Is mHealth just a tool or a widget that’s just like any other technology?

A MobiHealthNews article by Neil Versel suggests that Mobile Health is “not a field”, merely “a widget” or “a tool” that’s “just like any other technology” and that’s enough to get Health 2.0®’s Matthew Holt once again calling for the demise of the term “mHealth”:

Obviously this is nothing new, on this blog we’ve documented the growing acceptance of mHealth eg. by Intel’s Head of Health Innovation Eric Dishman who talked about the Hype and Hope of mHealth before asking only 18 months later why no one was building apps for seniors (they are it’s just they’re not on Eric/Intel’s radar – check some out here).

All the same the article is interesting to pick apart as it highlights many of the challenges that the Healthcare industry faces as opportunities in Mobile (the newest mass media) become increasingly apparent.

My thoughts:

What follows are some controversial remarks from last week’s 4th annual World Congress Leadership Summit on mHealth in Boston, where I represented MobiHealthNews as a panel moderator

Let’s get something very straight here. This isn’t the 4th annual mHealth anything. It’s a mispresentation of the facts by a conference organiser who is trying to add more credibility to an event that was initially called the “World Health Care Congress Leadership Summit on Wireless Health” which is quite clearly not fairing so well now that so many well respected thought leaders are referring to the subject area as mHealth and other conference organisers (who have realised this) are generating millions of dollars from their more successful rival events – such as the mHealth Summit (an event that is in it’s 4th year and hasn’t changed it’s title since it was started).

As you can see above (let me know if you’d like a look at the 2009 program) there was no mention of mHealth when this event series was launched. They’d plumped for a “WiHealth” term and have obviously changed this in line with the explosion in numbers of and interest in mHealth events (in 2012 by latest count there will be more than 70!) and continued commercial success of the Mobile Healthcare Industry Summit and the mHealth Summit (both events that are actually in their 4th year and which I have and continue to contribute to in various capacities eg. organiser/media partner/speaker/Chairperson).

In the final, sparsely attended session on Friday afternoon, after many registrants had headed to the airport, Paul Meyer, chairman and president of Voxiva, the company behind Text4Baby and other mobile health coaching programs, dropped this bombshell: “I honestly think there shouldn’t be a fifth annual conference,” he said. Mobile health is not a field. Mobile health is a tool

My thoughts are that this is a speaker who’s feeling let down by his own expectations of a conference. Perhaps he’s simply annoyed at having to present at the wrong event? I can imagine it’s not a great feeling to be presenting at the “final, sparsely attended session on Friday afternoon” but this was hardly a presentation being given during the nightshift (the program bills it at 2:30-3:30pm).

In sharp contrast I’m quite sure there wasn’t a single presenter at the 3600 delegate mHealth Summit in Washington DC who came away with such disappointment. As a rule of thumb a mHealth event is probably going to be a disappointment if it has no speakers or sponsors from the mobile network operators eg. this event featured neither AT&T or Verizon despite the fact that they both have made substantial investments in their dedicated mHealth initiatives and are generating $billions from the 100 million plus customers they serve.

Rather than complain about his audience perhaps Voxiva’s President work harder to be interesting and relevant? The latest innovation I noted from Text4Baby was it’s expansion to Russia where it’s now apparently sending free text messages to mums who have the latest iPhones and drive brand new Mercedes coupes.

Mobile health is not a field. Mobile health is a tool

Obviously Mobile Health (or mHealth as I refer to it) is “not a field” it’s the leverage of Mobile – the newest mass media – for Health. The concept of thinking of mHealth as a tool is a good idea but it’s not just any old tool: it’s the best shiniest tool that we’ve ever had, it can do things we haven’t even thought about yet and we’ve all already got it in our pockets.

To get a sense of this think about how we’re already seeing Healthcare technology and services converging to mobile:

I’d suggest you’re in the wrong industry if you can’t see the opportunity in patients meeting with an informed Doctor whenever they need to, imaging their environment (perhaps sharing a snap of a rash), listening to their surroundings (perhaps to add the audible output from a weigh scale/BP monitor or a cough sound to their cloud based Health Records), analysing an ECG (perhaps as part of a COPD monitoring program or sleep therapy), sharing an educational video (there isn’t a single area of patient care that isn’t being revolutionised by rich video content), raising an alarm in an emergency (mobile = the worlds biggest PERS), finding your way to a local pharmacy that’s open, monitoring your exercise levels (and providing you with timely motivation), sending and receiving data, getting a pill reminder, processing some data to get actionable info when and wherever you need it.

With eHealth (the leverage of the previous newest mass media in Health) we had a problem because we had to force fit eHealth systems into healthcare practices that needed to be reshaped because they had always been inherently mobile and community based. Evidence of this failure is everywhere eg. watch any GP hunched over a keyboard looking away from their patients as they hunt and peck type information into a system.

Conversely mHealth is being driven by professionals and patients using the devices they already own, know how to use and are familiar with to make the healthcare system more streamlined and fluid. Evidence of this can be found when you see Doctors sending videos to their patients mobile phones, loading up their iPads with their Text Books and bringing them to work, giving a patient their mobile number “you know – just in case”, asking a question to their social network (eg Sermo), etc.

Meyer, a former speechwriter in the Clinton White House who started Voxiva to help monitor disease outbreaks in developing countries, further said he would rather have been in Louisiana that day at a conference on diabetes prevention. He then added, “I think we’re done talking about the widget. Mobile health is a widget

As always it’s not the technology it’s what you do with it eg P2P mobile video calling was for a long time considered superfluous. Now that Apple have improved the user experience (by removing the uncertain cost issues, by adding presence, by removing keyboards so that screen size could be increased, etc) we’ll soon consider it to be unexciting and rather obvious to use this technology to connect with carers eg. if you have a very sick child and you’re calling a pediatrician do you really think it will be done with a plain old voice call in 2020? If you answered “yes” watch this TedX Talk.

For me, this recalled a similar eye-opener at a larger, higher-profile event put on by the same company, Woburn, Mass.-based World Congress. Five years ago at the World Health Care Congress in Washington, D.C., then-Tennessee Gov. Phil Bredesen let out his frustration with the slow pace of progress in health IT. “Enough with the grants, enough with the conferences, enough with the pilot programs,” he said, while sharing conference stage with people who give out grants and sponsor pilot programs

Slow adoption is a major issue when the patient isn’t the customer but instead of looking at the numerous dead ends that we see all over the world because of this approach check out what happens when a healthcare provider takes a “mobile first approach” and focuses on mHealth with a lot more than just a bit of lip service:

I mentioned this last year when the struggling Mobile Health Expo announced plans to start up a policy organization called the Mobile Health Association, which it did soon after. The association has touted a “tour” of 33 events with a total of more than 730,000 attendees this year, but it really only means that it has booth space and an educational program at massive conferences like the American College of Cardiology’s annual meeting and the huge Medica show in Germany

I’m failing to see what difference it really makes if the Mobile Health Association is hyping itself up after all it’s only trying to get companies subscribing to it’s membership fees and it’s not being promoted to patients.

Already we’ve seen the demise of the mHealth Initiative and the largest mobile health event, the mHealth Summit become a HIMSS property. The Wireless Health group on LinkedIn has morphed into the Digital Health group

I’m surprised that MobiHealthNews is lending importance to the demise of the mHealth Initiative as this really isn’t a surprise to anyone (the organisation was only set up in an attempt to continue the “Medical Records Institute” eHealth events that were growing increasingly irrelevant).

To suggest that the take over of the mHealth Summit by HIMSS is a bad thing is probably missing the point that this should be seen as a success story for the mHealth market as HIMSS represents the key decision makers in the world of Healthcare IT its take over of the mHealth Summit to me just highlights acceptance that there is a massive need for dialogue and sharing of best practice between mHealth innovators and the world of Healthcare IT.

I’ve already attended mHIMSS meetings and am very impressed by the commitment this organisation is now making to this new direction but obviously we only have to wait till December to see the results of this development. My position is quite clear we’ve already rebooked our exhibition presence and expect to do even more business there in 2012 (please visit us at booth #200).

What this tells me is that mobile and wireless health do not exist in a vacuum. They are part of the wider fields of health IT, medical devices and health informatics

To me this is akin to saying back in 1980 that TV News doesn’t exist in a vacuum but in the wider fields of radio news, set time scheduled TV broadcasts and newspapers (these were the dominant distribution means in 1980).

Obviously Ted Turner saw that there was a new opportunity for this new mass media (TV was the newest mass media in 1980) and it was in rolling 24 hour news and the arrival of the worlds first televised war proved he was right (and created Billions for the entrepreneur).

Similarly you could say the same when in 1999 Larry Page and Sergey Brin devised a way of sorting and helping us search the rapidly increasing quantities of information that the next newest mass media (the internet) was opening up.

Today the newest mass media is mobile and it’s really confusing because it’s a mass media that not only has it’s unique abilities but also has properties of many others because of the convergence of consumer electronics to the mobile device.

In my opinion the mHealth opportunity is going to make new healthcare brands just like TV made for instantly recognisable TV Doctors in the 80’s and 90’s (eg. Hilary Jones in the UK) and the Internet created the environment where the likes of WebMD could flourish. Mobile is simply the next new mass media and it will similarly let new ideas that leverage the unique benefits of this new media (click here to see examples of some of these) get traction and create brands.

Adoption of the newest mass media by patients is akin to TV adoption by the masses in 1980 or Internet adoption around the turn of the millenium in that it’s created a vacuum in which to innovate. Who/what will be the next CNN, Google or WebMD is anyones guess.

Sometimes we focus too much on labels when we should be concentrating on making healthcare safer, more efficient and more affordable. When I’m a patient, I don’t care how that happens. But it needs to happen

I think this is an interesting observation that’s reinforced by a comment made by Jim Bloedau:

Let’s be clear, the “xHealth” labels past, present and future are mostly for conference organizers, marketers and developers, not so much for the patient or provider and it will be a long time before they consolidate to where it will just be called ‘health’

I think the mHealth opportunity is so significant and disruptive that we’re ultimately going to end up not referring to it as ‘Health’ but as ‘mobile’. I’ve posted a detailed discussion of this here.

Neil and Jim seem comfortable with this idea of “when I’m a patient” or this happening long before we “become a patient”. This use of future tense is in my opinion because all most of us know about is a reactionary sickcare system. mHealth is already sticking this idea on it’s head.

Talk to the customers of mobile phones who have the Condom ringtone on their mobile and are doing their part to actively promote safe sexual practice messages and you won’t meet people who think they’re patients or are doing “Health”. They’ve just chosen a mobile ringtone.

Talk to millions of Japanese senior citizens about the pedometer app they have running on their phone and they don’t tell you it’s “Healthcare” or “Health” or “xHealth” they tell you it’s just their mobile because these apps come on the phone when they unbox it.

With the worlds biggest handset manufacturer announcing the launch of “S Health” mHealth apps are going native whether anyone likes it or not. This means we’re going to have patients increasingly going to their Doctors saying this is what I have wrong with me, this is what I need, what do you think is the best next step and when can I start treatment?

If you think this isn’t going to present any problems please read about my experience last year when I diagnosed a patient with a very serious asymptomatic heart condition using the Alivecor ECG Smartphone app/accessory (skip down to where it says “LESSONS FROM A REMOTE PATIENT EXPERIENCE”) who was then laughed at when they presented to their GP with the referral documentation 3G Doctor provided them with.

The problem I see confronting much of this technology is that it’s hard to deliver the potential value when you have a sickcare system that doesn’t know about or have any experience dealing with such disruptive new opportunities.

It is fundamental that the mHealth industry works to generate a body of evidence and acceptance so that clinicians can trust that this is something that’s good for their patients because in a few short years patients will be going into neurologists saying “this tremor app, detailed patient history and remote Doctor advice has booked me this appointment to talk with you about what might be the very early stages of Parkinsons Disease. What can we do about it?”

My fear is that if we sit on our hands and don’t communicate the mHealth opportunities to clinicians we will run the risk of more patients encountering an unaccepting Doctor who thinks it okay to laugh at them and we won’t do anything but continue to ignore these many low cost early opportunities to recognise patients with health problems and turn around their behavior so that they can stay healthy and out of the sickcare system for longer.

Take Away: look for win wins

We have been handed a fortuitous opportunity because consumer tech marketing can be twinned with preventative healthcare messages. This means it can be paid for by tech firms and doesn’t need to always rely on increasingly limited public Heath budgets. A good (and easy to understand) example of this is the work being done by AT&T, Microsoft and LG as part of their road safety initiative:

It’s a simple protective sticker that customers peel off to start using their mobile and reminds them of the dangers of trying to text while driving. It’s there because AT&T want to sell data services and mobile phones (note: AT&T doesn’t even regard it as part of their mHealth strategy) and they realise that parents often buy/pay for these phones and will think favorably of brands that are seen to be doing something to tackle this massive problem from harming their kids on the roads (drivers distracted by mobile phones have led to thousands of deaths and accidents).

mHealth provides massive opportunities to unlock the biggest untapped revenue opportunity in mobile (those aged 50+ in western markets own 80% of global wealth) and there are similar win-win opportunities but they’re in areas where telcos are traditionally unfamiliar (seniors are currently some of the lowest spending mobile user groups).

As senior mobile initiatives around the world clearly show seniors are willing to buy consumer intelligible offerings but the mHealth value proposition must be easy to understand and it helps if it doesn’t look like healthcare but more like a “mobile experience”.

About David Doherty
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12 Responses to Is mHealth just a tool or a widget that’s just like any other technology?

  1. Pingback: Is mHealth just a tool or a widget that’s just like any other technology? | healthcare technology |

  2. Pingback: Is mHealth just a tool or a widget that’s just like any other technology? | Digital Health Journal

  3. Derek Newell says:

    Thank you! I could not agree more!

  4. Phillip Sparks says:

    It depends on how you perceive it but should be referred to as a tool.

    • Hi Phillip,

      Is the tv, radio or the cinema a tool?

      • Phillip Sparks says:

        Yes they are. In context, TVs, radios, cinemas are tools for communication. Would you defer?

      • As mentioned above, the concept of thinking of mHealth as a tool is a good idea but it’s not just any old tool: it’s the best shiniest tool that we’ve ever had, it can do things we haven’t even thought about yet and we’ve all already got it in our pockets.

        As such the context that I think is the most exciting and holds the greatest potential to advance health is when we consider mobile as a “mass media” rather than something as ambiguous as a tool (which is normally considered to be a device that just facilitates work).

        When we look at Mobile in this way it’s then that the opportunities become clearer because we can appreciate it not only has many of the abilities of the other mass media (eg. you can read a paper on it, you can watch a news clip/video, you can listen to a radio show, you can write an email, etc) but it also has at least 8 unique abilities of it’s own as the newest 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

        Check out this link for some examples of the new opportunities that arise from these 8 unique abilities.

      • Phillip Sparks says:

        David, thank you very much for the insight. I can not agree more.

  5. Pingback: Is mHealth just a tool or a widget that’s just like any other technology? | eSalud y Salud 2.0 |

  6. Pingback: Is mHealth just a tool or a widget that’s just like any other technology? - DbtMobile, le blog

  7. Pingback: Is mHealth just a tool or a widget that’s just like any other technology? | PHARMA GEEK |

  8. Pingback: Pew Research launch Mobile Health 2012 « mHealth Insight: the blog of 3G Doctor

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