eHealth Second, mHealth First (Part 1) 2/7/12

For those that don’t recognize the title, it’s a play on a recent post by Mark Suster, a venture capitalist and former entrepreneur x 2. Mark’s premise is that while mobile deployment often makes sense as an initial strategy, it is only one channel, and other channels such as Web and tablet should not be neglected.

The article came out of the fact that Mark had seen many new startups pitching mobile-only. That’s why he reversed the order to Web Second, Mobile First, instead of the other way around.

Mark believes and I agree, especially when it comes to health services, that mobile is only one increasingly important part of what should be an integrated solution — inclusive of mobile, Web, and sometimes tablet. Mark makes good points, none of which directly apply to healthcare, so I thought it might be fun to look at a mobile first strategy when applied to health. I’ll start with consumer-focused strategy today and follow-up with an mHealth first post focused on the provider side next.

Everybody, myself included, tends to make the argument for mHealth based solely on data (usually from Pew Internet) that show increased adoption of mobile phones and maybe increased use of mobile devices to access health-related information. I’ve cited additional data on mobile engagement from Facebook statistics that shows that mobile Facebook users are twice as active as non-mobile Facebook users.

At a high level, this all makes for a good argument. But it misses a lot of the finer points of why mobile really matters and how it fits into a larger health and wellness strategy.

So why does an mHealth First strategy work for consumer-facing services? There are several important factors.

  • Mobile devices are individual. This is more important for health than most other types of services. Health is personal and private, and security is a big concern. Because of the personal nature of the device, providing access to private data over mobile is faster, typically requiring only a pass code. The individual nature of mobile devices also allow them to identify and authenticate individuals for uploaded data, both directly on the device as well as through sensors connected to other biometric monitors.
  • Mobile is location-aware. The obvious example is finding relevant local health services, such as those provided by iTriage and ZocDoc. Over time, I’m sure we’ll begin to see location-aware mobile marketing and coupons for health, such as offering discounts on healthy meals or ingredients or basic health/wellness products. I keep hearing people talk about check-ins for gyms, but I’m not sure if anybody is actually trying this.
  • Devices are limited in screen real estate. I love this hidden "asset" of mobile. As Suster points out, some e-commerce sites are starting to see higher sales from mobile vs. Web, with the presumed reason being that with less choice comes more action. I think this is especially powerful with mHealth, as targeted content can be created for users without their being overwhelmed by pages of content, much of which is not immediately relevant. Mayo probably does the best job with this, but there is still to much on each screen. Just like conversion rates of potential ecommerce customers, mobile has the potential to drive more powerful health decisions/actions as users have less distractions than Web browsers.
  • Mobile occupies leisure time. Health is a leisure activity for the vast majority. It’s harder to motivate people to log in on a Web browser to record something or read something related to health than it is to get them to do it over mobile while they are in the car, eating breakfast, waiting for a bus, or in front of the TV.
  • Devices are always present. An often-cited study found that 91% of people have a mobile device within a meter of themselves 24 hours a day. With health, so many decisions are made on the go. Whether it is dietary, activity-related, or medication adherence, chances are a lot better for a mobile device to be in reach than for a Web browser.
  • Lots of potentially valuable data associated with mobile use. People use mobile devices for so many things that it stands to reason that mobile usage itself is a valuable data set for lifestyle and health. Also, the collection of this data can be 100% passive. is a new company created specifically on this premise. Whether it works and has a viable business model remains to be seen, but it’s certainly an interesting premise.
  • So much health is basic data entry. When it comes to consumers, we’re not talking about entering H&P — we’re talking about discrete data points such as glucose, weight, mood, blood pressure, etc. Most consumer health data points are very easy to enter and I’d argue are easier over mobile than Web.

So once you have mobile, you’re done, right? I think mobile and web have very different strengths, and I agree with Suster that you can harness the power of each to improve the experience of the other. In other words, you need a integrated approach. You can use the two channels, mobile and web, to complement and extend one another.

In the case of health, a Web component for more intensive data entry, categorization, and reporting is a great way to add value to the mobile experience and potentially differentiate a service from the mobile-only competitors. Don’t just take the mobile app and make it a Web app. If you started with Web, don’t just make it mobile. That’s not the point.

Let’s take PatientsLikeMe as an example. The service didn’t use a mobile first approach since that didn’t make sense when it was founded. The strength of PatientsLikeMe for members is in the community to be able to visualize and compare both individual members as well as cohorts of members.

PatientsLikeMe is testing (or maybe it has launched) a mobile-enabled app called InstantMe. InstantMe is not a mobile version of the PatientLikeMe Web site. It’s a simple app for collecting discrete data from users, such as mood. It increases the overall data set by making data entry easier while making the online experience all the more powerful through the analysis and visualization of additional data.

I’m sure there are lots of other reasons why a mobile-first strategy works so well for health. What am I missing? What examples within health don’t make sense as mobile first?

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

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