HARNESSING THE VALUE OF

mHEALTH
Executive Summary

FOR YOUR ORGANIZATION

Authors: Fran Turisco and Mike Garzone

The proliferation of next generation smart mobile devices is nothing less than astounding. More than one-third of U.S. adults own one, and an increasing number use their smartphone, iPad, or Blackberry as their primary means of accessing the Internet. Physicians are adopting smart mobile devices at double the rate of the general population. Matching the rapid growth in devices is a virtual explosion in the number of mobile applications (apps). Among the many apps available are more than 17,000 for healthcare tasks, and the rapid pace of development and adoption will continue thanks to easy-to-use software development kits (SDKs) offered by device vendors and easy and well-known venues for selling them to the public (e.g., the App Store). What makes the new generation of mHealth exciting is the synergistic combination of smart device value-add capabilities (camera, GPS, video chat, blue tooth connectivity to medical and home devices), combined with innovative software apps. It is already supplementing or even replacing traditional healthcare tasks for physicians and consumers/patients, and the possibilities and potential value are significant. Case-in-point examples in the report illustrate the range of possibilities and their value. These include pocketsize diagnostic imaging for busy emergency room physicians, medication refill ordering using a smartphone camera, community public health tracking using large population data collected via smartphones, remote data reporting by subjects in clinical trials and mobile support to health plan members making financial decisions at the point of purchase. Dealing with mHealth is a sea change for many healthcare organizations. Though familiar with implementing large enterprise information systems, sometimes with pushback from end users, Chief Information Officers (CIOs) are being met at the door by the same end users eager for, and many times already using, mHealth apps. CIOs need to harness mHealth because of this demand and use by both physicians and consumers/patients, and more importantly because mHealth supported in an enterprise manner can accomplish many of the organizations own objectives. Providing an umbrella of governance and oversight will also protect against misleading or erroneous healthcare information and the potential risks of grass-roots solutions. A sound mHealth program should be founded on a strategy that sets the vision and direction and proactively establishes ground rules for use. With mHealth evolving so rapidly, the strategy to build the foundation should be completed within two-to-four months. It establishes the platform for major decisions regarding governance, priority setting, device management and security and identifies the first immediate need/short timeframe projects. However, the mHealth program is much more than the technology; it incorporates the technology solution into typically new business and care processes, changed roles and responsibilities, and added support services for devices, apps and end users.

Healthcare Information Mobility is not New

Clinicians have been using wireless laptops, tablets and other handheld devices in provider organizations for more than ten years. In fact, it is has become axiomatic that, like any highly mobile worker, physicians require, and are more likely to use, electronic health records (EHRs), online reference resources, messaging, and other frequently-accessed applications when they can access them from anywhere. The earliest mobile devices, connected to software applications via wireless local area networks (WLAN), mainly provided a mobile access alternative to hard-wired devices for clinician users of the clinical information system or EHR and then later also for Internet access.1 The use of cellular communication technologies for purposes in addition to telephone conversations started in the early 2000s, mostly employing short message service (SMS) to transmit information and reminders to both patients and providers. Early examples include using cell phone text messages to remind children with asthma to take their medications in 2002.2 A 2005 industry report listed more than 100 health-related tasks that could be accomplished using a mobile device. Collectively, this broader use of mobile communication devices in healthcare has come to be known as mHealth.

The New Generation of mHealth Has Matured on All Levels

Mobility for healthcare information or mHealth is the ability to access healthcarerelated applications using wireless consumer devices such as cell phones, smartphones and tablets, using a range of communications technologies.

The technical foundations for mHealth have matured considerably since they first emerged: the actual user devices, communications infrastructures and the healthcare applications (apps). As a result, the scope of what mHealth encompasses today and the types of end users have mushroomed. mHealth is similar to telemedicine in that solutions can be used for the direct provision of care, but mHealth allows for many of the telemedicine interactions to be done virtually anywhere, with technologies including cellular (3G and 4G), broadband, GPS and others actually providing the communication link. Applications are also much broader as they include the use of mobile devices to collect and transmit patient clinical and community data to providers, patients, consumers and researchers, and support real-time monitoring of vital signs and other health status metrics.

Todays Devices Are a Game-Changer Because Everyone Is Using Them

Consumer devices, such as smartphones and iPads (and iPad-like devices), significantly add to the scope of what can be done with mHealth because they are becoming universally available. For example, in a recent Pew Internet Research Study, 35 percent of U.S. adults now own a smartphone.3 Adoption of smartphones by physicians is more than double the adoption by the general population. A recent survey by Manhattan Research showed that 81 percent now use smartphones, an increase from 72 percent in 2010.4 For physicians, the three market leaders are Apples iPhone, Research in Motions Blackberry and Googles Android platform, with Apple having a substantial lead. Twenty-seven percent of primary care providers and specialists own an iPad or similar device, a rate five times higher than the general population, indicating that the ease of use is the leading reason for adoption.5

mHealth Is Currently a Grass-Roots Movement

The number and variety of mHealth apps is also growing on a steep curve. Healthcare alone has currently more than 17,000 apps with 43 percent primarily designed for healthcare professionals.6 There is a wide range of application types for both providers and consumers/patients those that promote continuous health and wellness monitoring, provide quick access to medical content and clinical data and promote care interactions between patients and providers as a means to deliver care outside the office setting. With the multitude of apps on the market and many more in development, there are even apps to help find the right solution. The search engine Mobilewalla, for example, provides searchand-sort capabilities through their numerous offerings. Another app called Appitalism.com combines a social community with an online store, enabling consumers to identify, discuss and download apps from a catalog.7

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An estimated 200 million health-related applications are already in use globally.8 In addition, baby boomers will likely expand the mobile health IT market to $4.6 billion by 2014 and to $12 billion by 2020, according to research from the Enterprise Forum of the Northwest. This group is interested in tech-enabled health and wellness products for personal use, and smartphones may represent the best opportunity since boomers already represent one-third of all smartphone users.9

Todays mHealth Is a Multifunctional, Multimedia Environment

What is exciting (and different) about this generation of mHealth is the synergistic combination of smart device value-add capabilities (camera, GPS, video chat, blue tooth connectivity to medical and home devices, high definition and larger screens, advanced processing capabilities, etc.) matched with innovative software applications that can supplement or even replace traditional healthcare processes. The possibilities and potential value to healthcare are significant. A recent research report, The Future of Healthcare: Its Health, then Care, described numerous examples of mHealth innovations ranging from wellness tracking to earlier diagnosis and treatment monitoring all supporting a growing healthcare ecosystem that promotes improved health outcomes for individuals, communities and medical research.10
The smartphone with its apps is the disruptive technology for patient-self management. For example, using a smartphone based diabetes monitoring app, patients A1C levels dropped by nearly 2.0 points. (Source: LEF The Future of Healthcare: Its Health, then Care, LEF, 2010.)

For care providers there are two emerging app trends: apps that much more easily extend and enhance access to their clinical information systems and those that provide niche functionality that incorporates smart mobility technology and medical attachments in some cases. These solutions take delivery of information to a new plateau of utility. For example, they can push content based on customized profiles, substitute 3D images and animation for text and still image content, and enhance e-mail with video. They also support new, more efficient and effective ways of delivering care (e.g., mobile ultrasound, mobile radiology viewers). Both extender and niche apps can reside on the same device and, with appropriate integration and security, they can work in concert to bring care support to a new level. Table 1 provides an overview of the care provider application categories with examples of currently available apps.
Table 1: mHealth Application Types and Examples for Providers
Application Type for Care Providers Examples

Medical information, images and News Content: QXMD11 release of medical research news with mobile app; Medpage12 research and medical news push Medical Images: Blausens medical Human Atlas with 3D animation and illustration, 3D4 Medical muscle system with ability to view different muscle layers13 Diagnostic tools using smartphone capabilities and medical device attachments to diagnose patient health problems Visit and communication tools Ultrasound: Mobisante14 Radiology Image review: ResolutionMD Stroke DX15, MIM software16 and palm-sized MRI developed at Massachusetts General Hospital17 Dictation: Dragon Nuance for iPhone18 Video Interactions: iPhone FaceTime19 and Android Video Chat20 Provider messaging in hospital: Voalte21 Physician clinical information system functionality with mobile apps that can be interfaced to EHRs: PatientKeeper22 EHR Mobile Extension: EPICs Haiku23 Mobility platform with EHR integration capability: CSC Patient In Your Pocket (view only)24 Physician practice EHR built for mobile devices: Drchrono25 and Clear Practice Eden26 (using cloud computing)

Application suites and EHRs

Todays mHealth for consumers also offers a rich mix of apps and device attachments that can address a spectrum of health management issues, from fitness to urgent care and disease monitoring. Blue tooth-enabled pedometers, scales, blood pressure cuffs and glucose readers are just a few examples of attachments that expedite accurate data capture. Educational content is made
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more consumer-friendly with additional capabilities for patients to self-triage their current symptoms and locate care providers when needed using GPS technology. Monitoring using mHealth is akin to a having personal health or wellness coach by your side at all times reminding the consumer to stay on plan, whether the support is related to diet, health checkups, recording vital signs or taking medications. All of this takes advice and support outside of the traditional face-to-face encounter and occasional telephone calls. Table 2 provides examples of the types of solutions on the market and in early development.
Table 2: mHealth Application Types and Examples for Consumers and Patients
Application Type for Consumers and Patients Fitness and wellness Education/first aid/ triage Diagnosis Examples Health, weight and fitness tracking: Healthrageous27, DigiFit28 and MyHumana29 Education and First Aid: iTriage (GPS locator for medical care)30, text4baby (includes reminders) 31, Organized Wisdom 32 Self diagnostic testing: eST12 (STD33, Personal Genome Assistant34, HIV test from Sandia National labs35 (in early stages of piloting and testing) Data collection, plans, monitoring reminders: WellDoc (diabetes, asthma, others)36, Handy Sana 201 (cardio vitals)37, Heart Wise (blood pressure)38, Voxiva/Positive ID (diabetes)39, WellApps, (GI monitoring)40, Asthmapolis (asthma tracking)41 Medication reminders: MyRefill Rx42, Refill by Scan43

Chronic condition monitoring

Medication management

Adoption Requires Making mHealth the Preferred Mode

mHealth solutions will be effective as educational, diagnostic and treatment, coaching, collaboration, and monitoring tools only if they are able to sustain user loyalty in the long term. According to one survey, 26 percent of apps were downloaded and used only once, and 74 percent of the longer term users dropped out by the tenth use.44 Despite the potential for mHealth, applications will need to deliver value to participants if they are to become a common tool in healthcare. Studies have already identified that ease of use tops the list of requirements for both consumers and providers. However, ease of use is only one requirement. To be successful, mHealth apps will need to significantly improve care or care-related tasks, making mHealth the end users preferred way of completing the task. The front-end mobile app engages the consumers and caregivers to regularly use the software. However, integration of the mobility app with back-end systems and the ability to communicate and share the findings in real-time will make mHealth an integral part of health and care delivery in the long term.

mHealth at Work Illustrates the Possibilities

The following case-in-point examples show how smart devices and apps are working together to create innovative solutions that provide value to the involved stakeholders and in some cases also provide value for other patients, providers, payers, and/or the community at large.
Imaging apps and mobile ultrasound devices make the patient-provider relationship more intimate when physicians use the device, they can explain what they are seeing in real time, so the patient can see it too. (Source: Quote from Dr. Eric Topols speech at the Wireless-Life Sciences Alliance Convergence Summit May 2011)

Case-in-Point: Provider Diagnostic Testing Solution Mobisante MobiUS is a U.S. Food and Drug Administration (FDA)-approved, portable ultrasound imaging system using smartphone technology. The diagnostic-quality imaging solution fits in the pocket of the physicians lab coat so it is on hand at the point of care and makes it possible to perform the diagnostic procedure immediately. For example, emergency room doctors can use it to verify or rule out internal bleeding without waiting for a cart-based system and a specialist. Images can be securely stored for archival or shared for a second opinion or remote diagnosis.45 Case-in-Point: Patient Medication Refill Solution Instead of calling Walgreens to refill a prescription, patients can use the camera on their smartphones to take a picture of the bar-code label on the medication bottle and send it seamlessly, using the Walgreens Refill by Scan app. Users can choose a
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preferred store location as a default, or change locations as needed, and also select pick-up date and time. The app processes the incoming request and users with the Prescription Text Alerts tool can be notified via text message when the refill is ready for pickup. The fact that this service has more than one million subscribers in just over one years time shows that both consumers and retail pharmacies are experiencing a more effective, efficient and less expensive process.46 Case-in-Point: Community Public Health Solution: Asthmapolis is an asthma tracking smartphone solution that includes both a GPS sensor that attaches to the inhaler to record when and where it is used, and a smartphone app that tracks symptoms and asthma triggers and sends medication reminders. The company has conducted one year of pilot studies and is planning to launch the first major implementation this year. Key findings from the pilots include: Most asthmatic attacks do not happen in the home. Rural asthmatics are no less susceptible to attacks than urban asthmatics. App improved asthma control from 25 percent of the time to 62 percent of the time (subjectively reported). The app provides objective data collection, which is important because when asked, most people cannot correctly recall the last time they used their inhaler.47 This helps not only in individual patient management (clearer understanding of triggers) but also in public health because the accumulated information can shed light on problematic locations in the community and further insight into the populations at risk.48 Case-in-Point: Life Sciences Clinical Trials Pfizer Inc. is conducting a drug trial using computers and smartphones instead of relying solely on patients visiting a clinic, the first all-electronic home-based study of a drug to receive U.S. FDA approval. Eligible subjects enrolled in the clinical trial are sent the medication and a smartphone with an application to track symptoms. The company will compare the results with those obtained from a previous, traditional clinical trial for the same drug Detrol, a medication used for overactive bladders. The goal is to see if mHealth can be used more broadly in clinical trials and studies, making it easier and significantly less expensive for pharmaceutical companies to recruit and track participants. Furthermore, this approach allows eligible patients to participate in clinical trials, regardless of where they live.49 Case-in-Point: Health Plan Information for Smarter Decisions MyHumana Mobile provides a suite of mHealth apps to help plan members make better care and spending decisions. The Find a Provider app supports the ability to find a network provider nearby, provides contact information, maps and directions. Urgent Care Center Finder is a specialized version of the Find a Provider app focused on urgent care centers, using the iPhones GPS feature. Mobile Spending Account viewer displays spending account activity, current balances for members using health savings accounts (HSAs) or flexible spending accounts (FSAs), designed for decision-making at the point of purchase. Drug Pricing has information on out-of-pocket costs for prescriptions delivered via mail order, or at local pharmacies, and is designed for members to use in discussions with their physician to find less costly alternatives. The app also includes a pharmacy locater with cost information and geographic selection criteria.50

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mHealth Is Here to Stay and Assuming a Greater Role for Both Providers and Patients
Statistics indicate increasing use of devices and healthcare apps, and uses are becoming more sophisticated. The case-in-point examples are just a few of the solutions that are demonstrating the value of mHealth to many stakeholder groups in the healthcare industry. Investors are focusing on mHealth, as are academia, current healthcare software vendors, startups, as well as health plans, provider organizations, and life sciences companies. Even the federal government is involved through its Health Data Initiative Forum, which seeks to accelerate momentum for the public use of data and innovation to improve health.51 The business world, too, is well aware of the mHealth opportunities. Current wellknown healthcare software vendors, such as Epocrates and PatientKeeper, have added mobility or enhanced their mobility product lines to take advantage of new capabilities and expanded market share. Niche mobile app vendors are plentiful and have several revenue stream opportunities that include download sales, such as offered by the App Store for iOS apps. Advertisement revenue helps to build end-user adoption by offering the product for little or no fee. For larger enterprise solutions, traditional direct-to-consumer sales and subscription options are the norm. Other non-software vendors are developing partnerships and business alliances, all attempting to build on what they already have to become part of the mHealth solution industry:
A recent pharmaceutical industry report found that pharmaceutical companies increased their new health technology initiatives by 78 percent in 2010. A staggering 41 percent of those new initiatives were smartphone apps. (Healthcare IT News, April 26, 2011)

Telecommunications vendors such as Sprint, Verizon and AT&T have formed alliances with mHealth companies.52 Health plans (and self-insured employers) are partnering with health and wellness vendors in an attempt to lower health risks and monitor chronic conditions. For example, Healthrageous health and wellness solution was originally piloted by EMC and now has 1,000 users.53 Pharma/life sciences/drug companies such as Phillips, Johnson & Johnson and Novartis use apps to remind patients to take their medications or order refills, which increases sales and provides valuable data.54

How to Harness mHealth for Your Organization

mHealth is here and it is growing rapidly. Physicians are already using smart mobile devices and mHealth apps, and the trend is toward greater demand for additional and more sophisticated apps and services. On their own, patients use mHealth for fitness, health content, self-management, and social networking. They are now being asked to take more responsibility for their care, and smart mHealth solutions allow them to do so anytime, anywhere. Healthcare organizations need to harness mHealth for several reasons. First, physicians and patients are already comfortable with mHealth, and the organization can accomplish many of its own objectives while enhancing the value for users (for example, by integrating mHealth with background systems). Second, under the umbrella of governance and oversight, the organization can ensure that information and advice are efficacious and avoid the potential risks of grass-roots solutions. In most organizations, grass-roots mHealth is already underway. Catching up will require developing an mHealth strategy that sets the vision and direction for mHealth and proactively establishes ground rules for use. In addition, boundaries that cover regulatory requirements, care reimbursement, and investment limitations are documented and agreed upon before enterprise solutions are implemented in order to avoid legal and financial consequences.

A sound program to manage mHealth should be founded on a strategy that sets the vision and direction and proactively establishes ground rules for use.

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Figure 1: mHealth Strategy Approach

Accelerate the investigation and analysis and identify high-priority and lowhanging fruit mobility projects.

mHealth Strategy
Success in building an mHealth strategy requires taking a holistic view, focused on business processes and imperatives with an underlying deep knowledge of mobility applications and infrastructure technologies. One of the challenges of mHealth is that smart mobility is evolving so rapidly. This makes long-term plans impracticable. A time-boxed approach used by CSC successfully in several industries builds a foundation for the organization to get started without making the initial effort unnecessarily complicated. A strategy, which can be developed in 2-4 months, establishes the platform for major decisions regarding mobility governance, priority setting, device management and security, and identifies the first projects that are high priority, address immediate needs, and are feasible in a short time (low-hanging fruit). Other characteristics of the approach are described in Figure 1: mHealth Strategy Approach. Questions addressed while developing the mHealth strategy should cover business and care goals, technology current status, desired future state and gaps, and the impact of mobility on operations as outlined in Table 3.
Table 3: Key mHealth Strategy Questions

Time-Boxed

Multi-Threaded

Execute parallel efforts across business, care and technical work flows.

Comprehensive

Bring multiple perspectives to the engagement industry, customer interaction processes, and mobile technology. The effort needs to be spearheaded by an executive sponsor who is also the issue arbitrator.

Collaborative

Involve business and IT stakeholders throughout the project.

Mobility Strategy and Approach Questions to Address Impact Business/ care goals and objectives 1. What are the key reasons for mobility (e.g., increase access, increase market share, introduce new business and care services, care and business process improvements, improve care provider and employee productivity, and others)? 2. What are the key business and care functions that are intended to be mobility-enabled? What are the target populations for mHealth care providers, employees, patients, etc.? What are the stakeholder value propositions for using mobility? 3. Are there vendor partnerships in place in support of your business goals or for future business or care initiatives that would be impacted by mobility? 4. What regulatory and compliance requirements need to be addressed in the context of mobile applications? Is FDA approval needed for solutions that are considered medical devices or an extension of medical devices? Also, is care provided within the boundaries supported by state certification and reimbursement requirements? 5. Are care providers and employees already using mobile devices and for what tasks? 1. What type(s) of mobile devices and operating system(s) do you intend to support? Will Bring Your Own Device (BYOD) be allowed? 2. What policies and procedures are in place to manage current mobile devices? This includes how they are provisioned, charge-back methods, software distribution, device refreshes, device tracking and troubleshooting. 3. How will you secure the devices and data stored on them in order to meet HIPAA privacy and security requirements? Will you require device segmentation to partition personal from organizational apps and data? In addition, will there be added device security? For example, if lost do you have the policies and technology in place for remote lock and wipe? 4. Is your organization planning to develop its own apps? If so, do you have or plan to purchase a Mobility Enterprise Application Platform (MEAP) tool? 5. Does your organization have an integration infrastructure for connecting with existing enterprise systems and applications? If not, how will integration be handled between mobile device-captured data and enterprise applications? Are there standards for data definitions, coded values and interfaces? 6. Describe the existing processes, if any, for the deployment and testing of mobile applications. 1. Describe the current IT environment supporting mobile devices and apps in your organization. 2. What skill sets are available for various aspects of mobile apps development, deployment, support and configuration? 3. What is the gap with planned mobility initiatives? What are your short- and long-term resource plans?

Technology

Operations and support

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mHealth Strategy Outcomes

Three major outcomes of strategy development are a mobility strategy and roadmap implementation plan, a capability development plan for resources, and documented governance and support models. Strategy and Roadmap Implementation Plan: The strategy outlines the vision and provides a clear understanding of the opportunities and priorities across the enterprise. The roadmap sets a plan of action for realizing the vision by setting out high-level timelines and dependencies and identifies projects and technologies for the next 18-24 months. With the rapidly changing technology and apps fields, anything beyond that timeframe is likely to be outdated. Together the strategy and roadmap are input for the other two. Capability Development Plan: The plan outlines the current skill sets, the gaps, and how to fill the gaps in the short and long term. Plan activities can include the use of third-party resources and educational and hiring plans aligned with future mobility initiatives. An mHealth-integrated Governance and Support Model: The mdel leverages existing IT environments and incorporates mobility into the current governance model and technical infrastructures. With the rapidly advancing sophistication of mobility-related technologies, it is especially important for IT governance to include a clearly-defined decision framework to identify key mobility opportunities and rank them in terms of business/care priorities and value delivered, with a keen eye towards next generation device capabilities and sophisticated apps, as outlined in Table 4.
Table 4: Mobility Current and Future Capabilities
Technology Current Trends/Capabilities Hardware Near- and Long-Term Capabilities Tablets replacing laptops, Dual core processors, high definition smartphones replacing cell phones camera and video recorder News devices that are specialized, iOS, Android and RIM operating wearable and ruggedized systems lead More sensors Processing power increasing for both Camera, GPS/navigation, sensors, split screen, medical device connectivity 3G, EDGE, WiFi, Bluetooth Pockets of 4G Near Field Communications (NFC) allows users to simply wave their phone over sensors to make payments 4G widespread, ad hoc mesh networks, personal area networks (PAN)

Networks

Apps

Innovation is consumer driven and MEAP reaches maturity consumer focused Cloud, social and big data services MEAPs are basic but maturing emerge Enterprise gets serious about mobility

Get Started with a High-Priority mHealth Project and Program

Opportunities and challenges abound with mHealth and they are always increasing enough to overwhelm many organizations. However, having completed the strategy and roadmap, mHealth-ready organizations are equipped to tackle their highest priority projects. These projects could include, for example, an mHealth app to keep newly-discharged, high-risk patients out of the hospital by providing mobile and home monitoring. Another example is a mobile app that allows physicians to access schedules and patient lists, possibly across campuses and settings of care. Both examples require back-end integration with the organizations clinical information system(s). But successful mHealth projects require much more than simply introducing new technology. There needs to be a program or process that incorporates the solution, and this can involve business and care processes, changing roles and responsibilities, and adding support services for device and application management and user support (Help Desk).
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An important aspect of completing the first few mobility projects is taking the time to learn from the experience by assessing challenges, issues, successes and overall impact. The outcome of this exercise can identify changes that should be made to technologies, services, processes and people to improve outcomes and minimize challenges for upcoming projects.

Authors:
Fran Turisco is a Research Principal for the Global Institute for Emerging Healthcare Practices, the research arm of CSCs Healthcare Group. Mike Garzone is the Chief Technology Officer for CSCs U.S. Health Delivery Group and leads the Technologies and Connectivity Practice.

Acknowledgements:
The authors would like to acknowledge the following individuals for their assistance: Caitlin Lorincz, Jane Metzger and Jim Petrassi. For more information, please contact us at 800.345.7672 or healthcaresector@csc.com.

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8. Boomers Demand Health Apps, Nextgov.com, John Pulley, January 18, 2011. 9. Ibid.

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12. MedPage Today Web site, http://www.medpagetoday.com/landing_page.cfm?lpg=mbr&xid=g_&gclid=CKWp6nQuKoCFchM4AodWFOV5Q, accessed August 5, 2011 13. Stacey Peterson, 12 Hot Mobile Medical Apps, Information Week, May 4, 2011. 14. Mobisante Web site, www.mobisantemobius.com, accessed June 16, 2011. 15. M. Merrill, iPhone Can Diagnose Stroke Quickly, Accurately, Healthcare IT News, May 9, 2011. 16. MIM Software Web site, http://www.mimsoftware.com/products/mobilemim, accessed August 5, 2011. 17. Pam Baker, Mobile Health Apps, Part 3: On the Cutting Edge, Technewsworld, April 28, 2011. 18. Stacey Peterson, 12 Hot Mobile Medical Apps, Information Week, May 4, 2011. 19. FaceTime for Mac Web Site, http://www.apple.com/mac/facetime/, accessed June 16, 2011. 20. Android Market Web Site, https://market.android.com/search?q=video+chat&so=1&c=apps, accessed August 5, 2011. 21. Voalte Web site, www.voalte.com, accessed August 5, 2011. 22. PatientKeeper Web site, http://www.patientkeeper.com/solutions/index.html, accessed June 29, 2011. 23. iTunes Epic Haiku Web site, http://itunes.apple.com/us/app/epic-haiku/id348308661?mt=8, accessed August 5, 2011. 24. Patient in Your Pocket Web site, http://www.csc.com/health_services/ds/11303/60182-patient_in_your_pocket, accessed April 2011. 25. Stacey Peterson, 12 Hot Mobile Medical Apps, Information Week, May 4, 2011. 26. ClearPractice Web site, http://www.clearpractice.com/pressrelease_110712, accessed August 5, 2011. 27. Healthrageous Web Site, http://www.healthrageous.com/, accessed June 29, 2011. 28. iTunes Digifit Web site; http://itunes.apple.com/us/app/digifit/id314841648?mt=8, accessed August 5, 2011. 29. Humana Web site, http://www.humana.com/resources/support_center/myhumana_benefits/mobile_resources.aspx, accessed August 5, 2011. 30. iTriage Web site, http://www.itriagehealth.com/, accessed January 2011. 31. Text4baby Web site, http://www.text4baby.org/, accessed June 29, 2011. 32. Pam Baker, Mobile Health Apps, Part 2: Making Life Safer and Sweeter, Technewsworld, April 21, 2011. 33. John D. Sutter, Mobile Phones May Diagnose STDs, CNN.Com, November 10, 2010. 34. Pam Baker, Mobile Health Apps, Part 2: Making Life Safer and Sweeter, Technewsworld, April 21, 2011. 35. Michael Haederle, Your Next M.D. Might be a PDA, Miller-McCune, January 8, 2011.

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36. Stacey Peterson, 12 Hot Mobile Medical Apps, Information Week, May 4, 2011. 37. Rebecca Kutzer-Rice, ECG-Equipped Smartphone Could Save Lives, Minimize Hospital Visits, Smarter Technology, October 27, 2010. 38. iTunes Heartwise Web site, http://itunes.apple.com/us/app/heartwise-blood-pressure-tracker/id311716888?mt=8, accessed August 5, 2011. 39. John Farrell, Voxiva, PositiveID Unveil Integrated Mobile Diabetes Solution, Mobilehealthwatch, November 10, 2010. 40. WellApps Web site, http://www.wellapps.com/, accessed August 5, 2011. 41. Asmapolis Web site, www.asmapolis.com, accessed June 22, 2011. 42. MyRefill Rx Web site, http://myrefillrxapp.com/, accessed August 5, 2011. 43. Pam Baker, Mobile Health Apps, Part 1: Taking Life into Your Own Hands, Technewsworld, April 14, 2011. 44. M Merrill, Smartphone Health Apps Having Trouble Retaining Consumer Loyalty, Healthcare IT News, April 26, 2011. 45. Mobisante Web site, www.mobisantemobius.com, accessed June 16, 2011. 46. Pam Baker, Mobile Health Apps, Part 1: Taking your Life into Your Own Hands, Technewsworld, April 14, 2011. 47. The Health Data Initiative Forum Web site, http://www.iom.edu/Activities/PublicHealth/HealthData/2011-JUN-09.aspx, accessed August 5, 2011. 48. Asmapolis Web site www.asmapolis.com, accessed June 22, 2011. 49. Jennifer Corbett Dooren, A Clinical Drug Trial via Phone, Computer, The Wall Street Journal, June 7, 2011. 50. Humana My Humana Web site, http://www.humana.com/resources/support_center/myhumana_benefits/mobile_ resources.aspx, accessed August 5, 2011. 51. Harnessing the Power of Open Data, HHS New Release, June 9, 2011, http://www.hhs.gov/news/ press/2011pres/06/20110609a.html, accessed August 12, 2011. 52. Pam Baker, Mobile Health Apps, Part 2: Making Life Safer and Sweeter, Technewsworld, April 21, 2011. 53. Brian Dolan, Healthrageous Counts 1,000 Users, Mobilehealthnews.com, May 16, 2011. 54. Pam Baker, Mobile Health Apps, Part 1: Taking Life into Your Own Hands, Technewsworld, April 14, 2011.1

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Healthcare Group 3170 Fairview Park Drive Falls Church, Virginia 22042 +1.800.345.7672 healthcaresector@csc.com Worldwide CSC Headquarters The Americas 3170 Fairview Park Drive Falls Church, Virginia 22042 United States +1.703.876.1000 Europe, Middle East, Africa Royal Pavilion Wellesley Road Aldershot, Hampshire GU11 1PZ United Kingdom +44(0)1252.534000 Australia 26 Talavera Road Macquarie Park, NSW 2113 Australia +61(0)29034.3000 Asia 20 Anson Road #11-01 Twenty Anson Singapore 079912 Republic of Singapore +65.6221.9095 About CSC The mission of CSC is to be a global leader in providing technology-enabled business solutions and services. With the broadest range of capabilities, CSC offers clients the solutions they need to manage complexity, focus on core businesses, collaborate with partners and clients, and improve operations. CSC makes a special point of understanding its clients and provides experts with real-world experience to work with them. CSC is vendor-independent, delivering solutions that best meet each clients unique requirements. For more than 50 years, clients in industries and governments worldwide have trusted CSC with their business process and information systems outsourcing, systems integration and consulting needs. The company trades on the New York Stock Exchange under the symbol CSC. www.csc.com
Copyright 2011 Computer Sciences Corporation. All rights reserved. WA11_0227 HCG August 2011