Issuu on Google+

Short Extract from a Report on mHealth Prepared for the University of Strathclyde and Scottish Enterprise Derek Jones, August 2012

mHealth - Setting the Scene Mobile Health or mHealth has no widely accepted definition but can be broadly defined for our purposes as

The Market Drivers for mHealth

the delivery, facilitation and communication of healthcare,

• Relatively ageing population - many individuals will live longer and require

health and wellness information or services, via mobile communication devices. mHealth takes advantage of a mobile phone’s core utility of voice and short messaging service (SMS) as well as more complex functionalities and applications including general packet radio service

care - potentially at home • Health care costs are rising - driven by chronic conditions such as diabetes and cardiovascular disease

(GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology. The mHealth market is seeing a rapid growth in commercial interest and activity. This is understandable as it seems to be at the perfect intersection between a

• Health care delivery systems and processes are inadequate to meet demand. Consumers may be inconvenienced, choose to pay more for access to care, or be deprived of adequate care.

problem and an opportunity. The problem is that our global healthcare systems are inadequate for the demands placed on them. In the

• Consumers are increasingly recognising that they need to take more individual responsibility for their own health

developed economies, population demographics show we are living longer but developing chronic conditions that damage quality of life and place significant and unsustainable economic pressure on society. Products and services that change the nature of how, when and where care is provided are urgently needed. In many parts of the world, access to adequate care remains difficult at best or very expensive. The opportunity is that brought about indirectly by utilising the technology

• Rate of adoption of mHealth will vary from country to country - with developing economies taking the lead • Wide availability of Smartphone and wireless internet technology harnessed to smart sensor systems - reducing the need for custom solutions

of the digital revolution to disrupt healthcare - in this report we focus on the opportunities made possible via mHealth.

© Derek Jones PhD, MBA


mHealth Review

With mobile communications technology, information has become portable, personalised and participatory. This is the opportunity to personalise and democratise healthcare - allowing individuals, wherever they live, to take greater ownership of their health and wellness whilst clinicians and other care providers focus on what they are good at. There will also be opportunities for learning as society starts to mine the massive data sets that mHealth can generate - a source of new insight and life science discovery. There are many startup businesses active in the mHealth area. The types of themes that are emerging with currently funded mHealth businesses are :Physician tools - (for example) workflow management tools for urgent care practices;⁠1 electronic health record platform;⁠2 HIPAA-compliant mobile messaging network for providers;⁠3 healthcare connectivity and integration solutions⁠4. Sensors - (for example) wearable body monitoring products;⁠5 stretchable silicon for the microelectronics industry;⁠6 personalising therapy by connecting to a mobile device;⁠7 turns any smartphone into a clinical-quality ECG recorder;⁠8 ultra-compact wireless, wearable sensors that automatically track activity data.⁠9 Home Health - (for example) web-based software for home health agencies;⁠10 telemedicine solutions;⁠11 patient engagement solutions⁠12 Data Analysis - (for example) industrial-scale data analytics to solve complex care, treatment and cost challenges;⁠13 tailored integration services and technology solutions;⁠14 enabling employees to compare costs and quality of healthcare services.⁠15 Some of these themes are more likely to apply to health care markets where the consumer has to pay either directly or via insurance and are less likely to be relevant in markets such as the UK. Of course, the presence of an opportunity does not guarantee that creating a sustainable, high growth business will be easy. Many of the early players into the mHealth sector will fail. One anticipated challenge for business growth is that the barriers to adoption of products and services will differ from country to country. Understanding how to approach the market potential in one country will not necessarily prove helpful elsewhere. In the UK for example, the NHS is the seventh largest employer worldwide and dominates UK care provision, and yet decision making powers are diffuse making the widespread adoption of new approaches difficult. Also the NHS’s “free at the point of need” service creates the perception of removing the economic burden of care from most of the population. Will British people feel the need to adopt a new approach when they have to pay from their own pockets? The difficult lesson is make time for health now - or make time for sickness later. The price British patients pay now for the NHS is largely inconvenience. A report by PWC⁠16 (commissioned with the Economist Intelligence Unit) surveyed a broad selection of patients and suggests the primary drivers for UK mHealth will be, first of all, convenience of access to healthcare (49% of sample), followed by a desire to take greater control of their own health (43%). Cost reduction was a lesser consideration (25%)

“mHealth Review Derek Jones 2012”

Page 2 of 42


mHealth Review

Success in this business sector will not come via technology alone. During recent years there has already been significant investment and development in areas of mHealth, with most of it being centred on early stage initiatives geared toward early-adopters, forward thinking hospitals and technology-savvy clinicians. A wider group, even a majority now, understand the need for healthcare reform and see the potential of the technology. However, for mHealth to succeed it must become widely adopted as a “tool” within a broader, politically-backed, plan to disrupt healthcare. There may be a real need for this disruption but evidence suggests that the established systems have a long history of effectively resisting change. Successful business models for mHealth are as yet unproven, but already mHealth is being best adopted where we might reasonably expect the “need” to be greatest or the barriers to disruption to be lowest. This partly explains why the main mHealth markets are initially likely to be in the emerging economies and wherever people already pay a large proportion of their income for healthcare - or perhaps where people are simply not getting effective care from the existing structures. The report by PWC⁠17 mentioned above suggested some guidelines to follow for companies who wish to succeed in mHealth. - Find applications and services that bring concrete value to identifiable stakeholders. It is good business sense to identify stakeholders or groups who are willing to pay for a solution to a real problem. The focus should be on the solution and how mHealth would be the advantageous infrastructure to implement this. - Think in global terms. The resistance to change which is a feature of the healthcare systems of the developed economies can be anticipated. The adoption of mHealth is already proceeding in the emerging economies and many lessons will be learned for later deployment in developed markets. - Focus on finding solutions to problems and not just technology. The core expertise within an mHealth business needs to be balanced across a number of disciplines. Too much emphasis on healthcare know-how may lead to a missed opportunity for the deployment of truly innovative technology. Similarly, too much early emphasis on technology might lead companies to miss identifying a significant healthcare problem that could be solved at a profit. As mHealth deployment is “personalised, portable and participatory” it is also likely that successful business models will need to consider human behavioural factors to a significant degree when designing products and services. - Identify possible partners to create a greater impact and find new value. Business thrives when there is a strong ecosystem of interconnected suppliers, developers and users. As the mHealth ecosystem grows there will be opportunities to develop profitable new relationships involving cooperation and co-creation between existing and emerging businesses, medical professionals, government agencies, insurance and third-party payers and even patients. Placing the individual at the centre of the business model is likely, in the longer term, to be in line with the general progressive trends in healthcare. All healthcare stakeholders are moving in this direction but at different rates and therefore new start-up offerings will need to consider carefully “who is the “mHealth Review Derek Jones 2012”

Page 3 of 42


mHealth Review

primary customer” in the context of who is willing to pay. As we will argue, the spirit of mHealth as portable, personalised and participatory suggests placing the individual client or patient at the centre of the offering. Conventional business models for healthcare in the past, perhaps based on Michael Porter’s notion of competitive advantage via the “value chain” placed the individual and related services at the periphery of attention - the product was normally the star. As shown by Chesbrough⁠18 and others, innovation in how services are delivered or how value-enhancing partnerships are created is likely to be just as important as sensor or mobile technology development. The PWC report further suggests that in the current marketplace mHealth solutions have begun to embrace the following principles. • Interoperability - they work with a variety of sensors and share data with other non-mobile applications and data sets. • Integration - the mHealth systems fit within existing processes and provide support for new behaviours • Intelligence - smart enough to work with data and produce productivity gains • Socialisation - act as a hub to share across a community to provide support, coaching or assistance • Outcomes - can demonstrate a meaningful return on investment (ROI) • Engagement - designed to illicit personal involvement and realise new behaviours in users. Initial Focus Discussions with the founding individuals of mHealth businesses have reviewed a number of potential start-up strategies. These have been appraised against the following criteria • Social impact - Is it a problem worth addressing? • Technical and operational risk - can we predict the technical risk? • Economic feasibility - can the business become profitable and have the potential for high growth • Innovation, creativity, originality - whilst not always the foundation for success, (pioneers sometimes get massacred by the “indians”) innovation can attract resources and make disruption of markets possible. • Likely speed of development. • Team knowledge and skills - It is essential to put together a balanced and experienced team with knowledge of technical, healthcare and perhaps even behavioural skills.

“mHealth Review Derek Jones 2012”

Page 4 of 42


Introduction to Creative Change The Austrian economist, Joseph Schumpeter⁠19 coined the term “creative destruction” in the 1950’s to denote the type of societal transformation that accompanies truly radical innovation. In recent years we have embarked upon a global digital revolution that is indeed proving to be radical and far reaching in its effects on all of our lives. This revolution provides a much needed opportunity to transform global healthcare but this will be challenging to realise. We have now created digital devices, information storage and communication processes and environments that infiltrate many aspects of how we live. These devices and the trends they embody have altered how we learn, inform, capture a moment, navigate, spend money, entertain ourselves, communicate with one another and our whole social network - and much more. Let’s consider these broad trends before identifying their likely impact on health and wellness via the technology we will refer to as Mobile Health or mHealth. Thinking Digital Today it seems there are more mobile phones in the world than toothbrushes and far more mobiles than toilets. Many of these mobile phones are indeed “smart” with a great deal of computing power and functionality. We will have 6 billion mobile phones by 2013 and 10 billion by 2016 (More than one per person) with over 85% of the world’s population having access to a mobile signal.⁠20 A article in emarketer.com⁠21 suggested that by 2016 almost 60% of Americans will use a smartphone, providing ready access to the worlds information networks and a significant amount of computing power. Whilst the availability of smartphones will vary from country to country it seems clear that they will represent a significant and growing share of the market. Access to the internet will become embedded into many everyday devices. For example, we expect the number of homes with internet connected televisions to be 43 million by 2015 - up from 2 million at the beginning of 2010. In 10 years we have seen the internet go from a slow, stationary, information vending machine to a fast, mobile, communications appliance that fits in your pocket. Information has become portable, personalised and participatory. This fact is one of the keys to the opportunity that exists for Intelligent Sensor Systems to participate in the revolution and become a high-growth business in the mHealth market. As this digital revolution has evolved it has produced a deluge of data. Erik Schmidt, former Google CEO, pointed out that from the dawn of civilisation to 2003 there were a total of 5 exabytes (10 power 18) or 1 billion gigabytes of data. Today, there are at least 5 exabytes added every two days. Social media and smartphones are adding to the flood: the number of messages on Twitter will exceed 500m per day by the end of 2012. In 1998 the TV show "Who wants to be a millionaire?" encouraged us to call a single trusted friend for help. Now we can instantly access a knowledge base of thousands or tens of thousands of people. By opening their data vaults, some ­national and local governments are contributing to this data flow.⁠22 In 2010 the digital universe crossed the zettabyte threshold (1021 bytes) or 35 trillion gigabytes of data. The number of wireless sensors was estimated to be 10 million in 2009 and projected to be 645 million by 2015. In late 2010, a report by the Economist on smart systems described a sea of © Derek Jones PhD, MBA


mHealth Review

sensors in which “anything and anyone” machines, devices, everyday things and particularly humans - can become a sensor, gathering and transmitting information about the real world.⁠23 There can be little doubt that the digital revolution is presenting unprecedented opportunities as well as some threats. Earlier revolutions proved to be disruptive as technological innovation first of all created the idea of centralised manufacture, then allowed more efficient production of identical items, then more efficient customisation became the norm. As the digital revolution takes hold we will be in the age of mass-customisation in which products and services easily and efficiently become tailored to individual needs and wants. The individual can be the recipient of truly customised products and services.

Defining mHealth - Portable, Personalised and Participatory mHealth can be broadly defined for our purposes as the “delivery, facilitation and communication of healthcare, health and wellness information or services via mobile communication devices”. The mHealth market has seen a rapid growth in commercial interest and activity as it seems to be the perfect meeting of opportunity and problem. The growing interest lies on the assumption that two trends will inevitably intersect - the availability of inexpensive, all pervasive wireless technology and sensors - and the growing pressure to transform how healthcare is delivered. The Chart 1 shows how the number of new mHealth searches on Google have grown significantly in recent years.⁠24

Our current health care & wellness delivery systems face a challenge. They need to respond to population demographics that show we live longer - but unfortunately also develop too many chronic conditions that damage our quality of life and place significant economic pressure on society. The opportunity to respond is that brought about by the digital revolution. Darrell West, in his report from the Brookings Centre for Technology Innovation believes that mHealth could save $197 billion over the next 25 years in the USA alone with most of the savings focused on chronic diseases such as congestive heart failure, pulmonary disease, diabetes, and skin ulcers.⁠25 Whilst cost savings are extremely important, the most radical opportunity is perhaps that in which we “mHealth Review Derek Jones 2012”

Page 6 of 42


mHealth Review

can personalise and democratise healthcare - allowing individuals to take far greater ownership of their own health and wellness, connecting and learning from others if they choose and freeing clinicians to focus much more on what they are good at and when they need to do it. There will also be opportunities for learning as society starts to mine the massive data sets that mHealth could potentially generate. During recent years there has been significant investment and development in mHealth, with most of the investment being centred on early stage initiatives geared toward early-adopters, forward thinking hospitals and technology-savvy clinicians. In the US at least there is a growing appetite amongst venture capitalists for digital healthcare startups with the RockHealth⁠26 incubator for example, reporting 75% more investments so far in 2012 compared with the same time last year. A majority of the investments were for startups that would trade B2B but B2C investments grew as a proportion of the whole in 2012. Appendix A gives background information on many of the startups that are active in the mHealth area. We contend in this report that mHealth has significant potential for broader adoption. Of course, barriers to adoption remain such as vested interests, policy, security, regulatory and “who will pay” issues.

The Global Digital Revolution The technology revolution has so far brought about the creative destruction of industries such as music, print and broadcasting and has brought others to life. It is curious that perhaps the most important aspect of our lives - our health - has until recently been largely insulated from the revolution. This is starting to change. As we will see, the convergence of a number of trends is changing how we as individuals perceive our health and how care is delivered. One of the most common uses of the Internet is increasingly for gathering health information. Research by the Pew Research Centre's Internet and American Life Project and the California HealthCare Foundation (CHCF)⁠27 found that 80% of Internet users now look online for health information, making it the third most popular online pursuit among all those tracked by the Pew Internet Project,⁠28 that tracks email and search engines. People don’t operate in isolation and networks of persons with shared health interests or even share disease conditions use the internet to find opinions and interconnect. It seems that members of a social network trust their peers and friends more than their doctors. A survey of 25,000 consumers from over 50 countries found social network members trusted their friends, family and peers for product recommendations and brands 90% of the time.⁠29 However, doctors are people too and a number of websites have sprung up to allow doctors to come together share knowledge and network. A Scottish-based, Wellness & Health Innovation (WHI) White Paper⁠30 opened by pointing out that within the last 10 years some 62,000 health-related websites have come online. Consumers have become “active health care shoppers on their own behalf .. enabling them to have the information,

“mHealth Review Derek Jones 2012”

Page 7 of 42


mHealth Review

interest and financial incentive to consume health products and services more like they consume other merchandise and services”.⁠31 The most visible aspect of mHealth at present is the phone “app.” Overall, the Apple iTunes store has over 12,000 apps related to healthcare.⁠32 It is estimated that there are over 40,000 mobile health applications across multiple platforms and that 247 million people have downloaded a health app.⁠33 While the impact of this growing market is still to be determined, it signals significant consumer interest in mHealth. Of course this does not mean that people are necessarily willing to pay from their own pockets or will remain interested long enough to change behaviour. The Economist Intelligence Unit found that 67% of respondents in their study who had used a health or fitness app with manual data entry had discontinued use within the first six months. The medical establishment appears very conservative and resistant to change. From some points of view this is understandable due to fears about data security, confidentiality, safety and treatment efficacy. Beyond the reluctance of clinicians to change, the life science industry needs to change too. The organisations that produce drugs, devices and tests and the regulatory agencies that aim to ensure safe and effective health care, need somehow to adjust to new opportunities and face up to some real threats. We live in a time of healthcare crisis and without finding some new ways of delivering care we will face rapidly escalating costs and essentially failure of our previously trusted systems.

Global Healthcare Challenge Healthcare worldwide must change. For many years, healthcare was a largely reactive process with people in the

Doctors prescribe medicine of

developed world expecting high quality care to be provided

which they know little, to cure diseases of which they know less, in

on demand - sometimes “free” - by clinicians whenever it became necessary due to ill-health. This largely “hospitalcentred” model of care has been failing us and is not

human beings of which they know

sustainable as operated at present. In the UK for example,

Voltaire (about 250 years ago) 

nothing - Francois-Marie Arouet

rationing of care has become a reality as the demand for limited resources has continued to grow. As our populations age in relative terms and yet live much longer than in the past, an increasing number of persons seem destined to acquire chronic conditions that consume the greatest proportion of healthcare resource and further increase the strain on our economies. Our healthcare systems are currently unsuited for the demands placed upon them. In developed countries, hospital-centric systems continue to focus on acute care even though we have long recognised that chronic conditions dominate the disease load. The Economist⁠34 pointed out that by 2030 some 22% of people in the OECD club of rich countries will be 65 or older and this is nearly double the proportions observed in 1990. China will catch up just 6 years later. Unfortunately about half of american adults already have chronic conditions such as diabetes or hypertension and as the world becomes richer these “diseases of the rich” will tend to spread further.⁠35 According to the 2010 Rand Study,⁠36 health care spending is growing faster than

“mHealth Review Derek Jones 2012”

Page 8 of 42


mHealth Review

GDP in most countries. Spending in the OECD countries has risen in the last decade from an average of 7.8% of the regions GDP to 9.7%. Of this, typically about 70% comes from severely constrained government budgets.⁠37 Last year the United Nations⁠ 38 held a summit on health that warned about the rising toll of chronic disease worldwide. The United Nations refers to these non-communicable diseases (NCDs) as a global public health emergency with 860 million people worldwide affected. For example, in the United States, chronic diseases, including NCDs, account for 70 percent of deaths and some 75% of health care expenditure.⁠39 Worldwide, NCDs kill over 35 million people each year, representing nearly two-thirds of the world’s deaths. More than 80 percent of NCD-related deaths are in low- and middle-income countries, and nearly a third of those deaths occur before age 60. The average person over 75 has multiple chronic conditions and takes multiple medications.⁠40 If this were not enough, we also know that caring for chronic conditions is not what doctors are best at. It is increasingly clear that we can not manage these issues with a 20th century approach to health care - for a start an impossible number of doctors would be required.⁠41 Nearly 50% of all Americans have a chronic condition for example, but yet, on average, spend only 3 hours a year with a health professional. Does this mean that the other 8757 hours of the year people manage (mismanage) their own condition – typically at home? Healthcare systems, most radically in the developing world, have changed the roles of clinical staff and modified processes to try to improve efficiency with some success. Britain for example has 27.4 doctors for every 10,000 patients whereas India has just 6; with so few doctors India is changing the way it uses them by refining the processes and placing more responsibility on competent, but less well educated (and less well paid) clinicians. However, the systems in most developed economies are generally still not productive enough. A recent US study reported that whilst labour productivity as a whole in the US has increased by 1.8% annually for the last two decades, the equivalent figure for healthcare productivity has actually declined by 0.6% each year.⁠42 Multiple studies have shown that it has generally taken about 17 years for a medical discovery or new, validated clinical knowledge to become a fixture of daily clinical practice. Fortunately the means for accelerating that process are at hand. A 2011 global survey of 114 nations undertaken by the World Health Organisation ⁠43 found that mHealth initiatives have been established in many countries, but there is wide variation in adoption levels. (North America, South America, and Southeast Asia have shown the highest adoption levels). The most common activity was the creation of health call centres, which respond to patient inquiries. This was followed by using SMS for appointment reminders, using telemedicine, accessing patient records, measuring treatment compliance, raising health awareness, monitoring patients, and physician decision support.⁠44 As stated above, healthcare up until now has largely been about “sickness management” and carried out by physicians and surgeons in hospital facilities. These facilities can be far from where people live and we are seeing innovative approaches, built on new technology, springing up to better connect clinicians and patients. Britain has completed the world’s biggest randomised trial of tele-health technology in a  study which examined 6000 patients with chronic disease across 230 GP practices. “mHealth Review Derek Jones 2012”

Page 9 of 42


mHealth Review

According to preliminary results⁠ 45 of the Department of Health in Dec 2011 admissions to the emergency room dropped by 20%, bed usage by 14% and mortality by 45%⁠ 46 Whilst not mHealth within our definition it demonstrates the disconnection of care from the necessity to be in hospital and represents an attempt to streamline the underlying processes. Conditions such as diabetes, cancer, heart disease and strokes are strongly influenced by our personal lifestyles and unfortunately too few of us have been taking responsibility for our own health and fitness. For example, diabetes has reached epidemic proportions in many parts of the world and is having a devastating impact on the individuals concerned and the global economics of healthcare. A change of focus toward active prevention of disease is logical, but our healthcare systems are not really setup to deliver this. In the UK there is a growing realisation that the Government will not necessarily be able to take care of us as we might wish into the future. We may be able to live longer but we all wish to do so with a high quality of life - and the health, fitness and independence to enjoy life to the full. Of course this challenging picture also means there are rich and varied business opportunities that may address these issues.

The Democratisation of Healthcare We have seen great advances in medical care that now allow many infectious diseases that once shortened lives to become a thing of the past. Chronic conditions however are providing a different and difficult challenge. Medical care today is largely shaped by guidelines for clinical effectiveness which are indexed to a large statistical population - rather than an individual. The evidence from clinical research is derived from population based studies that do not readily translate to the "real world" of the individual person. A recent trend (mass medicalisation) in health care has been toward prescribing some medications as a path toward “primary prevention” - for example, the drive to prescribe statins to men over 50 years of age. These trends, acting on the population statistics of evidenced based medicine have been criticised in some quarters. This is because for an individual, statistics can be misleading. If a statin reduces the risk of heart attack by 36% this sounds like great news until we recognise that in fact this means that around 3% of patients taking a placebo had a heart attack compared with 2% taking a particular statin. In other words for every 100 patients taking a statin, 1 was actually helped and 99 were not. With mass medicalisation we are well-meaning, but actually increasing the cost of healthcare with very little certainty of benefit likely for any particular individual; in fact, the individual is much more likely to suffer side effects of the medication than be helped. It has been the best we could do. At present we have only limited insight into the physiology of each and every individual - a non representative, fleeting, pinhole view, through an artificial environment filter. It seems attractive however that adoption of mHealth strategies can in future allow a greater democratisation of healthcare - personalised to the precise needs of the individual.

“mHealth Review Derek Jones 2012”

Page 10 of 42


mHealth Review

Understandably, the life science industry has no motivation to design drugs or devices that are only effective for a small, well defined segment of the population. Increasing costs, low patent lives and diminishing returns from the traditional drug development process have also led to a complete rethink about the future of life science. Andrew Wittey, CEO of GlaxoSmithKline stated in 2010, “The [Life science/drug development] business model clearly worked - and up until 2001, ironically at about the same time of the human genome breakthroughs, most would have expected this trend to continue. It has not. So now we are having to reinvent our industry”⁠ 47. At the same time, the regulatory authorities are risk averse and as a result can tend to suppress innovative and even the most frugal opportunities to change medicine. It is quite interesting to compare medical science with most other aspects of life today. The internet and digital era have driven customisation and targeting to emerge as the norm in almost every walk of life today - not just advertising, but manufacturing, media, retail, finance and travel.  According to Eric Schmidt, former CEO of Google, “the power of individual targeting provided by technology will be so good that it will be very hard for people to watch or consume something that has not in some sense been tailored for them”.⁠48 This is the trend toward mass customisation referred to earlier. Note that until recently medicine and health care have been exceptions. In contrast, the retail industry has been shaken up by companies such as Amazon. Many people would say that browsing a book store or a retail outlet was a pleasurable activity and yet this has not stopped the growth of Amazon and similar internet shops. However, it is hard to find anyone who gets pleasure from being in a hospital or from visiting a doctor. In 1946, George Orwell⁠ 49 characterised a Paris hospital from personal experience as the "antechamber to the tomb.” Whilst this may thankfully seem extreme judgement today, it is nevertheless likely that most of us prefer to spend as little time as possible in hospital environments. According to authors such as Eric Topol⁠ 50, the end result of the current practice of medicine is that most of the screening tests and treatments are overused and applied in the wrong individuals, promoting vast waste. He argues that not enough is being done to accelerate the true prevention of disease. Cynically one might say that currently the tendency is to practice “eminence” based medicine - deploying guidelines formed by eminent physicians who base opinions on a paucity of facts. The practice of medicine has not yet emboldened consumers “on-mass” to demand more despite their increasing awareness of a problem.  There is a definite move though toward the democratisation of medicine. This trend is in parallel with super convergence in which medicine is increasingly enabled by digital technology and novel types of sensing. At present we have only limited insight into the physiology of each and every individual - a non representative, fleeting, pinhole view, through an artificial prism. As we will see mHealth technology allows new opportunity and insight into our individual health and wellness.

“mHealth Review Derek Jones 2012”

Page 11 of 42


mHealth Review

Opportunities by the “Wellness Dimension” of the individual To summarise, we have so far seen evidence of trends characterised as follows. • Relatively ageing population - many individuals will live longer and require care potentially at home • Health care costs rising - driven by chronic conditions such as diabetes and cardiovascular disease • Health care delivery - systems and processes are inadequate to meet demand. Consumers may be inconvenienced, choose to pay more for access to care, or be deprived of adequate care. • Consumers are increasingly recognising that they need to take more individual responsibility for their own health • Rate of adoption of mHealth will vary from country to country - with developing economies taking the lead • Widespread adoption of powerful smart phones with communication capabilities A great deal of commercial activity is already directed toward impacting upon these issues. However there are a vast number of specific opportunities that may be more or less attractive for a number of reasons. David Shaywitz⁠ 51 commented in Forbes that currently investors into the mobile health area are largely coming from the traditional technology viewpoint rather than the healthcare viewpoint. His view is that investors in general, and technology investors in particular, are not always comfortable with physicians, and seem much more at home with engineers and developers.  These investors also tend to gravitate to businesses selling directly to consumers rather than those dealing with the complexities of our current healthcare system.  The danger of this investment bias is that a lack of understanding of healthcare will potentially lead to costly mistakes. A balance of viewpoints is needed. In order to give some structure to the mHealth marketplace we introduce the concept of a “Wellness Dimension” that is simply a way of classifying individuals based on their individual situation, needs and wants. Their wellness dimension varies from those who are very fit to those who are managing a chronic condition. For example, consider the following individual classifications or dimensions and a short key word to represent each class. • Elite athlete - “Elite” • Fit person - “Fit” • The Worried Well - “Worried” • Pre-diagnosis - “At Risk” • Active care - “Care” • Chronic care - “Chronic”

“mHealth Review Derek Jones 2012”

Page 12 of 42


mHealth Review

There is also a “granularity” about each of these dimensions. One dimension represents a unique individual and another a crowd of individuals that can be grouped together because they share some particular characteristic or motivation. For example - consider an individual who • Is fit and wants to be even fitter and who wants to have better advice or thinks “Give me the data and I will do it myself” • Is one of the “worried well” and is actually quite healthy but wants reassurance • Is ill but wants to be healthier - wants the knowledge and personalised information to take more control of their own health (the democratisation of healthcare) Across many of these dimensions there are subgroups or “crowds” of individuals who perhaps share the same desire for health and fitness or the same aspirations - For example, • Those who wish to lose weight, stop smoking, exercise more, compete at a higher level etc • Those who have the same medical condition and aspirations - They want to learn from each other and gain peer support • Clinicians gaining greater insight from large amounts of subjective data and the ability to work with massive data sets collected from mHealth systems • Clinicians wanting to work more efficiently and effectively with the resources available to them By taking this viewpoint, we can see opportunities that address fitness development and prevention of chronic conditions by improving health as well as those opportunities that tackle illness or rehabilitation more directly. Opportunities exist, for example, with mHealth to connect with the:- “Elite” or “Fit” - allow fit individuals to monitor and enhance their own health - helping them become even fitter and tapping into their self-motivation. Can we provide the tools via mHealth products and services to allow even elite athletes to compare themselves with others and share their performance, progress and goals with like minded people? Would they choose to be coached with mHealth tools in this way to supplement face to face encounters with their trainers? These individuals may not be old and may not have a chronic condition but will be passionate about their health and wish to maintain and improve it. According to recent studies there is even an urgent need to increase activity levels in primary school children in order to prevent health problems later in life.⁠ 52 Some Novel applications are emerging in this sector. Runners can get reward points for their exercise minutes through the Nexercise app, which turns physical activity into a game. Sportswear company

“mHealth Review Derek Jones 2012”

Page 13 of 42


mHealth Review

Nike Mexico has introduced its own twist on this concept with the Subasta de Kilometros which translates runners’ distances into currency in auction. Participants must first download the Running+ app – which monitors the details of exercise, such as pace, distance and time – or buy one of the Nike+ training products, which track similar data. The Facebook app then gives users the chance to bid on the ‘Subasta de la Semana’ – the Auction of the Week – using the amount of kilometres they have tallied by using the app in the last seven days. Each auction has a suggested price tag in kilometres and a finishing date. Runners must achieve the minimum price tag to bid, and the bidder with the longest distance wins the product. Items available include Nike apparel from Nike+ equipment to footwear. The Subasta de Kilometros gives people an incentive to increase their exercise regime and enables them to win rewards for their training. Further examples of applications focusing on this and other wellness dimensions can be found in the Appendix A. - “Worried”

- enable individuals to be better informed and take more responsibility for their

own health. A generation of individuals of all ages could be described as the “worried well.” They care about their own health and seek reliable information and guidance. They are concerned that most health advice seems contradictory and are unsure about how much general guidance would apply to them specifically. They are well-educated and concerned to rely on a health service that may not be there for them if they should need it. Can we provide guidance via mHealth tools that is very specific and individual to their personal health status; freeing them from the confusion that so often arises when health and wellness information is population based? - “At Risk” - allow those at highest risk of developing conditions to self-monitor and improve their health. We know that certain genetic profiles, lifestyle choices, general fitness and simply advancing age increase the risk of developing certain conditions. Can we provide them with the sensor enhanced, mHealth tools to reduce their risk, perhaps monitor themselves unobtrusively or provide an alert when treatment truly becomes necessary? In this way could we slow or even stem the growth in the number of people ultimately requiring care? This would bring greater convenience to the individual and ensure that their interactions with the health care system are always timely, necessary and sufficient. As an example in this sector, Sano Intelligence (part of the RockHealth incubator) is building a small, wearable sensor that can capture and transmit blood chemistry data continuously to virtually any device. In order to monitor blood chemistry in the past it has usually been necessary for samples to be given via large needles. For those requiring constant monitoring, this could be a serious and often painful burden. Roughly the size of a nicotine patch, Sano’s painless new “mHealth Review Derek Jones 2012”

Page 14 of 42


mHealth Review

transdermal device can already measure the glucose and potassium levels of the wearer’s blood. Eventually, the aim is for it to be able to monitor all the standard components of a basic metabolic panel, including kidney function and electrolyte balance as well. Such data, in turn, will be retrievable in app form via a third-party development and analytical platform. They aim to liberate this data to a third-party development and analytical platform they call "The API for the bloodstream". making it accessible to users on their smartphones or other devices. Each sensor reportedly costs between USD 1 and USD 2 in materials and enjoys a lifespan of a week. Now about to enter pilot testing, the device could reportedly be ready to launch as early as mid-2013. - “Care” - allow individuals with chronic conditions to self-manage their care. Even with a chronic condition life goes on. Can we provide reliable, valid tools to alert people to the urgent need for medical intervention, connect them to clinical help when essential but otherwise keep them out of the hospital care system? This is perhaps the most attractive market by potential sales volumes but there may be significant barriers to adoption if the assumption is that the world’s health services will be the customer (the payer); taping into the trends toward consumer self care may be more practical. Clinicians may resist such disruptive interventions to their processes of care and may in general mistrust mHealth systems thereby slowing adoption. In time, mHealth will become accepted as just another healthcare tool set, but this adoption may not be rapid in many countries. Regulatory hurdles will exist and applications will need need to be considered as high priority by both health services and users for adoption to take place. - “Chronic” - guide individuals to optimise their rehabilitation and know if and when to seek professional support. Most public healthcare rehabilitation processes provided after a stroke, spinal cord injury or heart attack are inadequate to really allow individuals to recover to their maximum potential. Expectations for recovery are rarely individualised and therefore people are discharged from the system based on the availability of health service resources rather than their true potential for improvement. Most individuals who experience the need for rehabilitation are shocked at the gap between their expectations for care and the reality of what they receive. Can we use mHealth to inform, mentor, guide and support individuals to tap much more of their potential for recovery? Rehabilitation receives relatively low levels of investment compared with other aspects of health care and individuals often already recognise the need to self-fund their rehabilitation process. In some cases, following a spinal cord injury or “return to work” situation following illness or trauma, clients have funding available through insurance or accident compensation. There are many possibilities for start-up business activity in these types of applications. The broad aim with this project is to explore the existing business activity and identify a sustainable, high growth activity that matches both our competence and ambition. A recent White Paper from the Wellness & Health Innovations Organisation in Scotland has pointed to the many possibilities in the preventative, Independent/Assistive Living and Wireless (mHealth) market place. It has been suggested that the most economically important markets of the near future will be those which involve the consumer/patient directly. This report identified 3 areas as representing the most promising opportunities for business start-ups.

“mHealth Review Derek Jones 2012”

Page 15 of 42


mHealth Review

- Elderly care - Care of the chronically ill - Preventative care As we have seen above, in reality these are not three individual issues but overlapping concerns. Whilst some changes in consumer behaviour - a democratisation of healthcare - are likely to be needed first before we can expect mass market adoption of products and services, certainly there is growing commercial exploration of this space.

Exploring Business Models A business model describes the rationale of exactly how an organisation will create, deliver and capture value. In this report we adopt a popular structure for presenting a business model based on the work of Osterwalder, Pigneur and others.⁠53 This is based on describing nine basic elements that describe the logic of how a business intends to make money. The nine elements cover the four main areas of a business; the customers; the offer; the infrastructure and financial viability. Specifically the nine elements are:1) Customer Segments - The one or several customer groups to be served by the business 2) Value Propositions - How the business will seek to solve customer problems and satisfy customer needs 3) Channels - How value propositions will be delivered to customers through communication, distribution and sales channels 4) Customer Relationships - How relationships will be developed and maintained with each customer segment 5) Revenue Streams - How revenue flows from value propositions successfully offered to customers 6) Key Resources - What important assets will be required to deliver on everything else? 7) Key Activities - What vital things will need to be done? 8) Key Partnerships - The business can’t do everything. What essential activities will be outsourced? What resources are to be used outside of the organisation? 9) Cost Structure - As a result of the other business model elements, what cost structures will result? In the aforementioned work, a graphical representation - the business model canvas - is used to present a summary in an easy to digest format. This structure can be used to outline some potential business models. We can also consider these models in the context of the “unbundled” corporation⁠54 which holds that there are three fundamentally different types of businesses, each with different economic, cultural and competitive imperatives. 1) Customer relationship businesses

“mHealth Review Derek Jones 2012”

Page 16 of 42


mHealth Review

2) Product innovation businesses 3) Infrastructure businesses Whilst the three types may co-exist within a single corporation, they are best treated as unbundled into separate entities in order to avoid internal conflicts, trade offs or diluted focus.

“mHealth Review Derek Jones 2012�

Page 17 of 42


mHealth Review

References 1 DocuTAP 2 dr

- workflow management tools for urgent care practices. http://www.docutap.com/

chrono - electronic health record platform. https://drchrono.com/

3 tigertext

- HIPAA compliant mobile messaging network for providers. http://www.tigertext.com/

4 HALFPENNY 5 Bodymedia 6 mc10

Technologies - healthcare connectivity and integration solutions. http://halfpenny.com/

- wearable body monitoring products. http://www.bodymedia.com

- B2B startup offering stretchable silicon for the microelectronics industry. http://

mc10inc.com/ 7 Proteus

- personalise therapy by connecting it to your mobile device. Proteus develops digital health

products that collect and aggregate various behavioral, physiologic and therapeutic metrics—such as medication adherence, heart rate, sleep patterns, physical activity and stress levels—into meaningful and appropriate personal management tools delivered to the mobile devices of consumers. Proteus recently announced the commercial launch of two product systems in 2012 based on its product platform—a remote body monitoring system called Metria™ by its partner Avery Dennison, and a digital health product for family care givers called Helius™ with its partner Lloyds pharmacy. Both product systems represent leading examples of an emerging industry of digital health products in which sensor-enabled devices associated with the body continuously monitor and deliver personalized information to individuals. 8 AliveCor

- turns a smartphone into a clinical quality ECG monitor. http://www.youtube.com/watch?

v=dY7ZQM5eah8 9 Fitbit

- wireless wearable sensors for fitness

10 Kinnser 11 Reach

Software - Web-based software for home health agencies. http://www.kinnser.com/

Interactive Clinical Access - telemedicine solutions. http://www.reachhealth.com/

12 INNOVATIENT

Solutions - patient engagement solutions for the healthcare industry. http://

www.innovatient.com/ 13 GNS

Healthcare. http://www.gnshealthcare.com/

14 LIASON

- http://liaison.com/

15 CASTLIGHT 16 “Emerging

Health - http://www.castlighthealth.com/

mHealth:Paths for growth” A report commissioned by Price Waterhouse Coopers LLP

from the Economist Intelligence Unit 2012. www.pwc.com/mhealth 17 “Emerging

mHealth:Paths for growth” A report commissioned by Price Waterhouse Coopers LLP from the Economist Intelligence Unit 2012. www.pwc.com/mhealth

“mHealth Review Derek Jones 2012”

Page 18 of 42


mHealth Review 18 Chesbrough,

H (2011) “Open services innovation” Published by Josey Bass.

ISBN978-0-470-90574-6 19 http://en.wikipedia.org/wiki/Creative_destruction 20 R.Kwok. 21 The

“Personal Technology:Phoningin Data” Nature 458 (2009) p959-961

‘Smartphone Class’: Always On, Always Consuming Content, May 2nd , 2012 Consuming

content in frequent, small portions means more touchpoints for marketers http://www.emarketer.com/ Article.aspx?R=1009014&ecid=a6506033675d47f881651943c21c5ed4 22 “Welcome

to the Yotta World” Economist, Nov 17th, 2011. http://www.economist.com/node/

21537922 23 “A

sea of Sensors - everything will become a sensor and humans may be the best of all”

Economist, Bov 4th 2010. http://www.economist.com/node/17388356 24 “Emerging

mHealth:Paths for growth” A report commissioned by Price Waterhouse Coopers LLP

from the Economist Intelligence Unit 2012. www.pwc.com/mhealth 25 How

Mobile Devices are Transforming Healthcare - Darrell West, Issues in Technology Innovation,

Number 18, May 2012. 14 pages 26 @Rock_Health

2012 Midyear Funding Report.

http://www.slideshare.net/RockHealth/rockhealth-2012-midyear-funding-report?ref=http:// medcitynews.com/2012/06/digital-health-deals-keep-getting-bigger-2m-investments-up-74-percentin-2012/ 27 http://www.chcf.org/publications/2011/02/health-topics-internet-users-information 28 http://www.pewinternet.org/Reports/2011/HealthTopics.aspx 29 Nick

Bilton, “I live in the future & here’s How it Works: Why your World Work and Brain are Being

Creatively Disrupted”. Crown, New York 2010, Chapter 5 30 “Opportunity

& cope: Technology to Promote Independence Prognosis Within Next 5 years. Laurie

M. Orlov, Ageing in Place Technology Watch, JUly 2011 WHI White Paper. Wellness & Health Innovation. http://www.wellnesshealthinnovation.org 31 Health

care without the doctor. California healthcare Foundation, May 2009

http://www.chcf.org/publications/2009/05/health-care-without-the-doctor-how-new-devices-andtechnologies-aid-clinicians-and-consumers 32 Lena

Sun, “Mobile Diagnosis: Coming, but Slowly”, Washington Post, January 17, 2912, p. E5.

33 Meredith

Cohn, “Hopkins Researchers Aim to Uncover Which Mobile Health Applications Work”,

Baltimore Sun, March 14, 2012. “mHealth Review Derek Jones 2012”

Page 19 of 42


mHealth Review 34 The

Economist, June 2nd 2012. "The future of Medicine - Squeezing out the doctor - The role of

physicians at the centre of health care is under pressure” Bangalore & Framingham 35 Some

of the most significant chronic conditions are life style related

36 htttp://www.rand.org/content/dam/rand/pubs/occasional_papers/2010/RAND_OP323.pdf 37 “Emerging

mHealth:Paths for growth” A report commissioned by Price Waterhouse Coopers LLP

from the Economist Intelligence Unit 2012 www.pwc.com/mhealth 38 “The

emerging threat of noncommunicable diseases” United Nations Summit, Septemer 19-20,

2011. http://www.cdc.gov/globalhealth/ncd/unsummit.htm 39 2

trillion dollars in the US

40 Merk

Institute of Ageing and HEalth 2004. The State of Ageing and Health in America

41 Britain

has 27.4 doctors for every 10,000 patients - India has just 6 - with so few doctors it is

changing the way it uses them. 42 Robert

Kocher of the Brookings Institute and Nikhil Sahni of Harvard University. McKinsey Global

Institute. An economy that works: job creation and America’s future. June 2011. Available at: www.mckinsey.com/mgi/publications/us_jobs/pdfs/ MGI_us_jobs_full_report.pdf. Accessed January 22, 2012. “Rethinking Health Care Labor” “Why hasn’t health care experienced the same productivity gains as other sectors of the economy?” by Robert Kocher. New England Journal of Medicine, October 13, 2011 43 World

Health Organization, “mHealth: New Horizons for Health Through Mobile Technologies”,

Global Observatory for eHealth Series, Volume 3, 2011 44 According

to a survey of 1,000 patients in the US, almost all patients (90 percent) want to use technology to better self-manage their own health. Accenture released the results from its survey at June 2012 America’s Health Insurance Plans (AHIP) conference. These patients were interested in accessing their own health information, refilling prescriptions, and booking doctors appointments online. Perhaps not surprisingly, some 46 percent of those surveyed did know whether their health records were available electronically. Another finding that should come as no surprise: While these patients are eager to leverage technology for better self-care, some 85 percent of them still want to keep their in-person interactions with physicians when those are needed. http://mobihealthnews.com/17749/accenture-most-patients-want-mobile-enabled-rx-refills/ 45 Whole

System Demonstrator Programme. Headline Findings – December 2011 Department of

Health http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/ dh_131689.pdf

“mHealth Review Derek Jones 2012”

Page 20 of 42


mHealth Review 46 UK:

Tele-health campaign launched to help 3 million people. Global Centre for ICT in Parliament.

http://www.ictparliament.org/node/4376 47 A.

Witty, “Research & develop”, Economist, November 22, 2011.

http://www.economist.com/node/17493432 48 Holman 49 In

Jenkins Jnr "Google and the search for the future" Wall St Journal, Aug 15, 2010

1946 George Orwell characterised a hospital as the "antechamber to the tomb". George Orwell

"How the Poor Die" Nov 1946. http://orwell.ru/library/articles/Poor_Die/english/e_pdie 50 Topol,

EJ (2012) “The creative destruction of medicine - How the digital revolution will create better

health care” ISBN 978-0-465-02550-3. Published by Basic Books, New York 51 David

Shaywitz “Want to revolutionize health? Enable physicians don’t replace them”. Forbes

6/24/2012 @ 2:06PM http://www.forbes.com/sites/davidshaywitz/2012/06/24/want-to-revolutionize-health-enablephysicians-dont-condemn-them/ 52 Early

Predictors of Objectively Measured Physical Activity and Sedentary Behaviour in 8–10 Year

Old Children: The Gateshead Millennium Study. http://www.plosone.org/article/info%3Adoi %2F10.1371%2Fjournal.pone.0037975 53 Osterwalder,A;

Pigneur, Y “Business Model Generation - A handbook for visionaries, game

changers and challengers” Published by John Wiley & Sons, 2010. ISBN 978-047087641-1 54 “Unbundling

the corporation” Harvard Business Review, Hagel, John; Singer, Marc. March- April

1999 http://hbr.org/1999/03/unbundling-the-corporation/ar/1 55 http://www.worlddiabetesfoundation.org/composite-35.htm 56 http://www.diabetes.co.uk/ 57 “diabetes 58 Abbott

in the UK 2010: Key Statistics on Diabetes: Published by Diabetes UK

CA, Vileikyte L, Williamson S et al (1998). Multicenter study of the incidence of and

predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 21 (7); 1071–1075 59 National

Diabetes Support Team (2006). Diabetic foot guide www.diabetes.nhs.uk/document.php?

o=219 60 Abbott

CA, Vileikyte L, Williamson S et al (1998). Multicenter study of the incidence of and

predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 21 (7); 1071–1075 61 National

Diabetes Support Team (2006). Diabetic foot guide www.diabetes.nhs.uk/document.php?

o=219

“mHealth Review Derek Jones 2012”

Page 21 of 42


mHealth Review

Appendix A mHealth Commercial Activity Business Incubator - “Healthbox”, Chicago Healthbox launched its three-month accelerator program on January 9, 2012 and seeded 10 companies chosen from over 200 applications with $50,000 equity investments (for a 7 percent stake). The 10 teams share space and collaborate at the accelerator’s headquarters in Chicago, where they are given access to an expert network of entrepreneurs, investors, and experts, a collaborative workspace, as well as forums led by these experts and investors, geared towards educating startups on partnerships, product development, and so on. SwipeSense Their product, which aims to tackle the problem of hospital-acquired infections, works with a simple swipe of the hand. By rolling a plastic dowel downward, a mist of alcohol-based gel spritzes onto a user's hand, instantly sanitising it. At the same time, an electronic chip embedded in the device transmits the data wirelessly to a proprietary web-based application that allows hospitals to track compliance. "With nearly 2 million cases of hospital-acquired infections each year and the average hospital having a 40 percent hand-hygiene compliance rate, we wanted to make it so easy you don't even have to think about it.” CaraHealth Patient Journey Record (Dublin, Ireland) uses a cloud-based system with machine learning capabilities to identify patients at high risk of readmission using patient and caregiver self-reported health status. The Cara Health workflow guides non-clinical call operatives through semi-structured telephone conversations with chronically ill elderly patients addressing various dimensions of wellness and health. http://pajrservice.com/site/ PUSH Wellness PUSH Wellness is an outcomes-based wellness incentive provider that efficiently and effectively drives behaviour change in health factors that are meaningful, measurable, and modifiable, producing tangible benefits for participants and employers. This results in reduced healthcare expenses and healthier, happier, and more productive employees.

At PUSH Wellness, we recognise that companies implement wellness programs for a variety of

reasons. Some employers want to improve their bottom line, while others aim to increase employee “mHealth Review Derek Jones 2012”

Page 22 of 42


mHealth Review

engagement. Regardless of your secondary motivation for beginning a wellness program, we understand that your primary reason is to improve the health and well-being of your employees. For this reason, we have designed a scientifically-valid disease risk prediction engine that provides accurate estimates of group savings in terms of three important clinical outcomes: incidence of newonset diabetes, heart attacks, and strokes. http://www.pushforwellness.com/ Azumio Azumio is dedicated to improve people's health and wellness by influencing behaviour through the use of innovative mobile applications. We work closely with research scientists from academic institutions - including Stanford University and UCSF - and collaborate with established industry heavyweights on next generation technologies in mobile health. Currently available Apps - Stress Check, Stress Doctor, Instant Heart Rate, Sleep time, http://www.azumio.com/?section=azumio CareLogger Helps people with diabetes measure and track their glucose levels, blood pressure, meals and weight. Basically diabetes log book software online and on Android and Iphone. https://carelogger.com/ Genomera Is enabling crowd sourced open health studies - aiming to be the “facebook” of healthscience. http://genomera.com/ HealthTap HealthTap is an Interactive Health Network dedicated to improving your health and well- being. We personalise health information for you and provide free online and mobile answers from thousands of the best physicians in the U.S. We help you better understand your health, make better health decisions, and find the best doctors. We help physicians better serve existing patients, find new ones, and build their reputation by demonstrating their expertise online. They say - “Answers from 10,000 U.S. licensed physicians - No waiting room” https://www.healthtap.com/ Massive Health Aims to help people gain control of their weight. They say - “With healthcare costs rising faster than inflation, a crisis looms on the horizon. Health happens between doctor visits. We need tools to address our health that we love to use. More than 750 people have applied to work with us, over half of them doctors and health professionals. Why? Because everyone knows change is necessary.”

“mHealth Review Derek Jones 2012”

Page 23 of 42


mHealth Review

They say - “Medicine needs a design renaissance. Why is it that we live surrounded by beautiful technology, but as soon as we get sick we're left out in the cold? We're working to fix that. We believe that people should be treated like people, not patients.” http://www.massivehealth.com/ Scanadu Scanadu Is creating a commercially-viable medical tricorder (ala Star Trek) “Body Hackers on a mission to create a mythical device, looking for fellow adventurers” At CES on January 10th, Peter Diamandis, CEO of the X PRIZE Foundation, announced the Qualcomm Tricorder X PRIZE to spur the creation of a wireless, portable health device to monitor and diagnose an individual’s health conditions. To win the Tricorder X PRIZE, a device must diagnose 15 distinct diseases in a group of 15 to 30 people. Critically, the tool must be used by a regular person, not a doctor or nurse. http://www.scanadu.com/ They have a link to a YouTube video from CarMD they shows a unit you can plug into any car to get a status report or fault report - analogous to what they are trying to achieve with Scanadu http://youtu.be/MyzAX_eoniM Also very nice trailer that shows the principle and the promise at work http://youtu.be/KSwMauCno6o ExtendMD Nearly 50% of all Americans have a chronic condition but yet, on average, you spend only 3 hours a year with a health professional. This means the other 8757 hours of the year you manage your own condition – typically at home. And if you���re like many, you have spiral notebooks, scraps of paper or electronic medical devices full of readings that never make it to your doctor. They say - Wouldn’t it be great if your doctor could see all this data to regularly monitor your condition while you remain in the comfort of your home? At ExtendMD, we’ve created a simple means to send these readings directly to your doctor through your PC, smartphone or other web-connected device. No need to buy expensive new equipment or become familiar with yet another gadget – simply use what you currently have and turn it into a medical tool. Your doctor will receive this valuable information about your condition and be able to coach you or intervene if you are trending in the wrong direction. They say ExtendMD believes that using simple everyday technologies to increase the communication between patients and doctors reduces costs and saves lives. https://www.extendmd.com/Default.aspx

“mHealth Review Derek Jones 2012”

Page 24 of 42


mHealth Review

Cellscope Created a medical microscope from your cell phone to your doctor. Healthcare systems around the world are embracing telehealth, but have no way to perform many components of a full medical exam using existing technology. For example, a significant majority of the 80 million paediatrician and clinic visits each year in the US and EU due to ear infection could be replaced by lower-cost, faster telemedicine interactions. CellScope brings medical expertise into the home by enabling high-resolution magnified imaging with smartphone cameras. These solutions save time and increase health at very low cost to consumers. CellScope's clip-on otoscope helps paediatricians increase the standard of care by creating a visual history of the middle ear and allows parents to save time by allowing ear infections to be diagnosed and treated remotely. Ear infection is the number-one reason why children visit paediatricians and hits 75% of kids by age 6, resulting in over 30M doctor visits per year in the US alone. CellScope's innovative clip-on dermatoscope enables patients to capture and transmit highmagnification, diagnostic-quality images of the skin from the privacy and convenience of their own homes. In addition to adult dermatology, skin rashes and irritations are the number-two reason why children visit the paediatrician. http://www.cellscope.com/ Zipnosis Allows you to get diagnosed and treated for minor health problems using a computer or smartphone. Not every medical problem requires a trip to the doctor. Zipnosis has carefully selected a few conditions that can be quickly and safely diagnosed by a clinician over the web. The interview takes only a few minutes, and you get your diagnosis back in an hour or less. Welcome to the world of highspeed medicine. https://www.zipnosis.com/ BrainBot Helps you monitor and learn from your brain activity with state-of-the-art EEG brain state detection technology http://www.brainbot.me/ Fitbit Tracker automatically tracks data about fitness activities, such as calories burned, sleep quality, steps and distance http://www.fitbit.com/ Fitbit is dedicated to helping people lead healthier, more active lives. We take a common sense approach to fitness, and believe that the key is to make it easier for consumers to be more active, eat smarter, and get enough sleep — in short, that small changes to your daily routine can add up to big results. To that end, we aim to create innovative, inspiring products and online services that harness

“mHealth Review Derek Jones 2012”

Page 25 of 42


mHealth Review

the power of new technologies to make people more aware of their everyday activities and motivate them to do more. Digifit Helps you track your cardio exercising iTMP Technology, Inc. was founded in Santa Barbara, California, to revolutionise the world of fitness and health metrics monitoring. iTMP partners with industry leaders to bring health and fitness metrics to the iPhone and iPod computing platforms. With iTMP’s DigifitTM Connect wireless bridge and its suite of applications, people can track their health and fitness information anywhere, with no syncing or additional uploading software. Everymove We are a team of dedicated healthcare entrepreneurs and technologists who believe that by working together we can inspire each other to better health. We call this the EveryMove Movement and we want you to join us. Why? Because we owe it to each other to take back control of our most important asset ... Us! We don’t want to rely on institutions to save us from ourselves. Let’s take back control of our health and have some fun in the process. How are we going to do that? By building the coolest, easiest rewards system for your health that you have ever seen. The more you do to improve your health, the more rewards you get from insurance companies, employers and brands ready to recognise you for the great things that you are already doing in your life. Now that’s taking back control! Go for it! Isn’t it time that you got rewarded for the good stuff? We are building our product now and if you’re interested in participating, sign up to be a beta customer here. https://everymove.org/ Fitnio Uses GPS to track your walk, jog or run and supplies you useful fitness-related data about the workout. http://www.fitnio.com/index.htm Getupp Getupp is a location-based commitment service. Commit to activities that require your presence at a specific location at a certain time, for example, going to the gym after work or being home on time for dinner. getupp verifies and shares whether you keep or break such commitments. Open the getupp iPhone app at the right location at the right time, and your commitment is completed. But if you fail to show up, your commitment is broken, and your failure is automatically shared with your friends on Facebook. http://www.getupp.com/

“mHealth Review Derek Jones 2012”

Page 26 of 42


mHealth Review

SportyPal Helps you improve your running or cycling performance using your gps enabled mobile phone. http://www.sportypal.com/ Gingerio Turn mobile phone data into health insights. Ginger.io is a behaviour analytics company that uses a proprietary mobile sensing platform to model patient behavior for different health conditions and symptoms. Our core expertise combines mobile sensing and machine learning to extract "meaning" from massive amounts of behavior data. We analyze and deliver insights via actionable reports, compelling user interfaces and interventions. http://www.ginger.io/Main/HomePage AgaMatrix Wavesense - Diabetes Care Created the first Apple-approved blood glucose meter that connects to the iPhone in real time. AgaMatrix develops and manufactures a line of diabetes products designed to improve the quality of diabetes care. The company’s products feature WaveSense, a new technology that personalises each test to provide world class accuracy. It detects and corrects for many errors caused by differences in blood samples and environmental conditions. Zero- ClickTM, the WaveSense diabetes data management system, was designed to simplify data download. WaveSense and Zero-Click consist of six FDA-cleared products and are protected by a suite of more than 160 patents worldwide. http://www.wavesense.info/ AliveCor mHealth for iHumans. is building a clinical-quality electrocardiogram (ECG) recorder http:// alivecor.com/ BAM Labs Everything is getter smarter – phones, cars, appliances, you name it. Now, pioneering a new age of connected care, BAM Labs’ Touch-free Life CareTM (TLC) System brings “smart” to the bed. BAM Lab’s Touch-free Life-Care (TLC) System transforms any bed into a cloud-enabled smart bed that empowers caregivers to easily and efficiently track the health of their residents remotely – without attaching anything to the resident. The BAM Labs TLC sensor mat, placed under any bed mattress, continuously detects heart rate, breathing rate, motion and presence. Data is automatically transmitted to the BAM Labs TLC analysis cloud. Caregivers receive health data and alerts on their PC or mobile devices such as smart phones, iPod touch and iPads. Using the BAM Labs TLC System, caregivers can monitor a group of people at all times while performing their daily duties. Caregivers can also review long term trend data for sleep patterns, resting heart and breathing rate and sleep quality to identify adverse changes in health for early intervention. http://www.bamlabs.com/ “mHealth Review Derek Jones 2012”

Page 27 of 42


mHealth Review

BASIS Created the Basis Band, a wearable wrist health and heart rate monitor that collects data calories burned and sleep patterns. Basis is a device that tracks heartbeats and more to paint the most useful picture of your health. Stay motivated by accumulating points and praise for your progress. Your heart rate is a great indicator of overall health and activity. With Basis, you can see how your heart responds to interesting moments in your day. Special sensors monitor your heart rate and more to calculate the calories you burn, and how sleep patterns and activities play into your wellness. A 3D accelerometer measures how active you are. Temperature and galvanic skin response sensors provide new insight into how your performance is impacted by events in your day. These factors in relation to your heart rate give you the richest picture of your wellness. All the information you receive is customised based on your data by our science team’s sophisticated algorithms. We’re constantly refining and adding to the product based on new scientific research, so you can be sure you’re getting comprehensive feedback, always. You are in control of your data, so you decide what to share — or whether to share. And we store your data in our highly secure, industry-standard cloud computing infrastructure, so you can be sure that it’s protected. Your privacy is important, and we’ll take extreme care of your data. https://mybasis.com/ Bodymedia Arm band collects real-time info on calorie burn & workout data. The BodyMedia FIT system gives you highly accurate information on activity, calories and sleep patterns – the most accurate in the market. Clinical study results show it can improve weight loss up to 3x! BodyMedia FIT is an on-body monitoring system that consists of the BodyMedia FIT Armband monitor, online Activity Manager*, an optional Display and free downloadable apps for mobile device users. BodyMedia FIT Armbands automatically track the calories burned during your daily activities — from pumping iron to using an iron — and monitor the quality of your sleep, an important factor in weight loss. The information tracked can easily be managed with BodyMedia's online Activity Manager. Add in the easy-to-use food log and you have the right information to improve your weight loss. http://www.bodymedia.com/ Cognionics Cognionics, a leader in non-invasive human bioelectric sensing, has developed a new patent-pending non-contact sensor that enables the acquisition of clinical quality cardiac (ECG) and brain (EEG) without the need for skin contact. More information about our sensor can be found in our technology and articles page. We are targeting this sensor for clinical, research and consumer markets, described in the applications page. http://cognionics.com/

“mHealth Review Derek Jones 2012”

Page 28 of 42


mHealth Review

Connected Health Develops health monitoring devices for remote health management. Health care providers have demonstrated demand for wireless monitoring solutions to provide care for patients as an alternative to hospital visits for some patients. Demand has been driven by policy changes that penalize health care providers that do not manage costs. Unnecessary hospital visits are the highest manageable cost faced by these health care providers. These health care providers are very motivated to implement wireless patient monitoring. Many began trials with proprietary, first generation solutions. These solutions used dedicated gateway hardware and proprietary communications approaches. While viable, these solutions approved expensive and difficult to scale. ConnectedHealth’s opportunity is to address health care providers demand for lower cost eHealth solutions that can scale by leveraging newly created standard communications standards (Continua), leveraging third party measurement devices and use of standard, third party health gateway hardware (Android phones with embedded ConnectedHealth client). Software Technology/Protocols – The core technology utilised in our WHP is based on specifications and standards mandated by the ContinuaTM Alliance. ContinuaTM is an industry organisation, consisting of around 300 medical technology and manufacturing technologies that mandates protocols that allow end to end transmission of medical data, from medical devices through the internet, to the Electronic Medical Record system. The following diagram provides an overview of the Continua system, which will be utilised in our WHP. Corventis Corventis believes that medical device, wireless and information technologies can be harnessed to enable early detection and timely treatment of cardiovascular events...without impacting patient lifestyle. Corventis is committed to improving clinical outcomes and lowering healthcare costs by enabling the early detection of cardiovascular events while allowing patients to maintain an active lifestyle. By combining medical device, wireless and information technologies, our patient and physician friendly solutions are designed with the goals of: • Wirelessly connecting clinicians and patients while increasing patient compliance • Providing focused and continuous visibility into cardiac health status • Delivering exception-based, actionable information to guide clinical decisions • Enabling seamless use by clinicians and patients across the globe Our Accomplishments Since our inception, we have made great strides in delivering on our commitment through a series of successful research, development, clinical, regulatory and commercial accomplishments including: Filing more than 70 patents in the United States and internationally for our technology and solutions Completion of the international, prospective, multi-center MUSIC (Multi-Sensor Monitoring in Congestive Heart Failure) program of clinical trials which enrolled 543 patients

“mHealth Review Derek Jones 2012”

Page 29 of 42


mHealth Review

510k clearance and CE Mark for the AVIVO® Mobile Patient Management System 510k clearance and CE Mark for the NUVANT® Mobile Cardiac Telemetry System Certification of the Corventis Monitoring Center as an Independent Diagnostic Testing Center (IDTF) by the Center for Medicare and Medicaid Services (CMS) Secured reimbursement for over 100M covered lives (Medicare, commercial payers) in the United States for use of the NUVANT Mobile Cardiac Telemetry System Recognition as a Technology Pioneer 2010 by the World Economic Forum and receipt of the President's Innovation Award from the American Telemedicine Association in 2010 Our Team Our employees and advisors include experts in the medical device and information technology industries as well as leading physicians in the fields of clinical cardiology, electrophysiology and heart failure management. Privately held, we are backed by prominent venture capital firms Kleiner Perkins Caufield & Byers, Mohr Davidow Ventures, DAG Ventures and PTV Sciences. http://corventis.com/us/default.asp Echo Therapeutics Is creating a non-invasive, wireless glucose monitoring system. Echo Therapeutics is a transdermal medical device company with deep expertise in advanced skin permeation technology. Echo is developing its Prelude® SkinPrep System as a platform technology to allow for significantly enhanced and painless skin permeation that will enable two important applications: Needle-free drug delivery, with the delivery of lidocaine as the first application. Additional applications for painless, needle-free delivery of drugs are planned. Analyte extraction, with the Symphony® tCGM System for needle-free, continuous glucose monitoring in hospital patients as the first application. Echo believes that transdermal drug delivery and analyte monitoring is a much better way of patient care than the current paradigm of invasive, needle-based therapy. Prelude has the potential to provide a safe, painless, easy-to-use and cost effective skin permeation process that Echo believes will increase patient comfort, compliance and ultimately patient outcomes. Greengoose Uses tiny wireless sensors and accelerometers to track everyday behaviour and record it online. GreenGoose sensors make doing everyday things more playful! They're wireless stickers and stick on anything that moves -- even pets. They're smart and can automatically tell what's happening; a dog gets a walk, a frisbee is caught, or the toilet seat goes down, you name it. It's part of a whole new world of apps in the works that helps us play more and live better. GreenGoose sensors send what they know wirelessly to a little green egg that attaches to your home WiFi. From there, the fun moves online to your mobile phone or any app on the Internet. No geeky setup, either. Just plug the green egg in, slap a sticker on, download an app to your phone and you're ready to go.

“mHealth Review Derek Jones 2012”

Page 30 of 42


mHealth Review

http://www.greengoose.com/ HealthPAL Uses bluetooth and M2M cellular technology to collect and transmit health readings from medical monitors to a user’s EHR. HealthPAL is currently FDA-cleared for use with glucose meters, blood pressure monitors, weight scales and pulse oximeters. The data can be accessed for remote monitoring by professional caregivers using enterprise EHRs, or by the end-user or authorized family members through the patient’s personal health record. HealthPAL is a dedicated device for transmitting health data only. Its core function of transmitting biometric data is automated and eliminates the need for a smart phone or computer to transmit and upload health readings. This promotes higher adoptability and compliance for the patient, and removes the opportunity for the misuse or “abuse” of data plans and equipment that is commonly associated with cell phone and computer health monitoring options. http://medapps.net/healthpal.html Jan Medical Jan Medical has developed the first and only portable brain sensing device designed to enable timely determination of ischaemic stroke. A determination can be made in minutes. The device is also being evaluated for possible reliable detection of traumatic brain injuries, including concussions. The Jan Medical device emits no energy into the brain and is therefore positioned as a “NonSignificant Risk” in clinical trial protocols. Continuous-monitoring options with the device include hours, days or weeks until the condition is resolved or requires intervention; all other brain assessment alternatives—such as CT and MRI—are mere “snapshots.” There are very limited tools available for timely diagnosis of ischaemic stroke or for continuous monitoring of stroke patients in the Neuro Critical Care Unit. For example, CT is only effective 15% of the time in determining whether or not a stroke is ischaemic during the critical first few hours in which therapeutic options exist for this disorder. Concussions are not detected by any current technology, leaving trainers and doctors without hard data upon which to base treatment or clearance to return to participation. http:// www.janmedical.com/ welcometojanmedical.html Jawbone Developed a motion-recording wristband and an App to work together and track users activity http:// jawbone.com/up MC10 Developed wearable, temporary tattoos that detect vitals. Published in Science for new work on electronics so thin and conformal they are able to be applied to the skin just like a temporary tattoo.

“mHealth Review Derek Jones 2012”

Page 31 of 42


mHealth Review

The systems can measure everything from heart rate to activity level to hydration, all in a thin, stickerlike package. This has enormous potential in the health, wellness, and health care markets. mc10 takes electronics 'out of the box' to create thin, conformal systems that are able to move with the natural world. mc10’s competitive advantage stems from its ability to transform rigid, planar electronics into new types of systems that can bend, stretch and wrap into novel form factors. We use the existing semiconductor industry infrastructure to make these systems, thereby leveraging proven performance and cost competitive economics. mc10 works with partners in a joint development model to prototype and manufacture novel applications for consumer, military, medical and industrial applications. The human body is neither flat nor rigid. mc10 enables high performance sensing and therapeutics that gently conform to the body's complex shapes and sensitive tissues. The days of designing products according to the limitations of rigid electronics are over. We call these intelligent medical systems interventional circuitsTM. http://mc10inc.com/ MyTrek Is a wrist-worn wireless pulse monitor http://www.scosche.com/mytrek Sensimed AG, Switzerland Their contact lens is a simple solution to continuously monitor fluctuations of intraocular pressure. Sensimed AG, a Swiss medical devices company, has developed a novel solution to monitor intraocular pressure continuously up to 24 hours. The solution consists of a soft, non-invasive contact lens which encapsulates a telemetric sensor. The external system consists of an adhesive antenna worn around the eye attached to a portable recording device. The SENSIMED Triggerfish® Sensor is a soft hydrophilic single use contact lens, containing passive and active strain gauges embedded in the silicone to monitor fluctuations in diameter of the corneoscleral junction. The output signal sent wirelessly to the SENSIMED Triggerfish® Antenna is directly correlated to fluctuations in intraocular pressure. The adhesive Antenna, worn around the eye is connected to a portable Recorder through a thin flexible Data Cable. The patient wears the SENSIMED Triggerfish® up to 24 hours and assumes normal activities including sleep periods. When the patient returns to his doctor, the data is transferred from the Recorder to the practitioner's computer via Bluetooth technology for immediate analysis. SENSIMED Triggerfish® is a breakthrough solution to continuously monitor fluctuations of intraocular pressure. http://www.sensimed.ch/en/products/sensimed-triggerfishr.html Withings Creates connected devices that improve health, fitness and well-being. Includes Wifi Body Scale and Blood Pressure Monitor http://www.withings.com/

“mHealth Review Derek Jones 2012”

Page 32 of 42


mHealth Review

MyZeo Developed a headband + bedside analytic tool for improving quality of sleep http://www.myzeo.com/sleep/ Glooko A digital logbook for people with diabetes who have to check their blood sugar every day. There are dozens of glucose logbooks in iTunes, but almost all of them require manual entry. What makes Glooko different is that the company designed a $40 cable (sold separately) that works with six of the top glucose meters. You just plug it into both devices and it downloads your daily readings. The app itself is free. It lets you mark whether the reading was done before or after a meal, add notes, and email or fax a 14-day summary to your doctor. The company charges for the cable. “What people want to do is download these readings into Apple devices,” explains co-founder Anita Mathew. “Many of these meters don’t work with Apple devices.” There are an estimated 19 million diabetics in the U.S. alone, and 17 million of them test their blood sugar levels. By 2025, one in five people in the U.S. is projected to have diabetes. Simply connecting these medical devices to iPhones creates a market opportunity, but this is just the first step. Once Glooko starts collecting diabetes data it could start to analyze it (although there are regulatory barriers—just plotting the data points on a graph requires FDA clearance). It could also charge for premium features. Glooko is an ambitious startup. It’s chairman and co-founder is Yogen Dalal (Xerox Parc, Mayfield Fund). Mathew worked for ten years in product marketing at Johnson & Johnson, where she helped launch several glucose meters. The third co-founder is Sundeep Madra. Glooko also has some serious backers. The startup raised a $1 million seed round in November, 2010 from Chamath Palihapitiya‘s Social+Capital fund, Bill Campbell, Vint Cerf, Andy Hertzfeld, Judy Estrin, Bumptop founder Anand Agarawala, Kosmix co-founders Venky Harinarayan and Annad Rajaraman, Russel Hirsch, and Xtreme Labs. The company lends some of its Palo Alto office space to Social +Capital. Omada Health They say “We’re revolutionizing health care through group-based programs for chronic disease prevention. Focused disease prevention is the next great opportunity in health. We’re combining behavioural science, human-centered design, and new technology to transform disease prevention, while building from established clinical precedent” Omada Health, a graduate of Rock Health’s first batch of startups, is announcing today that it has raised $800K in seed funding from a number of angel and venture investors, including Esther Dyson, NEA, Aberdare, Kapor Capital, and TriplePoint Ventures to name a few. Omada Health, simply put, has turned its focus to one of the most pervasive diseases in the country: Diabetes. Well, really, prediabetes. The CDC estimates that 79 million people in the U.S. currently have prediabetes — said another way, that’s approximately 1 in 3 adults. And the majority of those people are not aware of their condition, which essentially means that they are suffering from blood “mHealth Review Derek Jones 2012”

Page 33 of 42


mHealth Review

glucose levels that are not irregular enough to be considered diabetes, yet still indicate an extremely high risk of progressing to full-blown diabetes. And the projection is pretty grim. If nothing is done, the CDC estimates that half of the American population could have diabetes or prediabetes by 2020. Besides bringing attention to the ways that food is being produced, distributed, and consumed, Omada Health Co-founder Sean Duffy tells us that lifestyle programs have been (and are being) designed which can dramatically reduce a person’s risk of progressing from prediabetes to diabetes. The Diabetes Prevention Program, for example, was a recent, major multicenter clinical research study that developed a 16-week lifestyle program that succeeded in reducing progression by 58 percent. Omada Health, then, is leveraging these types of research and programs to bring interventions to the millions of people with prediabetes through group-based programs, “human-centered design, behavioural science”, and web technology. Duffy tells me that the startup aims to be (one of the first) online platforms for delivering preventative care at scale — at a cost point that demonstrates compelling ROI for insurance providers or self- insured employers. The Omada program matches people with prediabetes into small groups, pairing each group with a “facilitator” trained in the Omada curriculum, who then guides patients through a 16-week lifestyle course. While progressing through the course, Omada tracks their progress using a cellularconnected scale as well as other metrics. So far, the startup has run two prototypes and is currently preparing for a larger pilot early in 2012. The startup was first conceived as an internal project at the global design consulting firm, IDEO, where Duffy and co-founder Adrian James were both employed. In May, the two left IDEO to join Rock Health, were later joined by two more staffers, and today the team has added a round of seed funding to push forward with their pilot program and ramp up hiring. http://omadahealth.com/ mHealth Users of Remote Health Monitoring to Reach 3 Million by 2016: Smartphones Play Leading Role Additionally, Smartphone Hardware Peripheral Market to Gain Traction A burgeoning market for healthcare peripherals and increasing smartphone processing power will result in the number of patients monitored by mobile networks to rise to 3 million by 2016, finds Juniper Research's latest report on the mHealth sector. Remote patient monitoring, using the smartphone as a hub, will also lower the cost of mHealth services by reducing the need for costly tailored devices. Cardiac Monitoring Leads the Field The new Juniper report finds that the monitoring of cardiac outpatients is currently leading the field, as insurance reimbursement in the US market plays a key role. However, in time the management of diabetes and COPD (Chronic Obstructive Pulmonary Disorder) and other chronic diseases will play an important role in the remote patient monitoring market.

“mHealth Review Derek Jones 2012”

Page 34 of 42


mHealth Review

"Remote patient monitoring will step in to reduce the cost burden of unhealthy lifestyles and aging populations," says report author Anthony Cox. But while remote patient monitoring is already showing both positive medical outcomes and cost savings over outpatient care, more trials would still benefit mHealth in order to further convince the medical establishment of its benefits, finds Juniper Research. Further findings from the report include:• Mobile Healthcare and medical App downloads will reach 44 million in 2012, Rising to 142 Million in 2016 • Clarification from the US FDA (Food and Drug Administration) on which mHealth apps will require FDA approval is still required but is expected to add further impetus to the market. • Developing markets continue to benefit from SMS-based education programmes and stand to benefit in medium term from app-based healthcare services such as mobile ultrasound that are now being developed • EHR (electronic health records) have yet to gain significant traction even in developed markets but in the long term will become an important component of mHealth offerings A complimentary mHealth whitepaper and further details of the full study can be downloaded from the Juniper Research website. Press Release: Mobile Healthcare and Medical App Downloads to Reach 44 Million Next Year, Rising to 142 Million in 2016 Hampshire, UK - 29 November 2011: The combination of the smartphone and the app stores has created a vibrant market for mHealth apps which are forecast to reach 142 million downloads globally by 2016. Apps already cover a wide range of mHealth use cases, varying from medical calculators to monitoring software. However, in time, hardware peripherals attached to the smartphone will greatly extend the capabilities of these apps, finds Juniper Research. App Peripherals Hardware Peripherals designed to work directly with mHealth apps will allow the smartphone to become an important portable accessory to the healthcare establishment for both diagnosis and relaying medical data to healthcare staff, states the report. Consumer Focus Juniper Research notes that the consumer focus of many mHealth apps will result in mHealth becoming increasingly mainstream. According to report author Anthony Cox, "Acceptance of new healthcare practices like remote patient monitoring will come directly from consumers becoming engaged in mHealth through the smartphone." Other findings from the report include: (http://www.juniperresearch.com/shop/products/ report/pdf/ forecasts/699MHO11_LOFs.pdf) “mHealth Review Derek Jones 2012”

Page 35 of 42


mHealth Review

• Clarification from the US FDA (Food and Drug Administration), on which mHealth apps will require FDA approval, is still required but is expected to add further impetus to the market. • Significant cost-savings can be achieved through remote patient monitoring in developed markets through the avoidance of hospital stays and outpatient appointments. • The US has a notable lead over other developed economies for remote patient monitoring due to the structure of the healthcare industry and insurance funding. • The report nevertheless acknowledges the need for more trials to prove both the medical benefits and the potential cost savings of advanced mHealth services. • The report includes a comprehensive analysis of the current state of play of the mHealth market and contains five year forecasts covering areas including mHealth smartphone apps, remote patient monitoring for cardiac outpatients and chronic diseases, and enterprise healthcare smartphones. • The mHealth whitepaper is available to download from the Juniper website together with further details of the full report. (http://www.juniperresearch.com/whitepapers/mhealth_whitepaper) Juniper Research provides research and analytical services to the global hi-tech communications sector, providing consultancy, analyst reports and industry commentary. Jess Hanslip Juniper Research T: +44(0)1256 830 002 E: jess.hanslip@juniperresearch.com Related Reports Mobile Healthcare Opportunities - Smartphone Apps, Monitoring & mHealth Strategies 2011-2016 http://www.juniperresearch.com/reports/mobile_healthcare_opportunities Mobile Healthcare Opportunities Interactive Forecast Suite - Smartphone Apps, Monitoring & mHealth Strategies 2011-2016 http://www.juniperresearch.com/reports.php?id=354 6 Big HealthTech Ideas That Will Change Medicine In 2012 | TechCrunch Artificial Intelligence - Siri and IBM’s Watson are starting to be applied to medical questions. They’ll assist with diagnostics and decision support for both patients and clinicians. Through the cloud, any device will be able to access powerful medical AI. This has the potential to disintermediate some fields of medicine like dermatology which is a pattern based field — I look at the rash and I know what it is. Soon every primary care doctor is going to have an app on their phone that can send photos to the cloud. They’ll be analysed by AI and determine “oh that mole looks like a dangerous melanoma” or “it’s normal”. So the referral pattern to the dermatologist will slow down.

“mHealth Review Derek Jones 2012”

Page 36 of 42


mHealth Review

On the plus side, there are consumer apps like Skin Scan where for $5 you can take a picture of lesion and send it to the cloud, and it will at least give you an idea if it’s dangerous or not. If it is, it can help you find a nearby doctor, which could help dermatologists get more business. Many fields are going to change because of artificial intelligence, pattern recognition, and cheaper tests. Big Data - We’re gaining the ability to get more and more data at lower and lower price points. The primary example is the human genome and genomic sequencing. It cost a billion dollars or more 10 years ago to get a complete human sequence. However, the cost and speed of getting that data has dropped faster than Moore’s law to the point where it’s less than $5,000 when ordered online. From 23andMe you can now get a cheap SNP test, and it has a pilot program for $999 for a whole exome. (http://www.crunchbase.com/company/23andme) Maybe there were 10,000 patients sequenced last year. Next year it could be 100,000 and soon millions. A genome sequence could be the cost of a blood count today. When that information becomes queryable in an a crowdsourced and cloudsourced way we can be more predictive about what you’re more likely to get based on your genomics. You can then take preventative steps or get screened more often. So we’re pulling in huge data sets from low-cost genomics to proteomics (analyzing the proteins in the blood) to quantifiable self. The challenge is to make sense of that data and make it actionable information without making the patient or doctor overwhelmed. I think we need to make smart dashboards like they have for fighter pilots. They would piece together data from ubiquitous sensors, like those made by GreenGoose, and Microsoft Kinect that can measure your activity around the house. It would be like the OnStar for your body that could give you clues about when you’re about to get in trouble, and it could call for help or guide you to appropriate therapy. http://www.crunchbase.com/company/greengoose http://techcrunch.com/tag/kinect/

3D Printing 3D printing has been around for a while but now it’s being applied to medicine in ways such as being able to scan the remaining leg of a patient that’s missing one from an accident. It can then build a prosthetic leg with skin and size that matches. 3D printing is integrating with the fast-moving world of stem cells and regenerative medicine with 3D ink being replaced by stem cells. In the future we’ll probably use 3D printing and stem cells to make libraries of replacement parts. It will start with simple tissues and eventually maybe we’ll be printing organs. http://techcrunch.com/tag/3d-printing/ Social Health Network Social networks have the ability to change our behaviour. When you wireless weight scale shares metrics with your friends, you get praised for success and pressured if you’re not maintaining your

“mHealth Review Derek Jones 2012”

Page 37 of 42


mHealth Review

diet. Social networks are also quite powerful for tracking and predicting disease. James Fowler, coauthor of the book Connected is now working with Facebook to look at health data. Not surprisingly, the more friends you have, the earlier in the flu season you’ll get influenza. This could help predict when you’ll get the flu and let you take steps to avoid it. http://connectedthebook.com/ We’re in the Facebook era, and are more open to sharing information in the healthcare spectrum. Individuals will share their whole history through services including PatientsLikeMe and CureTogether where patients with similar problems from migraines to Lou Geghrig’s disease will consolidate health information. This will enable improvements in clinical trials. http://www.crunchbase.com/company/patientslikeme http://www.crunchbase.com/company/ curetogether Genomera is trying allow for low-cost web-based clinical trial around any question. Practice Fusion can also crowdsource that data from its electronic medical records. By collecting data from all the patients within a hospital or a region you can see trends and almost run clinical studies on the fly. For example you could see all the patients that have this gene and that are taking this drug, and determine if that drug is effective for them or not. http://www.crunchbase.com/company/genomera http://www.crunchbase.com/company/practicefusion Communication With Doctors New communication platforms similar to a Skype or FaceTime will help you communicate differently with your clinician. Many of these things are basically already here. The challenge is often not the technology but the regulatory and reimbursement markets around them. If you’re going to be talking with your clinician on your iPhone you may need to do that in a HIPAA privacy protected way. The physician is also going to want to be paid for that in some way. They’re not going to want to get all your data every time you have a hiccup or look at your iPhone pictures of your rash unless there’s a way to get paid. The regulatory system needs to adapt towards to becoming Accountable Care Organizations, which reward clinicians and healthcare plans for keeping patients healthy opposed to paying them to do extra procedures. This contrasts with a model of paying them for service like putting in stents and doing things after a problem has already progressed. Incentives need to be aligned and reimbursement needs to change to enable some of these new technologies to actually enter the clinic. Mobile The ability to have your phone tie to your healthcare record and track medical metrics will have vast repercussions. Though some aren’t cleared for sale in US yet, devices like the Alivecor electrocardiogram can monitor your heart in realtime, send the data to the cloud, and allow your

“mHealth Review Derek Jones 2012”

Page 38 of 42


mHealth Review

cardiologist to look at it instantly. Other devices are turning phones into otoscopes for looking in your ears, or glucometers for monitoring blood sugar. http://techcrunch.com/2011/08/23/alivecor-turns-mobile-devices-into-low-cost-heartmonitors-raises-3-million/ Quantified self devices like the Fitbit, Jawbone Up, and more medically themed devices will take what you used to do dsin a clinic or hospital and bring it home. This will allow therapies to be tuned much more effectively than scribbling data on a piece of paper and bringing it in to your doctor months later. Eventually these devices will converge into the equivalent of Star Trek tricorder that can perform a wide variety of medical functions. There’s even an $10 million X Prize proposed to reward the inventor of the first functional tricorder. http://www.xprize.org/prize-development/life-sciences#artificial Unfortunately, the strict regulatory system and entrenched, interested of the United States are pushing innovation offshore. A lot of the work for using mobile phones for health care is happening in Africa and India. Since there are few physicians in some of these areas mobile health and telemedicine are taking off. For example, microfluidics allows multiple tests to be done on a small chip at pennies per test, with the ability to connect to the web for analysis. The US will need to find a way to solve these regulatory problems while keeping patients safe, otherwise jobs and revenue could slip abroad. FutureMed 2020 program http://futuremed2020.com/ Mobile Technology Is Transforming The Health Industry, But To What Extent? Technology is in the process of bringing change to every piece of the health industry — wellness, fitness, healthcare, medicine — you name it. And as it always seems with introduction of new technologies, it’s awe-inspiring how quickly they can transform entire industries yet, at the same time, make us realize just how far we have to go (or how far behind we really are). The health industry has been touched (and defined) by cutting-edge technology for years, yet its relics, legacy infrastructure, paper-pushing, and archaic procedures are as obvious today as ever before. Nonetheless, today, we really seem to be at an inflection point. (Or do we hear that every year?) The current landscape is full of inspiring examples of how technology is changing the most fundamental aspects of how we keep track of our own health, how we approach diagnostics, treatment, and more. Earlier this month, Josh laid out six trends in healthtech that could have a big impact on medicine in 2012, and last week veteran Silicon Valley investor Vinod Khosla wrote an epic analysis of the significant role “Doctor Algorithm” could play in changing the literal and metaphorical face of healthcare. It’s pretty exciting, if not a little frightening.

“mHealth Review Derek Jones 2012”

Page 39 of 42


mHealth Review

http://techcrunch.com/2012/01/01/healthtech-2012/ There are many factors in play that are affecting the transformation of the health industry, but much of it seems to begin with — what else? — the growing ubiquity of cell phones, smartphones, and mobile devices. Early last year, PEW Research was already reporting (http://pewinternet.org/~/media/ files/reports/2011/pip_healthtopics.pdf) that 17 percent of mobile phone users were using their devices to look up health and medical information, and Juniper recently estimated that 44 million health apps were downloaded in 2011. (http://www.juniperresearch.com/viewpressrelease.php?id=352&pr=275) The amount of health data is exploding in line with the growing adoption of health and medical apps, much of this thanks to the increasingly wearable, portable and user-friendly devices using smart sensors that can capture and transmit all kinds of biometric data. Smartphones are connecting with these diagnostic apps and health-measuring devices to help you stay on top of your health and fitness — like Basis’ heart and health tracker, Lark, Fitbit, and Jawbone’s Up — to name a few. http://techcrunch.com/2011/09/22/basis-reveals-an-awesome-new-affordable-heart-and- healthtracker-you-can-wear-on-your-wrist/ http://techcrunch.com/2011/05/24/larks-silent-alarm-and-sleep-monitoring-system-lands- at-appleretail-stores/ http://www.crunchbase.com/company/fitbit http://techcrunch.com/tag/jawbone/ These “quantified self” devices are hot, as they help scratch our geeky itch for more data, and bring the doctor’s office home with us — or out on our jogs. The options are many when it comes to diagnostic and tracking tools like AliveCor, which helps you measure your heart rate from your phone (and is not yet available in the U.S.), or Philips’ Vital Signs Camera that measures your heart and breathing rates using your iPad camera — or Skin Scan, which measures your risk of skin cancer from your iPhone. http://quantifiedself.com/ http://techcrunch.com/2011/08/23/alivecor-turns-mobile-devices-into-low-cost-heartmonitors-raises-3-million/ http://itunes.apple.com/us/app/vital-signs-camera-philips/id474433446?mt=8! http://itunes.apple.com/us/app/skin-scan-the-most-accurate/id434196122?mt=8

The Biggest Opportunity For Disruption Today: Health Care Products That Work Many people believe home health will be the next big boom. The Rock Health incubator is churning out a slew of startups that will help you manage your health, the iPhone 5 is expected to launch with a built-in heart rate monitor, and sick people everywhere will begin to look at health care more as

“mHealth Review Derek Jones 2012”

Page 40 of 42


mHealth Review

consumers than as patients. • http://www.rockhealth.com/ There is reason to be skeptical here. In the past few decades, people have cared deeply about health yet have continued to take lousy care of themselves. Let’s face it: Healthy people have always taken it for granted, and unhealthy people are often terrible patients. So what’s changing, and why is now the time for a metamorphosis in home health? The answer comes down to two significant factors: (1) People are expanding their definition of “health” to include proactive wellness and ownership of treatment, and (2) There is a huge opportunity for designers to inject desire into this category. By the end of 2012, I believe the lines will blur between the health care, technology, and home products industries. Health used to be something we worried about at home and solved at the hospital. The reality is more and more health care management is happening in the home, and that’s where many solutions actually belong. One of the biggest shifts in how we define “health” is our recognition that there are two distinct parts of the equation: wellness and medicine. When it comes to wellness, or living a preventative lifestyle, Americans have been obsessed with losing weight since we started getting obese in 1990. But only in the last couple years have we actually started to care about full-body wellness. As an example, just look at the number of yoga studios and natural foods markets popping up throughout the Midwest and South. This movement is mainstream, not just for the hippies where I live. It represents a big shift: body weight to full-body wellness. Compare that to medicine, or the treatment of a condition, where we used to think doctors were the only ones in control of our health. Now, with our health care system so messed up, we only go to the doctor when it is absolutely necessary--for procedures and prescriptions. And with that health care system incentivized to push patients out of the hospital as fast as possible, people are quickly learning to take recovery into their own hands. Access to medical information through resources like WebMD has forever changed the way we handle our health. This is another big cultural shift: responsible doctor to self- responsibility. There is a massive opportunity for design and technology to make the difference in this $100 billion+ home health market. That’s not to say that the health care industry does not already have excellent designers and technologists in the ranks. However, there is a big opportunity to shift what those talented people are able to focus on. All truly great designs balance three distinct characteristics; they are useful, usable, and desirable. Sadly, the home health industry is often missing a third of the recipe--desire. That’s because the ingredients that make a product or experience desirable are the easiest to dismiss; they’re not rational or quantifiable. Because home health takes its roots in the medical industry, it is historically practical and lacks personality. The truth is that there is good reason for a surgical tool to be mostly useful and usable, because all you really desire is for the darn thing to save your life. But home health products are used by regular people, and most do not have the instant impact of immediately saving your life. Products like these need the element of desire to stand any chance in a competitive consumer landscape.

“mHealth Review Derek Jones 2012”

Page 41 of 42


mHealth Review

I’m not just talking about aesthetics--emotion is what drives desire. We are constantly challenged to make healthy decisions in our daily lives, and many times the unhealthy alternative is driven by an emotional desire. What if the healthy choice was also the most desirable? What if the home health industry emphasized the same psychology of desire as the consumer electronics, gaming, and food industries? Designers and technologists have the power to relieve the burden of managing one’s health by repositioning it in a different context. With healthcare costs rising faster than inflation, a crisis looms on the horizon. Health happens between doctor visits. We need tools to address our health that we love to use. More than 750 people have applied to work with us, over half of them doctors and health professionals. Why? Because everyone knows change is necessary. Recent statistics are shocking. 68% of adults in the US are overweight or obese. By 2020, 52% of Americans will have diabetes or prediabetes. 31% have high blood pressure. Whatever our system is doing, it simply isn’t working. We need to treat people like people, not patients. Interesting observations from Massive Health Do you feel loved or cared for when you go to the hospital? How about when you have a question about your health? We don’t think so. Right when we need support the most, we're denied it. It’s all well and good that we know there's a problem. What do we plan to do about it? Combined, our team has previously shipped products to over half a billion people. We're bringing all of the goodness you’ve come to expect on the web and your phone to healthcare. Your body is the ultimate interface problem. Sometimes, it just doesn’t give you the feedback you need. You don’t get thirsty until you are already dehydrated. You might forget to finish your antibiotics because you already feel better. When you eat a piece of cake, you don’t feel different for the rest of the day or the rest of the week; it’s the incremental cake you do or do not eat over weeks and months that makes you fit or fat. We create the tight feedback loops your body is missing to keep you healthy. Can you really expect your doctor to help you be healthy if you only see them a couple of times a year? Your phone, on the other hand, is always by your side. We are making beautiful products that sit in your pocket and give you deep insight into your health or conditions. We turn data into meaning, and make that meaning actionable. Of course, we also help your docs by giving them better insight into trends and issues, by doing the statistical and visualisation work for them. That lets them focus on helping you, rather than wasting time staring at numbers.

“mHealth Review Derek Jones 2012”

Page 42 of 42


Mhealth development review