title: A mobile health infrastructure to support underserved patients with chronic disease.
abstract: BACKGROUND
  Chronic diseases are the global leading cause of death, but the US health system is poorly designed to support patients with chronic disease. Underserved patients report high rates of cell phone use and interest in using mobile technology for health care. A mobile health infrastructure may help transform health care delivery for underserved patients with chronic disease.
  
  
  OBJECTIVE
  This study assessed the feasibility of integrating mobile health infrastructure with clinical information systems and the electronic medical record (EMR) to support patients with chronic disease through automated, bidirectional text messaging.
  
  
  OBJECTIVE
  Three priority areas of chronic disease management were targeted. Existing self-management support was expanded, and new support for laboratory test scheduling and medication management was created.
  
  
  METHODS
  Adult patients (n=135) with diabetes selected preferred content and scheduling for self-management message prompts. Outreach messages were sent to patients overdue for laboratory tests and medications. Manual review of pharmacy and laboratory outreach data was conducted for quality assurance. Focus groups were held to solicit patient perspectives.
  
  
  RESULTS
  Patients sent over 6500 response messages with response rates of 53.7% (blood sugar), 48.8% (step counts), and 31.9% (blood pressure). Laboratory data integration was achieved, but pharmacy data gaps required ongoing manual review. Focus group participants reported improved self-management and information awareness.
  
  
  CONCLUSIONS
  HIT was used to address dependency on visit-bound disease management in a novel, low-cost way. Use of a mobile health infrastructure was feasible. Text messaging solutions may mitigate barriers to access and enhance support for patients with chronic disease.
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Moore
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA. Electronic address: henry.fischer@dhha.org.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Fischer
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Steele
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: M
authors.initials: M
authors.lastname: Joshua Durfee
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ginosar
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rice-Peterson
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Berschling
authors.affiliation: Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Davidson
keywords: Chronic disease; Diabetes; Mobile health; SMS; Safety net; Text message