PwC: Formularies for health apps needed

By Neil Versel
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will falk Will Falk of PricewaterhouseCoopers

Mobile health, digital health, wireless health and telehealth, meet virtual health. That's the umbrella term preferred by Will Falk, managing partner for healthcare at PricewaterhouseCoopers Canada and executive fellow at the Mowat Centre for Policy Innovation in Toronto, who believes that virtual care is slowly taking over medicine.

"The virtualization of the healthcare system is moving quickly," Falk said Tuesday at the American Telemedicine Association's Fall Forum in Toronto.

A group with "American" in its name held a meeting in Canada's largest city because it's the home base of current ATA President Dr. Ed Brown. Brown, CEO of the Ontario Telemedicine Network, predicted that 25 percent of care will be delivered virtually, with provider and patient in different locations, by 2020, and Falk endorsed that forecast.

Falk said the shift to virtual care now underway is the "same order of magnitude" as the movement from inpatient to ambulatory care in the 1990s. "You know that the virtualization of care is a disruptive innovation in a Christensen sense," according to Falk. (Harvard Business School professor Clayton Christensen defined disruptive innovation as a new product or service that take hold at the bottom of a market before rapidly growing and displacing established players.)

Falk discussed a PwC Canada study he oversaw, in which 77 percent of Canadian consumers expressed willingness to willing to get a diagnosis through a virtual assessment of a skin mole as a way of ruling out cancer. "Canadians are comfortable being monitored at home," he said.

Virtualization improves access to care for people in remote areas as well as those who would prefer not to take time off of work for a short doctor appointment. "You have better waiting rooms, too," Falk quipped.

It also has a positive effect on the quality of care, staff productivity and sustainability in the sense that it reduces greenhouse gas emissions when people don't have to travel for care, potentially introduces auction-like pricing mechanisms and allows payers to substitute physicians for lower-cost providers, according to Falk. In terms of quality, virtual care help lower hospital-acquired infection rates and improve infection control, a major consideration in a place like Toronto, which Falk called the "home of SARS in North America."

However, Falk said some apps on the market amount to "virtual quackery, of, if you prefer, digital snake oil," which is why he believes the healthcare industry needs processes and standards for selecting the proper apps as well as taxonomy for "regulation" of apps, whether by health systems or government agencies. In other words, apps need organization, much like pharmaceuticals have been organized into formularies.

"We can look for hints from how the drug system does this," Falk said. "Apps and devices are in the same place drugs were two, three hundred years ago," Falk said.

Falk broke health apps into four categories in the way a drug store would: front-of-store mobile health "vitamins" with little oversight necessary; over-the-counter apps where patients get "the same level of advice as you might get for using children's aspirin"; general prescriptions from a physician; and controlled substances.

Falk likened the AliveCor Heart Monitor smartphone ECG accessory to a narcotic, in that it should be reserved for special cases and its usage closely watched by a doctor. "These are things where the physician is making a commitment to use [the technology] as an intervention," Falk said.

Falk surmised that academic medical centers might be in the best position to assess apps. Even so, it will be a daunting task, since the modern pharmaceutical system has evolved over at least two centuries. "This needs to be put together in a few years," Falk said.

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