According to Berlin-based consultancy and market research company research2guidance, which focuses on the mobile app economy, there are currently more than 260.000 mHealth apps available – 100.000 more than last year. Yet while the supply of health apps is rising, the demand is falling. Tjasa Zajc investigates the problem
Apps in general have a retention problem. Even when consumers discover and download an app, they are highly unlikely to use it repeatedly; some people download and never use it at all. Activate analysis, strategy and technology consulting firm for media, technology, entertainment and information businesses, reports that just three months after download, retention rate falls under 10 per cent. So what’s going wrong?
The intentions of innovators are good: a lot of developers are working on communication platforms for better access to reliable medical information and qualified professionals. But a huge number have no access at all. As the CEO of Babylon health Ali Parsa stated in a short documentary on hopes and hypes around digital health, ‘We have three million doctors in the world of seven billion people. You do the math.’ Babylon is one of the promising health startups using artificial intelligence, offering users with a medical problem a triage-like system for fast diagnosis through an app on a smartphone. In September 2016, Babylon Health got its license to operate digital clinical operations in Rwanda. As Pascal Murasira, Head of Commercial Operations for Babylon in Rwanda, said in October last year the company was averaging 1,000 new clients per day and 400 completed consultations per day.
Looking at some statistics, developers have a reason for optimism. 3.4 billion people are estimated to have a smartphone by now. A survey in the UK showed that 60 per cent of patients are interested in solutions to help them manage their disease.
The potential of technology, digitization and electronic health records is vast – fewer mistakes, better control, optimized work processes, convenience are just some of the possible advantages… On the other hand, there are unexpected consequences that are often hard to predict. Reliance on algorithms can cause mistakes without people realising they have even been made. Doctor Carol A Bernstein described her concerns in a recent debate on electronic health records (EHRs), ‘It’s really disrupting how we train the next generation of physicians. One of my major concerns is that, in addition to spending all of their time in front of a computer, they’re cutting and pasting. They’re not learning to think. Everything is about an algorithm. What is meaningful is our capacity to really take care of our patients, to help them and make them well. It’s why these kids went into medicine in the first place, but they’re not learning how to think anymore or to relate to the patients.’
It’s often stated is that it takes an average of 17 years for research evidence to reach clinical practice. Massoud Safaee from Mazzetti MEP, an engineering design and technology/IT consulting company, explained the reasons for setbacks in adoption in healthcare in a company blogpost: ‘Failing, making a mistake and learning from your mistakes in Silicon Valley is often referred to as “innovation”. The same thing in healthcare is often called “malpractice”’.
Because they are dealing with human lives, doctors are understandably cautious around the adoption and recommendation of health apps – ultimately they have to be sure their recommendation isn’t harmful for the patient. Alongside rapid scientific advancements in medicine, it’s impossible to expect doctors to professionally distinguish good from bad solutions in the rising flood of apps. Luckily, a lot of effort has already been put into app regulation. WHO recently published guidelines for reporting on mHealth interventions. In 2015, the FDA drafted guidelines on definition of medical apps. But perhaps even more promising in terms of assuring reliability and confidence are the incubators and accelerators inside high profile medical institutions. They help design, assure efficiency and commercialize good solutions.
In 2012 Cleveland Clinic experts designed the Medical Innovation Playbook – a detailed report on the diverse and rapidly evolving technology commercialisation programs of the USA’s top medical centres. It includes an overview of nearly 10,000 invention disclosures, 6,400 patent applications and almost 2,000 issued patents. They translated into 2,600 royalty bearing licences, 280 spin-off companies and $1.5 billion in healthcare/bioscience revenue. When the report was published, software presented eight per cent of Innovation Disclosures. That was four years ago.
By supporting an incubator inside medical institutions, doctors are given all the entrepreneurial support for product development. They have the knowledge for innovation and perfect environment for testing solutions, which is what some startups outside hospitals struggle with when it comes to proof of concept testing. Solutions and apps in these incubators are peer-reviewed, validated and consequently easier for physicians to recommend.
Cleveland Clinic started providing doctors with a supporting environment for innovation 16 years ago. In the book Innovation the Cleveland Clinic Way Thomas J Graham explains that innovators have so far developed or adopted dozens of mobile apps for patient education, better understanding and diagnosis of diseases. Health IT technologies present a quarter of their IP portfolio.
The Icahn School of Medicine at Mount Sinai went even further. They created a health app incubator in 2012. Four years later they launched a platform enabling physicians to digitally prescribe evidence-based mobile health applications. According to the Institution, in the first three months participating physicians prescribed more than 2,000 apps, exceeding 20 times the pilot goal. It’s not only in the US that efforts are made to help doctors with app assessment. In Europe, for example, NHS Education for Scotland, the health board responsible for supporting NHS services in Scotland, offers apps through the app store.
This year, the mobile health market is expected to reach a value of $24.2 billion worldwide. The digital health market is expected to reach $233.3 billion by 2020, driven particularly by the mobile health market. Research firm Markets and Markets estimates mHealth will grow to $60 billion by 2020. The biggest share of apps target chronically ill patients, a third are aimed at fitness-orientated people and a third at doctors. Setting aside specific goals of individual mHealth solutions, what they are essentially struggling to achieve is grabbing and keeping attention of users. Lost interest for apps and their regular use, known as ‘app fatigue’, remains one of the biggest challenges for developers.
Especially in the days after receiving diagnosis, patients need support and validated information. Not all current solutions are bad or problematic. It’s the complexity of people – the human factor – that’s the eternal mystery when it comes to what will and won’t work, what will be adopted and used and what won’t. In the fight for attention, the biggest unicorns are not apps but Google and social media platforms, with Facebook on top of the chain. According to Activate analysis, the majority of people spend less than an hour on non-work tech and media activities during work. The majority of attention goes on personal emails, reading the news, internet browsing, messaging and social media. Development of chat bots generated a lot of buzz last year, reflecting efforts to reach users where they already are – on messaging apps. Jan Rezab, Founder & Chairman of Socialbakers, provider of social media analytic tools, statistics and metrics, argues in a presentation that bots are the next apps, and will be the answer to this mystifying ‘fatigue’. The future, it would seem, will be bot-shaped.
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