What Happens If mHealth Succeeds?

What would happen if mobile health became addictive? This article by Joseph Kvedar, MD of the Center for Connected Health lays out how mobile devices have become addictive, with people checking their mobile phones almost constantly, up to 150 times a day. I have that addiction, too, and it’s something I’m trying to curb. I suppose acknowledging the problem is the first step to correcting it. But what if (and that’s a big "if") mobile health hits its tipping point?

Let’s just accept the "if" for now and not argue about whether or not it will actually happen. Just take the leap of faith with me. I’m curious what that would mean, not whether it will happen. What would it look like if somehow mobile health (or connected health) became addictive, pilot projects went to scale, we solved the major limitations regarding adoption and distribution of mobile health tools, and increasing numbers of consumers were compulsive about mobile health apps and services?

First, a really quick clarification on terms I’m using and often use. "Apps" means mobile apps – native, Web, and hybrid. I really just think of them for Android and iOS, though it doesn’t really matter if you want to add Windows Phone and even BlackBerry to that list. I always feel compelled to add "services" when I think about mobile health because mobile messaging (Push) and SMS, what I think of as non-app mobile, are just as valuable as apps. Apps and services can obviously work together (adding Push or SMS to an app for stickiness), and I’d argue very few apps are addictive enough not to include some messaging component. Services, or messaging, can exist and succeed independent of apps.

Back to considering what would happen "if" mobile health became addictive. To me, mobile and connected health services are simply a proxy for people thinking about (and likely caring about) their health. If people were addicted to mobile health apps and services, presumably they’d be thinking about their health more often and likely realizing that many of the day-to-day decisions they make could be altered.

I also infer another big “if,” that people wouldn’t keep checking into mobile health apps and utilizing services if they were falling embarrassingly short of being healthy or meeting health goals or just doing things that were contradictory to the apps and services they were using. So it would mean that people were actually getting healthier. That’s fantastic! That’s why we’re all in healthcare, right?

And if people are getting healthier through mobile health, presumably the cost of care is going down. It’s getting even better. And if the cost is going down, people are getting healthier, and people are addictive to mobile health services, then it’s not too much of a stretch to think people are happy with mobile health. It sounds like utopia. Certainly it’s something towards which we can aim.

But where would the existing health system — the massive and slow-to-move behemoth with more brick and mortar than most other industries — fit in this mHealth-addicted world? Regardless of the success and adoption of mobile health, you can’t replace the need for physical infrastructure and touch points. I don’t think you can come anywhere close to replacing the 80 percent of doctors that some have suggested, and this is accepting the massive "if" that mobile health becomes addictive like mobile phones have. Then there are all of the very expensive physical resources spent at the end of life, and that’s an entirely different issue that has pretty much nothing to do with mobile health.

The reality is that mobile health can’t prevent traumas (mobile phones increase car traumas, right?) Smartphones, increasingly with add-ons, can do a lot, but they will never deliver immunizations, though messaging campaigns are a great way to increase awareness of vaccines. There are lots of areas of health and healthcare that can’t be resolved or replaced with self-management (anything congenital, things like cancer, complicated pregnancy, some mental health, etc.) And where would individuals without homes or places to go end up on really cold winter nights when they have "chest pain"? That is the whole social component that is so tightly interwoven with healthcare.

The true disruption that would fall out of a mobile health-addicted society would be that individuals would finally see themselves as the owners and stewards of their health. I don’t know if the health system has fully considered what this means. Essentially our existing health system, which has held all the trump cards and authority, wouldn’t hold the same weight. There would be more than one option, there would be choice, and individual consumers and patients would be able to make more informed choices. We’re already seeing some of this with convenient-based care options like retail clinics, with telehealth now available everywhere as an out-of-pocket option, and even to a lesser extent with medical tourism options for cheaper care (not really more convenient, but certainly more exotic locales than Cleveland and Rochester.)

It’s similar to education and online educational tools like Khan Academy. There are many self-powered, online educational options that people are pursuing, which today at least seem to run predominantly parallel to our traditional education system. The challenge they face is integration. How do traditional educational institutions compete or complement self-learning? Those are still largely unanswered questions, but I feel like there is more dialogue about it in education than there is in health, and maybe that’s because the barriers to online learning learning are lower and the demand for it is higher.

Maybe none of this matters practically because it’s a pretty far-fetched picture I’ve painted, and well beyond even a lot of the hype in the industry. But like most things, traditional vs. emerging views of health and healthcare are not binary, they are a spectrum. I think we need to start considering what happens next, and how to we start building a hybrid model and approaches similar to this post/video covering how higher education remains vital in the face of online education. What do you think?


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

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