NoMoreClipboard

I'm at the Mobile Health Expo in the Ceasars Palace Convention Center in Las Vegas. Having succussfully maneuvered past Barry Manillow, Cher, Donny & Marie Osmond, and 20,000 slot machines, I encountered NoMoreClipboard and their interesting use of PHRs with low income diabetes patients.

Functionality
Looks pretty straightforward—view portions of the medical record, enter blood glucose, send prompts to patients and to physicians.
Uses desktop web, mobile web, and SMS

Implementation
They’re conducting a pilot w/ Howard University Hospital Diabetes Treatment Center in Washington, DC, in neighborhoods that have a high incidence of diabetes. Patients are typically low income and either Medicaid or uninsured. The program begins with community-based screening and initial treatment in a tricked-out RV (aka mobile health clinic). In the RV, their information gets entered in Howard’s EMR.

When they get off the RV, the patient is greeted by a “PHR Educator” (first time I’ve heard that term). The PHR Educator gets them set up with an account, which includes downloading their data from the Howard EMR system into the PHR, as well as filling in gaps in the data. Patients are encouraged to enter their glucose readings several times/day. About every three months, they collect HEDIS data from patients via online surveys.

They have 232 patients using the system so far. They've only recently launched the mobile component, and it's growing fast.

Incentives
For the patients: The program provides “medical minutes,” essentially subsidizing part of the patient’s data plan. But they’re very clear that they don’t want to pay for everything. The patient needs to pay for at least part of the phone and part of the data plan, to ensure they have skin in the game. The program will provide new phones, or patients can use their existing phones.

For the physicians: Cupcakes. They’ve succeeded in getting clinical buy-in by providing cupcakes. Every time a physician gets another 20 patients signed up, they get a hand-delivered box of Georgetown Cupcakes, which are evidently delicious.

Preliminary findings & observations

• Not all the patients use the system, but those who use it tend to use it a lot. This is consistent with findings from the California Health Care Foundation study that showed low PHR adoption by people with low socioeconomic status, but high usage by those who do adopt.
• Age 60 appears to be dividing line—over 60 they tend not to use it. This is different from other data I’ve seen, which shows 70 or 75 as a clearer dividing line
• 1/3 use once/week or more; 1/3 use PHR at least once a month; 1/3 rarely use it
• MDs report enhanced dialog between patients and providers. Communication is more frequent, complete, and accurate
• They’re claiming reduced HA1C, BP, cholesterol, ER visits, and hospital readmissions, but didn’t provide any specifics (to be published, but not yet)