M-health offers great potential if someone's willing to fix the system

As high-level executives of healthcare companies, telecommunications firms and multinational nongovernmental organizations were on stage at the Washington Convention Center predicting wonderful things for healthcare thanks to mobile and wireless technologies, many of us in the audience at the mHealth Summit were shaking our heads, asking questions among ourselves and making the occasional snide comment.

All this, of course, is supposed to happen "in the next five to 10 years."

If you read my column in yesterday's FierceHealthIT, you'd know that people were making similar predictions, well, five to 10 years ago. I've been covering healthcare for exactly 10 years and one month now, and I remember in my early days on this beat hearing how PDAs were liberating physicians from their desks, giving them up-to-date information in the palms of their hands and allowing them to capture all relevant charges right at the point of care to maximize revenue in a difficult reimbursement environment. A couple of years later, I saw a pre-release demonstration of the Windows tablet PC and was rather amazed.

But the battery power wasn't good enough, the units were too big to fit in the pocket of a lab coat and, above all, the early touch-screen tablets were simply too expensive. We now live in the era of the smartphone, the iPad and wireless home monitoring. At least one vendor at the mHealth Summit told me the Samsung GalaxyTab would be the "iPad killer" in healthcare because it runs Google's Android open-source operating system--complete with open application programming interface that some think will help Android overtake Apple in the realm of mobile apps--and the high-resolution screen is 7 inches diagonally, just the right size to slip into a coat pocket.

Plus, some versions of the Galaxy can take a SIM card for full mobile telephony. (Sprint's has one. Verizon Wireless' doesn't.)

There was a lot of gawking over hot, new technology like this at the mHealth Summit, but skeptics rightly abounded. John Moore of Chilmark Research, who sat next to me during the closing "executive panel" session, had some pointed comments for the oft-repeated statement at the conference that mobile health probably would never become a market in its own right since nobody's found a sustainable, replicable business model for m-health.

"The question is not whether or not there is an m-health market, the question is: How will mobile technologies and devices change care delivery models?" Moore wrote on the Chilmark blog. "Mobile technology is not going away anytime soon and is simply becoming more and more a part of our daily lives, both personal and work related. It is rapidly becoming ubiquitous. Likewise, as I have said many times before, health does not occur when you are sitting in front of a computer, it is mobile, it is with you, it is you."

But the technology needs to deliver value, and Moore noted that with all the heavy hitters on the program, there weren't enough actual practitioners presenting at the conference. "Hopefully by next year we [and the organizers of this event] will have heeded the sage advice of Sangita Reddy, Executive Director of Operations for Indian healthcare powerhouse Apollo Hospitals Group, and not focus so much on the policies and politics of m-health, but the opportunities and operational aspects of m-health to improve the quality of life for all people," Moore wrote.

Health economist Jane Sarasohn-Kahn, who was not at the mHealth Summit, offered her own reality check by questioning findings of a new report from public relations firm Euro RSCG's Life 4D Group. "Now, the conditions in healthcare are ripe for breakthroughs in mobile technology and applications. The professionals in the domain are the 'low-hanging fruit' in the healthcare ecosystem. The next stages of development in mobile healthcare will be shaped by technologies that serve the needs of patients in healthcare," the report says.

"Not so fast, Euro RSCG!" Sarasohn-Kahn writes on her HealthPopuli blog. "Low-hanging fruit" may be easy to pick off, but who's looking at the issues of reimbursement and whether mobile technology actually improves workflow and productivity?

"For patients, available apps thus far have largely been wellness oriented. The big return for healthcare costs happens when apps empower activated patients who want to manage conditions--particularly among those people diagnosed with multiple chronic conditions and those with complex therapeutic regimens," says Sarasohn-Kahn.

"The mother-of-all-barriers to mobile app adoption isn't the lack of smartphones. It's patient activation and peoples' lack of interest in health engagement," she adds.

And for physicians, she says, incentives need to be aligned. I was sporting a rather incredulous look on my face when Dr. Richard Migliori, executive VP and chief medical officer for UnitedHealth Group subsidiary OptumHealth, spoke about how doctors won't make mobile technologies a priority until reimbursement changes to encourage adoption. Uh, Dr. Migliori, aren't you an executive for a payer? Why can't you just make the change? You'd be a market leader while everyone else tries to catch up.

Silly me. Easy answers never quite work in healthcare. - Neil