mHealth and Extreme Uncertainty

7 billion people.  6 billion mobile connections.

What do we know based these two numbers?  We know that mobile has brought (and continues to bring) instant information and connectivity to people in far reaching parts of the planet for the first time.  It has created new methods for banking and it threatens to end the regular use of cash.

The possibilities of of mobile are far reaching and the claims of what it will do go even further.  In spite of the certainty that mobile will drastically change our planet, the question is, “do we really know how those changes will unfold?”  The answer is that existing roadmaps show where we will likely go, but the journey ahead will be a bumpy and uncertain one.

Eric Ries, author of The Lean Startup writes that an entrepreneur is anyone operating in an environment of extreme uncertainty.  So my latest pondering has left me wondering, is the whole field of mHealth is marred by extreme uncertainty?

One point Ries makes in regards to my field of planning and forecasting is the difficulty to predict the behavior of an industry that lacks a stable operating history and a relatively static environment.  The mobile industry is anything but static.  Mobile device activation and acquisition statistics are exponential, devices constantly change, and how consumers use them continues to evolve.

The underlying point Ries is trying to strike here is not railing against strategy, but advocating against large amounts of time spent in “the lab” testing your product.  Experiments withdrawn from reality can be of little value in an uncertain environment because its difficult to know how it will be received by your customer.

There is of course a place for strategy and planning in business, but Ries is correct when stating that learning in such an environment needs to be validated to mark progress and reveal necessary changes in your strategy.  Along the same lines, I found great value in Ries’s statement, [rather than hypothesizing how a customer will behave, or asking them how they will behave; experiment by providing them with a prototype to see how they behave when using it].

Extreme environments have not and will not eliminate a need for strategy. They merely remind us that the customer does know best and they must not be treated as the recipient of a product or service, but as a co-creator.

 

“In preparing for battle I have always found that plans are useless, but planning is indispensable.”

General Dwight Eisenhower

Reverse Innovation and Mobile Health

Technology will change healthcare as we know this. We read this and see evidence of it constantly, the promise of EHR, “the cloud”, genomic mapping, advanced diagnostics and now mobile technology. All of these incredible technologies make increasingly certain that when healthcare will be revolutionized is growing closer. What I am placing an increased curiosity towards is where these technological game-changers will be developed. The recently released book Reverse Innovation, by Vijay Govindarajan and Chris Trimble reviews that now and in the future innovation will not just flow from rich countries to poor countries but also from poor countries to rich countries. And it promises to shift the global balance of power.

In short, earth-shattering innovation has almost always been developed in wealthy nations with extensive R&D budgets. This has in turn resulted in solutions that are created for the developed world and are at best tweaked a bit in the hopes they will be appealing to emerging market clientele. The authors point out through their work that this “downhill innovation” flow will become increasingly challenged by locally developed solutions. Many goods and services making their way to poorer countries have often only been accessible to a small minority with adequate means to afford these –at least relatively speaking- expensive items.

In the future if developed companies do not innovate in poorer nations and continue the traditional downhill push, a new era of emerging market companies (emerging giants) will rise to properly address them. The global implications of this are significant according to the authors. The threat is twofold: losing access to hundreds of millions of clients (bad in of itself) but also that these frugal innovations will likely after sometime be scaled up and threaten to replace current products and services of the developed world.

Jeff Immelt, CEO of GE put it this way, “If we don’t come up with innovations in poor countries and take them global, new competitors in the developing world will. … GE has long had tremendous respect for traditional rivals. But we know how to compete with them. They will never destroy GE. The emerging giants, on the other hand, very well could.”

Implications for Healthcare

So what does this mean for healthcare? For one, mobile health is being developed and accepted more rapidly at present in poor countries (PWC report) than in developed economies. As the text would describe, once affordable emerging market mhealth solutions exist, a global threat may begin to emerge when pondering, “what features can be added to this good/service to make it of value in developed economies?” If affordable and useful innovations begin to move uphill from poorer to richer countries they could stand to unseat existing solutions as budgets here become increasingly strained and current solutions prove too expensive:

What might we see in healthcare?

• Apollo Hospitals perfecting its telemedicine model in India and scaling it up to provide primary care services for a fraction of the cost in the US
• Exporting of cost-effective hospital models near to or within the US (NH Grand Cayman Health City)
• Emerging market diagnostic equipment being exported to richer countries

The possibilities are endless and uncertain but Govindarajan and Trimble are certainly right in expressing the new world where innovation can come from anywhere.

Be Well.

The Tricorder & Social Medicine

The world of medicine in your fingertips and as easy to use as an IPhone.  Wouldn’t a world where managing and monitoring your health be wonderful?  Its coming.

Source: Forbes

The Urban Datasexual

According to some, we are now beginning to cross the point from capturing digital data as being knowledgable or niche to sexy.

Early adopters are obsessing about it to the point that it is beginning to catch the attention of the mainstream.  In addition to the individual drivers of the movement, high profile companies like Jawbone and Nike have certainly helped the cause.  The marketing of their devices has brought this to the attention of many that may peruse scholarly journals and forums.

Much of this takes root in Gary Wolff’s Quantified Self movement which is growing rapidly across the planet as people attempt to push the bounds on what they are able to capture.

With mobile phone companies competing aggressively for market share, the capabilities of devices are accelerating rapidly while being matched by tenacious developers who are determined to harness the power of the devices and rising levels of bandwidth.

As this movement enters the mainstream, it will show increasing numbers of consumers what there is to use and in turn demand more from providers of care and other health-related companies.  As data generating devices enter the mainstream, it pushes us closer to the consumer-driven revolution that Eric Topol says is required to disrupt the healthcare industry.

Source: Big Think

Can Mobile Augment the EHR & Improve Patient Satisfaction?

The Electronic Health Record is making progress.  Slow progress.  Data is becoming digitized and is helping physicians to better see a patient’s history.  However, the collection of that data is still proving difficult and turning it into something useful is a whole other story.

Something I was struck by while reading Eric Topol’s book “Creative Destruction of Medicine” is that EHR data collection isn’t just difficult for the doc but also the patient.  EHR configurations are still being worked out and often require much of the physician’s attention.  As a result, patients with the doctor may feel that the computer is getting more attention than they are – and they’re probably right.  This doesn’t mean that doctors don’t want to hear the patient, only that the technology is not built properly for interaction with the user.

Enter mhealth: From a financial and functional side, a recent report siting that data collection costs could be lowered by 24% with mobile technology is fantastic.  Data is more important than ever and the amount of it is increasing exponentially.  But when thinking about this report along with the patient-dcotor interaction side, it helped me see that this is one example of how technology promises to better humanize things.

If a doctor can walk into a patient’s room with an EHR already populated by a mobile device, it leaves more time for relationship building and conversation.  For the two parties to have more meaningful interaction and work to treat the whole patient is what healthcare should be all about.

A healthcare system where the data emanantes from the patient and is designed to personally relate to the patient.  That is patient-centric and high value care.

You Look Great! Thanks. Its My New Habits.

I’m about a quarter of the way into Charles Duhigg’s new book “The Power of Habit“.  If this book’s content doesn’t need to be applied to individuals and societies I don’t know what does.  We are a society and a planet that is finding ourselves increasingly unhealthy on the whole.

Duhigg breaks down what makes up a habit for those of us that aren’t neurologists and psychologists.  A habit consists of three things:

1. a cue that that triggers the habit
2. the routine in which we execute the habit
3. the reward we get for performing the habit

The key to creating, modifying or removing behaviors that are habitual is understanding the cue and the reward.  What is it that causes us to want to do the specific routine and what do we get out of it?

The cue to get us to brush our teeth is that they’re dirty, the reward is that they’re clean.  We like it when they’re clean so we are happy to do the brushing.  But here is the really interesting thing I learned that I didn’t consider.  Clean teeth isn’t great just because they’re clean, its great because they feel clean.  There is that cooling effect after you rinse out.  That is what clean feels like to us and its engineered in there to make brushing more appealing.

The implications of this example in a broader context is very important.  We have created all these poor habits for ourselves, now how do we create some excellent habits to replace or at least offset them?  In addition to new products and services, mobile technology can offer a great way to help build new habits.

Our phones are always with us, how can we utilize them to encourage more activity, drinking of more water (75% of Americans are chronically dehydrated), better eating habits.  Mobile technology will not solve problems on its own.  But its a fantastic way to help modify behaviors of countless individuals without having to draw them to a centralized location.

More to come on this topic.

Be Well.

VA set to Waive Co-pays on Telehealth Visits

VA is breaking ground on office visits.  In need of a routine or non-urgent consult?  Why not have it by phone without a co-pay.  This promises to up the focus on decentralizing the point of care.

Mobile technology will only further this as best practices are revealed through trials.  The non-urgent or routine office visit just became a whole lot more convenient.

Source: FierceHealthIT.

Healthcare Competition Will Go Global

A recent Op-Ed by David Brooks of the New York Times got me thinking again about healthcare and its current (and future) competitive environment.

Unlike manufacturing and consumer hotlines, hospitals and health providers have remained largely in competition with their “neighbors” (nearby hospitals, doctors and specialty centers).  If a patient has a life threatening disease they may be willing to travel great distances -across the country or the world- for premiere service.

Medical tourism is a growing piece of the pie but still remains a very small piece.  Due to travel constraints and/or the ability of a doctor to effectively administer a physical in-person vs from across a city (let alone across the world) leaves healthcare centralized and subject to a limited number of competitors.

But the advent of the internet and cloud technology are changing that and mobile technology promises to push it even further.  Email was first used to send x-rays to be read in India.  Now they can be read anywhere and anytime -by someone with secure access- globally through the cloud.  This is one example but represents a sign of change to come.  At present, scans are outsourced to other countries for help but in the future foreign companies may begin to offer competing health solutions that may be done for a fraction of the cost.  Same outcome + lower costs = higher valuer.  A comparison could also be drawn to intensive care monitoring.  Right now remote ICU monitoring is administered by companies here in the US but one day you may be monitored in  real-time by someone in a foreign country.

None of this is to say that proper clinicians will not be available in the healthcare setting, only that the cloud technology promises to make it easier for healthcare to become competitive on a global level and combat our healthcare workforce shortage.

Now to look at mobile health.  With a shortage of 30,000 primary care doctors in the US, who is going to administer routine care when you need it or just your annual checkup?  If a mobile device you wear compiles and quantifies all your health information and you can access a health specialist by email or telephone around the clock for questions it can be fielded by someone down the street or a hundred miles away.  With our healthcare demands as a nation increasing, we must find a way to commoditize what can be in order to make healthcare sustainable.

Mobile presents to make healthcare more efficient as we all know it needs to be.  The true benefit of a health dashboard that is monitored by a health professional here in the US or in a foreign country is that real-time information and alterts can be compiled in your PHR and your doctor’s EHR to ensure that information is ubiquitous and will maximize its benefit.

It will be a tumultuous road for sure.  Health professionals in this country play an incredible role but as wel advance the abilities of technology, it will help to improve the value of healthcare and the sustainability of our healthcare system.

Source: NYTimes.com.

mHealth meets p(ublic)Health

As the mobile health field moves forward, the speed of development and demand is almost blinding.  We have entered an era in which helping patients and providers to continuously monitor a variety of diseases to hopefully push back the spread of chronic diseases and influence  healthy choices is becoming a reality.

Our $2.6 trillion healthcare economy needs some healthy (and likely dramatic) weight loss itself.  With non-profit and private institutions bringing in revenues of billions of dollars there is only some room for most to state that they are having a hard time too.  Sure their institutions are bulky, slow to respond and burdened at times by low-paying patients but in the midst of that are fountains, zen gardens, delivery suites that look like hotel rooms and more.  Let me be clear about something, I believe that an excellent healthcare system does depend on a healing environment that comforts the patient and their caregivers.  This has moved beyond dispute.  But all of these things are made possible by an era of abundance.

Roll down the street into a disadvantaged neighborhood where most are underinsured, uninsured or on Medicaid and the zen gardens, fountains and concierge services mysteriously disappear.  Municipal and state-run medical facilities are often left to care for patients with lower incomes, less education, busy work-life schedules and in many cases lack proper access to fresh and healthy foods or a safe place to be active outside.  Providing excellent care to these disadvantaged populations has long proven difficult due to inadequate resources, connectivity and a host of social issues.

Mobile technology may offer a window into this field that needs to be dramatically improved.  A 2010 study by the Pew Research Center titled, “Technology Trends Among People of Color” highlights that mobile phone usage is dramatically higher amongst people of color than that of Caucasian Americans.  This is significant because looking at computer ownership paints the inverse relationship of the prior example.  The principle concept being that mobile technology provides a more affordable gateway to connect with someone than an expensive computer or with the approaching extinction-level event of the home telephone.  Mobile phones present a great way for patients and providers to better connect and increase the value of service.  To send medication reminders by text message, help eliminate food deserts (see Food Oasis) and to reduce health literacy gaps.  A portal exists into public health that has long been absent.  Now the challenge is harnessing this great technology to do good.

We are merely at the tip of the iceberg but I think it is important to acknowledge the potential that lies ahead and to work towards creating that better future today.

Be Well.

Pajamas May Help Parents in Child Care

After reading up on this new Exmobaby suit I have a slightly different outlook than Dr. Robert Marion of Children’s Hospital of Montefiore.  Dr. Marion expresses his concerns about this suit going off erroneously at times and thus causing anxiety.  I would certainly agree that this is a problem.

However, I think the principle of such an outfit is a well thought out idea and if perfected properly could prove of great benefit.  At a price of $100, if it could better help parents to better understand a child’s condition it would do enormous good for reducing anxiety and unnecessary ER visits.  This mobile device like so many on the market now faces the difficult task of being tested and tweaked to ensure that it generates proper readouts.  I do not think the problem with this suit is the concept, merely that the current edition is not as effective as it will be expected to be by consumers.

Source: Pajama set knows babies better than parents | SmartPlanet