mHealth masters: Separating potential from practical

From the mHealthNews archive
By Eric Wicklund

John Bojanowski is president of Honeywell Life Care Solutions. He has been in the healthcare industry for more than 20 year, holding leadership roles in privately funded startup businesses as well as multinational organizations. He has served as president of U.S. operations for NiTi Surgical, chief executive officer of Motus Medical and executive vice president for sales and marketing at Scandius BioMedical. Prior to that, he held sales leadership positions with Smith and Nephew and Tyco Healthcare (now Covidien). He is a graduate of Virginia Tech.

Q. What's the one promise of mHealth that will drive the most adoption over the coming year?

[See also: mHealth masters: The activated patient]

A. When we talk about the promise of digital health technology, we talk about enabling the movement from healthcare to self-care – a reflection of the idea that technology has the capability to allow people to manage aspects of their care they might have once relied on a healthcare provider to do.

In order for this to happen, I see two catalysts as imperative: 1) additional reimbursement at the federal and state levels around telehealth and telemedicine, and 2) the continued advancement of technology.

Recent Centers for Medicare & Medicaid Services (CMS) reimbursement changes with regard to chronic care use and televideo have validated that a well-run telehealth program has the capability to significantly impact readmission rate reductions and increase quality of patient care. And the telehealth technology itself has evolved to provide a level of care consistent with what a patient would have if he or she were in the physician's office – without ever leaving home.  

[See also: mHealth masters: Forget population health, start with individuals]

If those two continue on their current advancement trajectories as anticipated, they will provide the landscape for increased mHealth adoption in the next 12-18 months.  

Q. What mHealth technology will become ubiquitous in the next 5 years? Why?

A. The infrastructure behind mHealth technology has the potential to become ubiquitous in the coming 3-5 years for a couple reasons: 1) video capabilities that require high rates of data exchange and 2) the abandonment of traditional communication infrastructure.

New capabilities afforded by telehealth video technology, such as video visits between patients and healthcare providers or educational opportunities around educational videos, require immense amounts of data exchange when delivered via a tablet interface. In tandem, we are moving away from the plain old telephone service (POTS) and embracing cellular service as a preference. This yields numerous opportunities for consumers, but also creates challenges for technology that requires such a high degree of data exchange – an expensive cellular exchange.

The question then becomes how do we drive higher degrees of Wi-Fi connectivity?

Assuming we can, the existing infrastructure under which we've always delivered telehealth services will become all but extinct, and the ubiquitous backbone will be built on Wi-Fi capabilities.  

Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?

A. One of the greatest benefits that telehealth provides is its ability to deliver frontline healthcare services outside the walls of a doctor's office. One of the places we're seeing immense potential for growth around that idea is in health-focused kiosks positioned in mainstream pharmacies or even mass retail store locations. 

Imagine the role a video-enabled kiosk could play if it allows physicians to remotely communicate or even monitor their patients on a regular basis – in a space that also affords the ability for patients to fill prescriptions or purchase other health management tools. That type of data collection point could also serve as a valuable tool in the assimilation and analysis of large quantities of health-related data, which can be further disseminated by patient populations such as those within a geographical area or with chronic care conditions.

Blending those two benefits enables a platform that delivers increased ease and efficiency around patient care – for patients in both urban and rural settings – while providing the foundation for data analytics with the potential to address patient population challenges in the future.  

Q. What mHealth tool or trend will likely die out or fail?

A. One of the most powerful things we've learned from our years in the telehealth industry is that the key to maintaining long-term wellness is consistent and diligent attention to aspects of health that most of us only think about once or twice a year – when we go to the doctor's office. Our weight. Our blood pressure. Those little markers or identifiers of health that tell us so much about ourselves. 

This revelation is not a new one, which is why we've seen an explosion in the marketplace in wearables that track all those health and wellness details for us. 

But what's happening within the wearables market? Wired magazine recently featured an article about the long-term health of the wearables industry, with statistics that reflected high rates of product abandonment among wearable users – in fact, close to half of all wearables end up in a dresser drawer after only six months of use because the data isn't actionable. It doesn't back to that bigger picture of our health. And those products will never make it in the long-term.    

That said, the article also highlighted a group of wearable users who are much more diligent to the task of self-monitoring – people with chronic illnesses. In fact, 60 percent of people with two or more chronic illnesses have and regularly use a wearable. If we can leverage the benefits of wearables to give patients with chronic conditions the tools to manage their illness, it has the potential to radically reshape a large portion of our healthcare system.

Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?

A. The capital investment being made in the health IT space by non-traditional "healthcare" companies is not only surprising, but staggering, in its attempt to capitalize on what I'll call "the consumerization of healthcare." 

With a new direct pipeline available to the consumer under the guise of wellness products and wearables, there has been a rush by non-healthcare companies to partner with companies in the healthcare industry in an attempt to deliver a differentiable product. But to date, none have yet shown evidence of delivering real outcomes that impact the triple aim of healthcare – increased quality and efficacy of patient care with reduced costs to both the patient and healthcare provider.  

We need to be able to blend the best that technology has to offer with the established practice in healthcare of delivering evidence based medicine, which starts with identifying the problem, delivering a solution and documenting results.

Q. What's your biggest fear about mHealth? Why?

A. As a good segue from my previous response, I am concerned about the amount of money being poured into unproven technologies right now. With the proliferation of devices, software apps and services being pumped into the marketplace, all making bold claims about the value they bring and the outcomes they can deliver, I can't help but anticipate the inevitability of the "and as it turns out, the emperor is wearing no clothes" bubble bursting. 

There is so much noise in the space that it is difficult for both consumers and healthcare providers to separate what is real from the "hot new technology" with no real tangible value. 

In this environment, platforms that can drive true change are overshadowed and dragged into the muck of unproven, costly and time-wasting technologies. As the line between wellness and true health platforms merge, I anticipate this will get worse before it gets better. But in the way of technology advancement it could also pave the way for true leaders in the space to rise above the also-rans and provide products that can truly address the needs of both patients and providers.

Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?

A. As the middle ground between patients and providers, I believe it must be the payers.  Insurance companies need to separate health platforms from wellness platforms and appropriately reimburse providers for technologies and services that deliver documentable outcomes and prevent escalation of chronic conditions.

Wellness companies have delivered mixed results in documenting outcomes on a broad basis; however, established mHealth technologies such as telehealth have evidence and outcomes established over many years. 

As individuals take more active roles in managing their own health they have the ability to dramatically reduce their overall healthcare spend. That needs to be recognized and supported by payers. 

Q. What are you working on now?

A. Our customers have previously been mostly healthcare agencies – hospitals, ACOs, health systems and home health agencies. But in looking at the current direction of the healthcare industry and its shift to enabling patients to manage their own health, we've also looked more closely at the needs of consumers and how they differ – or are the same as – those of healthcare providers.    

What we've learned is that for the most part, the end goal is the same, and that goal hinges at the end of the day on empowering consumers.  

If we look at the traditional patient monitoring model, telehealth has been tested and proven, time and time again. So how do we extend a model we know works to enable a broader set of people to use it?

Building on that foundation of telehealth, we are continuously working to develop new technology to meet the needs of a broader range of individuals: 1) consumers, who are looking for tools that allow them to become more active contributors to their own health and better manage the day to day healthcare needs of their families; and 2) healthcare providers, who are looking for solutions that will engage their patients and drive more personalized care.

 

[See also: mHealth masters: Promise of continuous trend data ]