Customisation is the key to m-health success
A lack of cohesive planning and poor execution has dogged the Internet and online ventures. After the initial frenzy surrounding any Internet-based idea, the pharmaceutical industry sat back and assessed the situation, concluding that "e-anything" just does not work. This attitude could infect the mobile health, or m-health, arena.
Hooman Bahmandeji, President, MedSphere Corp., USA, says it doesn't have to be that way. A little thought, combined with some in-depth research into what the user really wants, will reap its rewards. If the service is appropriately targeted, then it will be able to overcome other technological restrictions, such as low bandwidth or complex user interface.
Hooman Bahmandeji will be speaking at IBC’s mHealth Conference on 4th & 5th November, Café Royal, London. To book your place or for further details of the agenda, please visit http://www.ehealth-europe.com/mhealth
How would you describe the current state of development of m-health?
I think there is currently a feeding frenzy around m-health. A lot of companies are developing products, but their value proposition is unclear. Pharma has begun to adopt the technology, so at least we can say it is on the agenda. Many pharma companies you talk to will say that "we're already doing something" and they are happy with that, but they are spending money with no results. There is no cohesive planning. It is like the early days of the Internet, there is no structure, or goal-oriented planning.
What trends are you currently seeing in this field?
We're seeing rapid growth in the technology through a worldwide effort. The traditionally different systems for Europe, the US, Japan… are all coming together in a unified way. We can't afford to have different technical standards. Europe has experience in developing cross-border standards and is leading the way here. But the US is getting in on that.
Mobile devices are increasing in speed, converging towards ADSL or cable modem speed. The bandwidth issue is going to disappear, especially as standards converge.
This will bring innovation in patient recruitment for clinical trials. Pharma has worked hard to get into doctors' offices, first through fax, then computers and e-mail. The next frontier is mobile devices.
Many people feel that WAP phones and other mobile devices will not take off because consumers do not want to surf on a small screen. What do you say to these doubters?
I think one of the things which will help to overcome this reluctance towards mobile devices is one-to-one communication. That is the state of the union for Internet technologies. As more and more Internet sites come online, the relevance of most parts of the Internet is lessening, so one-to-one service is critical.
What is happening is that pharma is having to understand its customers and market to them in the way they want. It is necessary to understand customer thinking, understand who and what pharma is doing it all for, for mobile technologies to work. With one-to-one, the size of the screen is not an issue. If the service is dedicated and of use to the user; the fact that they have to click a few arrows or scroll will not be an issue. If you hone what you do to the user's needs and make sure that the user is only one or two buttons from registering a decision, then WAP can be a success. But if you take an existing website and WAP it - that can be done very cheaply these days - then it won't be a success.
Systems that begin with a broadly targeted product and WAP it will earn the mobile industry a bad wrap, because of a poorly executed idea. Increasingly, a general website will appeal to one in a thousand; it won't be appreciated by the masses. So this is true if you take a current website and WAP it, but not if you personalise, let the customer drive, allow self-service. In terms of self-service you need to understand the needs of the customer. Privacy will be critical. Mobile devices are managed by satellites and it is possible to track patterns of movement, thought, purchasing… There is a lot of sensitive information available. If you don't want trouble, you need to adopt best practice on privacy laws. There will be regulation, but the industry needs to adopt self-regulation on privacy.
All services should be opt in/opt out and it should be clear to consumers how they can do this. You also need to make it easy for them to track what information is being held on them. You need to assure the protection of data and have to make all effort to safeguard it.
What kinds of services are currently being offered through mobile applications? What do you expect to see being offered in this way?
Everything from electronic prescribing to practice management support, patient compliance programmes… It will depend on the country - in some, doctors don't want the consumer involved; there are also issues of health service structure and advertising rules.
There is a lot of clinical information which is needed at the point of decision-making, but which is irrelevant soon afterwards. There is often a delay in getting this kind of information on to the web, or in getting access to it. With mobile, it can be moved to a new level because you can get information wherever you are and make the decision then and there. Genomics will force this trend. With the growth of genomics, the complexity of communication will be so much more. The arrival of personalised medicine will mean that the decision tools will be used to identify the right therapy for a candidate. Mobile devices will contribute to that. We'll move towards "diagnomics" - where the diagnosis and the response to treatment will be tracked as well as the decision about the suitability of a particular treatment. Decisions will be made while doctors are with patients.
The pharmaceutical industry has been notoriously slow to adopt new technologies and innovate. Do you think the necessary skills exist within the industry to take advantage of mobile technologies? How quickly do you think the industry will take these up?
I think your first statement is accurate, but that is rapidly changing and the business community is making a fairly quick turnaround. But I don't think the skills exist within the industry any more than they exist period. Look at retail, they are struggling to find the skills. But in pharma especially there will be problems. The bright young things, which have the skills, will get bored very quickly. The regulatory system stifles creative skills. This will open up opportunities to partner. That is happening fairly rapidly.
Do you expect to see mobile health services overtaking e-health in any specific areas? If so, which? What would you say are the reasons behind this?
I think in the area of clinical decision making, at the point of decision. When the infrastructure is better and services are better, I think that one will take over straight away. It is difficult to toggle between the web and different applications on a PC while you are with a patient. If a hand-held tool were available and it worked (it has to work, doctors are notoriously intolerant of glitches), it has a good opportunity to completely take over as a support tool at the point of care. Another area is R&D data collection. Physicians and consumers can get in on the act together to make progress in areas such as osteoporosis, cancer… The problem during research is that the patient may see the specialist only every 3-6 months; between visits things happen which it would be useful for the physician to know, but the consumer has forgotten by the time of the next visit. We are missing out on all that data. Hand-helds with the patient may be used to maintain and monitor these health states. This will help us to make decisions and to react with more complete and accurate information.
What about broad band technologies? How will their introduction affect market development?
It will affect mobile just as it has the web. Different people learn in different ways - some are feely, others visual, some learn by hearing… It hasn't always worked on the web, but they are now taking this on board. Wireless has been all text. With the growth of broad band, wireless will follow the same path. We are getting towards speeds of 400kb. Once we have laptops, palm pilots, etc. receiving at fairly high speeds, that will signal opportunities for education and compliance programmes. Pharma can track prescribing; health-pay organisations, compliance; government, standards for care. Broad band will facilitate not phones but PDAs.
Do you expect to see cross-sector alliances, eg between technology or telecom companies and pharma companies? What will be the driving force behind them?
Absolutely. We are already seeing that now. I think what is happening is that technology companies are seeing the opportunities of healthcare and are creating vertical healthcare divisions to create product lines for healthcare. There are protocols to partner with industry to develop solutions for healthcare. It is already happening and it is just going to grow. Most technology companies recognise the high spend in the healthcare sector - it is easy to justify moving into the sector.
Who will be the key users of mobile applications, doctors, patients, pharma sales forces?
Initially to doctors, then patients and sales forces will be about equal. Patients may be next, but there are a lot of them, so it will be a case of getting them to sign up to programmes. Pharma is already sending the devices to doctors. Patients will opt in through pharma companies or doctors.
Sales forces will be last. They already have hand-held devices and connectivity, but not mobile computing. Interactivity is not critical for this group. You can tell them what they need to do; you can't do that with doctors. Cost is a deterrent in the giving the devices to the sales force. At the moment, they check in one to two times a day. Real-time would be better, but not essential. When the cost barriers are removed, they will be released into the sales force's hands to allow them to better market to their customers.
Also I think you will see niche markets where patients and doctors communicate in common disease areas or on management programmes. The need to be connected will be more important than in the past, especially with genomics. Mobile will be important for that.
Where are mobile technologies likely to have the most impact in the pharmaceutical industry: in sales and marketing, in clinical development…?
First sales and marketing, then R&D. Sales and marketing will be first because that's where the prescribers are. It has the potential to increase revenue. In clinical, development will increase the accuracy of data and generate cost savings, as well as shorten time to market..
What about regulation? How do you see that developing in this sector?
Similar to the way it developed on the web. Baseline regulation will be required to create a non-competitive environment and set standards, but the majority will be self-regulation - that's the best way to go. Companies need to be ethical… adopt best practice. It will be necessary to keep identifiable information safe and out of the equation. Mobile devices have the additional capability to track a person's whereabouts. Pharma should not get into that, it is not needed.
Technological developments have allowed companies to operate across borders more easily - this is especially true of mobile communications. Are there any barriers in the way to developing cross-border pharma activities? Do you expect services to be local, national or international?
Part of the answer is in the organisational structure. Within the industry, some are centralised efforts, others are farmed out to national levels.
There should be a central organisation to create and manage infrastructure and then nationals will handle marketing and customer services. It is difficult for a central organisation to understand the regulations and customer strategy in each country. But the technology is very capital intensive, so a central body is needed to develop the infrastructure and general strategy for the platform. Individuals will manage the content and relationships.
The barriers will be technical standards, regulatory and marketing rules. So individual countries will need to take control to allow companies to tackle them in the best way.
How will the use of mobile applications help you to improve treatment/healthcare provision, to lower costs or to improve services?
This is what I talked about with access at the point of care. But we must ensure it is not abused. In the US, the managed care organisations are growing in power, if they are responsible for distributing the devices, then the holders, particularly doctors, will be suspicious. They will expect the advice sent out to be based on a lowest cost rationale. What happens will depend on the sponsor. Maybe regulation will be needed to ensure that certain standards are met in this area, and to ensure there is no reduction in the standard of care.
Which countries are most advanced in their development of services on mobile devices? From where do you expect to see the most growth?
The UK and the Scandinavian countries (particularly Sweden and Finland) are pretty out there. They have the most pilots and are doing real tests. It may sound chauvinistic, but language is also an issue. It is a lot easier to do tests in countries where English is spoken. It is nice that the countries where the most advances are being made can operate in a common language. That is another reason why the local operations need to take charge of content. Healthcare professionals can and want to communicate in English, but for patients it must be in the local language.
What new mobile devices do you expect to see coming on to the market in future? How will this affect the development of services?
It is still in its infancy. Most devices have poor performance in terms of speed, battery life and interface. There will be improvements in all these areas. There will be a lot of devices which are sensitive to location and take advantage of local networks. I think we will see devices which can tap into private broad band networks at home and in the office, but in public are capable of operating on narrow band networks. Ergonomics will need to improve for better interaction. Everything will be available on demand over time - videos, movies and education - because of bandwidth.
Are there other opportunities or barriers that you see that will contribute to the success or failure of m-health?
Like every other kind of effort, technology is only half the equation. You can have the best kind of technology and solution and still have failure because you didn't have the customer channels, or partners, or the credibility to be the source provider of these services. Take, for example, e-R&D. Everyone is trying to get better investigator connectivity, patient recruitment, and data capture, but no single company can dominate because of ethics, portfolio, expertise, and acceptance. I am involved in an industry-led collaboration on e-R&D. There is a limited pool of patients and a limited pool of investigators. Only 5 per cent of physicians are involved in research. In order to better recruitment and retention, it is necessary to pool resources. The coalition will allow better cost sharing. Regulators view it better when there is multiple ownership and this resource isn't just in one person's hands.
Hooman Bahmandeji will be speaking at IBC’s mHealth Conference on 4th & 5th November, Café Royal, London.