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.


HIMSS or Bust

CA or bustNext week is that proverbial event we all, in the HIT industry, look forward to with some trepidation - HIMSS’14. For an analyst firm such as ours HIMSS provides us a great opportunity to talk with end users, vendors of all stripes and just reconnect with like-minded folks. HIMSS is probably the only annual event that is a must attend to get a good perspective on where we are, as an industry, in advancing the adoption, deployment and use of HIT in the provider setting. That’s the upside.

There is a downside to HIMSS as well. Like most conferences of its type, HIMSS is a huge cheerleading event for all things HIT. In many ways, HIMSS is like the town of Lake Wobegon, where all of the children are above average. You will almost never hear anything called into question – no negativity here folks. Everything looks rosy and as one cruises the exhibit hall vendors pitch what they believe is the next big thing in healthcare.

HIMSS is the epitome of buzz-card bingo. Be forewarned ye vendors for which meetings between us have been scheduled for every time I hear “Big Data” I will yell out, BINGO! 

As Naveen pointed out in his recent post, HIMSS and the vendors therein must be approached with a healthy bit of skepticism. But as analysts, we must do our best to not let that skepticism slip into cynicism, for a cynic often paints a broad negative brush, losing their objectivity in the process and not see the good things that are happening as well.

HIMSS is also a fairly large event and I know that no matter how comfortable my shoes, no matter how much rest I get beforehand, by the time I take that flight back to Boston, I will be absolutely spent.

Despite these downsides, I am actually really excited about HIMSS this year and can’t wait to get there.

First and most importantly, this year’s event will be the first time that we have our entire team attending. Not only has this lessened my own meeting burden (last I counted, this year I only have 24 meetings in 3 days vs last year’s 35), it also gives us a great opportunity to interact with a far broader range of stakeholders in the HIT market with analysts focused on analytics, patient engagement, HIE, EHR and the biggest buzzword from last year, population health management (PHM).

I have always returned from HIMSS with new, invaluable contacts and an updated perspective on where the industry is truly at – not the picture the vendors paint, but the composite, the collage that is created from countless conversations over those three to four days of attendance. In having the Chilmark team there, I hope they will also walk away from HIMSS with a similarly refreshed rolodex and some nuanced thoughts on how their respective research domains will evolved in the years to come.

Secondly, we are seeing some interesting trends in the market as of late that need further validation. For example, today PHM is whatever a vendor decides it to be based on their own core competencies. Our conversations with healthcare organizations (HCOs) has not been all that insightful either as their PHM definitions are as disparate as the vendors. Where there is convergence though is on the need for strong analytics to drive PHM initiatives. So if analytics is the engine, what is the steering wheel, what are the tires, is HIE the gas tank, or the fueling station?

Looking to HIE, as we mentioned in late 2013, we see a need to redefine this sector. Where is the next opportunity for value realization for a provider once their HIE is live? Yes, we are looking beyond referrals! We have our own ideas, but we want to bounce those ideas off of others – HIMSS is a fabulously opportunity to do just that.

These are just a couple of my own thoughts. Our analysts; Cora for analytics, Naveen for patient engagement, Rob for EHR and Brian on HIE, all have their own questions they seek answers to. Hopefully, HIMSS will prove fruitful for us all in finding some of the answers we seek on the future trajectory of HIT, where the value is to be found and how together, we can all work towards a healthcare system that delivers ever higher quality care to all.


mHealth13: Lots Going On, But Few New Developments

precamAnother year, another mHealth Summit.

HIMSS’ younger sibling has slowly grown over the last five years, a period that has seen a Precambrian explosion of companies and advances in mobile tech. However, despite some early hints of maturity, the mHealth Summit revealed the mobile healthcare market’s overall identity confusion. Replace the old, or integrate with it? Add more functionality, or pare down and simplify? Is this a market driven by need, or want? Beyond the hype and the bold claims set forth by the usual suspects, mHealth’s central challenge is one of adoption: Neither consumers nor health care organizations are picking up mobile for healthcare at the pace and scale that vendors are claiming and hoping they will.

Evangelists have defaulted to pointing out the broader trends, waving around the hockey stick charts of mobile phone adoption worldwide, and referencing data about consumer mobile searches for healthcare data. We’ve seen those too. But let’s just be honest here for a moment – nobody cares if we are all becoming handset hypochondriacs. When we talk mHealth, we hope for clinical interventions, enhanced communication, behavior improvements, incorporation of patient-generated data, and so forth. To give credit where it is due, tireless efforts by HIMSS and their tradeshow peers, the vendor community, the public sector, and many others have begun to result in a vision for how mobile tools can improve how we plan for, pay for, deliver, and otherwise manage health care.

But it is still largely just a vision as we are not quite there yet. Progress is bubbling up along with a fresh set of challenges. Here are some more thoughts from DC, from regulation to startups, and product strategy to marketplace realities.

Can Someone Please Regulate the FDA?

The FDA’s recent ruling on mHealth has caused more confusion than it has cleared up. The agency offered little direction in its September ruling, sending mHIMSS’ network of experts scrambling to provide translation and guidance for the rest of us. Regulation is a central concern as this industry keeps trying to move past Powerpoint platitudes and into mobile-enabled clinical care in the home. As such, regulation aimed at protecting consumers generated much buzz at this year’s summit, with over half a dozen sessions involving some aspect of FDA regulation and still others geared towards privacy, security, BYOD policy, etc.

23andMe’s recent shaming by the FDA was a harsh reminder that regulation is serious business. Much can be written about this subject (Dan from Athena, a panelist at one session, does a nice job here) – but suffice to say it has become clear that HHS’ goals are out of sync with those of the FDA, which seems to have very little appetite for even the potential mitigation of an iota of patient safety for the sake of innovation. As heard at the water cooler after one regulation-focused session, “This is like HIPAA on steroids.” Unfortunately, this risk aversion is anathema to the nature of the risk-taking crop of entrepreneurs and innovators who have lined up to take a crack at driving improvements in healthcare.

If Startups are the Answer…What is the Question Again?

The mHealth Summit is becoming an official party for the world of healthcare startups, the overwhelming majority of which are now tech plays involving a smartphone app. Driving  (and capitalizing on) this trend, Health2.0 and StartupHealth each had a strong presence at this year’s Summit. Starting up a tech outfit is cheaper, cooler, and easier than ever before. It is certain that we badly need an injection of the energy, creativity, talent, and perspective of the entrepreneurial crowd – and the injection of capital from the long and growing list of VC firms and corporate investment arms doesn’t hurt either. Historically, we’ve all wondered whether these fledgling companies are ready to take on healthcare; For the first time, this year’s summit evoked the question of whether or not the industry is actually ready for these startups to disrupt it.

One seasoned VC at the Venture+ Forum, a daylong prelude to the actual conference, actually advised startups NOT to design products based on the ACO model, as value-based reimbursement is frankly not here yet; startups who need revenue in short order may be better served by basing their business model and strategy on the FFS-driven status quo. This notion, that innovation might be “too early” is not new in healthcare; several tales emerged across multiple sessions of failed good ideas like telemonitoring companies in the 90’s and premature doctor messaging networks in the early 2000’s.

The uphill road faced by startups is a broader reflection of our healthcare system’s challenges: Target customers have a deeply engrained resistance to change, are overburdened and under-resourced, and in many cases, still seemingly think of mobile tech as fools’ gold. Despite the occasional pilots or acquisitions trickling into our twitter feeds, there was a noticeable absence of “big” announcements or deals at the Summit.  So while we anticipate the majority of the dozens of startups who exhibited in the StartupHealth Pavilion will not be around in 3-5 years, perhaps this is just an evolutionary phase.

To be sure, there are still plenty of half-baked ideas out there. Some of the young companies we chatted with, from monitoring hardware plays to software engagement outfits, were woefully underinformed about some fundamentals: the need for properly structured data (Literally: “What’s HL7?”), the ignorance of a multiple-portals-per-patient approach, and even uncertainty of the difference between inpatient and ambulatory care. And these were not salespeople, they were founders.

Even startups that “make it” face an unclear future. At the Venture+ Summit, one company with multiple live pilots announced it recently closed a plump Series A round, but when we circled back with the CMIO at one of those hospitals, he had this to say via e-mail: “They are doing something with our [subspecialty] folks. I’m pretty sure it’s not large. I’ve visited with [founder] several times, but I don’t see how what they offer scales to a diverse patient population.” A myopic focus on a delivery system niche might help to secure funding, but reflects how startups are encouraged by their investors to think about scaling in terms of adding customers, rather than going deeper and wider within one organization. What is best for the startup might not be best for the HCO.

By the Darwinian school of thought, successful companies will be the more adaptive ones who are aware of market dynamics beyond the cookie cutter slide deck stats and buzzwords. Indeed, in observing some of the successful players and a engaging diverse set of discussions at this year’s summit, we gained some valuable insight about how mobile integration into the broader health enterprise necessitates product pivots, strategy shifts, and of course, a little bit of luck.  For example, simply singing about “data” holds less appeal than it did a few years ago: HCO’s are stretched thin due to health reform, MU, ICD, and so on – they are really only interested in things that will save them money or make them money. Pharma wants specific value-adds, such as adherence, or trials recruitment. Moreover, it’s still proving tricky to incorporate user-generated data into the enterprise.

A noteworthy example of a company capitalizing on these trends is Validic. Originally conceived as a wellness platform in 2010, they had trouble landing customers until last year, when they pivoted into an integration platform for device-generated data. Sales have since taken off, with support from blue chip investors like Mark Cuban, and are on track to have 30M lives covered by Q1 2014. As other entrants identify badly needed pieces of the puzzle, we hope to see more such gaps get plugged. The takeaway here is that product strategy matters a lot in mHealth, and a recurring theme out of this Summit was that embedding a key piece of technology within other products is a safer way to create new distribution channels. In a word: Partnerships.

The Rising Tide will Lift all (Partner)Ships

mHealth companies of all types are sensing that the quickest path forward in today’s competitive, overregulated, and change-resistant healthcare environment is to join forces with others. For startups, this might mean changing product strategy to provide the equivalent of a middleware service. More established companies like Nuance have positioned themselves squarely as leaders in a certain niche (voice recognition), setting themselves up to refine and evolve their technology based on emerging needs of the marketplace, while expanding their footprint through their partners’ deployments. In their case, they have added early “AI” functionality that interacts seamlessly with clinicians’ voice commands to guide them towards more accurate diagnoses (think autocorrect for dictation.) This “Trojan Horse” strategy leaves them poised to capitalize in multiple areas from ICD-10 to the coming wave of smartphone-driven patient engagement plays, as evidenced by their presence in Sharecare’s latest app. Tellingly, healthcare has grown to comprise half of their business.

Still larger in scale is the ecosystem approach, where vendors provide the plumbing, the infrastructure, and/or the devices, and bring on a spate of partners for actual health care products and services.  The model to emulate here is QualComm, who had the largest floor presence and has steadily turned their 2net platform into a rich offering of dozens of devices, apps, and other solutions to over 200 diverse customers worldwide. Not as successful are the Telecoms: AT&T and Sprint both seem to be building anemic versions of such a platform with small handfuls of promoted partners, while Verizon continues to stubbornly insist it is a real health care company, hiring a CMO and building out complete but wobbly-looking platforms for remote care management and virtual visits. There are no paying customers yet, but they did have a sweet video you could watch on loop at their booth.

As an aside – There is mounting eyebrow-raising going on internally at Chilmark with regards to all things telecom. Rather than focusing on a couple of obvious features where they could offer unique value – televisits, or pre-loaded smartphones, for example – these tech-driven, resource-loaded, and market-permeating behemoths seem to be trying everything and doing nothing well. One VC’s pithy remark to startups applies equally to this crowd: “Revenue is the greatest proof of concept.” Despite having the largest booths at the conference, our probing of the TeleComs did not result in a mention of a single live paying customer in mobile – just internal launches, repeated defaulting to old HIE partnerships from years ago, or shifty mentions of forthcoming press releases in 2014.

All of this simply confirms what we already know: The connected health model will be built upon a best-of-breed ecosystem of companies and technologies, rather than one soup-to-nuts vendor offering. This is highly different from the monolithic world of EHR and HIE vendors that many CIOs are used to planning and budgeting for. Indeed, one of the reasons for the lag in adoption in mobile health to date may well be that decision makers are simply overwhelmed with all of the options that are out there. As companies die on the vine, get acquired, prove their salt, or join partnerships, this menu will condense. In the meantime, working with one vendor who can offer a large, curated menu of solutions is simply an easier, albeit more expensive, option.

Conclusions and Awards

We look forward to seeing the continued maturity of this market, as well as this conference. While relatively well-run overall, the sessions were repetitive and watered-down at times, with a decidedly mixed quality of speakers and plenty of off-topic or mistitled presentations. Three days may be too much at this juncture, as many sessions were sparsely attended by the afternoons (By Wednesday the place was a veritable ghosttown), but as we have pointed out before, this conference is ultimately about HIMSS’ bottom line. Seemingly the agenda was designed to fill the cavernous Gaylord Convention Center, rather than curated to any extent for attendees’ benefit.

Moving forward, we hope to see less of the bad, most notably the abysmal (Note to HIMSS: ABYSMAL!) wi-fi access, mediocre keynotes, and session overload/redundancy. We also look forward to more of the good stuff, from effective customer service (notably, the highly responsive twitter support) to the occasional talks by thought leaders (fantastic insight this year from Harry Greenspun, Lisa Suennen, Stuart Blitz, Matt Hendricks, Stephen Bloch) to the welcome diversity compared to the annual HIMSS conference – at one point this analyst was on an escalator between an elderly Indian woman in a sari and an African gentleman wearing a kufi. Good stuff.

To close, here are our awards for vendor swag:

  • Best: Imprivata’s black gripped gloves. Timing is everything, and in the middle of a snowstorm, free winter gear wins.
  • Runner-Up: GopherMD’s Gopher – Stuffed Animals? Yes please.
  • Second Worst: Everything else – pens and keychains? Yawn.
  • Worst: Ionu’s “Digital Privacy Please” door hanger. My room didn’t have a standard privacy sign for some reason, so I thought it was a clever (albeit cheesy) touch when Ionu’s branded sign was slipped under my door the next morning. I hung it on the doorknob, but to my later dismay the housekeeping service came in anyway. Just another example of a vendor not being able to deliver on the promises in their advertising.

Benchmarking Payers Adoption of Consumer Tech

Awhile back, a large health insurer (payer) commissioned Chilmark Research to do a market scan on how payers across the country were using emerging consumer technologies to engage their members. We found this project to be quite interesting and rather than have much of that research sit on the shelves forevermore, we decided to build upon it.

Today we are releasing the results of that effort.

Our latest report: Benchmark Report: Payer Adoption of Emerging Consumer Technologies takes a close look at over 40 payer (health insurers) initiatives that are using a wide variety of consumer technologies (apps, social media, games, etc.) for member engagement. Here’s the PR announcing the report’s release.

Now it is well-known that payers have had a very mixed record in engaging their members. Part of the problem has been trust as members are justified in taking a cautious approach when sharing their health information with payers for fear of future denials. Secondly, many payer initiatives have been half-baked wherein payers have not been fully engaged themselves in the concept of member engagement.

But as we pointed out in a post earlier this summer, this is all beginning to change. Numerous market forces are now pressing down upon payers and payers are increasingly coming to the realization that they need to deploy member engagement solutions that work. Payers are now going to where consumers already are seeking to engage their members via a variety of consumer-based technologies. This report is our initial effort to gain a greater understanding of what payers are doing today and provide some guidance as to how their efforts will evolve overtime.

One thing we have learned in the course of our research is that despite all the talk, the majority of these efforts are in their infancy and that the vast majority of payers have not even begun to venture down this path. Therefore, we intend to update this report on a periodic basis to benchmark payer adoption of consumer tech in support of member engagement and gain an even deeper understanding of what works and just as importantly, what does not.

Thanks to the many that we have interviewed over the course of the last several months to compile this report as your inputs have been invaluable.


mHealth Apps & Patient Engagement – Moving Beyond Transactions

Despite a constant buzz around the idea of using mobile technologies for patient engagement, the depth and breadth of these solutions has remained consistently thin and frankly dated. Today, healthcare organizations who are adopting and deploying engagement solutions are focusing these efforts on marketing/patient retention (e.g., simplifying transactional processes such as appointment scheduling, prescription refills, etc., online access to lab results & records) and accelerating payments (online bill-pay). Despite all the talk about using mHealth for care provisioning, our research for the upcoming report that will be released later this month, mHealth Adoption Trends for Provider-Patient Engagement, finds a market that is still in an early, embryonic stage of development.

So why the disconnect between the hype of mHealth for care provisioning and reality? Of the many potential reasons, there are two that are dominant: a lack of solutions with proven clinical efficacy and few financial incentives to drive adoption.

While there is little argument that increasing the interaction between a care team and their patients is a good thing, the best means for accomplishing this feat are still unclear. A year ago, Group Health published results from an internal study testing just what impact this increased communication may have on outcomes and patient satisfaction. What they found comes as no surprise to us as trusting advocates of patient engagement. In this study, Group Health provided patients suffering from depression a relatively simplistic form of engagement wherein patients were able to communicate with their care team through the EMR portal. The results, impressive: antidepressant medication adherence increased 33%, overall depression scores decreased, and satisfaction with treatment improved 61%.

While this study fostered communication via a computer/portal, it is not too big a stretch to see such communication readily migrate to a smartphone modality wherein a patient would not be tethered to a computer and could communicate from virtually any location. But that is part of the problem. This study, which was published only last year, uses a relatively old model of communication (portal), which has been used to varying degrees in the healthcare sector for years. And if there is a paucity of clinical evidence for the efficacy of portals, for mHealth Apps it will approximate a vacuum. Sure, basic logic tells you that increasing patient-provider communication should lead to better outcomes, but the healthcare community can be a bit odd at times in its demands for stacks and stacks of clear evidence before it is willing to take the plunge, either providers adopting such models of care and more importantly, payers will to reimburse for such models of care.

Therein lies the crux of the problem – reimbursement.

Now we don’t mean to be crass but physicians are like the rest of us. We are dedicated to our work, we work hard and at the end of the day we receive compensation for those efforts. For physicians, who seem to be perpetually overbooked, their time is particularly precious and adding another activity (patient communication outside of the exam room) without compensation, is a non-starter. There is also the issue of how does one bring mHealth data into an existing HIS let alone into the daily workflow of a physician is not without costs. Who will shoulder those costs when there are few if any reimbursement models in place to support such? This idea scares away investors and many innovators.

And that creates a Catch-22. Without clear reimbursement models there is little incentive to support the adoption of mHealth for care provisioning and therefore, little financial upside for innovators and subsequently creating an unstable market. To date, no mHealth engagement solution for care provisioning has been able to gain enough traction (relates back to financial) in the market to make a significant impact and thus are perceived as risky partners by healthcare organizations. There is ample proof for such concern as there remains a tremendous amount of churn in the mHealth market. For example, two startups in the space were recently ‘acquired’ by other startups: Pipette by and WellApps by Medivo (both in the same week no less!), yet far more start-ups simply fold-up their tents and move on. But without having healthcare organizations willing to take a chance, how are these young companies going to demonstrate clinical efficacy. Yes, Catch-22 indeed.

But all is not lost.

As we’ve written before, reimbursement models are migrating away from the traditional fee for service model and one that is structured around value-based outcomes. These new reimbursement models will in-turn lead to more capitated models of care where healthcare organizations will take on greater responsibility for managing patient risk. To effectively and efficiently do so, these organizations will need to create new models and processes of care delivery that extend beyond the confines of the exam room and actively engage the patient as a critical member of the care team (where they are capable of course). This has the potential to create a “Golden Age” for such new technologies as mHealth. But like all new market opportunities, a big question is timing – just when will the inflection point occur that will truly launch this market. In that forthcoming report we mentioned previously, we intend to provide some insight into that question as well.

Stay Tuned.


mHealth: Seemingly Stuck in Neutral

As many readers know, Chilmark Research has been a strong proponent of mHealth for several years. Despite this enthusiasm, we sometimes come away from a conference, such as this week’s mHealth Summit, with the feeling that the only ones making a living with mHealth are conference organizers. Maybe it was the format of this particular conference – too many presentations that were not well vetted for relevance and content. Maybe it was the lack of exhibitors – where is the rest of the legacy HIT market who are all claiming to be bringing mHealth solutions to market? Maybe it was hearing too many mHealth vendors with weak value propositions asking the Feds to step in and jump start this market. Or maybe it was the over reliance on government presentations and an ill-fated alliance with HIMSS, who sponsored less than visionary sessions. Hard to point to any single thing that contributed to this ho hum feeling, so let’s just chalk it up to all the above.

That being said, however, the mHealth Summit, now in its third year, is the best conference one can attend in the US if one wants to get the global pulse on all things mHealth.

From its humble beginnings where the first conference was quickly over-subscribed and held in a small DC amphitheater, this year’s event drew over 3,000 attendees to the massive Gaylord Resort outside of Washington DC for three days of countless sessions running concurrently covering every aspect of mHealth one could imagine. While most sessions were structured as panels with several short presentations, one was thankful that presentations were indeed short for few had substance. But nearly every session had one stellar presentation that kept one hopeful. Those were the gems of this event and like any event, the networking that occurs in the halls.

And then there were those sessions that took a close look at mHealth adoption in developing countries. This is the current market for mHealth (albeit almost all nonprofit) for these countries have real health needs having to deliver healthcare to a highly distributed and often rural population with too few doctors and lack a robust land-line network (no Internet cafes here folks). But what they do have are cell phones – lots of them and they are not tied to legacy systems and associated processes. Even among some of the poorest countries, the rapid adoption of cellphones by the populace is staggering (e.g., India alone now represents 20% of all cellphones in use worldwide). Combine the need with very little in the way of legacy HIT infrastructure and the ubiquitous nature of cellphones and you have a ripe opportunity to redefine care delivery models. Look overseas to these developing countries for the real future of mHealth for this is where best practices in mHealth-enabled care delivery will likely develop and later be adopted in more developed countries, US included.

That is not to say they are no advances occurring here in the US. One of the keynote speakers, cardiologist Eric Topol, gave several live demos during his talk of the mHealth tools he is already using including stating that he has not used a stethoscope in two years, instead preferring to use mobisante’s ultrasound wand and iPhone App.  Then there was our conversation with WellDoc’s CTO who informed us that they are currently being deployed at a number of institutions and hope to have a host of CPT codes that doctors can bill against in late 2012. And there was the small start-up we spoke with who has done the hard work of first identifying what the value proposition is for all stakeholders in a community (payers, providers and consumers) and then developed an extremely compelling solution (think analytics & automated quality reporting, tied to reimbursement, tied to consumer engagement) that has a lot of promise in a market where physicians’ pay will increasingly be based on outcomes and ability to meet pre-defined quality metrics

Therein lies arguably the biggest take-away from the mHealth Summit. As one individual put it, ‘There was a bit of whining about getting the government to force large corporations to form strategic partnerships with smaller organizations.” But what these start-ups really need is to simply focus on addressing the age old question: ‘What’s in it for me?’ These companies need to stop the whining and do their homework defining the value proposition for not just the consumer, or just the doctor, but think more broadly of the impact their solution may have on the delivery of care, and how each stakeholder may benefit. Unfortunately, as these conference clearly showed, the mHealth market is still heavy on hype and little on substance.

For a slightly different take, check out the post by VC firm Psilos’ Managing Partner Lisa Suennen’s. Well worth the read. And more recently, Charles Huang, formerly of Spark Capital, provides his own view of the mHealth Summit, including a a call that once and for all, we need to kill the term mHealth.

Also, the image used for this story was taken by Joel Selanikio, CEO & co-founder of an organization focusing on mobile data collection, particularly, the App EpiSurveyor. Thanks Joel.