Diagnosis: mHealth

mhealth stethoscope smartphone
Like QR codes, Augmented Reality and beacons before them, the popularity of wearables seems to have plateaued in recent years. Devices that were once hailed as the future of mobile are now seen as a niche channel at best, and a luxury boondoggle at worst. However, the movement towards the quantified self that fitness trackers and smartwatches spurred has taken root elsewhere, in the professional healthcare market – and it doesn’t seem to be going anywhere.

In many ways, wearable technology emerged from the work of healthcare technology manufacturers. The sensors that sit in Apple Watches and Fitbits were built on decades of work by medical device designers seeking more accurate and discreet ways of measuring metrics like heartrate, blood pressure and physical activity levels. The ‘quantified self’ movement emerged from these kinds of technologies finally becoming available to consumers.

The meeting of medical and mobile has resulted in a new generation of these devices. The growth of the Internet of Things means that sensors can automate the process of information gathering, and connect to a wider network of machines, providing healthcare professionals with real-time access to huge amounts of data, informing their practice on both an individual and grand scale.

A healthy outlook
The latest estimates suggest that the global mHealth market will reach $102.4bn by 2022, up from $11.5bn in 2014, with a compound annual growth rate of almost 33 per cent. The mHealth market encompasses everything from connected blood pressure monitors – the largest segment, accounting for over 20 per cent of all revenue generated in 2014 – to sleep monitors, neurological sensors and pulse oximeters.

It bridges areas from wellness and prevention through to post-op monitoring and therapeutics, via diagnosis, treatment, and more. Cardiovascular, neurological and respitatory monitoring all account for key condition areas where mHealth is employed. Between the need for regular monitoring and a global rise in instances of the disease, though, the single leading condition when it comes to mHealth investment and revenues is diabetes.

Patient coverage is also rising rapidly. The number of remotely monitored patients grew by 51 per cent in 2015, to 4.9m. Reports suggest that growth will remain steady around that mark for the rest of the decade, reaching around 36m by 2020, as mHealth coverage is expanded to wider audiences and new markets. The global growth of 4G data and the impending introduction of 5G have helped to support this expansion, enabling richer data to be shared over mobile networks.

In fact, mobile operators are becoming more involved in mHealth every day, and are some of the major investors in the infrastructure required to make such services available at scale. According to GSMA figures, over 1,000 mobile operators globally are involved in mHealth, with more than 300 mHealth products and services actually led by mobile operators. The mHealth market helps operators to move away from a sole reliance on data and voice, diversifying revenue streams while also leveraging existing capabilities like mobile payments, hosting and cloud services.

“Cellular continues to be the only technology that can be used to reliably connect every patient with their healthcare providers,” says Lars Kurkinen, telecom analyst at Berg Insight. “These are very exciting times for everyone involved in the industry. mHealth solutions are approaching mainstream market acceptance and we are now very close to the tipping point. Changes in the payment landscape is without doubt the most important factor. This finally allows the incentives for payers, providers, patients and physicians to be aligned, which is absolutely crucial for the adoption of any new healthcare product.”

mHealth medicine tablets capsules pills
mHealth sans frontières

This investment is especially impactful in rural areas and developing economies, where access to healthcare providers has traditionally been irregular and difficult to achieve. mHealth data collection enables healthcare stakeholders to monitor patients remotely and even provide diagnoses, treatment and advice remotely via devices that patients carry with them at all times.

In fact, awareness of mHealth is greater in emerging markets, with 61 per cent of patients familiar with the terms ‘mobile health’ or ‘mHealth’, compared to 39 per cent in developed markets. Patients in these markets also have higher expectations. They are more likely to predict that within the next three years, mHealth will change how they seek and receive information, how they manage their overall health and how they deal with monitoring medication and chronic conditions. Perhaps most crucially, patients there are already adopting the technology at scale, with 59 per cent using at least one mHealth application or service, compared to 35 per cent in developed nations.

“We see it on the ground in countries we work with,” said Eric Dishman, director of health innovation at Intel. “While the US thinks about dealing with fundamental issues like secure electronic health records, in places like India, China and Singapore, mHealth is taking place.”

Doctors and payers in emerging markets are more likely to recommend patients use mHealth services, particularly in China and India – and more importantly, they’re willing to pay. Healthcare organisations and insurers in developing countries are 14 per cent more likely to provide a range of services via mobile devices as standard, including text-based consultations, patient access to medical records and analysis of general health and wellness data gathered using mobile devices.

Much of this is due to fundamental differences in the healthcare infrastructure in emerging markets, as well as differing patient needs. Reduced access to healthcare facilities and fewer doctors per head mean that mHealth provides essential access where none was previously available, whereas in developed nations it’s often a case of convenience or luxury.

Cost is also a crucial factor. 53 per cent of patients in emerging markets cite the expense of healthcare as a driver of greater use of mHealth, compared to 34 per cent in developed countries. Finally, less well-established healthcare systems mean stakeholders are more willing to adopt new methods and practices than in the complex and often slow-moving organisations of developed nations.

“In the developed world, the problem is this enormous medical infrastructure that is very conservative and resistant to change,” says Ian Leslie, professor of computer science at Cambridge University and expert in Chinese mHealth. “In emerging markets, you have a lot of the drivers of innovation without the barriers. In some ways, you can’t think of better conditions. Why waste time in the West?”

The disruptors
This reluctance to deal with the entrenched systems of large healthcare organisations reflects a fundamental difference in thinking between new tech firms entering the mHealth market and the stakeholders who have operated there for decades. Bringing with them a Silicon Valley ethos of agility and disruption, hardware and software startups are often frustrated by the slow pace of change in the deliberate, measured world of health, where issues like data confidentiality are more important than ever.

The healthcare field largely changes based on widespread consensus, often because untested innovation has real risks to human health and wellbeing. While this is a sensible precaution, it also means that even advances as simple as electronic record keeping are still in the process of being made in many countries, and 27 per cent of doctors cite an inherently conservative culture as a leading barrier to mHealth.

An excellent example of this is the NHS’s recently unveiled library of certified mHealth apps. Four years in the making and designed with the aim of showcasing the best in third-party mHealth applications, the library launched with just one app.

The size and complexity of health organisations also poses a challenge. The UK’s NHS is the biggest employer in Europe and the seventh largest worldwide, and most national healthcare systems around the globe include at least some elements of government and state control. This results in diffuse decision-making powers, substantial regulatory hurdles for new entrants, and deeply entrenched existing providers – all of which poses a challenge for innovative new firms looking to bring in radical solutions.

The same size and complexity issues are reflected in the scattershot approach to existing technology used by healthcare providers. Systems between local doctors, healthcare organisations, insurers, technology providers and other stakeholders have built up over time, often in a piecemeal fashion, resulting in a deeply fractured technology ecosystem. Only 53 per cent of doctors say that the mHealth applications and services they use are well integrated with their workplace’s own IT systems. And just 27 per cent say the services work well with existing national healthcare systems.

doctor mHealth white coat lab
mHealth on trial

With all these barriers to large-scale adoption by frontline healthcare providers, it’s no surprise that mHealth innovators have sought out and flourished in the areas of the industry with a similar pioneering spirit. mHealth has seen enthusiastic adoption by pharmaceutical companies, medical device manufacturers and other stakeholders involved in clinical trials, where new treatments and methodologies are put through their paces.

A survey by Applied Clinical Trials and SCORR Marketing found that almost 50 per cent of professionals involved in clinical trials and protocols were incorporating mHealth components into their studies. While 80 per cent felt the technology was still in its infancy, 60 per cent felt that it was already an important part of monitoring clinical trials, helping to improve data quality, patient engagement and patient trial adherence.

“mHealth holds a lot of promise when it comes to optimising clinical trials,” says Sarah Iqbal, head of digital life sciences at Biotaware. “The capabilities constitute a new paradigm for evidence generation in health research, promising perhaps more than any previous wave of innovations in health technologies.”

“Real-time data collection via mobile devices can provide potentially critical insights and offer advantages in consent management which together have the potential to transform drug discovery and development,” says Pamela Brankin, head of marketing and communications at Aridhia Informatics. “It’s perhaps the riskiest and costliest business there is; high failure rates increase the risks and costs associated with R&D, and any steps that can be taken to improve the success rates, and hence the return on pharma investment, are to be welcomed.

“For all the effort being put into driving awareness, trials continue to be significantly challenged by lack of participation. In an age where one in three people are using technology to track their health and activity, it is not difficult to imagine how an online consent app or platform could erase some of the major recruitment and engagement issues experienced by researchers.”

Despite the enthusiasm and clear use cases for mHealth in clinical trials, some hesitancy remains. Concerns over privacy and security are at the fore, with 22 per cent of respondents citing it as a barrier to mHealth adoption that must be overcome before mHealth is integrated fully into standard procedures. As with frontline healthcare organisations, interoperability and network issues are also a concern.

Many blame the entrenched business interests of vendors for the wealth of closed end-to-end solutions being offered, which can’t be integrated with existing systems. And while features like the gamification of data collection were held up as ways of improving positive patient behaviour, the need for a clear and intuitive user experience for patients and doctors in all mHealth apps was highlighted.

“Given the number of challenges that still remain, mHealth in its present state works better for short-term studies where the patient only needs the device for a brief, defined period of time,” says Jeff Daurity, associate director of medical device & diagnostics, cardiovascular therapies at Novella Clinical. “For larger, longer-term studies, mHealth technologies may not prove to be as beneficial.”

mHealth medicine pills blister pack
A prescription for the future

No one who has introduced mHealth into their healthcare practice seems to deny that the rise of connected devices is facilitating more personalised care, greater data gathering opportunities, and the potential for improved health and fitness in the general population. The major challenge in encouraging wider adoption lies in bridging the substantial gap that exists between the health and technology industries, and how they approach business.

The huge investment that mHealth has generated is unlikely to slow anytime soon, particularly as issues like the aging population in many developed nations mean that increasing pressure is being placed on health services and organisations. Drives for efficiency and higher quality of care mean that mHealth is advocated more and more as a potential solution to problems. A recent report by the Institution of Mechanical Engineers claimed that a widespread rollout of mHealth technology could have saved the NHS £1bn in the last five years simply by easing bed blocking.

But in order for that sort of widespread adoption to happen, the health and technology industries will have to learn from each other. Health stakeholders from frontline staff to huge organisations need to embrace innovative new practices that could save money and, more importantly, lives. On the other side, tech firms looking to disrupt and shake up established ways of doing things need to learn patience and diplomacy.

Still, the advances being made in clinical trial monitoring seem to point the way for health and technology working together with a unified purpose, and indicate a bright and successful future where both industries can learn from, and elevate, each other.