Lynn O'Connor Vos
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The pharmaceutical industry has taken a tentative view of digital medicine and, by extension, mobile health (m-health), for
far too long. But the industry can no longer afford to ignore a medium that patients will interact with more so than live
doctors or any other source. It is predicted that, by 2013, over 21 percent of medicine will be practiced online—much of it
via mobile phone—so pharma will need to be fully on board. With over 1.5 trillion SMS messages sent last year in the US, and 280 million phones in use in this country, healthcare companies must finally take
mobile-mediated health seriously as a communications medium.
As m-health takes its place in the overall marketing mix, pharma should ask itself several important questions before creating
a new initiative: Are you improving adherence? Can you use m-health to effectively survey products? Will this initiative help
create relationships with healthcare professionals? Other issues to consider include compliance with Federal regulation and
spotting and seizing the right marketing opportunities.
Power of Internet, Reach of Phone
Over the last decade, the computer has upended the existing health information paradigm, empowering millions of patients to
participate more fully in their own healthcare. But the standard computer is being rapidly superseded by mobile technology.
Sheer ubiquity makes even a basic cell phone a powerful alternative to the networked computer, and now smart phones like the
iPhone and Blackberry are—app by app—achieving true computer-grade power.
The stats tell a spectacular story. The cell phone represents perhaps the fastest technology adoption in history—trumping
even the steep adoption curve of the desktop computer. It is estimated that there are now 4.6 billion phones in use worldwide,
with roughly 30 new phones going into service every second.
In the US, cell phone ownership easily outpaces Internet access: 90 percent of people own cell phones whereas only just over
70 percent have Internet access. Of those with chronic conditions, only 50 percent are online. And an increasing portion—18
percent—of American households now are "mobile phone only." There are now more homes with cell phones than with televisions.
The Patient-Provider Cycle
Consider how the cell phone fundamentally changes how patients interact with healthcare resources and healthcare information:
it redefines the "patient-provider cycle," that critical flow of information, which ultimately determines effective allocation
of resources and associated health outcomes. This will have profound implications both for patients and industry.
Mobile phones enable a two-way communications cycle, connecting and sharing information between providers (including physician,
nurse, medical technician, etc.) and patients, in a way even more dynamic than the Internet. With m-health, the mobile phone
becomes a kind of surrogate health advisor, always close at hand. Using simple SMS messages, phones can deliver timely, tailored
health messages and reminders: "Watch your diet;" "Take your pills;" "Report health status signs and symptoms." Cell phones
also channel information back from the patient to report health status.
Stretching the Cellular Envelope
A recent m-health summit meeting highlighted success stories both in the US and around the world, demonstrating its promise.
Francis Collins, former head of the Human Genome Project and now head of the National Institute of Health (NIH), indicated
that game-changing developments are just over the horizon and drove home the point of just how central a seemingly generic,
mass communication consumer device will be in probing the next frontier of medicine and biological understanding. Some of
the advances discussed at the Summit:
» Dietary Monitoring: Numerous applications already exist to help patients monitor diet. But imaging technology linked with complex protocols allow
the rigorous collection of field data for large, ongoing nutritional studies; for example, a cell phone is pointed at a plate
of food before and after a meal to determine exactly what was presented and what was consumed. Imaging software recognizes
each meal component, analyzes caloric content, and compiles the data in the medical record (and clinical trial database).
» Activity Monitoring using Accelerometer: The same type of accelerometer routinely used in smart phones can detect levels of physical activity—running, walking, resting
(lying on a couch watching TV). Data captured and sent by phone is used to support obesity control research and behavior modification
programs.
Drug Delivery Implants
Small devices implanted under the skin or within the body control and monitor drug concentrations and send signals to an external
device that is connected to the cell phone. This is ideal for drugs with a narrow therapeutic window.
Social Networking
Other exciting m-health applications leverage social networking sites like Facebook and Twitter. With these, patients can
discuss medical issues with other patients, provide emotional support and share experiences. Similarly, physicians share insights
with their peers, discuss emerging trends, innovative solutions, and career challenges.
M-health technology contains the means for its own measurement, providing a rich data stream on which to evaluate its impact.
In one study, smokers receiving smoking-cessation SMS messages had a cessation success rate of 28 percent, versus 13 percent
for the control group. And SMS reminders improved primary care attendance from 48 percent to 59 percent in a study of text
message usage and attendance in primary care.
Complicating Factors
Not to say that there are not some challenging issues, as there will be with any new all-encompassing medium—just looking
at the US, there are many conflicting regulatory authorities at the state and federal level and different technical standards.
Health recommendations in California may not hold in Massachusetts. Cell phone specs may differ network to network. However,
the federal government is exploring ways to promote regulatory and technical cooperation, reconcile differences and thus open
the way to a universal system.
From simple SMS devices to smart phones, m-health is set to leapfrog the Internet-enabled computer as a healthcare communications
platform and provide a revolutionary gateway to better health.
Lynn O'Connor Vos is CEO of Grey Healthcare Group. She can be reached at vos@ghgroup.com
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