A few weeks ago I had the privilege of being involved with the Blue Button initiative through a joint Tufts/M.I.T/White House Innovation collaborative effort. About one hundred people descended upon Tufts University’s Harrison Avenue location to spend a weekend debating, discussing and designing solutions for healthcare that meet the goal of the Blue Button Initiative – to engage patients in their health through access to their health data in both human and machine-readable formats.
By the end of the weekend, four technologies with real-world applications emerged above the rest. The ideas were diverse, ranging from wearable technologies to preventative medicine tools. For example, one group pitched a Bluetooth-enabled bracelet (SimplyID) that would connect to an individual patient’s EHR through a clinician’s smartphone or tablet thereby eliminating the potential for error. Another team presented a new concussion assessment tool (HOME Field) that allows for faster on-field diagnosis of sports-related head injuries. We also witnessed the potential for a new cancer patient portal/dashboard (ArmMe) -which could be applied to any disease state- that provides a comprehensive interface for an individual patient’s coordinated care team, family and friends. Finally, a new take on preventive medicine (preventivehealthtools.com) and the challenges in dealing with patients who have multiple comorbidities and complex profiles came through as another of the winning ideas from the weekend.
In principle, the mobile health space can be segmented (broadly speaking) into two rudimentary categories: patient-dependent solutions and clinician-dependent solutions. For those technologies that are patient-dependent I simply mean that they rely upon patient engagement for success and, of course, clinician-dependent mobile health solutions rely critically on the uptake of the clinical community for success.
Looking at the winners from the Blue Button Challenge a few weeks ago, I’d like to illustrate some challenge-solution scenarios that need to be considered for a successful foray into mHealth. Let’s start with the patient-dependent solutions. Firstly, not all patients have access to smartphones and tablets which is an obvious problem. In addition, even many who do own smartphones do not feel comfortable using them in a health-related way. While it is true that smartphone/tablet adoption is growing rapidly, there is an entire world of people in emerging markets, for whom the smartphone is out-of-reach. The implication of this is that it could quite reasonably be decades before mHealth, on a macro level, makes meaningful penetration into the hands of the masses.
Secondly, many mHealth solutions require a degree of patient commitment that very few are able to give. If we were speaking about their behavior as it related to taking medication, we would call this group ‘non-compliant’ or ‘non-adherent’ patients. Similarly, these terms extend to the mHealth space. There are non-compliant patients with their mHealth solutions. They try them for a few weeks or months and are really engaged at the beginning and then their usage drops off. A potential solution to this is to properly incentivize these patients. This might be possible if ArmMe and preventivehealthtools.com (along with other mHealth solution providers) can convince third party payers that a reduction in health insurance premiums is a small price to pay for enhanced coordination of care or enhanced prevention.A third challenge is one of ‘crowding’ as I describe it. Simply put, where there’s a chance for profit, there are crowds. The ramifications for the mHealth space are this: as revenue models become clearer for mHealth solution providers, the landscape which was once dotted with two or three care coordination solutions is now congested with 20 or 30 offerings. The preventive medicine ‘market’ which was dominated by four or five key offerings is now a mishmash of 40 or 50 offerings. The market is fragmented. Fragmentation confuses patients. Confused patients (typically) default to the status quo or what they know best: which is to do nothing. Standing out with a unique proposition and first-mover advantage are obvious solutions to this challenge but, as we have learned with other industry verticals, they are no guarantee of success.
On the clinician-dependent solutions front, it is critical that mHealth solutions geared towards clinicians really be an improvement in delivery/diagnosis of care. Or, if they can’t truly leapfrog the existing options, there must be at minimum an incremental gain in efficiency versus the current ‘standard of care’ in order to gain traction. How to do this? My advice to our four winning teams would be to get their prototypes into the hands of clinicians as quickly as possible to conduct user acceptance testing. These young innovators need to understand where their technology falls down or stands up according to the toughest critics in a clinical setting – only then will they be able to refine their offering to meet the needs of the wider masses.
Clinician-dependent solutions—particularly those that integrate with EHRs- also need to be able to adapt to current patterns of care seamlessly with minimal cost and technological intrusion. To illustrate the importance of this, a recent article in Medical Economics, citing third party research, stated that 70 percent of physicians viewed EHRs as ‘not worth it’ and that 45 percent of them viewed patient care as worse off. In fact, when asked whether they were considering implementing an EHR system within their practice, physicians most commonly responded that cost and system functionality were the two biggest factors. These are sobering statistics but important signals for our four winners and for mHealth solution providers at large: if platforms are too costly and complicated, they’ll never be adopted in the long haul.
The final piece of advice I would deliver to our winning teams for any clinician-dependent solution is to remember the adage that ‘time is money’. Quite simply, this boils down to patient throughput. If our winning teams can deliver improved throughput-seeing more patients in the same amount of time or the same amount of patients in less time- the financial impact will be difficult to ignore. And we’re not just talking about clinicians being able to bill more or bill the same amount for fewer hours of work. Improvements in throughput have a downstream effect across health systems as either resources are freed up to be redeployed elsewhere or more patients are treated with the same bucket of resources.
In the end, the field of mHealth is rapidly evolving. The four Blue Button winners represent a sample of the incredibly creative thinking and the necessary marriage of medicine, engineering and software development that will create truly lasting change for our healthcare system.
Rohit Khanna is the Managing Director of Catalytic Health, a healthcare communications, advertising & strategy agency. He can be reached at: firstname.lastname@example.org
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