mHealth to Transform Healthcare: Can Pharma Compete?
David Doherty is the co-founder of 3G Doctor, a service providing documented mobile video consultations with registered Doctors.
David speaks to eyeforpharma ahead of his presentation at the Value-Added Services Conference 2014. As one of the first to realize the opportunity to use mobile technology to improve access to healthcare, David believes that for further mHealth adoption to take place, pharma needs to pursue radical change focused on aligning incentives with outcomes and handing over more control to empowered patients.
Since last year's Value Added Services event, how far has the pharma industry's participation in mHealth initiatives progressed?
Participation has grown massively. In the last couple of years, pharma has realized that this is their future business model and there is already an abundance of quality apps designed to add value. Samsung recently announced that they acquired a biosimilars company for $2bn and while this is a drop in the ocean for a tech firm with a $10B/pa R&D budget it should be a warning for pharma because Samsung has been very clear that it doesn't enter new markets unless it fully expects to be a leader. It's clearly a time of great change when the biggest rival to your pharma brand might not be an existing competitor but rather a mobile phone brand.
If pharma brands don't transform, I have every confidence that mobile phone giants will cannibalize them just like they did with consumer brands – like computers, watches and music players – in the last 'Nokia' decade.
When you realize the amount of data mobile telecoms companies are gathering, you realize they are in a very different position and that this enables very different opportunities to personalize healthcare delivery. If pharma brands don't transform, I have every confidence that mobile phone giants will cannibalize them just like they did with consumer brands – like computers, watches and music players – in the last 'Nokia' decade.
Who is making the most use of mHealth –pharma, physician or payer?
Patients are doing very well. For example, instead of making pointless journeys to pharmacies to get prescriptions or repeats, they are increasingly getting them through their mobile phone. That's obviously a great help if you have a physical disability and/or are trying to keep down a job. In addition, mobile connectivity allows you to turn pure data into the actionable information that patients need to make better health choices. For example, through the service supporting a seamlessly connected glucometer, an endocrinologist can set guidelines that suggest to a patient what they need to do – such as take a 10-minute walk - at a particular moment in time based on their blood sugar levels.
Health and social care budgets are struggling to keep up with the rising demands and cost of diabetes care, so this is the first area where new approaches are being scaled. Apps and patient communities are providing the engaging experience patients want and mobile connected glucometers are ensuring the advice is being generated by accurate blood glucose readings that are being reliably collected.
Giving patients and carersa more engaging experiences has already been shown to help employers in the US reduce their healthcare spend. Even a slight improvement in the way employees manage their blood glucose leads to a reduction in hospital visits, days off sick and complications such as amputation or blindness.
For many large companies, such as General Motors, the biggest cost they have is healthcare, so mHealth can have a massive impact on their bottom lines. With thousands of diabetic employees, there’s an obvious business case for connected glucometers, which help patients to more effectively manage their health. It means we can move on from the idea of having two office visits a year and start seamlessly collecting data and using it to provide actionable information when and where it's needed.
Pharmaceutical retailers are also benefiting. In the US, Walgreens is already reporting that the company generates $325 million per month from the company’s mHealth services. Mobile connectivity also saves pharma lots of money because it enables tracking, which ensures they don't have stock sitting on shelves going out of date etc.
Other major beneficiaries are mobile operators, as they are required to provide the seamless connectivity that can transform the medical device experience.
What are the most obvious benefits of mHealth for patients and how do these benefits correlate with those for physicians and payers?
One of the major benefits is being able to interact with a personal device you carry all time. When patients were given the opportunity to access medical records online, via desktop computers, there was little uptake. Mobile presents a convenient, personal proposition, which is more attractive to patients. When Boots or Lloyds Pharmacy connect with patients via SMS, they get a good response. Similarly, if the hospital texts you asking “will you be attending your appointment tomorrow at 2:30pm?” for example, it's very easy for you to reply “…No I can't make it” so that the hospital can cancel the appointment and give it to someone else.
A lot of people still think that mobile is a small form of the internet that you can pocket, but it's key to appreciate that mobile is very different from the Internet. Mobile is the newest mass media; just as different as previous mass media were from one another - i.e. the PC compared to the TV, the TV to radio and the radio to newspaper.
History offers similar examples of this kind of cognitive bias.The first cinema adverts, for example, were a combination of a radio advert played on speakers and a newspaper advert shown on the screen. Understanding the unique attributes of a new mass media is critical in order to leverage disruptive opportunities. This always takes time; it took decades until the media entrepreneur Ted Turner arrived to capitalize on the big difference between the Cinema and TV with his rolling news channel.
Seamless connectivity, as with consumer devices like the Kindle, can now be embedded in things such as weighing scales and medical devices.This is opening up huge opportunities for healthcare providers: when monitoring patients with gestational diabetes, hospitals will find a large majority of them have smartphones and tablets, but they're not yet leveraging them to help the patients. When they educate patients and give them a glucometer, many will go home and use it perfectly, returning in two weeks with a complete diary and having made some important diet and exercise changes. Others, however, won't manage to monitor themselves as easily; forgetting or choosing not to use the device, missing appointments, attending without their diary or even adding fictitious entries to their diaries in the carpark outside the hospital to appease their doctors.
We could transform things by providing the patient with a connected glucometer and installing an app on their phone. This will give them far better access to the information they need as well as an engaging experience using technology they are very familiar with. Hospitals can set protocols too, for example, if a patient doesn't test within the first 24 hours, they receive an automated message from their endocrinologist asking if things are okay. If a patient is struggling to manage their diet, a nurse can video call them and if things still aren't improving a community health worker can arrange to visit the patient in their own home, to help them with personalized nutritional advice.
If you tried to provide this type of hands on monitoring to every patient it would be far too expensive for hospitals to even consider. However, when you use data to identify and stratify the needs of patients, the business reasoning becomes very clear. Down the line it will reduce the number of people that will need major surgery, reduce complications with birth and reduce hospital days.
Many hospitals still operate like hotels and find it challenging to adopt practices that move services and care outside of their buildings, even if they are highly cost effective. However, there are some disruptive new models arising. For example, big insurers are starting to pay for health outcomes rather than just patient management. When the incentives are aligned, we've got incredible opportunities to use mHealth to improve outcomes for patients.
Talk a little about integrated health. Why is this new model gaining ground?
We don't yet have integrated healthcare, partly because healthcare isn’t documented. When you go to the doctor, you don't typically get any written information supporting the interaction and giving you guidance. Most patients don't even get to share information with their doctor until they walk into the consultation room. Instead we have a model where doctors try to collect information and somehow answer everything in three or four minutes. This model poorly serves chronic diseases in particular, where a large proportion of healthcare budgets are being spent. Patients with chronic diseases aren't going to the doctor for a cure but to get help managing their health. This can't be achieved with one or two interactions a year that last for ten minutes.
Part of the solution may come from dropping our belief that patients need everything done for them. Patients are perfectly capable of using well-designed questionnaires to give their own medical information. Given that they are most incentivized to do so I think we should look to patients to help their carers document their own care, for example by tapping details in to an iPad in the waiting room. By doing this, we can also avoid waste in the system. Many patients are going to see physicians when it's not necessary and a brief look at their concern instead would be enough to refer them directly to a specialist.
Ultimately, a lot of healthcare delivery is completely undocumented and out of date. I think we should look more at how other industries are using mobile technology and translate best practices into the way we design services for patients and carers.
David Doherty will be speaking at Value Added Services 2014, September 17-18, London. For more information on his presentation, click here.
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