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The Second to Last Mile

flying cadeuciiThanks to the ubiquity of cable, fiber and wireless internet, the “last mile” telecommunications gap that has long separated the consumer from the wide world web is finally being bridged. According to Pew Research, 84% of Americans now regularly use the internet, and 68% use smartphones to access increasingly available broadband services.

The impact on healthcare has been considerable. More than half of all Americans have already uploaded their vital signs, benchmarked their fitness levels, co-managed their medications, communicated with their providers or researched health-related information.  No wonder the “mHealth” market could grow to $60 billion by the end of the decade

Yet, as more and more patients have rushed into this growing ecosystem of apps, wearables, home devices and other gadgets, a considerable body of research suggests that U.S. health care providers are not keeping up.  The poor second-to-last mile fit between consumers’ personal health technology and the providers’ incumbent information systems is turning out to be an important barrier to fully realizing the full potential of mHealth.

How should mHealth leaders respond?

Everyone agrees that healthcare technology is beset by unfriendly interfaces, poor clinical fit and opaque “black-box” programming logic.  In addition to this, physicians are also well aware of the perils of inbox data overload.

Resolving these technical challenges is well within reach.  Yet, healthcare leaders who are sponsoring mHealth initiatives should also consider three lessons that address the very human dimensions of connecting the second-to-last mile:

Less is more:  While the PowerPoint allure of large and multi-faceted mHealth solutions is considerable, their real-world implementation should be easy. Before connecting the second mile, health system leaders and mHealth providers should ask 1) why any mHealth initiative should take multiple days or require the assistance of legions of “super-users”, and 2) why patients shouldn’t be able to navigate within a user interface with the “Yahoo” standard of just “two-taps.”

Additive work vs. substitutive innovation.  As that second mile is bridged with increasingly efficient mHealth technology, the inevitable additions to existing provider workloads should prompt a collaborative search for any incumbent low-value processes or tasks that can be modified or discarded.  If the result is ultimately increased work for the providers, that downside cost needs to be explicitly vetted against any tangible patient benefit.

Unintended consequences:  While there may be a natural preference to deploy mHealth for everyone who qualifies, second-mile link-ups should be initially limited to the patients who have the greatest potential for benefit.  This is not only a time-honored way to grow expertise, but allow other known and unknown dimensions of the provider-patient relationship to catch up with the technology.  Limiting the scope of a first-time mHealth initiative will also diminish the prospect of unanticipated consequences while also facilitating the disciplined measure of a limited set of key outcomes.

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5 replies »

  1. Its amazing how the world changes….the internet has evolved significantly in the last years, which has brought major changes to the world (the “arab” spring)

  2. Thanks for the comment LeoHolmMD. As a physician, your skepticism resonates with me. That’s why Mr. Randhar and I wrote the post in the first place. If society deems the cost (and it may or may not be $60B) is sustainable, both users and buyers need to be absolutely sure that the outcomes are worth it. What’s more, there’s only so much room for additional work, which is why that bloat needs to be attacked by carefully understanding the difference between additive vs. substitutive innovation. While “data” isn’t necessarily helpful, there is the very real prospect that the resulting information can lead to the kind of insights that can help our patients. Finally, we agree that there is a significant risk of adverse selection and why careful limited roll-outs should help clarify if mHealth’s interventions are helping or not helping the target population.

  3. Most providers are just having a hard enough time keeping up with the multitude of acronyms being thrown at us daily.
    Margalit called it “death by a thousand acronyms”.

  4. US Healthcare providers have not “kept up” because they see no point. Although I’m sure after tacking on another 60 billion onto an already bloated health system, things should get better. These are the same unfulfilled promises that industries like home health and electronic medical records have already made. Mhealth will be no different. Lots of data, mostly useless and self serving, increasing episodes of care while taking their cut of the action. Mhealth has contributed mostly to health noise. You can upload your vitals constantly: what good is it going to do you? The compulsive jogger and the slob laying on the couch upload their fitness information: now
    what?

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