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Friday, December 7, 2012

An mHealth Value Model

I spent a couple of days at the mHealthSummit 2012 in DC this last week.  A short summary of my impressions have already been posted.  What I want to do this morning is talk a little bit about the definition of Mobile Health (or as some like to call it, mHealth).

My definition is short and tweetable:  #mHealth is Connecting Healthcare without wires.

What I found at the summit was that while this definition clearly describes what vendors were offering, there was wide variety in the value mobile access provided. There are two ways in which you can look at it, the first is the barrier removed by mobile access, and the second is by what it connects.  The two are quite related:

ValueBarrier RemovedConnecting
People to Devices
A lot of what I saw simply exchanged wires for a radio and a mobile power source. This removes physical barriers, but not much else.  Some of the wire removal allows activities to be monitored outside the healthcare environment, which also eliminates the distance barrier. This leads to the next level.  At some point, I think we'll stop calling this "mHealth".

▂ ▃      
Platform Variation
Developers to Mobile Devices
One barrier introduced by Mobile is variation in platform.  We have Apple, Android, and basic Web (with HTML5+CSS) on the mobile device as different ways to create your application.  A number of vendors are working on making it possible to build one app for multiple platforms.  The audience for these tools is pretty limited.  Little of this is related to specifically to healthcare.  The few offerings I did see with any focused attention to healthcare in this spaced touted their "HIPAA" qualifications.  A reminder to you all:  HIPAA compliance is a property of an organization, not a product.

▂ ▃ ▅    
People to People
Instant/unwired communication, including text, audio and video eliminates barriers related to time and/or distance. A good bit of this is simply a matter of hooking up a keyboard, speaker or camera to a radio, sometimes with a design intended for use in the healthcare environment. Some of what I saw didn't take the last step.  The more Healthcare oriented design that goes in, the more I feel comfortable fitting these offerings into the "mHealth" space.

▂ ▃ ▅ ▆ 
People to Information
There are several levels in here. Web application that have a mobile friendly input/output is the most basic level. SMS access to information is very big in emerging markets where smart phones aren't ubiquitous. This has more value, I think, than simply mobile enabling a web site. One site connects your phone's camera (via an eTag) to a map of nearby an automated external defibrillator, which begins to move into level 4.

▂ ▃ ▅ ▆ ▇
Information to Information
This is the highest level, and few mobile applications are there yet. Many are just creating new silos (e.g., Like my FitBit, which uploads to a website where I have to pay an annual fee to get access to the analyzed data, and have no access to the raw data). There are some PHR applications which connect your data with other data sources (e.g., MedLine Plus Connect), but these are still pretty limited.  This level has the highest potential value to both patients and providers.  BTW: If you make me type it in, you aren't thinking about my error rate on phone keypads, and I hardly count it in this space.

These "levels of value" shouldn't have any ramifications of "good" or "bad".  Removing wires can be very useful, especially when doing so eliminates significant risk for patients, enables care that couldn't be provided previously, et cetera.  My purpose in building this classification system is to understand the impacts of mobile health on the "cost curve" of healthcare.  I don't see offerings at level 1 having as much an impact on the cost/quality of the care that I get, as offerings at level 5.  Your mileage may vary.


  1. Keith, can you provide a few examples of the vendors who are trying to address platform variation? Not specific to the healthcare industry, I know phone gap and Titanium trying to make it possible to create platform agnostic apps.

    Are there any companies trying to do this specifically for the healthcare industry?

  2. On the topic of platform variation, there was a presentation at Infoway's Partnership conference last week about experiences at B.C. Cancer Agency here in British Columbia, where they talked about a radiology pilot using iPads, Citrix and wi-fi within the hospital. The outcome was interesting - clinicians loved the accessibility but hated the small screen size compared to a 19" monitor... so they started asking for a native app, which is now under development. It gets a foot in the door and it demonstrates both the pros and the cons of theform factor.