Mobile Health: A call to the doctor?

Mobile Health: A call to the doctor?

A new political battlefield

Healthcare is one of the most essential and complex issues of the moment, with huge direct and indirect impacts on people, countries and communities. Different issues are colliding from access to healthcare and affordability to ageing population in the developed countries, chronic diseases and illnesses due to hunger and poverty in developing countries, global recession and financial/budgetary constraints. All these drivers are combining to increase the importance of mobile health as a way to reduce costs, improve access, rationalise the management of massive healthcare organisations.

Mobile health could be providing pathways to provide state-of-the art medical services whilst reducing their overall costs. As such, it could be a powerful new tool for medical research, medical treatment, drug delivery, monitoring, etc. with strong impacts both in developed and in emerging and developing countries.

It is likely that this topic will increasingly be at the core of crucial public policy and political discussions and decisions in the UK, in Europe and Internationally. It could give new ammunitions to Governments and Political Parties to build a balance between the needs to decrease healthcare costs and budgets whilst proposing more positive perspectives that are increasing the individualisation, quality and flexibility of healthcare. Several major policy, regulatory, privacy and political issues will be raised and must not underestimated as they could significantly limit new products, services and business developments.

A potential for important revenue streams

In a study realised in common with the GSM Association in 2012, PWC estimated hat for the period 2013-2017, mobile health revenue should grow worldwide from US$ 4.5 to 23 billion, an increase of almost 520%. To this amount shall be added the direct and indirect savings resulting from better healthcare management and avoiding illnesses, etc. The GSMA and PWC also estimated that Europe and Asia-Pacific will each represents 30% of the total revenues, with North America immediately behind at 28%.

A complex ecosystem that require cooperation between players from many different segments

Partnerships and cooperation between ecosystem players in the mobile health segment are crucial. Mobile network operators, medical organisations and professionals, medical devices manufacturers, Public Authorities and health authorities are key players that need to agree on a wide range of specifications, standards and operational protocols. Several trials are taking place in Europe and testing the new usages of mobile applied to healthcare.

They involve private market players like mobile operators (Orange, Telefonica O2 and Vodafone), public stakeholders (the EU Commission, the Red Cross). Many commercial applications and activities are already live and developing, particularly in the wellbeing/wellness segments and often through the impulsion of start-ups companies.

The healthcare market is extremely highly regulated and many legal and regulatory issues are very sensitive from patient and user privacy to responsibility and liability issues in case of malpractices, device malfunction. Insurance companies and governments are therefore potentially crucial players as their decision to

Encourage electronic patient data and to cover treatments using wireless devices or applications will increase growth and penetration.

In developed countries, mobile health could become essential in the coming years to curb rising health expenses for the states. The developed countries are faced with a foreseeable increase of healthcare per capita expenditures linked to ageing populations in the coming years. Expenditures are growing at 75% and more and have risen far above income levels. The impacts on both public debt and deficits and cost of living for individuals are immense. It is also crucial to improve citizen’ health and promote social inclusion and integration.

Individualisation of healthcare however means that individuals feel more responsible for their own health and search for self-solutions to their problems, increasing the demand for medical information available to all.

In developing countries, the lack of resources both at individuals and States levels are leading to major health crisis compounded by poverty and hunger. The World Bank is particularly active, working with governments to fund mobile health projects to diagnose, control, treat and monitor patients and illnesses.

Mobile health services can be categorised into several areas:

• Patient face to face treatment: Solutions across the Patient Pathway

• Patient remote monitoring and remote treatment: Prevention, Diagnosis, Treatment and Monitoring. It includes the control of drugs delivery. By using mobile devices as remote sensor, controller and monitor to support diagnosis and treatment, monitor conditions and adherence to treatment, monitor vital signs and raise alarms in case of any concerning change, the comfort of life for patients in particular those affected from chronic conditions could be significantly improved.

• Wellness and prevention solutions:  information, interactive services and fitness monitoring to help obesity management, child and elderly cares, smoking addiction treatment, prevention of infectious diseases, etc.

• Integration of mobile and wireless devices into active medical devices: Although it could appear far-fetched, the active inclusion and integration of wireless technologies into artificial organs (e.g. limbs, pacemakers, artificial pancreas, etc.) is already emerging as a reality.

• Health services administration: Emergency Response, Healthcare Practitioner Support, Healthcare Surveillance and Healthcare Administration, etc. that are primarily aimed at improving the efficiency of healthcare providers in delivering patient care but also improving the patient care experience. Another major cost saving opportunity for health services is the use of mobile devices to organise the work of medical personnel, sharing of information between teams, hospitals, doctors, are providing both major efficiency and cost savings and benefits. The role of mobile and wireless technologies in medical continuous learning and training is already developing fast pace and allowing remarkable progresses.

• Wellness and prevention solutions will further add cost savings, targeting individuals with information, interactive services and fitness monitoring to help obesity management, child and elderly cares, smoking de-addiction to prevention of infectious diseases.

The so-called Machine-to-Machine segment or M2M provides underlying combined managed infrastructures/networks/capacities allowing permanent connection and communications between a multitude of devices and stakeholders. A large part of Mobile Health products and solutions will be cloud-based, both elements being crucial building block to allow the development of the Mobile Health ecosystem. The interoperability between all the different technologies and infrastructures will have to be absolutely seamless.

Mobile Network Operators (MNOs) are particularly keen to develop these managed integrated networks to provide directly services to their enterprise and public sector clients. But they also know that they can bring significant additional revenue by commercially providing wholesale M2M platforms to an ecosystem of hosts such as service providers, Over-the-top (OTT) players and Mobile Virtual Network Operators (MVNOs) specialising into Mobile Health.

As an integral part of the M2M sector, a number of other sectors will be relevant to provide this new Mobile Health ecosystem such as sensors, smart connected building, smart connected domestic appliances, particularly important for monitoring, surveillance and prevention.

A number of policy and regulatory issues could limit Mobile Health developments

Although these new Mobile Health services and solutions could have many positive benefits and impacts for the society at large, policy and regulatory concerns are also significant. The political sensitivity around the overall emergence of Mobile Health could be another limiting factor.

The most immediate concerns are linked with the protection of privacy and highly sensitive personal data that require the highest levels of security possible. It is a fundamental element to ensure user confidence and adoption of Mobile Health.

Infrastructure interoperability and resilience are also fundamental requirements that could lead to Public Authorities imposing specific conditions and standards to market players providing Mobile Health related products and services.

Also, as for all Mobile convergence products/services, the thorny issue of applying sector-related regulatory provisions to merging/converging industry segments could lead to potential conflicts. It is likely that the need to coordinate more closely both the healthcare and communications legislations/regulations and the roles/actions of sector regulators will strongly emerge as a major endeavour.

Finally, the requirements for cooperation between various public and private market players and the need to share information and data could raise quite sensitive competition law concerns.

There is little doubt that Mobile Health could have a very crucial role to address some fundamental political, economic, public policy and societal issues and developments. It could contribute significant added value to better healthcare, more efficient, less costly and more tailored to the need of individuals. However, policy and regulatory concerns will have to be carefully considered to avoid early disappointments and lack of adoption and confidence.