Last week, HCI Assistant Editor Gabriel Perna spoke with Deloitte’s senior advisor for healthcare transformation and technology, Harry Greenspun, M.D., to talk about the opportunities and challenges in mobile health (mHealth), and where the industry is headed. Deloitte recently released a report, “Open Mobile: the growth area accelerates,” which stated the mHealth market is projected to grow to $4.6 billion by 2014.

In the first part of the interview, Dr. Greenspun talked about why mHealth is so appealing to mobile developers. The report’s authors asserted that more than any other sector, it has the greatest potential for 4G mobile app growth. Greenspun said the reason was two-fold. Mobile, he noted, had yet to create a market where patients could connect to healthcare delivery.  Also, he said apps will make sense as healthcare enters an era where patients are paying providers for the value as opposed to paying for the volume.

Greenspun also talked about why 4G networks represent opportunities and issues for mobile developers, patients, and providers. While mobile devices will be able to access higher-speed internet connections, they’re also potentially creating a devastating digital divide. Lastly, he talked about how the growth of mHealth plays into the regulatory acts that are popping up in healthcare, specifically cutting down preventable readmissions.

Part two of this interview series covers other opportunities in mHealth, including the appealing area of remote patient monitoring. Greenspun also discusses some of the difficulties that will lie ahead for mHealth developers and stakeholders. Lastly, he discusses how social media and health 2.0 issues tie into mHealth. Below are excerpts from the interview.

Harry Greenspun, M.D.

The report mentioned remote health monitoring as a growth area for mHealth. What makes this area appealing to developers, providers, and patients?

One of the Achilles’ heels of healthcare is of course having patients follow through with a doctor’s instructions, once they have been given out. There are dozens of reasons why people don’t. They don’t understand them, believe them, they are bothered by side effects. There are lots and lots of reasons why people don’t do what they need to do to maximize their chance of their best recovery. If you can remove some of these burdens, and get back that information to those who need it, [that would help].

Here’s an example; for people with congestive heart failure (CHF), once of the best ways to monitor the CHF condition is checking their weight every day. It’s one thing to ask someone to get on a scale, write it down, monitor every single number, and if there’s a problem, reach out to someone. It’s much easier if you get them to get on a web-enabled scale every morning and everything is done automatically. It removes the challenge for them. Same thing can be applied for diabetes or a lung condition. It can encourage you to stick to your low-salt diet, or get you to do any part of your medication, or do other parts of your rehab.

Within mHealth, besides reducing avoidable readmissions, where do you see some growth opportunities?

The social aspect will continue to be big. The issue of how you connect patients with each other as a way of improving their health, this is the motivating aspect of being in a group. We’ve seen medical practices implement group patient visits.  To understand what parts of what this mobile health market will best utilize these devices, you have to look at it by age group, who is interested in having this data available, who wants a personal health record, who wants to have a smartphone. It varies by age group.

What are some of the challenges that the mHealth sector will have to address as it gets bigger?

Healthcare is different. There is a reason things have taken a long time. You cannot stress enough the privacy and security elements that are so critical in healthcare. It’s different from other industries. With your financial information, you are worried about someone getting your credit card number, and you’re worried about someone doing identity theft, and draining your bank account. What people worry about in terms of healthcare and privacy is the sharing of discrete pieces of information in their record. There is stuff in there people don’t want to share. They are concerned about how that information gets moved around, how that can be used to discriminate against them, who might get that, who might find out about it. That’s a big issue.

The other thing is, in this economy, we’ve seen lots of people move from other industries into healthcare. Many are not familiar with the landscape in healthcare, the players, etc. The regulatory issues and the differences between the apps that help you regulate what you eat each day, and the app that tracks your medication adherence. There are fundamental differences in how those work together. And also the challenges in trying to pull information from a modern industry like the mHealth world and the health IT world, which again lags these other industries by about a decade. Trying get information back-and-forth when there isn’t widely adopted standards and a lack of interoperability, is tough.

How will social media and Health 2.0 play into the growth of these apps?

The impact of social media will be huge on healthcare for a number of reasons. It increases patient engagement and involvement. It increases connectivity between individuals. It allows for much better flow of information.

The dark side of this, going back to the consumer survey, is that for most individuals, when you ask people about the quality of care they receive, their perception of quality is based entirely on their service experience. What was it like to go to that doctor? What was it like to be treated at that hospital, or ER, as opposed to any measure of that outcome?  When I speak to a large group, I’ll ask them who has a good doctor. A bunch of people raise their hand, and I ask them how they know. The things they describe are they pay attention to me, the staff is nice, and they get me in and out on time. It’s not related to real measures of quality, like my shots are up to date or I’ve been given the proper evidence-based treatment. They don’t have that kind of information; all they know is what it’s like to go there.

What we need to move towards is a simple way for people to understand the cost and quality of their care, and what the experience is like. Much like people can do with restaurant and product reviews, we need to move into this in healthcare, with comparing real quality measures, and this data does exist.