The 2013 Mobile Health Summit was hosted by HIMSS at The Gaylord Resort in suburban Washington DC, taking place over 4 days during the mid-atlantic region’s iciest conditions in years. But inside the cocoon of this convention space, 5,000 conveners took in demonstrations of innovations using mobile platforms and standards that extend health services, knowledge and self-help tools to people and providers.
Several themes emerged out of the meeting…
Lots of apps, too few business models. There are too many apps and not enough companies, Esther Dyson noted in a keynote session during which she dialogued with two Steve’s: Steven Krein of StartupHealth and Steve Case, entrepreneur and Chair of Startup America. Coupling Dyson’s comment with Case’s observation that mobile health must shift from platforms to products, the point is that mobile health must “productize” itself. There’s a lot of development under the mHealth umbrella, but much of it isn’t packaged and managed for longer-term sustainability.
Grow the evidence to support mHealth innovations that work. A key challenge: proving what works. Without the evidence, the health care industry won’t adopt these innovations. There is growing evidence, a bit of which was published in the Journal of Mobile Technology in Medicine which published a supplement (Volume 2, Issue 4S) to coincide with the Summit. This features 15 abstracts highlighting evidence supporting the adoption of mobile health: text messaging to improve anti-cancer adherence, primary health care extension in urban Malawi, mHealth tools to combat the spread of TB, how mobile can support HIV care, promoting physical activity among Type 2 diabetes patients, and nudging women to greater physical activity, among other mHealth proof points. But most of these projects aren’t using commercially available products yet.
Mobile is about behavior change, not the technology. Throughout the Summit, it’s clear that mobile health can’t be about the technology – that’s fairly straightforward stuff, given standards, opening APIs, cloud computing, and an energetic Red Bull-drinking cadre of programmers who seem to enjoy hackathoning their way to coding in health. The heavy lifting comes once a mobile health tool is in a provider or patient’s hands (or body): that the tools support behavior change that lead to improved patient outcomes and lower health costs – or at a minimum, aren’t cost-increasing unless that can be balanced with a quantifiable benefit (say, faster return-to-work for a patient or increased productivity for the doctor).
A data tsunami must be avoided. A new word was introduced to many of us: “infobesity.” This is the phenomenon of too much data and an inability to deal with it. We can’t jump to big data analytics until we sort out how to move the growing bits of fragmented “small data” from peoples’ wearable devices into larger data sets that can make meaningful and actionable suggestions to patients and providers. No physician wants to read the raw output from peoples’ Fitbit’s, Misfit Shine’s, or Withings scales. To that end, Arielle Carpenter of Withings talked about their devices and data connecting to the larger health ecosystem: the company has over 100 different partners with open APIs. This is a challenge for the “other” side of HIMSS, electronic health record companies who remain fairly closed to the concept of Observations of Daily Living smoothly sailing into patients’ medical records.
“Disruption” is a word that should be cautiously used around providers. The phrase “creative destruction” was used more than once on the main stage of the Summit. These two words are central to the title of Eric Topol’s book, The Creative Destruction of Medicine, and originally come from the theory of creative destruction developed by Joseph Schumpeter in 1942 (my economics roots are showing). But when this two-word bomb was used by various people during the Summit, the Twitterverse erupted with comments about how “scary” or “intimidating” or unhelpful the idea of “disruption” is in health care. Someone tweeted, “we are losing respect for doctors.” What about physician workflow? And aren’t providers health care lives disrupted enough by the Affordable Care Act, EHR implementations, Medicare payment cuts? Words have meaning, and if we seek culture change and successful marketing of the use of mobile health tools, then perhaps some other framing would be useful.
Don’t over-forecast or over-expect mobile health adoption in the short run. Because mobile is about behavior change — for patients, caregivers, providers and payers – the shiniest new technology won’t get adopted quickly without quite clear evidence and aligned incentives. This week, a survey found that only 10% of medication adherence programs use mobile platforms: mail and pharmacist interaction (real-time, face to face) were by far the most-used tactics. And Susannah Fox of the Pew Research Project’s latest data shows that most people are still self-tracking health in their heads – not via digital means.
What will work will get patients and physicians on the same page, working together for shared decision making and participatory medicine. One project to watch is WebMD’s program that will enable physicians to send directly to patients clinical instructions and articles between their Medscape (physician-facing) and WebMD (consumer-facing) portals. As WebMD is a much-trusted source for health information among consumers, this project could get some traction fairly quickly – if physicians embrace the information-therapy approach pioneered by Healthwise over a decade ago (emphasize: a decade ago).
It is fundamental to note that mobile health is taking off much more quickly outside of the U.S., in places that aren’t burdened by sunk costs in an HIT infrastructure that is fragmented, legacied, and cumbersome. Interoperability in the U.S. remains a barrier to many health innovations. So does payment, and all the talk of moving from volume-to-value is another forecasting challenge for those of us who are in that business: we shouldn’t over-forecast value-based care when there continues to be discounted fee-for-service throughout much of the nation, coupled with consumers facing high-deductible health plans they don’t really know how to use.
Health Populi’s Hot Points: I cut my teeth on forecasting for ten years as a research affiliate with the brilliant team at Institute for the Future. Roy Amara, the founder of IFTF, said that “we tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.” This has certainly been the case with mobile health. We see greater mHealth traction outside of the U.S. than in America, the top healthcare spender in the world.
We trust that mHealth’s impact in U.S. health care will be tremendous in that long run. But getting ‘there’ will require more evidence, more business acumen, and a greater scale that so often prevents the fragmented U.S. system from innovating the way other nations’ health systems do.