I’ve been toiling in the field of connected health for 20 years now, watching for signs of adoption that will move us into the steep part of the curve. I have to wonder, with announcements from several huge consumer companies recently, if that time is coming.
By now you’ve heard about Apple’s HealthKit announcement , which involved not only Apple, but Mayo Clinic and Epic.
Samsung is not sitting still, having released increasingly sophisticated versions of their S Health app.
Rumor has it that Samsung will also be coming out soon with the next version of their Galaxy Smartphone accompanied by a developers’ toolkit for health apps. Google will be launching Google Fit.
Some of this exuberance (is it rational?) also involves excitement around wearables, and the intersection of mHealth and wearables is an area of particular interest. To wit, Microsoft is rumored to be introducing a smartwatch this fall, amid lots of interest at Google, Apple and Samsung in the role of the smartwatch in mHealth.
OK, you get the picture. Any analyst worth her salt has got to be predicting a break-out year for mHealth. The mHealth market is said to have been $1.95B in 2012, growing to $49B by 2020; the wearables market is predicted to be $12B by 2018, of which 60% will be health tracking. We just coined a new term, the Internet of (Healthy) Things to describe this convergence.
What’s not to like here? Well, I’m not sure, but there are some reasons to be cautious. Better still, there are some things we must get right as we steward this amazing opportunity to harness a game-changing technology (mobile) and apply it to the laudable goal of improving the health of our citizens.
First the words of caution. My friend Nancy used to tell me she hated to be the skunk at the picnic, and those words ring true here. But allow me a couple of comments contrary to all of the enthusiasm. As noted previously, if HealthKit is just another place to store health-related data — moving from a web application to a mobile phone — do we really think consumers are going to jump for joy? Santayana said, “Those who do not learn from history are doomed to repeat it.” Did we learn the lessons from Google’s failed PHR? From Microsoft’s HealthVault? If you build it, they do not necessarily come. For health, it has to be more compelling than that.
Here are some facts that remind us of the challenge:
- Although one out of ten U.S. adults over the age of 18 owns an activity tracker, within six months, one-third stops using it.
- More than 80% of health apps (like Lose It! or MyFitnessPal) that are downloaded are abandoned within two weeks.
- Also of note, Aetna discontinued CarePass last week, seemingly because their members weren’t enthralled by it.
Most app development is based on the adage, “Give the people what they want.” Snapchat, Instagram, Tinder, etc., are all designed to meet a basic human need in a very simple way. The challenge in health care is that, though we know what patients/consumers need to do to improve their health, most of them don’t want to hear about it. That makes building ‘sticky’ health apps and devices much tougher than a messaging or photo sharing app.
Today, most health care app development is still confusing education with inspiration. They are not equivalent! I’ve told the story before about how we check our smartphones 150 times per day. But in a blood pressure monitoring study at the Center for Connected Health, we had difficulty getting patients to push one button once a day to participate in a program their doctor enthusiastically recommended for them.
What, then, do we do to take full advantage of the opportunity that Samsung, Apple, Google and others are providing us? The answer, simple and yet elusive, is: Focus on Engagement
Over these 20 years, I’ve seen technologies come and go, trends take hold and others fade away. We are learning a great deal about how to empower patients to self-manage their health, and what to do with all of this patient-generated data. The common denominator, the one critical element we must get right, is how to ‘sell’ health to consumers and keep them coming back for more. I say it’s got to be personal, motivational and ubiquitous. What do you say?
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Sounds to me like there will be two groups of mhealth users. Those who are using it as a means of independently tracking and improving their own health and those who are using it as an extension of the traditional health care (i.e. sick care) system.
I find the first use above to be the most exciting because it empowers individuals to take charge of their health. However, after having used an app that allowed me to monitor symptoms and correlate them to variables such as diet, exercise, sleep, and environment, I found the data entry to be far to tedious to keep up.
Major improvements to make applications “sticky” will come as technology evolves to allow the data entry to become more seemless (i.e. through the use of voice data entry or wearable sensors embeded in clothing that automatically track health related biometrics). Merrilee’s idea of “gamifying” the data entry and mhealth usage also seems key.
In the meantime we will need to keep clunking along with the current apps like S Health. The currently available technology is a good start preparing our mindset for a more proactive future with respect to the detective-like approach needed for staying healthy in an increasingly complex world.
I’ve been following mhealth for the past 7 years. I was very excited with its potential initially. Now I’m not so much.
The people who are already into health will adopt them and they are not usually the ones who will benefit the most from them.
At this point, unless mhealth can become “gamified”, I don’t hold out an expectation that it will improve health or health care costs for most people using it.
Oddly, I found myself going out for one last walk last night so I could set my iPhone 6 era steps record. It’s not much, but it’s something.
Develop an app that cures “erectile disfunction” – now that will sell.
Excellent points raised in this essay, I was nodding along until we got to “Focus on Engagement.” Which sounds good but like many statements about engagements, strikes me as a bit vague and also feel-goody.
Is “selling” the avg person on health the right way to go? Or shd we think about Cass Sunstein’s ideas in “Nudge”, and just make it the ultra-easy default for people to do better things for their health?
I am not a Quantified Selfer by any means.
I’ve chuckled at the notion of logging the number of emails I write, scoffed at the notion of tracking my broccoli intake and impact on my happiness level (I’m sure there is one, but I don’t want to know what it is), remained vaguely aware of the correlation between the number of miles I run / walk and the number of hours of television I watch. (I suspect the real correlation may be number of miles I run to number of beers consumed post run at Daves, an intriguing psychological effect I have labelled Dave’s syndrome).
I suspect my case is typical of many people.
After a lot of downloads and a lot of wasted time, I generally resist technological trends until I feel they’re worthy of my time.
And even I am starting to do this. And If I’m doing it, then a lot of people are going to be doing it.
The real question is not if people are going to being doing this. It is what they are going to be doing? And what impact is all this tracking and behavior influencing going to have?
What is going to work? What isn’t?
“we had difficulty getting patients to push one button once a day to participate in a program their doctor enthusiastically recommended for them”.
Take this point a bit farther and out of the specific example noted in the post. If I got an email or letter from my internist pointing out some program I should join (there is literally no program they could recommend to me that I would participate in), I would want to know the following: whose program is it? Who funds it? Who make money from my information? Where does my information go? Does my doc make money by showing his group/network that a lot of his patients “engaged” or “participated”? What do those terms mean? Is my engagement/participation going to be used to upsell me more things that I don’t need? What’s the evidence basis for the claim that my participation or engagement are likely to be beneficial to me? Over 1 yr, 5 yrs, 10 yrs?
The secret to better health and long-term cost control for most Americans is to stay out of the healthcare system unless and until it is absolutely essential that you engage. The notion of prevention through the “data” tracking of generally healthy adults is completely baseless.
Great points, Joe. Don’t forget another population: those of us who are very health-conscious but just don’t feel the need to track everything we do. I run 3 days a week and go the gym 2 days a week, and just want to keep track of my overall miles and how many reps of each weight I do respectively. It is much easier to store that in a spreadsheet. (I do like to track some runs on a Garmin GPS watch but mainly to show off to my friends all the cool places I run due to my exotic travel schedule.)
I, for one, have been glued to the health dashboard on the new iPhone.
(That said, it hasn’t changed any behavior yet…)
Yes!