Who put the 'm' in mHealth? 

Keith Nurcombe

28 March 2014

mHealth is currently the topic of much discussion. The problem is nobody really knows what it is, and nobody’s defined what it is — everybody’s interpretation is different. So when you talk about mHealth services people immediately put it into a box according to their interpretation.

To some it involves electronic health records, to others it is something you do on a mobile phone. The problem I have with this is where do you draw the line? Does a standalone fitness app that records how many steps you take in a day count? How does that differ from an application that monitors a serious condition?

Others take a wider view, including anything health related that isn’t a traditional approach, something other than having an old fashioned face to face conversation with your doctor, for example a remote consultation with a doctor over Skype would be mHealth. It’s all very confusing.

All of the above probably are mHealth in the widest interpretation, but to me it’s just health. Take the ‘m’ off the front. We’re simply delivering health care in a different way.

The evolution of healthcare

The concept of delivering health support to a patient outside of a healthcare setting has gone through a journey. It started with the telephone, enabling patients to speak to someone when they had concerns. That took a step forward and became telemonitoring, which we now see as clunky, unfashionable, bespoke pieces of kit, hard-wired into a monitor the size of an old school tv.

We connected blood pressure monitors but they were hard wired through USB and provided very basic information back to whoever was monitoring you at other end. This was large, intrusive equipment for patients and it was also hugely expensive for health payers, not just in providing the equipment, but also managing installation, maintenance, logistics and support.

In the last year or two this has started to move forward and we have seen the introduction of much slicker, more manoeuvrable devices — tablets, mobile phones, laptops — that allow people to have more flexibility to move. But these programs have mainly provisioned devices, still require hard wiring in terms of broadband, and as a result hold similar expense for the payer.

The remote control to our lives

The real win-win for both health payers and for patients as I see it is to get to a place where you can use the patient’s own communication, health and lifestyle devices. Not only is the patient already familiar with it, payers are not required to purchase, provision and install the kit, and you scale back the level of support required. Initially this means mostly manual entry of data from external devices, glucometers, pulse-oximeters etc., but over time many of these devices will come with Bluetooth (or the next generation of connectivity).

This will be truly advantageous to the payer because the upfront systems is a minimal as can be, and will bring huge benefit to patient because they can be being monitored and supported, but don’t have to have extra devices.

I find this if have a work phone and my own phone — charge 2 phones, bring them with me — it’s just a matter of time before I forget one, or it becomes a hassle. Someone said to me recently the mobile phone is becoming the remote control to our lives — but you want that on a single device, how did we live before the universal remote!

I believe this model will bring phenomenal results for payers, but the benefit is only going to be seen if these solutions have low entry costs, and more importantly, the patient actually uses them — if the patient doesn’t use them there will never be return on investment (RoI).

Are patients ready?

There is a big misnomer being bandied around, that patients don’t want to or can’t use technology. This is nonsense, society is becoming increasingly tech savvy with a basic level of functionality — I don’t know how a computer works, and I certainly don’t know how to take it apart, but I don’t need to. I think this is wonderfully summed up by the study conducted using iPads for cardiac surgery. The patients were ’70-years olds on morphine’ and yet achieved 98% engagement using the iPad — this gives hope to us all!

To me the critical piece is ensuring the patient understands what the benefit is to them. If you ask them to use a new device, and put in readings they already take every day just because you’ll get some nice data out of it, the instinct of patient is “what’s in it for me?”.

But provide a solution that will show patients results, help them manage their care and better understand their condition. It will give the information they want, when and where they need it, rather than seeing a doctor every 4 months and walking away 6 minutes later realising they didn’t ask anything they had wanted to.

Allow patients to access that information and empower them to share it with caregivers, relatives or whoever might be in their circle of care. Put that to a patient, explain the only downside is to punch the blood sugar reading they already take each day into a phone, and the phone will remind you to do that, and it will tell you when you need to take your medication.

The market is still in its infancy, however there are some great examples out there to draw from. The Dept. of Veterans Affairs in US is probably the biggest in terms of patient numbers, provided excellent accredited data. In the UK the Dept. of Health Whole System Demonstrator (WSD), which ran for over year with over 10,000 patients, gave compelling evidence in terms of lowering of mortality and lowering of hospitalisation. So there is reputable early evidence that these kinds of remote patient monitoring programs provide RoI for patients and payers.

I’m also extremely excited by the prospect of the COPD (Chronic Obstructive Pulmonary Disease) program being rolled out in the UK by AstraZeneca and Exco InTouch. This is the first time I have seen full scale deployment of the truly mobile approach which I believe is the future. The program uses a light touch, connecting information across the patient’s own devices to monitor, support and empower patients to take control of their condition. It seems to be the right model that will provide clear benefits to patients with the low cost of entry that will give RoI to payers.

The secret is to make system link up, but not by owning it, but take existing pieces and linking them together to provide an integrated picture, tailored to each stakeholder. This will be the health model of the future.

Keith Nurcombe


To top