Mobile is continuing to turn healthcare delivery on its head. James Chase caught up with LifeScan's Joe Shields for a list of key trends that will shape the future. Of course, each one is already happening. Anticipate the change or risk becoming a victim of it
1 Can mobile enable better health outcomes? The fundamental question. Fortunately, the answer is yes. Example: WellDoc set up a bona fide clinical trial to test whether its DiabetesManager—which integrates clinical, behavioral and motivational applications with everyday technologies like smartphones—could help lower A1C in patients with Type 2 diabetes. Turns out it could. The average decrease was 2.03% compared to 0.68% for control patients. “This is the rigor that's required now,” says Joe Shields, global strategic marketing and new product development at LifeScan, a Johnson & Johnson Company. “Payers want to see [evidence of effectiveness]. If it is considered a medical device and it is considered part of care, it will need clinical trials.”
2 Can mobile impact chronic disease management? For many in the industry, chronic disease management is a sweet spot. It's also where mobile's greatest potential lies, and a category like diabetes is awash with apps and devices. For example, Telcare's blood glucose meter sends data to the cloud, where it can be shared with healthcare providers and payers, assuming the patient has opted in. “It's about always-on data collection,” says Shields. “And as you get more data, a huge benefit is looking at patterns, trends and adding to the database of evidence-based medicine to make care more efficient.” Not only that, monitoring a patient remotely means fewer trips to the doctor's office or ER and, ultimately, lower costs. Shields cites reimbursement as a potential stumbling block, noting that while many developers are rolling out innovative ideas (“shiny toys”) not enough thought is going into the business model. “99¢ an app can only go so far when you need medical staff and clinical trials to back up your data.”
3 Can mobile improve medication adherence? Adherence has long been the holy grail for drug companies and healthcare providers. Marketers that have, in the past, built websites, CRM programs and pharmacy programs are almost certainly now building apps, too. Janssen Healthcare Innovations' Care4Today is a prime example. This secure messaging platform attempts to integrate fully a patient's care, rather than focusing on a particular therapy, and offers numerous reminders.
4 Which is better: app or browser? Apps and browsers do different things. Each does some things well but neither does everything well. By using native code, apps offer higher performance and an easy user experience with provided libraries. They can also run offline and be launched in one step. Mobile sites can work on any platform, are generally faster and cheaper to develop, and can be found via search engines. But it's generally more difficult to charge for access or usage than it is for an app. Shields says a determining factor is that apps are currently required for personal data transfer. “It doesn't work in an open browser.”
5 How can you cut through the clutter? The trouble with apps is that you are asking people to pluck yours from hundreds of others in a store. For example, the Care4Today medication adherence app (from #3) has approximately 219 competitors at the iPhone store alone. How do you stand out? “Part of it is positioning,” says Shields. “How is your app different, better, than the all the others that do the same thing, and most probably for free?” Shields acknowledges the need “to think more like a software company, in terms of iterations and releases, as opposed to a drug or device company, where once you deliver something, it's done for a long time.”
6 What will smart phones look like tomorrow? Nothing dates a movie or TV show like the appearance of a giant, early cellular phone. As technology advanced, handsets became increasingly tiny, before further advances heralded smart devices on which we could perform other tasks. Now, we are seeing a convergence of smartphones and tablets, such as the Samsung Galaxy Note. “We've gone from big to big, but with a lot in between,” notes Shields. “Hybrids are small enough to fit in your pocket, yet big enough to draw, write, use spreadsheets and do a number of things you normally do on your PC.”
7 What do mobile medical devices look like today? Medical devices, once designed with only function in mind, are looking cooler and shinier. We are seeing a convergence between devices and consumer electronics, and the smartphone or tablet is at the center. One examples is AliveCor, a heart monitoring device and app that fits to the back of your phone and takes readings when the user places two fingers on its sensors. Approved by the FDA in April, Shields calls it “a very sophisticated iPhone case.” There is even a convergence between devices and pharmaceuticals. The Proteus Digital Health monitoring system, embeds microchips into pills which, when swallowed, send a signal to a skin patch that transmits the data to your phone.
8 How can location-based mobile become useful in healthcare? Location-based services are at a relatively early stage in development. Initial uses include personal emergency response systems, patient trackers (for wandering Alzheimer's suffers, for example), locators for retail pharmacies and point-of-care, mobility and exercise trackers, and hospital staff and equipment utilization.
9 What are the advantages of cloud computing in healthcare? The cloud is a series of connected servers, providing a supercomputer in the sky. The potential for healthcare is the ability to deliver care anytime, anywhere. It also allows different stakeholders (patient, physician, payer, government) to access, with permission, the same data, and offers the opportunity for immediate and longitudinal insights. Aggregating and mining data is not only useful to physicians, says Shields, “but enables large payers and government to understand population management in a real way and make data-driven decisions.”
10 How can mobile health expand beyond the wealthy nations?
Smartphones are still the domain of the world's wealthiest populations, but in emerging nations, SMS-based programs have provided access to healthcare services and information for patients. Even in the US there have been examples of successful text-based services, such as text4baby, and others at a local level, that require users to own only a basic device. However, even that may be about to change. Google executive chairman Eric Schmidt is among those convinced that the availability of a $50 smartphone is the tipping point for adoption in emerging markets. “It's coming sooner than you think,” says Shields.
Edited highlights from Joe Shields' presentation at “txt 4 pharma—strategies and possibilities in mobile health” (an MM&M Virtual Event) on August 22, 2012. Click here to register and view the full presentation on demand.
The context of healthcare is changing dramatically. According to LifeScan's Joe Shields, Connected Health is the convergence of the following five trends:
• Pay for performance
• Scalable chronic disease management
• Ageing populations
• Global financial crises
• Data transparency
• Data liquidity
• Precision medicine
• Precision care
• Wireless networks
• Cloud computing
• Personal emergency response systems
• Responsible for health
• Access to data
• Paying more out of pocket
• Social networks
• Personal health data
• Smart phones
• Location-aware devices
• Non-traditional players
• Healthcare information technology