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Thursday, July 08, 2010

Hippocratic Oath - mHealth; Hey it's Free!!!

Though there are a different set of audience and different kinds of mHealth services that are already monetized, it goes to show that for health related services, the initial adoption has to be driven by making it free. Once the user sees value in the offering the willingness to pay will also be there.

Does mHealth really need to be free?
Wednesday - June 23rd, 2010 - 11:00am EST by Brian Dolan | 3GDoctor | AT&T | Center for Connected Health | iPhone | mhealth | mobile health | Partners Health Care | SMS | text messaging | Text4Baby | Verizon Wireless |
By David Doherty, Business Development, 3G Doctor
Rob Havasy, a Business Analyst and mHealth Strategist at the Center for Connected Health, has posted a somewhat confusing article entitled “The Uncertain Price of mHealth.”
The basic premise is that the move from flat rate unlimited data to tiered data plans is something that “will surely impact smartphone use in mHealth.”
The article goes on to explain that data caps introduced by operators (who are rapidly losing interest in supporting Data Hogs who are eating up >2 GB per month) “throws uncertainty into the equation and will cause patients to reconsider embracing mHealth solutions and providers and payers to hesitate paying for them.”
As a basis for this argument Havasy explains that “until patients can be reassured that adopting an mHealth intervention will not incur additional, unexpected costs, they will be reluctant.” Doesn’t this fail to achieve a rather basic prerequisite of good business — that you offer services that customers can see value in and are prepared to pay for?
Havasy seems to be all at sea when it comes to appreciating the cost of data vs. SMS. Indeed mobile data services offer much better value than the “simple text messaging program” Havasy’s team recently offered to a population of young patients (of whom 20% refused to even consider due to the cost of SMS) eg. in comparison to mobile data plans of 2GB per month for $15, text messaging “penalties of only 25 cents per additional message” could be regarded as extortionate!
Havasy goes on to explain that after speaking “with colleagues and with other people in the mHealth field… we all agree on one thing: unless we can tell a patient that our program is absolutely free to them, adoption is an uphill battle.” Havasy then justifies this by suggesting that the underperforming Text4Baby program offers unequivocal proof for this.
“One of the central features of the program is that, in conjunction with the CTIA (the Wireless Industry Association) and the major American cellular carriers, messages are delivered free of charge to the user. This was considered a requirement for the program’s success – why should we think differently for other mHealth interventions?”
What’s convincing Rob and his colleagues at the Center for Connected Health that patients aren’t prepared to pay a single dime out of their own pocket for a service that makes their care experience better?
The final paragraph is a call on operators: “If the carriers are listening, please, give us fixed cost plans. Make it simpler – not harder – to figure costs and I’m sure you’ll be rewarded. The inevitable result of these pricing changes will be a shift away from the smartphone (and consumer data plans) as an mHealth platform and a shift towards more dedicated devices with embedded connectivity (think Amazon’s Kindle). Negotiated data rates and plans by device manufacturers can provide the cost certainty the market needs. Unfortunately, this will come at the cost of the rapid and innovative development made possible by smartphone platforms. The Center for Connected Health continues to investigate both dedicated and smartphone platforms for mHealth solutions, but the predictable costs associated with dedicated devices are very attractive for near-term deployments.”
Surely there’s a better answer to this than calling on operators to offer unlimited data plans? Which patients need to send 10GB of data a month anyway? Why isn’t Rob and the CFCH celebrating the opportunity that these more value conscious data plans offer?
Wouldn’t it actually be unfair if mobile operators retained their unlimited data plans so that patients (who wanted to use mobile data to improve their care experience) were faced with expensive data plans because they had to subsidise the mobile data usage of other more data intensive users?

Hippocratic Oath - mHealth; Time to DEFINE mHealth

mHealth threatens to evolve to a USD 19.5 Billion industry by 2015. But considering the fact that it is still in its infancy, there are confusions regarding clear definitions of mHealth. Currently, due to lack of a proper definition, anything from a health related service delivered on a device to a downloadable health app to a mobile device that can record or transmit patient data is treated as mHealth. It’s time that the regulatory bodies woke up to the looming evolution of mHealth and clearly define what constitutes mHealth and what doesn’t and also to put in place much needed regulations around technology’s newest billionaire (potential) infant. Read on…

It’s mHealth but will it be a Revolution?
Friday - June 25th, 2010 - 06:51pm EST by Brian Dolan
By Jon Linkous, CEO, American Telemedicine Association
The funny thing about “mHealth” is that it has taken on such a cult-like status among investors, industry and the media. Certainly the potential for the use of mHealth in the delivery of healthcare is huge and it may have an impact on other parts of healthcare such as chronic care management, emergency response services and the role and responsibilities of the consumer in their own health.
The market for mHealth is still in its infancy. There is still confusion about all that is encompassed in the term. It may include a mobile device or a service using mobile technology. The devices include an array of products and services that use mobile, wireless technology: cellular phones, wide-area, local-area and personal networks. These use different parts of the radio spectrum, different standards and protocols and different levels of signal strength or power. Generally the term mHealth does not include the use of satellite technology.
Some parts of mHealth are devices and services focused on direct consumer purchases and use. For example, the vast majority of the 6,000+ health-and-wellness smart phone applications are designed for use by consumers. However, when measured by dollar volume, these applications are probably smaller than other mobile devices and services aimed at the use in the traditional healthcare system.
The wide-spread media attraction in the mHealth market is because it’s new and it’s fun. It is still a bit of a Wild West atmosphere with new ideas and crazy applications coming up every day. Some include incredibly smart and exciting approaches to solving age old health care problems; others appear to be solutions in search of a problem. The investment money is flying out the door. Although there is a positive growth in sales, almost all of the mHealth companies or divisions have not yet made a profit. It reminds me a bit of the dot com (sometimes called the dot bomb) market of the 1990s. Certainly at this point mHealth is close to the top of the “hype cycle” (as described by Gartner, Inc). There are new associations and think tanks devoted to the subject, academic and commercial conferences galore. We are approaching the cycle’s “Peak of Expectations.”
For those on the sidelines it makes great fun. For developers and investors it is much more serious. It is a bit like a game of musical chairs. Most of the mHealth ventures are hoping to be bought up or merged into another, larger venture. At some point the music, or the outside funding, is going to stop (as we enter the Trough of Disillusionment) and those ventures not bought out or turning a profit will be in trouble.
But here is an important point – mHealth is not a stand-alone market. It is part of a mature, two trillion dollar healthcare business. To be successful, mHealth devices and services have to understand how the healthcare market operates; how it is funded and regulated; and, most important, how buying decisions are made. Developing a way to use a mobile device to measure blood glucose and send the data to another location may be interesting but is not nearly enough.
Further, relying on consumer expenditures for mHealth is probably not the answer for most such ventures. Out of pocket expenditures for healthcare in 2008 were a little below 12 percent, following a steady decline of over fifty years. This still represents a lot of money but it describes a public expectation that insurance, private or public, will pay for almost all of health care. Efforts to have consumers get more “skin in the game” will have only limited success when consumers are not even paying for their own drugs or eyeglasses anymore. Even the use of Flexible Spending Accounts will be restricted or eliminated as health reform is implemented.
Therefore, to recognize the benefits and opportunities offered by mHealth applications for healthcare delivery, they need to be incorporated into traditional healthcare financing and services. Surprisingly, despite the huge increase in health expenditures, the place where health dollars are spent has stayed relatively the same. Hospital care continues to be roughly one third of expenditures, physician services at about 20 percent and prescription drugs about 10 percent. Home health constitutes about 2 percent of national expenditures. What is changing is the source of these funds and who controls the spending. Accompanying the decline of direct consumer expenditures is the growth of public funding. On the horizon are more comprehensive regional healthcare networks with a broad authority to provide integrated, comprehensive care. This will dramatically accelerate with health reform.
The point of all of this is that the success of the mHealth revolution in the United States is directly linked with developments occurring in broader health reform and how mHealth applications may be an option for use in such developments as Accountable Care and Independence at Home initiatives. Such change is coming fast, really fast. In three to five years we may see an incredible change in the way various organizations are involved in health care delivery. It will be interesting to see how much mHealth is picked up and integrated into these changes.
Finally, assuming mHealth becomes recognized as an important component of mainstream health delivery, regulatory oversight is sure to increase. The Food and Drug Administration has played it light so far but the agency’s role in reviewing and approving mHealth devices may grow. Similarly the Federal Trade Commission, Federal Communications Commission and all of their counterparts in other countries will also soon take notice and start similar regulatory oversight activities.

Hippocratic Oath - mHealth; Mobile Marketing for Pharma Companies

I would say that this would be a skewed mindset to look at opportunities. Opportunities for mobile marketing for Pharma might actually start in the emerging markets a lot earlier than the emerged markets.

Text4Baby 50K; Microskia trial; Mobile pharma

Friday - July 2nd, 2010 - 12:01pm EST by Brian Dolan | cell phone microscope | e911 | HealthEd | Microskia | mobile health marketing | Pharma mobile health | SMS | telemedicine | Text4Baby | UCLA |

Mobile marketing for healthcare not a strong opportunity yet: Pixels & Pills has a short and sweet interview with Manhattan Research’s Monique Levy that is well worth a read: “The opportunity for healthcare marketers to leverage mobile marketing for patients in this time frame is comparatively less strong. As with PC-based access, patients predominantly use mobile devices to look for health information today; relatively few have or are interested in using tools or services to help them manage their care or benefits. What’s more, adoption and interest in health mobile activities skew towards younger age groups, which typically have a lower incidence of chronic conditions.”

Cell phone microscope trial nears: Microskia, a startup out of UCLA is set to begin trials in Africa later this year. Microskia created a $10 1.5 ounce microscope peripheral out of off-the-shelf components. The invention won numerous awards from foundations and the NSF, which have helped fund the forthcoming trial.

Telemedicine coupled with E911 saves lives: PDX pharmacy customers can now enable customers to manage prescriptions via their mobiles: PDX and mscripts announced a deal that will enabled PDX Pharmacy System users to communicate with their patients through their mobiles. PDX counts 10,000 retail pharmacies as customers in the US.

Pharma opportunities: The folks over at HealthEd have a comprehensive and well-written feature on early opportunities for pharmaceutical companies in mobile health.

Text4Baby cracks 50,000 users. (It actually said 50,000 women, but out of curiosity in January even I subscribed to the free service. I suspect I’m not alone.)


Interview with Manhattan Research’s Monique Levy
July 1st, 2010 •

As Senior Director of Research at Manhattan Research, Monique Levy focuses on consumer and physician eHealth trends and marketing strategy. Prior to joining Manhattan Research, Levy was Senior Analyst at JupiterResearch for six years, leading their health coverage. She also applied her health psychology expertise at, managing community and providing strategic and research support to the executive team. During this time, Levy produced an award-winning cognitive-behavioral learning and multimedia tool for weight management. She also worked on environmental issues at the World Bank and was a fellow at the Pan American Health Organization. Levy has been quoted in major media outlets such as The Wall Street Journal, NPR, and The Economist as well as other trade media including MedAdNews. Today, Pixels & Pills talks to Monique about current digital trends in the healthcare community.

By Kimberly Reyes (@CommDuCoeur)

What can healthcare marketers learn from recent trends in mobile usage, among both physicians and patients?
On the physician side the first thing for healthcare marketers to grasp is the extent of smart mobile device adoption. Our recent Taking the Pulse® v10.0 study shows that almost most three quarters of physicians own smartphones and many have a second smart portable device such as an iTouch or eReader. Another finding to which healthcare marketers should pay attention is that physicians are as likely to use browsers to find information on smartphones as they are to use apps – which means marketers have to look into mobile optimization of websites in addition to app development. Last, while physicians predominantly use smartphones to search for information and communicate today, strong growth in other activities such as patient monitoring, patient record keeping and learning are expected in the next 18 months.
The opportunity for healthcare marketers to leverage mobile marketing for patients in this time frame is comparatively less strong. As with PC-based access, patients predominantly use mobile devices to look for health information today; relatively few have or are interested in using tools or services to help them manage their care or benefits. What’s more, adoption and interest in health mobile activities skew towards younger age groups, which typically have a lower incidence of chronic conditions. Nevertheless, the personal, private and ‘always with you’ nature of smartphones, make them an ideal platform for condition and health management, so mobile health will likely grow in the midterm as mobile health products and mobile devices improve.

Can you briefly explain physician attitudes towards eHealth and ePatient communities?
Myths of physicians being intolerant of patients bringing in information from the Internet into consultations still persist even though we’ve found no evidence of this attitude in our research over the last few years. In fact, only about 1 in ten physicians say that patients referencing such information harm the relationship and the majority of physicians say patients are more informed after doing their online health research. At the same time, physicians are a bit wary of recommending websites and other online resources to patients, mostly because they can’t always vouch for them.

How is the healthcare community currently using social media, and what are some noticeable trends for 2010?
Physicians are very comfortable accessing content other healthcare professionals have created online for example on blogs, message boards, YouTube, and other websites. However, they have adopted closed professional communities or networks at a relatively slow pace mostly, according to the survey, because they haven’t had time to set up their profiles and become members of these services. The data suggests it’s much easier for physicians to stumble across professional user-generated content as they go about their regular online research than to go and log in to another dedicated resource. However, adoption of closed physician social networks may accelerate as these services evolve and provide exclusive content and other value-added services that make the extra step worthwhile.

Hippocratic Oath - mHealth

Disappointing news for someone who came in with a lot of promise. I can foresee kneejerk responses to this already. For starters the developed markets will look at regulating these devices in a more efficient manner than they are handled today (more so under healtheconomics and the FDAs). Secondly the bubble of mHealth will shrink in the minds of analysts. However, what is promising is that these regulations will move the drive for innovation out of the developed markets in the longer run leading to a lot of potential for innovation in emerging and less regulated markets.  

United Healthcare: CardioNet is “unproven”

Wednesday - July 7th, 2010

More bad news on the reimbursement front for CardioNet and other mobile cardiac outpatient telemetry service providers: United Healthcare told the company that it is maintaining its position that “outpatient cardiovascular telemetry is unproven for managing cardiac arrhythmias” and as a result it will not cover the service for its members. CardioNet, of course, disagrees and promised to continue to work with the payer to demonstrate the efficacy of its MCOT services.
The update from CardioNet about United Healthcare’s continued stance follows a similar move by the nters for Medicare and Medicaid Services (CMS) that proposed last week that the technical component of mobile cardiovascular telemetry (CPT Code 93229) remains carrier-priced for calendar year 2011.
Highmark CMS originally paid $1,123.07 for MCOT services when the CPT code took effect in early 2009, however, by July Highmark CMS announced plans to reduce the reimbursement rate substantially. On September 1, 2009 a new rate of $754 per service, a 33 percent reduction from the original $1,123, took effect. CardioNet was disappointed: “This surprise decision by HMS on July 10, 2009 must be readdressed and not be allowed to put at risk either the investment in new technologies or the benefit to the patients we serve,” the company wrote in a statement.
Since then the company has had to tighten its belt and cut operations costs to adjust for the lower reimbursement rate. The news that United Healthcare, one of the largest payers in the US, maintains its policy on not reimbursing for CardioNet’s services certainly points to the climate of wireless health reimbursement today.

Friday, July 02, 2010

The Four Legged Inhabitant

Circa 3500 AD. 

Captain's Log: 
Day 365: Closing in on a yellow star. Looks like there are terrestrial bodies circulating this yellow star from our research on the star. 
Day 380: Went past an asteroid belt between giant planets. Minimum damage to the space shuttle. 
Day 384: Closing in on the 3rd rock from the yellow star. This is from where our scientists had deciphered a distress signal for help. Preparations to land on the alien terrain made for Day 385.
Day 385: Special day in the history of our species. Amazing discovery made. Proves that there was intelligent life on this planet that communicated with our scientists. Sadly, no evidence of any existing life forms. 

Air Samples: Contain high levels of sulphur-di-oxide, carbon monoxide and carbon-di-oxide.
Water Samples: Contaminated with different forms of chemicals, some unknown to us. 
Terrain: Only a small bit of landmass has survived. The rest is covered with contaminated water. Seems to be a result of huge nuclear activity coupled with seismic activity that destroyed the lifeforms on the planet. 
Day 386: 
Discovery: We have insights on what the life form that inhabited this planet looked like. They were small (2-3 feet in height and 3-5 feet long) four footed animals. From the evacuation site, we were able to get a pieces of artificially created, hard, grey colored slabs. Seems to be a ritual or sacred routine to set their feet in cast on these slabs. Going by the structure of the feet, it is amazing how these life forms could create something which could destroy the entire planet or for that matter something as simple as the slabs they left their footprints on. 

Day 387: 
More success. Discovered another slab colored in their star's color. Has a strange inscription that I have tried to recreate here - ಬೆಂಗಳೂರು 

Going by the number of cement pavements in Bangalore that have dog paw prints, this is what would happen if beings from other planet were to discover Bangalore after the earth is destroyed. ;)

The Jockeys of Jakarta

Ingenuity is something that is a feature of the emerging world. In my recent trip to Indonesia I noticed this phenomenon evolve a business model out of a regulation passed by the government.

Typical of cities bursting at their seams and with opportunities, Jakarta has a huge number of automotives that descend on the streets cometh the rush hour. To reduce the traffic burden in the core business district (CBD), the Jakarta Traffic Police have come up with a regulation. The regulation states that when a private car enters the CBD, there have to be a minimum of 3 people in the car. This was a move to encourage car pooling. The fines that one has to pay if the regulation is violated are steep. However, I didn't meet a single local who knew what the fine was. Everyone manages to get away with IDR 50,000 as coffee money to the cops. Don't be scared by the numbers, the conversion rate for IDR to INR is 200 and to USD is roughly 10,000.

Cut to the streets of Jakarta. Just before you venture into the CBD, you see people standing on the footpaths with their hands outstretched and pointing their finger(s) at the sky. This number of fingers pointing indicates the number of people willing to be temporarily employed as "Jockeys". So this is how it works, you are one person short of three, you pick one Jockey from the street. They accompany you to your officeand there you drop them off paying them IDR 10 to 15,000. If you are alone, no need to be concerned about picking up 2 adults; there are plenty of women jockeys with their infants in tow. The mother and child count as 2.

"Necessity is the mother of invention", so very true. Though I was shocked at the thought of picking a total stranger to accompany you in your car, there are some locals who have the comfort of "regular" jockeys as well. Ingenuity Indeed!!!