This 1800 word blog post from Eric Dishman has given me lots to think about. For those of you who aren’t familiar with Eric and his work at Intel Health here’s a quick introduction and background:
Eric Dishman is an Intel Fellow and director of Health Innovation and Policy for Intel’s Digital Health Group, which he helped launch in 1999. He founded the Product Research and Innovation team responsible for driving Intel’s worldwide healthcare research, new product innovation, strategic planning, and health policy and standards activities. In 2007, Dishman was named an Intel Fellow, one of only 46 Intel executives awarded this designation in recognition of industry leadership in science, technology and innovation.
Dishman is widely recognized as a global leader in driving healthcare reform through home and community-based technologies and services, with special focus on enabling independent living for seniors. He and his team’s work have been featured in publications including the New York Times, Washington Post, Business Week, and USA Today. The Wall Street Journal named him one of “12 People Who Are Changing Your Retirement.”
An internationally renowned speaker, Dishman has delivered dozens of prominent keynotes on independent living across the globe for events such as the annual Consumer Electronics Show and the IAHSA International Conference, as well as for organizations including the National Governors Association. He has published dozens of articles on independent living technologies and co-authored many government reports on health information technologies and health reform.
Dishman co-founded some of the world’s largest research and policy organizations devoted to advancing the cause of independent living, including the Technology Research for Independent Living (TRIL) Centre, the Center for Aging Services Technologies (CAST), the Everyday Technologies for Alzheimer’s Care (ETAC) program, and the Oregon Center for Aging & Technology (ORCATECH). Dishman has received numerous awards for his work in helping to shape the future of health care.
Connected Health Devices that Intel’s Digital Health group have demoed/sold to Healthcare Providers:
HealthGuide (Read my review here):
Medication Dispenser (similar to a low cost RFID enabled mobile alternative I’ve demoed here):
Intel Reader (retail price = >£1500):
Intel @Home Alzheimers Testing device:
Now onto what I think about Eric’s posting:
First up I think we have to commend him for making this post. We shouldn’t underestimate what a brave thing it is to do for a Director within such a large corporation to be open about his thoughts and opinions. Secondly Eric’s post does feature a caveat in which he admits he may “have probably been too hard on mHealth and have made too many gross generalizations about the movement” so we shouldn’t use this post as a stick to beat him with. Instead I think we should consider this an opportunity for mHealth industry participants to add value by exercising our right to reply. Here’s what I think, as always I welcome your thoughts:
“Another day, another flyer arrives for a seminar on “mHealth.” One that showed up in my mailbox this week is typical: high-gloss images of mobile phones and heart signals, celebratory claims about how all of this will “revolutionize” healthcare, and liberal use of the words “innovation” and “transformation” in almost every keynote title. I bet I could circle the globe going to all of these mHealth events if I would let myself”
As someone who feels directly responsible for this state of affairs I think it’s worth me justifying what’s going on here. In 2008 I wrote my predictions for 2009 (which you can view here) in which I stated that I felt 2009 would be the year that mHealth would eventually start replacing eHealth. At the time this was slightly interesting because unlike in 2010 (in which I’ve noted some 30+ mHealth events) in 2008 there had been none. In 2008 I’d chaired an eHealth conference at City University in London alongside the Director of R&D of a leading mobile operator and it became obvious to me from discussions that there needed to be an event catering for the increasing need for the mobile and healthcare communities to showcase best practice in their collaborations and to convene with one another.
Shortly after the posting of these predictions I was approached by Informa Telecoms and Media (Europe’s largest Medical and Telecoms publisher/event organiser) who saw an opportunity in these predictions and wanted me to help them found the inaugural Mobile Healthcare Industry Summit. The announcement and success (read my review here) of this event has directly led to the huge number of similar conferences by competitive event organisers. Click here for full details on the 2nd annual event – taking place in London on the 21-22 Sept 2010.
Of course in a time when we have online business networking communities offering mHealth networking groups (like the mHealth group that I set up on Linkedin back in 2008 which represents a 400 strong tribe who work in the global mHealth industry) there are some who are dismissive of the need for these events. Whatever your personal reservations I don’t think it’s fair to blame any of these conference organisers for being entrepreneurial and serving a growing market in a time of global downturn. Personally I think the success of this format merely highlights how face to face continues to trump other forms of communication.
Whilst I have no doubt hundreds of entrepreneurs are knocking the door of Intel Health offering them attractive collaboration opportunities I know for a fact that the scenario is very different for mHealth entrepreneurs who may have some great ideas but only a maxed out credit card to support their development! With speakers including Vittorio Colao, CEO of Vodafone (the worlds biggest mobile operator), who chaired the inaugural Mobile Healthcare Industry Summit, and our own exhibiting experience I think it’s no understatement to say there is nothing that comes even close to having direct first hand access to the most influential executives across these convergent industries. We got some great feedback, new business and suggestions on how to improve our service making it an invaluable use of our time and plenty of justification for our continued involvement this year as media partner and demoing service provider.
I have to agree completely with Eric on his comment about the “glossy images of mobile phones showing heart signals” as this unrealistic graphic demonstration is akin to the ludricious claims that I hear some supposed experts claiming eg that there are mobile phones which enable patients to conduct their own ultrasound examinations!.
“Then there are the numerous press articles starting to beat the drum about mHealth. Concepts like “home health” and “wireless” and “smart phone” and “telehealth” are being bandied about as if they are all the same thing, under the rubric of “mHealth,” without much distinction between these very different capabilities, value propositions, and markets. Methinks we doth proclaim too much!”
What’s wrong with press interest? Whilst it’s not always informed I can’t help but think it’s more effective than press releases and glossy sales brochures featuring airbrushed images. Here’s some examples of Intel Health brochures that I picked up at a recent Connected Health Conference that will give you the idea of the volume of these that Intel is distributing. It’s worth noting that one of these contains over 50 full gloss pages and I can find next to nothing contained within it that displays thought leadership:
Same goes with Intel Health’s online strategy which seems to be all about expensive display advertisement rather than engagement and thought leadership:
Indicative of a poorly accountable online strategy I found that even their online banner adverts (this one I found prominently placed on the online version of the “Telemedicine and eHealth” Journal produced by Mary Ann Liebert Inc) don’t offer a working landing site:
“I have no doubt that we are living in a world in which personal technologies–from PCs to smart phones to game machines to wearable and eventually even implantable sensors–will become increasingly important for capturing healthcare data, prompting us to adhere to care plans, and connecting us with providers and each other in some powerful new ways for collaborative care. I have done, sponsored, and funded R&D at Intel in wireless technologies, sensor networks, mobile applications, and home-based services for healthcare”
Yeah we can all sit back and say we’ve done it all before behind closed doors but where’s the evidence that this R&D was effective? We can all see the rather disappointing state of Intel’s Health product line up (see images at top if you need a reminder). Despite claims that might suggest the Health Guide is some gift from above even my small company has developed a simple mobile application that runs on a huge range of low cost smartphones that can achieve all of the things that this expensive and cumbersome box can do and more… and the user experience (based on only a small groups daily interactions) is lightning years ahead.
What’s more it’s obvious that Intel has only just woken up to the Smartphone opportunity with it’s new ATOM chip. In contrast to its domination of the PC market it now faces the prospect of having to enter a new chip market which is very different and already dominated by rivals such as TI and Qualcomm.
To get an even better insight check out Eric’s TedMed talk in which you’ll hear him enthusiastically describing the opportunity for dumb shared landline phones to help sense patient health and well being despite the fact that the whole fixed phone idea is a concept that is on the decline the world over and will never be able to leverage the 8 unique benefits of mobile as the newest mass media:
“And I believe that consumer empowerment tools are a disruptive and important part of healthcare reform globally. However, this well-intentioned but premature celebration of all things “mHealth” may come back to bite us, if we’re not more careful. Here are some of my concerns:”
As someone who has been using mobiles in healthcare since 1995 and doesn’t know a single Doctor who doesn’t rely heavily on their mobile phone, I’m dumbstruck that anyone can claim that this is all “premature”. If you’re in any doubt check out this post detailing how mHealth is already here and very successful, also reflect on the fact that mHealth underpins the growing adoption levels and billions of $’s in revenue that are originating from mobile adoption by senior citizens. Rather than premature the evidence shows it’s doing very well thank you…
“1) Defining mHealth: I am becoming worried that we don’t really know what each other is talking about when we say “mHealth.” I’ve been asking a lot of the conference organizers calling how they define the term–what’s in and what’s out of the definition. There is always a long pause followed by lots of stammering and false starts when I ask what should be a pretty simple question”
Here’s the definition I use for mHealth. I think the crux of Eric’s problem is that he seems to be listening to the opinions of conference organisers for direction on an industry. As someone who has organised conferences going back to 2005 it’s always surprised me how unaware people are about what this entails: Conference organisers are responsible for “organising conferences”. An important part of this is bringing the big corporate decision makers to the table as these are the ones the industry wants to hear from and meet with. They’re also well positioned to spend money on those big ticket sponsorship packages.
“Then, some tell me it is all about “wellness” applications for the masses to drive prevention. Others define it as mobile applications, usually on smart phones, that leverage some of the government’s public health data so consumers can know things from their pollution exposure to flu migrations. Still others focus on it as videoconferencing with a doctor from a cell phone (I wish I could just get graphic-intensive websites to load consistently on my 3G smart phone and am skeptical that we’re ready for a video chat to review ultrasound results with my kidney specialist yet!). Some tell me it is about anything healthcare, or anything “wireless,” done outside of an institutional environment, and still others say it is about any “gadget” (a terrible word!) that enables consumer health empowerment”
All of these examples fall within my definition of mHealth, but I think something much more interesting is being revealed here. Eric seems to be facing the same problem adults have faced for years: Just how do you programme the video recorder? How come my grandson can just do it first time? Can someone at Nokia Research please please please just send Eric one of your new Meego Smartphones – maybe the one with the Atom chip? ;)
If you share Erics problem (but you haven’t got insider access to the best mobile devices from the world’s biggest mobile manufacturer) and you can’t get graphical websites to load on your mobile check your settings or install a better browser (opera, firefox, firefly are all great at keeping load times to a minimum – there is after all no reason for your mobile with its limited screen resolution and limited battery capacity to be wasting effort downloading high resolution versions of images for basic website viewing). I wonder if Eric has actually even tried the Apple iPhone (the best mobile for browsing)? By the sounds of things he hasn’t and I would guess that he probably thinks the Apple adverts are just some fictitious ‘jetson’ future scenario!
As for consulting with a kidney specialist over a 3G Video Call why not? It would be very useful if the patient wanted an explanation of something in their records, a second opinion on a recording that had been made earlier (something that will no doubt become more common place if patients start taking the advice of Googles’ Chief Health Strategist and begin routinely video recording consultations), or would like advice based on the results of a point of care test that they’ve conducted in their own home (something that thanks to “lab on an chip” technologies is becoming an ever more possible reality for a whole range of conditions that formerly required analysis in a hospital laboratory).
“As a supposed expert in the field (at least by measure of the number of invitations I have to speak at these forums), I’m left having no clue what this “movement” (I’ve heard it called) is really supposed to be about. If “mHealth” is all of these things and more….if “mHealth” is everything…then it is nothing. The phrase has become so slippery, so ubiquitous as to become almost useless. We must be more careful in defining and aligning what we’re talking about, and I encourage these various workshops and organizers to spend some time clarifying and specifying what’s at play here.”
Does Eric really think these flattering calls are coming just because he’s an expert? I wonder how many calls Eric thinks he’d be getting if he was that struggling startup trying to bootstrap his new connected health venture in one of the worst economic slow downs in history?
Big lesson here: When someone is selling something they may be excused for calling it a “movement” “all these things and more”, “everything”. In Ireland we call this type of exaggerated talk the Blarney, most people with money/power have an acute sense of it and don’t let their self opinion get carried away as a result of the flattery they may be subjected to.
“2) Managing expectations: As we’re reaching a fevered pitch about mHealth, I fear that no technology solution could ever achieve the enormous claims and utopian breakthroughs so many are promising. We’re doing a terrible job with expectations management because consumers and clinicians are all likely to believe that these solutions and services are widely proven, affordable, and available. This is just not the case yet. The potential is there, but not yet the products and price points.”
Before doubting the breakthrough potential of mobiles to transform the patient experience read about the Nokia Decade we’ve all just lived through. If you’re still in doubt at the fast moving pace read Digital Korea which details how the mobile has transformed every other industry sector in the more advanced mobile markets that all free nations are trending towards.
“I once begged a prominent engineering school in the United States not to do one of their legendary “fashion shows” of new concepts for telehealth and wearable health technologies. I was concerned that they would do a Flash-in-the-pan demo of cool concepts but wouldn’t stay around long enough to do the long, hard, expensive work of building real solutions with a real evidence-base. Even worse, the painstakingly slow progress made over the years to convince already-skeptical physicians and nurses about the value of telehealth technologies could come to a crashing halt if they were exposed to hype-filled demos without hard-found diligence”
Starting to sense that this cynicism is a theme Eric extends to a wide range of areas of technological innovation. I wonder how many wearable health technology entrepreneurs were deterred from pursuing their dreams as a result of his begging? I suppose it’s lucky he never met a young Larry Page or Chad Hurley with their bizarre concepts. Can you even imagine how much hype that first Google/YouTube demo needed to convince anybody it was a business worth pursuing?
“So, too, there is much risk in trumpeting the power of mHealth prematurely. It’s easy and quick to put up a slick demo. It’s hard and time-consuming to do a clinical trial, or a complete redesign of a care model that integrates mHealth data into meaningful medical practice, or a longitudinal ROI or behavior change study. We can’t let mHealth technologies become silicon-and-software “supplements” that drive consumer fads and fraudulent claims like so many so-called “diet pills.” No, not every mHealth application or service requires a randomized, clinical trial to prove its worth, but some kind of evidence is warranted”
Fortunately patients the world over still take reassurance in the advice of registered Doctors as Pew Internet Research continues to document. Allied with the fact that there are very few registered Doctors who are going to be happy peddling services that have no evidence base I think we’ve already got regulated market conditions that will require this to happen anyway.
“For that matter, there are still regulatory issues abounding around software, mobile devices, decision support tools, and online forums that provide medical protocols, care plans, or advice. I’ve seen no end of small and large companies making incredibly un-validated medical claims on keynote stages, and the jury is still out on how, when, and to what degree the FDA and other regulatory bodies are going to weigh in on these new capabilities. Similarly, there are HIPAA and privacy policies to be negotiated and navigated with this convergence of consumer electronics and medical technologies. And it’s hard to even ascertain how many consumers are meaningfully incorporating mHealth technologies into their lives today. The oft-cited “explosion” of I-phone apps involving health, for example, is perhaps an indicator of consumer (or developer) interest, but how many of these programs are downloaded more than once? Are actually paid for? Or used in a sustained way by consumers a month after “first contact”?”
The iPhone App store paid for/usage argument is spot on. Although mobile guru Tomi Ahonen dispels the hype with much more clarity here.
But when looking for customers who are meaningfully incorporating mHealth technologies into their lives instead of looking at the very tip of the iceberg that makes up the current iPhone App Store – which is only accessible to a small minority even in the US home market – look to 911/999 services were you will see massive adoption of mHealth technologies such as location, caller ID, video, SMS and it already has 99% + awareness and usage levels amongst patients.
“So again, I hope the mHealth proponents and prognosticators (and I count myself as one of those!) can better manage expectations, tease out these thorny issues, and under-promise while over-delivering what mHealth has to offer
3) Moving Beyond mHealth Biases: I recently had a revealing exchange with the chair of a mHealth conference who had invited me to keynote. I dutifully sent in my proposed abstract. Some weeks later, she called to tell me that my topic (showing an in-home independent living prototype) wasn’t really a good fit for their event
I asked what was wrong. First she told me that my talk didn’t feature a cell phone–this, after I had been told repeatedly that “mHealth” is an all-inclusive term for anything that consumers use outside of a clinic environment. Then she told me the sensors in my demo (simple accelerometers to detect motion changes to help prevent falls in elderly households) weren’t “novel enough” and “do you have any cooler gadgets you can bring?” And then she asked: “Do you have anything that focuses on younger populations instead of seniors?””
What’s so hard to get about the m in mHealth. This m denotes the newest mass media and the newest Trillion $ industry and the combination of it with the “Health” word denotes the convergence that we are seeing happening more and more between these two industries.
“She had managed to include all three of the biases of the mHealth movement that concern me in one two-minute phone call: it’s supposed to be about cell phones, with cool gadgets, for young people. I know there are many out there who don’t share these biases, but that phone call, like so many other conversations I have had around mHealth recently, underscores real issues I think we need to tackle”
Whilst that particular individual may have these three biases they aren’t shared across the industry. Here are 3 examples explaining how at 3G Doctor we haven’t fallen for for any of these biases:
1) I’m not into “cool gadgets”. All we use is the 3G Video Mobile and the internet. With over 14 million people in the UK and Ireland having a 3G Video mobile it went beyond cool some time ago. That’s a much bigger number of familiar in market already used devices than anything we’ve seen from Intel’s Digital Health group (see product list/pics above).
2) My address to the Senior Mobile Market Conference in London reinforced the message that the mHealth market needs seniors to adopt mobile services before it can reach its potential.
All the same we still shouldn’t ignore the need to serve the health needs of young people. And if you think this is a problem for the future consider this fact to get a handle on the issue we already face today: More young people in the UK own a mobile than a Book. If you can excuse me for not beating around the bush: the current “mobile” strategies that are being pursued to address these needs are failing the next generation:
“First, do we really understand who the users of these technologies will be and what the specific scenarios and contexts of usage are? In particular, I am concerned there is some anti-aging bias in this movement”
As someone who has done extensive research with seniors using mobiles I can find little evidence to support this. Indeed I find a lot more bias and misunderstanding of patient needs when I look at the static/fixed devices such as the Intel Health Guide which makes massive assumptions of users eg. that they only ever reside in one fixed place (can’t take it on Holiday or to stay at a friends), that they don’t want personalisation (despite the prominent space in the home the device has no screensaver features), that they don’t want to use the device for social engagement (no email, video calling with friends/family etc).
As a good example of how important 3G Doctor regards senior use of our services here’s a picture showing our service being used by a very distinguished 82 year old gentleman. Note this wasn’t a staged scene or a photoshopped image and there was no tutorial/explanation required before it worked. mHealth really can be as straightforward and simple as answering a call…
“While there is great promise for mHealth applications to drive a more prevention-oriented paradigm for younger populations worldwide, the fiscal reality is that we’re going to have an aging demographic–many of whom aren’t comfortable with or just can’t see smart phone screens–to reckon with for the next 20 years or so. The Medicare-eligible population with multiple chronic conditions are the largest cost challenge we face in healthcare–they see more than a dozen physicians, fill 50 different prescriptions annually, and account for almost 3/4th of physician visits (see Gerard Anderson’s Senate testimony). We need to make sure we are designing solutions and systems that fit well into the lifestyles and cohorts who most need them”
Mobiles have the potential to improve the delivery of healthcare across society. But the fiscal reality also includes an appreciation of the childhood obesity epidemic, poor access to quality maternal health and education about issues that affect younger populations such as sexually transmitted diseases/illegal drug taking/depression etc etc
Even seemingly small initiatives can have huge impacts for seniors. Imagine if we could implement caller ID and/or video calling based solutions into our 911/999 services. Image the billions of $’s in public service savings by elimination of bogus calls, better more informed management of patient needs and more knowledge of our patients family/carer situation.
Small initiatives matter: If patients registered their mobile numbers with clinicians when being fitted with implants, follow up, performance and recall information could be handled much more effectively, at a much lower cost and with greater convenience for the patient. Something that’s top of the news headlines at the moment with the recall of 93,000 J&J DePuy hip replacement products. The effectiveness of the Toyota brake recall program should remind us that there is no other industry performing so badly when it comes to product recall.
“Second, there is a certain amount of “technology bias” here–I think we’re caught up in a bit of Apple I-mania, in particular, that focuses our attention way too much on the technology and not enough on the use cases and care models which these technologies need to enable. Our cultural obsession with the mHealth “gadget” of the moment (perpetuated in press clipping after press clipping which tries to out-shock the audience by showing what is technically possible) leaves us with a cheap, one-night stand with these technologies whereas we need a more sustained, meaningful relationship with (and through) them. Yes, I-phones, Android phones, old phones, smart phones, and new, futuristic Jetson-like phones we haven’t even imagined yet will be an increasingly important part of the healthcare landscape some day”
Press clippings are what press clippings are. For this reason the leading mHealth companies I’m following just don’t do them, instead we use our efforts to communicate and listen through the means of laborious blogs like this one. Falling for hype is another thing altogether. As with Conference Organisers, publication editors need to shift something and so no point blaming them either.
“but personal health will require many touchpoints, form factors, and connected devices (some of them may even still be wired!) to meet the diverse needs of a diverse set of consumers”
At the heart of this lies what for me is Eric’s and maybe Intels achille’s heel. Wired is a legacy property that is becoming increasingly redundant. As the head of Digital Health at one of the worlds leading technology companies this is to my mind as fool hardy as those who favored the idea of faster horses when Henry Ford was proposing engine power.
Of course not everything can benefit from being wired but medical innovations can leverage wireless connectivity to offer:
> more robust easy to service/monitor devices
> greater ease of cleaning
> avoidance of trip hazards
> greater automation and less need for patients/carers to do anything
> more interaction and hence greater personalisation
Medicine that can leverage the mobile can also begin to leverage its 8 unique attributes as the newest mass media:
1st – mobile is personal
2nd – mobile is permanently carried
3rd – mobile is always on
4th – mobile has a built-in payment channel
5th – mobile is available at the point of creative impulse
6th – mobile is most accurate at measuring its audience
7th – only mobile can capture the social context of consumption
8th – only mobile can offer augmented reality
Of course Intel has until very recently been missing out on the smartphone market, leading to the growth of a whole raft of competitors in this rapidly growing market, but it’s not too late. Instead of dismissing the fads that are currently populating the Apple App Store, check out the user experiences they’re offering and use the success/failure of these to make deeper understandings of the patient experience instead of continuing to create new products without patient/customer feedback. For one thing I’m certain that created this way the Health Guide wouldn’t have reached the market with so many user experience challenges eg. 24 hrs of feedback on the appstore would have highlighted how stupid it is to include a rather baffling combination of cursor and touch screen input mechanisms.
Intel’s Connected Health product portfolio could learn an incredible amount from the mobile connected innovations that will (in my opinion) inevitably supersede their expensive dedicated device solutions. This example of Google Goggle’s Mobile Augmented Reality shows a really good example of how low cost mass market smartphones can offer a much more efficient and easy to use alternative to that offered by the £1500 dedicated Intel Reader device pictured above:
My advice to Eric: hang up the cynicism, dump those clumpy >£1000 devices that are designed to be just another “appliance” or “white good” for the “Home” and start thinking about “Patients”. Start with personalisation try wherever you can to add some fun, above all see where you can really add value before jumping on the words of a few conference organisers to make some presumptions about an industry that is most definitely generating the interest it deserves.