The multi-faceted and transformative potential of mhealth

By Philippa Hobbs

According to Thierry Zylberberg, Executive Vice President and Head of Orange Healthcare Division at France Telecom, ‘mobile healthcare’ is ‘un mot valise’ – a ’suitcase word’ that combines multiple meanings. During his keynote at Informa’s second annual Mobile Healthcare Industry Summit last week, he confirmed Orange’s ongoing interest in developing new and varied services for the health sector, one example being its ‘Health Gateway’ – a secure web-based platform for SMS-based services such as appointment reminders.

Orange’s view is that the area of health management – essentially, internal communications for healthcare providers and communication between providers and their patients – offers the most promise. The opportunity to improve communications in the health sector has also captured the imagination of other operators besides Orange: Telefonica O2 UK considers the business case in the UK market to be proven and already works with NHS trusts all over the country to deploy a range of enterprise services.

But, as Zylberberg pointed out, ‘mobile healthcare’ means many things. Mobile services for healthcare go beyond distributing Blackberries among nurses or sending SMS appointment reminders. They include new innovative products such as a digital pen, which records and transmits data as it is written on paper, or diagnosis-aiding mobile functions such as using a camera-enabled phone to assess wounds remotely, both of which have emerged from Telefonica O2’s health division.

Further examples include remote monitoring of chronic disease sufferers using specialist devices which transmit data to a managed data centre, a service developed by Orange for cardiac disease sufferers in partnership with medical device manufacturer Sorin. Many more services and applications in development or deployment by a range of companies were discussed at the conference, from international mobile medical records to intelligent pill bottles that not only remind patients to take medication but also enable them to re-order when supplies are running low.

But are healthcare providers embracing these new types of tools, which may fundamentally change their day-to-day working lives? Apparently so, despite their reputation as being resistant to innovation and change. Representatives at the conference from both public and private health providers, including medical practitioners, made it clear that the healthcare landscape is in need of transformation to cope with exponential growth in demand (caused by increased chronic disease, aging and obesity) and its impact on expenditure. Importantly, they believe that communication technology has a key role to play in this transformation. ‘Saving time and saving money’ will be the key short-term drivers of service adoption, explained Don Jones, Vice President of Business Development for Health and Life Sciences at Qualcomm, during his on-stage interview.

Of course, the desire to save time and money is true of any vertical. But in healthcare, the patient landscape is also changing. As one panel member and medical practitioner explained, a fundamental shift is occurring: patients are becoming consumers who demand health service access at their convenience and in many forms. This, combined with the need to eliminate the burden of the ‘worried well’ and low-risk patients on health systems by putting health information or remote access to health services in their hands, may well be the impetus for real communication technology innovation and adoption.

Dr Nicholas Robinson of NHS Direct outlined this concept well: if a member of the public can use a trusted source of health information on their PC or mobile to satisfy themselves that they don’t require a visit to the doctor (as 5.2 million people did during the UK’s swine flu outbreak this year), then that time spent in a face-to-face consultation – at the provider’s or insurer’s expense – is freed up. One medical practitioner at the conference suggested that as many as 65 per cent of patients actually present ‘dis-ease’, not disease, so don’t necessarily require the kind of face-to-face assessment needed by the other 35 per cent.

Yet widespread deployment of myriad mobile services in healthcare, whether b2b, b2b2c (or b2b2patient) or b2c, is not without its barriers. The question of who pays for services, where the bill isn’t picked up by a public provider, is still unanswered. Insurers were not represented at the conference and this is presumably because they are, reportedly, only just becoming interested in having a direct relationship with patients and reimbursing new types of health service delivery.

Furthermore, any behavioural change required by patients who already fail to engage in their health management will also be met with its own challenges: one panel-member and psychologist explained that as many as 25 per cent of kidney transplant patients fail to take their post-surgery medication, so short-term incentives are paramount to maintain patient interest in services such as those that enable self-monitoring. Additionally, regulation surrounding the use of mobile devices as medical monitoring devices remains early-stage and requires the collaborative effort of both telecoms and health regulators.

Collaboration and partnership were key themes to emerge from the conference: ‘No single operator can deliver an end-to-end service without collaborating’ was the central message of the keynote presentation given by Sarah Sanders, Global Commercial Manager at Vodafone Health Solutions. She cited the work that the operator has done in Tanzania with pharmaceutical company Novartis and IBM to develop mobile-enabled stock management tools that ensure medical centres don’t run out of antimalarial drugs. Emerging markets present a different set of needs and ‘mobile healthcare’ opportunities from developed markets in their lack of both fixed line telecoms and health access infrastructure.

Along with over 200 other companies, Vodafone is also member of the Continua Alliance, a US-based organisation established specifically to foster cross-sector collaboration and develop standards for interoperability in ‘mobile healthcare’ technologies. Given the wide-reaching nature of ‘mobile healthcare’, fora such as this that enable collaboration between key stakeholders will hopefully serve to convert the many ideas and wealth of enthusiasm present at last week’s conference into practical implementations, beyond simple enterprise services.