Feeds:
Posts
Comments

Posts Tagged ‘iPhone’

The rapid adoption of smartphones and now touch-screen tablets (e.g., iPad) by clinicians will trigger enormous growth in the use of mHealth Apps within healthcare enterprises, with the market for mHealth in the enterprise projected to reach $1.7B by end of year 2014.  Similar to the hockey stick growth for mobile shown in the slide by Morgan Stanley’s Mary Meeker in last week’s post, the mHealth App market will see a similar trajectory as healthcare enterprises strive not only to meet physician demands for mobile access to clinical information, but seek to improve workforce efficiencies in preparation of future healthcare and payment reform.

These findings and quite a bit more are part of Chilmark Research’s latest report that is being released today: mHealth in the Enterprise: Trends, Opportunities and Challenges. The report is the result of roughly three months of dedicated research by lead analyst Cora Sharma who has interviewed numerous leading adopters of mHealth Apps (Beth Israel Deaconess, Children’s Hospital Boston, UPMC and others) as well as both traditional HIT  vendors, best-of-breed mHealth vendors and consultants.

While this report has plenty of charts and figures providing details as to what mHealth App categories will see the strongest growth in the healthcare enterprise and just how big those specific App markets will get, one area that will reach saturation in the very near future is medical content. Companies such as Epocrates, Medscape and Skyscape have been providing this capability for a number of years to physicians and we peg current adoption and use north of 60%. By the end of 2013, this market will reach saturation. This may partially explain Epocrates’ acquisition move yesterday, picking up Modality for $13.8M. Modality will provide Epocrates with critical relationships to many health content publishers and further solidify and strengthen its position in this market. But of Modality’s some 140 iOS-based Apps, only half are heath and life sciences related. Might Modality provide Epocrates the opportunity to expand into new markets now that the health content market is reaching saturation?

But we digress as health content Apps are strictly physician-driven – they do not connect into the enterprise’s health information systems (HIS) and are of limited value to a healthcare enterprise. What is of value to an enterprise is providing physicians with immediate access to the information they need to deliver the highest quality of care in the most efficient manner. This report specifically targets those enterprise mHealth Apps that link into a healthcare enterprise’s HIS including EHR, CPOE, eRx, CDS and Charge Capture. Providing physicians mHealth Apps that will enable them to deliver higher quality at the point of care will rapidly become an important competitive differentiator as healthcare enterprises look towards not only meeting meaningful use requirements and structuring themselves for payment reform, but also improve internal workflow leading to higher efficiencies and more competitive positioning in the broader market.

To obtain a copy of this report head over to the Chilmark Research Store.

ADDENDUM:
Have received a few private comments requesting Table of Contents, List of Figures, Table etc., which is now provided below:

Table of Contents

  • Executive Summary
  • Why mHealth in the Enterprise
  • Early Adoption Strategies and Trends
  • Initial mhealth Offerings a Mixed Bag
  • Barriers to mHealth App Adoption in the Enterprise
  • Proliferation of Devices and Macro Forces Promise Strong Growth
  • Conclusion and Recommendations
  • References
  • Appendix

Figures

  • Figure 1: Physician Adoption of mHealth Apps in the Enterprise, EOY 2010
  • Figure 2: mHealth Apps Market Diffusion EOY 2010
  • Figure 3: Physician Smartphone Adoption EOY 2010
  • Figure 4: Physician Smartphone and Content App Adoption
  • Figure 5: Worldwide Touchscreen Tablet Units Sales Forecast
  • Figure 6: Physician Touchscreen Tablet Adoption Forecast
  • Figure 7: mHealth Apps Market Size Forecast
  • Figure 8: mHealth Apps Market Diffusion Forecast

Tables

  • Table 1: Crucial Information Gathering Physician Usecases
  • Table 2: Meaningful Use Stage 1 and mHealth Apps
  • Table 3: Early Adopters of mHealth Apps
  • Table 4: Usability Comparison by App Category Smartphones vs. Touchscreen Tablets
  • Table 5: Architectural Deployment Tradeoffs: Benefits vs Costs
  • Table 6: Representative Sample of Current Vendor Offerings
  • Table 7: mHealth App Growth Forecast
  • Table 8: Vendor Recommendations
  • Table 9: Enterprise Recommendations

 

Read Full Post »

Yesterday, the big 800lb gorilla in the PHR market, WebMD announced 3rd quarter earnings that were quite mixed. While its public portal business continues to see strong growth in uniques (now over 83M visitors/month) and advertising revenues that grew 26%, its private portal business continues to produce lackluster results, with flat revenue and holding steady with 124 clients. Even worse for the private portal business, WebMD is projecting a net decline of some 8% for this division in the 4th quarter.

Strong growth for the public portal reflects what other studies and recent surveys have shown: Consumers continue to turn to Dr. Net for a second opinion, self-triage, or simply advice on how to deal with a specific condition.  What is interesting in the case of WebMD is that despite the increasing power and sophistication of search engine technology from Google and the more recently introduced Microsoft Bing, consumers still look to a site like WebMD’s to provide more structured content that is easy to search, review and assist them in managing their health or the health of a loved one.

Zero growth and projected contraction in Q4 for the private portal operations of WebMD is a different story. The private portal business serves both the employer and payer markets wherein WebMD hosts a member or employee PHR for a client. Since late 2007, Chilmark Research has been tracking WebMD’s private portal business as a barometer for sponsored PHR adoption by employers and payers. Now one might easily assume that the downturn in the economy and the lay-offs of hundreds of thousands of employees may have something to do with WebMD’s Q3 results for its private portal business. Problem is: WebMD has been reporting lagging results for this line of business for as long as we have been tracking it so something else must be at play.

Late last year I had a discussion with a senior executive at BCBS-MA. During that conversation I asked what motivated them to take the bold move (at least it was at the time) to allow members to export their claims data to Google Health (BCBS-MA was one of the first payers, if not the first, to allow claims data to be exported by the consumer to a site outside of the payer’s control, in this case to Google Health). The answer, it was a simple business decision. BCBS-MA was spending a lot for WebMD’s private portal and few members were using it. So instead of spending that money on WebMD, the decision was made to turn over the data to the member/consumer allowing them to export it to Google Health and let the member decide how they wished to use their data. Thus, like BCBS-MA, other payers are likely not seeing tremendous adoption and use of their WebMD-hosted PHRs and are not increasing their investments in the service.

On the employer side there may be some contraction in use due to employee lay-offs and a tightening of the belt by employers, but this is likely a very small factor in why WebMD has failed to grown this line of business. Other factors at play are:

Employees still remain reluctant to participate in an employer-sponsored PHR due to concerns of privacy of their health data and how that data may be used against them e.g., deny a promotion.

The efficacy of employer-sponsored PHRs in lowering MLRs (medical loss ratios) and subsequently health insurance costs is far from proven, thus employer ROI is in question.

WebMD has a reputation of being expensive and difficult to work with. Chilmark has also heard some rumors that WebMD is putting very little into improving the capabilities of the private portal platform,- its on life-support. This last point should not come as a surprise considering the results of this business line.

So what does this mean to the broader market?

First, consumers are increasingly turning to sites such as WebMD’s to gather information to assist them in their health and wellness decisions. The WebMD property is a very strong brand, remains one the top go to sites for health information, their iPhone app has consistently ranked as one of the top health apps and thus WebMd can command a premium from advertisers. Unlike most Health 2.0 companies who also seek to leverage the all too common internet advertising model to drive business with little success, WebMD is actually doing it quite successfully.

But WebMD has a major problem in its private portal business and rather then make a concerted effort to put this business back on the right track, the company seems perfectly content to milk this cow for all its worth. That strategy provides an opening for other companies to step in.

The challenge for new entrants, however, will be their ability to provide a comprehensive health and wellness solution that is comparable, if not improves upon the WebMD offering. Today, while there are plenty of products and services in the market that attempt to address various health and wellness needs of employers, there are virtually no solutions that provide as comprehensive a portfolio of services that WebMD currently provides. Employers and payers are looking for options (this was part of the justification for some employers who came together to create Dossia and the separate efforts of Aetna and United Health Group), there is demand, but few options exist outside of creating your own.

Ideally, through acquisition(s), partnership(s) and merger(s) such a solution can emerge to serve the employer and payer markets. Now the question is: Who will step up to the plate and make it happen.

Read Full Post »

Introductory Remarks: Chilmark Research is pleased to welcome a new addition to our staff, Cora Sharma.  Cora will be leading our research efforts in the mobile health app market (mHealth) and below is her first post on the subject.  Cora has a great background having received a BSc in Computer Science, worked in the software sector for several years and recently graduated from MIT’s Sloan School of Business. While at Sloan, Cora did an internship with McKesson where she found her calling, HIT and the desire to become an analyst.  She’s a great addition to Chilmark Research and I’m confident she’ll produce some excellent research. – Stay tuned.

The concept of mobility in healthcare is nothing new to providers, vendors, and to Chilmark Research alike.  The current media and investor buzz surrounding mHealth stems from the belief that: 1) mobile technology has finally matured to a point where age-old healthcare processes can finally be revamped; and 2) mobile technology has not only matured but has actually been adopted en-mass by physicians and shows no signs of abating.

Doctors Love Smartphones, but are GaGa over the iPad
Recent reports from SpyGlass Consulting and Manhattan Research show that the vast majority of physicians already use smartphones. Pamela Dolan at the AMA has a nice commentary on these latest numbers. Chilmark Research’s recent talks with industry folks shows that the iPad is also gaining significant traction with physicians.  At a recent conference in Denver where Chilmark Research attended and spoke, the CIO of Catholic Health Initiative (CHI) sees providing their doctors with mobile apps (in CHI’s case on the iPad) as critical to the success of complying with meaningful use requirements.

mHealth Apps in Acute Care
Given that physicians have now ‘gone mobile’, does this imply that they will no longer be satisfied with computers-on-wheels (COWs), demanding mobile access to every piece of data buried in Health Information Systems (HIS)?   If yes, providing doctors with mobile access to patient and hospital data could be just the perk needed to attract more affiliated physicians, satisfy existing ones and ultimately drive the adoption and use of HIT by clinicians.

Here is a brief look at the mHealth acute care vendor landscape:

  • Pure play inpatient mobile solutions companies like PatientKeeper and MedAptus have built their businesses on providing clinicians with mobile apps, each having started with charge capture and quality measures.  PatientKeeper expanded into CPOE with a limited roll-out that is scheduled to go GA in 2011. As the mHealth market continues to gain momentum, it will be interesting to follow the fate of these two companies.
  • The big boys of HIS (Cerner, Eclipsys/Allscripts, Epic, GE Healthcare, McKesson, MEDITECH, Siemens) all have mHealth stories, albeit weak ones that revolve mostly around mobile browser access to their core EHR.  Early this year Epic released the Haiku app to Apple’s AppStore, resulting in some fanfare from the tech community.   Also, the Citrix Receiver app makes it possible to run Windows-based apps like McKesson and Cerner securely on the iPhone/iPad and Android, though with obvious usability issues associated with being a non-native app.
  • Potential entrants/disruptors from outside the industry face a battle with the big boys, who seem to want to reduce mobility to an extra feature on their systems.  Diversinet is making a play in secure doctor-doctor and doctor-patient communications for the enterprise. The company has made extensive investments to the tune of some $80M spent over the last decade developing IP in encryption and identity management.

mHealth Apps in Ambulatory
There are a multitude of physician content and productivity apps in the AppStore, from anatomical diagrams to medical calculators to ICD-9 lookup and arguably the most successful category, medical content apps.

Mobile medical content companies such as Epocrates and Medscape have had a presence on physicians’ phones/PDAs for years.   We are closely following Epocrates’ expansion into the SaaS EHR market.  If mobile EHR access is a truly compelling value proposition for ambulatory physicians (we aren’t convinced it is), then Epocrates may be able to leverage the brand’s mobile association and large, existing installed base to stand out from the 400+ competing EHR vendors.

A number of ambulatory EHR vendors (AllScripts, eClinicalWorks, Greenway and NextGen) have recently introduced their own EHR mobile apps, most built for Apple’s mobile OS. Currently, it appears that little is on offer from EHR vendors for Google’s Android mobile OS, though that may change as Android becomes an increasingly compelling alternative to Apple.

Onward Ho!
Dipping our research fingers into the mHealth market, Chilmark Research is launching a new initiative that will culminate in the report: Enterprise Adoption of mHealth apps: Trends, Issues and Challenges. Over the course of the next couple of months (target release date is in advance of NIH’s mHealth Summit in DC) we will interview executives from the major HIS vendors, best-of-breed vendors, tech entrants, and leading Hospitals/IDNs. Through both primary and secondary research we will answer such questions as:

  • What top mobile apps are currently being adopted in the enterprise?
  • What are the priority unmet needs among leading Hospitals/IDNs?
  • What challenges are currently hindering adoption of mHealth apps in the enterprise?

In the meantime we will be posting every other week specifically to give updates on our mHealth research.  Onward Ho!

Read Full Post »

While the Apple iPhone was first targeted at the general consumer, Apple has been taking the necessary steps to bring this device into the enterprise, directly competing with RIM’s Blackberry.  Unseating the Blackberry in many sectors, such as finance, may be near impossible but healthcare is another story.  Within healthcare, Palm, with its Treo was extremely popular as it was not only a communication device (cell, email, etc.) but also supported other apps such as the very popular Epocrates.  Palm lost its focus, sat on its laurels, the Treo became dated, barriers to entry lowered.  Enter the iPhone, its intuitive interface, a touch screen, an ever increasing number of medical apps and Palm is basically out in the healthcare.

The iPhone was first adopted by physicians independently of the organizations (hospitals) they worked for to do simple communication and access numerous apps that helped them in their day-to-day activities.  Seeing this adoption trend. some of the EMR vendors also started to get on-board offering iPhone access to their app (AllScripts introduced theirs at HIMSS’09). But this adoption, for the most part, remained separate from broader enterprise (hospital) initiatives as early versions of iPhone’s operating system (OS) were simply not enterprise ready.

But this is changing.

Apple’s iPhone OS, which has seen significant improvements since its introduction and now has robust enterprise features, including security ( HIPAA compliance), integration to the ever popular Microsoft Exchange Server (calendar, email, etc.), and an SDK to build apps for internal purposes.

To showcase the iPhone in enterprises, Apple now has a section of their website dedicated to showcasing customer deployments of the iPhone in an enterprise.  Of the 15 enterprise case studies presented, 20% of them are dedicated to the healthcare market; Mt. Sinai in Toronto, Memorial Hermann in Houston and Doylestown Hospital in Pennsylvania. Of all the enterprise verticals to profile, dedicating 20% of case studies to one market, healthcare, signals Apple’s intent to invest in this market.

Common threads in each story:

1) Security features of iPhone OS insure HIPAA compliance.

2) Ability to use Microsoft Exchange ActiveSync for email and calendaring features.

3) iPhone’s intuitive interface minimizes training requirements.

4) iPhone is readily portable and can deliver the right information at the right time to the right individual.

5) iPhone’s ecosystem of applications allows a hospital and its clinicians to tap a wide range of applications to customize the iPhone to their particular needs. Many of these apps are free thus not a drain on ever tight IT budgets.

As Hermann Memorial’s CIO, David Bradshaw stated:

Healthcare is a real-time business.

And as we’ve said before:

Health is mobile.

The combination of an ecosystem of relevant applications with enterprise connectivity in a secure, easy to use, mobile construct is the future of healthcare IT, at least for clinicians.  The next step is bridging the divide between clinician and consumer through the use of such technologies. We’re not there yet, but hopefully, Apple is working with a healthcare organization (or at least will uncover one) and present such a case study in the near future.

Read Full Post »

itriage

iTriage is a slick iPhone app that we first took a look at back in April.  A couple of weeks back we had a chance to meet with the CEO, Dr. Peter Hudson (yes, he’s an ER doc who still practices medicine) who was in Boston to attend a conference.  During that meeting, Peter gave us a brief update on progress to date, including their recent announcement with HCA to become a premier listing service for South Florida.  Following is what we learned.

Since its launch in April 2009, iTriage has maintained an enviable position as one of the top downloaded apps in the iPhone AppStore, currently in the top 10% of all apps downloaded.  When one thinks about all the 35,000+ apps currently available and some 1 billion apps downloaded to date, that is pretty impressive for a small company.  Clearly, they must be doing something right.  That being said though, if they are such a popular app, why don’t they at least show up on the AppStore Health & Wellness or Medical sections in the list of top paid apps? Curious.

The parent company’s (Healthagen) business model is to solicit providers, mostly large integrated delivery networks (IDNs) to become premier sponsors who pay an annual subscription fee (based on number of hospitals & clinics) to Healthagen to have their facility listed along with some brief marketing content, including the ability to upload videos, as to why one would want to go to their facility (typically ER) versus others. Thus, Healthagen is tapping into the marketing budgets of IDNs. With home offices in Colorado, Healthagen has done a good job of landing the big IDNs in Colorado including Centura Health.

On October 5th, HCA announced that they would become a premier sponsor as well for their facilities in South Florida.  What is particularly cool about this announcement is that in addition to the standard promotional marketing content that one may find in iTriage on a given HCA facility, HCA will also be providing real-time information on expected wait-times in ER, right there in the palm of your hand on your iPhone and in a recent upgrade of the software, a Blackberry as well.  (In November, they’ll release versions for Android and PalmPre.) This is all part of a larger push by HCA, which includes posting wait-times on billboards in this region to drive consumers seeking medical attention to their facilities as a significant percentage of those admitted to ER wind up being admitted for more extensive care.

Granted, someone having a heart attack will dial 911 and go to the nearest facility, or as in my recent case, choose a hospital known for excellent care based on a recommendation (the EMT that treated triaged me suggested I go to Brigham & Women’s as they have the physicians to treat nasty cuts, in my case a plastic surgeon stitched me up). But there may be other cases where someone who is feeling ill and cannot get an appointment with their primary care physician or are on travel, may find this feature useful.

Now, if I can only get something like a change:healthcare feature embedded into iTriage for costing information, a medication checker like PharmaSURVEYOR or DoubleCheckMD (who knows, maybe that new med I was prescribed is causing all the grief) to evaluate current meds I am on and while we are at it, a more user friendly mobile interface (yes, they do have an avatar on the Web) then we really would have one powerful app to support consumer-driven healthcare.

Read Full Post »

iphoneMedJust received an email this afternoon from Children’s Health Informatics Progam (CHIP) here in Boston announcing the release of a workshop derived document: Ten Principles for Fostering Development of an “iPhone-like” Platform for Healthcare Information Technology. Not sure if release was serendepidous or not but timing is interesting in light of yesterday’s release of Draft Meaningful Use Recommendations and today’s webcast by CCHIT outlining future certification processes.

The workshop itself came about as a follow-on to the paper CHIP researchers Mandl and Kohane published in NEJM last March.  Maybe with all that ARRA money floating about in the HITECH Act, ONC should just go ahead and build such an “Open” platform that supports modular apps to meet specific needs wihin this highly fragmented market.

Seriously, this needs some consideration.

Congress did grant authority in the ARRA legislation for HHS to develop an open-source EHR if existing vendor solutions do not adequately meet market needs. So, rather than build a full-fledge EHR which is almost doomed to fail in the market (despite what VistA promoters may argue) a better strategy may indeed be the building of an Open, iPhone-like platform with open SDK, open APIs, etc., heck, even throw in an AppStore (with an app review feature) and let the development community have at it.  This could really get things moving and accelerate adoption of HIT, especially in small practices where 80% of care is delivered.

Are you listening Washington?

Read Full Post »

sadscale1While it seems that there are an unlimited number of consumer-facing mobile apps for calorie counting/diets, exercise, menstrual calendars and symptom checking, Chilmark has been somewhat struck by the dearth of apps focusing on mood disorders.  Not sure why that is, but we were pleasantly surprised when Sad Scale showed up on the iPhone AppStore.  Having used this app several times now, Chilmark remains severely underwhelmed and it is arguably one of the worst apps we have demo’d.

A core tenet of Chilmark Research’s which contributes to our perspective on consumer-facing applications and technologies is:

“Health is Mobile”

Health does not happen when one sits down in front of a computer screen, health occurs everyday in every action a consumer takes.  This is in large part what the Robert Wood Johnson Foundation (RWJF) uncovered in their first round of research under Project HealthDesign (PHD). RWJF has taken the next step in round two funding of PHD now focusing grant funding on technologies that support “Observations of Daily Living” or ODLs.  Earlier this week, RWJF received over 100 proposals for the ODL grants.

SadscalerateGetting back to Sad Scale, this little iPhone app provides the ability to self-assess one’s mood in three specific categories, Depression, Post Partum Depression and Geriatric. For depression, Sad Scale uses the Zung Self-rating scale.  Post Partum uses the Edinburgh Postnatal Depression scale and Sad Scale does not reference the scale for Geriatrics, simply referring to it as “Geriatrics Scale.”  Each of these scales provide a list of questions that are automatically scored upon completion of the self-test.  Upon completion of the test, scores can be charted and also shared via email.

Very basic, simple straight forward app, so what’s not to like?

The app is nothing more than a series of questions on the iPhone and no effort has been made to leverage many of the rich features that the iPhone API offers.  It is a simple questionnaire ported to the iPhone – nothing more, and seemingly a lot less.

The color choices for text make it difficult to read some of the content presented.

At the end of the questionnaire, it has a link to resources but these are nothing but links to the home pages of sites like the Mental Health America, PostPartum.net or American Geriatrics Society.  Could not these developers at least take the user to some truly relevant content.  Seriously, is that the best these developers could find?

When someone is suffering a depressive episode they may balk at going through and answering a series of questions like this, especially all 20 questions under the Zung scale – when someone is depressed, it is often difficult for them to even get out of bed and get dressed, so why have them go through standard questionnaire that provides no personalization and quick feedback that is meaningful.

Some suggestions to improve this app?

How about we begin with the RWJF concept of ODL, let’s provide the consumer an opportunity to record their self-observations as it pertains to mood.  For example, how about a quick mood question, how do you feel right now, at this moment in time with a simple color wheel to express mood and make color a back-end quantifiable metric for clinicians.

What about a simple open-ended question that they can answer on why they are feeling they way they are? If needed, one could also have a question with a multiple choice of common triggers to answer, including “Other” with a fill-in the blank.

Also, it might be useful to have within the app a timer that can be set that asks the user what their mood is at that moment in time.  This may prove beneficial in understanding at what times of day the user is vulnerable to the mood disorder.

Provide some meaningful resources including direct links to relevant content.  Don’t make the user have to look for it on some website.

Now, I am no specialist in mood disorders and I am sure that there are other attributes that could be added to the app that might be helpful for the consumer and even possibly the clinician, but I have close family members who do suffer from depression and it is a severly debilitating disease and it does, at least from this vantage point seem ripe for an ODL platform.  Downloading Sad Scale I had hoped that this may be the beginning of something interesting.  Unfortunately, this was the most disappointing (dare I say depressing) health & wellness app downloaded off of the AppStore to date.  This is one sad app, that even at the paltry price of $0.99 is not worth it.

Read Full Post »

Older Posts »