Some time ago I had the privilege of being involved with the Blue Button initiative through a joint Tufts/MIT/White House Innovation collaborative effort. The goal of the blue button initiative is to engage patients in their health through access to their health data in both human and machine-readable formats.
In principle, the mobile health space can be segmented (broadly speaking) into two rudimentary categories. Patient-dependent solutions, by which I mean those that rely upon patient engagement for success, and clinician-dependent solutions, for which uptake of the clinical community is critical for success.
mHealth challenges
I’d like to illustrate some challenges that need to be considered for a successful foray into mHealth. Let’s start with the patient-dependent solutions. Firstly, not all patients have access to smartphones and tablets which is an obvious problem – nor do those who do feel comfortable using them in a health-related way. One could argue that smartphone/tablet adoption is growing rapidly – and it is. However, there is an entire world of people, in emerging markets, for whom the smartphone is out-of-reach. The implication of this is that it could quite reasonably be decades before mHealth, on a macro level, makes meaningful penetration into the hands of the masses.
Secondly, many mHealth solutions require a degree of patient commitment that very few are able to give. If we were speaking about their behaviour as it related to taking medication, we would call this group ‘non-compliant’ or ‘non-adherent’ patients. Similarly, these terms extend to the mHealth space. There are non-compliant patients with their mHealth solutions. They try them for a few weeks or months and are really engaged at the beginning and then their usage drops off. A potential solution to this is to properly incentivise these patients by convincing third party payers that a reduction in health insurance premiums is a small price to pay for enhanced compliance, which will result in lower claims and payouts down the road.
A third challenge is one of ‘crowding’ as I describe it. Simply put, where there’s a chance for profit, there are crowds. The ramifications for the mHealth space are this: as revenue models become clearer for mHealth solution providers, the landscape which was once dotted with two or three solutions is now congested with 20 or 30 offerings. The market is fragmented. Fragmentation confuses patients. Confused patients (typically) default to the status quo or what they know best: which is to do nothing. Standing out with a unique proposition and first-mover advantage are obvious solutions to this challenge but, as we have learned with other industry verticals, they are no guarantee of success.
Ensuring real improvements
On the clinician-dependent solutions front, it is critical that mHealth solutions geared towards clinicians really are an improvement in delivery/diagnosis of care. Or, if they can’t truly leapfrog the existing options, there must be at minimum an incremental gain in efficiency versus the current ‘standard of care’ in order to gain traction. How to do this? Get prototypes into the hands of clinicians as quickly as possible to conduct user acceptance testing. By understanding where the technology falls down or stands up to the toughest critics in a clinical setting, only then will they be able to refine their offering to meet the needs of the wider masses.
Clinician-dependent solutions – particularly those that integrate with EHRs – also need to be able to adapt to current patterns of care seamlessly with minimal cost and technological intrusion. To illustrate the importance of this, a recent article in Medical Economics, citing third party research, stated that 70% of physicians viewed EHRs as ‘not worth it’ and that 45% of them viewed patient care as worse. In fact, when asked whether they were considering implementing an EHR system within their practice, system functionality and cost were the most common responses influencing their decisions. These are sobering statistics but important signals for mHealth solution providers at large: make platforms too costly and complicated and adoption is sure to suffer.
The final piece of advice is to remember the adage that ‘time is money’. Quite simply, this boils down to patient throughput. If mHealth solutions providers can deliver improved throughput – seeing more patients in the same amount of time or the same amount of patients in less time – the financial impact will be difficult to ignore. And we’re not just talking about clinicians being able to bill more or bill the same amount for fewer hours of work. Improvements in throughput have a downstream effect across health systems as either resources are freed up to be redeployed elsewhere or more patients are treated with the same bucket of resources.
In the end, the field of mHealth is rapidly evolving and it takes incredibly creative thinking and the necessary marriage of medicine, engineering and software development to truly effect lasting change for our healthcare system.
