Time to SMAC the Healthcare Consumer

Big brother is watching youSMAC – Social, Mobile, Analytics, Cloud – is a popular framework for optimizing business performance through IT. The basic idea is that these four elements all play key roles in generating value from data through capture, storage, and application.

  • Social refers to the consumer or end-user level, where data is created and collected
  • Mobile describes the shift to smartphone and tablet-driven computing
  • Analytics speaks to the growing ability and need to interpret and understand data big and small
  • Cloud refers to the advent of virtual computing through untethered storage and access to data, applications, services, and more

Compelling visions are emerging about how SMAC might be applied to improve the delivery of care. These generally describe a connected patient population that is actively and passively generating new health and behavioral data that are captured through an array of apps and sensors. These data are funneled and blended into algorithms that can suggest trends or predict medical needs, which can then inform appropriate patient engagement. A wide range of specific clinical applications also bubble up from this process, from care alerts and medication reconciliation, to rules authoring and risk scoring.

In theory this sounds great. But of course, there are several obstacles to making it work.

Lately, a different vision of SMAC seems to be emerging in healthcare, focused on the consumer rather than the patient, and the marketing rather than the clinical. Some of these business-oriented applications may look something like this:

  • Social: Advanced use of social media as an interactive brand and rich source of insight on consumer preferences and trends.
  • Mobile: Tools to help consumers navigate the healthcare system the same way we look for movie tickets or deposit checks: with our phones.
  • Analytics: Using population data to understand linkages between people (make of car, marital status, education, vocation, social media presence) and their tendencies (paying for a wellness visit, missing appointments, using digital tools, writing online reviews).
  • Cloud: Virtually everything that everyone does is captured and sent into a cloud, from web searches and click patterns to credit card purchases and retail behavior.

If this seems more like futuristic fiction than reality, consider what your smartphone is tracking. After a recent trip to the local coffeeshop, my phone sent me a note of exactly where I had parked, based on Google’s ability to interpret patterns of passively generated geolocation and accelerometer data.

Are We There Yet?

An article about the digital dust left behind by consumers recently made the rounds online, generating excitement about some of the potential applications of all of this non-health data. It pointed out ideas such as clinical trials eligibility, or public health surveillance. Such uses read well in the press, but others don’t, as MedSeek found out in June. The article also goes into detail about how such use cases are being built at UPMC. The Pittsburgh health system has mined, bought, and mixed census records, claims, prescriptions, utilization, household incomes, education levels, marital status, race, number of children, number of cars, and more. They have created correlations to predict people’s use of services, though they claim not to use those correlations to alter care delivery today. Since UPMC has rolled out its own narrow network plan, does the collection of this information cross a line – will it be used to determine the relative risk of a patient and his or her family when signing up for insurance?

Has Data Ethics Caught up with Data Collection?
The elephant in the room here is if we are ready to openly acknowledge and condone these practices, or if there are still some questions that need answering. To name just a few: If these correlations lead to differential treatment based on disease or age, is this just a watered down, post-reform version of pre-existing conditions? What are repercussions of a company acting based on correlations to someone’s race or gender? Are some of these data falling through a HIPAA loophole? Does it make sense to develop a disclosure or data consent policy here, or even to set rules on which data can be collected and how they can be used? Finally, while efficiencies are needed in healthcare, is it worth feeding giants like UPMC, a non-profit with $10.2B operating revenue, at the potential cost of consumer privacy and autonomy?

While the debate about civil rights continues, consumers may be past the point of outrage, thanks to a rolling banner of stories about how much data about us is being used without our permission. NSA’s surveillance and Facebook’s mood manipulation are treated with a headshake and a shrug. Even if this attitudinal shift serves as a weak thumbs up from consumers, HCOs may still be wary of losing their brand standing in a fiercely competitive marketplace. UPMC and Highmark’s turf war, for example, is so entrenched it has generated its own About.com page. Perhaps too there is a correlation between a person’s likelihood of voting with their feet after a PR crisis, and their education, affluence, and level of health.

Data Talks, But Who’s Listening?
While HCOs have shown some reluctance to SMAC their consumers to shift their operations, others have moved forward. Pharma and medical device manufacturers have been studying us for decades, trying to understand our preferences, what we watch on TV, and where we eat. Now they follow what we’re doing online. Digital agency and social media analytics firm WCG has become adept at monitoring and analyzing data on millions of individuals on behalf of their industry clients, with the end goal of connecting the dots between what people are saying online and what they may be doing in real life.

“We can map patient journeys through various therapeutic areas, based strictly on the social exhaust we are picking up on people,” said Greg Matthews, a managing director at WCG and creator of the MDigitalLife project. Referring to a recent project to track online discussions of cancer, he explained further, “What we’re able to do is look deeply at conversations online, related to a diagnosis, ascertain language using NLP, and understand where they are in the patient journey, from pre-diagnosis to post-treatment.” Matthews also noted that while doctors and individual providers have been active in these conversations, hospitals and health systems have been missing thus far.

While some applications of SMAC may appear controversial, others are simply convenient. Thanks to innovative tech companies, HCOs are able to subtly leverage consumer data to help business, without compromising their integrity. iTriage and Axial Exchange can leverage GPS to define geographic boundaries for lists of providers and facilities. Virtuwell and AskMD are proving that people are willing to divulge their PHI straight into a computer (and pay for it out of pocket) if it gives them better access to care. HCOs are paying all four of these companies to help them rein in patients by giving them something useful.

With tight market competition and a macro shift towards value-based care, the value proposition for using consumer data intelligently has become clear. HCOs now have the means to capture, understand, and act on data about people based on the digital footprints they leave behind. Early applications have been limited to tighter network management and customer retention through apps like iTriage. The next wave of applications is right around the corner, led by systems like UPMC and vendors like MedSeek: selective marketing of services and programs, more sophisticated utilization management, and some degree demographic/socioeconomic targeting. As we collectively become accustomed to this new normal, look for HCOs to begin taking on consumer engagement with an all out SMAC.

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Can Apple Keep the Doctor Away?

health“His treatment was fragmented rather than integrated. Each of his myriad maladies was being treated by different specialists – oncologists, pain specialists, nutritionists, hepatologists, and hematologists – but they were not being coordinated in a cohesive approach.”

Steve Jobs, by Walter Isaacson (p. 549)

As you’ve undoubtedly heard, Apple made a big splash last week by announcing “official” involvement in healthcare through a new app and accompanying SDK. In the past week much fanfare has been made and many speculations have been raised. As an industry that is built on the notion of looking forward, the obvious question right now is, “Will Apple Succeed?” An important precursor however is, “What is Apple trying to do?”

The announcement at WWDC was scant on details, comprising just three minutes of the broader two-hour session. More detail is available elsewhere, but the basics are that this fall, Apple will release an app called “Health” to track and store multiple health data, mostly from devices, of around 60 parameters upon release with iOS 8. The app will enable selective sharing of data, across other apps or with other individuals. The app’s release coincides with the pre-release of an SDK called “HealthKit”, designed to allow third party apps built with HealthKit to be able to have common data structures for data management, sharing, and privacy control. Two early partners were announced in Mayo Clinic and Epic, though details of those partnerships are still TBD.

So the vision here appears to be that patients and healthcare providers can use multiple apps written on Healthkit, all through a consumer-controlled, portable hub (that also makes calls!) to help fill the healthcare void when patients are away from a health facility.  Sound familiar? So much for “Think Different” – Apple is not trying out anything new here. Rather, they are betting that this particular formula of consumer-friendly hardware, new software, brand strength and market clout can result in a win. But they are also, finally, addressing a problem that has plagued health apps for years: an inability to aggregate data into one spot for a more complete view of one’s health.

Over the long term, the web-dominant approach to the above vision is slowly dying; the notion of sitting down at a computer to upload workouts or blood sugar readings into a website already seems antiquated compared to automated tracking on a device. So if mobile truly is the future, then Apple seems better positioned then others to capitalize on that trend, save Samsung.

With Samsung’s recent announcement of the SAMI platform, their S-Health app on the S4 and S5, and other recent activity in health IT, they too have arrived to the party. We will cover both tech titans’ varying approaches more deeply as part of the CAS as details around them emerge. For now, looking at ghosts of PHRs past as well as the current mHealth environment, we can point to several issues that will define the success or failure of Apple and their contemporaries.

Timing: Compared to predecessors, Apple has the benefit of timing on their side. Consumer-friendly hardware is now ubiquitous in the market (much of it Apple’s) and growing in sophistication. Healthcare software has decidedly shifted in a mobile-friendly direction, from a wellspring of APIs from major HIT vendors to emergence of standards like HL7’s FHIR. With the MU3 PGHD provision set to roll out this fall, the timing here could work out in Apple’s favor.

Wellness vs. Health: Many from Aetna to Microsoft have struggled trying to straddle the fence between wellness and medical care. We suspect Apple will be no different. Despite the umbrella of “health”, fitness tracking and condition management are two different marketplaces. Apple’s best bet for success may be to drive Wellness growth through B2C efforts, and drive clinical adoption through healthcare partnerships and clinical evangelists. For now, it is Apple’s best interest (and the broader industry’s collectively) to keep these lines blurred.

Quality and Curation:  With regards to adoption, the biggest healthcare complaint about mHealth is that there is too much going on. With over 43,000 apps available in some flavor of health, Healthkit adding more may not necessarily be better. It remains unclear what Apple’s involvement at this level will look like, but if they really want to get a foothold in the marketplace, they are best served by addressing this issue on some level.

Data: Apple is essentially the Epic of their industry: They’re big and well-fed and they don’t play well with their peers. Apple may take the same approach that Epic took before being regulated into interoperability by the ONC; they are big enough and far enough outside of healthcare that the NPRM for Stage 3 PGHD might not matter to them.

Closing Thoughts: Potential vs. Reality

At this early stage, questions can go on forever. Speculation aside, one thing we can safely say is that Apple is not all of a sudden a healthcare company. With this recent announcement they have simply provided some new tools to a broken industry, tools that appear to be arriving at the right place, at the right time.

Hopes seem to be higher within the healthcare industry and across the blogosphere that this is just a first step for Apple. With its beloved brand, vast resources, design-driven thinking, and technological expertise, many are rooting for Apple to be the one to rewrite the chapter on enterprise mHealth strategy. Realistically however, Apple’s goals here are likely more simple: to sell more phones, tap directly into a booming mHealth market (Remember, Apple keeps 30% of all app revenue), and grease the wheels of their widely rumored iWatch rollout.

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Whose Data is it Anyway?

privacyA common and somewhat unique aspect to EHR vendor contracts is that the EHR vendor lays claim to the data entered into their system. Rob and I, who co-authored this post have worked in many industries as analysts. Nowhere, in our collective experience, have we seen such a thing. Manufacturers, retailers, financial institutions, etc. would never think of relinquishing their data to their enterprise software vendor of choice.

It confounds us as to why healthcare organizations let their vendors of choice get away with this and frankly, in this day of increasing concerns about patient privacy, why is this practice allowed in the first place?

The Office of the National Coordinator for Health Information Technology (ONC) released a report this summer defining EHR contract terms and lending some advice on what should and should not be in your EHR vendor’s contract.

The ONC recommendations are good but incomplete and come from a legal perspective.

As we approach the 3-5 year anniversary of the beginning of the upsurge in EHR purchasing via the HITECH Act, cracks are beginning to show. Roughly a third of healthcare organizations are now looking to replace their EHR. To assist HCO clients we wrote an article published in our recent October Monthly Update for CAS clients expanding on some of the points made by the ONC, and adding a few more critical considerations for HCOs trying to lower EHR costs and reduce risk.

The one item in many EHR contracts that is most troubling is the notion the patient data HCOs enter into their EHR is becomes the property in whole, or in-part, of the EHR vendor.

It’s Your Data Act Like it
Prior to the internet-age the concept that any data input into software either on the desktop, on-premise or in the cloud (AKA hosted or time sharing) was not owned entirely by the users was unheard of. But with the emergence of search engines and social media, the rights to data have slowly eroded away from the user in favor of the software/service provider. Facebook is notorious for making subtle changes to its data privacy agreements that raise the ire of privacy rights advocates.

Of course this is not a good situation when we are talking about healthcare, a sector that collects the most personal data one may own. EHR purchasers need to take a hard detailed look at their software agreements to get a clear picture of what rights to data are being transferred to the software vendors and whether or not that is in the best interests of the HCO and the community it serves..

Our recommendation: Do not let EHR vendor have any rights to the data – Period!

The second data ownership challenge to be very careful of is the increasing incorporation of patient generated health data into the healthcare delivery system. We project an explosion in the use of biometric devices, be it consumer purchased or HCO supplied, to monitor the health of patients outside of the exam room. Much of this data will find its way into the EHR. Exactly who owns this data and what rights each party has is still debatable. It is critical that before HCOs accept user data they work out user data ownership processes, procedures, and rights.

If the EHR vendor has retained some rights to data the patients need to be informed and have consented to this sharing agreement. In our experience this is rarely if ever explicitly stated. HCOs need to be careful here as this could become a public relations disaster.

We are not lawyers, we are offering our advice and experience to HCO CEOs, CFOs and CIOs, from the perspective of business risk and economics. At Chilmark we have deep experience in best practices used in other industries with regards to data use and sharing agreements. We have also spent significant time reviewing the entire software purchasing lifecycle and culture, and are here to help HCOs in reviewing these contracts.

Addendum: Rob and I worked together on this post but our WordPress backend doesn’t like to do co-authored posts.

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At the Intersection of Obesity and HIT

We Americans are on a very terrifying path, health-wise, based on the latest obesity projections from RWJF.

Medical “innovations” around the obesity epidemic are unsettling, to say the least. Most recently, Dean Kamen (of Segway fame) filed a patent for a self-serve Stomach-Pumping Machine.

Disturbing medical devices aside, what does the obesity crisis mean to healthcare IT (HIT)?  Yes, increasing obesity rates means more metabolic syndrome, more intervention, more biometric data,more data stored in EHRs, more HIE to share that data, more clinical analytics and care coordination software, …

Does this sound interesting to you?  In my research I am more focused on how technological innovation can function as a solution to the obesity crisis. First let’s consider the payers — the large, innovative ones who continue to rally for behavior change.

Payer-Sponsored Wellness & Patient Engagement Soldier On

Payer-sponsored behavior change programs have never sustained results in the long term, but this doesn’t stop the early adopters from soldiering on.   For our 2012 Payer Benchmark Report, we profiled several large, innovative payers working to engage their members and the public through low-cost consumer technologies.

Some interesting new developments in this space include:

  • Aetna is looking to make running on a treadmill bearable. Its new ‘Passage’ app (storing data in CarePass), promises to make exercisers feel as if they are travelling within a city of their choosing.
  • Cigna has just released a ‘Healthy Living App Pack’, bundling the extremely popular FoodEducate app with 3 less-popular ones.  (Cigna didn’t develop FoodEducate, but licensed it from founder Hemi Weingarten).
  • Humana has begun offering the HumanaVitality rewards system to a group of Medicare Advantage members. Let’s hope that seniors will take more kindly to this program than to HumanaVille, Humana’s failed attempt at creating an online senior health education community.

Consumer Health Companies Need to Move Beyond Fanatics

If payer apps can’t motivate widespread weight loss, then maybe the consumer space can? Consumer companies are currently busy developing software and testing out motivational models on the fly.  This is not exactly the scientific method but it works for small agile environments…and is definitely something that large payers are less adept at.

There is a belief among many of the quantified-self set that just the act of presenting health data to the consumer affects behavior change.  I seriously doubt this, and believe that consumer health startups have played a miniscule role in affecting real behavior change.  So far, they have provided diet and exercise fanatics better tools to fuel their obsession.

In order to reach the ‘bottom of the pyramid’, must we then dole out dollars for weight loss? I recently spoke with Gregory Coleman, one of the founders of nExercise, which offers a gamified “rewards program” where users randomly accumulate points, similar to a lottery, which can be applied towards real world discounts.

(nExercise is also the driving force behind the recently formed FITco, or ‘Founders In Technology Combating Obesity’. FITco functions as a place for founders to form data sharing/interoperability partnerships, and aggregate marketing dollars).

Talking with Gregory, I found myself better understanding the challenges these consumer companies are up against as they seek to move beyond their core base.  In offering financial incentives, they must spark interest without destroying intrinsic motivation. Framing financial incentives in term of ‘rewards’ and ‘discounts’ helps, but the real goal is to wean users off of them.

Cash, Friends, and Coaching: A Pipe Dream?

Several academic studies have shown that a combination of financial incentives, social support, and coaching from a trusted ally, produced significant behavior change, at least in the short term.

I can imagine a day when I seamlessly upload exercise and diet related data into a CarePass-type platform, where:

  • my insurance carrier’s app notices that I have been working out, maintaining my BMI, and applies discounts to my premium.
  • my doctor’s app (motivated by value-based reimbursement), suggests that I keep my maximum heart rate below 160 BPM
  • I display achievement badges to my friends, and make my data available to health companies in order to receive discounts/free samples

Hmmm, what is that distant feeling of unease, the feeling like I am a pawn in someone else’s Grand Plan?  It might have something to do with the complete loss of privacy around my data.  However, if those premium discounts are steep enough, I can live with that.

Whether we get people sharing their health data or tempt them with financial incentives for weight loss, the systematic nature of the obesity problem remains a force to contend with. In the end it will be up to all of us to push back against the institutions that make us fat. Seeking out motivational consumer solutions is a low cost place to start.

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Sex Sells (or at Least Leads to Some Interesting Analytics)

One guarantee in the healthcare sector is that when it comes to personal health information (PHI), there is no lack of issues and pundits to discuss security and privacy of such information/data. If one does not jump up and down bleating on about the sanctity of PHI and the need to protect it at all costs, well then you may be labeled a heretic and burned at the proverbial stake.

Now don’t get us wrong. Here at Chilmark Research we firmly believe that your PHI is arguably the most personal information you have and you do have a right to know exactly how it is used. Whether or not you own it remains to be seen for we have seen, read and heard on more than one occasion – some healthcare providers believe that it is their data, not yours, and may only begrudgingly give you access to some circumscribed portion of your PHI that they have stashed in their vast HIT fortress, or worse, scattered in a number of chart folders.

But where we do differ with many on the sanctity of PHI is that the collective use of our de-identified PHI on a community, regional, state or even national level can give us some amazing insights into what is working and what is not in this convoluted thing we call a healthcare system in the US. Using PHI for such purposes needs to be strongly supported. Unfortunately, we do a terrible job as a country in educating the populace on the collective value of their data to understand health trends, treatments and ultimately ascertain accurate comparative effectiveness. This leaves the door wide open for others to use the old FUD (fear uncertainty and doubt) factor to keep patients from actively sharing their de-identified PHI.

One of the more popular and edgy online dating sites, OK Cupid, has done some great things with the data they collect on their users. They take the vast amounts of data they collect and do some pretty fantastic and fun (fun is good, fun is engaging) analysis to understand their users and what makes them tick. For some reason, the healthcare industry just doesn’t do fun things with the data – always so morbid!

Imagine if we could collect similar data on health, or heck, even better, imagine taking some of OK Cupid’s findings on body image and sex drive, (see chart 7 & 8) and using that to educate the public on why it may be in their best interest to keep their weight in check. Sure doesn’t seem like the threat of diabetes, heart failure, etc. is doing the trick to lower obesity rates, maybe hitting them below the belt will work.

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300 Million Asthmatics and the Future of Respiratory Monitoring

A few years ago my daughter began developing asthma-like symptoms brought on by reactions to pollen, cat dander, and other triggers.  I can still remember the panic I felt in my chest the first time she ran to me wheezing and crying that she couldn’t breathe.  Thankfully, her wheezing episodes are mild, have decreased over time, and she never received the ‘Asthma’ diagnosis.

Serious health events such as a severe asthma attack produce such a strong, albeit negative demand for health care that the patient often winds up in the ER.  In this respect, asthma is unlike other chronic conditions with more deferred consequences (e.g. ‘diabesity’).

Clay Christensen wrote about this phenomenon in his book, “The Innovator’s Prescription”. Despite the significant behavioral change required (carrying inhalers, taking medication, tracking symptoms, following Asthma Action Plans), asthmatics and their caregivers have good reason to be engaged and compliant with treatment – immediate consequences (relief) to severe attack drive behavioral change (see figure).

A Growing Problem [a Growing Market]

In the US, the CDC reports that 1 in 12 people have asthma. There has also been an unexplained increase in rates among African American children – an almost 50% increase in the past decade.

[Note: Why are asthma rates soaring? Possible causes are not fully understood within the scientific community.  The ‘hygiene hypothesis’ blames ultra-clean western societies that suppress the natural development of the immune system. Other research refutes the hygiene hypothesis and points to western lifestyles/obesity as culprits. There have also been more Asthma diagnoses due to improvement in diagnostic methods over the last few decades.  Further reading on possible causes can be found at Scientific American.]

Given that asthma is a severe, chronic disease affecting a large percentage of the population, it is easy to make the case for investment in asthma-related products.  The American Academy of Allergy Asthma and Immunology (AAAAI) estimates 300 million people worldwide are currently affected – almost 5% of the population, with incidence rates on the rise.

Segmenting the US asthma market by age provides a model to understand key engagement models:

  • Asthma Moms are continually engaged in their child’s care.  They oftentimes take information, tips, and questions to the blogosphere.
  •  Adolescents manage their condition with Mom’s guidance, though they are not as vigilant in adhering to treatment plans.
  • Adult Asthmatics no longer have Mom looking over their shoulder, but are nonetheless motivated to keep symptoms at bay.

Devices to Monitor & Prevent Asthma Attacks

When my daughter was having frequent wheezing episodes, I would have found piece of mind in a technology that could detect and predict when she was going to have an attack… or at least warn of nearby environmental triggers.

Taking a quick look at the Apple App Store, there are almost 100 asthma-related Apps available.  These range from free educational Apps to diary-style Apps that require data entry to track peak flow and symptoms. Do Asthma Moms, especially those whose children have low-severity asthma, really have the time and motivation to write asthma diaries? Not to mention adolescents and adult asthmatics?

One company, iSonea, is building technologies to avoid this tedious (and possibly erroneous) data entry.  iSonea is currently making a big bet that consumer and provider appetite for asthma monitoring technologies will grow in the coming years.

iSonea

iSonea is a recently restructured and re-branded company that has been developing proprietary acoustic respiratory monitoring (ARM) devices for years. These devices are equipped with sensors and software that detect acoustic markers such as wheezes, rhonchi and cough.

Note: iSonea was formerly KarmelSonix, a medical device company consisting of a joint partnership between Israel and Australia.

I had the opportunity to speak with the new CEO of iSonea, Michael Thomas, who sees iSonea transitioning from a device-centric company to one that is software-based (guarding the castle with already-acquired IP).  In a future filled with Smartphones,   iSonea will try to reach those 300 million asthma patients through mobile Apps rather than through proprietary, expensive devices.

Imaging breathing into your Smartphone, which will analyze and quantify your wheezing in the audio.   Or, imagine your Smartphone setting off an alarm as it detects nearby environmental triggers, crowd-sourced in almost real time by nearby asthmatics.

iSonea is looking at the following revenue streams:

  • App downloads and upgrades. The first version of their AsthmaSense™ App will be released in 2012 with a subscription service.
  • Data. Anonymized patient data will be up for sale (iSonea is partnering with Qualcomm Life to get data out of devices and into the cloud). If a statistically significant number of asthmatics use the iSonea App, this data becomes valuable to a host of buyers.
  • Ads. Products and services could be marketed to the user based on usage patterns.  For example, coupons for therapy drugs could be displayed, etc. (This remains a sensitive area – iSonea needs to find the right amount and types of ads, if any)

Emerging Technologies to Engage Consumers

Another topic I discussed with Mr. Thomas and his VP of Marketing, Michael Cheney,  was the issue of how to make the Smartphone App ‘sticky’, or compelling to use.  All of us mobile-addicted folks know the feeling -  when out of the blue your brain sends you a signal to take your phone out of your pocket and start slinging angry birds.

Will the healthcare space tolerate consumer engagement strategies that have shown success elsewhere?   For example, can we social-ify and game-ify healthcare apps and expect higher user engagement?  I remain hopeful that, treading carefully, healthcare apps that use social media and gamification strategies can indeed achieve higher engagement rates, especially among  digital natives (youths).   App developers are already starting to wade into these waters. One interesting example is the DiaPETic App, where users are rewarded via their pet avatar for sticking to a glucose testing plan, much like the popular children’s online game, webkinz.

Who knows, maybe iSonea’s App will indeed spread virally as users encourage their friends to start “playing along” with them as they manage their symptoms and avoid attacks. Engaging adolescents in this manner would especially be appealing to Asthma Moms, who could do with a little less stress in their lives. But iSonea will need to take their existing mHealth App a bit farther than they have to date to enable such viral attraction among adolescents.

Anyone Else Out There?

There is a surprising dearth of competitors to iSonea, which means that either iSonea is particularly early and/or the space is an especially risky one – with no worn paths to tread.

One company that may morph into a company more like iSonea is Asthmapolis.

Asthmapolis is based out of Madison, Wisconsin and founded by Dr David Van Sickle, formerly of the CDC. They manufacture GPS-enabled devices that attach to inhalers, tracking when and where an asthma puff was needed. Recently, Asthmapolis announced a partnership with Dignity Health (formerly Catholic Healthcare West) where doctors will monitor patients’ inhaler use via a mobile App.

Like iSonea,  Asthmapolis will make asthma data available to patients and clinicians, and sell it to public health agencies and scientists.  Asthmapolis is also developing mobile Apps to receive and display this data, but is not currently (or publicly mentioning) any intent to move beyond GPS-inhalers and towards Smartphone-based asthma monitoring, which is a little surprising in this day and age when just about anyone that is considering a mobile App, typically ahas a smartphone strategy associated with it.

Market Analysis

How will iSonea (and Asthmapolis) defend their strategic positions if the market revs up and new competitors race to the honeypot? Will iSonea’s IP be strong enough? Will they have enough cash to hire good patent infringement lawyers?

Or, maybe this market will really be about the data and network effects.  The service to garner the most momentum early on will become exponentially more valuable until the market tips.  I wonder if Dr Van Sickle’s relationships with the CDC and medical researchers are strong enough so he has first dibs on selling data for population health management.

It will also be interesting to see when and where pharma will step in here (GlaxoSmithKline comes to mind).  Better daily monitoring leads to improved medication compliance, which will help fill pharma coffers.  I’m sure iSonea/Asthmapolis are already entertaining numerous solicitations for partnerships from Big Pharma.

Towards the Utopia of ACOs

The improved monitoring and prediction of asthma attacks definitely has a role to play in a post fee-for-service, ACO/PCMH world.  No doubt these technologies will help shift the patient’s perceived role from passive recipient of care to a more empowered consumer of health, resulting in less ER visits, less readmissions, and ultimately lowered healthcare costs. The social/crowd sourcing component may prove to be especially valuable – with asthma sufferers steering clear of various dangerous locales where several “attacks” occurred. There is, of course the whole privacy debate and clearly, patients should be given an option as to whether or not they wish to have their data shared. More than likely, most will choose to share their anonymized data, but that should be their choice and not that of the vendor of such solutions.

Of course there is no guarantee that consumers will adopt these technologies en masse. Will this be a technology that consumers ‘pull’ rather than it being pushed on them by providers? Will they adopt without a physician’s order or feedback and without FDA approval? One remaining issue is how to monitor children who can’t be trusted to carry a smartphone – either they need to wear some form of (expensive) proprietary device or then again mobile platforms such as the Apple iTouch with a simple data plan may fill this gap.

On a personal level, I would nevertheless like to see asthma monitoring stand out as a poster child for remote monitoring success.  If we can figure out a way to engage Asthma Moms, adolescents (with Social/Gamification strategies), and adult sufferers, then moving on to other chronic conditions on Dr. Christenson’s 2×2 matrix will begin to look more achievable.

Just this morning my daughter told me that she had trouble breathing last night. I look forward to the day when instead of me learning of her symptoms after-the-fact, a phone can wake me up in the middle of the night to warn me to check on her immediately.

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