A new report by IMS studying 43,689 apps in the iTunes app store as of June 2013 suggests there may be a lot of noise out there in mobile health (mHealth). Any sort of mHealth engagement signal may be lost.
Jane Sarasohn-Kahn highlights the report in a new post, “Mobile health apps – opportunity for patients and doctors to co-create the evidence.”
She summarizes the report,
“The bottom-line: there’s no base of evidence that mobile health apps deliver clinical value in health outcomes or support and sustain health behavior change.
IMS found that, in health:
- Few apps focus on managing chronic disease for the highest health-spenders, who tend to be older
- 5 apps account for 15% of downloads
- Most apps have been downloaded fewer than 500 times
- There’s currently little guidance from physicians on health apps, largely because
- Evidence is scant supporting which tools yield clinical benefit.”
The problem, Jane suggests, is the evidence. If there were more evidence we’d have much greater adoption. She concludes:
“The very nature of the mobile health app requires collaborative research between patients and the health care system, working together. This is an opportunity to build shared decision making, participatory medicine and community-creation of health.”
Health IT in general needs additional evidence. If patient-engagement is a drug, then the various technology solutions (the new drugs) need to be tested. Although I’ve argued that engagement is more of a strategy and a process than any one tool, the tools that are part of any digital engagement strategy should have the weight of evidence behind them.
To every startup I meet that is working on patient engagement in various flavors, I ask, “Do you have any evidence that this improves outcomes and decreases cost?” Granted, while it will likely take more runway to answer that question than most startups have, I have not met one that says unequivocally, “Yes.”
Part of what’s lacking is what I call a “four-pronged” solution to digital patient engagement:
- Communication: must have a social and sharing component between patients, each other and care team.
- Data: must continuously access and incorporate outside data in a meaningful way
- Trust: established competence, consistency, and transparency about how data will be used, and by whom
- Incentives and behavioral economics for continued use
Some apps or solutions have one or two of these components, but rarely does a solution have three, and there are very few that have all four (PatientsLikeMe still the clearest stand-out) of these components that will drive engagement, adoption and outcomes.
By far, the hardest to accomplish and the most overlooked by even established players is trust.
Close behind in difficulty is the psychology and creation of the addictive qualities of the most popular apps. David Harlow chimed in on the topic of Jane’s post, searching for what he calls the “secret sauce” of successful apps:
“Until the addictive qualities of wildly popular apps are isolated in the lab and grafted onto health apps that seek to promote and reinforce healthy behavior change, we will continue to have 40,000 tail-chasers out there.”
Online communication, of course, is key. A survey shows that 76% of patients would actually choose telehealth over human contact! Colorado patient communication company CirrusMD has found that 70% or more of doctors are already texting with their patients! Patients and doctors want better communication, but docs also want a reimbursement model and regulations that support it. Communication is the glue that ties the other pieces together.
We need more research, clearly, but there’s a lot of great info out there that hasn’t quite coalesced in most health apps. As I’ve written before, the addictive quality comes from several aspects of psychology and game design:
- Intermittent rewards (think e-mail and slot machines, you never know when an important event will happen)
- A compelling narrative
- Progressive mastery
- Social elements, including status development through points and social communications
Let’s hope mHealth designers in the future catch on. There are some bright spots. Ryan Lucas, an emerging expert in wellness apps, suggested SuperBetter, built by master game designers, may be one app that may be the future, containing several elements of the secret sauce.
Finding Signal in the Noise
How can we create an environment where we can bring all of these elements together?
Two recent pieces of news suggest organizations are starting to recognize the value in helping consumers sift through the endless piles of health apps.
First, Partners Center for Connected Health has launched Wellocracy. According the the brief “Wellocracy is focused on inspiring and empowering individuals to self-manage their health and wellness by providing up-to-date information, expert guidance and innovative ideas to help people get the most out of personal health technologies.” It also has a social component to develop trust and recommendations on which apps to use.
Partners has been looking into ways to make mHealth addictive, and now on helping people select the right mHealth tools with Wellocracy, working to separate the signal from the noise.
Second, WebMD has acquired Avado, the patient engagement platform run by Dave Chase.
The compelling thing about this acquisition is that it appears to pull together at least three of the prongs I mentioned earlier.
Communications and Trust
WebMD has reach, trust and communications ability. Their mobile health webpage gets 22 million page views per month, they have over 20 million downloads of health apps and they’ve been named as one of the most trusted consumer brands on more than one occasion. Trust is an afterthought and an impossibility for many health IT and mHealth players, but consumers care about the risks inherent with their data.
Avado provides a platform for patient-physician communications that works with apps, but does not currently have a native app, potentially connecting the WebMD (patient) and Medscape (Physician) communities onto a single communications platform.
Dave Chase and Avado support BlueButton and Direct messaging, and it would make a lot of sense for them to continue to do so under WebMD. With the reach and trust of WebMD and Medscape from both the patient and provider side, there’s a real opportunity to create a trusted connection around actionable BlueButton data between patient and provider using Avado’s platform.
Done right, this could be a tipping point for BlueButton if Avado and WebMD can really make it valuable in a workflow. Data is only the starting point to decisions and action, but it’s also the foundation.
Meanwhile, all the content from WebMD and Medscape could work to provide more meaning and context to communications.
Motley Fool, the investment site, posted a question, “Can Social Networks Unify the Fragmented EHR Market?” back in early September.
The author, Leo Sun, asked,
“Why haven’t WebMD and athenahealth stepped up yet? Project Medyear’s approach is a stark contrast to WebMD’s (NASDAQ: WBMD) main portal, which is a top-down search tool for symptoms, ailments, and drugs. WebMD users can reach out to other uses via discussion forums, but the message boards are mostly anonymous. Advice received there cannot be considered professional, and worse could be misinformed or misleading.
“It makes sense for WebMD to create a medical social network to unite professionals and patients with verified patient records under a credible umbrella. Considering that WebMD’s health portal currently has 125.5 million users and another 2 million health care professionals are using its medical reference app, Medscape, it has all the resources it needs to become the “Facebook of Healthcare.””
Avado CEO Dave Chase has long argued that EHRs should be communications platforms, not billing systems, and a social component to health communications platform is not only about improved communications, but improved incentives for patients to get better. Could this be the secret sauce Harlow is looking for?
The Trusted Marketplace
The Holy Grail of Health IT right now is to create a trusted app platform and marketplace. We’ve seen that with Aetna’s CarePass and platform strategy. We’ve seen hints of it with UnitedHealthcare and Optum.
Could the Avado acquisition signal the beginnings of a true, trusted mHealth platform?
WebMD and QualComm presented together at HIMSS this year to showcase that WebMD is using the QualComm 2net Platform to integrate information from a curated set of medical devices that can be aggregated and connected (presumably) via Avado’s communication platform between patient and physician. The idea appears to be to use the WebMD appspace as the hub of activity, connecting with various apps and devices.
According to a statement from last March by WebMD CTO Bill Pence:
“WebMD is preparing to roll out its first patient-to-physician connectivity app this year.”
(This is presumably part of what Avado will be extending.)
Pence goes on to say:
“We won’t start with biometric data, but with intake forms, patient education, prescription refills, a lot of productivity transactions that we can web enable… We’ll also be working on the ability for physicians to prescribe apps and embed them. And some of those will have the ability to collect biometric data.”
Although there’s a long way to go to execution, it sounds like a good strategy, and it just may work to integrate all the disparate pieces of health information around patients while connecting with physicians. Altogether, this signals a welcome step forward for mHealth trust, communication, and data sharing. If they can find trusted, effective and addictive apps focused on the user experience, and prove the efficacy, they’ll have something.
To maintain trust, they’ll need to find a way to promote openness and transparency in what looks like a walled-garden approach, to consistently answer “What are you doing with the data?” Because, while they may be attempting to create “the Facebook of healthcare,” unlike the actual Facebook, trust, privacy and security will be paramount.