PETALUMA -- Redwood Community Health Coalition recently took part in a pilot project testing a mobile health application that enrolls patients in public assistance programs, a potentially pivotal development for the public health sector.

The accelerating convergence of mobile technology and health care will likely open new avenues of access to under-served populations, which could in turn help states with implementing key pieces of health care reform, officials said.

Much of the acceleration of mobile technology has occurred in the private sector, particularly in lieu of the Affordable Care Act and its emphasis on access and technology, while the public health sector hasn't moved nearly as quickly, according to Lucy Streett, senior policy manager for Social Interest Solutions, the Oakland-based developer of the application, called One-e-App.  

In an attempt to address that disparity, the nonprofit developer selected the Petaluma-based Redwood Coalition, a consortium of federally qualified health centers across the North Bay, to test the mobile version of One-e-App, a web-based enrollment system, on some 80,000 patients from Sonoma County, many of whom qualify for some type of public assistance such as Medi-Cal or Healthy Families.  

Such patients often don't obtain access to those and other programs because of a byzantine system of bureaucracy, according to Pedro Toledo, director of community and government relations of Redwood Coalition.

"Getting enrolled is just so difficult. People get denied because of confusion, or they don't fill out the application right," Mr. Toledo said.Mobile devices to bridge enrollment gap

But with the continual march toward smartphones and tablets from nearly all corners of the population, Social Interest Solutions, working with the California Endowment and the Redwood Coalition, said there is great potential for mobile devices to bridge the enrollment gaps that persist in the public health realm while assisting state-run exchanges that will be a key mechanism of health reform.

Some 85 percent of all adults own a cell phone, 42 percent of them smartphones, according to the study, citing the Pew Research Center.

One goal of the Affordable Care Act is to establish multiple enrollment channels for health care and human services.

"The mobile environment, the wave of the future, must be one of those channels," the report states.

"It's an interesting area that is a bit untapped," Ms. Streett said.

The pilot study was funded by a broader two-year, $1.2 million grant from the California Endowment focused on modernizing enrollment. It's among the first in the nation to test the effectiveness of public program enrollment using mobile devices, according to Social Interest Solutions, and the Redwood Coalition is the first organization in California to test the mobile application.

It was selected because of its familiarity with the web-based One-e-App, as well as its success in enrolling 96 percent of all children in Sonoma County into some form of health insurance, an important step in improving health outcomes, Mr. Toledo said. 

"That's where we fit in -- in an effort to try to expand these services beyond children in preparation for health care reform," he said.Fill in one form, complete many

The pilot study closely watched certified application assistors at seven Redwood Health clinics. Each assistor was equipped with an iPad 3 and a wireless printer, which they then used to enroll applicants in a number of programs. One-e-App is effective because an individual can fill out one application for, say, Medi-Cal, and the software will automatically fill in as many other applications possible, thereby streamlining the process and eliminating the need to go to one agency at a time.

"Usually, agencies focus on one application," Mr. Toledo said. Social Interest Solutions' "innovation is that you can do all of them with the same application."

A mobile version of that software could be especially helpful with the implementation of health care reform, particularly as states set up health exchanges meant to help consumers easily purchase health insurance through an online marketplace.

"The health exchange, Covered California, is really interested in making the enrollment piece … as easy as buying airline tickets on Kayak," Mr. Toledo said.

Ms. Streett, of Social Interest Solutions, agreed, adding that her organization has consulted a number of states on how to set up exchanges.

"We think this is an important chance for states to be looking at how they can maximize enrollment in their exchanges," she said.

Peter Rumble, director of health policy, planning and evaluation for Sonoma County Health Services, said mobile technology will greatly benefit both access and the delivery of care as more people enter the health care system. Particularly, it will permit trusted health care organizations and others to reach communities where they live, rather than hoping underserved populations obtain services at a fixed location.

"We'll need to engage people in the community where they are. We'll need to be in the community to get people enrolled," Mr. Rumble said. "And so mobile technology, it's not really a thing of the future; it's a thing of now. And it will help us not force (people) to go outside of their community for care. That's a big cornerstone."

For example, established community centers, churches, schools or even homeless shelters can be used as sites to enroll an otherwise hard-to-reach population in important health programs, Mr. Rumble and Mr. Toledo said. Once enrolled, and once access to a physician occurs, that physician could then easily see if a person is on Medi-Cal, which could alert them to other services the patient may benefit from, such as Women, Infant and Child program or CalFresh, Mr. Toledo said.Security, privacy concerns

The study does note that mobile technology, when used for health information, presents "unique security and privacy matters, including oversight against loss and theft of mobile devices and use of the devices in public environments...."  But the mobile application is in compliance with the Health Insurance Portability and Accountability Act, and Ms. Streett said that by the time health exchanges roll out in late 2013, security issues would likely be resolved.

Another pilot is now underway in San Diego, where Social Interest Solutions is testing the mobile application on Samsung Galaxies; the Sonoma County study focused on Apple products. The study notes that a key challenge to the mobile One-e-app is building something that can be used across the multiple mobile platforms.

According to the study, users of the mobile One-e-app were able to process more applications in less time, they could help people in nearly any setting, and an iPad was more than sufficient to complete the application.

Redwood Community Health Coalition currently has 28 full-time application assistors, a number it hopes to double within in the next six months, Mr. Toledo said.

Social Interest Solutions developed and manages the ongoing operations of One-e-App for a wide range of health and human services programs that is used in 14 counties in California and in Arizona, Maryland, Indiana and Florida.  To date, One-e-App has facilitated enrollment of more than 13 million people nationally into Medicaid and other federal, state and local programs. 

The Redwood Community Health Coalition consists of health centers in Marin, Sonoma, Napa and Yolo counties, including Marin Community Clinics, the Petaluma Health Center, Santa Rosa Community Health Centers, Clinic Ole in Napa and numerous others.

While elements of health care reform remain in flux, California's health exchange is on schedule and is considered farther along than most other states. That could help enrollment go relatively smoothly, Mr. Rumble said.

"The California exchange is moving forward. We know generally what it's going to look like," Mr. Rumble said. "We're only about a year away from a strong push to get people enrolled. The implementation of this technology is really important."