One App to Rule Them All

I find I use the "One BLANK to rule them all" expression a lot. I love “Lord of the Rings.” I’m waiting impatiently for my kids to be old enough to start reading the books to them. Any suggestions on what age is appropriate for that series? Our kids started watching “Star Wars” at age 4 and the level of obsession with it is very satisfying to me. We’ve also got Narnia and Harry Potter standing by while we work through more appropriate classics like Indian in the Cupboard and Tale of Despereaux.

I’ve been talking to lots of physicians lately about apps for healthcare. The majority of the ideas are mobile, but Web makes sense — at least as another point of access — for most concepts. The apps vary from internal practice-based apps to virtual care apps to some consumer direct wellness apps. I find it fascinating and very positive that I’m having these conversations and that there seems to be a lot of interest.

What’s also interesting is many of the app ideas aren’t terribly original. They are original to the docs that I’m speaking with, but that doesn’t mean similar apps don’t already exist that do the same thing.

An OB friend called me a few weeks ago to tell me how great it would be if she could monitor her laboring patients using her iPhone. I pointed her to AirStrip, but her hospital doesn’t have a contract with them and she’d never heard of it.

The potential conclusions I draw from these discussions are: (a) there is way too much noise to find what you’re looking for with health apps; (b) docs just don’t know what’s happening with health apps or where to start looking, which could be a result of the noise or just because they don’t even know to be looking; and (c) docs put a premium value on their own ideas. That last item is the most intriguing conclusion to me.

Also in the last few weeks I’ve had two related conversations, one with a health system exec and the other with an investor, about doctor-built apps. The response I got in these discussions is that doctor-built apps are a bad idea because they just create more fragmentation, silos, and noise. It’s a logical argument, especially with the current state of health apps. Creating more apps, especially if distributed to the App Store, does create more noise for those searching for apps. Also, building apps that don’t communicate with other systems or apps also creates more data silos.

When I think about doctor-built apps, I come to a different conclusion, and it in part is based on my belief in conclusion (c) above, as well as how and why patients will eventually find and use apps.

Doctors are used to leading. Team-based care is a big part of training and care, but ultimately physicians are used to being in charge — directing care decisions and leading medical teams. There’s nothing wrong with this and it doesn’t run counter to current Pit Crew thinking. It makes sense that docs would think their idea for a diabetes app or a whatever app is better because it’s their idea. This really isn’t a unique quality of physicians — everybody does this.

The main difference is that docs are a huge part of app success. Getting them to buy in, even if that means having lots of different but similar apps, is not really a bad thing. That last sentence reminds me of the expression my wife and I heard countless times when we were backpacking through Southeast Asia: "Same Same, but different" (they even have shirts with this expression on them). From what we gathered, the expression means "similar," but "Same Same, but different" fits better in this situation than just "similar."

I agree there is way to much app noise, but that’s only relevant if people are having to search for apps themselves. If the app has a physician’s name associated with it or the doc distributes links to the apps, it doesn’t matter that the rest of the app store has another 100,000 diabetes apps. People will still find and use the app recommended by the doc. No noise issue. In fact, I think it solves some of the noise issue for patients and docs. Even better, my hypothesis is that docs will be more vested in patients using these apps and incorporating them into standard care.

The other problem with all of these different doctor-driven apps is the data silo problem. This one is hard to solve.

Let’s start with what we have now. Today we already have silos with health apps, so I’m not sure adding more silos is necessarily making things worse. If data is stuck in silos, then it’s stuck in silos, right? It doesn’t matter if it’s 10 silos or 100,000 silos. Fixing 10 silos is probably easier than fixing 100,000 silos, but you still need to fix silos regardless. I’m just not sure adding more silos is bad enough to offset what I think is the gain.

At least we have some emerging patient standards in CCDA and BlueButton Plus. Hopefully more and more apps will support these standards, solving some of the silo problems in the process.

I’ve gotten a few blank stares when I’ve discussed this with people. Do physicians want their own apps and should we encourage them to build them? Is it a net negative or positive?

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

  • kylesamani

    howdy Dr Travis

    I’m sure you’ve heard of happtique, but I’m willing to bet most MDs haven’t. http://www.happtique.com/

    I really believe and support happtique because of everything you said above. Apple and Google will never provide good tools to filter through the noise.

    I also think it’s interesting to look at the other end of the specturm: hospitals and health systems building proprietary apps for themselves. John Halamka just wrote about the subject here.

    http://geekdoctor.blogspot.com/2013/04/optimizing-electronic-medication.html

    We should encourage more physicians to get into app building. Although most of them will be more noise, it will create greater engagement and belief in the power of apps in healthcare. I believe happtique will be one of the transformational stories in healthcare in 10 years, and anything we can do to get more doctors on board with the concept of “prescribing apps”, the better

  • Love the “silos is silos” thought, Travis. Connecting them – 10 or 10M – remains unsolved, but that’s not a great argument against free market innovation for these little mini-silos. If we can’t be well-connected in the near-term, what? We should stop all innovation until that indeterminate time we are?

    Your “if the doc [or hospitals/ACOs/health maintenance orgs] distributes links to the app” it reduces noise for end users makes a valid point. Most people still prefer and have more trust in health information their provider recommends; there’s still a lot of trust between care givers and receivers. I suspect apps may be similarly perceived if so recommended.

  • Frank C.

    Regarding LOTR – It’s been a long time, but I recall reading these books to my daughter (beginning with “The Hobbit”) starting when she was 6 or 7 years old. I don’t know how much she got out of them at that age but it was a tremendous bonding experience. I may be off by a year or two because that was 25+ years ago.

  • Travis Good

    Hi Kyle! I know Happtique very well (I think I was its first radio show guest in 2011) and yes, I don’t think most docs know about it. The interesting thing will be seeing how Happtique gets buy-in from systems and potentially associations, and I think AMSA and several of the systems they are working with are a good start.

  • Travis Good

    Thanks Frank!

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