Set the right expectations for mobile health

By Brian Dolan
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Frank AvignoneBy Frank Avignone

You cannot pick up a trade journal, newspaper or watch the news at night without hearing about some new spectacular development in the wireless device or application market. It reminds this author of the Internet boom era, especially the Super Bowl ads during that time, which included infamous characters like the Pets.com puppet.

That said, there is more substance to this new frontier we have come to know as the wireless health space.

The overwhelming number of mobile phone applications being introduced every day combined with the innovative uses of the mobile technology framework to solve complex challenges in the health care is clear evidence that mobile can play an integral role in the current and reformed health care vertical. Combine the existing efforts with the current mobile applications development boom that is occurring thanks in part to Apple’s iPhone, iPad, and the App Store and the inertia is irrefutable. These facts when combined with the fever pitch of health care reform have created an environment where almost overnight there is a health care mobile phone application for everything that ails you.

Having just returned from the ATA (American Telemedicine Association) trade show and plenary this trend is showing no signs of slowing down. There were so many health care applications for mobile technology it would take several days and many more pages to describe a fraction of the solutions and would not be justified in this forum. This is an extremely positive fact, however, in light of all the blog posts and feature articles it seems like a good time to bring up some facts to consider about this fledgling mobile health care environment.

Adoption: The majority of solutions are individually launched and vertically oriented. That is to say the solutions presented are designed to manage a disease like diabetes (very popular for obvious reasons), medication reminders or messaging for care management engagement. The vendors presenting these applications include one common theme throughout every value proposition: They will have superior end user adoption based on any number of suppositions like “ease of use” or “cool” features. Ask about real adoption numbers, however, and the answers become harder to understand. The fact is that many applications, heath care or otherwise, that do not impact an individual’s lifestyle positively or in a meaningful way (LinkedIn, Facebook, Twitter) simply go unused or deleted all together. Health care is no different.

A recent study by the Deloitte Center for Health Care Solutions identified six segments of the U.S. consumer market today, of which only three exhibited any interest in health care information or involvement in health care decisions. These three groups represent approximately 40 percent of the total population.

Combining the Deloitte work with a Pew Internet & American Life Project “The Mobile Difference” (March, 2009) reaffirms an earlier work that the use of advance cell phone features beyond voice is an extension of the individuals digital lifestyle. This group of users also has computers, broadband Internet, and is already heavy users of digital technologies in general. The study goes on to illustrate that in general only 31 percent of the US population or roughly 100 million of the 300 million individuals in the US have any predisposition to utilize mobile data applications. The study further states that this number is expected to rise modestly over the five-year horizon to an estimated 48.5 percent in 2014.

What this could indicate is that the market for effective mobile applications in health care is at the intersection of the Pew and Deloitte populations. That intersection lies between those who have participatory health care attitudes and are mobile data users. This changes the picture painted by vendors of these applications dramatically: Forget Hundreds of millions – it’s a (possible) estimated market of 25 percent by 2014.

Alternative Theory: One theory that this author finds intriguing is tying mobile health care applications to lifestyle management episodes. That is to say that as one goes through their life there are episodes of things that have to be done in order to treat disease or stay healthy. Instead of having one application for disease management for diabetes there is a diabetes life style management kit. This kit could be reimbursable if we work toward that type of revenue model however that in of itself is an entire conversation. The underlying theory is based on the premise that if you provide a lifestyle management tool set that consists of a mobile application for diabetes management integrated to a glucometer, provided with testing supplies and then connects the diabetic patient to a service with a care manager which can then include care givers (family members) and physicians on the same platform there will be better adoption. This approach creates a care collaboration environment and not just a mobile phone logging application. Perhaps this is an over simplification but in theory patients do better with coaching and interaction not necessarily supported by only a self-reporting mobile phone application.

Health care mobile phone applications today for the most part are not provided as connected care coordination and collaborative care environments and they will predictably continue to have lack luster adoption rates. Adopting a lifestyle management approach leveraging existing health plan, health system and consumer health tools is not trivial matter, however, it is one moderately successful approach taken in this market to date. Mobile application developers deploying their applications in the described integrated environment will provide the ability for adopters to layer in other life style management tool kits for Hypertension, CHF or better yet wellness and disease prevention, as they are needed.

The Future: The good news is that there is enough evidence that the mobile health application space is the best viable frontier for helping individuals to make better decisions in areas ranging but not limited to medication adherence to re-admissions avoidance programs and many other challenging areas of health care delivery.

The mobile phone based health care application is just one aspect of the new health care technology ecosystem and not the centerpiece. Mobile applications have to take their place in the arsenal of effective tools in a larger health care management market place. Attempting to hold these applications out, as the “be-all-and-end-all” for the problems plaguing health care is a mistake. Mobile phone based health care applications do, however, extend much of the existing investment in the health care IT space the last mile to the individual consumer whom as a society we need to be engaged.

There is no argument that this space is valuable and holds much promise for the future. Mobile health care applications will play a pivotal role in helping to reshape how health care is delivered. However, being realistic about how the technology is delivered and setting appropriate expectations, will dictate how successful the channel will be.

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