moving from idea to impact the emergence of m health 2.0
DESCRIPTION
Supported by the proliferation of smartphones and tablets, consumers and medical providers are snapping up medical technology via mobile apps and mobile sensors at an unprecedented rate. In the process, these early adopters are drawing tremendous attention to the mHealth space. This explosion of products and interest has brought the space to an inflection point: the emergence of mHealth 2.0. At this next stage, mHealth aims not just to provide information but to create meaningful behavior change in both patients and their medical providers. While the underlying idea is simple and the technology astonishing, it has been a challenge to deliver. I will argue that, going forward, the focus of players in the mHealth space must be on closing specific patient behavioral loops, building bridges between non-interoperable data systems, and permitting doctors to provide better care through deeper clinical insights—and all of this must happen without drowning doctors in a deluge of raw data. So how do we get there? The future lies in the aggregation of data from multiple sensors, analyzed and re-expressed as actionable insights for behavioral change. The winners will be those who can produce the most useful sensors (embedded in the most attractive and easy-to-use form factors) and marry them to cloud systems and intelligent algorithms that enable effortless analysis and sharing of insights that inspire action.TRANSCRIPT
Moving from Idea to Impact: the Emergence of mHealth 2.0
Luca M. Sergio
Managing Partner, Ethis HealthTech, LLC
+1-201-744-3364 [email protected]
Twitter: @lmsergio
LinkedIn: www.linkedin.com/in/lmsergio/
how did I first come to mHealth?
• Catalyst and commercialization of Topcon Medical’s EyeRoute Synergy mini-PACS system
• 1st mHealth platform for ophthalmology
• Your diagnostic images, anytime, anywhere
• Now assisting mHealth companies with commercialization
what makes up mHealth?
mHealth begins & ends with the patient
PATIENT Data
App Developers
Health Social
Networks
Mobile Sensor Mfgs
Patient Portals
RHIOs Hospitals
HIEs CMS
Device Mfgs FDA / CE
Pharma
EHR EMR PACS RIS
Payers–morphing into svc
providers
MD Associations
ACOs Individual Providers
what is so exciting today?
• Smartphones everywhere • Increasing EMR adoption • Focus on quality of care • Consumerization of healthcare
is happening now • Personalization of care
emerging • New opportunities for
collaborative care • Current healthcare spending is
out of control • Care must be doctor and
patient driven
why mHealth 2.0?
mHealth 1.0 was an app for an app’s sake
What is mHealth 2.0?
• Marshaling data across silos to effect behavioral change
• Closing behavioral loops with actionable data, involving both doctor and patient
• Intelligent systems to handle the data deluge
why mHealth 2.0?
Where should we apply it? Chronic diseases:
• Obesity
• Hypertension
• Diabetes
• Chronic heart failure
• Chronic obstructive pulmonary disease
(>80% of US healthcare spending)
why mHealth 2.0?
How should we apply it?
• Greater personalization of medicine
• Move beyond fitness tracking into medically accurate, pervasive sensors
• The medical home, medication adherence, collaborative communications, and care plan adherence
• Focus on giving a sense of control to the patient
• Fill the gap between fitness tracking and in-hospital care
why mHealth 2.0?
What is needed to make this happen?
• A unifying catalyst
• A player who enables behavioral change by cementing a connection between patient and doctor
• A player who combines sensors, with standards, with cloud systems, with fun and compelling UI/UX
questions to remember: how can mHealth…
1. Improve patients’ lives?
2. Enable doctors to profit?
3. Create efficient “systems of care”?
4. Foster partnerships between doctors and payers to create patient value?
essentials for the patient
Self care information, but
connected to valued partner:
the MD
24/7 access to providers
Easily closing compliance loop
for MD care instructions
Smart, contextual, actionable
alerts
Seamless communication with broader EHR systems
Passive sensors should fade into the background
essentials for the doctor
Instantaneous view of patient
Mobilized, easy workflow
Closing patient compliance loops
Collaborative communication
Minimizing office visits
Freeing-up of time to focus on
overall care
ecosystem today
Patients
• Consumerization is driving the overall transformation
• Expectation of “anytime, anywhere, any device”
• Need to move beyond annual / episodic check-ups
• Self-monitoring and management
• Demanding new dialog with MD
Doctors
• Less time than before
• Changing reimbursement models
• Focus on quality of care
• Need to have greater insight into patient outside of office
• Fearful of change
• Not yet aligned with consumer driven health, but soon…
Hospital Systems
• Consolidations with disparate IT systems
• Competition to offer services
• Managing tremendous info complexity
• Focused on reducing readmissions
ecosystem today
Payers
• Emergence of Payer / Provider systems (Kaiser Permanente)
• Emergence of value-based care
• Difficult for Payers to add patient value
• Open to new technology solutions to drive quality or cost
• Morphing into service providers (United Healthcare, Aetna, Cigna, Wellpoint)
Big Pharma
• Medication adherence
• Initial focus on educational apps
• Large budgets, but constrained by regulatory agencies (FDA)
• Some focus on improperly prescribed medications
Tech Players
• Initial focus on apps & fitness sensors
• Realization that tech alone is insufficient: must build services
• Many copy-cat sensor companies, but few that close an important patient loop or integrate into broader HealthIT system
• Many players ignorant of standards and integration requirements
ecosystem today
Government
• Affordable Care Act
• Meaningful Use Stage 2
• ICD-10 coding
• New FDA Guidance on mHealth
• Proposed SOFTWARE Act in Congress
• Blue Button Initiative
• HIPAA Omnibus Rule
• Studies emerging (VA and NHS in UK) evidencing cost reductions via mHealth
Finance & Exits
• Health IT VC funding topped $737M in Q3 2013
• AthenaHealth’s acquisition of ePocrates for $293M in Q1 2013
• Basis smartwatch received $11.5M and celebrity advisors Deepak Chopra and Esther Dyson
Other Players
• mHIMSS
• mHealth Alliance
• The Clinton Health Matters Initiative and Wellable (wellness incentive company)
• Johns Hopkins Global Health Initiative
barriers to widespread adoption
MD apathy Tension between MD & ePatient
Lack of interoperability with existing
Health IT systems
Reimbursement/business models/
nonalignment of incentives
Need for medical
relevance & accuracy
Poor signal-to-noise ratio because of data overload
problems to avoid
Sensors not easy to integrate into consumers’ lives
Sensors & apps not easily
feeding data to doctors
Non HIPAA compliance
(data privacy)
Wasting time to learn a
nonintuitive interface
Adding complexity to MD workflow
Creation of new data silos
future trends
delivery of care:
Home health care/remote patient monitoring
Pharmaceutical adherence
Reduction of hospital readmissions
Explicit cloud services linked to Mayo Clinics…
tech itself: Sensors
everywhere (wearable, ingestible, implantable)
Wearables in the operating room
Middleware cloud systems to integrate disparate data silos
doctors:
MDs will have still less time
Collaborative care will become essential (also with patient)
Clinical education support systems
Intelligence dashboards (just essential info)
future trends for patients
Overall: shifting of monitoring
and action into autopilot
Easy sending of factual summaries
to doctors from our devices (small
data)
Ongoing communication with providers,
outside of hospital
Easy sending of actions taken
with intelligent alarming to MDs
Easy access to detailed health
records
Personal genomics
how to realize the vision?
via technology:
Own the communications on-ramps
Build a better data highway
Essential apps in smartphones (medical image viewer, secure communications)
Novel sensors
via partnerships: Tie into Payer
systems (cost reduction + member benefits)
Establish mHealth innovation centers in NYC and San Diego
Empower certain ePatient groups–PatientsLikeMe.com
via services:
Tech alone is not enough
A choke point: data systems integration
Medically accurate sensors with smart alert cloud platform to avoid data deluge
how to realize the vision? – the consumer
general consumer requirements: • Provide truly actionable intelligence without reminder
fatigue
• Be demographically appropriate
• Sensors, apps, cloud, and wireless communications need to work 99.9% of the time
• A fun, compelling UI/UX
• Incorporate elements from behavioral psychology
• Facilitate secure, encrypted, HIPAA compliant conversation
• Make the technology “disappear”
how to realize the vision? – the consumer
medical problems to address:
• Obesity
• Hypertension
• Diabetes
• Chronic heart failure
• Chronic obstructive pulmonary disease
• Adherence to medication
how to realize the vision? – the consumer
points of consumer data interaction: • Creation of personalized health plans with EHR
integration and lab results (going beyond patient portals)
• Sharing of electronic data
• Self monitoring/documentation
• Remote patient monitoring (diagnostics, Rx compliance)
• Secure communication with healthcare providers
• Provider “prescribed” educational materials
• Self education on symptoms
how to realize the vision? – the consumer
wearables: • Easy, elegant, unobtrusive, and doesn’t necessitate 12
clicks
• Differentiate via medical accuracy of sensors
• Sell not only via retail/online, but also MDs, health clubs, corporate environments (“I lost my husband to Fitbit…”)
• If MD is paid based on how a patient performs post-discharge, he’ll slap a wearable monitor on his wrist…
• Data analysts to help make sense of the tide of small data
• Insurance premium reductions for good behavior
mHealth 2.0: making an impact
The future will lie in aggregation of data from multiple sensors, analyzed and re-expressed as actionable insights for consumer behavioral change.
Open question: who can own both the most interesting sensors, in the most compelling and easy-to-use form factor, and then who can gather, store, analyze and share/integrate the data, incorporating a patient feedback loop?
Luca M. Sergio Managing Partner,
Ethis HealthTech, LLC +1-201-744-3364
[email protected] Twitter: @lmsergio
LinkedIn: www.linkedin.com/in/lmsergio/