mHealth is currently being billed as the magic pill that will transform the provision of healthcare services on a global scale. Described in the US as 'the biggest technology breakthrough of our time', advocates claim that mobile technology can help engage patients, improve compliance, support preventative care models and lower healthcare costs by reducing avoidable hospital admissions. But commentators fear that, in an evolving marketplace with few proven business models, mHealth could yet represent more 'technology-led hype' and expensively fail to deliver its promise. The pharmaceutical industry could therefore be forgiven for being characteristically cautious about the 'next big thing'. But that's not quite the case. The industry is trying hard to harness the potential of mobile technology. But is it doing enough?
The mobile technology market is currently in rude health. As the myriad of healthcare infographics attest, professional and consumer use of mobile media and uptake of healthcare apps is growing exponentially. The number of healthcare app downloads increased by almost 200 per cent between 2011-2012 and continues to grow. Alongside this, payers and prescribers alike are increasingly recognising the potential of mHealth, with more than 60 per cent believing it will inevitably become an important part of healthcare provision in the near future. Data suggests there are currently more than 30,000 health, fitness and medical-related apps available for smartphones and tablets. These range from apps to monitor blood pressure or track sleep patterns, to those supporting diets, improving patient compliance or providing information to help manage medical conditions. A recent study showed that 31 per cent of global payers provide funding for drug adherence and health-related communications to patients, and 40 per cent encourage patients to allow doctors to monitor them using mobile healthcare services.
The delivery of healthcare services is changing and mobile technology is in the vanguard. Or as PwC puts it: “The growing pervasiveness of technology is enabling the emergence of a new, more patient-centric healthcare value chain. As a result, conventional business models, which typically place consumers at the periphery, may soon no longer apply.”
So can the reality match the rhetoric? And, more specifically, as the revolution gathers apace, where is the pharmaceutical industry in all of this? True to form, it's thinking about it. A growing number of companies are dipping their toes in the mobile waters. At the same time, the wider industry is collaborating with stakeholders from across the mobile market to develop a European roadmap for mHealth. EU MovingLife will shortly publish a blueprint to accelerate the widespread adoption of mHealth solutions by 2025. Earlier this year, a joint report by mobile operators' association GSMA and PwC predicted that mHealth will become a key enabler of healthcare delivery, reaching every corner of the globe by 2017. It forecast that Europe will account for the most mHealth sales in the next five years ($9.6bn).
So what of pharma? Refreshingly, it's noticing the opportunity and trying to exploit it. But is it getting it right? Duncan Arbour, European digital strategy lead, InVentiv Health, thinks progress is being made, but pharma can learn much from the mobile industry itself. “It's not that long ago that mobile was thought of as an emerging 'third screen' behind TV and the PC,” he says. “But now, for many people, particularly in emerging markets, mobile is very much a first screen – and it's a screen that pharma's rushed headlong to have a presence on in the form of health-related apps. But the promise of mHealth is less about the presence of a screen in a patient's pocket than it is about a SIM card in their pocket connected to an increasing number of portable, wearable and interlinked sensors. But I don't think this is how much of the pharma industry is thinking.
“Consider two current initiatives that could be grouped under the mHealth umbrella. On the one hand you've got an organisation seeking to improve children's understanding of genetics via an app-based game in which a mutant cheese takes over San Francisco. On the other you've got an organisation offering a $10m prize to crowdsource a solution to use mobile devices to capture key health metrics and be able to diagnose 15 conditions, without the need for any medical expertise. Basically, to develop a Tricorder straight out of Star Trek. The app-based game – 'Ralph's Killer Muenster' – is brought to you by the pharma industry in the form of Genentech. The dream of a Tricorder comes from the mobile industry itself,” Arbour says.
“It's obvious which of these two industries has a better handle on the transformative potential of mHealth. The sooner pharma moves its mobile conversation beyond screen-based sales and marketing support to SIM and sensor-enabled innovation in areas such as homecare, adherence and remote monitoring, the better. Likewise, in terms of smart sensors and connectivity, there are opportunities to accelerate and improve current processes around clinical trial recruitment, management and patient reported outcomes. The clinical environment is increasingly seeing intelligent use of digital, and mobile is at the heart of much of that innovation.”
So what does the mobile industry think? Benjamin Sarda, head of marketing, Orange Healthcare, believes pharma is still battling to distinguish between incremental and disruptive innovation – and is at present developing tools that fall on the wrong side of the revolution. “At the moment, mHealth is the disruption of digital health. We started working on digital health because we wanted to lower costs and be more efficient – and we moved to mobile because it was simple and it triggered a new kind of innovation. Everything in digital health was incremental innovation; we didn't bring in any new usage. But with mHealth we see patients and HCPs doing things that they didn't do before and finding new ways of delivering healthcare.
As long as pharma companies insist on working alone, they risk missing out on innovation
“In digital health there are three kinds of incremental innovation. Firstly, what we do for healthcare professionals (HCPs); for example delivering services like cloud computing for medical imaging. Secondly, there is remote management, where HCPs follow up on patients using, for instance, call centres. And finally there's prevention; online communications that provide information that empowers patients to manage their lifestyle and health.
“When you go mobile, all three of these markets completely change. For example, as soon as medical imaging is available on smartphone or tablet, people rush to it because they want to be able to work from home. In remote management, mobile phones, rather than call centres, are used to follow up with patients – engaging with them across devices they're familiar with. And in prevention, it's possible to SMS an entire country to broadcast health information to help prevent disease. 'Text to Change' is a great example of this. But in truth, all of these things are still incremental innovation. We're doing the same things we did ten years ago, only we do it mobile.
“But mobile can become disruptive. For example, in pharmacies, using a smartphone, patients can scan a data matrix code that will calendarise reminders to take their medication; this is not only changing the pharmacy model, it can help ensure patient compliance. Moreover, you can have a therapeutic application on top of it that will enable companies to deliver more services around the drug. Pharma marketers are beginning to think about how they can leverage smartphones to develop differential packages of care around their products.
“mHealth is also being used in pharmaceutical distribution to secure the supply chain and, in the battle against counterfeit drugs, help verify product authenticity in real time. And it's also changing the way device manufacturers work; in France, SIM cards are being inserted into devices such as sleep apnoa machines to monitor whether patients are using them. This not only helps companies understand – and respond to – why patients aren't wearing their masks, but it also has economic advantages. If patients prove not to be compliant with the device, their national insurance plan funding is withheld.”
And efficiency is certainly a key driver. GSMA estimates that mHealth could deliver nearly €100bn in cost savings to the EU by 2017, adding more than €90bn to the region's GDP. This is clearly a version of reality where the real opportunities lie somewhere well beyond mutant cheeses or 'me too' calorie logging devices.
The general consensus appears to be that, despite the obvious potential of mHealth, pharma is not yet optimising it in a disruptive way that will transform healthcare. Many companies are trying to do it by themselves, but end up developing small, complex proprietary solutions. But innovation will come from openness and the ability to integrate information from all stakeholders.
“As long as pharma companies persist in working alone, they risk missing out on innovation,” says Benjamin Sarda. “Work collaboratively and openly with partners that can help you develop things quickly. And crucially, talk to your end-users. One company recently launched a proprietary solution – for iPhone – for the management of patients with a particular chronic disease. It failed. Why? Because they subsequently found out that the majority of their target users don't have iPhones. If pharma starts to work with companies that are aware of the mobile market, they can easily avoid that mistake.”
Until companies collaborate – with patients, other industries and fellow pharma organisations – mHealth will almost certainly fail to match the hype. But the industry should not retreat into its traditional shell. “I suspect that right now mHealth is still somewhere at the peak of inflated expectations at the start of a classic technology hype cycle. But that doesn't mean it's too soon to start investing in a proper understanding of its potential,” says Duncan Arbour.
“We might not wake up tomorrow to find that smart devices and sensors have meshed and tied us all in to an intertwined internet of things and an internet of people, but it seems inevitable that this type of future is on the horizon. The industry needs to understand its role in this world before it's too late. This means looking at new relationships across all areas of the value chain. Mobile network operators, device manufacturers and innovative new start-ups are going to be vital partners for industry.
“Pharma managed to miss much of the potential of the web. Let's not see it miss the potential of mobile too. You need to be thinking about how your business is geared up to identify, validate and partner with new players who can shift your mHealth focus beyond the app store and onto the growing store of health and outcomes data that connected devices have the promise and velocity to deliver.”
It's time to get upwardly mobile.