Ahmed Albaiti is the founder and CEO of Medullan, a Cambridge, Mass.-based digital healthcare consultancy, and a keynote speaker at the HIMSS15 Conference and Exhibition this past April in Chicago. Prior to founding Medullan in 2004, he led the Clinical Research Enterprise IT Group at Partners Healthcare Systems.

Q. What's the one promise of mHealth that will drive the most adoption over the coming year?

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A. In a word, price. The price point of mHealth offerings - particularly wearables and other connected devices - will inadvertently continue to drop this year. With the exception of the Apple Watch, which is going through its initial “launch pricing” phase, a ubiquitous number of wearables, including smartwatches - which provide many reasons to be worn and used for monitoring health - are going to flood the market. Studies show that price is a huge barrier and the easiest one removed for adoption to occur. If you look at FitBit’s numbers released in preparation for their IPO, their distribution price point (as opposed to retail) is closing in on $25 for the hardware, while FitBit Premium, their digital service offering, is at $50. I think you should expect that trend to continue sharply in 2015. 

Q. What mHealth technology will become ubiquitous in the next 5 years? Why?

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A. To be coy, the most ubiquitous mHealth technology is already here: the smartphone. mHealth apps are still the cheapest, most adopted mHealth solutions in the market today, despite the ever-growing graveyard of failed attempts from start-ups and Fortune 500 companies. That aside, the next ubiquitous mHealth technology will undoubtedly be the smartwatch. It is a convergence device, wiping out the need for multiple other devices. mHealth needs a platform that can be more readily interactive, can package up more sensors and can be closer to human beings physically. That physicality is important. Finally, the smartwatch can provide holistic, personalized interventions that are valuable because of the simple fact that they are anchored on something inexorable to humans: time.

Q. What's the most cutting-edge application you're seeing now? What other innovations

might we see in the near future?

A. The most cutting-edge mHealth technologies we are seeing today are in the diagnostic sensor space. Paradoxically, they are pursuing opposite ends of human interaction: non-invasive to ultra-invasive. I think the two ends of the spectrum actually lend intriguing gravitas to the words “cutting edge.” Non-invasive diagnostics will see the end of blood strips, EKG halters, etc., and simply use topical means to measure critical biometrics. On the other end of the spectrum, we find ingestibles, which, in some ways, are ultra-invasive and will be further enhanced by advancements in nanotechnology. In other words, if you’re afraid of needles, you’re in luck, as long as you are also open to sensors swimming around inside you.

Q. What mHealth tool or trend will likely die out or fail?

A. Single-use devices are going to die. The first-generation pedometers are all going to die. Once again, I cite FitBit’s numbers ahead of their IPO. You can discern from those figures that the price point of the FitBit pedometers continues to drop while their service offering has grown tremendously - from 600,000 to 9.5 million subscribed users. Monetarily, an even larger jump than their devices, at a richer price point and the added benefits of subscription and scale. In the near term, we’ll see many more pedometers entering the market at super low prices or for free, but they will eventually become obsolete as convergence devices take over. When was the last time you saw someone wearing a beeper - except maybe a doctor in the hospital?

Q. What mHealth tool or trend has surprised you the most, either with its success or its

failure?

A. For failure, and I’m not sure this qualifies as an mHealth “tool,” curated mHealth app stores (either publicly available or within healthcare organizations) have surprised me by their absence. None have emerged. I would have thought it a logical step that would have boosted adoption - especially with clinical apps. I stand corrected and mystified.

For success, I think the trend with virtual reality also surprised me. For something that has been around forever (Lawnmower Man, anyone?), virtual reality is poised to make a big comeback and will have an impact in areas of health that we haven’t even thought of. Why now? Because smartphone computing power and reworked imaging and rendering technology are now possible on a very personal and mobile level - look at Samsung and Oculus’ Gear VR on Galaxy phones or Microsoft’s HoloLens. Move past Google Glass - we are talking about taking healthcare access and shared decision-making and completely wiping out barriers that have been around forever. Absolutely brilliant.

Q. What's your biggest fear about mHealth? Why?

A. Regulation. You can’t win. Too much is too much, too little is too little. Lack of evidence for digital therapeutics, lack of policy on user data, and the speed at which these things evolves makes me dubious and in many ways afraid that mHealth will inevitably have a “death-like moment” when something worse than the Anthem security hack happens and stops many life-saving technologies in their tracks.

Q. Who's going to push mHealth "to the next level" – consumers, providers or some other

party?

A. EMR vendors. Wow, did I just say that out loud? Yes! Let’s face it, for mHealth to happen and spread within the walls of the hospital, one of the biggest barriers right now - literally between mHealth and over a million doctors and many more clinicians in the U.S. alone - are the EMR vendors. They really haven’t moved forward much until very, very recently. With some open standards and early adopters of SMART on FHIR and similar constructs, we are finally seeing an opportunity to take mHealth to the next level. mHealth is a technology that thrives in a multi-user, multi-party environment and use cases, and the EMR vendors are finally opening up. Phew.

Q. What are you working on now?

A. We are working on ways to better evaluate and validate the impact of digital interventions, many of which could be considered mHealth. The biggest adoption barrier from a commercial perspective is ensuring there is an acceptable, consistent and transparent way to evaluate these solutions in the wild. This enables “at scale” distribution and, therefore, affordable pricing. Apple’s ResearchKit is an excellent model, but that leaves quite a few billion people out. By 2020, smartphone adoption will be at 80 percent across the globe - that’s a lot of people without iPhones. We are working on how best to learn from ResearchKit, expand its footprint, but also scale our approach beyond a single platform or device. Additionally, we’re helping more and more companies in the life sciences and genomic diagnostics to deliver a unique and impactful experiences for browsing and understanding.

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