Connected Health Target Areas

Connected and mobile health is wonderful! It’s exciting! It has tons of potential to fundamentally change the way we interact as patients and providers, expand our knowledge of science and the human body, break down boundaries to accessing care (even specialty care) when and where it is needed, reduce the cost of care (for individuals and the system), and give patients powerful tools in their pockets to help them make healthier, tailored, and impactful decisions. And the hardware (sensors, phones, tablets) and software (apps, messaging services, analytics) are only getting better.

But connected health is lagging in several key areas. If 2013 is going to be the tipping point for the industry, we better get moving on some of these because it’s just about April already. Also, I think the areas below broadly apply to the buckets of technology and/or business challenges.

Efficacious. It’s not that mobile health apps don’t work, it’s that we need more data or more availability of data. I’m not talking about randomized controlled trials, just more data on the effectiveness of mobile health apps. I’m betting most app developers could generate these reports on how effective their apps are, but maybe this sort of tailored clinical analytics, based on specific parameters and references ranges, should be built into apps from the start.

Interoperable. Health apps should ideally work together seamlessly so people don’t have to have multiple health profiles, but this is a big challenge and a problem lots of people are trying to solve. I tend to think most approaches are missing the mark by just providing access to data, but they are new and will be evolving quickly. Platforms are trying to integrate third-party data. CarePass seems to be getting the most press, but there are lots of others like Optum and Caradigm. It’s going to take more time to see how these all tie together and get implemented.

Secure. I’m not a compliance officer, but I think health apps need to clearly spell out and enforce security and privacy settings. This is essential if apps are going to be endorsed (I avoided the word "prescribed") by health systems or providers. Security in healthcare is a hot button issue that gets certain people all riled up, so it’s something that can roadblock a health app developer if they aren’t ready to address it.

Integrated. This ties from a technical perspective to both of the topics above — interoperability and security — but there are also business challenges with integration. While some forward-thinking organizations like Kaiser are starting to explore integrating activity data as a part of the more formal medical record, this is really in its infancy. Integrating exercise, activity, or diet — or any data collected or reported by the patient — is a great start, but you need to give some meaning to the data to make it useful. Clinicians, and patients to a large extent, know how to interpret a blood pressure reading, but I’m not sure they’d know what to do with a step count or Fuelpoints. That’s where analytics come in and give meaning to all this self-reported and self-collected data. It also relates to clinical workflow.

Scale. This isn’t really a challenge so much as the status of the industry. It also builds on the areas above, so I guess this list does build and scale was what I was driving at the whole time. We talk about the reasons why mobile health hasn’t gone to scale. It always falls into reimbursement issues and fitting mobile health into clinical workflows. These reasons assume we’re reliant on clinicians (to be paid and have a place for mobile health in their practices) to get mobile health to scale. This isn’t true with the quantified self apps. Scale is really caused by the problem of lack of integration.

If reimbursement and workflow are the challenges, we should not lose sight of the settings where these are more easily fixed. In particular, I’m thinking about concierge and payers. Scaling in concierge medicine is not exactly real scale, but payers are certainly scale. Scaling, while related to technology, is more of a business issue than anything else.

You may disagree that mobile health is lagging in these areas or think other challenges are more pressing. I’d love to learn what you think those are, either from a technology or business perspective.

A note on syntax. I tend to bounce back and forth between using the words "patient" and "consumer." Talking to my wife and other clinicians, it’s always "patient," but reading health IT news and blogs, it’s almost always "consumer". I think both are accurate but both carry connotative baggage for different sides. I tend to go with "patient" more frequently, especially when it’s an individual reference, and "consumer" when it’s an aggregate reference. Ultimately I mean the same thing. What do you prefer?

One final thing. I’m looking for health app developers and feedback and insights about health app development. If you’re interested in talking to me about your experience building health apps, please e-mail me.

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Shannon Werb

    Hi Travis, great post. Curious, how will al, the mobile data be managed in your opinion? Will it be structured like the EMR or unstructured like the related clinical content requiring data management, integration and context?

    Interested in your thoughts?

  • travisjgood

    Great question Shannon! I had this exact discussion with somebody just the other day. My big fear is that the rise of the vendor controlled mobile health platforms (CarePass, Qualcomm, Optum, Caradigm, Runkeeper, etc) will result in a new round of siloed data sets. This may not be the case if it’s recognized early and the vendors work together (wishful thinking), trying to compete and survive on value of apps and services and not integration revenues. I’d say I’m cautiously optimistic at this point.

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