Hype and Tipping Points 8/6/12

I was on vacation last week and much more out of touch than planned. I was in northern Door County, WI, a peninsula between Lake Michigan and Green Bay (don’t feel bad if you aren’t familiar with it — I had no clue where it was a year ago). Growing up close to the beach in Florida and having lived in Colorado after that, I wasn’t planning on being terribly impressed with Wisconsin’s summer getaway, but I was, and I find myself wanting to go back. I’ve had my fill of whitefish and cherry-everything for a while, though. I’ve come home feeling refreshed.

Is it just me, or have there been lots of articles and posts the last several weeks debating the hype and reality of mobile health? I think lots of writers and commentators just regurgitate the same material they read, not really adding anything new to the discussion other than maybe a couple of links. This is probably the case with all the mobile health hype stories. I’m not sure who or what to credit with starting the hype discussion.

Maybe I’m not any better since I’m writing about it, but I wanted to weigh in because I disagree with the conclusions I’ve been reading. I’ve also been contacted by investors recently to ask about hype in the mobile health space, so I figured I’d document my thoughts.

To start, there is too much hype in mobile health right now if you take what you read as anything close to reality. Lots of interesting apps and services are being discussed and/or developed but they don’t have much real impact today. I think this overhype is the inevitable outcome from several trends.

First, the government is driving change (or at least driving dollars) into the healthcare system, and this is a very real opportunity to create new services to improve healthcare delivery and healthcare outcomes. Second, creating mobile apps or services is cheaper than ever, especially when developers build isolated solutions. Third, seed funding is readily available. Fourth, technical talent is flocking to healthcare.

So the hype is more about what may be, and not about what is happening today for docs or patients. That’s fine, too, because that’s what hype usually is about. If it was real, it wouldn’t be hype, right? The real questions is whether mobile health will live up to the hype.

Summing up the current view of how that will happen, once we get to a tipping point apps and passive monitors (sensors) will be everywhere, we’ll have more big data than we know what do to with. We’ll change people’s lifestyles (which they’ve had most or all of their lives) with personalized, socialized, gamified, visualized content.

That to me sounds a bit overstated and overhyped. But my bigger concern is what I keep reading will lead to the tipping point for health apps — a patient/consumer spring that will "demand" and "clamor" for mobile health apps. As much as I’d love to see consumers clamoring for apps that make them healthier, I think waiting on them is going to not be well received by investors waiting for a return on their investments. I’m talking health, not wellness and quantified self.

How can we reach this tipping point and bring mobile health solutions to scale? First, I think providers and health systems are essential and need to be the ones demanding health apps, not consumers. For this to happen, I think larger health systems will be the big drivers — Kaiser, Intermountain, Geisinger, Denver Health, VA, Mayo, and a bunch of others I’m less familiar with. These systems have the resources and the grant writers and are thinking beyond Meaningful Use. I think we’ll see them driving adoption and evidence.

As mobile health moves beyond these larger systems, the key to adoption is finding incentives for community docs and practices to use them. The other key to moving out of integrated systems is creating apps that provide a continuity of patient experience across settings so patients don’t need an app for their GI, an app for their cardiologist, an app for their PCP, an app for their lab, and an app for their pharmacy. This continuity of patient experience isn’t unique to mobile. This is going to be a pretty big challenge, but I’m confident we’re going to see some real, viable solutions for this in the near future, though seeing them at scale will take a lot more time.

I’ve come to realize I don’t share the optimism of some of my counterparts and some of the luminaries in mobile health. But  I do see most of the potential. I just disagree on the path and time to that potential.

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

  • Travis, as you know, I couldn’t agree more.  The role of health systems is critical at this point.  This is not a consumer market; until it becomes prescribed by the provider.  Getting to the point that providers have the confidence to prescribe mHealth will take time – measured in years, not months.  By then, health systems will realize that they need mHealth as an engagement tool, in addition to the outcome and cost savings benefits.  When we finally make it to that stage, I believe we will begin to see real signs of a tipping point.  

    Eric Rock
    Intuitive Health

  • I don’t think a true tipping point will come until we see mobile health being talked about and used on a regular basis in schools. Get ’em while they’re young (and we all know kids love tablets) and I think investors will get over their ROI fears. That being said, a more systemic can of worms is opened up – providing equal access to resources within school systems and underserved communities, funding, teacher training, etc. Which brings us full circle back to the “hype” of government. I wonder if private enterprise like payers, or nonprofits might feel like getting involved.

  • Christopher Wasden

    I both agree and disagree with your conclusions.

    On the agree part, there is a lot of hype that is linked to the promise of what could be. Just as we saw similar hype regarding the internet’s potential in the late 1990s and early 2000s. It turned out that the internet became MORE pervasive and transformation than was initially thought but that the hype ended up creating false assumptions regarding all the things it could change (i.e. selling dog food over the internet). Similarly, we will see trial and failure in many areas, but mHealth will be more pervasive and more transformational than most people currently think, but in ways that they don’t yet realize.

    I disagree with the comment that we can’t wait on the consumer and that big healthcare systems will lead the change. While Kaiser has stated that 67% of their patients use their PHR, which is great, there is only one Kaiser and most organizations find it hard to replicate Kaiser in small ways let alone revolutionary ones. Also, using a PHR is a long way from incorporate mHealth in all aspects of healthcare. I have done many domestic and global surveys of physicians willingness to use mHealth and I find, especially in the US, a real resistance to use any disruptive technology that really changes the way medicine is practiced. For this reason, we have seen consumers, not physicians, leading the charge so far, and we will continue to see physician adoption lagging patient adoption just as we have seen the same phenomenon in physician vs consumer adoption of the internet and email.

    One of the striking findings from my global survey of physicians, consumers and payers is that consumers across all countries agree on why they want mHealth and how they want to use it, to drive down costs, improve more convenient access, and take more control of their healthcare. What we find among providers is no real agreement regarding mHealth across countries, and in the US the primary interest is on using mHealth to decrease the provider, not the patients, cost and inconvenience.

    Until the providers start to care about using the technology to become more patientcentric in their services, it will continue to be the consumer that demands mHealth ahead of the provider.

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