Charles "Chuck" Marlin recently launched Healthcare Technology Solutions, LLC, which evolved out of Interstate Healthcare, a Detroit-based medical malpractice underwriting and risk management agency. He has more than two decades in the healthcare technology arena, beginning with the pulse oximetry space, and is a member of the HIMSS mHealth Committee.
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. Limited access to physicians in general, coupled with wait times. Directly behind that should be chronic disease management. The difference between the two is that the first is self-pay, while the second has no reimbursement except for a few beta models out there with Medicare, some commercial payers, and the VA. Reimbursement is the only thing that will allow for widespread adoption. The data is already in concerning telemedicine and remote patient monitoring for chronic diseases and patient discharges.
Q. What mHealth technology will become ubiquitous in the next 5 years?
A. Telemedicine (physician patient exams over smartphones, diagnosing, prescribing and treatment modalities), coupled with remote real-time patient monitoring of chronic diseases and patient discharges.
Why? The technology is already there, the savings when unilaterally applied will net a reduction in healthcare expenses of hundreds of billions of dollars, and all of this infrastructure will go on to promote and support wellness initiatives to root out the underlying causes of many of the chronic diseases that are preventable or very manageable at early stages.
Q. What's the most cutting-edge application you're seeing now?
A. Remote real-time monitoring of patients by a company called My-911. I’ve learned that they are the mobile call center backbone to 80 percent of all of the 911 mobile calls in the country. They are used to route these calls based on geotracking features in cell phones. They already pay for the satellites, and have the infrastructure to follow a patient anywhere, determine if they’ve fallen, deliver messages, medication reminders and use various Bluetooth devices to monitor BP, pulse, temp, PulseOx, weight, glucose, cardiac … in real time. They can use any smartphone, tablet or computer, as they are agnostic in that regard. Their cost of delivering this real-time monitoring is a fraction of what others are contemplating.
As for the future, the future is now. Remote imaging, ultrasound are already here and will become much more common and integrated into remote patient monitoring solutions. All of this boils down to reimbursement, as there are many poised to deploy these technologies if they could get reimbursed for the visit and get the technology paid for. A typical remote patient monitoring device(s) covering the basic vital functions is about $500 at present. If you add cardiac monitoring and PulseOx were likely looking at $750. When we’re deploying millions of these small Bluetooth devices the price will drop about 50 percent for the best-of-breed devices.
Q. What mHealth tool or trend will likely die out or fail?
A. Too many to mention. They are like shiny objects. We are all attracted to them, but few of them ever survive even though they might be the best medicine possible.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. BIA measurement. BIA allows you to measure the resistance a cell provides inside and outside of the cell. Through this measurement you can obtain a phase angle. The phase angle will tell you how healthy you are at the cellular level or, conversely, the state of your health if you are battling a major disease or injury. BIA testing can project the number of days or hours you may have to live based upon this measurement. Very progressive measurement capabilities when you apply it to health, wellness, dietary changes and ongoing measurement of your battle against a chronic disease. Spooky from the standpoint that for your physician, family or you to know with relative certainty how long you have to live is a game-changing piece of information. Physicians are just beginning to use the technology, and reimbursement is around the corner. Let’s see how this plays out.
Q. What's your biggest fear about mHealth?
A. Adopting the wrong solution. Why? Money, politics and who you know often drive decisions. Best practice and the best technology often is left out in the cold. As a very smart man once told me, “It’s never about the money, it’s about the amount.”
Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?
A. Consumer/employer demands for solutions to mitigate the spiraling cost of healthcare will create pressure on health plans, providers and the government. As early adopters begin showing this new technology around and it becomes even more price-competitive, consumers will drive the train for the new gadget, just like they want the latest cellphone.
Q. What are you working on now?
A. As an aggregator and advocate of mobile technology I make a point of being observant and attempting to keep updated on the mHealth revolution/evolution. I beat the mHealth bandwagon for MTAM as their mHealth chair, and as their representative to HIMSS. I then share that with practices who are clients in an attempt to keep them educated.
