eHealth: state of the art.The wave of consumer-driven digitalization sweeping through all the industries has reached the healthcare industry and is quickly re-defining standards for governments, care providers, insurance companies and customers all at once. The main scope of this article is to identify the state-of-the art in terms of eHealth and more precisely mHealth, after a brief overview of these two disruptive megatrends.
The United States are leading the way in terms of technology, software and number of start-ups that are contributing to the growth of the e-health sector, one major factor being the way in which the American healthcare system works. The Affordable Care Act (ACA) of the Obama Administration has among its objectives to encourage preventive health care and workplace wellness programmes and thus reduce the number of emergency room visits and the costs that come along with it. To support the ACA the administration has introduced a form a sanction for the hospitals in the US that have issues with patients that suffer from specific chronic diseases and constantly return to the hospitals for readmission. One of the solutions identified by the hospital management that would limit the numbers of returning patients and help avoid the ACA sanction is telehealth, which is still an emerging trend that helps doctors stay in touch and monitor the state of their patients from remote.
What about the normal patient who does not need special treatment and follow-up by a doctor? Here the key is again, wellness and prevention – in line with the ACA – and the trend is now shifting towards mobile devices, including tablets, giving a great boost to the mHealth sector. For this reasons great amounts of funding are being made available for this fast-rising sector and investors are working with innovative start-ups to get as much of the market share as possible. According to Halo Report Q1 2013, 60% of business angel investment deals closed in the in the U.S. targeted internet, mobile, telecommunications and software and the second biggest amount of funds were allocated to investments in healthcare. Putting two and two together, one can distinguish a very clear path that points to mHealth as being the digital touch that will change the way healthcare and preventions is dealt with.
The World Economic Forum identified workplace wellness as one of its top priorities this opened up a whole range of opportunities and a solid argument for health and wellness-monitoring app developers to approach the employers and offer them better solutions that will help combat absenteeism, apathy and chronic disease.
Emerging trends in eHealth
Taking a look at the emerging trends in eHealth, one cannot help but notice that the number of health-monitoring devices and wellness gadgets are definitely on the rise, with production costs going down and the technology constantly being improved and adapted. One such example is Smartex, the intelligent undershirt that monitors your heart-rate and respiration, the posture of the body or activity, and an estimation of energy expenditure. This can prove to be very useful for patients that need constant monitoring from remote because the shirt comes with an integrated solution for storing and processing the data made available by the sensors in the shirt. Here the next step would be designing clothes that are able to also track glucose levels and other important metrics in medical care.
Of course the solutions for monitoring your health come in various shapes and sizes, take for example FitBit One that is now pretty much well-known after going through a couple of years of rework and is among the leading devices of its category. It tracks the number of steps, the distance and burned calories and is also able to distinguish between normal walking and stair climbing. When asleep, it measures your sleep quality and hours and can also act as a silent vibrating alarm in the morning. Recently Fitbit has also released Flex that has almost the same functions as One but is missing the altimeter which “reads” when someone is going up the stairs. Fitbit is also open to a bunch of third party apps like Run Keeper, which allows you to sync the data for alternative data analysis. Flex’s main competitor is Nike+Fuelband which is rumored to launch the Nike Fuelband 2 that will include a heart rate monitor and the possibility to connect with third party apps, which is now one of the main down sides. To keep up with the competition Nike has created a tech incubator named Nike Accelerator with the purpose of mentoring and financially sustaining 10 start-ups. The only condition imposed to the beneficiaries is that they would have to build upon and integrate the NikeFuel, Nike+ FuelBand or Nike+ Running platforms.
For now, the most useful approach among the emerging trends remains telehealth applied technology for monitoring and assisting those patients in need of special treatment from the comfort of their homes, thus saving hospitals time and money. On a more practical note, as a byproduct created instead around the concept of mobile, involving text messaging and photos rather than video there is the mHealth solution. This gives the user the possibility to have constant access to medical advice and assistance on their smartphones, both for the healthy people who want to stay informed about how they can continue to lead a healthy life and for the ones that have a medical condition and have unanswered health-related questions.
mHealth: specific trends
The mHealth sector is gaining momentum: Whether you chose to replace your personal trainer with an app, or you are in search of a medical practice or hospital near you or you just want to have a doctor that can answer your health-related questions in the click of a button, the applications for smart-phones can save you a lot of time and effort.
Looking at the available studies, the data that emerges from the Parks Associates survey in the U.S. is that memory improvement apps along with apps that help people to lose weight or to have a proper nutritional intake, have the greatest number or users. In the same study they also predict that the number of people who will use online and mobile wellness applications or services will rise from 14 million to 29 million by 2016.
If one takes a look at the number of medical apps listed in the US App Store the approximate number is 19,474 (2.21% of total number of apps) and healthcare and fitness apps hit 23,784 (2.70% of total number of apps). On the other hand Google Play seems to be a bit lagging behind in the medical app department as it has somewhere around 8,000 apps even if, according to App Annie, Google Play has a 10% higher number of downloads (this is also caused by the fact that Android has 80% of the smart-phone market share - according to Strategy Analytics). All in all the opportunity for start-ups is great given that app economy is predicted to double in the next couple of years, reaching from $72 billion in 2013 USD to $151 billion USD in 2017, according to APPNATION.
One of the main uses of the apps, as we have seen previously, is in synergy with the wellness-related gadget, they are very catchy for the consumer and so are the apps that work with them or that have a way of independently help you better organize your daily habits.
The other use is for the remote health advice: apps with services vary from just locating a doctor near you or using content-driver symptom checkers that can help you evaluate your health-related issue to offering you the means of chatting with your personal doctor or with a specialist that does not know your identity. Some apps even offer you the ability to take pictures or videos and share them with the doctor you are chatting to so that they can give a more informed advice. In this case, compared to telehealth which is mainly designed for patient-doctor relation, the advantage is that the user could stay anonymous, asking even the more private questions that they would not dare make in person to a doctor. Like this, both doctor and patient would be able to text in the moment of convenience for them without the daunting task of having to aligning their agendas and setting an appointment.
Focus on remote health-advice mobile apps
Given the fact that nowadays the great majority of internet users turn to online search when it comes to finding medical and health-related information, this also applies to a high number of smartphone and tablet users. The problem that arises very often is that they do not know how to find the reliable sources of information or there is too much information dispersed all over the web in an unstructured manner. This represents a niche for remote health advice applications for smart-phones, allowing users to chat in real-time with doctors from the comfort of their own smartphone. Who wouldn’t want to be able to ask for information or advice from a specialist even as they are vacationing or staying at home and taking care of the children?
The U.S.-based application for smartphones, PingMD, was initially created for parents to be able to ask their pediatricians questions about their children’s health. Now it has evolved to encompass doctors of all specializations throughout the U.S. that want to stay in touch with their patients using their smartphone. If their doctor is not yet listed, the patient can suggest to PingMD that their doctor be contacted in order to invite him or her to create an account and start communicating with patients. The service is free of costs to both patients and doctors and it is based on predefined content from which the user needs to choose step by step in order to explain the health issue that they or their loved ones are encountering. One can attach photos or videos before sending a so-called “ping” to his or her doctor with the possibility to add a written comment in order to better explain the situation and if needed the doctor can share the ping with other practitioners with the patient’s approval. The application is ideal for managing the patient-doctor relationship outside the practice but what if your doctor does not want to join PingMD? There should be a solution for people that are in search for answers and don’t have their personal doctor online.
The U.S.-based HealthTap has an integrated approach for its website, widget and mobile/tablet applications and it addressed the needs of the users by including the possibility to search for doctors by name, specialty, topic or location. After browsing the list of doctors available one can choose to ask a question to a specific doctor for the sum of $9.99 or instead go for the free option which allows you to write up to 150 characters and gets you answers from the available doctors at that time. For the fee of $0.99 – allocated to charity - one can add an urgent component to the initially free question. Also there is the possibility to fill in a form and fix an appointment with a doctor of your choice. The website and application offer a range of tools with predefined content in order to help users stay informed regarding medication, diseases, symptoms, medical procedures and others, including a ranking of other medical applications available in the online mobile stores. The doctors are ranked according to an algorithm that also takes into account peer-recognition, thanks and recommendations from patients, years of experience, studies and training etc. Heath Tap offers a pretty complete users experience providing multiple choices for people that are in search of reliable answers and opinions from certified specialists.
iTriage is created to help direct users towards the closest most suitable caretaker available: after assisting the users in evaluating their problems using a symptom checker tool that gives both visual and written content, the application offers various suggestions based on the issue that it helped identify. One can then browse through the list of doctors, practices, hospitals, drugstores or emergency rooms available near the user’s location. The service is available free-of-cost for patients whereas for caretakers, hospitals, urgent cares and employers they can ask to test a demo version of the services they can be provided with – there is no price available on the official website for services offered to caretakers. Just like Heath Tap, iTriage comes with a widget that can be embedded on a websites in order to bring added value for the users and caretakers can also chose make available (for a fee) an appointment form that potential patients can compile when browsing for doctors.
ZocDoc, always U.S.-based, offers mainly the same free services like iTriage, although lacking the symptom checker and the implicit suggestions for what type of caregiver one needs to contact for the previously identified health issues.
Taking a look across the ocean, the Italian-based website Medicitalia manages to provide a searchable database of Italian doctors by location, specialty and rating, also allowing users to ask questions for free in a forum-like manner (the question alongside the answers are available to the users of the website). The downfall is that one cannot choose to talk to a specific doctor and most of the doctors listed have not been active in more than three months. Moreover the site does not come with an application for smartphone and tablet.
As seen above, the previous services were targeted mostly at patients as end users but the next application is very useful for medical practices in managing their after-hours calls from patients. Ringadoc provides caretakers with the means of receiving, archiving and answering in an organized manner to after-hour calls, without losing track of any detail. The service costs $49 per month and doctors can manage their calls and messages either from the Ringadoc website, smartphone application or standard phone. On the basis of their target segment, Truth On Call addresses the needs of various industries that are in search of expert-approved medical content or information in order to use it for developing products or in other processes. The cost of these services is confidential and cannot be found on their official website.
There is still room for improvement
The remote-health app market is certainly on the rise and there is room for much improvement in the quality and services available for users, as demonstrated by the above analysis.
After taking a look at the U.S. best practices there are still some points that can be improved in order to render the whole experience more effective for the user of the application. The first one consists in offering complete anonymity to the user - the existing applications manage more or less to do so in the sense that many rely on publicly displaying the question but hiding the real identity of the user. This approach works to a certain degree but the issue of privacy, nowadays, gives rise to more and more concerns and the solution of a private chat with doctors is able to solve that issue. Add to this crowd-power when it comes to the responses given by qualified doctors to a user’s health question and you have an easy to access source of knowledge and information for people to tap in, when in need of quick answers directly on their devices. Last but not least, when one is faced with a real health issue and wants to find the best medical specialist available in a certain location the internet offers you disorganized and even outdated information. Thus, people should be able to access a database which allows them to search by location, specialty and level of expertise of the doctors – this implies the creation of a relevant and accurate system of rating based on reviews coming from patients and peers and other relevant factors.
