Posts Tagged ‘mHealth’

Awhile back, a large health insurer (payer) commissioned Chilmark Research to do a market scan on how payers across the country were using emerging consumer technologies to engage their members. We found this project to be quite interesting and rather than have much of that research sit on the shelves forevermore, we decided to build upon it.

Today we are releasing the results of that effort.

Our latest report: Benchmark Report: Payer Adoption of Emerging Consumer Technologies takes a close look at over 40 payer (health insurers) initiatives that are using a wide variety of consumer technologies (apps, social media, games, etc.) for member engagement. Here’s the PR announcing the report’s release.

Now it is well-known that payers have had a very mixed record in engaging their members. Part of the problem has been trust as members are justified in taking a cautious approach when sharing their health information with payers for fear of future denials. Secondly, many payer initiatives have been half-baked wherein payers have not been fully engaged themselves in the concept of member engagement.

But as we pointed out in a post earlier this summer, this is all beginning to change. Numerous market forces are now pressing down upon payers and payers are increasingly coming to the realization that they need to deploy member engagement solutions that work. Payers are now going to where consumers already are seeking to engage their members via a variety of consumer-based technologies. This report is our initial effort to gain a greater understanding of what payers are doing today and provide some guidance as to how their efforts will evolve overtime.

One thing we have learned in the course of our research is that despite all the talk, the majority of these efforts are in their infancy and that the vast majority of payers have not even begun to venture down this path. Therefore, we intend to update this report on a periodic basis to benchmark payer adoption of consumer tech in support of member engagement and gain an even deeper understanding of what works and just as importantly, what does not.

Thanks to the many that we have interviewed over the course of the last several months to compile this report as your inputs have been invaluable.

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The market is abuzz about all things mHealth. Press coverage on provider-patient mHealth solutions is ramping up with a recent example being the pointcounterpoint piece in Forbes following the press waterfall about Happtique’s app-prescribing platform. We even wrote a piece recently about a personal experience using the iTriage app to self-diagnose E. Coli poisoning.

Here at Chilmark Research we have been following the adoption of mHealth solutions for some time and in addition to several private contracted studies for clients, published the report, mHealth in the Enterprise in late 2010.

We are now releasing our newest report, mHealth Adoption for Patient Engagement, Status, Trends and Forecast. This report takes a close look at adoption trends for mHealth apps that will facilitate provider-patient engagement. Our research uncovered a market with an enormous future ahead, (market will exceed $1.1B by 2017) but significant hurdles continue to stand in its way, at least for the near-term.

The report is both heartening and saddening. Heartening for the market will accelerate quickly in about three years time, a fairly short window for the healthcare sector. Saddened, because it means a lot of the current hype will overinflate expectations of impatient technology investors foraying into this unfamiliar space, greatly increasing the potential for high rates of failure as these investors pull the plug on their young prospects.

For the report, we started with the definition of mHealth from the WHO report mHealth, New Horizons for Health Through Mobile Technologies, published in 2011:

“…mHealth or mobile health is medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices.

We then narrowed the scope to those offerings that went beyond mere monitoring and are truly engaging care providers in more continuous, patient-centered care. What we found should surprise no one that follows this market: there is almost no current market demand for such solutions, and offerings today remain in perpetual pilot stage.

The market won’t really be one to speak of until 2014 comes around. This is when CMS begins basing quality payments on a competitive scale. The advantage for these payments will go to provider groups that have already starting internal testing of first line innovations such as two-way patient messaging services.

The current mobile priority for progressive healthcare organizations (HCOs) is simple transactional systems that allow a patient to view their records via a mobile optimized PHR portal, and perform simple transactions such as appointment scheduling and prescription refill requests. These initiatives are largely being driven by the marketing department of HCOs to increase member/patient loyalty.

Adoption of these services is still incentivized by current payment models, where fee-for-service reigns supreme. Scheduling tools have repeatedly been shown to decrease patient no-shows and are hugely popular among users. Increasing the opportunity to provide billable services in the short term will equate to greater access to care in the long term as patients have the opportunity to adjust appointments according to their schedule, reducing issues around last minute cancellations, which happen with approximately half of all primary care visits.

The true revolution is in its earliest stages as more innovative organizations start to adopt patient-physician messaging tools. Over the past few years, a number of doctors were already starting to do this to improve their connection with patients, but standard email is often not secure enough to meet the requirements of HIPAA compliance. This has led to a number of companies developing solutions specifically for the sake of enabling more secure communication, some of which are just starting to be worked into the mPHRs previously discussed.

These ad hoc messaging systems are the first generation of what will later become true patient engagement solutions that focus on specific chronic diseases driven in part with patient-derived data. This will result in fundamentally different models of care provision, as patient-generated data factors into proactive, near real-time decision-making.

Over the ensuing years we predict convergence of disease specific care provisioning mHealth apps with an mPHR, secure messaging and various transactional tools. Today, no HIT vendor, whether from the mHealth, PHR, EHR or other has publically articulated such a solution suite though many look to be heading in that direction. The recent announcement by Aetna of its win at Banner Healthcare may be a very early indicator of what is to come.

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It is almost becoming the norm to say that it has been another tumultuous year in the healthcare IT market. Market consolidation, pushback on timelines, growing chorus from IT departments that enough is enough against the backdrop of the political circus in Washington and across the land as we prepare for the 2012 election year. If 2011, was a bit bumpy, believe we will see craters in the road to HIT enlightenment in 2012. But we’ll save that discussion for our future predictions for 2012 post, which we hope to get to next week. (Editor’s Note: Don’t hold your breath though, if the snow flakes are flying, we’ll be on the slopes next week.)

Today’s post takes a look back on 2011 by reviewing our predictions earlier in the year and assessing where we hit the mark, where we missed and if there is such a thing, where we came close. So without further adieu…

1. MU Initiatives Move to Tactical 
Hit This did come true as meaningful use, while still top of mind for the CIO, is not top of mind for others in the executive suite who are now looking at how to compete in the future as reimbursement models shift from fee-for-service to value-based contracts.

2. C-Suite Strategy Focuses on New Payment Models 
Hit An admittedly “softball” prediction, this was a natural fall-out of prediction numero uno. And yes, the consultants are making out like bandits as we predicted they would helping senior execs figure out their future competitive strategy.

3. RCM & Charge Capture Systems Require Overhaul 
Miss By and large, most vendors in this sector have not done a whole lot yet as they await to see how the market develops. With most healthcare organizations struggling to get the basics done (e.g., meet MU requirements, ICD-9 -> ICD-10, apply analytics, etc.) we are not seeing big demand from customers and subsequently, not a big push by vendors.

4. Mergers & Acquisitions Continue Unabated
Hit Another “gimme” of sorts for we had this prediction in 2010 and it was a “hit” and need only look at this market with its some odd 300+ EHRs to choose from, everyone wanting to call themselves at HIE vendor (last we checked, HIMSS listed some 189 HIE vendors alone), countless other HIT solutions to see that this market is far from mature. But arguably the biggest news in 2011 was Microsoft’s capitulation that despite the billion dollar plus investment, it wasn’t cut out or the clinical market and dumping its HIT assets into a new joint venture with GE. What we are also seeing is some rationality return as valuations have moderated. This may have led to Thomson Reuters’ recent decision to not sell-off its healthcare division – no one was willing to pay the high price tag they had on this property.

5. Federally Funded State Initiatives Struggle
Toss-up There has been some progress and there are those that would vehemently argue that Beacon Communities, RECs and state HIEs are moving ahead briskly. But then again, we do get some disturbing reports that all is not progressing as once envisioned, one might even go so far as to say some of these programs are beyond just struggling, but clearly going off the tracks. We’ll reserve judgment until we see clear evidence of such pending disasters, which will likely be prevalent, but highly distributed.

6. Changing of the Guard at ONC
Hit Not long after we posted our 2011 predictions, Blumenthal announced his resignation from ONC. We could not have been more prophetic if we tried.

7. Physicians will continue to go Ga-Ga over the iPad and the fast-following touchscreen tablets much to the chagrin of CIOs.
Hit Enabling physicians access to health information systems via their hand-held mobile devices, including touch-screen tablets is still a struggle for most organizations. At first, IT departments turned to Citrix as stop-gap measure, but the UX was far from ideal. In our recent research we found many an IT department still struggling to address this issue. mobile enablement of physicians is a top priority.

8. Apps Proliferate: Consumer-facing First, Private Practice Second, Enterprises Dead Last
Hit In hindsight, another admittedly easy prediction to make. What may be a more interesting prediction is when will mHealth Apps really become a truly viable market? Does the profitable exit of iTriage/Healthagen, which was picked up by Aetna portend such? By our standards, no. Go back to our recent post from the mHealth Summit for more in-depth analysis.

9. The Poor Man’s (doctor’s) HIE Takes Hold
Miss We thought that the Direct Project would quickly take hold and see rapid adoption among smaller physician practices and those organizations looking to “connect the last mile” to small affiliated practices in their network. Not happening yet though the current administration is doing its best to push this technology by requiring all state designated entities that are standing up statewide HIEs to include Direct in the strategic operating plan.

10. Analytics & Business Intelligence Perceived as Nirvana 
Hit, kind of… 
In retrospect, not even sure this was really a prediction but simply more of a statement as to where healthcare organizations are headed with their HIT investments. We have a long ways to go, though there is certainly no lack of vendors that now are touting some form of analytics capabilities. Our advice, tread carefully as most solutions today are half-baked.

11) The Buzz at HIMSS’11? Everything ACO! 
While some vendors were discussing ACO enablement at the 2011 HIMSS, the vast majority were not with the key focus continuing to be meeting Meaningful Use requirements. As mentioned in previous prediction, we see MU as a tactical issue with the strategic issue being: How do we leverage IT infrastructure to support communities of care? Maybe at HIMSS’12 we’ll see more discussion of this issue, but we’re not holding our breath.

This may have been our best year yet with our predictions having only 3 clear misses out of 11 predictions made. Granted, some of those predictions were not exactly the most profound or shall we say big stretches, but we do take some satisfaction in really nailing a few.

And while we intend to provide our own 2012 predictions, no time like the present to begin the process. So we ask you dear reader, what is your 2-3 top predictions for 2012? Will Todd Park stay on at HHS? Will forced budget cuts decimate HITECH? Will the Supreme Court’s ruling on ACA have any impact on HIT spend by either payers or providers? Will mHealth Apps such as WellDoc’s for diabetic care finally receive a CBT code thereby accelerating adoption of such tools?  We look forward to your input.

And of course we wish everyone a Joyous holiday season and wish you and yours continued good health in the new year to come.

Home for Christmas by Thomas Kinkade

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As with the last shuttle mission making its re-entry into the Earth’s atmosphere yesterday, I am re-entering the world of healthcare IT after an extended family vacation in the wilds of Alaska. No, I did not see John Halamka up there, it is after all a VERY BIG state, but I did get the chance to go completely off-the-grid, a blessed reprise and observe what is one of the more beautiful and still untouched landscapes in the northern hemisphere. Upon finally arriving in Vancouver I made the vow to return, but next time it will be to spend more time in the small coastal towns of the Alaskan peninsula, likely via an expedition kayak, to get up close and personal with the people and environs of this small corner of the world.

After being away for nearly two weeks, it is a challenge to pick up where one left off. Cruising through the reams of email (please excuse any delays in getting back to you I’ll get to your email yet, I promise), trying to catch up on my reading of the various industry rags and tapping twitter I feel pretty comfortable in stating the more things change, the more they stay the same (not exactly the best quote for an analyst to say as we thrive on turmoil…).  That being said, following are a few items that did catch my attention and may look into further:

FDA Releases Proposed mHealth App Regulations
On Tuesday, the FDA finally released guidance on how it intends to regulate mHealth Apps. Having taken a cursory review of these proposed regs, have to say I’m quite impressed as the FDA has struck a careful balance of  applying regulatory review where warranted while allowing plenty of room for innovation in this very young and still immature industry sector.  MobihealthNews has a fine write-up on this story.

WebMD Provides Abysmal Guidance and Tanks
WebMD, which has been seemingly immune to the recession, provided Q2’11 guidance that sent its stock into a tailspin and leading to a very rapid (next day) letter to investors from the Chairman to quell fears. Why is this significant? First, pharma is feeling the effects of the recession and is pulling advertising dollars off the table. Over the last few years, WebMD has been putting virtually all of its “eggs in one basket” – pharma. It appears that the golden goose of pharma is no longer laying golden eggs which will likely have a ripple effect on the multitude of other smaller Health 2.0 like companies whose business models are advertising based. Secondly, once again WebMD is projecting contraction in its “private portal” business. This is, or at least was, the 800lb gorilla in the PHR market for employers and payers. WebMD has milked this cow for about all its worth and do not be surprised if others start aggressively moving in. Cerner is one and we’ll talk about another tomorrow.

Stage 2 Meaningful Use Likely Delayed till 2014
Can’t say we didn’t see this coming as ONC’s advisory board basically recommended such but it does complicate the schedule for incentive payments which, as part of ARRA were meant to create jobs and create those jobs quickly. As the recession continues to drag on, there appears to be an acceptance that getting back to near full employment in this country will not occur quickly. Such acceptance has appeared to bring some rationality as to the rollo-out of EHRs. Choosing, installing, mapping workflow, testing, training and going live with an EHR, let alone meet the various requirements of meaningful use (MU) is no small task and this delay will bring a sigh of relief among many a CIO and eligible professional. But now one has to wonder: What does this mean for Stage Three?  Don’t be surprised if Stage Three gets the ax.

I’m sure there are other bits of news that I missed and welcome your input to help educate this off-the-grid analyst on all the wonderful things he missed as he was trudging through the temperate rain forests of Alaska or battling grizzlies for a share of their salmon (note, grizzlies don’t share).  BTW, this last picture is of one of the “deep forest creatures” you’ll find in that rain forest.

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Yesterday, Morgan Stanley analyst Mary Meeker gave her annual presentation on the State of the Web 2010. As always, she has done her homework with some excellent stats presented that draw some provokative conclusions. While this presentation looks at the broader market, it is not too hard to start connecting the dots and apply some of her findings to the healthcare sector.

Slide 8 above shows just how dramatic the pace of adoption is for mobile+internet. What this slide points to and what our own recent research has uncovered (more to come – mHealth in the Enterprise report to be released tomorrow) is that mobile+internet is going to have a tremendous impact on all industry sectors, including healthcare.

Fasten your seat belts folks, this ride is only going to accelerate.

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I recently had the opportunity to speak with Henry J. Feldman, M.D., instructor of medicine at Harvard Medical School at the Beth Israel Deaconess Medical Center (BIDMC).  Dr. Feldman also serves as Chief Information Architect in addition to practicing as a hospitalist at BIDMC.

Dr. Feldman discussed BIDMC’s platform-agnostic mobile strategy, whereby clinicians access all HIS data through the browser of whatever device they happen to be using.   Talking to Dr. Feldman was a far cry from talking with certain app-crazed technologists, who recoil at the thought of using the browser to deliver information into a busy doctor’s workflow.   At BIDMC there are no cool mobile apps, just web forms (Ajax is not welcome either).

This is not a story of antiquated technology.  I would consider BIDMC to be a lead user in the field of HIT and wireless health as they develop the majority of their systems in-house, have very large IT and informatics departments, and house the likes of globally recognized HIT leaders like John Halamka. (Full disclosure: I have been a fan of BIDMC since CEO Paul Levy co-taught my class ‘Economics of Health Care‘ at MIT.)

According to Dr. Feldman, BIDMC’s platform-agnostic architecture is working wonderfully well for them, and BIDMC has no need to jump on the app bandwagon.

Why Not the BrowserOne argument I have heard for shunning browser architecture is that the web-based user experience for a lot of clinical software is paltry – that the true potential of native UI is not realized.   Another argument centers around network connectivity, for example: “Wi-Fi doesn’t reach the basement of our hospital”, or “10 days of patient data has to be stored on the device – we can’t take chances with the network”.

Tackling the user experience argument: Most mobile browsers use the Webkit rendering engine, which renders UI widgets with the same look (but not always the same feel) as native widgets.  For a well designed webpage, this means consistency between the platform UI and the browser UI, something that nearly everyone prefers.

Now on to connectivity issues: BIDMC has invested heavily into its network infrastructure, creating a highly available, secure, very fast network. The result is that clinicians have high levels of confidence in accessing data through the browser anywhere at anytime within BIDMC.

It is a different story, however, when a doctor is out of range of the BIDMC network, where she doesn’t have the same talented networking team working for her.  Also, most hospitals don’t have a true medical grade wireless network like BIDMC.   What may help here is the FCC’s recent announcement on the use of white-space (vacant analog TV airwaves), leading to wi-fi on steroids in the not so distance future.

Headaches Avoided
Thinking of some of the headaches avoided by using a browser-based strategy:

  • No client to install and support on the end-device.  Lowered complexity and fewer points of failure.
  • No possible way to store data on the device.  This means no complex mobile device management because of privacy/security risks.
  • No worries about who will win the smartphone and tablet wars.  If a device has a browser it is supported.

Of course, everything is a trade-off and while BIDMC has thrived with a platform-agnostic philosophy, this may not be the best strategy for all hospitals seeking to roll-out mobility to their clinicians.   In Chilmark’s upcoming report, “Enterprise Adoption of mHealth Apps: Trends, Issues and Challenges, we’ll dive into the specific factors that would benefit a hospital to choose one architecture over the other, and highlight the trade-offs involved.

This week I look forward to visiting Kaiser Permanente Garfield Center for HealthCamp 2010, and Health 2.0 in San Francisco with John.  It is going to be a busy week!

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Over the last few weeks there has been a lot of hype regarding mHealth.  In late August Deloitte published an Issue Brief: The Mobile Personal Health Record (mPHR) that led to the conclusion that an mPHR will become the “killer app” healthcare app for the consumer.  Then we have PWC who released their own report: Healthcare Unwired at the beginning of this week which stated that some 40% of consumers were willing to pay for wireless health solutions.  Jane Sarasohn-Kahn did a nice write-up on the PWC report, though Paul McNamara may be closer to the truth on what consumers are really willing to pay for when it comes to mHealth-type solutions.  And last, but cettainly not least is the plethora of mHealth conferences.  As the fall conference season heats up, seems like one could go to some form of mHealth event every other week from now till Christmas.

As Eric Dishman of Intel points out in an excellent post, part of the problem may be one of definition, part of it  al ack of truly trying to understand th market, its needs, the technology currently available to meet those needs and how does that technology become a part of the workflow of traditional care processes, or augment if not disrupt that workflow.  Many questions that remain unanswered or poorly answered.

So is there really any justification for all this hype?

Yes and No.

Quite awhile back, when Chilmark first started looking into the mHealth market, we felt that indeed, there truly is something here and that provided the tools were simple enough, the value big enough that mHealth. It was at that time that we coined the term: Health is Mobile. Health does not happen when you are in-front of your laptop or desktop computer, it happens when you are on the move, going to an appointment, picking up a sick child from school, etc. Chilmark agrees with Deloitte that an mPHR like app has incredible potential, however, the lack of personal health information (PHI) in a common, computable digital format, (eg CCD or CCR) is a significant hurdle. There are also the issues of the need for a well-defined, simple to grasp value proposition for the consumer (see previous post) and subsequent business model(s) and a go to market/commercialization strategy that will make mHealth a sustainable success in the market. Not easy hurdles to overcome.

But there is significant change occurring and the rapid acceleration in adoption of smartphones is staggering. Recently, the market research firm IDC upped its 2010 smartphone growth projections from 44% growth to 55%. Then take a look at app sales on Apple’s iTunes. On September 1st Apple stated that 6.5B, yes, that’s BILLION, apps have been downloaded and 120M iOS devices (iTouch, iPhone, iPad) had been sold. This equates to 54apps/device. While many of these apps are for games and productivity tools, there are literally thousands of apps for medical, health and wellness purposes. What is particularly interesting about app download growth is that it is overtaking downloads of music. Maybe Apple needs to start calling iTunes iApps instead.

And then there is the story from Stanford Medical School where new med students this year have been issued an iPad in the hopes of replacing mounds of paper that are typically distributed to students for a course over a semester. The students seem to like it and even one of the doctors is quoted as saying towards the end of the article that the iPad is in an ideal form/function factor for a busy physician.

This may truly be key, for as the PWC report points out, most consumers would prefer to get their mHealth solution from their physician.  Thus, if physicians get on-board in using something like the iPad, this could become a virtuous circle.  First, the doctor will be able to easily create and update a patient’s record, digitally creating the content (PHI) that a consumer/patient could then use to populate their own mPHR. The physician’s familiarity and use of such technology will also drive a higher comfort level with using such in the process of care coordination and engagement with the consumer, including reviewing data in the consumer’s mPHR that may not have originated from their practice.  Likewise, the consumer trusting in their physician and possibly with physician encouragement,  will more readily adopt and use such a technology to better monitor and track their health or the health of a loved one.

Closing thoughts:
As Dishman points out in his post, too much is being put under the general rubric of mHealth. A clearer set of definitions are required to make sense of this market for today it is simply a mish-mash of terms extending from telehealth monitoring, which has been around for years, to novel apps on smartphones and the iPad to small, self-monitoring devices such as fitbit or even those devices that are embedded for say cardiovascular monitoring (defibrillator implants).  Even PWC in its report, decided against the term mHealth, instead going with Healthcare Unwired to express a more encompassing view of the technology advances/capabilities arriving in the market.

But are we really doing anything breath-takingly new?  On the technology front, not really, though the hype will have you think otherwise. Where the new really comes into play is in how will these mHealth/Health Unwired technologies affect the practice of medicine and the the delivery of care?This is where the real revolution will occur. This is where it gets interesting. So let’s not get so ga-ga over the technology, let us cool the hype-cycle and get down to the real business of understanding how these technologies will impact the delivery of care, the cost of care and the models of reimbursement, be it to the consumer, the physician, or the hospital.  Now that is something to get hyped up about.

Giving Credit: Thanks to asymco for the great figure charting music vs app sales on iTunes.

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