Mobile health – a potentially disruptive technology ?

Mobile health or mHealth has recently become one of the fastest growing and potentially disruptive segments of healthcare technology. Some typical mHealth segments include medication reminders, remote patient monitoring and wellness management. Key challenges faced by mHealth include data storage and management, network availability and maintenance, compatibility and interoperability. The single biggest issue however is considered to be security and privacy – in terms of access control, infrastructure integrity and data anonymity.

M&A, drug costs and mHealth shake up US healthcare
In December 2015, consultants PricewaterhouseCoopers (PwC) said that mHealth ranked just behind mergers & acquisitions (M&A) and the escalating costs of prescription drugs as a key factor shaking up US healthcare.
PwC noted that one reason for such an impact was mHealth’s status as a late starter. Smartphones and apps have been relatively underutilized by the healthcare industry, and playing catch-up has catalysed an ultra-fast pace of growth. The consulting firm noted that 71% of US adults now own a web-enabled smartphone or wireless device and users with health or fitness apps doubled from 16% to 32% in 2015 compared to the year before.
Other figures endorse the enthusiasm about mHealth.
93% of US clinicians now believe that mHealth apps can improve patient’s health, according to a GreatCall survey on their rising popularity. This is well above a level of just 52% in 2013, according to a survey cited by US telecoms carrier Qualcomm. That report also noted that another 16% percent also noted ‘that the use of mobile technology will dramatically change the way that healthcare is delivered in the future.’

Europe and mHealth
The picture is more nuanced in other parts of the world.
In Europe, for example, Pew Research figures show smartphone penetration is roughly equal to US levels in northern countries such as Sweden, Denmark and the Netherlands, as well as on the other side, in Spain. The levels are 60-70% in Germany and the UK and 50% in France. These three, together, account for 45% share of the European mHealth market.
There also are some major differences between European countries in the mHealth climate, as another recent report, by Germany’s r2G, shows. As a result, usage of ePrescription varies dramatically, from 0 all the way to 100%. In Europe, regulatory differences can indeed have profound implications for mHealth. For example, ‘remote treatment of patients is prohibited’ in Germany, ‘whereas in Spain telemedicine is encouraged.’
In spite of being Europe’s largest economy, Germany remains a major challenge. According to a report from FTI Consulting, ‘only 28% of German hospitals have a clear strategy’ on digital healthcare. In spite of this, a proposed new law on eHealth ‘does not even mention the opportunities’ provided by mHealth (or personalized medicine). In effect, Europe has some way to go before it approaches mHealth benchmarks in the US, where doctors in several states can ‘bill health insurance companies for the costs of email-based consultations,’ according to a survey by A.T Kearney.

India among most mHealth-ready
Overall, revenues in the global mHealth market are expected to rise annually at a rate of 33.5% between 2015 and 2020, based on forecasts in an Allied Market Research report. Leading the pack will be the Asia-Pacific, with a growth rate estimated by Allied at more than 35%.

India is a special case for several reasons. Although Pew reports penetration of just 17% in the country in 2015, India recently overtook the US to become the second largest market for smartphones, after China (where penetration is much higher, at 58%).
Indeed, the speed of growth in the Indian market has surprised experts. As recently as August 2015, researchers IDC were forecasting that India would surpass the US in smartphone sales, in 2017.
India is in fact considered as one of the most mHealth-ready markets, in spite of a per capita income which is still among the world’s lowest. A survey in 2012 by PwC and the Economist Intelligence Unit (EIU) explained the reasons for the paradox: ‘In developed markets, mHealth is perceived as disrupting the status quo, whereas in emerging countries it is seen as creating a new market, full of opportunities and growth potential…. Consumers are more likely to use mobile devices and mHealth applications, and more payers are willing to cover the cost of mHealth services.’ The report notes that the pace of adoption of mHealth ‘will likely be led by emerging markets that rank highest among ten countries on a score of mHealth maturity.’

Demand driven by both business and consumers
The Indian case in the PwC/EIU survey illustrates one of the salient features for mHealth, everywhere. mHealth technology is both B2B (business-to-business) as well as B2C (business-to-consumer). Indeed, it is consumers who are pulling mHealth, in both developing and industrialized countries. This is probably less for cost than for reasons of access ( anywhere, anytime’ diagnosis, monitoring and treatment). The title of the PwC/EIU report underscores such an observation: ‘Consumers, it says, ‘are ready to adopt mobile health faster than the health industry is prepared to adapt.’

4 million downloads a day
Overall, the near-frenzied enthusiasm for mHealth is illustrated by figures from German consultant R2G. Even in 2014, it says there were over four million downloads of mHealth apps every day.
The number is expected to keep growing. By 2017, it’s predicted that 50% of smartphone users will have downloaded mobile health apps.

Hospitals and mHealth
In spite of the incipient mHealth consumer boom, heavy-hitters in industry are also marshalling their mHealth strategies.
Hospitals and health plans see mHealth as a tool to contain costs and enhance efficiency, and enhance healthcare safety and quality too. A growing number of top hospitals have begun to incorporate mHealth – the use of mobile technology devices and smartphones for healthcare purposes – to connect patients and clinicians, improve care coordination and reduce avoidable, costly hospital readmissions.

In the US, one driving force for mHealth consists of reforms imposing penalties on hospitals for avoidable readmissions. Although hospital readmissions fell from 19% in 2011 to 17.5% in 2013, more can clearly be done. According to Kaiser Health News’, 2,225 hospitals paid 227 million dollars in penalties during 2013 for high hospital readmission rates.
The reforms have provided strong incentives to implement mHealth systems – for example, to track cardiac rhythms, glucose levels and vital signs, and to identify health issues in time so as to prevent repeat trips.
Evidence for this kind of direct benefit from mHealth is provided by the prestigious Mayo Clinic, who report that use of a smartphone app during cardiac rehabilitation can reduce hospital readmissions by a factor of three. Mayo researchers found that only 20 percent of cardiac patients who used the app visited the emergency department or were readmitted to the hospital within 90 days, compared with 60 percent of those who did not use it.

The role of mHealth in increasing efficiency is apparent from Canada’s Ottawa Hospital. The Hospital and IBM have launched a mobile-enabled platform to streamline workflow and create a circle of care’ around patients. Care providers have 24/7 access to patient information, collaboration tools and available hospital resources via a custom mobile app, which has enhanced process efficiency, leading to more accurate discharge scheduling and reducing over-occupancy rates from levels of 110 percent.

European hospitals are also enthused about mHealth. In Britain, the National Health Service is encouraging remote medical monitoring and mobile health access as part of the country’s digital healthcare revolution, according to a report in The Telegraph’. The programme, which focuses on greater efficiency in providing medical services, includes use of wearables, video link consultations, e-prescription and connected clothing. Its objective is to make virtual healthcare ubiquitous within five years and save the NHS up to 5 billion pounds over a decade.

The pharmaceutical industry and mHealth
The pharmaceutical industry, too, has got into mHealth, with hundreds of mobile apps providing information on drugs, drug interactions and enabling patients to track usage. A study by Avella Specialty Pharmacy found apps focusing on HIV medication significantly boosted adherence. Despite this, it has ‘lagged in mHealth app development and adoption,’ due to concerns about liability and the need to follow strict regulatory compliance.
There are three other reasons for the lack of success. Pharma company app portfolios are not globally available. It is also built around their core products, rather than market demand. In addition, there is no cross-referencing, or a common and recognizable design providing a corporate identity.

Profiling mHealth apps
At present, some sources estimate that there are over 100,000 mobile health apps that have been developed. 85% of the apps are for wellness, while the remaining 15% (or 15,000) are directed at medical purposes. Even though a late starter, as many as 42% of mHealth apps available in major stores have a paid business model.

Nevertheless, the bulk of mHealth apps are forced to struggle.
A November 2015 survey of the global market by R2G found that 62% of app vendors attained less than 5,000 downloads per year for their entire mHealth app portfolio. 11% percent reached over 100,000 downloads. Just 2% had 1 million-plus downloads. Of the latter, about half had been in the business before 2010.
R2G said that as many as 60% of developers of mHealth apps were dissatisfied with the market reception for their apps. Many also found that the performance of the apps fell short of their goals.
The survey also reported that over half mHealth app developers were technology companies, and they viewed the presence of medical professionals on their team as a priority. In terms of targeted customers, patients with chronic conditions were most common, accounting for 48% of apps. Hospitals are the second biggest target, with 32% of developers focusing on them.
Another finding of interest was the fact that the most successful vendors were more likely to develop apps for hospitals as opposed to patients. This may be one of the strongest indicators that the mHealth apps industry still has to mature, and that there is much more to come. During the same month as the R2G survey, New York University School of Medicine released another mHealth report. The study found that though consumers frequently downloaded mHealth apps they ‘don’t necessarily use them a lot.’
For consumers at least, there is much more to explore in mHealth.