“It’s mHealth but will it be a Revolution?”

Jonathan Linkous, CEO of the American Telemedicine Association, has posted an article on his blog and MobiHealthNews in which he points to how mHealth “has taken on such a cult-like status among investors, industry and the media” before furthering interest in mHealth innovation by stating that “the potential for the use of mHealth in the delivery of healthcare is huge and it may have an impact on other parts of healthcare such as chronic care management, emergency response services and the role and responsibilities of the consumer in their own health”.

Here’s a brief summary of the thoughts I had on the 900+ word article weighing in on mHealth from an ATA perspective…

The market for mHealth is still in its infancy

This seems to be a common misconception… somewhat contradicted by appreciation that mHealth is already here

There is still confusion about all that is encompassed in the term

Not everywhere. Here’s a definition that I think will stand the test of time: “mHealth is the leverage of Mobile, the newest Mass Media, to improve Health“.

It may include a mobile device or a service using mobile technology. The devices include an array of products and services that use mobile, wireless technology: cellular phones, wide-area, local-area and personal networks

The widespread substitution by Americans of “Mobile”, “Wireless” and “Cellular” seems to have led to some confusion as to what constitutes mobile amongst opinion leaders from the region. Here’s the definition/explanation of Mobile that I think is most accurate and valid: Mobile is the newest mass media.

Some parts of mHealth are devices and services focused on direct consumer purchases and use. For example, the vast majority of the 6,000+ health-and-wellness smart phone applications are designed for use by consumers. However, when measured by dollar volume, these applications are probably smaller than other mobile devices and services aimed at the use in the traditional healthcare system

Evidence I’m seeing suggests this isn’t accurate. The vast use of mHealth doesn’t involve smartphones or applications, rather SMS, calls and the reassurance that a phone offers. The smartphone applications which I’m seeing generating revenues (and no doubt sustainable profits) are not designed for “use by consumers” but by professionals working in the “traditional healthcare system”. Here are a few examples: Epocrates, Clinical mTextBooks, BlackBerry Enterprise solutions.

The wide-spread media attraction in the mHealth market is because it’s new and it’s fun

Or could it be because it involves the convegence of two trillion dollar industry’s? …or maybe the potential that mHealth offers to put patients in the driving seat – finally empowered through engagement/ownership of their care?

The investment money is flying out the door. Although there is a positive growth in sales, almost all of the mHealth companies or divisions have not yet made a profit

I find this impossible to believe. Every mobile operator that has healthcare clients is making serious money out of their customers. The odd thing is I can see more revenue and profits in mobile companies who are serving healthcare than I can find in telemedicine companies serving healthcare.

It reminds me a bit of the dot com (sometimes called the dot bomb) market of the 1990s. Certainly at this point mHealth is close to the top of the “hype cycle” (as described by Gartner, Inc). There are new associations and think tanks devoted to the subject, academic and commercial conferences galore. We are approaching the cycle’s “Peak of Expectations.”

To my mind this is simply what happens when market opportunities open up, conference organisers succeed by identifying and serving participants of markets that need to engage and the lack of understanding of even the definition of mHealth certainly gives rise to the opportunity for events that can help clarify things… …this is no different to the millions of marketing dollars that have been spent over the years on the ATA’s publications and events.

For those on the sidelines it makes great fun. For developers and investors it is much more serious. It is a bit like a game of musical chairs. Most of the mHealth ventures are hoping to be bought up or merged into another, larger venture

That’s contrary to what I’m seeing. Most mHealth ventures I know of are trying to add value in clinical areas so that they can replace the current more expensive and less effective services eg. iPlato works with Healthcare Providers to have them start text message dialogue with patients (as opposed to the letter/envelope/postage), Biancamed offer a non invasive alternative to expensive sleep lab monitoring, Cardionet offer a 3x more effective than LOOP monitors, MedHand offer immediate/collaborative access to up to date versions of all the familiar clinical textbooks without the cost/environmental impact, etc, etc.

At some point the music, or the outside funding, is going to stop (as we enter the Trough of Disillusionment) and those ventures not bought out or turning a profit will be in trouble

On the other hand isn’t it just as likely that the continually expanding costs of care and economic slow down will lead to wider appreciation amongst healthcare providers/insurers that they can’t sustain the status quo – creating the perfect market for those offering more value for money with newer lower cost mHealth alternatives?

But here is an important point – mHealth is not a stand-alone market. It is part of a mature, two trillion dollar healthcare business

Who’s saying it’s stand-alone? Which mHealth companies are offering solutions that are stand-alone? At the moment the vast majority of medical devices used by this two trillion dollar industry aren’t connected and the newest trillion dollar industry has worked out a financially successful and widely accessible (5 billion and counting!) way of doing this. So why aren’t they natural allies?

To be successful, mHealth devices and services have to understand how the healthcare market operates; how it is funded and regulated; and, most important, how buying decisions are made. Developing a way to use a mobile device to measure blood glucose and send the data to another location may be interesting but is not nearly enough

Good point but this example has been around for a while now – in 2006 LG Electronics even shipped a Mobile phone that measured and sent blood glucose levels – and successful clinically validated glucose monitoring services are in the market delivering value to patients and their Diabetes Nurse Specialists eg. Diabetech

Further, relying on consumer expenditures for mHealth is probably not the answer for most such ventures. Out of pocket expenditures for healthcare in 2008 were a little below 12 percent, following a steady decline of over fifty years

Whilst I agree that there is a lot of easier money to be generated by mHealth services that can be sold to health insurance companies, this US statistics ignore some key facts eg. other costs associated with ill health such as loss of earnings, most of the world’s population doesn’t have health insurance, etc etc

Efforts to have consumers get more “skin in the game” will have only limited success when consumers are not even paying for their own drugs or eyeglasses anymore

This expresses something similar to that mentioned in a comment on my blog from Tammi Devore of AT&T, I’m going to write a post dedicated to this rather uniquely USA sentiment but essentially I think this arises from the lack of thought, imagination and design that goes into most sickcare experiences. In my opinion patient engagement in their care should be the starting point, if you think your patients haven’t got “skin in the game” start by redesigning your service (I’ve heard such issues presenting when patients discovered they needed to reach a certain BMI in order to qualify for Gastric Band Surgery on the NHS – it turns out that once you appreciate the effect this may have on patient behaviour the idea of setting a “qualifying BMI” probably isn’t the best way to select patients).

Therefore, to recognize the benefits and opportunities offered by mHealth applications for healthcare delivery, they need to be incorporated into traditional healthcare financing and services

Maybe I’m too biased to offer an impartial opinion on this but the way I see it this is written the wrong way around… the way I think it should be written is “to recognize the benefits and opportunities traditional Healthcare services need to incorporate mHealth services”

About 3G Doctor

The Corporate Blog of 3G Doctor
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3 Responses to “It’s mHealth but will it be a Revolution?”

  1. Kevin says:

    Thoughtful response David – nice job.

    My one add on your article is to bring attention to the role that my company (Diabetech) has had to fulfill as an extension to the clinical practice serving as a kind of medical service provider intermediary between practice, technologies, patients and their social networks which may be analogous to the telco NOC – network operations center. Waiting on traditional health workers to fully embrace these new methods may be a very long wait vs. slotting in an organization that knows how to dis-intermediate all of the noise from the precise information that needs to be acted upon by a skilled health care professional.

    I’d rather not call this role a HOC (healthcare operations center) so if you can think of a better term I’d appreciate it if you would let me know. 😉

  2. Pingback: ICMCC News Page » “It’s mHealth but will it be a Revolution?”

  3. Pingback: ITU gets it so wrong about mHealth « 3G Doctor Blog

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