The organisers probably weren’t expecting snow, but it didn’t stop the audience turning up en masse to Mobile Monday’s mHealth meeting in Amsterdam last week. The presentations were far from chilling; mHealth is moving from a position of relative obscurity a year ago, to something that every network operator feels they need to have. Vodafone, AT&T and Telefonica have already declared that it’s a key part of their strategy. The potentially still-born US health reform and accompanying monetary stimulus plans have convinced many more that there’s money to be made from it, and 400 plus attendees were keen to understand where those opportunities may be.
There’s nothing like a church for evangelising, and Mobile Monday had provided the ideal venue in the form of de Duif – a splendid former church on the Prinsengracht in central Amsterdam. It’s the first conference I’ve ever spoken out that had a live organ to regale the delegates as they came in. It brought a very civilised touch to the proceedings that others would do well to emulate.
The aim of the conference was to explain what mHealth is, look at what it can do and investigate some of the business models. First up was Bart Collet of Zogbeheer.com. Bart runs a care home and writes software to help in the management of such homes. That makes him a good spokesman for this industry, with practical experience both of developing and using the technology. Bart set the scene, by examining the five key challenges for healthcare:
- the increasing size of an aging population,
- the associated increase of chronic diseases,
- a shortage of funds, along with a shortage of medically skilled personnel,
- a change in patient expectations of healthcare, and
- the barrier of rules and regulations.
Bart gave some stats that indicated that 98% of the aging population do not want to move to a care home (I wonder about the 2% that do). To achieve that we have to take the route of monitoring people at home. That means more and better deployment of monitoring equipment. The good news is that the hardware should not be a problem, as small, inexpensive sensors are becoming available. The anticipated cost savings are estimated to be 64 billion euros in Europe.
mHealth is already saving money, even using simple services. I’d argue that it’s only the simple, process based ones that are saving money, but we’ll come to that later. The classic mHealth cost saving that are always trotted out is the example of using SMS for appointment reminders. In the UK, no-shows cost the NHS 645 million euros every year. Simple text reminders have reduced that by 27%.
Staffing is a more intractable problem. In most of Europe we have staff shortages, and we don’t have time to train new staff. Keeping patients out of the medical system should help, but I’m sceptical that this will arrive in time. And as we get more technology and change, politicians will probably slow deployment by giving us more regulations
Moving to trends, Bart enthused about the use of cellular modems in medical devices, creating great opportunities for mobile operators. Allegedly 19% of users would upgrade their mobile plans to engage in mobile health, or change provider if they thought it would help. Hence the rush to the watering hole. I have more time for that argument, but there are immense barriers to make it compelling. There are plenty of commentators who look to third world take-up, and suggest that the third world will export eHealth business models to us. Again, I’m less than convinced.
There’s no doubt that fitness and wellness apps will overtake medical ones. Vital signs are already being monitored, and the line between health and fitness is blurring. Bart envisages that we will move to the point where the body itself is the ultimate point of care. It’s a world where we will wear sensors that monitor every moment of our existence. That’s a message that comes from an observation of the ludicrous speed of sensor development. The difficulty is in believing that anyone will do anything with that overwhelming quantity of data. It sounds worryingly like some science fiction storylines, where a population has come to accept a supposedly benevolent medico-dictatorship.
Following on from Bart, I felt the need to play Devil’s advocate and question whether the belief that the world is even ready for mHealth . I think that the technology side of personal monitoring will get solved in the coming few years, as the new Bluetooth low energy standard makes it cheap and easy to manufacture sensors that push our personal data to the web via our mobile phones. That’s the easy bit. The difficult bit is in persuading anyone to wear the sensors.
I disagree with the easy pitches that mHealth will save us money, or that any large constituency actually wants it. In the long term it may save money, particularly if it helps to establish a broader database for evidence based medicine. But that’s a long way in the future. The fundamental fact that no-one dares speak, is that we’ll only make a major dent in health costs when we get rid of half of the current medical staff, as it’s salaries that take up much of the spending. I don’t know any government minister that would publically say that. And as more parents push their kids into medical school in the hope of a career that pays the mortgage and gets the pension, things are only going to get worse. It’s like building more roads. They just encourage more people to drive.
Meanwhile, the general medical profession is less than keen on mHealth. Whilst a few may embrace it, for most it threatens their professional status and careers. Nor do most patients want it. The sad fact is that most people like to ignore their health until it goes wrong. Which is why we have an increasing issue of obesity and similar illnesses.
The corollary from that is that we need to find solutions to easy problems that we can persuade people to use. To get the debate going I threw up four possible business plans:
- Engage the open source community and patient groups to design their own applications for those with long term chronic conditions. I call that model “the Wisdom of Sick Crowds.”.
- Target the guilty, selling dieting plans or similar,
- Don’t forget alternative medicine. There no reason that mHomeopathy shouldn’t be just as profitable as mHealth (although I hope it’s not.) However, alternative medicine has fewer barriers than traditional healthcare and may well innovate faster. In the same way that the porn industry drove internet development, alternative medicine may drive mHealth.
- Use personal monitoring to sell generic (and alternative) drugs directly to the patient. On average, we digest around 54,000 pills each over our lifetime. It’s got to make commercial sense to find a better way of prescribing and dispensing them.
And if all else fails, don’t forget to look at schemes that monitor your kids and pets. A copy of the slide set is available here.
Bringing us back to reality, Jeana Frost talked about her experience with Patients like me. The medical experience that most people have is very much a top down one, Companies like Patients like me are trying to change that. Jeana recalled how, as a student, she had been influenced by discovering that patients become more involved with the healthcare decisions when they were able to take a greater part in the treatment process. Patients like me has taken that into reality. It allows patients to enter their data, which is then aggregated, allowing groups to see how others live with the same disease. Today they have over 50,000 patients in 9 different condition groups. They’re working on how to provide meaning out of the information they aggregate, particularly in the form of mood charts, which members can use to compare themselves with each other, it’s an interesting take on feedback and a good example of where mHealth data manipulation needs to go.
The community is also proving useful for researching treatments. Patients find it useul in learning about their symptoms; from there, improving the way they record them and in turn reporting them to their doctor. In a warning shot to the pharmaceutical industry, the database is beginning to bring up a range of side effects and reactions to drugs that can be sharply at variance to those reported in clinical trials. That’s because it’s coming from patients that have become comfortable with their conditions and have started to describe them honestly as a part of their life. It’s another sign of how mHealth could dramatically increase the evidence base behind modern pharmacology.
Robert Houtenbos, from Dutch insurer Univé-VGZ-IZA-Trias provided an overview of mHealth in Holland, and the issues faced in trying to attain the Holy Grail of mHealth. From an insurer’s viewpoint, everything must be based on trust – their business model is predicated in a trusted relationship between insurer, patient and doctor. To move forward, he believes that they need to open up APIs, so that multiple sources can share information. It means changing their perception from Big Brother to Big Sister (although what she’d place in Room 101 wasn’t explained).
It’s not just about technology. 3G doctor is a service that lets patients use their phones to have a video consultation with a doctor. It might be 3G, but it’s not about technology – the phone is just the vehicle in your pocket. The core concept is simple. But, as Dave Doherty explained, the reality of delivering the service is very different. In order to be able to launch the solution, it required every segment of the medical profession to be convinced that the patient is not compromised. They needed to persuade the authorities that data would not be lost, that patient’s records would be continuous and integrated and that the information offered met professional requirements.
It illustrated the issues (and benefits) of working within the system. It took prodigious effort for the medical profession to accept it. As a sideline, 3G doctor also offer vast amounts of reference materials to doctors via their phones, which the doctors love, as it reinforces their status as knowledgeable Gods. So having got there, it’s win-win. It’s a good example of how mHealth can work when you scratch the back of the medical profession, and hence a perfectly valid business model. But I’m not convinced that it’s the sledgehammer that we need to change the current way we deliver healthcare. For that we need something far more disruptive.
That only took us to the break. The presentations should available soon on the Mobile Monday site. Next week, I’ll cover the second half…