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By Robin Jay, BHC Editorial Director

More than 10,000 US Army soldiers who have returned from duty in Iraq or Afghanistan with traumatic brain injury or other serious injuries are participating in a pilot study to test a telehealth outreach program that’s designed to track progress, improve quality of care and increase optimal outcomes. The mobile phone health information management application provided by AllOne Mobile is a secured two-way mobile technology that links wounded soldiers at home with case managers. The system allows case manages to monitor and stay in contact with the wounded warriors through personalized, encrypted interactive messages. The information received back from the soldiers helps to enhance personalized daily care. The current results of the pilot program were discussed at the 5th Annual World Healthcare Innovation and Technology Congress near Washington D.C. Afterward, Behavioral Health Central interviewed AllOne Mobile Senior Director Frank Avignone, Ph.D.

“We’ve seen compliance numbers in the high 80s with respect to the soldiers actually utilizing the AllOne Mobile infrastructure and gaining some advantage from it,” said Dr. Avignone. “It’s actually in its pilot phase (we’ll launch the actual study in phase II early next year and should have the results back next summer), but the preliminary control group that we’ve used in the study have been extremely compliant with the messaging with the care managers’ instructions, and they’ve reported back on a structured basis that they’ve enjoyed using the product and that it does enhance their lifestyle.”

The AllOne Mobile system is designed to be the ‘dial tone’ for any type of healthcare information exchange between an individual and a care manager or provider, which Dr. Avignone says is the biggest differentiator of this technology compared to other systems. A case manager can now reach out to a person where they live, according to their lifestyle. So an answer to a patient’s query can be provided securely and in a time frame that’s convenient for the individual, versus making a phone call and sending an email, none of which will probably be returned.

AllOne Mobile is designed to run on any handset, so the soldier doesn’t have to have a smart phone, and many of the soldiers don’t. They usually have very rugged phones that they use when they were in warfare. They don’t have to switch phones or service, so they can use the device they’re accustomed to. AllOne Mobile provides a very simple, user-friendly, easy way to get to the information that the care manager is trying to provide with just a couple of clicks or screen touches in order to get the information to the patient and to provide information back to the care manager,” said Dr. Avignone.

The mCare Project started out with traumatic brain injury patients, but has since been extended to any soldier who would like to have the application, irrespective of his or her injury. But with respect to TBI, there are many comorbidities that can be associated with it, including depression and issues with basic cognitive abilities. “The mobile system allows the care manager, without disrupting the soldier’s daily routine, to measure where that soldier is. They might ask, ‘Do you know what day it is? What time it is? What your name is? Your wife’s name? Your parents’ names?’ They can actually measure the ability of the soldier to answer simple questions and then make judgments based on that,” continued Dr. Avignone. “They also can involve the caretakers of these individual, as well. If they don’t get an answer back to a query through the mobile phone, then they can reach out through AllOne Mobile to the caretaker of these individual to ask ‘have you checked on your son or your daughter? Do you know where they are? Are they okay? They aren’t answering our queries. Can you find them and ask them to answer the questions that we’re asking?”

Because of the way the mobile system has been designed, case managers using AllOne Mobile can track almost any indicator or any metric: when a message was sent, whether it was received, whether it was read, and whether it was responded to. “It actually provides a number of actual measurements – from an overall lifestyle scale – that allows us to do a lot more than just care management. For example, ‘Have you registered for college yet? These are your personal goals. Have you opened a checking or savings account?' Things that help the soldier transition back into civilian life or back to active duty. When a care manager looks at their console dashboard, they can actually see a graphic representation of where that soldier is in his total lifestyle management.”

There are many healthcare scenarios this mobile technology can be applied to. In the current healthcare reform initiative, most all of the bills on the table in Congress right now are geared around a patient-centered medical home. And care coordination is going to be key in this model of care. So case managers and practitioners may soon be able to utilize additional mobile technology applications in their day-to-day practices. In fact, the AllOne Health Group was the first to launch personal health records for mobile phones to health plans, giving consumers instant access to healthcare records anytime, anywhere.

“All of us carry mobile phones; they’ve become very personal and they’re part of our everyday lives. We have about 303 million people in this country and there are 271 million wireless contracts,” said Dr. Avignone. “If you look at it from a care manager’s perspective or a reform perspective, we’re not going to change healthcare by legislating healthcare. They way we are going to change healthcare in this country it to make people personally responsible for some portion of their own wellbeing. The mobile phone, being as personal and pervasive as it is, allows the care manager to assist through coaching, through a channel that people are used to using, to communicate, to help them make changes to their lifestyle required to become healthier.

"We are moving away from treatment and procedures, to prevention and wellness. If you look at the way our healthcare system is designed today, there are 9,000 treatment and procedure codes for billing, but there are none for wellness or care management. So, in changing the perspective of the individual to taking care of themselves, being assisted through a device that they’re already carrying them every day, I think that’s probably one of the more radical approaches and one that can have the ability to change healthcare in the country today.”

If you would like more information about the AllOne Mobile technology or would like to follow the case study of the mCare Project with the US Army, go to www.AllOneMobile.com. To listen to the complete interview with Dr. Avignone, click on the media player at the top of this page, or read the written transcript that follows.

BHC: This is Robin Jay with Behavioral Health Central. Today we’re speaking with Frank Avignone, PhD from AllOne Mobile. He is speaking today about solving military and consumer challenges with remote access technology. Dr. Avignone, tell us about the mCare Project and the technology that was used in it.

Dr. Frank Avignone: Sure. About a year and a half ago, we were approached by the Army to provide a communication channel between the wounded warriors who were coming back from Iraq and Afghanistan who has sustained traumatic brain injury. We provided answers around out technology called AllOne Mobile which is a secure messaging and mobile publishing platform. We were chose and now provide that technology to about 10,000 soldiers around the country.

BHC: Let’s talk specifically. What is the technology compared to the other services out there that you were competing against? And what are the practical applications for case managers and patients who are returning home for recovery>

FA: Unlike a lot of the applications you see out there today, AllOne Mobile is a horizontal platform for mobile publishing and secure messaging. Many of the other applications that you’ll see on the market have a specific target audience and a specific target application. So if you go out to the Apple Itunes store and download a pill look-up application, or a wellness application to track your running or your exercise, those are vertical applications that have a specific target audience. AllOne Mobile is designed to be the dial tone for any type of healthcare information exchange between an individual and a care manager or provider, so that’s the biggest differentiator. A case manager can now reach out to a person where they live, according to their lifestyle. So an answer to a patient’s query can be provided securely and in a time frame that’s convenient for the individual versus making a phone call and sending a secure email, none of which will probably be returned, or trying to provide a web infrastructure to acquire some of these answers or to provide care. So AllOne Mobile extends this reach of all these types of exercises that a care manager will go through to where an individual is.

BHC: Frank, with AllOne Mobile in the case study for the military, what outcomes have you seen as a result of using this technology?

FA: We’ve seen high compliance numbers in the high 80s with respect to the soldiers actually utilizing the AllOne Mobile infrastructure and gaining some advantage from it. It’s actually in its pilot phase and we’ll launch the actual study in phase II later this year or early next year and should have the results back next summer. But the preliminary control group that we’ve used in the study have been extremely compliant will all messaging with the care managers instructions and they’ve reported back on a structured basis that they’ve enjoyed using the product and that it does enhance their lifestyle.

BHC: Can you give any specifics of the technology that helps improve compliance?

FA: AllOne Mobile is designed to run on any handset, so the soldier doesn’t have to have a smart phone, and many of the soldiers don’t. They usually have very rugged phones that they use when they were in warfare. They don’t have to switch phone or service, so they can use the device they’re accustomed to. AllOne Mobile provides a very simple, user-friendly, easy way to get to the information that the care manager is trying to provide with just a couple of clicks or touching the screen in order to get the information and to provide information back to the care manager.

BHC: Frank, in the mCare Project with the US Army, the application has been used with traumatic brain injury patients. What are the applications used with that specific injury.

FA: The project did start out with TBI patients, but it has since been extended to any solider who would like to have the application, irrespective of their injury. But with respect to TBI, there are lot of comorbidities that can be assigned to TBI patients, including depression and basic cognitive abilities. The mobile allows the care manager, without disrupting the soldier’s daily routine, to measure where that soldier is. Do you know what day it is, what time it is, what your name is, your wife’s name, your parents’ names, etc. They can actually measure the ability of the soldier to answer simple questions and then make judgments based on that. They also can involve the caretakers of these individual, as well. If you don’t get an answer back to a query through the mobile phone, then they can reach out through AllOne Mobile to the caretaker of these individual to ask ‘have you checked on your son or your daughter? Do you know where they are? Are they okay? They aren’t answering our queries. Can you find them and ask them to answer the questions that we’re asking?

BHC: What type of analytical reports does the system provide so that case managers and physicians can look at their whole population and see trends?

FA: That’s the beauty of the mobile space. Because of the way our system has been designed, we can track almost any indicator or any metric when a message sent, whether it was received, whether it was read and responded to it. So Mobile actually provides a number of actual measurements – from an overall lifestyle scale, that allows us to do a lot more than just care management. For example, “Have you registered for college yet? These are your personal goals. Have you opened a checking or savings account? Things that help the soldier transition back into civilian life or back to active duty. When a care manager looks at their console, they can actually see a graphic representation of where that soldier is in his total lifestyle management.

BHC: Let’s talk about some of the other scenarios your technology can be applied to. In the healthcare reform initiative, most all of the bills on the table in Congress right now are geared around a patient-centered medical home. And care coordination is going to be key. So for case managers and practitioners, what are some of the additional applications they may be able to use this technology for in their day-to-day practices?

FA: All of us carry mobile phones with us and they’ve become a very personal and they’re part of our lives. We have about 303 million people in this country and there are 271 million wireless contracts. If you look at the number of devices that are out there today, that’s probably two for every man, woman and child that’s capable of managing a mobile phone, albeit they’re not in the ICU, sick or too young. If you look at it from a care manager’s perspective or a reform perspective, we’re not going to change healthcare by legislating healthcare. They way we are going to change healthcare in this country it to make people personally responsible for some portion of their own wellbeing. The mobile phone, being as personal and pervasive as it is, allows the care manager to assist through coaching, through a channel that people are used to using, to communicate, to help them make changes to their lifestyle required to become healthier, less of a burden. We move away from treatment and procedures, to prevention and wellness. If you look at the way our healthcare system is designed today, there are 9000 treatment and procedure codes for billing, but there are none for wellness or care management. So, in changing the perspective of the individual to taking care of themselves, being assisted through a device that they’re already carrying them every day, I think that’s probably one of the more radical approaches and one that can have the ability to change healthcare in the country today.

BHC: Certainly, because it reaches the consumer on a personalized level at a point where he’s comfortable communicating. Let’s talk about why consumer engagement is so important in health and wellbeing overall.

FA: If you look at what we’ve done traditionally for the last 70 years in healthcare in the United States, there’s been a sense of entitlement. Our employers have provided insurance, we go to the doctor when we’re sick, but we haven’t necessarily taken control of their healthcare. If you ask folks in an audience what their credit score is, a good number of people will raise their hands. But if you ask them what their health score is, nobody has a clue what that means, never mind any type of measurement of where they are in their health. If you consider where we are in healthcare today and where we need to be, mobile is well positioned to help in assisting to get to that position where people are more involved in their healthcare.

BHC: If listeners would like more information about the technology or would like to follow the case study of the mCare Project with the US Army, how can they do that?

FA: They can to go to AllOneMobile.com and we’ll be updating the information from time to time. Or they can contact me or the staff through the website by clicking on any of the links and we’ll be able to provide them information.

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