Evaluating the innovation potential of Mobile Health
April 5, 2017//
Remember the bloodmobile? I chaired the annual blood drive at my high school for two years during the 90’s. It was during the Saturday Night Live Wayne’s World era, and our theme was “Vein’s World”. The bloodmobile was a large bus equipped with a clinic to accommodate the entire blood donation procedure within: a private interview area, donation beds, sample refrigeration, refreshment station and confidential storage. The mobility factor was the key to the bloodmobile’s success: it provided a convenient outreach initiative to communities on their turf, integrated with their culture, and was fueled by positive peer pressure associated with the blood drive event itself.
While mobile clinics have been around pretty much as long as mobility and clinicians have been around, in recent history, we credit their resurgence to community healthcare providers. As is often the case where, “necessity if the mother of invention”, community healthcare and safety-net clinics have been drivers of innovating new healthcare delivery models where conventional paradigms failed their patients’ ability to access care. Mobile health clinics have traditionally been used by safety-nets to provide outreach services to remote, reclusive, and underserved patients. While there is no dearth of suppliers offering custom designed mobile health medical and dental units, often these units are buses, trucks or and RV’s self-retrofitted by community providers to save money.
How might we both sustain and disrupt mobile health innovation?
Sustaining innovation means we identify needs not currently being met within the existing mobile health market to improve upon the service delivery and supporting design. Current mobile clinics serve homeless persons and street workers in urban areas, agriculture workers and migrants in rural areas, and at-risk children in all areas. Services include preventive and acute care, immunizations, dental care, behavioral health and even palliative care. Existing specialized services can include diagnostic imaging such as mobile mammography. Identifying unmet needs serving these existing users means reaching out to both safety-net clinics and mobile teams. For example, typical exam rooms in clinics serving homeless patients often include a designated foot care sink basin. Extending this to a mobile operation might mean offering a pedi-mobile designated to treat diabetic-related foot conditions among homeless persons or outfitting existing mobile units with foot sinks. Extending existing services to new users means reaching out to a broad range of healthcare providers to test delivery of mobile care to less vulnerable, but still access-challenged patients such as those with limited physical ability, driving impairments, infectious patients, immune-compromised patients and others.
Disrupting innovation suggests we expand the applicability of mobile health to new markets, and rethink the delivery of these units– such as the fabrication, design, and portability of the mobile clinics– to expand its impact. In the spirit of on-demand care, new markets for mobile clinics could bring care to urban workplaces (workplace-based clinics) and school based health centers (SBHCs).
Since it became a state funded program in 2006, school based health centers (SBHCs) have reached 61 in the state of Colorado serving 35,000 users. Initially tucked into unused spaces in schools and former “school nurse” rooms, school administrators are realizing that these retrofitted spaces aren’t the ideal infrastructure to deliver healthcare services, nor in the cases where these centers also serve communities such as rural areas or elementary schools, create an appropriate community interfaceDisruptive innovation of the mobile health clinic might explore questions around just how mobile, or transportable, these clinics need to be? Does mobility offer clinic sharing opportunities among schools to serve a greater reach of patients, or is care compromised when the clinics are not fully integrated into the school administration??
In terms of the delivery of such clinics, would pre-fab SBHCs create an opportunity to reduce the cost to a price point where more schools and communities could acquire a clinic? Is it realistic to standardize clinics given district specific regulations and varying healthcare delivery models across providers?
In terms of reaching new user groups who do require mobile units, just how large do the clinics need to be, and can there be a common chassis customizable to a range of populations and services? During the 1950’s bloodmobiles unfolded onto a site often from large semis to accommodate up to accommodate a staff of over 20 persons and serving 200 users in a 6-hour day. In this era of personalized medicine, what benefits would we incur if clinics unfolded from a Prius or Smartcar?
The sustaining and disruptive innovation paths are not so discrete that discoveries along the way in one can certainly inform developments in the other. Ultimately our aim is to program and design for the forward-looking present as well as the future models of care.