The Economist: Can mHealth work the miracle of making healthcare both better and cheaper?

Economist mHealth Health and Appiness

Great to see mHealth being profiled in this print and online edition of the Economist.

A few of the thoughts I had on reading the article:

Those pouring money into health-related mobile gadgets and apps believe they can work the miracle of making health care both better and cheaper

I’m not so sure this is a miracle as it’s actually the norm eg. it’s far cheaper and better for example to SMS Doctors on their mobile phones than provide them with a pager and subscription, it’s far cheaper to SMS patients with appointment reminders than to post letters or just tolerate no-shows, it’s far cheaper and better for a medical school to provide students with course and text book content on an iPad than in print, etc, etc.

When Kenneth Treleani was told last summer that he was suffering from high blood pressure, his doctor prescribed medicine to tackle the condition. He also made another recommendation: that Mr Treleani invest in a wireless wrist monitor that takes his blood pressure at various times during the day and sends the data wirelessly to an app on his smartphone, which dispatches the readings to his physician. Mr Treleani says the device (pictured), made by a startup called iHealth, has already saved him several visits to the doctor’s surgery

Probably being a bit too particular but the pictured device obviously isn’t iHealth’s wrist worn BP Monitor it’s actually their arm worn device which is (in my experience) a lot more reliable/accurate.

Portable blood-pressure monitors have been around for a while. But the idea of linking a tiny, wearable one to a smartphone and a software app is an example of how entrepreneurs are harnessing wireless technology to create innovative services

While I’m a big fan of mobile tethered BP Monitors I think it’s important to realise that it won’t be long before the market is crowded with embedded mobile (kindle-like) Blood Pressure monitors so it’s a bit of a shame the author hasn’t for this article looked to a mobile embedded medical device (like Telcare’s Blood Glucometer) rather than a tethered device that requires Patients to have a specific smartphone and installed application and remember to interact with them which is a rather high barrier to adherence when you look at the target audience for hypertension and the importance of seamlessly gathering the data (if for the target market this was a workable solution I think it’s obvious that we’d already be seeing Patinets just texting their BP readings into their EHRs).

By letting doctors and carers monitor patients remotely, and by making it simpler to collect vast amounts of data on the effectiveness of treatments, the mobile-health industry, or m-health as it has become known, aims to drive down costs while improving results for patients

It’s interesting that the Economist is clear that this is a mHealth industry and not some indeterminate ‘digital health’ or ‘wireless health’ industry in the face of the efforts that some very strongly invested parties have made to push back against this.

Many experiments are already under way in emerging markets, where new mobile devices and apps are helping relieve pressure on poorly financed and ill-equipped clinics and hospitals. But the biggest prize is America, which splashes out a breathtaking $2.8 trillion each year on a health-care system riddled with inefficiencies

I’ve seen this odd point of view expressed before as a result of some misleading PWC report and papers propelled by big charities that claim outside of America poor people are using mobile phones to do ultrasound scans and sharing the results via MMS with their Doctors.

The m-health market can be broken down into two broad categories. First, there are the apps and appliances used to monitor the wearer’s physical fitness. Firms such as Nike, Fitbit and Jawbone make wristbands and other wearable gadgets full of sensors that let people record their performance, and their calorie-burning, as they pound the pavement or sweat in the gym. Second, other apps and devices link patients with a medical condition to the health-care system. Last month Google said it was working on a contact lens containing a tiny wireless chip and sensors that would measure and transmit the glucose levels in a diabetic patient’s tears

I can’t see any sense in this arbitrary categorisation and it’s easy to highlight how it’s flawed e.g. as a result of the integration of FitBit devices with Telcare’s management platform Diabetic Patients can already simply link their fitbit data to the healthcare system.

In December Apple was granted an American patent on a means to incorporate a heartbeat sensor into its devices

It’s very sad that an Economist article is championing this classic example of how the US Patent Office is failing entrepreneurial endeavours eg. it’s nonsensical that anyone should be able to patent something that is not only already FDA cleared and CE Marked but you’ve been able to buy it for the last couple of years.

The fitness apps may help people to keep up their training regimes, and in time make the population healthier. But in the shorter term they will not have much effect on the health-care system. Nor may they make many investors rich. IMS Health, a research firm, says that of the 33,000-plus health-related apps on Google Play’s app store (the figure for Apple’s iTunes is over 43,000), just five of them—of which two are calorie-counters—account for 15% of all downloads

I think this is a commonly held misconception of the app market. Investors don’t always need to make money from the app as this isn’t the only business model eg. Apple is itself making less than 2% of it’s revenues from the Appstore, Facebook’s app is free and it’s making most of it’s revenues now from mobile, etc.

Research firms obsessed about the long tail being unprofitable are missing the reality that healthcare service providers are typical local and can now increasingly deliver rich information to customers at anytime and from anywhere with practically zero overhead.

Among those firms with products already for sale, AliveCor makes a $199 gadget that attaches to a smartphone and lets patients take an electrocardiogram by placing two fingers on metal plates. It also sells a veterinary version for taking pets’ ECGs. The data are displayed in an app on the phone and can be reviewed (for a fee) by a cardiologist

Alivecor get’s a profile in the Economist to add to the list that now includes ABC, BBC, CBS, CNN, Fox, RTE News and the Colbert Show. Of course you read about it first here!

As Don Jones of Qualcomm Life puts is, just as a car’s electronics tell a driver about its condition, so m-health devices and apps “give people dashboards, gauges and alarm signals” that make it easier for them and their doctors to track what is happening with their bodies. This may alert them to the need for action well before the patient’s condition deteriorates to the extent that he needs hospital treatment

Seems to me to be an opportunity for a completely different type of Doctor…

Don Jones VP Qualcomm Consulting with 3G Doctor's Dr F Kavanagh MRCGP

The development of machine intelligence, another hot area for investment (see article), may eventually mean there is less need for doctors or specialists to analyse test results

With the current Doctor shortage and the increasing age and disease profile of society I think it’s unlikely we’re going to be seeing Doctors in the jobless queue anytime soon and it’s only a very small affluent niche with interpersonal trust issues that will ever claim they want a Doctorless healthcare system.

One snag is that techies’ enthusiasm for such innovation is colliding with the health-care industry’s conservatism. Doctors in America have been paid for delivering more care, so products that might lead to fewer billable patient visits are viewed with suspicion. This is changing gradually as insurers switch towards rewarding hospitals for providing a better quality of care instead of simply paying them for the quantity delivered

It’s great that it’s becoming obvious that we need to get beyond this idea that the product we sell is the office visit. I think mHealth will really help people with this transition.

Encouraging iPochondria. Insurers may have cause to worry that, instead of reducing doctors’ workloads, the spread of m-health devices and apps may only encourage hypochondria: surgeries may be flooded with the “worried well”, fussing over every slightly anomalous reading. That may keep the medical profession nicely busy, but will not curb the ever-rising cost of health care

​These commonly held misconceptions really highlight for me the need t​o get care documented as we take it mobile, and highlight how mHealth designers need to ensure that while making things as simple as ​possible that they’re not making them simpler​ than they need to be.

I​ look forward to the day when we are publishing research showing the cost of the medieval practice of not documenting care and the way t​hat undocumented ​care is actually prevent​ing us ​from ​moving to self care models and creat​ing​ ill informed Patients who ​unsurprisingly behave in odd ways ​focus​ing​ on “​every slightly anomalous reading” because that’s all ​we​ have ​given them ​to focus upon.

So, to win over doctors, hospital managers and insurers, m-health firms will need to gather evidence to support their claims of cost-cutting and improved patient outcomes. Such evidence is still surprisingly scarce, says Robert Kaplan of the National Institutes of Health, a government agency

Obviously there’s an easy way to get over the need of “winning over doctors” (eg. like we did here at 3G Doctor you can simply start with Doctors designing and launching the business) but I find it odd that the NIH isn’t seeing evidence supporting cost cutting and improved patient outcomes eg. Telcare have announced that they’re achieved savings of $3,300 per year per employee by simply introducing a mHealth service that’s enabled by their connected glucometer). ​

​”​Makers of more sophisticated m-health products, aimed at doctors, clinics and hospitals rather than patients, will have to build a sales force like that of a pharmaceuticals company, says Bob Kocher of Venrock, another venture-capital firm. That will take time and lots of money

I had colleagues convinced that this would be the case until last year when the Pharmaceutical giant Servier contacted me via my blog and started buying Alivecor ECGs from us and then giving them to their Cardiologist customers and having their reps marketing ​them at tradeshows etc.

Servier Exhibition Booth at Irish Cardiac Society Meeting promoting Alivecor ECG giveaway mHealth

​”Firms that aspire to make serious money in m-health will need plenty of patience and deep pockets. But they may be able to rely on an army of technophile patients who lobby their doctors to incorporate the new devices and apps in their treatment programmes. Mr Treleani is one of them: “I’d be suspicious of medical practices that aren’t moving forward with these new technologies

I think the crowdfunding success enjoyed by Scanadu shows that we live in a completely new world in which the winning mHealth brands are those that aren’t fixated with straight line thinking…

What thoughts did you have reading the article?

About David Doherty
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4 Responses to The Economist: Can mHealth work the miracle of making healthcare both better and cheaper?

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  3. Charles Lowe says:

    For me the biggest weakness of the article is that is focuses on the kit, whereas to improve people’s health, they need a service, of which the kit is but a part. Perhaps the single most important point missing is the need to change behaviours to a healthier lifestyle, where there is some evidence that mHealth can help – we need more though!

  4. Hi Charles,

    Totally agree with you the service is always going to be the most important part. Unfortunately I think the limited scope of the article (investment opportunities in smartphone apps and mHealth technologies) means that there isn’t space in something like the Economist to cover such complexities.

    Thankfully that leaves lots of room for insiders like you there at Telecare Aware to take the opportunity to add that important missing piece 😉

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