Global Lab for Innovation Innovation Profile Mobile Care Delivery Systems Mobile Care Delivery Systems, also called Mobile EMRs, are telemedicine platforms used by Community Health Workers to support their supervision by clinicians while working in the community. One study reported lower administrative costs, and a savings of 80% per case. Summary Application Profiled: ClickMedix Category Documented, Focused Savings Level 2 Access Experience Application Profiled Here: ClickMedix Engagement Outcomes Barriers Regulatory Technology What it is Mobile Care Delivery Systems are telemedicine platforms that enable physicians to manage community health workers during their interventions with patients. Most models can be accessed through mobile telephones, tablets, or computers. New Workforce Investment $ to $$ Training Significant EMR Integration Required Potential for Spread User Sites 14 countries Problems addressed Shortage of clinicians and lack of physical access for patients in remote rural or inner-city areas. Community health workers who see patients in their homes or at community sites are restricted in their ability to manage patients efficiently because they must meet with patients, then return to the clinic to review cases with supervisors, obtain treatment plans and then return to meet with patients. High transportation costs and lost time for community health workers to travel back and forth to patients. Patient follow-up may be lost or delayed in later visits with patients.
How it works Community health workers use a mobile care delivery system to consult with supervising clinicians who can diagnose and determine a treatment plan based on information transmitted through the mobile platform. With information including photos and video recordings of the patient, supervising clinicians including physicians, nurses, or pharmacists can direct health workers to initiate care immediately, avoiding delays in treatment. Some platform models include patient assessment protocols and a library of standard treatment plans. The platform stores patients clinical information, thus serving as a mobile EMR. In some systems the mobile unit merges patient information and treatment updates with the delivery system s electronic medical record system. Savings are achieved by: Increasing the number of patients that clinicians can treat and manage within a span of available office hours. Increasing the number of patients that a community health worker can see in a day because some cases that would require multiple visits for diagnosis can be handled in one visit. Reducing travel costs for health workers and patients. Reducing patient wait times for specialist consultations, thus incurring savings from earlier detection, correct diagnoses and treatment. Innovators ClickMedix was founded in Boston in 2010 and now has headquarters in Washington, DC. ClickMedix was used in developing countries to facilitate specialist consultations through a community health worker. Some of the conditions treated by community health workers supervised by a specialist in developing countries include: diabetes, cardiac conditions, dermatology, ear conditions, and dementia. ClickMedix also has developed applications for use in the United States. In May 2014, ClickMedix announced a collaboration with the Western Diabetes Institute of Western University of the Health Sciences in which ClickMedix will be used on mobile phones and tablets to facilitate remote diagnosis and treatment of diabetes. ClickMedix will also be used for remote training and supervision of aides, nurses, and health workers. 2 ClickMedix also has designed an Alzheimer s program and applied for funding from CMS (Centers for Medicare and Medicaid Services) for support. 1 ClickMedix also has companion products including Click-Training, which is used by medical schools for training of clinicians; and Click-Data, which supports data collection for clinical research. These products are both interactive extensions of ClickMedix. Complexity (How complex are the organizational requirements) Focused. Delivery systems adopting ClickMedix must have community health workers or other physician extenders in place or be willing to recruit and train those workers. (Click-Training can be used to facilitate the training programs for community health workers and supervising physicians.) Delivery systems must review ClickMedix protocols and accept or adapt them. Fees vary with the size of the delivery system and number of users. Several options are available for multiple site clinics including a lifetime license of $50,000 to $100,000 or an annual license ranging from $10,000 to $30,000. Global Lab Profile 2
Savings ClickMedix and the International Partnership for Innovative Healthcare Delivery documented the following savings in developing countries: Physicians increase the number of patients they serve by up to 4 times. Physician practices decrease administrative costs by up to 25%. 2 An 80% reduction in dermatological care costs per case. 3 Access Yes. In a California hospital, ClickMedix eliminated a patient backlog of 500 dermatology patients within 4 months by using consulting teledermatologists once-a-week for dermatology clinic. Patient experience Engagement Outcomes Spread ClickMedix is currently used in 14 countries including the U.S., Canada, Bangladesh, China, Ghana, Guatemala, India, Kenya, Mexico, Peru, Philippines, Taiwan, Trinidad and Tobago, and Uganda. Global Lab Profile 3
Barriers and Drivers Barriers Regulatory: In the United States, state regulations require supervising physicians to be licensed in each state where community health workers see patients. Also, licensing regulations that determine tasks that a health worker may perform and whether telemedicine supervision by a physician is viable or covered by payers varies by state. Technology: In rural areas and in developing countries access to stable and confidential connectivity may be limited. New Workforce: Community health workers or other aides who travel to patients must be available or need to be recruited and trained. Drivers Workforce Shortage: Rural areas and remote parts of the inner city lack sufficient numbers of physicians to meet patients needs. Cost of Care: Limited healthcare funding encourages the use of physician extenders such as community health workers. Similar innovations CommCare is headquartered in Boston. Its operating systems were developed in cooperation with Dimagi. CommCare is used in nine Asian and African countries and conducted a pilot study for advanced HIV-AIDS patients in Boston, with Partners Health. Grand-Aides uses audio-visual connectivity with health aides to manage home visits to patients. Grand-Aides does not have a proprietary platform that stores patient profiles and follow-up assessments. The focus of Grand Aides is upon the corps of health aides trained for specific types of interventions. Tele-dermatology innovations also facilitate specialist consultations, but most require in-office equipment and the specialist works through a primary care physician rather than a community health worker. Tele-dentistry innovations enable trained dental aides to deliver dental care with supervision by distant dentists for diagnoses and some procedures. Some tele-dentistry equipment is portable and can be used to provide dental care in community sites such as schools, day-cares, and elder care facilities. Global Lab Profile 4
Innovation contact Ting Shih, CEO & Founder, ClickMedix E-mail Address ting.shih@gmail.com Website www.clickmedix.com Original Date of Post May, 2014 Case Study Source International Partnership for Innovative HealthCare Delivery (IPIHD), based at Duke University, Raleigh, North Carolina, USA and Pathways Foundation, Boston and Washington, DC, USA. Endnotes 1 ClickMedix. Western Diabetes Institute Transform Diabetes Care Using Mobile Technology to Scale Integrated Care Team Model. May 3, 2014. http://clickmedix.com/clickmedix-western-diabetes-institute-transform-diabetes-care-using-mobile-technology-to-scaleintegrated-care-team-model/#.u4uexfsuf8e 2 IPIHD. ClickMedix Profile. Profiles and Case Studies of IPIHD Innovators. 2013. http://www.ipihd.org/innovations/ipihd-innovators/ ipihd-innovator-profiles-and-case-studies 3 Ibid. Global Lab Profile 5