Monday, December 9, 2013
By Dawood Khan
mHealth Summit, Washington, D.C.
WASHINGTON, D.C. – In many ways, today was a day of juxtapositions.
While an impressive array of keynote speakers spoke about the incredible future as a result of innovative technologies and solutions, the audience of close to four thousand healthcare practitioners, entrepreneurs, vendors, service providers, regulators, sat patiently listening as the lights flickered at a state-of-the-art facility in Washington DC, experiencing electrical problems as a result of what many would consider a mild storm.
The mobile industry was revolutionized with the inception of the iPhone in 2007 and then Android in 2008 – the possibilities for healthcare from mobile are limitless. There are close to 6.6B mobile connections worldwide today according to the GSMA, and these are expected to exceed the human population shortly. According to the keynote speaker from Qualcomm, the Internet of Things (IOT) will be everywhere – even doorknobs can be made mobile. IOT is expected to generate revenues of $1.5T by 2017. The predictions on the number of connected devices vary between 25B and 50B connected devices by 2020 – admittedly a large window, but a difficult prediction to make.
The healthcare industry spends more than $6.5T globally on an annualized basis. An aging population with a growing need for chronic disease management represents roughly 860M patients worldwide. Some developed countries report spending close to 84% of healthcare spending on chronic disease management. A study for the NHS reported an almost 45% reduction in mortality from chronic diseases when telehealth was adopted.
The revenue predictions of the global mHealth market also vary. According to Transparency Market Research, the global mHealth market is expected to reach $10B in revenues by 2018, up from $1.3B in 2012 – representing a CAGR of 41.5% from 2012 to 2018. Majority of the revenues thus far have been from monitoring services contributing about 63% of the global mHealth market revenue in 2012. According to research2guidance the mHealth app market will reach $26B by 2017, with 50% of mobile users expected to download a health app by then. Today, majority of the apps have been lifestyle focused, with smaller, nimble app developers and innovators avoiding diagnostic apps as a result of regulatory concerns.
Speaking of regulation, the Food and Drug Association (FDA) in the US recently issued its final Mobile Medical Applications Guidance for the industry. This is a first of a kind guidance. The FDA claims that innovation isn’t counter to patient safety, and has identified categories of devices to “focus only on the apps that present a greater risk to patients”. However, defining what “greater risk” is trickier than one would assume. So, a Food and Drug Administration Safety Innovation Act (FDASIA) Workgroup has been set up to provide expert input on issues identified by the FDA, Office of the National Coordinator for Health IT (ONC), and the Federal Communications Commission (FCC) to help develop a risk-based regulatory framework pertaining to health information technology including mobile medical applications. The framework promises to promote innovation, protect patient safety, and avoid regulatory duplication. The folks at HIMMS couldn’t wait for further regulatory guidance and have issued their roadmap version 2.0 for the adoption of mobile and mHealth devices. mHIMMS also launched its 3rd survey of mHealth today. Results of the previous survey indicate interest in consumer focused applications.
The CEA discussed its Wearable Devices Market Study, identifying that there is over a billion dollar industry of wearable fitness devices in the US by 2014, with products from companies such as Jawdrop, Bitfit. 75% of consumers who own devices are in the 18 – 34 years bracket. However, older more affluent shoppers also own fitness devices. Most purchase devices at brick-and-mortar sports stores rather than online – as consumers want to know how they feel. While price is the most compelling driver for selecting a wearable lifestyle device, battery life, form-fit and ability to keep them clean are important decision criteria for consumers.
So, why has mHealth been so slow to take off? Esther Dyson, the Chairman of HICCup likened these early days of mobile in healthcare to be like the late 80’s for Internet, when people thought it was very sleazy to put commercial traffic on the Internet, which was till then purely a research Network. “Mobile in healthcare is like that. But it is charging.” She said.
AOLs founder, Steve Case lamented that it took the Internet almost two decades to reach main stream, and mobile in health will also take time – especially as older and established stakeholders try to maintain status quo.
Major barrier to adoption of mHealth include the resistance by established Vendors and Providers of accepting new, unknown entrants with nascent, sometime unproven innovation. Clinician reimbursement models were also identified as a barrier for the US market.
Trust is a major concern. This can only be overcome through maturation of the mHealth Industry. In terms of mPayments – how many people rip up the cheques after they deposit it? Only a handful, most hold onto it in case the deposit didn’t work well. It will take time for people to start trusting the app. As noted earlier, another challenge is that most firms want to stay out of the critical health care apps and stay in fitness and wellness to avoid being regulated.
Jordan Shlain, an MD and entrepreneur who founded HealthLoop – a startup focused on providing Clinicians the ability to follow-up with their patients digitally, put the situation of mobile in Healthcare well – “will mobile go viral?” he asked, and then responded “…like most things in health – I think it may end up going bacterial instead.”
Perhaps so – but only for the near term. I came to mHealth to see if the Healthcare industry was ready for the change, ready to move at a much faster pace, adopt innovation, and adapt its existing processes and regulation to meet the needs of a much faster moving Mobile Industry converging with a slow moving, established Healthcare Industry in. I am happy to report that I think that while we’re at the very early stages of the phenomenon, the trend is definitely irreversible. Exciting times ahead!
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