So often I hear of Telcos’ failed efforts to engage patients with mHealth offerings while Apple seemingly continues with it’s golden touch so I think it’s helpful to share how a US telco (Sprint) is working to drive adoption of Google Wallet – a contactless payment service that’s been struggling with adoption.

Quite a simple value proposition really: activate the feature within 7 days and receive a $50 credit.

I can imagine an offer like “Activate your TELUS HealthVault account within 7 days and get a free 3G Doctor consultation to use whenever you want” would work well for mHealth service providers and really help drive a whole plethora of downstream market opportunities, loyalty and new channel partners for a Telco:

A BBC report claims that the UK’s largest mental health charity is not answering 16,000 calls made to it’s 9-5 Mon-Fri advice line “because of demand” that has increased “since the start of the recession” and by 28% in the last year. It astounds me that there’s no mention of the failure to offer effective digital means of engagement as a complement to their telephone services.

Perhaps a prerecorded message could be played to those callers who are currently getting an unanswered call could say something like: “we’re currently very busy, why not try engaging with us on our website? MIND.ORG.UK”

The charity claims “calls about personal finance and employment issues have doubled since 2008″ so can you imagine the rich content they could support citizens with – this is after all a charity that excels at making it’s own quality online video content:

It depresses me to think that 12 years since Ryanair (Europes largest airline) launched it’s website and we’re still at a stage where connecting with a leading mental health charity that raises £27 million per year means you either send an email (to info@mind.org.uk) or call a number between 9 and 5, Monday to Friday…

Obviously I’d recommend they introduce a mobile web accessible advanced medical history taking questionnaires that have been clinically validated but there should be no excuses as even the NHS have basic survey tools for this type of thing that they’re looking to syndicate across the websites of charities:

Well there’s no need to anymore as the Line HQ team, winners of the Stockholm Health Hack Day Challenge have shown it’s already possible:

Standard Urine Test Strip + Camera Phone + Cloud based image processing and analysis = millions of new opportunities to engage with our health at anytime and (nearly) anyplace

When you think this little app was conceived and developed over a weekend it really doesn’t take much imagination to think of how informed Doctor advice service providers (like us here at 3G Doctor) will be providing inclusive home health check services incorporating such point of care testing/analysis in the not too distant future…

How long before we realise we’ve already got the Tricorder in our pockets?

O2 telefonica is currently trialing a 4G LTE network in London with 1000 individuals. I’m struggling to see why customers want/need this and have grabbed the above image from O2 website’s coverage checker as it clearly shows that the vast majority of London already has indoor and outdoor 3G coverage (colored blue).

The following video produced by Cambridge Broadband Networks has been made to highlight the project from a backhaul perspective:

My thoughts:

> Use cases

I see the same misguided efforts going on with the London Underground connectivity build out. Rather than getting some reliable mobile connectivity to commuters (SMS would be a very fine thing) the powers that be have decided that it would be better to provide free WiFi network on the platforms. Maybe this is just way over my head but I can’t see how this is going to help.

First of all I think the communication requirements in a hot busy underground tunnel (a SMS to say I’m running late?) are very different to what a spotty WiFi network can ever acheive. The security advantages are a false argument (they could just as easily monitor mobile network traffic) and I think it’s going to create it’s own set of new problems eg. where are the power sockets? Will this result in several thousand more pick pocket crimes being reported (TFL’s advice to commuters starts with the line “keep valuables out of sight”), etc.

In the video above all we see is a QuickTime movie being played in Soho Square:

And a Vimeo Online Video being played in a central London cafe:

I can think of half a dozen reasons why most people wouldn’t want to be using a £1000 laptop on a bench in Soho Square and I cannot remember when I was last in a London Cafe that didn’t have WiFi for customers (eg. in an odd twist I’ve noted that O2 recently began providing completely free WiFi at Cost Coffee cafes and already have a product called “Wi-Fi Bolt On” that gives customers access to “unlimited” Wi-Fi at public hot spots across the UK with BT Openzone). What’s more the likes of IBM have developed much more effective and advanced means of reducing the backhaul needs associated with online video eg. the local cell mast storage solution Vodafone UK are rolling out.

> Why don’t they just upgrade the backhaul to their 3G masts?

The oddest bit about the video is that it actually explains there isn’t a need for 4G becuase the technologies are speeding up the backhaul (ie. between the mast and cloud not between the mast and the mobile device) and “are also applicable to 3G and HSPDA+” networks. Instead of the waste of funds marketing 4G why not just plough this into making the best 3G and educating customers about the benefits of offloading mobile networks by using WiFi (when/where available).

> Are Mobile Operators capable of communicating 4G to end users?

A simple google search highlights how O2 Telefonica has been caught up in several major communication failures with their 3G Data offerings. Even their customers who pay for a “Wi-Fi Bolt On” for “unlimited” access to Wi-Fi at BT Openzone hot spots are informed that there’s “an excessive usage policy”.

If they can’t even make these offerings comprehensible to the average custiomer today (years after widespread adoption) what chance have they of communicating something that’s being marketed as mega fast connection speeds, a fixed line alternative, HD Video on big screens delivered through non mobile optimised websites, etc?

To me this latest 4G LTE marketing effort needs to start with a compelling value proposition otherwise it’s just going to be felt by customers that they’re trying to sell them on more of what they’re already not allowed…

Julius Genachowski, Chairman, FCC, claimed in a press conference at George Washington University Hospital that the move would result in the development of “new monitoring technology” that “will result in higher quality care and also lower health care costs”.

These claims were supported by claims that this spectrum would ensure “that wireless sensors don’t have to be replaced when a patient is moved from one area of the hospital to another” and this “alone could result in $1.2 billion in annual savings”.

Supporters of the initiative include GE Healthcare, whose CTO, Michael Harsh, supported the initiative by claiming that “the technology would not only make it easier to monitor patients, but could help reduce infections, since cables used to connect monitors can harbor disease-causing bacteria… …the technology will free patients from the tangle of cords currently used to connect sensors”.

Richard Katz, Director, Cardiology, George Washington University Hospital, contributed to the need for dedicated spectrum to be allocated by claiming “I can’t even get my stethoscope on the chest any more. There’s just no room”.

Asides from the regulators and a few big legacy MedTech firms is this really in the best interests of patients?

I think it’s laughable to try and suggest it is a failure or shortcoming of wireless networks that is preventing patients being followed up when they leave the hospital.

It continues to amaze me that anyone could think that connectivity protocols developed for medical devices will be more open, robust and cost effective than those that are being developed from technology that is being exploited by billions of connected consumer devices and a world of innovation.

Over the last decade we’ve seen step changes happening in terms of the quality of patient care because rapidly advancing consumer devices are ALREADY being used in healthcare eg. SMS and MMS being used to communicate with patients, connected tablets being used to revolutionise access to information in clinical settings, programmable OS’s have enabled millions of mobile subscribers to benefit from health monitoring services, bluetooth 4.0 devices that have enabled encased smartphones to record and share ECGs, 3G mobile video calls that have literally put an informed Doctor in the pockets of patients, etc, etc.

In my opinion the FCC and the supporters of this bid have a flawed understanding of the challenges and they’re lending support to a counter-productive effort. It won’t be regulators stepping in to drive the creation and development of dedicated medical networks that will help us exploit the potential mHealth offers but the recognition that we’re at a stage where we should be accepting that it’s time to follow what’s working in other more technologically advanced industry sectors.

Agree? Disagree? Am I being unfair to the FCC? Please share your thoughts in the comments…

“How Mobile is Rapidly Evolving the World” is an interesting article by Mark Fidelman in Forbes but on page two in bold it highlights how a direct selling firm is now taking a “mobile-first approach”.

When the CEO of the worlds most profitable internet company has told the world this more than 2 years ago and we’ve since seen Android become the worlds best-selling smartphone platform is this really still news to anyone?

In time for mothers day (for some reason we have it earlier in Europe than the USA) I posted this story about the value for society if we can help seniors go mobile. With a sharply contrasting focus this IEEE Spectrum article by Willie Jones shares the tragic news of how spotty network coverage led to the death of an elderly couple after they had an accident in an area where there was no network coverage:

“Arthur and Madeleine Morris, an elderly New York City couple whose vehicle fell down an embankment near the end of the driveway of their vacation home in New York’s Catskills region. After it became clear that the car was stuck, they made five unsuccessful attempts to call for help. Calls to 911, Madeleine’s son, and a neighbor failed to connect because of spotty cellular reception in the sparsely-populated rural area. From what investigators have been able to piece together, Arthur Morris then attempted to climb out of the vehicle, but got wedged between the bottom of the door and the ground. He soon died of asphyxiation. His wife managed to get out, but four additional attempts to use the cellphone proved fruitless. After giving up on technology, she walked to the home of their closest neighbors. Finding them already gone, and unsure of what else to do, Madeleine covered herself with a tarp to protect herself against the rain, but died of hypothermia after nighttime temperatures dipped into the forties“

It appears some commenters are criticising the network operators for their failure to build out their networks but I think it’s also important that we realise that there are things we can do to help ourselves. In my opinion top of those should be getting our loved ones using quality mobiles and using SMS, here’s why:

1) SMS can get through when calls can’t. In many instances a mobile that is picking up a signal that is too weak to make a call can still manage to send a SMS and the send receipt service and error check processes can reassure a sender that it’s been recieved/sent. Unbelievable as it may seem this tragic outcome could have been avoided with a simple SMS saying: “Dad’s run the car off the side of the road outside the rental house send someone to help ASAP”

2) SMS takes up much less battery power in comparison to a voice conversation and it can be important to preserve this in instances where you’re remote, there’s a power out, the authorities need your device powered to be able to locate you, etc.

3) SMS can enable people to connect with others in ways that can enable new care possibilities eg. in this case a simple SMS saying “I’m heading out now will be at yours by 3pm” could have helped raise that all important alarm much sooner.

A client shared with me this Healthworks Collective post from Joan Justice asking if mHealth is the leverage of the newest mass media for Health what’s so wrong with the very different definition being used in this article:

“mHealth”….. “mobile health”…….. what is it exactly? And how does it give patients access to better care? I like Dr. Ruchi Dass’s definition of mobile health: “Mobile health is not about healthcare and mobile phones; I think that’s a misconception. It’s healthcare that is available anytime, anywhere, wherever you need it, whenever you need it. It’s healthcare that can be accessed by whatever you have, be it your mobile phone, be it your television, your radio, or your iPod. That’s the kind of healthcare that we are talking about.” So mHealth, for me at least, is healthcare that you can access where and when you want it. And this field is exploding. I went to the mHealth Summit last year in Washington DC and was overwhelmed with all the lectures, discussion groups, exhibitors, and conversations. I will certainly attend again this year and I am ready to be even more overwhelmed!”

Here are my thoughts:

1) Mobile Health is going to be a very confusing term if its “not about healthcare and mobile phones” in some shape or form. Perhaps Ruchi is trying to talk about some other type of more inclusive term like connected health etc but from reading this article I can’t help but think there’s a lack of appreciation of what patients actually have and their capacity to use it to connect to their sensitive personal needs:

“It’s healthcare that can be accessed by whatever you have, be it your mobile phone, be it your television, your radio, or your iPod“

If you’re uncertain about the pervasive distribution of mobile it’s well worth getting to understand some of the quality stats being shared by Tomi Ahonen (Forbes top 10 power influencer in Mobile). Before you even think about iPods consider how more people in the world are using a mobile than using a toothbrush and how for a big chunk of the worlds population (me included!) their mobile phone actually is their TV, Radio, iPod, Torch, etc

If you work with people who don’t appreciate the developing world opportunity for mobile please print out the following quote (from 2009) and post it on your office wall:

“If you intend to communicate with prospective customers in the Developing World today, then you cannot think of mobile as the ‘fourth screen’ and consider possibly including it in your communication mix, as we still can think in the Industrialized World, as a luxury today. No, in the Developing World mobile is the first screen – and obviously, for as many as 1.8 billion people – one quarter of the planet – it is the ONLY screen. These 1.8 billion people do not have a PC, not a TV, not even FM radio, but they have a live, active mobile phone account. Out of all 3 billion people in the Developing World who have some kind of connection, a massive 60% have no other way to connect, than their mobile phone!”

Again it’s quite old now (mobile moves very fast!) but here’s a helpful image to go with it showing how mobile is the ONLY DEVICE that breeches the digital divide and has MORE OWNERS in emerging markets:

2) In my opinion Ruchi’s definition fails to appreciate the massive capacity mHealth has to deliver preventative health services. In these healthcare isn’t made “available” or positioned so it’s there when patients “need it” (eg. pulled) but is actually pushed to patients. Okay today this isn’t a widespread phenomenum in today’s sickcare industry but the concept of this shift shouldn’t be too abstract as most of us remember the days when email worked the same way eg. before our BlackBerry’s vibrated we used to go to a computer, open it up and pull our messages down off the server.

Here’s an example of how we do that at 3G Doctor to give you the idea how this works for us:

When patients pay to use our service they share with us their Date of Birth. A few years ago I read some research showing how a birthday increased the interest an individual has in taking preventative health measures and making a positive change. It seemed simple enough to me to set up a system whereby we text patients on their birthday to wish them well and encourage them to have a General Health Check Consultation with us. The majority of customers we’ve offered this to have taken us up on the offer, it’s helped raise awareness of what our service can offer and it’s helped patients approach their healthcare with a preventative outlook. Whilst it’s hard to conceive and introduce such services and it’s very different to the pull service that we currently offer (eg. The Doctor Can See You Now) I think in 5 years time the vast majority of our business (powered by EHR’s like HealthVault) will be focused on proactive efforts like this.

For those interested I expand on some more of these opportunities in an Introduction to mHealth article that I wrote recently for Touch HealthCommunications

“In 2007 I met up with Don Jones and we started talking about opportunities for mobile devices and healthcare to converge. The smartphone does give us a window into each person that we never had before and so that will be for management of a condition, the prevention of a condition, I mean there’s opportunities galore here. It’s actually archaic the way our system works today in that we still rely heavily on paper and charts, the old way, and that’s really a reflection of the fact that the medical community has been in a separate orbit from the digital world and that’s going to change“

Eric Topol MD, Cardiologist, Author of The Creative Destruction of Medicine and Founder of the Scripts Translational Science Institute

After watching this neat explanation of the mHealth opportunity I continue to be baffled as to how Eric Topol MD could let his best selling book ship with a USB stick on the front cover.

The video profiles two mHealth technologies that I’ve reviewed first hand on this blog before, the Alivecor ECG iPhone case (review) and the GE V-Scan (review) it also mentions Don Jones, VP Lifescience, Qualcomm. Here he is experiencing his first 3G mobile video call way back in 2009 with 3G Doctor’s Fiona Kavanagh MRCGP:

I had to share this HealthTech Zone article by Deborah Hirsch as it’s the classic perspective I hear when techies are speculating on the remote consulting opportunity:

“Generation Y may feel it’s a real pain to visit the doctor in person, preferring instead to look things up on their smartphones or just skip medical care doctor altogether. But when you’re really sick, only a doctor will do. But you still may not have to go in person. Enter telemedicine. Youths are using their mobile devices to be “examined” – or at least explain what’s troubling them medically to get prescriptions and care instructions – right over the phone. Phil Galewitz Gannett writes about a young woman who felt awful but wasn’t able to go to the doctor, and after a brief text, had a conversation with a doctor on her smartphone, got a diagnosis and a prescription, all for $45… …Clearly, this is where medicine is going. I’m not sure I like it, but it sure beats being able to read The New York Times cover to cover while waiting for a doctor“

In many ways it all reminds me of the mobile content future that was being widely predicted before Apple started taking operators out of the way and enabling content providers to offer services over the top directly to their customers. Remember all that hype about how we were going to pay mobile networks to watch videos and they would control what and when the customer would see things? The reality couldn’t be more different (we watch what we like for free on YouTube as part of our data plan).

I think we get a better idea of the big opportunities and future by not thinking of the remote care opportunity as a cheaper way of getting a prescription but as a means of opening up the potential to share and discuss digital healthcare content with an informed registered Doctor.

To help you appreciate this imagine the following scenarios:

> a patient views a really good YouTube video produced by a Harvard Medical School Professor who is a specialist in their specific disease area. It’s got some great advice but it’s 35 minutes long and it’s hard for this patient to go to their regular Doctor to discuss an online video that the Doctor has probably never seen before (remember in the real world some very good Doctors are still computer illiterate).

Imagine the value of being able at a time that suits you to just meet with a remote Doctor who is familiar with this content and your medical history?

> a father joins a patient community and reads about alternative drug options for the condition that his child has. It appears from reading the other posters (and as readers of this blog know some of these might be pharma reps, multilevel sales prof, computers, etc) that it would be best for their child to change to an alternative medication so Dad books an appointment with his pediatrician and tries to explain in a consult room why he’d like to try a new medication. Now let’s suppose the pediatrician knows all about this alternative but there are X, Y and Z reasons why it is unsuitable for this particular child. Dad’s now got a bit of egg on his face and from now on the relationship is changed because despite Dad’s best efforts at apologising he’s just directly questioned the ethics and skills of a very busy caring professional.

Imagine the value of being able to just share the link to this patient community thread with an independent Doctor and then having a discussion with them to learn more about it instead of making that expensive appointment with your pediatrician?