Dr Val Jones, CEO at Better Health (a medical blogging network) and Partner at DocTalker Family Medicine (a pay-as-you-go house call provider) shares some thought provoking views on the outlook for the Smartphone App mHealth opportunity.
With MobiHealthNews’ latest report reporting as many as 13,000 mHealth apps in the Apple App Store alone I think it’s quite obvious that no one’s going to be using the vast majority of these apps but I don’t think the reasons for this are even touched on in this article.
Todays Smartphone is tomorrows Feature phone and most boomers are already using “Smartphone Apps”
As someone who’s been using a mobile for nearly two decades I’m really amazed that so many people still haven’t realised that with the rate of innovation in the mobile market todays smartphone really is tomorrows feature phone and we’ve already actually all got phones with smart features. I expand on this in this point by point comparison of the features on my first proper (and very expensive) Smartphone (a Nokia 9100 Communicator) with the latest EasyPhone (3G Doro PhoneEasy 615).
It’s not up for dispute: If you’ve used a cameraphone, sent a picture message, set an alarm/calender, used the calculator, made a video call that’s a smartphone app that the manufacturers of mobile phones have already baked into your familiar mobile.
Of course there’s little stopping care providers leveraging the existing smart features that we can find on feature phones (eg. letting them interact with you via your mobile web optimised health portal, sending rich video content to patients mobiles, letting them video consult with you, etc) but over the next few years we’re going to see the next phase of tech and service convergence have a massive impact on healthcare.
To get a sense of this check out this post about the Nokia Decade and then think about how biosensors (like the Alivecor ECG tech) will be embedded into the featurephones of the future in the same way that we’ve already seen happen with music player, camera and computing tech.
Think it’s all going to be too difficult to use? Check out how firms such as Doro are expanding into the smartphone software market making the latest smart devices easy to use:
Isn’t this about modernisation as much as quick profits?
“Last year the FDA put a damper on the app industry’s quick-profit hopes by announcing that it intends to regulate certain medical apps as medical devices”
It always surprises me to hear people talk of “quick-profit” hopes when referring to mHealth ambitions. For an industry full of bloat and middle-men we’re talking here of innovations that are mostly filling in the gap in patient information (eg. Doctors sending video content to their patients mobiles) and providing more modern ways of providing care offering patients more convenient access to info and advice (eg. Kaiser Permanente’s mHealth portal).
Enthusiasm for the “FDA Chilling effect”?
“if the app is used to connect with a medical device or to turn a smart phone into such a device (whether it can check your blood sugar, blood pressure, heart rhythm, etc. or suggest diagnoses), it must undergo safety and efficacy checks by the FDA before it can be brought to market. That process is likely to inflate app development costs exponentially, thus creating a chilling effect on the entire industry. I actually think that FDA oversight is a good thing in this case, since it could protect patients from potentially misleading health information that they might use to make treatment or care decisions. But more importantly, I wonder if a lot of this fuss is moot for the largest, sickest, segment of the U.S. population?”
I’m surprised a medical Doctor is heralding the administrative interventions of the FDA on the basis that it’s got the ability to prevent patients being misled. Perhaps Dr Jones is unfamiliar with the FDA’s failure to mange the issues surrounding the online advertising of prescription medications?
To my mind the largest sickest segment of the USA is getting sicker because of positive health campaigns are up against big business that is spending billions marketing unhealthy products where the impact of regulations are negligible/non-existent.
For an example of the impact this is havign consider how the FDA’s focus on mHealth is already forcing mobile diet and fitness mHealth app developers to consider cumbersome and uncertain regulatory roadblocks and compare this to the scarce controls on the promotion and sale of high-fructose corn syrup sweetened sodas to children.
Probably an even bigger impact is arising because such uncertainty is discouraging interest from the type of developer talent the healthcare industry so desperately needs. Remember: the best developers don’t work for you).
Stop thinking about “RoboGrannies” and start with the opportunities to simply connect what should be connected
“For all the hype about robo-grannies, aging in place technologies, and how high tech solutions will reduce healthcare costs, the reality is that these hopes are unlikely to be achieved with the baby boomer generation”
For me this highlights the inherent problem the mHealth industry will face when it employs hype to claim the future is here already rather than focusing attention on what’s already getting results.
Instead of thinking of future scenarios Dr Jones should visit these elderly patient homes and consider what we can do to add value to that patient and their carers lives but be open minded that a lot of these things DON’T look like healthcare technologies but can have dramatic effects.
Here’s a couple of examples to give you the idea:
> a CO/smoke monitor that SMS’s my neighbour and carers to inform them it’s battery is low can not only provide assurance that there is a working alarm in her home (30% of smoke alarms in the US aren’t working as the battery has expired/been removed) but that someone will be alerted in the event it is triggered.
If this senior patient is deaf, disabled, forgetful such technology can also help prevent them suffering a very tragic, avoidable and untimely death.
> a connected care monitor that will alert a carer if an independently living patient falls, has a boiler failure, power outage, or intruder in their home, can help their Doctor monitor for nocturnal urination issues, etc.
Notice the way neither of these mHealth technologies requires ANY new learning for “the baby boomer generation”?
Is there really a pig in the python?
“I believe that the generation that follows will be fully wired and interested in maximizing all that mobile health has to offer, but they’re not sick (yet) and they’re also not the proverbial “pig in the python” of today’s healthcare consumption”
This idea that there is such consistency to the boomer generation doesn’t make sense to me. Perhaps I’m just very fortunate to have met so many senior citizens who do amazing things, invent crazy cool iPhone apps, continue to teach and inspire younger medics, still drive racing cars (and think it’s us youngsters that are the doddery ones) or have just got their first mobile and want me to teach them how to send text messages so they can share jokes with their grandchildren.
mHealth isn’t in your DNA but neither is your pacemaker
“I’m not saying that mobile health apps have no role in caring for America’s seniors – their physicians and care teams use tablets and smart phones, their kids do too, and a small percent of seniors may adopt these technologies, but I’m a realist when it comes to massive adoption by boomers themselves. Wireless connectivity, texting, personal digital health records, and asynchronous communication is just not in their DNA”
I’m see this adoption happening as a result of increasing patient expectations and cost pressures rather than a desire to bag some cool new tech. You could of course argue much the same about the MRI approved ICD the cardiac surgeon implanted in their chest but for years now we’ve had firms like BioTronik incorporating mHealth tech to even connect these to their home monitoring services so that they can monitor the effectiveness of their devices and supply data to their physician so that patients health can be managed more effectively.
The patients mobile is simply the last mile we need to connect for us to get real value from this journey.
Seniors aren’t overwhelmed by mobiles they just fail to see the point
“Take away a teenager’s smart phone and he or she is likely to be completely flummoxed by reality. Now give that phone to a baby boomer and the flummoxing will be roughly equivalent, but centered upon the device. The teen can’t live without the constant phone/internet connection, and the senior is overwhelmed by the lack of human interface and unfamiliar menus”
This is a common misconception of the way seniors look to technology. I’m not underestimating the hump we need to get over (what are the benefits? how much will it cost? will it let me down? will it break? will i lose it somewhere?) but once you’ve helped a senior see the value in getting a mobile phone a tailored/personalised approach gets much better results. Here’s a few tips on how to get a senior texting that you might find helpful.
What’s in it for me?
“When I asked one of the seniors if she’d be interested in using a cell phone to check her blood pressure and have that automatically uploaded to her doctor’s office she replied, “I’m too old to learn that stuff, dear. I’m lucky if I can find my slippers in the morning.””
This is a classic issue that I notice care providers struggling with. It’s time to get over ourselves and realise that patients aren’t really bothered about how easy they can put data into our clinics EHR so that our job is easier and we can make more money.
On the other hand talk about some fun or some benefits for the patient (eg. more accessible care) and you’re onto a winner…
The preventative strategy has to start with those who aren’t sick
“The reality is that the average app user isn’t sick, and sick people don’t see a need for apps… yet. So our challenge is to meet seniors where they are instead of trying to change their habits”
I think this is a classic symptom of the current sick care focus of the US’s healthcare industry. If we have no hope of engaging those who aren’t sick we really do have a run away train. I’m more optimistic that Dr Jones on this one and think society is going to be a lot healthier if it looks to rational use of healthcare resources rather than the grim alternative (increased rationing of resources).
Will mHealth bring back the House Call?
“House calls are the best way I know of to get a full appreciation for individual quirks, compliance challenges, and health habits. If we are really serious about reducing healthcare costs in our aging population, it may take some low tech solutions. As un-sexy as that may be, it’s time that we put down the iPhone and practiced some good old-fashioned medicine”
I’ve repeatedly shared on this blog how mHealth represents the biggest opportunity to control future healthcare expenditure and I have no doubt that there will be a return to house calls.
I also think it’s going to be through the use of mobile technology such as video calling that we have the best opportunity to provide this at a cost, ease of use, level of convenience and quality that patients and carers will find attractive.