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Upwardly mobile

Wireless medicine is coming of age as mHealth connects patients and doctors virtually

wireless pointProviding patients with superior health outcomes at a time of fiscal austerity is a challenge for leaders across the globe. To do so against the demographic time-bomb of a rapidly aging population makes the challenge tougher still.

Wireless medical technology is an unprecedented opportunity. This fusion of healthcare applications and mobile telecoms has created mobile healthcare (mHealth), a set of services that remove the need for physical co-presence between physician and patient.

Emerging economies and countries with sparse and widespread populations were early adopters of wireless technology. Now the US and Europe are looking towards more IT-driven solutions to drive greater self care and deliver greater independence and quality of life to patients — especially those with chronic and long term conditions.

Most telehealth experts cite the US Department of Veteran Affairs (VA) as a pioneer in this area. Dr Adam Darkin, chief consultant for care co-ordination, says telehealth is a rapidly growing segment, expanding from 3,000 home patients in 2003 to a projected 69,000 VA home telehealth patients by the end of 2011. Between its three telehealth programmes, the VA manages around 300,000 patients each year.

In the UK, the transition from PCTs to GP consortia will encourage the mHealth trend. In Germany, around 15,000 patients are currently being cared for by telemonitoring and telehealth services. Roland Hueppmeier is brand manager for Bosch Healthcare and notes the increase in telehealth across the industry: "Conversation has moved on from 'Why' to 'When'." He predicts a growing demand for mobile systems with 'a gradual change towards higher mobility in the coming 10-15 years'.

The evidence increasingly supports this view. One of the most relevant German trials, Partnership for the Heart, has provided positive results for telehealth and, based on these, the reimbursement process is expected to be initiated with insurance companies for around 150,000 congestive heart failure patients.

Reimbursement has been a key barrier to adoption and the US has travelled furthest, fastest. McKinsey estimates that the US market for mHealth is about $20bn, and the global market is between $50bn and $60bn. Research firm Parks Associates says that US sales of wireless home-health technology will grow from $304m in 2009 to $4.4bn in 2013. However, Europe is catching up. In November 2010 UK Health Secretary Andrew Lansley revealed the Government was investing £31m in the world's largest trial of telehealth and telecare, involving over 6,000 people.

Patient benefits
Yet this is a movement based on genuine benefits as well as political expediency. It is about opening up new and better channels between patients and professionals, as well as wringing inefficiencies from the system.

In May 2009, billionaire Gary West and his wife Mary pledged $45m to establish the first independent non-profit research institution dedicated to wireless and mobile technologies in healthcare. The West Wireless Health Institute, in La Jolla, California, aims to cut healthcare costs by identifying, creating, validating, and commercialising wireless technologies to transform medicine.

mHealth employs wireless technology to enhance a whole series of services, from 'smart' bandages that record vital signs to GPS trackers that keep tabs on Alzheimer patients. This 'nana technology' will help improve the quality of life for older adults who otherwise might be institutionalised.

Combining existing medical devices (such as ECG machines, stethoscopes, or glucometers) with a mobile chip offers a unique growth opportunity for earlier detection and more meaningful intervention. Devices are appearing in a constant stream. The WristClinic by Medic4All, for example, measures seven parameters: blood pressure, one-lead ECG, heart rate, heart rhythm, respiratory rate, haemoglobin oxygen saturation, and body temperature. In this ecosystem, a mobile network operator authenticates, encrypts and relays data to its own server before transmission to a storage/analytics server.

Bluetooth 3 will introduce faster data transmission, and Bluetooth 4 offers a low-energy mode to enable communication with peripherals and sensors. This makes it an ideal fit for industries such as healthcare. The Littman Electronic Stethoscope relies on Bluetooth to transmit sounds in real time to a PC for analysis.

Industry experts are forecasting an explosion of health-related apps on smartphones. A recent study by the research2guidance group predicts the mobile healthcare market will grow exponentially to reach over 500 million mobile users (or 30 per cent of an estimated 1.4 billion smartphone subscribers worldwide) by 2015. Bill Gates recently validated this opportunity at the mHealth Summit, a conference for companies involved in mobile technology and health. He said: "Diagnosis of malaria and TB will likely be the first ones you can assign a number to and say without this mobile phone app these people would have died."

New applications will enable physicians to view and interpret radiology results any time, anywhere. For example, AirStrip delivers remote monitoring of foetal heartbeat and maternal contraction patterns to a physician's smartphone.

Increasingly too, mobile apps are improving the tracking and accuracy of clinical trials.

Human benefits
Steve Brown, creator of a home monitoring device, Health Buddy (now part of Robert Bosch), talks about 'connected health' in another way: not about devices, sensors, and gadgets but about how people connect with each other and the profound impact these connections have on their health. Connected health in this context is a much bigger idea than the original idea of telemedicine.

His 10-year-old Health Buddy is an interface between at-home chronically ill patients and their care providers. Some 30,000 patients connect remotely as part of their daily routine care. Patients can answer a series of questions about their health and symptoms, and receive information that helps them better manage their chronic conditions. Patient data gathered by the device is transmitted to a secure data centre so a professional can intervene before the patient's condition becomes critical.

Scotland too is seeing the human benefits and is also at the forefront of establishing mHealth in the mainstream. Its remote and rural areas have accelerated the adoption of telehealth: video conferencing is widely used in the Highlands, and teleneurology and teledialysis have reduced the amount of travel for patients and maximised the number of patients consultants can see in the time available.

NHS Highland consultant neurologist Dr Bethany Jones says communicating with patients is not affected by taking place via a monitor screen. Some patients have told her they prefer it as it is less daunting.

Business benefits
So how successful are we at marketing mHealth? Not very. According to a recent Digitas Health analysis, less than seven per cent of pharma consumer brand sites are classified fully mobile facilitated. This needs to change. Fear of change is the second barrier to adoption (alongside remuneration) and we need to demonstrate mHealth as 'all part of the service'.

Both physicians and patients place their trust in same-place consultations and long-term personal relationships. The key is to demonstrate that mHealth can enhance these relationships and establish an extra level of care. Marketing needs to recognise this.

People living with a long-term condition can benefit enormously from supported self care. They can live longer, suffer less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent. These benefits need to be set out clearly.

At Digitas Health, we are using the power of behavioural economics and the UK Government's Mindspace programme to inform our thinking. We recognise that people do not think logically about their own health and that sensitively designed choice architecture can help them. For example, when we place self-diagnosis tools in a patient's hands, he is likely to give disproportionate significance to more recent readings, or miscalculate the consequences of abnormal data. Patients tend to fret too much about uncertainty and fail to see the full picture. We are working to build applications that guide patients towards the most effective use of the tools provided.

Results can be impressive. South Yorkshire Barnsley Primary Care Trust has introduced the Bosch Telehealth Plus System to areas where 25 per cent of the population is living with chronic illnesses. Margaret Kitching, director of nursing and professions at the Trust, believes that 'people living with chronic conditions who are supported with telehealth are more likely to take control of their own wellbeing, such as stopping smoking, losing weight, take more exercise and looking after their mental wellbeing'.

The tools themselves can be used to nudge patients towards better self-treatment. Take for example Vitality GlowCaps, a SIM-chip-enabled pill dispenser. It's a great idea but it only works if the patient opens the box, so this year AT&T is introducing wireless connectivity for GlowCaps, sending visual and audio reminders to patients to remind them to open the box and take their medication.

The final point should go to my US colleague, Brendan Gallagher, senior vice president of emerging technology and channels at Digitas Health. Brendan fervently believes pharma has the opportunity to be more relevant at some of the most crucial moments in a patient's life — the point of diagnosis and the treatment decision.

"Being relevant and useful requires a deep understanding of the user at those moments and designing content to match their unmet needs. For chronic conditions, there are multiple opportunities for using mobile to connect people, track progress or help with adherence."

Let's do it
We live in a connected world. People of all ages — in almost all countries — use mobile devices to interact with the physical world around them, from payments (Square) to smart shopping (Red Laser) and location awareness (Glympse). The savviest businesses are picking up on this and redesigning their models with mobile in mind. Health is no exception.

In the digital space we are all empowered by mHealth. Physicians, patients, organisations, governments... the benefits will reach us all.

The Author
June Dawson is the managing director of Digitas Health UK

To comment on this article, email pm@pmlive.com

1st February 2011

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