mHealth – been there done that?

An interesting interview by Brian Dolan with Keith Seymens, Venture Partner at Vesalius Ventures, over at MobiHealthNews gave me lots to think about:

That was almost 20 years ago. …Really, this [mobile health space] hasn’t fundamentally changed all that much

Is he serious? Can we really dismiss the importance of mHealth in driving the fastest ever adoption of a technology in the history of mankind? The creation of the newest Trillion $ industry? The transformation of Nokia from a rubber tyre and toilet paper company in Finland into the cannibal of all cannibals and the worlds biggest manufacturer of computers?

Seymens said that mobile health won’t really take off until the telcos of the world — the AT&Ts, Verizons and Vodafones really start implementing mobile health services

In 2010 there is no confusion that they already are, its’ just that outside the basic telecom services they sell into every single healthcare company on the planet they may not all talking about the next generation data services for competitive reasons of course. For some years now mobiles have been making the vast majority of emergency 999/911 calls and the operators have all by now set up mHealth teams eg AT&T (“We Get It” Enterprise Division), Verizon (John Maschenic) and Vodafone (Joaquim Croca).

the mobile health industry really deserves some admonishment. While there is a new wave of individuals interested in this space today, they are covering the same ground the industry covered 10 to 12 years ago. And there’s not yet a lot of traction

I don’t agree they’re “covering the same ground” because I can’t see how they can. 10 to 12 years ago the technology had to be given to the Doctors/Patients. In 2010 the technology has been adopted and is now pervasive. Epocrates is being used by 20% + of all US clinicians despite not receiving billions of federal aid. This has been achieved by remaining focused on the content and the user experience and NOT having to give $1000 devices to Doctors, it’s also not having to teach them how to use these devices, argue for the benefits of using these gadgets etc etc

I took away some key lessons that I think may be helpful to the mHealth developer community:

At Apple, one of Seymens projects included distributing Newtons to public health workers in India

Learn from this and don’t waste your time and resources on devices. Leverage the end users device because this is the one that has scale, that is valued, familiar and they know how to use. Forced adoption will never have the same outcome as swimming with the tide eg the opportunity in giving one hundred $500 devices to Doctors will never have the same impact as giving $100 worth of mHealth Applications (eg. Doctor Companion) to five hundred Doctors who’ve already gone and bought their own smartphone.

The healthworkers drove around on Vespas to various villages to record health information, Seymens said. That was almost 20 years ago

Think of mHealth as a way to mobilize the care you offer rather than just your workers. Think about opportunities to remove the need to go anywhere. In this example health information today could be reliably be collected from the phone of a village elder saving the expense/time and enabling more effective utilisation of the vespa riding healthworker.

Seymens is a believer in the concept of deploying mobile health solutions in developing markets and once their efficacy is proven, bringing them back to the US

This is a commonly held belief that I’ve discredited before. Asides from the ethical challenges that come from experimenting with disadvantaged and underrepresented patients it’s worth remembering that by the time mHealth services in developing markets are even catching up to where we are today with mHealth services (that are already in the market being offered in countries such as France, Japan, Korea, UK, Ireland etc) these markets will themselves be leveraging the ever more advanced (and unpredictable) potential of increasingly more powerful smartphones and network services.

The following picture should help you visualise this as it neatly encapsulates the increasing speed with which technology is aging.

Seymens left Apple in the late 1990’s to found a startup… …which focused on creating medical apps for the Apple Newton among other devices… ….ahead of its time and it eventually ran out of gas… and its Angel funding. “…trying to change practice patterns for physicians is no small task”

Find the path of least resistance. As an example of how we’ve put that into action here at 3G Doctor: we don’t waste our energy/time trying to sell Video Consultations to people who don’t yet have 3G Video Mobiles and are happy to leave that to someone else – and they’re not doing all that bad eg. the UK and Ireland now have over 15 million customers using 3G Video Phones and living within 3G cellular coverage.

It’s interesting that [Microsoft founder] Bill Gates is going to speak about mobile health at the FNIH mHealth Summit,” Seymens said. “He did the same thing at the HIMSS conference in San Antonio 20 years ago. He said then that Microsoft would be the platform of choice for HIT. Surprisingly, that didn’t really push the industry as far along as we thought it would, but that same kind of momentum is happening again

As CEO of Microsoft it wasn’t Bill Gates’ task to “push the industry” and there is no point in even suggesting that he didn’t achieve his goals of making Microsoft the platform of choice for HIT, depending on who you ask there is no competition! All the same Microsoft have lost it with their mobile strategy (as this open letter to Steve Ballmer articulates very nicely – note it was written before the billion $’s that MS wasted killing the Danger MVNO and KIN devices) so you’d be better looking to the likes of Steve Jobs at Apple, Olli Pekka Kallasvuo at Nokia, Koh Dong-Jin at Samsung or Vittorio Colao at Vodafone (Chair of the Mobile Healthcare Industry Summit – the event that started the global and somewhat unrelenting interest in mHealth conferences).

Mobile operators already have the infrastructure in place, the billing in place and a captive audience, Seymens said. The mobile operators can sit back and watch the mobile health pioneers and treat them as stalking horses. When they decide the market is ready, mobile operators can work with the managed care organizations to launch mobile health services developed on the backs of the early startups

Being mindful of this potential threat is a good idea but I think Seymens is ignoring the potential for direct billing and distribution that has opened up with the (rather recent) creation of AppStores by handset manufacturers (eg. Nokia/OVI, Samsung/Bada, Apple/AppStore) and independents (eg. Google/Android, GetJar.com)

Early mHealth start ups have a big advantage when it comes to direct to patient offerings as they can serve services regardless of the patients device/network choice.

This perspective also overlooks the impact that an announcement to launch mobile healthcare services would have on the investors in telcos as there are very different regulatory, financial and risk profiles if they were to charge their proposition so drastically eg. health information is much more sensitive than even call records. This is one of the major reasons behind operators reporting that they’ll be working with partners eg. Orange, O2.

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