| 10.07.10 | Epocrates co-founder’s new mHealth startup; Genuine mHealth revenue

MedApps Where Remote Healthcare Meets the Cloud

mHealth demand among payers, providers, employers

Brian DolanThis week MobiHealthNews produced its 3rd Everywhere Healthcare event at CTIA in San Francisco. After my introductory remarks and short presentation, Spencer Hutchins of Booz & Co. (also co-author of the healthcare section within the FCC’s National Broadband Plan) led a spirited discussion between a panel of wireless health thought-leaders on the current state of the industry.

Below are a few excerpts from that discussion. This section focuses on mHealth market demand and true opportunities for mobile health revenue generation today:

Hutchins: Which customer segments actually warming up and making real purchasing decisions around this. Where is there genuine revenue being created? Is it employers or are you seeing it from the payers or the providers?

Mobile health demand: Payers

“In the payer and provider market everyone is interested,” Mark Trigsted, EVP of Healthcare at Diversinet said. “Everyone is a little trepidatious, but it is being driven from the top. The C-suite is saying: ‘We want apps!’ and ‘We need them now!’ So, they are trying to deliver those, but what they are really struggling with is figuring out what is actually applicable to their patients or members. They are asking: ‘How do we do that securely and stay out of jail?’ And: ‘How do we make money out of it?’  At Diversinet we really are seeing this push primarily from the payer and provider space though.”

“The biggest issue that we see right now is that there exists this automatic assumption that we cannot do secure applications in the mobile environment,” Trigsted continued. “Well, you really can. It’s interesting: There are two schools of thought out there: One group believes, ‘Yes, we can do anything and it’s automatically secure.’ The other is of the opinion that ‘No, we can’t do anything because it’s impossible to secure [mobile].’ So, at Diversinet, we’re trying to mitigate that… Nobody has the business model yet, but I think we’re going to get there.”

Mobile health demand: Aging population

“We’re a direct to consumer player and historically we’ve been focused on the 65-and-over demographic,” Madeline Pantalone, VP of Strategy and Business Development at GreatCall said. “We’ve done a lot of market research and this year that included primary research that indicated that the number one issue for seniors and aging boomers like myself is healthy aging. Boomers have to stay in the workplace longer. Seniors want to stay out of the inevitable assisted living facility. Healthy aging is really key. We’ve found that they are willing to pay $5 to $10 per month for wellness applications, or applications that will help them actually manage their lifestyle in a non-intrusive way.”

“The challenge for us with the 65-and-up market (predominantly the 75-plus market) is getting them to keep the cell phone on,” Pantalone said. “There’s a generation of 75-plus people who only use their mobile phones to call their kids and then they turn it off and put it back in their purse.”

“One of our biggest challenges and where we think we’ve been a leader in the market is to create a number of devices that actually appeal to a number of individual consumer sand get them engaged with 24/7 customer care,” Pantalone said. “Connect them with people who will help them use the technology so when they hit a bump in the road that they won’t turn their device off and never use it again. As we move people up the technology curve, they are more than willing to integrate these applications for wellness and healthy aging. And they are willing to pay a small amount per applications. What makes it appealing then is that if you can capture seniors who make up 15 percent of the population but have 35 to 40 percent of the healthcare costs. That kind of talk will catch the ear of the managed care organizations. And the real issue for them: ‘How can we leverage this platform to reduce the cost of healthcare delivery because we’re in a capitation model?’”

Mobile health demand: Providers

“We spend a lot of time in the provider space and what we’re seeing right now has to do more and more with the electronic medical records and getting the back-end systems in place to use all of those electronic records,” Fred Castillo, Executive Director, Mobility Application Consultants for Healthcare, AT&T. ”At that point in time you can begin to mobilize everything. If once you have that done, then it does come down to all different elements. The security piece definitely comes up as part of that.”

Mobile health demand: Self-insured employers

“I’ve had the luck (and maybe the pain) of trying to do this in two different markets so far. My life at Partner’s Health Care was all about building a business model and a revenue generating business out of this remote monitoring, self-management stuff,” Doug McClure, CTO, Healthrageous said. “There was a bunch of work we did early on around congestive heart failure monitoring–there are some very serious disease management programs around remote monitoring. There were some challenges involved in making that a viable business model within the provider market — frankly, that’s what took us at the Center for Connected Health to think about the different markets where we could use these same kinds of tools but change the focus a little bit. And that’s where we started working with self-insured employers.”

In either case you end up in this game of ‘where’s the money at?’ With providers it’s all about fee-for-service. With providers it’s: How do you take the very small, relatively limited pay-for-performance initiatives out there and begin to twist them to meet how you want to deliver your programs. By going directly to self-insured employers, you have a different market problem. You have the challenge of going off and trying to meet all those self-insured employers; convincing them that they want to do something like this; and explaining how it’s different from all the other programs they are buying.”

“That was really what created the initiative to spin out [from Partners] and become this new thing called Healthrageous,” McClure said. “Right now, what we’re seeing is that the market is about ‘How do you work with those that are at risk, financially for the health of the individual?” These programs can end up looking like either designed disease management or wellness. What you’re doing is selling into folks that are already carrying the burden of the cost of those in one way or another. Trying to scale that…has it’s own challenges then.”

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Fujitsu unveils first Continua-certified phone

According to reports coming out of the CEATEC conference in Japan, Fujitsu has unveiled a concept phone that the Continua Health Alliance has certified for meeting its guidelines of interoperability with personal health devices. While the concept phone’s name has yet to be released, the phone at the CEATEC Fujitsu booth getting the most attention is a dual-screen, touch screen device reminiscent of the handheld gaming device Nintendo DS.

Whatever the phone might look like, it is the very first phone that the Continua Health Alliance has certified as interoperable with personal health devices like Bluetooth-enabled pulse oximeters, blood glucose meters, blood pressure cuffs and the like.

The Fujitsu phone is likely only to be available in the Japanese market and is rumored to hit store shelves there within the year.

UPDATE: Continua issued a press release but it offered no new details about the phone:  ”The world’s first Continua Certified mobile phone, created using Continua’s design guidelines, will also be unveiled this week at CEATEC. The new mobile phone will manage and transfer health data collected by healthcare equipment that is also Continua Certified,” the statement read. “Japan has a strong interest in the health of its residents,” Rick Cnossen, president and chair, Continua Health Alliance stated in the release. “Allowing consumers the opportunity to manage their own health helps to reduce healthcare costs, allows greater independence for seniors, and can help manage—and sometimes prevent—chronic illnesses.”

Earlier: A representative from Continua indicated to MobiHealthNews that an announcement was forthcoming. Stay tuned for more.

Meanwhile check out this “hands-on” with the dual-screen Fujitsu phone on display at CEATEC — (still unclear if this is the Continua certified one, but I’d be surprised if it’s turns out to be as high end as this one.) Video below: Continue >>

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“There are two schools of thought out there: One group believes, ‘Yes, we can do anything and it’s automatically secure.’ The other is of the opinion that ‘No, we can’t do anything because it’s impossible to secure [mobile].”

- Mark Trigsted, EVP of Healthcare, Diversinet

Stimulus: $9.9M to reduce heart failure readmissions

The HHS Agency for Healthcare Research and Quality has awarded Cedars-Sinai Medical Center LA plus a consortium of five University of California medical schools $9.9 million to determine the efficacy of using wireless and telephone care management to reduce hospital readmissions for heart failure patients.

UCLA is leading the consortium in the three-year grant for the study called, “Variations in Care: Comparing Heart Failure Care Transition Intervention Effects.” The funding comes from the HHS program: Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE).

The study will determine how standard practice compares to transitioning patients from inpatient to outpatient care via telephone or via wireless remote monitors and telephone. The researchers aim to improve quality while reducing costs.

“Heart failure patients have high rates of hospital readmissions, and a critical window for preventing readmissions is as the patient transitions from the inpatient to outpatient setting,” Dr. Michael Ong, assistant professor of medicine at the David Geffen School of Medicine at UCLA and the grant’s principal investigator stated in a press release.

“This funding is critical if we’re to learn how to reinvent health care in the United States,” Dr. Tom Rosenthal, chief medical officer for Ronald Reagan UCLA Medical Center stated in the release. ”Our goal is to improve quality and reduce cost of care and, most importantly, to identify approaches that are applicable in every community, not only large academic centers.”

“UC is committed to developing innovations and a new paradigm of health care delivery that creates a culture of deliberate improvement.” Dr. John Stobo, UC senior vice president for health sciences and services.

More from the press release here

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WebMD personalizes WebMD Mobile with PHR data

At the Health 2.0 event in San Francisco today, WebMD CEO Wayne Gattinella will announce that the company is enhancing its WedMD Mobile application to include user’s personal health record data in order to personalize that application’s symptom navigator and other functions. The app will leverage the user’s symptoms, medications and pre-existing conditions, according to the company.

The PHR-enhanced WebMD Mobile application will launch early next year, the company said.

Of course, WebMD already supports personal health records for millions of employees and health plan members and has been doing so for more than 10 years, according to the company.

Last November, Gattinella announced that WebMD’s Medscape Mobile app had already secured more than 200,000 downloads — just a few months after launching in July. This week WebMD announced that its Medscape Mobile application for medical professionals had crossed the 1 million download milestone, too.

“We’re also investing into markets for the future as we see the market going more mobile and more global,” Gattinella said at the time. ”Our WebMD mobile health applications for consumers… launched on the iPhone less than a year ago, and they have already generated over 1 million downloads, consistently ranking at the top of the app store for health applications.”

Just shy of a year later — and WebMD Mobile has already been downloaded by more than 2 million consumers. The company’s iPad app has also done well: It has already received more than 500,000 downloads.

Stay tuned to MobiHealthNews this week as we’ll be covering Health 2.0 and CTIA live from San Francisco — more mobile health news from the events in the coming days.

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Epocrates co-founder launches Doximity mHealth startup

This week Jeff Tangney, co-founder of one of the (if not the) most popular smartphone medical apps, Epocrates, launched a new mobile-centric service for physicians called Doximity. The service is a physician’s private network (like Sermo?) and iPhone app designed to help physicians save time. (Always a good pitch for that group.)

Doxmity aims to be the gold standard national directory of physicians, health professionals, hospitals, nursing homes, imaging groups and labs. It also offers search functions for finding medical school classmates or other colleagues for consultations: Doximity provided “psychiatrist in Tampa who speaks Spanish” as an example.

Doximity looks to distinguish itself from Sermo, perhaps the best known online social network for physicians, by being a real-time professional network and not an anonymous networking site. Of course, Doximity also views its mobile-centered design as key, too.

Since Epocrates recently filed its initial public offering plans, the subsequent startups coming from Epocrates alums like Tangney is an important space to watch. Tangney was former President & COO of Epocrates, and Doximity’s founding team also includes: Dr. Elise Singer, Dr. Marc Lawrence, Shari Buck, Mark Pagura, and Al Fontes. Dr. Richard Fiedotin and Dr. Tom Lee, who co-founded Epocrates with Tangney, are advisors and contributors to Doximity, according to the company.

And, oh yeah: “Doximity”? It’s a play on “proximity for doctors”.

For more, check out the video demo of the app, below: Continue >>

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Pager replacement; iPad in HC; Design with patients

Pagers to smartphones — a long road: CIO.com has a lengthy report on the trials and tribulations of hospitals replacing pagers system-wide with smartphones and paging apps. The article chronicles Emory’s slow switch to an all mobile phone solution from Amcom. ”There’s lots of underlying issues that have to be worked out,” says Jay Flanagan, senior manager of the messaging team at Atlanta-based Emory University. Flanagan has 850 users in the pilot — 6,000 pagers to wean the facility off. CIO

iPad changing healthcare? While I take issue with this article’s headline: “How the iPad is Changing Mobile Healthcare” (Is it, really?) Enterprise Mobile Today’s thorough review of the iPad’s various opportunities in the healthcare industry is well-worth a read. Choice quote from the review’s conclusion: “It has been the first tablet to be widely adopted by health care professionals (by hospitals, medical groups, and individuals). While no other tablet has seen this level of success in or out of health care, many of these advantage will apply to Android tablets when they hit the market in large numbers. Many will also apply to Windows 7 tablets (though the health care professionals that I’ve spoken with seem much less enthusiastic about a Windows-based tablet) as well as webOS tablets that HP is expected to launch next year or beyond.” Enterprise Mobile Today

McKinsey mHealth podcast: Just discovered this — it’s not new, but new to me. 30 Minute mHealth Podcast

Short video from Body Computing: Designing to bridge the gap between patient and provider: Worrell Design presented this 7-minute video at the Body Computing conference that took place in Los Angeles, California last week. Worrell has designed for a number of medical device companies, including a handful of wireless health device makers. The video features interviews with both a patient and a physician and urges those working in the industry to engage with both groups to understand the needs apparent — and implementing accordingly. Well worth a look: Continue >>

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Survey: MDs and smartphones, EU vs. USA

According to a recent online survey conducted by EPG Media, physicians in the United States are almost twice as likely to own a smartphone as European physicians. The EPG survey of more than 300 physicians found that around 81 percent of US physicians currently own a smartphone, only 44 percent of European doctors do. In a blog post on the research company’s site, the researchers point out that their figure of 81 percent is where Manhattan Research predicted smartphone adoption would be among US physicians in 2012. The most recent data from Manahattan (which polls significantly more MDs for its survey: 2,000+) pegs the current smartphone adoption rate at just north of 72 percent of US doctors.

Interestingly, EPG’s survey predicts that European physicians are eager to switch over to smartphones: While the current adoption is around 44 percent, the firm predicts that will jump to 65 percent adoption within the next six months.

According to EPG’s blog post:

There are currently over 250,000 apps available for download from the Apple store and according to MobiHealthNews, in the first quarter of 2010 over 7,000 of these were health and fitness apps, with 30% designed for use by healthcare professionals and the remainder for patients or health consumers. Despite this, EPG Health Media’s research indicates that demand outstrips supply for content for HCPs via smartphone, especially in Europe.

I find it hard to believe that demand could outstrip supple of smartphone medical apps when it comes to medical reference apps and the like, but I do agree that operational applications — like those that provide remote access to electronic medical records (what physicians seem to really want to do with their smartphones) is still a wide open opportunity.

For more, be sure to visit EPG’s site here

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Allscripts launches home care EHR smartphone app

Electronic Medical Records developer Allscripts announced a new mobile medical application at the National Association for Home Care’s (NAHC) event this week: Allscripts Mobile Homecare, a smartphone application intended for use by physical therapists, nurse assistants and other home care health clinicians. Allscripts Mobile Homecare is a point-of-care, remote access app for Allscripts EHR for homecare agencies.

“Allscripts Mobile Homecare comes at just the right moment, making it easier for our physical therapists to take care of more patients in their home,” said Beau Sorensen, Chief Financial Officer of First Choice Home Health & Hospice, whose 170 clinicians provide home-based and hospice care for patients across Utah. “We expect that Allscripts Mobile Homecare will increase both the speed and quality of our therapist’s supporting documentation, increasing our compliance with government regulations, while improving our clinicians’ work-life balance.”

According to Allscripts, “traditional laptop point-of-care platforms are not well suited to the mobility, flexibility and ease of use requirements demanded in the variety of post-acute care environments,” while existing PDA apps focus largely on admin or scheduling. Allscripts believes its app is distinct because it focuses on remote access to clinical information for home care workers.

Allscripts Mobile Homecare aims to extend “the benefits of the EHR into the home.”

“Homecare agencies and hospices are, for the first time, being understood as a critical component in the continuum of care,” said Glen Tullman, Chief Executive Officer of Allscripts. “We need to leverage technology to provide clinicians, nurses and other caregivers in this space with better clinical information so when they receive patients from hospitals and other care environments, they can deliver optimal care and spend less time on administrative tasks. Allscripts Mobile Homecare connects to real-time information and new capabilities that not only make it easier for clinicians to make informed decisions but also save them valuable time.”

For more on Allscripts Mobile Homecare, read this press relase

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CMI Center gets director; Adherence apps unpleasant

Adherence apps “unpleasant” to use: The New York Times has reviewed a handful of medication adherence apps (seemingly picked at random), choice quote: “I tried some apps that remind users to take their medications, including MedsLog, Medsy, MotionPHR Health Record Manager and others. Appropriately enough, the experience was like ingesting medicine — an unpleasant chore, but good for you.” NYTimes

Center for Medicare and Medicaid Innovation gets director: CMS Administrator Don Berwick appointed Dr. Richard Gilfillan “Acting” Director of the new Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services. Appropriately enough, Gilfillan was director of the CMS performance-based payment policy staff. The CMI holds great promise for mobile health as its mission is to “innovative payment and service delivery models to reduce program expenditures… while preserving or enhancing quality of care.” Hopefully the center will help new services gain reimbursement more expediently. Health Affairs (Background on hopes for the center and mHealth here)

RIM PlayBook booster: Dr. John Halamka named BlackBerry’s PlayBook as his cool technology of the week: “I predict that the iPad and the plethora of new similar devices are going to be the emerging clinical platform of choice for healthcare in 2011. The latest announcement from RIM, the Playbook, seems to address my requirements list very well – it’s small, lightweight, and advertised as stable/reliable/secure/enterprise ready.” Life as a Healthcare CIO (Also: Check out our paid report on the iPad and other tablets eyeing the healthcare market.)

Wellness programs is where job creation is? ZDNet

India’s 3G mHealth? As 3G gets off the ground in India, operators believe 3G entertainment services will pave the way before mCommerce and mHealth services leveraging 3G will hit the market. Hindu Business Line

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September 30, 2010 Edition

Top Headlines

ATA Mid-Year Meeting - September 26 - 28 Baltimore

Health 2.0
October 7 – 8, San Francisco

Through nearly a hundred speakers and plenty of new healthcare demos and technologies on display on stage and in the exhibit hall, you’ll get a sweeping overview of the ways that information technology and the web are changing healthcare. We’ll be looking at the "traditional" Health 2.0 areas like vertical search, online social networks, and tools for consumers. But the conference will also be focusing on the emergence of the data utility layer–exemplified by Microsoft HealthVault and Google Health, and will be examining the impact of the huge growth of social media outside of health care on Health 2.0.

Click here for more

WWHI Health Care Innovation Day DC (HCI-DC)
October 12, Washington, DC

In keeping with the its mission to accelerate low cost health care solutions through innovation, the West Wireless Health Institute (WWHI) will host its first Health Care Innovation Day in Washington D.C. (HCI-DC) on October 12. HCI–DC will focus on bridging the gap between industry and government to enable a thriving ecosystem.

Click here for more

2010 Connected Health Symposium
October 21 – 22, Boston, MA

Partners HealthCare’s Center for Connected Health 7th Annual Symposium: The Way Forward: Reform’s New Focus on Health and Wellness, Independent Aging, Chronic Condition Self-Care and the Tools That Support Them

Click here for more

iHT2 Fall Health IT Summit
Nov 3 – 4, 2010
Beverly Hills, CA

The Fall Health IT Summit is designed to help top-level executives, legislators, physicians, regulators, and technologists come to grips with the swirling forces of health information technology change, policy development and changing business models. The Summit provides an intimate, high level forum that facilitates open avenues of communication amongst executives and stakeholders in healthcare fostering the growth and adoption of HIT resulting in safer, more efficient healthcare.

Click here for more info

Accelerating EHR Adoption
November 4 – Boston, MA

Featuring industry experts such as HIPAA Academy co-founder Uday Ali Pabrai, this complimentary event provides actionable strategies on integrating health care technologies to meet HITECH and Meaningful Use requirements. Sessions will reveal what the healthcare "app store" of the future will look like beyond the iPad, provide tips to prevent security beaches, and much more. One lucky attendee will walk away with an Apple iPad.

Click here for more

mHealth Summit
Nov 8 – 10, 2010
Washington, DC

One event where research, technology and policy come together to shape the future of mHealth

The 2010 mHealth Summit is bringing together leaders from diverse stakeholder groups to strengthen health delivery all the way to the farthest reaches of wireless networks.

>Promoting cross-sector mHealth discussion and collaboration among experts from academic, government, business, development, health, policy, scientific and technology communities.

>Exploring the critical challenges and opportunities in sustainably scaling the deployment of mobile services and technologies for wellness, medical research, diagnosis, patient care, and health system strengthening in the developed and developing worlds.

>Finding the health and economic value chains in mHealth. Focusing future development and research.

Click here for more info

Resource Center
Six Lessons Learned as Hospitals Journey to Smartphone Utopia

This white paper explores what hospitals have discovered as they incorporate smartphones into their existing communications infrastructure. Click here to download this free white paper (pdf)

mHealth’s Enabling Role in Healthcare Reform

m-Health (mobile telehealth) solutions can help improve the present healthcare system and enable the legislative initiatives currently under way, including the National Broadband Plan, the HITECH Act and the Beacon Community Grants. Furthermore, m-Health can address many of the challenges that healthcare innovators collectively face in getting their health IT solutions deployed… Click here to download this free white paper (pdf)

Special Edition: iPad in Healthcare

Every 2.3 seconds Apple sells another iPad. The company has sold 3 million iPads in the last 80 days. iPads, a device form factor that by many accounts has never really existed before, has created a new market for mobile computing. The iPad is just a new beginning for tablet computing in healthcare. It’s not the be-all-end-all. Click here to read this special issue covering iPad’s opportunity in healthcare.

Special Edition: 9 Mobile Health Hospitals

The nine mobile health hospitals detailed in this special edition have lent a hand to wireless health startups across the spectrum of devices and services, including text message reminders, wireless peel-and-stick vital sign monitoring, wireless implantable devices and much, much more. These are nine care providers worth recognizing as their support for and publicity of mobile health helps many more than the startups and vendor partners they worked with directly. Their willingness to share their interest in mobile health raises all boats. Click here to read this MobiHealthNews Special Edition