Is Apple’s ‘HealthKit’ really set to revolutionise the healthcare industry, or is mHealth all hype?

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Apple will be officially launching iOS 8 this autumn, and at the same time it will also launch HealthKit. This new health app will provide Apple smartphone/tablet users with a dashboard of their health and fitness data. They have also created a new API tool for developers which will enable other health and fitness apps to work together. HealthKit has already been integrated with Nike’s running apps and the Mayo Clinic app, which will allow blood pressure to be recorded.

Apple are saying that HealthKit is going to revolutionise the healthcare industry so is this all hype or can mHealth solutions in the shape of mobile apps really help to tackle some of the key problems our healthcare system faces?

New levels of patient engagement, as observed in many studies, are proving that patient outcomes are improved and costs reduced when patients are more involved in their own care.  And the advent and continued development of mobile health apps (mHealth) is responsible for driving that patient engagement.

Studies have shown that on average, people check their phones 150 times a day. Healthcare providers have now realised the potential advantage of this “addiction” to engage with people over health issues.

The birth of mHealth could be attributed in large part to Joseph Kvedar, MD, the director of Partners HealthCare’s Centre for Connected Health in Boston.  Since he first began to launch ‘connected health’ through technology some eighteen years ago, the landscape has changed dramatically. Kvedar started with telemedicine as well as dermatological imaging.  The camera he used at that time had less than 1 megapixel resolution, and was the size of the average shoebox.  It cost twelve thousand dollars. In those early days, videoconferencing capabilities cost fifty thousand dollars. Since then, technological changes have been dramatic, with the number of mobiles in use greater in number than landlines.  Other tools like Skype and Facetime make it possible to videoconference anytime and anywhere.

Kvedar’s centre was also the origin of the moniker ‘connected health’ in 2005. This was in response to the lacklustre enthusiasm that there was to the terms telemedicine and telehealth. The mobile revolution was taking off at that time and now, it seems inconceivable to think of developing any program that does not involve the use of mobile technology.

From that point the rise and rise of mHealth has continued.  It is now one of the most exciting prospects for the management and interaction of patients with health care provision that there has ever been. Along with the concept of meaningful use, another important factor that drives the patient engagement trend is the rise of models of accountable care along with payment restructurings. Under these accountable care models, health providers are responsible for the management of an entire population with payments based on results  (keeping the population well and getting them better) rather than a fee based system based on services provided. This makes providers even more keen to find effective ways of engaging their patients in the management of their own health, in between visits to the surgery

Before rushing headlong into digital patient engagement tools, however it is worth mentioning information inheritance and the way in which most providers still currently engage with patients in their care. This includes printed copies of health records, discharge instructions, simple diagrams or descriptions of exercises, medication timetables, and other instructions.  There is still reliance on phone call reminders follow-up phone calls and one to one conversation with healthcare providers.

So, while some of the expanding tools for digital patient engagement aim to be replacements for traditional channels, most aim to be a complementary or offer augmentation to existing channels of communication and contact.  There is no doubt that mHealth has advanced fast since the iPhone came onto the scene just over 7 years ago.  So, it will be interesting to see what impact Apple’s HealthKit is going to have on the healthcare sector and what health and medical apps we’ll have access to in 7 years from now.

Babylon Health App – Our Initial Impressions

A hugely exciting development in the world of m-health is the launch of Babylon, a subscription health service and mobile app that allows you to book virtual consultations with doctors and at the same time track symptoms and receive prescriptions.

The system is not design to replace face to face consultations but to reduce the number face to face consultation required, cutting the burden on the NHS and associated costs with it. It’s also more convenient for patients being able to arrange virtual consultations at their convenience without having to take time off work and within a timeframe that suits them.  The company behind Babylon will keep all notes and videos from any consultation undertaken which, with the permission of the patient will share with other healthcare professionals like their GP.

The ultimate ambition of Babylon is to move healthcare from a reactive model to a proactive one. Ali Parsa explains “We are used to dealing with our health like we used to deal with cars; we’d wait until they broke down and then take them to the mechanics. Now cars have sensors all over them so it doesn’t matter what’s going wrong, we know ahead of time.”

Although Babylon won’t suit everyone, particularly those who have yet to own a smart phone, this is a huge leap forward in proving an integrated service designed to give patients a choice while providing referral and testing services.

Initial impressions

However, trying to access the app has proved challenging. It’s easy enough to download but using iOS, the sign up form is painful in its execution with a date selector that won’t stay on the day you’ve selected, returning to a default value of 4 and when a mistake is made and the next button is used, it overwrites exiting values already included on the form. Android is fine. Once the submission has been made, you’re then presented with a screen explaining that you cannot have access to the service yet and you’ll be informed as part of a rollout programme. This is really poor and should have been made clear well before the download was made. There is also nothing to support this from their website and no information about pricing for example if you had to sign up to a minimum contract length or you could just pay for a month at a time.

Whether it’s a success or not will depend on how well the business can be scaled to cope with demand, which they are clearly having problems with already and many people are comfortable talking to a virtual ‘locum’ GP rather than their trusted local GP. Opening up to a complete stranger about health issues, even at your own surgery, can seem quite daunting and the mere convenience of being able to do this via an app may not be enough of an incentive to use the service.

EU to adopt a Green Paper on mobile health

Today, a Green Paper on mobile health (mHealth) will be published by the European Commission. mHealth covers all medical and public health practice that is supported by mobile devices. This document will launch a community discussion process that will continue until 2 July 2014.

Covering all practice supported by mobile devices – including tablets, smartphones, and other wireless devices mHealth also includes wellbeing and lifestyle apps that connect to sensors and other medical devices. This is an important and emergent part of eHealth where Information as well as Communication Technology is used to improve services, processes and health products.

The Commission will be looking at several issues surrounding mHealth:

  • Data protection
  • Patient safety
  • Users trust
  • Input to the delivery of healthcare of the highest quality
  • The level at which this should be applied e.g. – national, regional, or EU wide.

As well as the Green Paper, European Commission direction will also be given through a Staff Working Document, to those involved in app development. This will analyse existing EU legal frameworks currently applicable that are applicable to wellbeing and to lifestyle apps.

There is no doubt that mHealth can help to tackle some of the challenges that our healthcare structure faces. And according to a report by PWC mHealth could potentially deliver €99 billion in care costs by 2017. It is a fast evolving field with the potential to improve healthcare quality and improve efficiency by offering support to professionals in healthcare and in the area of patient treatment. It will also facilitate continuity of care. Some estimates show that as much as 30% of time spent accessing or analysing information could be saved if medical professionals used mHelath-based technology. Remote monitoring facilities could help many more patients live independently supported by technological monitoring systems. Despite this potential, the uptake of mHealth, at present, remains restricted in EU countries and healthcare authorities may look for more confirming evidence before they are prepared to adopt mHealth more comprehensively.

Some criticisms have been:

  • Lack of observance and transparency might make users wary of placing their trust in these apps, which may impact on market development.
  • Insufficient knowledge among developers with regard to the legalities applicable to lifestyle and well-being apps.

It is hoped that the Staff Working Document being issued with the Green Paper, will raise awareness amongst app developers of the rules being imposed by the EU surrounding issues of data protection, and will assist them in determining whether the legislation is applicable to their app, or not. It will also issue consumer directives.
Some of the areas of concern have been:

  1. How mHealth can be aligned with national health care strategies
  2. Technology/Interoperability standards
  3. Data protection and security
  4. Regulation and compliance keeping pace with development
  5. Getting patients and HCP involved earlier during solutions
  6. Lack of evidence of economic or clinical benefit – (it is worth noting that before email became widespread Intel surveys showed that most people claimed not to want it.)

The era of mHealth has arrived.

Stage 1
At this first stage consumer friendly products link fitness to general wellbeing as seen with Jawbone/Fitbit.

Stage 2
Apps and mobile connected devices permeate the medical field (we have entered this stage)

Stage 3
Mobile, wearables & data-collection devices mesh together to provide the backbone for optimisation & customisation of preventative health, medical treatment & hospital processes.

This is new and exciting technology and the release of the Green Paper is a step to its validation. In years to come will we wonder, as we do now with email technology, how we ever managed without it?

View the Green Paper

If you’d like to respond to the paper visit the EU website where the paper is published

Apple’s Healthbook app could make it easier for you to manage your own health

In line with the current trend towards health apps and wearables, Apple is due to launch their own app, Healthbook.  The release of the app is likely to be timed to coincide with the release of iOS 8.  It will collect and then organise specific information as well as data points that relate to the health of the app user.  Included in the app’s offerings is the chance to access statistics on fitness, delivered from the new M7 processor in the iPhone 5.  Other data will be collected from a new wearable device (the iWatch – rumoured to be a ‘smartwatch’ that acts as a small wearable computer worn on the wrist and synced with the iPhone.) The app will be preinstalled and will be capable of tracking data points such as information on things like blood pressure, heart rate, hydration levels, and has the potential to monitor other significant data for conditions like diabetes with measurement of blood glucose levels. Another feature could be the capability to remind the user of times at which they should take their medication.

Taking multiple user interface cues from the Passbook app, also produced by Apple, the Healthbook app has been developed to store such things as coupons and loyalty cards as ‘virtual cards’ removing the need for the actual item to be carried in a physical purse or wallet.

Apple's Healthbook Screen Mockup

Essentially the interface of the new Healthbook application is a virtual store of cards that can be swiped with ease. Each of the stored cards signifies a different data point for a health or fitness parameter. The logo for the Healthbook app bears a striking resemblance to the Apple Passbook icon.  The design of the Healthbook app, however, is decorated with graphics that depict vital signs.  Along with this new app, Apple are rumoured to be working on the design of their iOS 8 with the iWatch very much in mind.  Sources also suggest that both the iWatch and iPhone will be dependent on each other to a great extent to enable the health-tracking features.  It is thought that the iWatch will be able, in the same way as the Healthbook does, to measure health parameters that include vital signs such as heart rate etc.

An Apple App a Day Will Keep The Doctor Away

Although as yet the speculation as the launch date of the app is just that, sources do suggest that Apple have managed to combine several of the health sensors into just one chipset to keep the size as small as possible.

Recently, Apple has also even requested a few patents. According to one document filed with the U.S. Patent and Trademark Office, the company is developing technology that could possibly unlock a device like an iPhone by identifying the owner’s unique electrical signals from the heart. And last year, Apple hired several health, medical, and fitness experts to work on these hardware and software projects.

None of the above comes as a surprise to me as Apple are looking at a number of new areas to diversify into to help re-ignite its growth and with the healthcare app development market set to grow to over $20 billion by 2017, I guess Apple want a slice of that tasty pie and with lashings of cream on top!

World’s first prescription only app

Take Two Pills Twice a Day – and An App

Without our mobile phones we would be lost, appointments would be missed, and our lives would fall apart.  We rely on smartphones to get us up and get us through the day but are we ready to rely on them for medical advice?  An innovative new app is due to launch later this year, as BlueStar’s prescription only app for smartphone becomes a trailblazer in its field.

Could this potentially be the start of something momentous, and poses the question – just how far away are we from being prescribed apps with our medication?

Do we even want to go down that route?  What are the pitfalls and the benefits?  Is introducing this remoteness and prescription by app to be welcomed or feared?  Will GP’s be comfortable prescribing an app with medication and how will a prescription only app be paid for? Furthermore, what restrictions will be placed on marketers with regards to promoting the app, will it fall under the ABPI code of practice as do prescription only medicines (POMs)? So, are we likely to see the buzzword POA (prescription only apps) being added to the pharma jargon dictionary?

WellDoc – a prescription only app

WellDoc - World's first prescription only appThe Blue Star app can be downloaded to tablet, computer or smartphone in the normal way but will only become interactive with a special prescription code issued by a pharmacy. This is the first healthcare app that needs a doctor’s prescription to work and it is being trialled in a small area of the US where it is already causing quite a stir, as several large US corporations have announced plans to incorporate the app into the health cover that they offer their employees.  The precise cost of the app is not yet known but speculation is that it is very likely to be some way over $100 per month.

This medical app has been put through its paces by the FDA in the USA and was approved for use in 2010.  The app has been designed as an aid for people with type 2 diabetes.  It prompts them to check blood sugar levels and gives them useful information about controlling fluctuations in glucose levels along with other advice to help them manage their condition. The prescription only app will offer encouragement and praise for regular blood sugar checking and might also issue helpful reminders to take medication with food, for instance.

Following in the wake of Nike’s FuelBand, an app that is designed to record health related performance, Blue Star’s app does not monitor a patient directly but rather provides a platform for them to use to record the information needed to best manage their condition.  The question is how will doctors receive this innovation?  Not having immediate control of their patient may not sit well, but BlueStar plan to calm any qualms by sending patients statistics to doctors who can then use the data to make adjustments to treatment.  Another potential stumbling block may be the perceived intrusion that might be resented by patients if no immediate improvement or benefit is seen. Only time will tell if the prescription only app is going to become mainstream.

NHS Health Apps Library

In March this year The NHS Commissiong Board launched its Health Apps Library with the main aim of  making it easier for people to find health and medical apps that they can trust and which adhere to NHS safety / medical app compliance standards in health IT.

With over 40,000 healthcare related apps available globally, a key focus for the NHS is on ensuring that the apps listed in the Library are all clinically safe and suitable for people who are living in the UK.  Dr Maureen Baker, Clinical Director for Patient Safety, and her team  developed a review process that applies, for the first time, safety standards in health technology to health apps.

At the time of writing this post I was able to discover around 70 apps listed on the site, so it is by no means a comprehensive source of information yet. The main focus is on apps aimed at patients but I would imagine that it would also be a useful place to list apps that are aimed specifically for use by healthcare professionals. As we know, many HCPs are using apps in their day to day roles to help perform medical calculations and diagnose patients etc, so adding a list of apps that have been tested and approved for use by HCPs would no doubt be of great value to them.

Mobile revenue rise for Twitter

Speaking at The Economist Group Conference in San Francisco, Twitter founder and CEO Dick Costolo revealed that the social network had generated more advertising revenue from its mobile incarnation that its desktop version for many days in the last quarter. Twitter only introduced ads to smartphone users’ timelines in February, so the news highlights the way in which mobile marketing campaigns can be quickly and successful integrated – as well as confirming the ever increasing popularity of mobile devices such as smartphones and tablets amongst consumers.

“We’re borne of mobile,” Costolo commented, when asked about Twitter’s mobile strategies. “We have an ad platform that already is inherently suited to mobile, even though we launched our platform on the Web and only started running ads on mobile recently.”

It is interesting that whilst Twitter’s mobile ad campaigns appear to be flourishing, their prime social media rival Facebook is frequently criticised for their equivalent offering. Facebook have stated that they hope to make improvements to their current mobile strategies, but as of yet they have not experienced the levels of success that Twitter is reaching.

Comparison between the advertising of the two platforms demonstrates both the positives and the pitfalls of mobile marketing campaigns. Mobile marketing is a valuable technique within the digital marketing industry, but only when it is done well. Campaigns that are too invasive or offer information that is not particularly relevant to the  audience will not provide the desired results, so it is important for marketing professionals to strike the right balance to ensure that their campaigns produce the desired results.

Mobile technology to foil counterfeit drugs

An American technology company is utilising mobile phone technology in an attempt to combat the $75 billion-a-year counterfeit drugs market. Copies of proprietary brand drugs not only eat into the margins of pharmaceutical companies, who invest hundreds of millions of dollars in developing medicines every year, but also threaten the health and safety of those that take medicines not subject to stringent industry testing.

Drug counterfeiting is a global problem and is endemic in certain parts of the developing world where up to 30% of all medicines are counterfeit. To combat the increasing availability of fake drugs, PharmaSecure has developed a system that creates a direct link between manufacturers and the end user. This provides consumers with a guarantee that the medicines they are taking were produced by the licensed and regulated company.

PharmaSecure’s track and trace authentication system provides a unique ID code on product packaging, which can be used to track every stage of the drug’s journey through the supply chain right into the hands of the end customer. The customer can then use a simple SMS messaging system to verify authenticity. The system ensures the customer is protected from the dangers of counterfeit medicine and the company protects its trademark as well as maintaining the integrity of its products and brand identity.

Due to the simplicity of the system and the relatively low cost of implementation, PharmaSecure track and trace programme has the ability to be scaled on a global level and deal a severe blow to the counterfeiters.

Mobile health apps need new regulatory framework

Last month, a mobile phone app became the first of its kind to be registered by the Medicines and Healthcare products Regulatory Agency (MHRA) as a medical device.

The app was developed by the team at the Mersey Regional Burns and Plastic Surgery Unit and is designed to help medical staff assess burn damages. This neat bit of kit is listed by the MHRA as a class 1 medical device and is available for free in the Apple app store.

According to research, 81% of healthcare professionals own a smartphone and as a result the Mersey Burns app will no doubt be useful by sharing the specialist knowledge from the burns unit with their medical colleagues. However, the licensing of the app has raised all kinds of questions on the future registration of mobile phone apps for use in the healthcare professions.

On the face of it, registration is eminently desirable; in healthcare accuracy is everything, so it is important that diagnostic, treatment and monitoring apps are rigorously tested to ensure their suitability for public release. Unregulated mobile health apps have the potential to put the public at risk.

However there is concern, particularly in the US, that excessive regulation of mobile apps will vastly increase the costs of app development and slow market availability down to such an extent that the technology could be out of date by the time it hits the market.

As a result, on both sides of the Atlantic, medical app developers and healthcare and pharmaceutical companies are calling for a new regulatory framework which will allow the testing and processing of relevant mobile apps at speeds equal to the pace of rapid technological change.

Mobile apps on the rise in pharma

Pharmaceutical and other life science companies are becoming increasingly aware of mobile applications’ potential to boost the effectiveness of their communication.

According to Cutting Edge Information, a US company that provides management analysis reports, support services and consulting to pharmaceutical biotechnology companies globally, apps also hold the key to pharma digital marketing in the future.

Casey Ferrell, research analyst at Cutting Edge, said: “Apps for physicians hold the potential to revolutionise the way in which healthcare is administered.

“There are digital imaging apps for ECGs and radiological procedures; there are apps that improve emergency room efficiency; and there are apps designed to improve patient-physician interaction, including some that facilitate remote consultations.”

Other research from Cutting Edge Information study shows many early implementers of apps and mobile technology are now finding that the pre-launch commercialisation period presents the best phase for successfully utilising mobile pharma technology.

Ferrell said: “”I would argue there is an opportunity for the industry to shift its focus and look for innovative ways to use mobile technology to improve clinical development.

“From streamlining trial data collection and analysis, to connecting potential trial patients to investigators, the clinical development space is an opportunity for pharma companies to differentiate themselves from the pack.”