Healthcare is about to change as two disruptive forces come together. Those forces are Internet connected consumer medical devices and websites that bring the use of cognitive behaviour research and e-therapy to remote treatment.  Together they’re poised to combine their respective segments of expertise to produce a new generation of consumer health products.  It has the potential to be the most disruptive change to medicine in two centuries.  If it succeeds it will take healthcare out of the hands of today’s professionals and transfer it to the High Street as a true consumer offering.


Forget what policymakers say, healthcare is about to change and change disruptively.  We’ve all heard about eHealth, whether it goes under that name or the equally popular aliases of telehealth or remote healthcare.  For the last decade it’s been touted as the saviour of our healthcare systems, whether they be public or private, by letting patients take care of their own wellbeing and reducing costs for healthcare providers.


Far from delivering that promise, it’s spawned a culture of pilots and trial.  Many of those working in the area have retreated so far from the marketplace that the word deployment is now seen as a four letter word.  Yet walk into any department store or supermarket and you’ll find a growing range of medical devices from blood pressure meters to heart rate monitors.  They would not be there if there were no demand.  But as stand-alone, unconnected devices they’re remarkably unpersuasive – at best they’re a reminder that we should probably go to see the doctor, rather than fulfilling their promise of being a daily tool for monitoring our health and improving our quality of life.


There’s a reason for that.  These are all standalone devices, which measure a particular parameter of our health and give us a reading.  Unfortunately for most users that’s about as interesting as the sound of one hand clapping.  The first few times we use them we’re likely to be stressed and thus record a blood pressure or heart rate that only serves to convince us that there’s probably something wrong.  That does nothing to help us improve our lifestyle – it just raises our hypochondria level and increases cost by propelling us back to our GP. 


These products are only the first step in an evolution to personal healthcare.  The medical profession already knows that individual spot measurements don’t tell us much, or they ought to.  What we need to know is the trend.  This is where device manufacturers currently have a problem.  Small cheap devices don’t have the screen size or memory to display trends in a useful manner.  And asking a consumer to regularly write their personal data down or upload it to a website doesn’t work.  It’s not compelling.  So most medical devices rapidly find themselves destined to gather dust at the back of the bathroom cabinet.  Meanwhile our lifestyle continues unchanged and our health declines.



We’re mired down in trials


Most current trials of eHealth devices focus on retrieving patient data and then sending it to a doctor for analysis.  That often means more work for the doctor, which is one reason why the trials are generally limited.  Because there are health researchers involved who deliver the devices and train the patients there’s little effort put into making them easy to use.  Which means they stay a long way from looking like a commercial product.  Typically the only reasons the patient continues to use them is the fact that they are generally only enlisted into the trial because they are at the more critical end of their condition and because they want to please their doctor.  If the doctor moves on, the trial grinds to a halt.


None of this feels like a recipe for a mass market solution.  This isn’t the way that we sell satellite TV services, mobile phones or anything else that catches our interest.  It shouldn’t be the way we sell healthcare.



Making it compelling.


We happily spend our hard earned cash on services like satellite TV and mobile phones because they’re compelling.  They do something that we want and we get the appropriate positive feedback or reward.  Why can’t we do that with health?


The answer is we can, but until recently successful examples were noticeable by their absence.  The most well known one is probably Weightwatchers.  They understand the process of providing regular feedback and using peer group pressure to affect behaviour.  And they’ve worked out how to make money out of it. 


Over the last few decades a lot of research has taken place in cognitive behaviour training. Much of it focussed on the treatment of various addictions and behavioural traits, but it is beginning to mature and expand into other areas, such as depression and phobias.  In the recent years these treatments have made the transition to the web, under the collective name of eTherapy.


The exciting, and not necessarily expected finding has been that these are remarkably successful, in some cases significantly more so than conventional group therapies.   Pioneers like Victor Strecher at the University of Michigan and founder of HealthMedia have been instrumental in laying down the basic requirements – the need to make web based programs address the key issues of motivation and self-efficacy, or confidence.  The latter is critical – we often have good motivation for changing out lifestyle, but fail because of a lack of confidence in being able to accomplish it.  The best results come when that confidence can be positively reinforced.


What the successful eTherapy programs have also taught is the need to keep interaction simple.  People who need help don’t need complication.  That’s a message that is equally important for device manufacturers who need to move away from the concept of adding features and technology as a means of differentiating their products and concentrate on ease of use and simplicity as the key selling points.



Adding Connectivity


By itself, e-therapy won’t cause a paradigm shift.  What will accomplish that is the fact that it is appearing at the same time as a new wireless technology that will herald an explosion of low cost, connected medical devices.  That technology is a new version of the well-known Bluetooth standard.  Bluetooth has been immensely successful, getting incorporated into over 1 billion products every year, from mobile phones and headsets to game controllers and credit card readers.  Next year, in 2009, a new version of Bluetooth will come to market that offers some extraordinary advances:


   It will be so low power that wireless devices can run on coin cells for years.


   It contains features that allow consumer devices to automatically connect to each other with almost no user intervention, and


   It allows low cost consumer products to interact directly with a web site, using a standard mobile phone to send the data.


This new version of the specification is called Bluetooth low energy. It is the first time a wireless standard has been written that defines the entire process of how information is sent from a device, through a phone, all the way to a web application, as well as explaining how that application can interact directly with the remote device.  It adds almost no cost to the devices, but will revolutionise their use and appeal.



Two disruptive technologies meet


The timing is fortuitous.  Each of these two new technologies – e-therapy and Bluetooth low energy have the potential to bring radical change to the market; e-therapy by developing a growing range of self-help websites and Bluetooth low energy by spawning a new generation of internet connected medical devices. By themselves, each would have a slow gestation to attain the critical mass that is needed to fundamentally disrupt the market.  With Bluetooth low energy we would see a rash of connected devices, but it’s unlikely that the web applications provided by the device manufacturers would be compelling enough to produce a massive uptake.  Equally, without connected devices, e-therapy is likely to evolve and roll out through existing medical channels, which would result in slow, piecemeal adoption.


If these two come together we will see the combined advantage of compelling hardware with compelling applications.  It’s too early to predict what the first successful marriage will be, whether it’s in sports and fitness, disease management, wellbeing or beauty, but whatever it may be, once it succeeds it will signal an explosive growth in the consumer medical market.


Brands and Opportunity


One of the most interesting questions about this new opportunity is which companies will win this market?  The medical industry is not renowned for its speed of movement nor disruptive innovation.  In contrast the web and wireless industries have driven technology and applications into the market faster than almost any other.  However, each of the obvious contenders for this new market face problems in growing to critical mass:


·          Current consumer medical device manufacturers have little understanding of web applications, or how to change their products into connected devices.  Their expertise is in selling boxes that they can forget about.


·          eTherapy providers have limited experience of how to turn applications into revenue streams or how to integrate their software with remote physical devices.  They are generally still closer to academia than the mass market.


This opens up the market for other established players to combine these technologies and establish new brands for personal consumer healthcare.  It raises the interesting question of who a consumer will trust with their day-to-day health and wellbeing?  We may see the established High Street pharmacists, like Walgrens or Boots Alliance make the running.  Given the mobile phone component of these connected devices, network providers like Sprint and Vodafone may equally take the opportunity to add healthcare to our mobile subscription.  One of the biggest opportunities could be for the UK’s National Health Service to grasp the role of international healthcare provider and make NHS a global brand, but it’s unlikely that will happen.  Nor is it any more likely that traditional healthcare providers or insurers will react positively or quickly enough to become the initial leader within this new market.


What is clear is that now is the time for companies who want to become significant players in the new role of personal connected healthcare provision to start thinking about services and products and to develop or acquire the expertise to deliver them.  With a looming recession and pressure on healthcare budgets there will be an ever increasing appetite from both consumers and healthcare providers to find more accessible, cost effective methods of providing that care. 


The introduction of connected monitoring will radically change the way that we think about medicine.  It may well be the first serious challenge to the medical profession by changing the balance of power in the way we think about and pay for our health.

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