Is Healthcare facing a Wireless Health or a mHealth revolution?

The difference between Wireless and mHealth (check here for definition) may at times seem trivial or just a mere play of words and some people even express disdain for the term altogether. Reading it literally you may be forgiven for thinking that mHealth was simply a subset of Wireless Health eg. mobiles are just one type of wireless device whereas one could argue the term “Wireless Health” includes mobiles as well as other devices that aren’t mobile phones eg. Pocket TV’s & Radios, iPad’s, iPods, scalpels, thermometers, band-aids with integrated SIM cards, RFID questionnaires etc etc.

In my opinion the larger and more dramatic opportunity lies in the use of the newest mass media (the mobile phone) to revolutionise Health and hence we’ll probably all refer to it as mHealth. There are lots of people who I am sure will disagree with me, for one thing in the US the word “Wireless” is commonly used to refer to the mobile phone making it so confusing that one of the most significant proponents of the mHealth industry has set up a $100 million backed non for profit designed to accelerate market adoption of these technologies and named it the West Wireless Health Institute.

But I fail to see how the opportunity can originate from the device being wireless, after all haven’t we had other mass market wireless devices (eg. radios and TV’s) spamming us for decades with adverts about sugary drinks and sedatory pursuits? To me the key to revolutionising the way medicine is practiced and Health is accessed by patients will be from leveraging the 8 (and maybe some more that are yet to be discovered!) unique attributes that ONLY the mobile phone has as a 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

Click here to get a mhealth example of each.

Here’s a great example of a mHealth technology that I think we’d have never seen happen as a result of wireless properties. I think it’s a great example of the sensory ability that we’ll soon take for granted as smartphones make computing ever more personal. Called the iStethoscope (I mentioned it before after watching Dr Ivor Kovic’s demo at Mobile Monday Amsterdam):

Developed by Peter Bentley of UCL (where I’ll be giving a talk in a few weeks as part of the London Design Festival) the application enables an iPhone to detect and record ascultatory sounds, and display and transmit a spectrogram:

When placed strategically on the chest wall:

As such an exciting development of the mobile it’s not surprising that it’s confused the journalists reviewing it with some claiming that 3 million Doctors have downloaded it (oblivious to the fact that the vast majority of people with iPhones aren’t actually Doctors), that 3 million have paid for it (oblivious to the fact that there is also a free version and that free apps are by far the most commonly downloaded) and others claiming it will make the physican owned device obslete (I can’t see it doing that until the mobile or at least the separate part that touches the patient can be cleaned) or even suggesting that it can do the job of a properly calibrated £13,000 piece of hospital equipment.

Let’s ask ourselves why and how this has happened. Why this didn’t/won’t happen with the Stephophone (a stand alone electronic wireless device that’s been around years yet is still only used by a minority of Physicians/Veterinarians) and how this is all related to those 8 unique attributes, 6 of which I think add the particular value here:

1st – mobile is personal

Despite stories suggesting the iPhone could replace a Doctor’s Stethoscope the facts are it shouldn’t until it can be properly cleaned. Whilst you have to accept community acquired infections are always going to be a problem, to use your unhygienic mobile phone to listen to the chest sounds of a patient would be negligent in my opinion.

So this stethoscope application is a personal application which makes it all the more interesting because the market for Personal stethoscope’s (or stethophones) is small (nonexistent) and has never really taken off. Mostly because of cost and the usability barriers (it takes a lot of experience to know what you’re doing when listening to the heart). This innovation has removed the cost (you paid that when you bought the phone) and improved usability (as the output can now be analysed by a remote physician) so much so that it has dramatically extended the potential market for stethoscope ownership and use.

2nd – mobile is permanently carried

Having a stethoscope functionality isn’t going to sell a million phones anytime soon. Likewise it’s probably not going to be the feature you see written in bold on the point-of-sale poster next time you go to buy a mobile. All the same there is a massive advantage for patient’s if their mobile phone CAN record and share accurate stethoscope sounds because we don’t know when it might help.

We’re not always poorly and more often than likely the time when we’ll need that remote help will be when we’re out in the outback, on a safari, at sea etc. because we permanently carry our mobile it makes it the ideal device to have this additional functionality. This small need for commitment is a massive plus for adoption of rarely used medical technologies.

3rd – mobile is always on

Always being on is a massive advantage for the clinical future of the iStethoscope application as a patient tool. Current digital stethoscopes upload via a PC to the internet, by integrating the capture of clinical data with the patients mobile phone it helps add value to the diagnostic potential. Whilst asynchronous communciation has benefits in the case of patient-clinician interaction it can sometimes reduce effectiveness if the patient was not reachable when the reviewing clinician is looking at the data and had a question. The ability to text/call the patient spontaneously offers incredible new potential for specialists to care.

4th – mobile has a built-in payment channel

The major innovation with the AppStore is that it has given developers a (relatively) straight forward & easy, low barrier way to get paid for their work and take control of their own destiny. By removing the various middlemen eg distributors/aggregators/operators/etc the level of innovation has exploded and although I’d guess that the vast majority of these 3 million downloads were free the PRO version (with added features) is a great way of getting another bite at monetising the customer for the developer (especially as the developer isn’t charged for the hosting/delivery of these free apps).

5th – mobile is available at the point of creative impulse

Throughout the design of this application it has leveraged this advantage. Can you imagine a friend showing you the application working and recommending you to download it to your phone right there and then while you’re riding the train to work? Other than the mobile what other device can offer this?

Creative impulse is also used to upgrade customers from the free version to the paid for version. Let’s suppose you’re Uncle’s a Doctor and you have his email. Off on a vacation forgetting about his work, it’s his birthday. What’s stopping you paying 59p so you can send him your Ascultation recording to ask his professional opinion. Completely out of the blue and rather randomly one Doctor friend of mine has already had 2 such “friends” email her their iStethoscope readings after playing about with the app! Warning to doctors: mHealth is going to make it difficult to share email addresses with your friends and family 😉

Note: Although potentially a little humorous I would not recommend sending emails to Doctor’s who may be your friend or relative as it subjects them to ethical challenges. Also I’d be cautious about using this application as it sends this potentially sensitive data via email – an unsecure means of communication.

6th – mobile is most accurate at measuring its audience

This attribute is all about discovery. With millions of apps it wouild be next to impossible to find useful apps (Read this brilliant post to learn of the magnitude of this problem eg. if customers spent just 2 seconds considering each app it would take over 34 hours just to browse the free apps on the Apple AppStore).

Fortunately the mobile offers audience analysis making it easy work for Apple to deliver users a highly personalised experience. For those who’ve never used such an appstore or online store like Amazon/Ebay with it’s recommendation engine this personalisation is in effect similar to going into a supermarket where you don’t need to walk by the bananas or milk because it knows you don’t like them or need them. Imagine how much more effective that would be?

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8 Responses to Is Healthcare facing a Wireless Health or a mHealth revolution?

  1. Dr George Margelis says:

    The iPhone Stethoscope is a great example of technology trying to wag the clinician tail. While it seems very impressive that we can use an iPhone to capture heart sounds, clinical care is much more than caturing a bunch of vital signs, it is integrating them into a model of care which affects the patients status which is important.
    We have to be careful that we don’t confuse capturing information and delivering it electronically with the provision of healthcare. These devices and solutions are just tools, and until we develop models of care that utilise them effectively we will not provide better outcomes to our patients.

  2. Hi George,

    Have to disagree with you on this as I think the iStethoscope shows us a great example of the possibilities for patient owned and patient used technology that smart mobiles are going to be increasingly making a reality in the near future.

    Listening to the patient is fundamental to caring for patients and in the following post you can read an explanation of what I am tipping will be the most powerful use of mobiles in healthcare:

    http://bit.ly/cLIAqC

    I see lots of opportunity for the integration of a smartphone application output (eg. such as the spectrogram produced by the iStethoscope app) with a personalised interactive questionnaire and the combination of this with a remote registered informed Doctor consultation (like we offer at 3G Doctor) to offer new care paradigms.

    As we all know the regulation of the medical industry is going to present barriers to adoption for this type of innovation so as an industry I think we should be grateful for entrepreneurs like Peter Bentley who can work out ways of paying the bills whilst helping creating familiarity and acceptance of future care possibilities.

    If you’re looking for the mHealth intervention that is wagging the tail of the clinician I think you should check out the runaway successes of medical textbook content on mobiles such as is being offered by the likes of Epocrates.com and Medhand.com

    For inspiration watch Dr Ivor Kovic explaining how the ability to carry updated versions of the latest medical textbooks is transforming his ability to care:

    http://bit.ly/9qcbvL

    • Dr George Margelis says:

      Medical textbooks online and on mobile devices are a game changer. When I went to med school access to that sort of information was limited to a few, now it is freely available to the masses, and an educated patient is a better patient.

      My beef with apps like the istethoscope is that the foster the myth that physical examination tools and diagnostic tests are all you need to provide healthcare. As Hippocrates tells us there is also the art of medicine and Sir William Osler told us to listen to the patient. Just capturing heart sounds without models of care that integrate the information does not lead to better outcomes.

      Mobile devices are a very important tool, but we need to understand how we integrate them into our models of care, not just showcase them in isolation.

      • “My beef with apps like the istethoscope is that they foster the myth that physical examination tools and diagnostic tests are all you need to provide healthcare”

        Are you pulling my leg? This is a fun app that could have important future healthcare potential. The developer is making a return on investment from the affluent iPhone App Store customers and the Healthcare industry is getting some great lessons on what mHealth has instore for it.

        It’s funny that you’re sold on mTextbooks, because I regularly show these to people who express concern that books on their own aren’t what’s needed, afterall you also need professors and classrooms etc etc.

        To my mind moving with the times and getting rid of the out dated solution is what’s needed. Mobile text books give us a hope in hells chance of getting rid of paper based out of date text books and clinical information. It means greater access (in poorer regions of the world distribution costs kill because carers can’t afford the latest texts), it means patients NEVER have to rely on a carers memory as the accurate data is always there at their fingertips, etc etc

        In a world of uninformed medical call centres and poorly resourced and sporadic follow up care practices, I cannot see how using sensors built into mobile phones is not following Sir William Osler’s teaching and “Listening to the patient”. Surely it’s just giving us more potential to listen?

        Please read the reply I posted below to Mike…

  3. Mike says:

    David, whilst I normally agree with what I read here on your blog how can just listening to the heart “offer new care paradigms”????

    Seriously?

    • Hi Mike,

      The specific answer to this question is exactly the type of professional advice I offer companies like yours.

      In short: Lot’s of patients take heart medications and undergo surgical interventions on their heart.

      The effectiveness of these are highly dependent on the individuals health and lifestyle choices. They may be cheap or expensive, they may cause adverse effects or be highly effective.

      Today there is no financially viable or straightforward way for the cardiologists who prescribe/operate on these patients to listen to their heart remotely.

      The ability for an application like iStethoscope to be adapted so that it prompts a patient to submit acoustic recordings of their heart at regular intervals would give a whole new meaning to follow up care and I have little doubt that when the collected data is analysed properly (eg. together with patient history, other bio data and the long term outcomes) it would begin to redefine the current way we trial and prescribe treatments.

      In medicine there are lots of things “we don’t know that we don’t know” and new found abilities to listen to the organ that we are treating open up enormous scope for new appreciation of science.

      Please get in touch if your company would like any further independent analysis of this opportunity.

  4. Dr George Margelis says:

    David
    I congratulate Peter Bentley on writing a good “fun” app, my concern is when ill informed journalists publish articles saying 3 million doctors are replacing their Littman’s with it and that it replaces a hospital echocardiogram.

    That fosters the belief that a gadget solves the problems we have in healthcare. Your response on ehealthcentral captures it best:

    “I personally see lots of opportunity for the integration of a smartphone application output (eg. the spectrogram produced by the iStethoscope app) with a personalised interactive patient questionnaire and the advice of remote informed registered Doctor consultations (like we offer at 3G Doctor) to create new care paradigms.”

    Its the smart use of the technology to create new care paradigms, or as we call it down under “models of care” where the true innovation lies.

    Keep up the great work!

  5. Pingback: Who’s pushing back on the term “mHealth” and why? « mHealth Insight: the blog of 3G Doctor

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