I’ve been researching mobile technology use and strategy for pharmaceutical companies. I find the whole drug discovery, distribution, and marketing industry to be fascinating because of the sheer size and tightrope walking that needs to be done around regulation and brand marketing to consumers.
I also think pharma has a lot to overcome when it comes to perceptions, especially with the younger generation of providers that has been taught that drug companies are the evil empire. I don’t think any issues are that black and white, but it is certainly the perception that most of my friends and I gained from medical school.
I met a couple of people from Merck recently at a conference. When the subject of pharma’s rep in medical training came up, both told me that Merck has always had a commitment to medical education, dating back to the original Merck Manual from the 1800s. It was funny because I obviously knew the Merck Manual, but hadn’t even made the association that it could be the mega-drug company. I was told by the Merck folks that the Manual is kept separate from the rest of Merck so as not to tarnish its image.
Whether you like it or not, pharma is a major player in healthcare. Like payers, pharma has a lot to gain through technology-enabled services and also has some resources to invest in the area. What I’ve found is that pharma seems to dabbling in different types of mobile health services, but no major successes or standards exist. The big areas of mobile that seem to fit best with pharma are clinical trials, adherence, and education on the consumer side and med reference and access on the provider side.
In terms of consumers, clinical trials are a big area where mobile can be utilized. Mobile enables pharma to do better recruitment and pre-screening, reducing the cost and burden of CROs. Once a patients is enrolled, mobile also enables collection of mobile patient reported outcomes (mPRO) and better connectivity to study coordinators, ideally leading to higher engagement levels and higher retention rates.
A good example of the potential of mobile in clinical trials was the recently initiated Participatory Patient-Centered (PPC) trial in which Pfizer leveraged Exco InTouch as a mobile platform to recruit, enroll, and retain study subjects, regardless of location and without dedicated clinical sites. With clinical trials recruitment, especially of minority participants, so expensive and time consuming, leveraging mobile to breakdown geographic boundaries while maintaining virtual connectivity is something we should be seeing a lot more of in the future.
Medication adherence is another area with lots of different people are going after it. In addition to the reduced cost associated with better adherence rates, pharma companies have a lot to gain from increased utilization (more frequent refills) associated with higher adherence rates. From connected devices like Vitality’s Glowcaps and MedMinder’s Maya (connected pillbox) to ingestion monitors like Proteus Helios, companies and investors are betting big on automated monitoring of medication adherence.
I think some of these (like Proteus) are probably a bit much, but I’d love to see something like a Striiv for medication adherence — something that combines automated collection of adherence data (like GlowCaps) with an always-on indicator of adherence status. I’m not sure if it will work for adherence, as I think the cause of adherence is multi-factorial, but I’d love to see somebody try.
On the provider side for pharma, there are the obvious apps that can act as dynamic and focused product inserts and dosing guides. I think to make this higher value for providers, it would be great to add in some functionality around samples and access programs. Maybe providers could be able to automatically order more samples of medications, providing pharma with good insights on sample use while also helping providers have enough samples on hand for those patients that need them.
Additionally, helping providers with the process of enrolling, or initiating enrollment, in patient access programs benefits both the provider and the patient while helping to meet the mission of access programs to deliver medications to those that need them, but otherwise might not have the means to acquire them.
As I’m writing this, I’m realizing lots of these services, which have obvious financial and image benefits for pharma, really do have significant benefit to both providers and patients, not to mention retail pharmacies and connected family members. It even makes me wonder if pharma couldn’t extend some of these services, if done correctly, to be more than complementary to existing products.
Could pharma start earning real revenue as a technology and mobile services provider? I’ve heard people at both insurance companies and pharma companies say their companies want to become technology companies. For pharma companies, I can’t really buy it. What do you think?
If you’re interested the potential of mobile from the pharmaceutical industry perspective, sign up for a free webinar I’m co-presenting next week with Aaron Kaufman, general manager for Kony Healthcare and Life Sciences.
Apple releases incredible quarterly sales numbers. Putting itself in the normally exclusive domain of oil companies, Apple made $13 billion in profit on $46 billion in revenue last quarter. The math comes out to 378,000 iPhones and 157,000 iPads sold every day, respectively. Apparently Apple is now worth more than Greece.
Wireless glucose monitor company Telcare signs a partnership agreement with health plan management company MagnaCare. It’s not totally clear in the release, but I’m guessing that MagnaCare will offer this as an additional service to its clients, taking a piece of the transaction. What was interesting was the quote from MagnaCare that talked about the how Telcare’s product enables patients to connect with loved ones, not providers. In many ways, it’s a better group to lean on than providers, especially in the short term.
Fitbit, which announced a partnership with UnitedHealth last week and unveiled its new wireless scale at CES, closes a Series C funding round worth $12 million. I imagine with this funding, Fitbit will be looking to scale sales both direct to consumers as well as through partnerships like the one with United. I’d also expect to see more testing of Fitbit as a part of an employer wellness program. I think we’ll also see a lot more gamification of the activity tracking that Fitbit does, which would tie well to partnerships with both payers and employers.
Kaiser releases an Android app and mobile-optimized site for patients. The app and site provide access to medical records, messages, location listings, test results, and appointment scheduling. It looks a lot like a mobile version of the web portal, which I guess it is, but it makes me wonder why it took so long to build for mobile. I would have used it when I was a Kaiser member. Now I can’t even get my crappy insurer to send my paper cards to the right address. I guess I’m insured, so I shouldn’t complain.
A new Pew Internet survey finds that tablet ownership in the US doubled from 10% to 19% from mid-December to mid-January. That trend definitely contributed to Apple’s monster numbers.
With Quantified Self and self-monitoring predicted to be a big trend in 2012, this is an interview with a guy struggling to get access to his heart rhythm data recorded by his implanted defibrillator. It brings up some interesting issues he encountered. It also ties nicely to the push to provide consumers access to all of their medical data. Personally, I say give patients the data they want — just don’t expect it to fix our health and lifestyle problems.
Sharecare announces it has raised $14 million and acquired physician directory The Little Blue Book. (TLBB). Sharecare is similar to HealthTap, which recently raised $11.5 million, in that it is a platform where healthcare consumers can go to ask questions of physicians. With the acquisition on TLBB, Sharecare will be trying to be the place consumers come not only to ask questions but also to find providers. It’s taking an interesting approach as it is planning a premium subscription model for providers, but will also be making money from real-time analytics sold to drug companies and other brands in health an wellness. Sharecare was co-founded by Dr. Oz of TV fame.
AT&T adds two new offerings that it hopes will help with mobile adoption in healthcare. The first, AT&T Managed Tablets, is a device management offering that apparently works on both enterprise-owned devices as well as employee-owned personal devices. The second, AT&T Global Smart Messaging Suite for Healthcare, is a partnership with Soprano that enables encrypted messaging from providers to patients, as long as both have the app from AT&T. The app apparently works on any smart phone on any network. It would be nice if it worked on non-smart phones.
This post is very Quantified Self (I’m not sure why I started capitalizing that) heavy, so I’m sorry, but here’s one more. The video above is for the new Nike+ FuelBand. It’s a wristband, much like the Jawbone UP, that tracks daily activities. Each activity is assigned a point value. The points are called NikeFuel and you have daily goals. The wristband’s lighted scale shows daily progress towards your goal and tells you things like steps taken and calories burned. It also syncs with iPhone and iPad apps (no Android until spring.)Retailing at $150 won’t help with competition priced at $99, but Nike does have a great fitness brand.
A new corporate survey (non-healthcare specific) finds that iOS devices are the most common platform connected to "corporate environments." 30% of devices were iOS, followed by BlackBerry and then Android. Android was considered by IT professionals to be the least-secure platform. I’m curious about specific data from hospitals and healthcare organizations.
A new study of women aged 50 years or older finds that fewer of them accessed health information posted online than reviewed identical print health information. The content was related to colon cancer and screening recommendations. I think the main conclusion to be drawn is that taking paper material and digitizing it into non-interactive material does not get you very far when it comes to health education and prevention.
An American Medical News story says payers are moving into the mobile health space to offer more health-related tools, not just mobile member cards. The examples given are Aetna (iTriage), UntitedHealth (CareSpeak, Fitbit, Lose it!), and WellPoint (Verizon).
I’m an iPhone user. I like it a lot, although I don’t line up at stores for new product releases and I don’t like to spend time in the stores unless I’m with my kids.
With that out of the way, one of the new features in iOS 5 that I was particular excited about last fall was the new Notification Center. I was surprised it took so long to make the lock screen useful and to put a little user control in the way that notifications (e-mails, SMS, etc.) are displayed.
I like having notifications appear briefly at the top of my screen without requiring any user action. I also like the ability to adjust notification settings on an app-by-app basis. I still love the Notification Center after several months of use, at least compared to life prior to it. But I’ve recently discovered inconsistencies with some of my apps and notifications.
I actually only have a few apps that show up in my lock screen or pop up a notification when a new message or alert is triggered. Several (mail, calendar, and SMS) are Apple apps and seem to work fine. Others (for social stuff, productivity, or tasks) are non-Apple and have started to not work as set.
One app (Path), which I wrote about recently and love, does not work at all for notifications any more. I’ve turned notifications on and off, changed them around, uninstalled and reinstalled the app, and made sure I’m on the most recent version of iOS. Nothing seems to fix the problem.
(Before anybody suggests that this is user error, which I’m sure it could be, let me say that it doesn’t really matter. My point is that if I can’t fix it, then it is either flawed in deliver of notifications or in the experience of setting notifications. Either is a problem.)
This specific case with Path is not exactly life or death. it’s actually probably a positive for me because it’s not distracting. It did get me thinking of apps that are life and death, or at least billed as tools to help people manage their health. I’m thinking of things like medication reminders, ovulation calendars (life or death for some), appointment reminders, or any other health reminders.
A reminder app or a reminder service should never be counted on 100%, but in reality, once people start using things like this, they become reliant on them. Once the apps stop working and people start missing appointments or doses or ovulation windows, there is a problem.
This isn’t unique to the iOS notification center. The same problem could happen on Android or one of the 14 BlackBerry phones still in use today or even with iMessage (iMessage has it’s own problems) or SMS-based notifications, though I imagine to a much smaller degree with SMS. It’s a problem with being reliant on any platform or wireless network when it comes to health.
If an FDA-approved diabetes app or connected glucometer takes glucose readings, uploads them, analyzes them, and then sends back an insulin or dietary recommendation that never arrives, whose fault is it? The platform, the app, the carrier, the provider that recommended it?
As I was thinking about this, it reminded me of an interview I read with MedApps CEO Kent Dicks several years back, in which he said MedApps had decided to develop a dedicated connected health device after trying to develop tools for mobile phone because "using a mobile phone platform helped us realize that we didn’t want to be at the whim of mobile phone makers." A platform maker can at any time change the way that notifications work as Apple did, how Bluetooth functions, or whatever a health app might depend on.
This issue — dedicated device vs. app — is a broader post. I’ll be reaching out to MedApps and a couple of other vendors with questions about dedicated devices vs. apps. For now, I’m curious if readers — especially providers or health systems looking at apps and services for patients — think about being dependent on platform and carrier performance for health issues?
There were some great comments on the In-Car Health post from earlier this week.
From Heidi Pape Laird: "I could see interactive voice commands and responses where you ask for calming music, or a seated exercise suggestion or a meditation, but nothing too stressful, exciting or distracting."
From Chris Wasden: "I think the key is passive monitoring….The seat can weigh me, the steering wheel can gather some information such as pulse, temperature, chemical info. I think that there is something here, but not sure the business model."
From David Lester: "While I agree that this may appear to be overkill at present, I think it is important to begin to explore these different opportunities. The value of this will be realized when all of these recorded activities come together. Hopefully it will be an integrated solution based on the best available components."
I can see the value of the car as a place for monitoring, as long as it’s passive and non-intrusive, and especially if it is integrated with other data about the patient. I think that last point, about integration, will be the biggest challenge. We’ll have to see who can start pulling some of these disparate services together. I know we’ll see carriers like Verizon or Qualcomm fighting to do it, but there are also platform companies like Microsoft and HealthVault or an underdog like RunKeeper. In the back of my mind, I have a nagging feeling it’s going to be the payers that pull it off.
I appreciate Chris Wasden’s response to my post about FDA regulation: "I met with senior leadership of the FDA last week on this topic and was quite impressed by their attitude and approach. They will be providing some guidance in the future that makes things more clear, but in general their view is that they want to only regulate a small subset of the mhealth world. We got on the topic of algorithms and intelligence in apps and they said if all you are doing is making electronic a paper based system or tool that has already been vetted over time, then they don’t need to regulate that. If you are providing fairly low levels of intelligence in the app, that won’t require their review either." I’m hoping I can find the same people at the FDA to give me a pass for my app. Thanks, Chris.
It’s been an off couple of weeks for news with the holidays and the silence before CES. But with CES done, we are seeing a lot of announcements from vendors, mostly fitness related, but still interesting.
UnitedHealth announces partnerships with mobile health companies CareSpeak, Lose It!, and Fitbit. CareSpeak offers a health-specific, two-way SMS platform for patient communication and engagement. Lose It! is a nutritional app that helps user track intake and work towards weight goals. I used Lose It! a couple of years ago and had great results. I burned out after a couple months, but my snack intake has remained low despite not using the app anymore. Fitbit offers the snazzy pedometer for activity and sleep monitoring, associated mobile app for tracking nutrition, and most recently a connected scale. I consider this to be a pretty big deal for mobile health companies as long as it is more than just a PR play. I want to see how United rolls these out to members and if/how they tie them together and incentivize members, hopefully with financial savings.
ZocDoc made some superstar additions to its Advisory Board. Joining: former Senators Bill Frist, a Harvard-trained cardiac surgeon of HCA and end-of-life/Terry Schiavo fame, and Tom Daschle. ZocDoc continues to extend its impressive list of dignitaries. The story also states that ZocDoc is used by 800,000 people each month, but my bet is that this is probably total searches and not booked appointments. The number was 700,000 about 4-5 months ago, so I’m not sure if this is a good trend considering the amount of money and press ZocDoc is getting. The number of open slots available on the system has gone from 500,000 to 550,000.
Independa announces a partnership with LG to incorporate Independa’s Angela platform into LG TVs in long term care facilities. In a move to extend its reach as an elder care player, the new offering by Independa will enable those in long term care facilities to communicate with loved ones and caregivers, enter health-related information, and use Facebook or the web, all on a platform designed for the non-tech savvy senior and with all data incorporated into Independa’s CloudCare platform. The idea seems great to connect isolated seniors, as long as long term care facilities have LG Pro:Centric-enabled devices. I’ve heard of other companies working on similar smart TV integration for health services. One other thing, can we please make 2012 the year that people stop calling everything "game-changing?"
iHealth Lab announces its iHealth Smart Glucometer. It connects to the dock of Apple mobile devices and automatically sends readings to iHealth’s portal. The device is still awaiting FDA approval. The press release says the system uses industry standard test strips, but it would be sort of crazy to make a glucometer and not make money by selling your own test strips.
Fitbit, the maker of the popular connected pedometer, introduces its Aria Wi-Fi Smart Scale. The scale, much like the Withings scale, tracks your weight, but instead of sharing it with third parties, it sends it up to the Fitbit portal, where users can now automatically track activity, sleep, and weight. The scale can recognize up to eight people, so it can be enjoyed by the whole family. Fitbit is becoming quite the force in the quantified self movement.
Not to be outdone, Withings announces its Smart Baby Scale. The scale does just what you’d expect — weighs your child and automatically shares the results with Facebook friends or remains private through the Withings smart phone app. I think parents are supposed to buy this to help them track their child’s weight and automatically plot it on a growth chart. I’m really struggling with this one. It seems incredibly dumb and a waste of money but maybe there are enough high-strung parents out there to sell a few of these. Who owns a regular baby scale, anyway? I’m much more excited about the Withings Smart Baby Monitor, but haven’t seen any news about that. By the way, the video above is priceless, as the guy demoing the scale manhandles the doll and then the app malfunctions and he says "it’s quite slow" and "it froze."
A new retrospective study in the Archives of Dermatologyfinds that live teledermatology consultations resulted in clinical improvement almost 70% of the time. I don’t have access to the full text, but based on the abstract, it looks like the telederm outcomes were only compared to the the outcomes without telederm, or from treatment by the referring physician. Am I missing something, or is this just to put some data behind the claim that telederm works as a viable treatment option?
I found this story on recent smart phone sales interesting. It’s pretty impressive how Apple is trending up and closing the gap on Android, with the biggest loser being RIM’s BlackBerry. According to the report, iPhones accounted for 37% of smart phone sales over the last three months.
Despite the chart above — which shows the poor performance of Windows Phone — this story highlights reasons to not write off Microsoft as a mobile platform vendor. The reasons: ease of app development, UI, global reach, and hardware. I think Microsoft is beaten like Apple was beaten in the mid-1990s and it’s going to take a very impressive turnaround to claim mobile territory. Maybe it can leverage its global reach with Nokia to win in emerging markets, but I think real growth in the US is not going to happen.
Healthcare mobile app store Happtique announces that it will be creating a certification program for mobile health apps for providers and patients. Developers will pay to submit apps to be certified. It is estimated that it will take six months to develop the certification program. This is an inevitable course for Happtique. What I’m most curious about is how transparent the certification criteria and process will be.
RunKeeper’s CEO talks about the head start his company has to be the platform for integration of personal health data. I personally think RunKeeper should focus on fitness, but since it just raised a large amount of capital, this is a guaranteed extension. The problem is that the two markets, fitness and health, are vastly different in terms of user motivations, effort to acquire users, and customer channels.
Physicians Interactive Holdings (PIH), a division of Skyscape, raises $17 million from Merck’s Global Health Innovation Fund. PIH provides tools, many of them mobile, for physician education and reference. PIH also recently announced a mobile health advertising platform for vendors of mobile apps. It’s an interesting investment to me. I realize Skyscape generates revenue from pharma and so do many others, but now pharma owns part of the company that develops products to help clinicians with treatment decisions at the point of care. This seems like a huge conflict of interest. If medical schools are going to ban pharma companies from academic medical centers — something that’s been a trend in academic medicine that has severely limited lunch options on medical campuses –then medical schools should stop licensing products for faculty, residents, and students that are developed or owned by pharma.
The Lancet, which is the UK rival of JAMA and NEJM, releases an iPad app to provide subscribers access to articles on the go. It allows readers to annotate and share articles. This is an awesome way to stay current if you’re a Lancet subscriber.
Congrats to HIStalk Mobile sponsor Kony for being selected mobile platform vendor for Independence Blue Cross (IBC) of Pennsylvania. Kony has had a lot of success in the payer space and I think we’ll likely see more announcements like this in the coming months.
Nuance announces the 2012 Mobile Clinician Voice Challenge. Nuance is looking for mobile and web developers to integrate speech into their apps. The winners get good press and free licenses for Nuance’s speech platform for 12 months.
This story claims the Telcare connected glucose monitor, which is a dedicated glucometer device with a wireless card in it, is going to officially launch this week. I was told by Telcare at the mHealth Summit that the device would be comparable in price to other glucometers, but users would have to buy Telcare test strips. Also in the news, Telcare reached the semifinals of the CES Last Gadget Standing Competition.
This was an interesting study assessing ICU nurse perceptions of tele-ICU. The most important findings were that 79% of nurses thought knowing the telemed physician was important and that 61% were more likely to contact the telemed physician if they knew them personally. That bias seems like it could impact care.
Harvard Business Review has an good story on why patients aren’t typical consumers. It comes down to what consumers/patients are able to process and what decisions we should expect of them, regardless of the amount of "big data" available to them. The example of a good application from the story is one from Mayo that helps maximize the value of a meeting between patient and provider. I think we’ll see more of this type of application in 2012.
Despite having a smaller market share of the total smart phone market in the US compared to Android, iPhones accounts for 25% of mobile web traffic while Android only accounts for ~15%. This intuitively makes sense, as the average iPhone user is a heavier mobile data user than the average Android user. The iPad, interestingly, has about the same amount of mobile traffic as the iPhone.
This is a story on passive monitoring and specifically Ginger.io, the Android-based service that monitors mobile phone use and activity to identify trends and habits. Ginger is conducting its first trial with Cincinnati Children’s and teens suffering from inflammatory bowel syndrome.
This amusing story was written by a medical student about startups selling products to physicians. I think all of the points are valid.
The above infographic depicts the similarities and differences between iOS and Android. It’s not a bad basic, high-level synopsis. The best is the quote at the end from Symantec: "Even though iOS and Android both have their weaknesses, the mobile platforms are still more secure than their PC counterparts." The real problem stems from the fact that more people are trying to bring their own Android or iOS devices to work than their own PCs.
During a keynote last week at the Digital Health Summit (part of CES in Las Vegas) Ford, Microsoft, Healthrageous, and BlueMetal Architects announced a new partnership to research digital health and wellness integration into Ford cars. The idea here is that connected health tools are supposed to interact with consumers and consumers are spending an increasing amount of time in their cars. That plus the personal nature of the car setting theoretically makes it a good place to conduct health services. So why not marry connected health tools and connected car technology?
Specifically, data will be collected from drivers, transmitted using BlueMetal and Ford SYNC technology to Microsoft HealthVault, then to Windows Azure, where Healthrageous will analyze the data and provide the user with personalized health advice before he or she gets out of the car. This is very early stage and part of a research effort. Also of note is that Ford has announced a similar partnership with WellDoc and Medtronic.
I’ve written before about how I don’t understand in-car health systems like this, but I’m floored that Ford keeps announcing partnerships with big name connected health companies to test these services out. Is this just about PR, or do any of these companies think that this stands a chance of being used? I’m going with PR. At least I hope so for the health companies.
Maybe I don’t get this because I don’t drive very much. I try to use public transport or bike or work from home as much as possible, so I don’t have a regular commute. But when I get in the car, I just want to have a few minutes to relax and listen to music or maybe a podcast. If I had RunKeeper asking me how many cups of water I drank today or what my blood pressure is, I think I’d burn out pretty quickly. If we’re looking to engage and motivate patients, I think we need to be careful to not follow them around everywhere they go, like Big Brother issuing health and wellness advice. Passive monitoring is great, but don’t remind people that you’re doing it everywhere they go.
If this wasn’t Healthrageous and maybe somebody like Fitbit being tested, I might see it making some sense. The Quantified Self people like to be monitored and would probably love to have a dialogue about themselves while in the car. For people with diabetes or other chronic, lifestyle-related conditions, this is just overkill.
If Ford was looking for a health-related service to integrate, the one that makes the most sense is ZocDoc. Since the in-car technology (Ford SYNC) is voice activated, why not enable a person to tell you the search criteria for a doctor, read them some options, and then enable them to book? Then e-mail or text them the info about the appointment before they get out of the car. That makes more sense to me. Or maybe enable instant access to nurse call services or even telepsych services like the new iCouch, so a driver can have somebody talk them down while they’re losing their patience in traffic.
What do you think? Do commuters out there see this being a valuable in-car service?
