Rumor has it that Robert
Istepanian, Professor of Data Communications at Kingston University London, was
the first to use the term mHealth as early as the late 1990s (then “unwired
e-med”) with specific mention of the term “m-Health” in 2003. He described it as, “emerging mobile
communications and network technologies for healthcare.” While concise and to the point, Professor
Istepanian’s definition lacks depth.
Granted, our world has changed significantly since he coined the phrase. Consider that the smartphone really became
pervasive in 2007 (thanks Steve).
Like many cool and sexy things, mHealth
seems to defy description – not for lack of one, however. Try searching the internet for mHealth (who
knows, maybe that’s how you found me).
mHealth is everywhere, but it’s nowhere.
It’s got thousands of definitions, but not one that’s comprehensive
enough that everyone can agree on.
Originally, I sought to find
clarity around the topic. I intended to
explore the vast descriptions to concisely define what mHealth REALLY
encompassed. However, I wound up in the
exact place I started – staring out at the technosphere with more questions
than answers. Is mHealth delivered solely via smartphones? Is it for patients or providers? What about remote patient monitoring? Is mHealth a subset of eHealth? Or Telehealth? Is it used in the hospital or at home? How about public health?
Yes. No.
Sometimes.
With that exhausting (but
enlightening) experience in my rear view mirror, I am now throwing my pursuit
to define the enigmatic term of mHealth out the window. Because, ultimately, what does it really
matter? This isn’t about neatly placing
things into tidy little boxes with catchy names on them. This is about breaking down clinical
barriers. This is about taking control
of our well-being. This is about saving
lives. But how? What will ultimately shake out of the current
frenzy (Gartner calls is the “Hype Cycle”) around these hot new tools?
For some market perspective, we
don’t need to look much further than the dotcom days of the 1990s. New ideas were popping up every day. Some were funded by deep pockets. Others were about to spend their last red
cent in the hopes that an IPO might save them.
Consumers and businesses alike were gobbling up technology and marketing
new ideas faster than they could be deployed.
It seemed like everyone was winning.
Then the unthinkable happened – the market got smart. Venture capitalists were no longer throwing
money around like drunken sailors, and consumers were developing preferences
and habits. Despite the fact that so
many ideas were still undiscovered, the market was consolidating.
Similar to those booming 90s, we
will ultimately be left with consolidation driven by value and viability in the
mHealth space. Here’s the difference –
the internet revolution had a captive, active market. mHealth seems to have the opposite of
that. Everyone in healthcare has heard
it talked about ad nauseum, but it is hardly pervasive. Why? I believe there are four intertwining reasons:
-
Disinterested
Consumers: The historical
sentiment around any type of healthcare in the United States has been
passive. Those that perceive themselves
to be in good health rarely seek preventive medicine. So, why would someone bother to adopt some
type of healthcare technology unless the doctor ordered it? We are experiencing a minor uptick in the use
of wellness apps, but that seems to be the extent of it. One exception to this is where we are seeing
some penetration is around patient engagement.
Providers and payors are rolling out smartphone apps and portals to
allow their customers to book appointments, access their medical records, pay
bills, request prescription refills, and in more rare instances receive lab
results. While this is certainly a
welcome improvement to a fairly archaic norm within healthcare services, its
focus is more on loyalty than actual patient care. Great stuff for the marketing folks and
administrators, but little to do with outcomes.
Stage Two of CMS’s Meaningful Use Criteria includes requirements focused
on this type of engagement, and long-term adoption on both the payer and
provider side will lead to administrative cost reduction. While most everyone will concur that these
are good things, you may also agree that this is a fine example of where the
mHealth definition becomes fuzzy at best.
Is scheduling a well-baby visit with your pediatrician really
mHealth?
-
Lack of
Viable Revenue/Payment Model:
While attending the recent Southern California HIMSS Chapter’s recent
event, “Health IT Innovation Summit – mHealth in the Era of Affordable Care,” I
was honored to listen to true thought leaders in the healthcare space. This coincided with the Supreme Court’s
ruling to uphold the Patient Protection and Affordable Care Act in its
entirety. The facility was abuzz with
commentary on what it could mean for the industry, and the possibilities it
would create for mHealth. This topic of
revenue and payment modeling was particularly popular. Over the past ten years that we’ve discussed
mHealth as a game-changing technology, there was never really a clear answer as
to who would be responsible for the price tag.
In an overwhelmingly fee-for-service-based market, mHealth simply didn’t
have a home. The patient didn’t care,
the doctor saw it as a malpractice risk, and the payer couldn’t develop a
return-on-investment strategy. However,
with specific programs around Accountable Care Organizations, Patient Centered
Medical Homes, and bundled payment provisions, the Affordable Care Act has
revitalized this topic. With a
redirected focus on outcomes, readmission reduction and cost control, traction
in this area is inevitable. Tools such
as disease management apps for smartphones and wireless medical devices,
including glucometers, scales, and blood pressure cuffs will be prevalent in
the self-managed disease states.
Diabetes, Congestive Heart Failure, Hyperlipidemia, and Hypertension to
name just a few. Many of these devices
are already in use in trials, but I anticipate at least two years before we
see general viability.
-
Lack of
Clinical Evidence: There is a
phrase I hear quite often in this business – the technology is the easy
part. It’s true across all industries,
but overwhelming in emerging ones like mHealth.
So much so that one must wade through idea after idea, revision after
revision, just to find the tool that presents real value to the user. In healthcare, we are nothing if not
thorough. Until something can be proven
via clinical trial or pilot, it is worthless - and therefore unfunded. A common occurrence in any emerging field is
a solution in search of a problem.
Indeed, mHealth suffers from this a great deal. Such distractions are an important part of
the evolutionary process, but one must exert tremendous caution to not get
hypnotized by the shiny object. Without
achieving a goal of improved outcome, enhanced workflow, or cost reduction, it
is difficult to justify layering in a new technology to a healthcare
environment. This is why successful
trials are crucial. The mHealth market
is currently sitting squarely in the trial phase, and it is quite exciting to
see where positive impacts are realized.
The trend is to pick one thing – a workflow, disease, condition,
initiative, and determine how mobile technology impacts it. As time goes by, more and more technologies
and use cases will be vetted, and we will see official programs rolled out by
forward-thinking healthcare organizations.
Some interesting examples recently include remote stroke diagnosis via
smartphone, wearable heart monitors, and medication adherence tools.
- Disruptive
Workflows: “Disruptive
innovations” is actually considered to be a good thing these days (albeit
overused to a point), but try walking into a hospital and telling a clinician
you’re going to disrupt their workflow with innovation. You’ll be handed a discharge summary and
shown the door. For healthcare technologists,
there is a very fine line between enhancing and recreating. If you can’t gain adoption, any potential
gain your technology may bring to a patient is lost. That is why the user plays such a critical
role in mHealth, and why so many trials and applications fail. Sometimes the interface is wonky. Other times the application requires too much
bandwidth or processing. Regardless of
the issue, if you cannot improve the workflow or create a layer of convenience,
your initiative will fail. That is why
we are seeing a recent shift for the positive in the involvement of physicians
and nurses. Clinicians are participating
with much more enthusiasm. They are
engaged in surveys, and vocal during the interview process. They want their voices heard. Folks from the medical profession are even founding
their own mHealth companies. This is a
very exciting turn of events, as it signifies the embracement of mHealth by a
group notoriously resistant to change.
When Biz Stone, co-founder of Twitter, spoke at the 2012 HIMSS National
Convention, he made a statement that resonates within the mHealth space. “We will win if we always do the right thing
for our users.” While he was speaking
from a more global perspective on technology, the point remains salient. It will not matter how powerful your
technology is if it is not embraced, adopted, and evangelized.
I recently caught up with Todd
Plesko, Chief Executive Officer of Extension, Inc., a middleware company that
delivers clinical data and alerts to disparate smartphones, WLAN devices and
desktops used by clinicians. He shared
his viewpoints on the state of mHealth, and offered some insight on adoption. “We are finally starting to see the
mobilization of information, and it’s empowering. We have an opportunity to truly improve
workflow, clinician satisfaction, and patient outcomes. We must be careful, however. If you cannot demonstrate an immediate
improvement to the end user, you’ve lost the war. It’s about putting the right information in
the hands of the right person, at the right time, in the right way that will make
mHealth successful. It can be done. The possibilities are endless. It’s a very exciting time in US healthcare.”
If a healthcare organization can
overcome these four hurdles, mHealth will become a viable tool. It is important to note, however, this will
not happen overnight. There is much
political, administrative and organizational change that must take place before
patients and providers can truly leverage mHealth technology. However, given some recent milestones in
consumer sentiment, regulatory intervention, positive trial outcomes, and
adoption patterns, there is hope for the proliferation of mHealth in America. A sound plan that addresses technology,
workflow, analysis, and governance is critical. We may never agree on the definition of
mHealth, but it is clear that the world is getting smaller, people more mobile,
and we are at a tipping point in care delivery.
The mHealth tide is turning from neat gizmos and cocktail party chatter
to powerful care delivery tools and strong financial returns. Are you ready to ride the mHealth wave?
Where do you or your organization stand on mHealth? Let me know!
Where do you or your organization stand on mHealth? Let me know!
