Scientia Advisors: Defining mHealth

Michael Tapella, Senior Associate at Scientia Advisors, has attempted to make a “clear definition of mHealth to make it “possible for players who want to capture a piece of the growing mHealth market to better understand what their product criteria should be, and to enable clearer product positioning”.

Readers will know of the definition I propose: mHealth is the leverage of Mobile for Health. Where Mobile = the newest Mass Media and Health = The state of complete physical, mental and social well-being.

But I thought it might be a worthwhile exercise to discuss my thoughts on Michael’s valiant attempt:

There is a lot of buzz in the media about mobile health (“mHealth”). While developments in the area are fascinating, the market is hard to define—a problem common to new spaces

Not so sure it is a new space. I remember having my first mobile in 1995 and it was paid for exclusively for use in a healthcare role. This makes it impossible for mHealth to be “new” as this was a time before dominant internet companies like Google or Facebook even existed.

Without a good definition, it is difficult for market participants to understand the size of the opportunity, who the customers are, which products to develop, what core competencies to possess, and what business models to consider

Although some people have pointed out that making definitions is a rather pointless exercise and that we should just get on with “issues that actually effect care”, I realised this problem some time ago. A classic example of the problem I found because of this was that without an understanding of “what mHealth is” the larger companies that make up the mobile industry found that they didn’t have to even consider it yet. Back when I wrote this post no mobile operator in the UK had a member of the team with “mHealth” in their title or list of responsibilities. Today every large UK telco has at least one and the largest operator has now even got its own mHealth brand (O2 Health).

Going on to list “must have” features of mHealth the report lists:

(1) mobile communications technology enabling the wireless gathering and transmission of information, (2) either a consumer or a professional application, and (3) a health focus

I think this is completely misleading as it defines a new mass media by what we do with it today rather than its scope. In the early days of TV we had limited channel choice and only a few hours of the day as broadcasting times – yet today for a lot of people TV means rolling 24 hour news, weather etc.

There are lots of examples of mHealth that already don’t have these 3 features eg. (1) The medical library content that is being used by Kenyan pharmacists on their smartphones (it doesn’t have to use network technologies as it is supplied installed on a SD memory card) (2) The boundary between “consumer” and “professional” has all but disappeared – patients have long been conducting research on PubMed etc (3) Lot’s of mHealth doesn’t have a health focus eg. The GSM doorbells/home alarm systems being installed today are mostly being fitted for security reasons (it just so happens they can also monitor for falls, enable carer keyless access to the property in event of an emergency, etc)

Identifying what is in and out of the mHealth market becomes clearer if we define mobile communications, not as a class of technology, but rather as a utility for the user

I think this is where the argument put forward fails. Mobile is not a device or a connectivity it is the newest and least understood mass media – even if we haven’t all realised it yet.

Mobility in mHealth should be defined as the ability to move freely within an undefined space (as opposed to the ability to move freely in a defined space) while still maintaining connectivity. This will immediately help us understand how three market segments are in fact adjacent markets rather than mHealth market sub-segments

The idea of something being mobile or not mobile based on what we do with it hasn’t made sense for a long time. GSM PayPhones put paid to it for me. These are fixed payphones that only need a plug socket (they communicate via mobile networks). If fixing the positioning of something stops it being “mHealth” the industry is going to have a massive problem with the concept of new products that are coming to market eg. sleep monitoring devices that are fixed to the bed etc.

With this definition of Mobility, Telehealth products are excluded. mHealth service markets are not covered in this article and are deserving of a separate discussion. This blog seeks to define mHealth product markets only

I can make no sense of this statement. In the UK’s biggest TeleHealth trial they are using a wealth of mobile technologies so to exclude the two seems counterintuitive.

First: remote patient monitoring, which is part of Telehealth, becomes clearly adjacent to mHealth rather than a subcategory

I can also make no sense of this statement. If I’m using an app on my smartphone that has me uploading my weight, blood pressure, dietary intake, medication info, etc (like I’ve done for a few years now) into my EMR why is this not mHealth but something “adjacent” to it?

a stationary device is placed in a patient’s home to monitor their health. While it fits all of the other criteria that define a product as mHealth (as detailed later in this blog), it does not enable patients to leave their defined space (their home)

I think this argument is far from watertight. If true the mobile based fall detector I have in my home no longer qualifies as mHealth, likewise mHealth devices used by those who are incapable of leaving their home would also presumably not qualify?

With this definition of Mobility, “professional” Point of Care products are also excluded. If mHealth devices allow users to move freely in an undefined space, then professional products such as Point of Care (PoC) diagnostics would also be in a separate market as they are intended to be used in defined spaces

So the Doctors I know who have deployed Apple iPads and iPhones in their clinic are not using mHealth? Even though the coding was all done using a mobile phone based SDK and the devices are completely mobile. Doctors from this practice can use the devices outside of the clinic (eg. on a house call) but several members of the staff (and their devices) never leave the facility with devices.

In fact, PoC products have historically been categorized under diagnostics, and like many other products in the diagnostic market, PoC products are meant for use in professional settings (hospitals, clinics, etc.). Examples are Abbott’s iStat blood gas meter, diabetes meters like Lifescan by JNJ, or portable products like Sonosite’s ultrasound or cardiac impedance devices. These “professional” products should be separated from mHealth, leaving us with a strictly consumer-focused definition

Historically it has long been the case that MOST diagnostic tests are done outside of the professional setting (a shift that kicked off in the 80’s with the emergence of the Glucometereven since diabetics started glucose testing).

Exceptions: There are two exceptions to excluding professional uses from mHealth. First, it should be noted here that this is a first-world-centric definition… …Second, the emergence of consumer electronics-based health applications targeting professionals in first-world mHealth markets is beginning…. ….Future expansion of the mHealth definition may be required. With this definition of Mobility, personal Health Monitoring devices (unconnected) are excluded

Exceptions: Always a hallmark of an inaccurate definition that won’t stand the test of time.

However, the bulk of the mHealth market today continues to be unregulated “iFitness” types of applications

The bulk of “appstore” content categorised as “mHealth” may indeed be defined in this way but I wonder if the author appreciates that the app store isn’t the extent of mHealth. There are millions of patients in the UK who are receiving SMS communications from their healthcare providers and more than a billion people have access to an emergency services call service on their mobile phone. These examples are much more representative of the bulk of mHealth market in my opinion.

Finally, mHealth does not include “mobile” health monitoring technologies used by consumers that are without connectivity. To be considered mHealth, mobility must include some level of connectivity, for example transmission of information collected by the device to a centralized databank. While personal health monitoring devices (used exclusively by consumers) such as blood pressure cuff, weight scale, or digital thermometer are technically mobile, they aren’t connected devices, nor do they record data longitudinally

I disagree completely with this. If this was the case the millions of patients who use the unconnected native calendar app on their mobiles to remind themself to take their medications, attend appointments are not using mHealth.

Step two: Separate consumer from health. It is also valuable to parse “consumer health” into two separate categories, “consumer” and “health.” By doing so, we draw the boundaries around mHealth, excluding the use of “vanilla” consumer mobile communication devices from “true” mHealth products. Under the original definition (before parsing the categories apart), a mobile telephone call between two consumers during which they share health information (e.g., weight loss tips) would qualify their cell phones as mHealth devices. This would not make sense. Cell phones are primarily communication tools, not health tools. mHealth should only include devices dedicated to health purposes, with declared medical or health intent. Taking intent into account, mHealth will require a consumer to communicate health information generated with an mHealth software application to another consumer, using a mobile device. The application would then qualify as an mHealth “device.”

In my opinion this is a classic sign that the author doesn’t appreciate how patients interact with services or the fact that consumer devices now have increasingly more technologically advances than their professional counterparts. Video Consulting with patients (like we do at 3G Doctor) would presumably not be a mHealth service as the video mobiles of our customers are “primarily communication tools, not health tools”. The nonsensical idea that “mHealth should only include devices dedicated to communicate health information” is made clear if you ponder for a moment on a quote from Dr Levy Gerzberg, President & CEO of Zoran Corporation (a medical electronics guru who has recently sold his company to CSR): “If you have the average consumer living room with an HDTV, a Blu-ray and an average quality audio system, you have more computational power than the most advanced missile in the world

Note: mHealth services may in fact employ cell phones without forcing them into the definition of an mHealth product. This will be the subject of a follow-up blog on mHealth services

Explaining what this means fails me.

Step three: Introduce measurement or recording…. The final step in developing Scientia’s definition of mHealth is to introduce the measurement or recording aspects. For a communication to be mHealth, data must be shared, stored, accessed, or modified. The measurement or record is required because without it, many mHealth devices would not be able to demonstrate medical or health intent; they could easily be categorized into other established segments of the eHealth or communications market. For example, describing symptoms over a teleconference is not considered mHealth, but rather telemedicine. Sharing/ transmitting glucose readings or caloric intake records, or even temperature or pulse records (especially longitudinal readings), however, could be considered mHealth

Surely this is all far too ambiguous and uncertain to be considered a definition?

Products that definitely belong to mHealth include health-specific applications run on smartphones (iPhone, Android smart phones) or devices like PDA’s

PDA’s? Okay I think I might of wasted my time reviewing this one – thank the heavens for Dragon NaturallySpeaking!

About David Doherty
This entry was posted in Uncategorized. Bookmark the permalink.

2 Responses to Scientia Advisors: Defining mHealth

  1. Bart Collet says:

    Great post (again!). I still think the best mhealth definition = ‘having the right (health-) info at the right place’.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s