Healthcare Goes Mobile

When U.S. President Barak Obama went before Congress last month to talk about how his administration intends to focus on innovation, he made a strong case for the adoption of mobile health technology. “Within the next five years, we'll make it possible for businesses to deploy the next generation of high-speed wireless coverage to 98 percent of all Americans,” the President said. The spread of mobile technology will help a wide range of people, he went on, including “a patient who can have face-to-face video chats with her doctor.” Indeed, analysts are predicting that mobile and wireless healthcare services will expand dramatically during the next few years to reach 500 million mobile users around the globe, including more than 30 percent of an estimated 1.4 billion smartphone subscribers worldwide, according to a report from research2guidance.

 Venture-backed start-ups are springing up to supply the underlying technologies.  Airtstrip Technologies, a San Antonio, Texas-based maker of monitoring technologies, for example, recently raised $30 million in new capital from Sequoia Capital and other investors.

Mobile operators, for their part, see mHealth services as a new source of revenue. Telefonica, for example, is rolling out premium-priced mHealth services in Spain, the U.K., the Czech Republic and throughout Latin America, says Alvaro Araoz, the company’s director of new business development.  The Madrid-based global operators’ clients include insurance companies, municipalities, ministries of health and private health facilities.

Services offered by Telefonica and other mobile operators include remote testing and chronic disease management, using devices such as glucose meters and cardiac monitors that can send data back via mobile phones for relay to doctors and nurses. That is not all.Telefónica has co-developed a knee brace embedded with motion sensors that allows doctors to remotely monitor patients' rehabilitation after they've been discharged from the hospital. Want a second opinion but can’t get out of bed? Video consultations are now possible. And, says Araoz, Mhealth-connected devices can also be used, in combination with location based services, to track the movements of Alzheimer’s patients or the elderly and trigger an alarm if they wander beyond a certain defined radius.

 There is also a whole range of  mHealth software being offered by other mobile operators which allows doctors and hospitals access to constantly update data on the state of patients’ health and allows them to check a drug database and write prescriptions right on their phone: a software package called Epocrates is used by 175,000 American doctors. mHealth is also being used to train medical personnel and keep track of illnesses such as the spread of HIV in Africa and flu epidemics in the U.S.

 But mHealth also involves wellness applications that are directly available to consumers. There are currently 17,000 mHealth applications in major app stores, according to German market researcher research2guidance.

Chris Wasden, a managing director for strategy and innovation in healthcare at consultancy PricewaterhouseCoopers, says the potential mHealth market is worth anything from $7 billion to $45 billion a year. “If consumers have to pay for it all themselves without really the participation of the insurance industry, then it’s a $7 billion market,” Wasden says. “If the insurance industry starts to see this as a way to save money and starts to be reimburse as part of the payment mechanism, then it can be a $45 billion market.”

Don Jones, vice president for health and life sciences at Qualcomm, points out that the healthcare market globally is currently $4.5 trillion, about 4.5 times the size of the wireless market. “Very little of the healthcare market is connected today,” Jones says. “Quite a large part of it can be connected in the near future. “

Jones reckons the lion’s share of the market will be for embedding cellular technology in medical devices and putting low-power radio into sensors called smart band-aids. These are peel and stick disposable sensors, such as cardiac electrodes that send heartbeat information over  a communications network rather than an electrocardiagram device sitting in a doctor’s office. He estimates that by 2014, they will sell 400 million units annually at a price somewhere between $10 and $50 each.

 Since the technology is disposable, Jones believes that the business model will be similar to the way Gillette sells razor blades: make the razors inexpensive so the consumer buys the blades. In addition, the device will have the ability to reorder supplies directly built in, connecting the consumer to the manufacturer for the first time without a middle man.

The biggest race at the moment is in the diabetes care segment, where companies are striving to provide mobile solutions to the old fashioned glucose meter, which must be manually read and it is up to the patient to decide whether to communicate with his doctor.

A number of companies are selling software and hardware packages to get glucose data transmitted wireless to doctor's offices. Some 80% of respondents to a survey by research2guidance said they felt that diabetes was the leading market potential for Mhealth solutions, followed by obesity and hypertension.

 A Baltimore, Maryland start-up called TelCare plans to start selling a glucose meter with embedded cellular technology in Europe in the second quarter and later in the year in the U.S. Telcare CEO Jonathan Javitt, a doctor who has studied diabetes for two decades, says research shows that people with diabetes who are in control of their disease cost $4,000 a year less than those who aren’t. He says many health insurance companies spend millions manning call centers to communicate with diabetes patients to make sure they are keeping up with their testing, whereas the new technology will provide that data automatically and at much lower costs. He says the new Telcare 3G meter will compete with standard glucose meters at around $75 each, including the cost of the cellular plan.

The medical benefits of remote monitoring are “phenomenal,” according to Dr. Leslie Saxon, a cardiologist who heads the University of Southern California's Center for Body Computing, which studies how technology can improve the practice of medicine. “People live longer if they’re followed,” Saxon says. That’s because they more constantly engage in communications with their doctors and health problems were detected at an early stage that would not be found in periodic office visits.

Despite the many advances available in the West, the real benefits of mobile health may be felt the most in the developing world, where health resources are scarce, but mobile technology is plentiful.

   “The markets where we will probably see a lot of the most interesting and innovative healthcare solutions with mobile health are going to be in China, India and Brazil," says PwC's Wasden. "The reason is the pain points on access to care are going to drive people towards using the technology which is the most ubiquitous and that is the mobile phone.”

There is already a profitable company in India called mDhil that provides medical information about such things as birth control and sexually transmitted diseases to wireless phones. India is expected to be among the biggest markets for remote diagnostic software that includes the use of smartphone cameras to help carry out physical exams because so many people live in remote districts where there are no trained medical personnel. Smartphones are also being used in Kenya by field surveyors to track the spread of certain diseases, providing detailed patterns to epidemiologists.

Robert Fabricant, New York-based creative director for Frog Designs, a global design firm, says his company developed a mobile messaging service for South Africa that is the largest deployment of text messages in the world for health purposes. The programs sends two million messages a day throughout South Africa tied to self testing and counseling for HIV.

Although the technology has advanced by leaps and bounds in recent years, one sticking point that has not been resolved is how to pay for its deployment. In many countries like the United States, but also in France, doctors are paid a fee for services. If patients can stay home and don’t have to come for a visit, doctors earn less. “The typical doctor does not really want to receive it today,” Telcare’s Javitt says of his new glucose device.

Patrick Flochel, a Swiss-based partner for Ernst & Young who heads the life sciences for Europe, the Middle East and Africa, notes that the incentive system still has to change. “Otherwise it is going to be very difficult to justify the investments in those technologies,“ he says.

This story appeared in a print publication Informilo produced in partnership with Raconteur Media, which was distributed at The Mobile World Congress in Barcelona February 14-17 and in a regular issue of the Times in the UK. The print publication is the second in a series  on innovation and technology that Informilo and Raconteur Media have produced.