Last month, the 2013 Mobile Health Summit was hosted by HIMSS at the Gaylord Resort in suburban Washington DC, spanning 4 days during the Mid-Atlantic region’s iciest conditions in years. Inside the cocoon of this convention space, 5,000 conveners took in demonstrations of innovations that use mobile platforms and standards to extend health services, knowledge, and self-help tools to people and providers.
Several themes emerged…
- 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 Steves: Steven Krein of StartupHealth and entrepreneur 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 takeaway was that mobile health needs to “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. Without evidence, the healthcare industry won’t adopt new innovations. To this point, the Journal of Mobile Technology in Medicine published a supplement (Volume 2, Issue 4S) to coincide with the summit. Its 15 abstracts highlight existing evidence supporting the adoption of mobile health. The topics included text messaging to improve anti-cancer adherence, primary health care extension in urban Malawi, mHealth tools to combat the spread of TB, mobile usage to support HIV care, and the effects of promoting physical activity among Type 2 diabetes patients, and more. However – and here’s the rub – most of these projects aren’t using commercially available products yet.
- Mobile is about behavior change, not the technology. Tweet This
A recurring theme was that it’s become clear that – given standards, opening APIs, cloud computing, and the hackathon approach to coding in health – mobile health can’t be about the technology alone. The heavy lifting comes once an mHealth tool is in a provider or patient’s hands (or, in some cases now, body). The approaches we adopt need to support behavior changes 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,” and it refers to the phenomenon of having too much data and not enough ability 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’ Fitbits, Misfit Shines, or Withings scales. To that end, Arielle Carpenter of Withings talked about connecting their devices and data to the larger health ecosystem. This is the new challenge for the “other” side of HIMSS – electronic health record companies who remain fairly closed to the concept of programs like the Robert Wood Johnson Foundation’s Observations of Daily Living smoothly sailing into patients’ medical records.
- “Disruption” is a word that should be cautiously used around providers. Frequently used at the conference were the words “creative destruction” (you might recognize them from Eric Topol’s book, The Creative Destruction of Medicine). But, interestingly, when they were used by various people during the summit, they acted like a two-word bomb. Time and again, the Twitterverse would erupt with comments about how “scary” or “intimidating” or unhelpful the idea of “disruption” is in healthcare. At one point, someone tweeted, “We are losing respect for doctors.” (Yet what about physician workflow? Aren’t providers health care lives disrupted enough by the Affordable Care Act, EHR implementations, Medicare payment cuts?) Words have power, so 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 tied to behavior change – for patients, caregivers, providers and payers – the shiniest new technology won’t get adopted quickly without quite clear evidence and aligned incentives. Last week, a survey found that only 10% of medication adherence programs use mobile platforms: mail and face-to-face pharmacist interaction were by far the most-used tactics. Similarly, Susannah Fox of the Pew Research Project noted that their latest data shows that most people are still self-tracking health in their heads – not via digital means. Essential to progress on this front is to get patients and physicians on the same page, working together for shared, participatory decision-making.
Mobile health is taking off much more quickly outside of the U.S., in places that aren’t burdened by costs sunk into an HIT infrastructure that is fragmented and cumbersome. Frustratingly, 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 brings up an important reminder: We shouldn’t over-forecast value-based care when there continues to be discounted fee-for-service throughout much of the nation. Less so still when that’s coupled with consumers who are facing high-deductible health plans they don’t really know how to use.
We trust that mHealth’s impact in U.S. healthcare will be tremendous in that long run, but getting there will require more evidence, more business acumen, and greater scale – all things that so often prevent the fragmented U.S. system from innovating the way other nations’ health systems do.
This article was provided by the Kareo Marketplace partner ZocDoc.
About the Author
Jane Sarasohn-Kahn, MA (Econ.), MHSA, is a health economist and advises organizations at the intersection of health, technology and people. Jane’s clients span the broad range of stakeholders in health, including technology, bio/life sciences, providers, plans, financial services, consumer goods, and public sector. Her latest venture, HealthcareDIY, is a portal to engage and inspire consumers in self-health: to eat right, shop smart, live well, and use technology to bolster health. She’s been named One of 8 Health IT Thought Leaders to Follow,One of the #HIT100, One of Ten Twitter Profiles of Public Health Advocates, A Woman Rocking Health, and One of Five Fierce Female Health Bloggers to Watch.