Stanford Children's CMO: Mobile disruption key to new care models [Q&A]

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Digital tools, including wearables and other Wi-Fi connected devices, will be vital to the transition of healthcare to focusing less on volume and more on value provided, according to Stanford Children's Health Chief Medical Officer Dennis Lund. Such technology, he says has "the potential" to keep patients out of hospitals and doctors' offices, which ultimately could lead to benefits down the road.

Such devices, Lund says, "will be able to continuously stream information to physicians and nurses that will preclude the need for frequent office visits and even hospital admissions."

In part two of FierceMobileHealthcare's interview with Lund, the hospital executive also discusses the promise of electronic health records, as well as the need for data analytics and the challenges with telehealth. Read part 1

FierceMobileHealthcare: Where does mHealth stand today in terms of providing viable and valuable care? What is your expectation for the next five to 10 years?

Dennis Lund: Mobile healthcare is just getting started. In the realm of telehealth, the technology for e-appointments is clearly here, and we utilize it quite often at Stanford Children's Health in the region and even overseas. However, the regulatory and legal environment has not caught up with the technology, and as a result, telehealth is not as widely applied as it can be.

For example, in many situations, for a physician to have a telehealth visit at another hospital requires full credentialing of the physician at the outside site, which is a major undertaking. Similarly, billing mechanisms for these activities have not yet been fully developed. As we move toward more population health, however, I believe digital health technologies have the potential to help with population health management in an important way to try to keep patients out of doctors' offices and hospitals. This would be a huge step toward improving patient health and lowering medical costs.

Still, the promise of the electronic health record has yet to be met. For the most part, we use it as a glorified data repository rather than using it to help manage patient care in real time. I believe this will come fairly soon, however. One of the basic problems in healthcare today is that medical knowledge is increasing so quickly that it is difficult for physicians and nurses to keep up. In the not-too-distant-future, our EHRs will mine data in real-time, including vital signs, blood test or x-ray results, as well as suggest potential treatment pathways to clinicians using large cloud-based data sets of information.

FMH: Talk about SCH's efforts to collaborate with Stanford School of Medicine; how are you working to improve patient care?

Lund: Stanford Children's Health has been developing a geographically distributed network of pediatric care delivery over the past four years. We now have ambulatory clinics in over 60 sites and more than 500,000 ambulatory visits yearly. All of these patient visits are entered into the common version of the electronic medical record. This gives us a huge opportunity to study a large population, as well as develop and implement best practices of care.

We are working with Stanford University School of Medicine and Stanford Healthcare and its network to develop a learning and teaching collaborative. Our large data warehouse will play a huge role in this, but we will be able to study methods of care and enroll patients in all types of trials to improve outcomes. This really will be the advent of a learning health system. In the realm of basic science and discovery, we are working with the school of medicine on the development of programs in gene therapy and immunotherapy, both of which are very data intense.

FMH: What are some of the top hurdles thwarting mobile health innovation? Do you see those obstacles being eliminated anytime soon?

Lund: The sky is the limit in this realm. However, our healthcare system at present is based on a model of direct patient-doctor interaction, which leads to a billable encounter. An emphasis is placed on procedures. Regulations and payment mechanisms all support this way of doing things.

We will need to develop new models of care and interaction that ease the burden on patients to get directly to the doctor or hospital, but also keep the economics of the healthcare system sound. This is going to require a collaboration between payers, providers of all kinds, regulators and patients. This seems may seem like a daunting task, but I believe that some of the disruption that comes from mHealth can be an important driver toward that end.

Editor's Note: This interview has been edited for clarity and length.

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