The Barriers for Digital Health Startups

It’s over forty years since the first personal wireless telecare products came to market.  Over the years, along with many others, I’ve been writing about their potential and the opportunity they present to save healthcare costs and by extension, our healthcare systems.  Five years ago, many of us got excited when the Tricorder Prize was announced, with the promise of a Star Trek-like device that would diagnose multiple conditions being demonstrated by 2015.  That deadline has now slipped to 2017, but it’s not stopped a plethora of new healthcare devices being announced in the meantime, helped along by the twin vogues of crowdfunding and lifestyle.

So where are all of these digital health devices?  If you visit a hospital or GP, they’re mostly noticeable by their absence.  Startups are coming and going with ever greater rapidity, whilst healthcare costs grow relentlessly.   What is stopping digital health devices fulfilling their potential?  At the recent Future of Wireless International conference, I chaired a session with speakers from within the medical device community and working at the sharp end of healthcare, who shared their views about the challenges.  It was one of the most brutally honest and candid discussions I’ve come across, which deserves to be heard by anyone entering this market.  So here is a precis of their essential advice for any digital health startup.

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Mobile Operators, Utilities and Customer Segmentation

For many years the best way to insult a mobile operator was to suggest to them that they were just a pipe for voice and data.  They’d foam at the mouth and point out that they were a brand, not a utility.  They’d justify this by pointing out that they had marketing people and that they offered differentiated products.  It took a far more expert brand in the guise of Apple to make the commercial point with the iPhone, which was offered to mobile operators on the “stick it up your pipe and smoke it” principle, giving the consumers to Apple and ultimately forcing the operators into a price war in supplying a largely undifferentiated consumer data pipe.

At the same time, utilities were beginning to think that they might be more than a pipe.  Particularly in areas where the market is deregulated, allowing consumers to switch energy supplier, they’ve been toying with ways to attract customers through segmentation and selling other services.

On the same day this week, in the UK, we’ve seen two interesting examples of this playing out.  O2, which had been chasing the health market with their Help at Hand and Health at Home products, unexpectedly pulled out.  At the same time, British Gas launched an initiative to become the energy supplier of choice to young renters.  It’s useful to consider what these say about the potential to gild your pipe and rise above the status of utility.  As we enter the era of the Internet of Things, the market will need service providers who can aggregate services and who have trusted relationships with consumers.  These moves suggest that although utilities and network operators ought to be well placed to extend their relationships, they may lack the skills to do so.

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NHS claims 200% of Global Telehealth Users

If you’ve been following the UK health pronouncements on telehealth, you’ll be aware of the policy of recruiting 3 million patients to become telehealth users by 2017.  And if you’ve been following the industry analysts you’ve probably spotted the recent report by InMedica, suggesting that by 2017 there will be 1.8 million patients using telehealth worldwide.  In other words, the UK’s program will be responsible for around 200% of telehealth patients.  I know we did well at the Olympics, but that’s setting the bar rather high.

It suggests that either our ministers in the Department of Health are doing a Chris Huhne, or else the analysts are being uncharacteristically understated about the future.

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Mobile Health needs some Medical Pornography

If you’ve been working in Mobile Health or telecare, you’re probably frustrated by the slow progress being made in bringing products to market.  Whilst analysts like research2guidance see a rosy future, more down to earth reviews, such as the recent 2020health report “Healthcare without walls: Delivering telehealth at scale”, and Frost & Sullivan’s “E- Healthcare Initiatives in the United Kingdom” continue to point out that very few projects have scaled up past a few tens of users. 

Many reasons are put forward for that, ranging from the natural inertia of the medical industry, the barriers imposed by regulators, through to the difficulty in persuading doctors to hand over disease management to their patients.

Technology has been blamed in the past, but that’s no longer a valid reason.  Over recent years there have been major advances in sensors, wireless connectivity and processing power.  We certainly don’t have solutions to every problem, but there is a wide range of conditions where mHealth could provide significant benefits.  So what’s holding it back?

Next week the Mobile Health Industry Review at the King’s Fund in London will be bringing experts and VCs together to talk about business models.  I’ll be suggesting that mHealth isn’t the first industry to have suffered from this phenomenon.  Even for disruptive technologies, it often needs an unexpected and sometimes even unconnected industry to invent and develop a new application in order to drive things to a point where the disruption can be taken up and embraced by others.  One of the classic cases is the Internet.  Much of the development of streaming, payment mechanisms and user interface was driven by the porn industry.  Once that work was done, it was adopted by others, giving us the e-commerce, video streaming and compelling content that we now expect from every site. 

So, if Mobile Health is going to get anywhere it probably needs to follow the same course and forget about conventional medical thinking, (which generally involves a doctor), and embrace some more disruptive models.  To put it more bluntly, we need to find out what the equivalent of pornography is for healthcare.

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Medica goes Wireless

Medica claims to be the world’s largest medical show.  It’s a very monochrome event – all of the equipment is white and shiny, and most of the exhibitors and visitors are soberly dressed in dark suits, as befits the serious profession of medicine and spending money in Dusseldorf.  Looking at the equipment on display and the crowds thronging the show, you certainly wouldn’t get any impression that there’s a recession around, other than slightly more suits than normal and rather fewer bow-ties around the necks of the visiting consultants.

As far as the medical industry is concerned, it’s business as usual, and hopefully more so, as more of us get older and less healthy.  But there are some interesting trends.  One of which is the increased prevalence of wireless connectivity.  In previous years equipment manufacturers were happy for nurses to jot down the readings from their instruments.  A few devices had wireless links, but they were the exception.  This year, particularly at the consumer end of the market, wireless was becoming the norm, at least at the top end of product ranges.

Almost all of that was Bluetooth.  I stopped counting after the first hundred devices, and that was in just two of the twenty halls.  ANT was in evidence, helped with a demonstration of a prototype X10 Nano phone from Sony Ericsson, which was using the ANT protocol to connect to a weighing scale, heart rate belt and pedometer.  Wi-Fi was there in a few products, but mostly confined to tags for asset management, and I failed to find a single ZigBee medical device.  There also seemed to be very little profile for the Continua Alliance in terms of products or signage.  Even The Intel stand was conspicuously Continua-free.

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mHealth in the NHS – Everywhere and Nowhere

If you follow the mHealth blogs and groups on LinkedIn you’ll see a constant debate about where mHealth is in out existing health services.  I’ve been looking at some of the applications which are already in use within the NHS.  As yet, there’s no central policy for mHealth, and it’s debatable whether much of the good practice using mHealth is even acknowledged, but that doesn’t mean it’s not providing benefit. 

Much of mHealth is invisible.  It’s not the high tech monitoring that we find in glossy medical device brochures, but far simpler, everyday applications.   Many of these use SMS, but mHealth extends through voice and video, and we’re already seeing local use of applications on iPhones and Android.  However, there is little coordination of deployment, and almost all that is happening is as a result of local initiatives. 

Let’s look at some of the examples. 

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