Finding an apt app

Experts agree that mobile devices will significantly impact healthcare and not just delivery of care as we know it today. How fast that will happen and how broadly are the unanswered questions.

“It's time,” says Bryan Sivak, the newly appointed chief technology officer at HHS. “From my perspective, and I believe the perspective of the department, mobile is a technology that winds its way through everything we're doing and we're planning to do—not on its own, but a channel to deliver content. As devices and sensors in a mobile context just become more common, it's just a great way for us to collect more real-time information and connect physicians and patients with each other.”

Mobile health technology, sometimes shortened to mHealth, was defined last summer in a report from the World Health Organization's Global Observatory for eHealth as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices.” Those devices use an array of messaging techniques, including short messaging service, or SMS; general packet radio service, or GPRS; a the global positioning system; short-range Bluetooth; and wider-range, third- and fourth-generation mobile telecommunications, or 3G and 4G.

Chilmark Research, a health IT market research firm based in Cambridge, Mass., recently estimated the U.S. market for what it described as mHealth tools and applications, or apps, used by healthcare providers and patients together, at only $8.3 million this year, but it will double next year and quadruple the next, as the effects of healthcare reform kick in. After that, Chilmark sees the mHealth market surging above $1 billion by 2017 (See chart).

Earlier this month, GlobalData, a New York-based market research firm, pegged the U.S. mobile healthcare market at $660 million in 2011, with software and services accounting for 80% of the spending. Roughly 30% of current healthcare applications are used by clinicians, to access or analyze patient information, their researchers conclude. The other 70% of apps are “consumer facing.” Worldwide, the mobile healthcare niche is expected to grow nearly 900% over seven years, from $1.2 billion last year to $11.8 billion by 2018.

By late 2011, according to International Telecommunication Union data cited by a recent PricewaterhouseCoopers analysis on mobile healthcare, nearly 6 billion of Earth's 7 billion people had mobile phone subscriptions, with U.S. cell-phone usage reaching about 275 million.

The PwC researchers found that consumers were far out front of providers in their acceptance of and demands for mobile health services, while developing nations were adopting mobile health much faster than in the U.S. and other more developed counterparts.

“The main barriers are not the technology,” but rather the healthcare industry's “inherent resistance to change,” Dr. David Levy, PwC's global healthcare leader, says in a statement accompanying the firm's report. “Though many people think mobile health will be ancillary or bolted on to the healthcare industry, we look at it differently” as “the future of healthcare, deeply integrated into delivery that will be better, faster, less expensive and far more customer-focused.”

But for now, “It's kind of like a wild, wild West in the mobile health space,” says Lee Perlman, president of GNYHA Ventures, a for-profit subsidiary of the Greater New York Hospital Association, which serves 250 hospitals and other care organizations in the metropolitan New York region. “We've tried to put some rationale to it.”

The subsidiary has invested $2.5 million in creating Happtique, a mobile health services platform for hospitals, doctors, developers and provider organizations as well as patients. It includes a mobile app management software system that enables hospitals and other provider organizations to control access to their electronic health-record systems by users of mobile applications.

It also offers a catalog of apps, sorted into more than 300 healthcare categories for easier searching. This online market will allow hospitals and other healthcare organizations a place to brand and sell their in-house developed apps, serving as a gatekeeper for apps used by their patients. It has a program under way to vet and certify applications for operability, privacy, security and content. (The public-comment period for the first round of mobile application certification criteria ends Aug. 17.)

Happtique also plans to launch a service enabling physicians to write their patients “prescriptions” for pertinent mobile healthcare applications. Patients can then go to the site and download to their smartphones or tablet computers a specific application to fit their medical or preventive healthcare needs. “We're looking at apps in a similar vein as drugs,” Perlman says. “They are pills of information.”

Perlman already has plenty of competition. According to marketing information for Happtique, 63% of physicians are using mobile health solutions that are not connected to their practices or hospitals.

MobiHealthNews, a mobile health market research company based in Cambridge, Mass., reports that in April there were 13,600 consumer health apps and an estimated 5,200 medical professional apps now on Apple's App Store. According to Brian Dolan, the firm's co-founder and managing editor, developers of mobile health apps for Apple devices typically release counterparts for phones and tablets running on Google's Android mobile operating system, either simultaneously or soon thereafter. “And if it's in the Android store, it's almost certainly in the Apple store,” Dolan says.

Yet another competitor is Orlando Portale, chief innovation officer at the San Diego-based Palomar Health, who oversees development of the health system's own mobile application platform under the working name of MIAA, which stands for “medical information anytime, anywhere.”

When the new 288-bed Palomar Medical Center opens Aug. 19 in Escondido, Calif., plans call for fully leveraging mobile wireless technology throughout the hospital. In September, it will launch a new program “tying in the mobile platform with next generation mobile devices,” Portale says. “We're partnering with some companies that are reinventing the physiological monitoring space. You have sensors on the body that capture physiological indicators and connect them wirelessly.”

The MIAA will connect mobile devices to a hospital's EHR and “as well as information coming from medical devices, ECG wave forms, all that stuff coming from monitors from a hospital. We'll push all that stuff out and allow physicians to access it in real time.”

Palomar has licensed its intellectual property on MIAA to Airstrip Technologies for sale outside its system, Portale says.

From the physicians' side, demand for mobile apps has not yet peaked, says Dr. Jonathan Bertman, founder of Amazing Charts, North Kingston, R.I., a developer of EHR systems for smaller physician practices.

“Yes, slowly and surely, there is a push for more mobility apps, and I believe in the future that will be stronger,” says Bertman, who was named Physician Entrepreneur of the Year in 2010 by Modern Physician, a sister publication to Modern Healthcare.

His company has a dedicated mobile app to access its EHR, but “the interest of existing clients is not quite there yet.”

Privacy and security concerns are still an issue for his customers, Bertman says, “The whole question that gets asked is the privacy issue. So often we hear about the breaches of the scale you just can't imagine.”

Health insurer Aetna recently received approval from Apple for an iPad application that runs on the 4G network. Aetna plans to launch the app in a few weeks, says Dr. Charles Kennedy, CEO of its accountable care solutions unit.

The demand is already here from people who are integrating smart devices into their everyday activities, Kennedy says. “They're seeing what's coming out,” and then turning to healthcare and saying, “I can do this stuff, why can't I do this other stuff.”

The new devices have raised the bar for EHR vendors, who no longer will be able to rely on Web browsers to connect mobile device users to their clinical systems, he says. They must develop mobile-enabled versions of their systems.

“Web-based products make the customer frustrated,” Kennedy says “They say, 'Why can't my experience be like on an iPad?' ”

He recently led a round table of 80 customers to preview the new application with attendees representing about 10,000 doctors. “The feedback that I got, the minute you get the iPad out, I will make that a mandatory device and I'll get the doctors to use it. Call me in six months. But my gut tells me that this technology is going to have a shift in the use of EHRs. I don't think doctors want to use keyboards and machines plugged into the wall.”

Picking one or two devices for use by the entire medical staff is one approach, but not the most common one, says Erik Westerlind, senior research director for KLAS Enterprises, an Orem, Utah-based health IT market research firm.

Westerlind says the mobile momentum is toward BYOD, or “bring your own device,” in which clinical staffers are free to use the smartphone or tablet of their choice.

In a recent survey of 103 hospital IT leaders about their mobile strategies, 72% reported they were using mobile devices on the corporate level. But of those mobile users, just 14% allowed only corporate-supplied and supported devices and only 28% indicated a majority of their devices were corporate supplied.

“A large majority of providers are dealing with 'bring your own device,' ” Westerlind says. Mixed use also applied to devices themselves, with Apple products in use by 93% of those with mobile programs, but Android-based systems also were used by 49%.

“A lot of providers out there are not using mobile device management software, but they are starting to get interested in it,” he says. Security measures, meanwhile, were “kind of all over the place.”

Sivak, HHS' technology promoter, has a tough act to follow, taking over from the high-amperage Todd Park, who was bumped up to White House CTO. Park catalyzed entrepreneurial interest in mobile healthcare applications with three annual Health Datapaloozas, developers' contests and other promotions. Sivak says that although he'll probably not use “awesomeness,” a favorite Park descriptor for all things health IT, quite as often, he promises to carry on with the same promotional zeal. “We're going to be doing another Datapalooza next year in late spring or early summer. We're already doing planning for it, and it's going to be bigger and better than the last one.”

The federal Office of the National Coordinator for Health Information Technology recently launched the Million Hearts Risk Check Challenge. It's a contest to develop a mobile app that can help a person find the nearest drug store to have blood pressure and cholesterol checked, capture that data and run a personalized assessment to calculate heart-attack risk. The app should assist in developing a plan to help a person improve heart health. The winning developer will receive $100,000.

How will providers and their systems integrate all of this incoming patient-supplied data and be able to act on it?

“That's the $64,000 question,” Sivak says. “If you talk to a lot of providers out there, they'll talk to you about patients coming into their office with the iPhone application tracking their diet and saying, 'This is new information about me.' The big question is how do we integrate that information back into the concept of a centralized record? There are a lot of smart people—within the walls of HHS and outside of HHS—thinking about that.”

For now, many leading IT vendors are doing a poor job of integrating mobile health apps into their systems. Neither they nor providers have figured out yet what to do with incoming patient-generated data, says Chilmark's founder and managing partner, John Moore.

“From a policy perspective, from a data integration perspective, I don't see EHRs integrating that information yet,” Moore says. “People talk about it, but I have yet to hear of anyone who has solved that problem.”