(ED NOTE: This old article raises some interesting points; in todays’ digital world, communication spreads fast, as does promotion, some of which is not, as the ole’ watchword in medicine is, NOT evidence-based)

In the Huffington Post Barbara Ficarra, Founder of Health in 30®, asks is there too much hype in the mHealth app world?

When I last heard a good argument being put forward for the mHealth market being over hyped it was by John Chilmark Jnr, Health IT Analyst at Chilmark Research. This is interesting because John’s recently joined a mHealth startup (Prescribable Apps) founded by John Chilmark III.

John’s followed a classic “Is mHealth a Market?, Is there too much hype?, If we can’t beat them let’s join them!” realisation process that I’m seeing happening in the world of eHealth/Health 2.0 as thought leaders there begin to appreciate the transformational new experiences that the newest mass media can support.

I hope the feedback on this article will boost Barbara’s confidence in the mHealth market and we’ll soon be welcoming yet more expertise and industry experiences to another cool new mHealth initiative.

My thoughts on the article:

The Wild West of mobile health (mHealth) is taking the health care industry by storm, but “there are no rules to the game,” said Joseph C. Kvedar, M.D., founder and director at the Center for Connected Health in a recent interview. Mobile health is a “game changer,” he added, but there is a lot of hype because there are a lot of people developing health apps just to “get rich quick.”

I find it odd that so many people think there are “no rules to the game”. In my opinion in a world where Communities Dominate Brandsthe reverse is true: there have never been more and the punishment for ignoring them has never been so cruel.

Perhaps there’s an imagined problem that somehow smartphone apps offered by unrecognised brands and those without medical qualifications are being taken seriously by patients? A client paid me to investigate the “alternative” mHealth market a few years ago and I was amazed at what I learnt. Asides from all the various “this XYZ can protect you from mobile phone masts that are killing you” most of the scams involving mobile involved getting people to click online ads and enter their information and then following this up later with a deceptive telephone call in which they use this info combined with other information they collect/buy to convince their victim they are somehow blessed/magical/all-knowing in order to win their trust.

I’ve yet to see much evidence that smartphone apps are going to be able to achieve the same as there are still much easier ways that offer less chance of being detected eg. they’ll be all over Mobile advertising and Location Based Services before targeting Smartphone App Stores which have been forced to be much more up front with users about what information is being shared and when as a result of the development of mobile payment scams (eg. crazy frog subscriptions, etc).

A good point made later in the article highlights the speed with which this is certain to happen: “There’s a lot of enthusiasm surrounding mHealth — from mainstream media tapping into the mHealth rage to social networking sites exploding with discussions about mobility in health care“. In my opinion the get rich quick scammers are going to be up against this and a world where everyone can express an opinion and there’s so much passion/interest is going to prove very hostile to these scammers.

Thankfully when apps involve registered medical professionals who have real identities and are regulated by professional bodies (like theGMC or IMO) none of these approaches work or will be sustainable for more than a few hours.

According to the U.S. Department of Health and Human Services, mHealth is “the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research.” mHealth includes gamification, text messaging, telemedicine/telehealth (remote patient monitoring), electronic health records, and health apps, to name a few

Clearly I think this consensus definition is very inaccurate and this will become obvious as users of it begin to look beyond the device in the hand and to the Health opportunities that mobile networks can offer (these are obviously accommodated by a definition that recognises mobile as the newest mass media rather than as a device).

Examples of the mHealth potential of mobile networks are becoming much more obvious as public health authorities use network tech to better manage the way they handle incoming 911 calls, locate individuals who are lost, broadcast emergency SMS’s (eg. weather warnings, night time mosquito spraying notifications, etc), etc

Despite mHealth being in its infancy, the revenue projections are significant

The article uses optimistic projections made by research oganisations that make their money by selling research reports that ultimately wouldn’t sell if they didn’t boast optimistic market projections. In my book it’s quite simple: successful mHealth examples are already here and it’s been a massive driver of adoption of mobile – the newest trillion dollar industry – as it’s the thing that helped the need for mobile devices to expand beyond the early adopter phase because it’s what gave mobile the mass market initial consumer intelligible reason to have a mobile and keep it on (be reachable).

According to a 2011 press release statement from Juniper Research, the number of mobile healthcare and medical app downloads will reach 44 million this year and will reach 142 million globally by 2016

To put these numbers into context of the mobile market where most of the revenues are still made with native apps, look how many smartphones Samsung have been selling since the start of 2012 (nearly half a million a day!). By the end of 2012 Samsung alone will have sold more than twice as many smartphones as Juniper are predicting there will be apps downloaded.

Just think for a minute about the apps that are natively installed on these devices and how they can and are being used for healthcare purposes eg. a voice dialer that will let the user roam onto any network in order to make a call to emergency services while automatically sharing their network location data, a forward facing camera that can connect users with a remote Doctor, a calendar/alarm that they can use to set pill reminders, SMS so they can communicate with their Doctors office, an internet browser that they can use to look up information on a symptom or disease they are concerned about, a multimedia player that they can use to watch rich health videos, etc.

By 2016 S Health – Samsung’s mHealth strategy – will have easily dwarfed this Juniper statistic for downloaded apps with native ones eg. by 2016 it’s more than likely that there will be more than 300 million Samsung branded smartphones that have been sold and are in use that have native mHealth apps installed (and by 2016 all these devices will support HTML5 too).

Consumers are downloading apps to help them stay fit, track their pregnancies, monitor their moods, eat healthier, and sleep better. They are also downloading apps for chronic disease management. They can manage their prescriptions, have medication reminders, and monitor blood pressure and sugar levels. Consumers can be empowered to take charge of their health, but right now navigating the array of health apps can be confusing. Consumers lack guidance on choosing a safe, secure, medically sound health app. Trying to navigate the health app craze without direction can be painstakingly difficult

I’m not so sure this is true and I’m not so sure why anyone would presume consumers are so out of their depth on this. As I’ve written at length before the first thing a customer sees is an apps community rating and feedback, as soon as you click on an app it tells you who it’s developer is. One more click and you can see other apps by this developer. Another and you can report it.

I think the open access to app experiences is a very positive development that will help the development of mHealth Apps greatly as there are many lessons to be had from other mobile entertainment experiences just as the entertainment services on the internet have helped in the creation of the best healthcare experiences on the internet eg. anyone building a social community like Sermo or ACOR is building on the success of Facebook (a service that was started as a dating website), anyone incorporating rich video content onto their hospital website is building on the success of YouTube (a service that was started so people could share home videos), etc.

Cleveland Clinic, Nike Fuel Band, American Red Cross, and Walgreens are known in the space, and consumers may find it easy to trust them and download apps associated with them. However, consumers may find it confusing to navigate the mHealth app world from companies that are off the radar. How do consumers know if the apps are safe and reliable?

Surely with a crowded app market this is only a problem for the companies that offer these apps to work out as without it they’ve no chance of even getting customers in the first place? Speaking from personal experience at 3G Doctor we’ve done this by putting a fully insured registered Doctor in your pocket and helping patients appreciate that we’re safe, reliable and to be trusted by letting them read our FAQs, what other people are saying about us and providing them with a fully documented consultation experience (currently only available to patients in the UK and Ireland).

The FDA is prudent on drafting guidelines for developers, but will it stifle innovation? “It may slow innovation, but I don’t know that it stifles it. Regulations do create barriers to entry as they set a high bar. But in so doing, they also create significant economic opportunities for those who follow the appropriate processes and win regulatory approval,” said Bill Crounse, M.D., Senior Director of Worldwide Health at Microsoft Corporation, in an email. “I do think thoughtful regulation is required in the health industry to protect consumers. This is certainly true related to pharmaceuticals and medical devices to protect consumers from harm

As partners of Microsoft (we’ve developed a 3G Doctor app for the HealthVault platform and will be announcing the availability of a new service with them shortly) I think it’s obvious that they’re well placed to help mHealth app developers innovate but I’d be a bit concerned that most app developers aren’t yet aware of the opportunity they have to work with HealthVault.

In my opinion before mHealth app data can properly add value and have the potential to go somewhere it needs to be aggregated on a secure accessible platform. Currently, the vast majority of mHealth apps are creating silos of data that effectively lock it up rather than letting it flow and add value.

As a backbone for the aggregation of this data the HealthVault platform enables developers to build multiple apps that can complement one another, aggregate data across time and share it back so that they can create permission based biofeedback mechanisms that can drive positive patient behavioral changes whilst enabling secondary care information technology and consumer health systems to operate seamlessly.

The primary role of the FDA is to insure consumer safety,” notes Kvedar. “Mobile health has the potential to get out of hand if not regulated. For example, there is an app that based on self input of one’s carbohydrate count; it will generate insulin dosing suggestions. Clearly this could be dangerous,” he added. “While I don’t think the FDA process will ever eventuate in a ‘consumer report-like’ or ‘D Powers-like’ rating, it will be a filter. If apps get through the filter, we should at least be comfortable that they are safe

I’ve commented on the FDA approach in much greater detail here. I’m not sure they’re anywhere near to being capable of insuring consumer safety eg. they’ve sent one of the USA’s biggest mobile R&D firms off down a dead end to look for fruit where there are no trees.

Aside from safety concerns, there are “two problems with health apps,” said Kvedar. First, after downloading the app, it may be used once or twice and then it’s forgotten, he said. “There’s no engagement.” Secondly, health apps can be prone to error because the data that is self-entered by consumers may not be true. It’s a “social diversity bias problem,” he said, because the data entered isn’t honest and there is no meaningful engagement to help change consumers behavior. After downloading health apps with enthusiasm, the “shiny new toy isn’t so shiny anymore,” because there’s “lack of interest and lack of engagement,” said Kvedar.

As far as I can see these problems aren’t unique to health apps. The first applies to nearly any experience that lacks engagement (all the junk apps that no one uses). The second applies to nearly any service where the consumer might think they can benefit from dishonesty (eg. energy meters).

mHealth innovators are already creating solutions to these challenges eg. look how KP have added connectivity with carers to make their Mobile first strategy engaging, look at how Alivecor has linked it’s embedded ECG tech with cloud based storage so there’s no room for patients to effectively tamper with medical data, look at how interactive medical history taking questionnaires can help patients share their important history to their Doctors in a more honest way, etc.

Happtique, a mobile health application store and total app management solution released a draft of the standards that it will be using to certify medical, health, and fitness apps under Happtique’sApp Certification Program. The purpose of the program is to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content… …Happtique App Certification Program represents a major step in setting standards for safe and reliable health, fitness, and medical apps. Certification will assure users that the app meets security, usability, privacy, and content standards. Happtique has curated and categorized over 12,000 apps to date in over 300 categories

I think it might be helpful to write a longer post on my thoughts on Happtique’s approach but I think it’s a bit of a stretch to be referring to an app that provides reviews of other apps as a “mobile health application store and total app management solution”.

Beyond the marketing and discovery benefits it could offer mHealth app developers I’m not so sure that it’s Certification Program will be able to differentiate apps enough eg. whilst I can’t imagine any patients refusing to use an app their Doctor prescribes them if it doesn’t have a certain “hAPP” rating, I could easily imagine the certification process being undermined by a patient being reluctant to download an app prescribed by their Doctor that had a high Happtique rating but also had strong negative reviews on the Apple AppStore download page.

Mobile technology has allowed consumers to receive information at lightning speed and gives consumers health and wellness apps that can help improve their health care. Mobile technology may help to transform the lives of patients and provide a stronger partnership with health care providers

Here in Ireland there are 50,000 Doro EasyPhone customers many of whom are living independently thanks to their mobile phones. I’m not sure many of them would agree with the assumption that this “may help” as for many of them it’s already a critical part of the means by which they maintain their independence – that’s if it’s not considered a lifeline.

Of course whilst this is rarely recognised by those of us who today take mobile connectivity for granted it’s not new eg. mobiles are giving reassurance to the independently living in ways similar to how Marconi’s invention more than a century ago began to take much of the fear out of journeys on the seas.

Bottom Line. Consumers need safe, reliable, trustworthy apps to help guide their health and wellness and help them manage their chronic diseases. The health app world needs guidance. The vast assortment of apps to choose from makes it difficult for consumers to navigate. Which apps are reliable, trustworthy, and medically sound? Joseph Kvedar, M.D., Justin Major and Carol Colman are actively involved in writing a series of books for consumers titled Wellocracy; it’s the first in a series of books to help consumers navigate the ever-growing and dizzying array of health apps

I can’t wait to buy this whole set of books so I can donate it to a museum. I’ve shared with you the mHealth Space Pen and I’m quite confident this set of books will be the fastest horse the eHealth industry could develop…

So, how do consumers navigate the crowded world of health apps? “Common sense rules,” he said. If consumers think it’s a “magic app,” it probably isn’t. In this exciting world of health care where technology rules, one thing is for sure, technology will never replace the doctor/patient relationship (or health provider/patient relationship). Face-to-face communication with health care providers will always be paramount

It always amazes me that it remains so difficult for many to even consider that some of these mHealth Apps (eg. Skype, Facetime, 3G Mobile Video Calls, GTalk Video Calls, etc) will be the way those paramount face-to-face communications are conducted?

It doesn’t seem as if there is too much hype — just little guidance. The push to move the mHealth app world forward may be in the power of consumers to clamor for health and wellness apps that are safe, reliable and trustworthy, developed by companies who are not just those looking to “get rich quick,” as Kvedar said

In a world where VC’s are voicing their concern that there’s not enough to protect apps from would-be copiers I think the idea of companies thinking there’s a get rich quick opportunity is unlikely.

My thoughts on the comments:

LymphomaJourney: Liked the piece. But not convinced that these will necessarily change peoples behaviour. The lowly bathroom scale, around for years, has not made any difference to increase in obesity rates.

I always wonder why this is used as a counter to the idea of value of monitoring health data. How would anyone know the bathroom scale is so ineffective? Perhaps the obesity rates would be even higher than it is today? Perhaps the reason it’s made so little difference is we have an idea of what to expect? Perhaps the ineffectiveness is directly related to the lack of engaging feedback?

I’m optimistic that Mobile will connect the things that should be connected and that the weighing scale is most definitely one of these things. I’ve already seen some interesting results in clinics where they’ve introduced A&D digital scales (that automatically log data into the patient electronic records) so as this connected technology gets increasingly adopted in patients homes (as the result of mHealth brands like VitaDock’s TargetScale and Withings Body Scale) I’m expecting even more as patients and their communities can leverage this data to support one another achieving goals.

I also think things there will be a transformation as these connected devices start uploading into patients HealthVault records so that their Doctors can start pushing healthcare to them at times when things are changing rather than after they’ve changed.

mHealthMarket: In our view, mobile health will eventually bifuracate into two distinct markets: a regulated industry, deployed by hospitals, doctors and ACOs, and an unregulated direct-to-consumer industry of diet and exercise apps. These two industries will feature dramatically different investment, pricing, ROI, marketing and management issues

I think it’s unlikely that two distinct systems will develop as I’m optimistic that the regulated industry is waking up to the preventative healthcare opportunities and to try to engage patients before they get sick (or notice that they’re ill) they’ll need to get very imaginative…

dereknewell: “Health “apps” will transform healthcare and it is certainly the wild west right now. The main thing we need is apps that connect to the healthcare system”

I think Derek’s hit on a massive challenge for the smartphone mHealth app market here. In my opinion the Microsoft HealtVault platformapproach is the most viable way of achieving this at scale.


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