www.pwc.

com/ca

Apps Formulary for Health

Care Organizations

A Working Model for Discussion

@MarkCasselman

March 2014
 Making Care Mobile: Shifting Perspectives on the Virtualization
of Health Care

Goal of the report

• Report explores Canadians’ attitudes towards pertinent

issues in the health care industry
• Provides analysis of what citizens expect decision makers to
keep in mind when thinking of the future of health care in
Canada

Key Questions

• What improvements are citizens looking for in health care?

• What channels are citizens using to access health care and
information now, and in the future?
www.pwc.com/ca/virtualcare • What innovations are citizens ready to use that can make
health care delivery more efficient?
• What are the future possibilities in health care delivery?

PwC 2
Making Care Mobile
Shifting perspectives on the virtualization of health care
More than 2,400 Canadians participated in our research to address the
central question, “What does the future of health care delivery look like?”

PwC 3
Virtual assessments via apps are good options in
the right situation…
77% of Canadians were comfortable with virtual mole assessment app

52%
scenario – although, at this time, most prefer doctor-controlled option.

Doctor takes the photo and communicates with

36%
dermatologist
You send it to your doctor using an app 21%

You use an app for an initial assessment 20%

of patients None of the above 15%

indicate that Not sure 8%

faster access to No answer 1%

care is the
primary
appeal of
virtual
assessment

PwC 4
Canadians told us they are ready for virtual
monitoring for chronic conditions…
Most Canadians indicated they would be comfortable

79% having a chronic condition monitored virtually...

Yes, definitely
Probably
36%
43%
Not likely 10%

of Canadians Definitely not

Not sure
5%
4%
indicate that No answer 2%
they are
comfortable ... and 62% of caregivers indicated that virtual health
care would help them to provide care for someone
with virtual else (e.g. parent/ child)
monitoring for
chronic
conditions

PwC 5
… and virtual visits for post-surgical follow-up.

The majority of Canadians indicated they would be

54% comfortable having post-surgical follow-up visit

done by video conference.
Yes, definitely 24%
Probably 43%
Not likely 17%
of Canadians Definitely not 11%
indicate that Not sure 5%
No answer 0
virtual visits,
home
monitoring,
and virtual
wards are good
care delivery
options
PwC 6
Consumer mHealth is exploding in part as a result

Q: Are mHealth and vHealth different?

PwC 7
Telemedicine and mobility are coming together
facilitating delivery of virtual care anywhere

Telemedicine mHealth Virtual Care

PwC 8
By 2020, more than 25% of care will be delivered
virtually (with provider and patient in separate places).

- Dr. Ed Brown, 2012

many small pilots 25%

PwC 9
 Virtual Health Care: We have been through
similar shifts before…

1992…
More people leave
hospital after procedure
than remain overnight
Virtual
Care
Outpatient
Care
202X?…
More virtual visits than
Inpatient physical visits
Care

Each transition involved people, process, and technology changes.

Major shifts in how we organize our care delivery services and assets
PwC 10
How might this happen; Well here are IDC’s top
ten connected health IT predictions for 2014…
1. mHealth + Telehealth + Social Will Be the New Healthcare Delivery Model
2. BYOD Will Come to Health Monitoring, and Smartphones Will Become Biosensors
3. Wearables and Embedded Sensors Will Become Mainstream
4. The mHealth App Formulary: There Will Be a "Prescribed" App for That!
5. Value-Based Healthcare Will Move Care Delivery from the Four Walls of the
Traditional Care Setting to the Community
6. Retail Clinics Will Disrupt the U.S. Healthcare System
7. By 2016, 30% of U.S. Healthcare Organizations Will Have Achieved the Repeatable
Stage of the IDC Mobile Maturity Model
8. HIE Solutions Will Be Repositioned for Population Health
9. "Little Data" from Connected Health Devices and M2M Connectivity Will Create
Opportunities for Big Data and Analytics
10. Select Healthcare Organizations Will Experiment
with Google Glass

PwC 11
 We need to construct the Apps Formulary
Apps Pharmacy not Apps Store
Tech Rx

Take 2 Apps and

Call Me in the
Morning
Apps Formulary
AliveCor Cardiac
Withings Blood Pressure
UK (Cambridge Healthcare): “Europe’s First Health-
App Store” developing certification process for apps it bant Diabetes
sells. Pain Squad Pain Mgmt
US (Happtique): market-leader in health apps
published set of standards to certify apps operability, MyIBD Crohn’s Disease
privacy, security, content reliability

PwC 12
We need a process and standards for selection,
and a taxonomy for regulation of apps
Front of
Store

Criteria for evaluation include: Over the

Counter
• Operability
• Privacy & Security
• User Data Safeguards
• Functional Validation Prescription

• Clinical Efficacy

Controlled
Substance

PwC 13
Front of store apps are mHealth ‘vitamins’ that
supplement a healthy lifestyle

Front of
Store

Over the
Counter

Prescription

Controlled
Substance

PwC 14
Smoking Cessation: Crush the Crave
Front of
Store

Crush the Crave

• Evidenced based smoking application targeting
19 to 29 year olds
• Users develop a customized quit plan, tracks
cravings and smoking habits
• Targeted SMS for stage in quitting process
• Virtual awards for goal attainment

PwC 15
Sleep Cycle Alarm Clock –
Helps you wake up rested
Front of
Store

Sleep Cycle Alarm Clock

• An intelligent alarm clock

that analyzes your sleep-
wake cycle and wakes you
in the lightest sleep phase
• Helps you sleep better and
wake up rested

PwC 16
Fitbit –
Helps you achieve your fitness goals
Front of
Store

Fitbit – Flex 4

• Measures data such as the number of steps and

distance walked, stairs climbed, calories burned,
activity duration and intensity as well as sleep
quality.

PwC 17
Nike+ Fuelband –
Set your daily activity goals
Front of
Store

Nike+ Fuelband

• Pedometer tracks steps taken, calories

burned, and a proprietary measurement of
activity called Nike Fuel
• User set daily activity goals. The band's
LED display lights up from red to green
showing progress throughout the day.

PwC 18
Withings – Pulse
Future Innovation…
Front of
Store

Pulse

• First activity tracker to record heart

rate with a touch of a button, steps,
distance, calories, strides and quality
of sleep
• Using Bluetooth smart technology,
the tracker communicates with the
Withings Health Mate app
connecting to iOS and Android
devices featuring on-device display
and alerts

PwC 19
Health services apps to enhance patient experience

Hamilton Health Sciences App Front of

Store

BC Health Service Locator App Alberta Health Services App

PwC 20
Over the counter apps may be dispensed after an
assessment of the patient's needs

Front of
Store

Over the
Counter

Prescription

Controlled
Substance

PwC 21
Mood Watch –
Monitor your mood over time
Over the
Counter

Mood Watch

• Self-monitoring and care for clients

with mood disorders like anxiety,
depression, bipolar, borderline, and
post-traumatic stress disorders.
• Prompts users to track components of
their mood such as anxiety, calm,
mindfulness and energy
• Tracks blood pressure, pulse, sleep, and
medications

PwC 22
PTSD Coach
Over the
Counter

PTSD Coach
• The PTSD Coach app can help you learn about and manage symptoms that
commonly occur after trauma.
• Reliable information on PTSD and treatments that work
• Tools for screening and tracking your symptoms
• Convenient, easy-to-use skills to help you handle stress symptoms
• Direct links to support and help
• Downloaded over 100,000 times in 74 countries around the world.
PwC 23
AlcoDroid Alcohol Tracker
Over the
Counter

AlcoDroid Alcohol Tracker

• AlcoDroid is an alcohol consumption tracker, diary, and blood alcohol
content calculator.
• AlcoDroid helps you get a better handle of what you drink and change
your drinking habits.
• Set goals and chart your alcohol intake habits daily, weekly or monthly

PwC 24
W/Me Wristband
Future Innovation…
Over the
Counter

W/Me Wristband

• Device and platform that monitors

the autonomic nervous system
including respirations and heart
rate to improve wellness
• A medical-grade sensor captures
electrical impulses
• Proprietary algorithm decodes
heart rate variability, maps
autonomic nervous system activity,
which then produces a visual of the
user’s mental state at any given
moment

PwC 25
Mobilyze – real-time depression detection
Over the
Counter

Mobilyze

• tracks users' behavior patterns and

moods to identify states that trigger
depression before it happens
• support patients with depression in
making changes in behavior that will
reduce or eliminate depressive
symptoms
• uses sensors to learn and identify
patients’ states at any given moment,
allowing intervention in real-time

PwC 26
recoveryBox
Over the
Counter

recoveryBox

• Designed to provide tools needed to help

with addiction recovery and accountability
• Breaking habits requires knowing why we
do what we do, when do we do it and
coming up with goals to break unhealthy
behaviors
• Facilitates tracking of daily life activities
by easily breaking them down into your
"lights“
• recoveryBox is designed to work with
many addictions including drugs,
gambling, pornography, and alcohol

PwC 27
Withings– Blood Pressure Monitor
Over the
Counter

Withings
Blood Pressure Monitor

• Monitors blood pressure and

heart rate
• Attaches directly into any iOS
device
• Allows users to view
measurements, graphs and
trends over time

PwC 28
<30 Days – Heart & Stroke Foundation
Over the
Counter

<30 Days

• Guides users to break bad habits and adopt a

healthier lifestyle in 30 days or less.
• Evidence-based and consumer survey derived
heart health promotion app

PwC 29
Zensorium – Tinke
Over the
Counter

Zensorium– Tinke
• Measures heart rate, oxygen saturation,
respiratory rate, and heart rate variability
• Attaches directly into any iOS device
• Clients place thumb over Tinke device sensor
• Displays readings after 10 seconds
• Allows patients to track vital signs over time

PwC 30
Patient Education Apps
Over the
Counter

Patient Education Apps

• Standardized, customizable approach to client/patient education in real-time or

asynchronous manner
• Promote patient/caregiver/provider communication with visual aids
• Teach-out, follow-up, triggered instructions for self-care
PwC 31
 Patient Education Apps
Over the
Counter

Visual Anatomy Muscle Trigger FINR Brain

Points Atlas

Orthopedic Patient HeartDecide BabyBump

Education by Pregnancy Pro
3D4Medical.com

Muscle System Pro Heart Pro III CANRISK

By 3D4Medical.com Diabetes

Knee Pro Canadian Cancer AHA Pocket 1St

Glossary Aid CPR

Cancer.net Medical French

SpineDecide

PwC 32
GE and Healthline Networks – BodyMaps
Over the
Counter

GE and Healthline Networks – BodyMaps

• A education tool for healthcare providers to explain diagnoses and
possible treatment options to clients/caregivers
• Full color, high-resolution display 3D rotatable images depicting over
1,000 anatomical structures
• 200 videos depict how major health conditions, treatments and bodily
functions work

PwC 33
DrawMD
Over the
Counter

DrawMD
• Enhance patient/caregiver/provider communication
by offering a new paradigm for explaining the complex
issues surrounding medical and surgical care
• Contains background anatomy images covering a
variety of surgical procedures and medical diagnoses
• drawMD utilizes the iPad's unique interface to allow
anyone to sketch, stamp, or type directly on the
detailed anatomic images included in the application
• Allows providers to send the drawings discussed
thereby helping Help patient/caregivers remember
and process the conversation

PwC 34
WebMD
Over the
Counter

WebMD
• Web-based and mobile platform for clients/caregivers that permits fast convenient
assess to easy-to-understand health and medical information
• Using WebMD, clients can access valuable information about medical conditions, drugs
and treatments, first aid as well as a symptom checking tool
• Additional WebMD apps include: (1) symptom checker; (2) WebMD baby; (3) WebMD
pregnancy; (4) WebMD allergy; (5) WebMD pain control

PwC 35
Greatcall
Over the
Counter

Greatcall
• Phone-based platform that promotes safe
independent living through access to urgent care
respondents and medication reminders
• Urgent Care app combines a medical library
and medical symptom checker tool with unlimited
access to live, registered nurses who can escalate
to a physician
• Pressing the button on the 5Star personal
emergency response app, connects users to
certified response agents.
• MedCoach for iPhone, Android, and Jitterbug
mobile phones provides daily calls to remind client
to take their medications at the correct time of day
and when to refill their prescriptions

PwC 36
GlowCap
Over the
Counter

GlowCap

• Medication reminder device

• GlowCap devices fits over commonly used
prescription bottle
• Cap lights up and rings when it is time for
next dose
• Prompts a phone call for additional
reminder
• Emails updates to family and doctors
• Syncs with pharmacy for automatic
prescription refill

PwC 37
Mango Health
Over the
Counter

Mango Health
• Promote medication adherence and safety
• Sends reminders when it is time for their next
dose
• Allows users to enter all of their medications
and supplements and provides warnings
regarding potential interactions
• Gamification: with adherence, users earn
points which they then enter for a change to
win prizes

PwC 38
Prescription apps: plan of care written by
physician or other health professional

Front of
Store

Over the
Counter

Prescription

Controlled
Substance

PwC 39
Bipolar Disorder Connect Mobile

Prescribed

Bipolar Disorder Connect

• Bipolar Disorder Connect Mobile is

the place to start conversations, talk
about treatments, and learn from
others

• Connect with people who understand

what it’s like to live with bipolar
disorder
• Find answers and caring support as
you learn from their experiences
• Get real-world tips and advice to help
you manage bipolar disorder
• Ask questions, start discussions, and
comment on what others say

PwC 40
Lawson Supportive Mental Assessment
Rehabilitation and Treatment (SMART)
Prescribed

Lawson SMART Record

• Customized mental health PHR

• Created for Lawson Health Research
Institute
• iPhone’s were provided to mental health
patients
• Provided patient with a single-coordinator
with whom they could connect
• Includes: health journals, daily tasks,
alerts, personalized tracker, secure
messaging with care providers, and
appointment reminders

PwC 41
eCBT Mood

Prescribed

eCBT Mood

• targets depression by using the scientific principles of cognitive behavioral therapy

• can be used as a uniform, structured adjunctive support intervention for clinical trials
of antidepressants or other therapies for depression
• has been used both as an adjunct to traditional psychotherapy (involving a therapist
and patient), as well as a stand-alone intervention

PwC 42
Ginger.io

Prescribed

Ginger.io

• Turns smartphone into a

diary that writes itself
• App asks questions related
to medical condition and
automatically collects
information about
movement patterns.

PwC 43
Medeo – Virtual Visits

Prescribed

Medeo – Virtual Visits

• Medeo lets anyone access health care
regardless of their location, mobility or time
pressures
• Doctor and patient connect from home or
office using computer, iPhone or iPad
• Date is protected by bank-grade Canadian
data centres to secure health information

PwC 44
Wellx
Improve Efficiency Increase Access
Prescribed
“Patient messaging
improved my practice “It's very easy to use and
efficiency and allowed me to saves time as opposed to
have a less crowded waiting on the phone”
schedule” Patient Survey Respondent
Dr. David Verrilli, Village
Family Health Team Wellx
• EHR
• Secure communication with
healthcare provider
• Providers can broadcast news and
send reminders
• Healthcare providers and patients
can share test results, treatment
plans, and other information
• Refill prescriptions

PwC 45
Get Real Health – InstantPHR

Prescribed

InstantPHR

• PHR with EHR capabilities

• Secure communication with healthcare provider
• Receive lab results
• Refill prescriptions
• Pre-configured solutions available for readmissions management,
chronic disease management, care transitions, and patient engagement

PwC 46
MyChart

Prescribed

MyChart

• Person health record

• Online appointment requests
• Clinic visit notes
• Medication refill requests
• Appointment reminders
• E-messaging with healthcare provider

PwC 47
Controlled apps: require close supervision of
management and use

Front of
Store

Over the
Counter

Prescription

Controlled
Substance

PwC 48
NeuroSky – Mindwave biosensor
Controlled
Substance

Neurosky

• EEG solution digitizes analog electrical

brainwaves to power the user-interface of
games, education and research applications.
• brainwave algorithms, developed by
NeuroSky researchers and partner
universities and research institutions are
uncovering new ways to interact with our
world

PwC 49
Ignition Interlock Devices
Controlled
Substance

AliveCor

• The interlock records all the times a driver takes the test and their alcohol level.
• Each month's results may be sent to driver's probation officer.
• After breathalyzer tests driver at the start of the ride, it can monitors them while on road

PwC 50
Ignition Interlock Devices
Controlled
Substance

AliveCor

• The interlock records all the times a driver takes the test and their alcohol level.
• Each month's results may be sent to driver's probation officer.
• After breathalyzer tests driver at the start of the ride, it can monitors them while on road

PwC 51
Buddi – forensic psychology GPS tracker
Controlled
Substance

Buddi

• most commonly used by local authorities to monitor individuals with dementia

• allows individual to be easily found if they get lost after wandering away from their homes
• lockable version used to track mental health patients that may pose danger to community
or themselves

PwC 52
Mobile Cardiac Arrhythmia Diagnostic
Service (m-CARDS)
Controlled
Substance

m-CARDS
• Arrhythmia Diagnostic Service
• Alternative to Holter monitoring
• Improved access to and timeliness of
monitoring services
• Can monitor for up to 2 weeks
• Auto detect/auto send wireless Event
Loop Recorder (ELR) transmits ECG
through BlackBerry smartphone
• Patients are taught to self connect
using video instruction
• Information is sent to a diagnostic
center where it is interpreted by
cardiac technologists

PwC 53
SpiroSmart – Mobile Phone Spirometry
Future Innovation…
Controlled
Substance

SpiroSmart

• An affordable, user-friendly mobile phone based

platform that analyzes common lung function
measures (FEV1, FVC, PEF).
• Analyzes lip reverberation to measure pulmonary
ailments such as asthma, COPD, and cystic fibrosis
• Home spirometry enables early detection and
management of pulmonary exacerbations and
improves outcomes of chronic lung conditions.

PwC 54
MobiSante – MobiUS
Controlled
Substance

MobiSante – MobiUS
• Accurate and inexpensive smartphone-based
ultrasound imaging system
• 2011 – FDA cleared
• Ultrasound probe transducer plugs directly into a
smartphone device
• Images can be securely shared using cellular
network, WiFi, or direct connectivity to a personal
computer
• Enables healthcare providers to augment their
assessment findings with ultrasound images

PwC 55
Welch Allyn – iExaminer
Controlled
Substance

iExaminer

• Increase utility of fundus exams

• 2013 – FDA cleared
• The combined system allows clinicians to
image the eye while saving the images for
later review or to share with patients/ other
healthcare providers
• Enables telemedicine– allows healthcare
providers in remote clinics to share images
with ophthalmologists

PwC 56
CellScope – Otoscope
Controlled
Substance

CellScope – Otoscope
• Increase the standard of care by
creating a visual history of the
middle ear
• A special iPhone case which features
a protruding probe
• Enables physicians to perform ear
examinations using iPhone's camera
and LED.
• Images of the ear canal and the
eardrum can be saved, analyzed, and
shared

PwC 57
Nephosity – MobileCT iPad Radiology Viewer
Controlled
Substance

Nephosity –
MobileCT ipad
• iPad diagnostic imaging tool
• 2013 – FDA cleared
• Diagnostic viewing of CT, MRI, PET and x-ray
images
• A pro version, available as an enterprise
installation, enables real-time streaming of
medical images and collaboration of those
images with other users of the same app
• The collaboration is fast and scalable to a
roomful of users, and synchronizes the screen
cursor, object measurements, and user
annotations

PwC 58
Zephyr – Life
Remote Monitoring System
Controlled
Substance

Zephyr – Life
• Noninvasive, continuous
monitoring
• Measures heart rate,
respiration rate, ECG as well
as position change and
activity

PwC 59
Intel–GE Care Innovations Guide
Controlled
Substance

Intel—GE Care Innovations Guide

• Home care management client application that
facilitates daily biometric data collection and
transmission, interactive education delivery, and
regular contact with healthcare professionals from
a client’s home
• An intuitive touch screen interface and support
enables capture of daily biometric data through
peak flow meters, weight scales, pulse oximeters,
glucose meters, blood pressure monitors, and other
input devices

PwC 60
Intel—GE Care Innovations QuietCare
Controlled
Substance

Intel—GE Care Innovations

QuietCare
• Promote safe independent living with
advanced motion sensor technology
• Motion sensors are positioned
throughout a client’s home in order to
track their daily activity
• The software analyzes data for
potentially urgent situations and major
routine changes, then alerts caregivers
so they can respond promptly

PwC 61
Virtual care and Apps fulfillment is now a new
class of service offerings

Front of
Store

Over the
In this stage of their
Counter
development, the
‘prescription’ and
‘fulfillment’ of
Prescription
mHealth Apps need
not be separated
Controlled
Substance

PwC 62
 Will Falk
Managing Partner, Healthcare
416.687.8486
william.f.falk@ca.pwc.com
@willfalk

Mark Casselman
Director, mHealth
416.687.8480
mark.casselman@ca.pwc.com
@markcasselman

This content is for general information purposes only, and should not be used as a substitute
for consultation with professional advisors.

© 2013 PricewaterhouseCoopers LLP, an Ontario limited liability partnership. All rights

reserved.

PwC refers to the Canadian member firm, and may sometimes refer to the PwC network. Each
member firm is a separate legal entity. Please see www.pwc.com/structure for further details.