledge available to citizenship in a comprehensive and pedagogical language.

Being the first “Health Site of a Public Hospital”, supported by a referral public hospital of the Spanish public healthcare system, with a non-profit and completely altruistic vocation.

I invite you to follow up my blog during the gestation of this great project.

Integrating #mHealth in the health care process #2

Analyzing the process of care for diabetic patients from A to Z

Continuing with the series of posts dedicated to the project we are working from our hospital, today I’ll focus in a little more detail about the methodological approach we are following to identify the best alternatives for addressing this integration.

The first goal in this phase is to describe the entire care process, from beginning to end, so first identify which are the one or more entry door(s) for patients in the diabetes care process beyond wherever it occurs, and secondly identifying individual patient profiles and his life style from medium to long term.

Given the nature of our health system (Catalan Health System), and this disease’s peculiarities, most of diabetes diagnosis occurs at the primary care level, by the physician, in the case of adults, and the pediatrician for younger patients.

Diabetes Diagnosis

Another possible entry door is occurring more casually following medical examinations and analyzes requested for other purposes, company health reviews, to enter gyms, health coverage hiring health insurances … that crop suspicious results derived in a diagnosis of this disease.

From here on, we performed a detailed description of the different profiles of frequently patients, depending on the type of diagnosed diabetes.

Type 1 or Type 2 in its two possible variants, complex and say less complex or normal. The latter is one that can be handled by the General Practitioner (GP) without too much trouble.

Another level of analysis required, is to know in detail what are the actions that take place during the first year after being diagnosed with diabetes, and how is the patient follow up after the first period.

The differentiation between the year in which the patient “debut” in sickness and the following is very important in this type of pathology. It is in the first year, when the patient is educated in managing their illness, so they can live a life as normal as possible under the circumstances of this chronic disease.

Image from Canal Diabetes

Imagen obtenida de Canal Diabetes

Therefore, this step is very important for the subsequent management and monitoring of the disease, because it will largely determine the likelihood that in the future this patient can be monitored from the hospital relying on any of the existing devices today.

This is another important point to work together along with the cycle of life of patients and types of devices necessary for the management of the disease, as they will be crucial in the design of this project and decisions arising from this.

It is in this sense that we’ll zoom in deeply once we have well drawn the whole process in detail.

This description allows us to identify the impact on the hospital’s information systems of the information we decide to incorporate and provided by patients’ devices registered daily and ubiquitously.

Define which indicators should be systematically feed and register in the hospital’s information systems from mobile devices will be one of the key issues to be decided by the medical team.

I invite you to read my next post to continue analyzing exhaustively the process as the project evolves.