Summer edition

TELUS Talks Health

It is estimated that 80% of adults on Earth will own a smartphone

by 2020i. Already, these devices intersect with nearly every

aspect of our daily lives and occupy a growing proportion of our

attention throughout the day.

The impact of mobile devices on individual lives, societies,

and industries is transformative due to their ubiquity and

increasing sophistication. The healthcare sector is not exempt

from the disruptive impact of mobile and is slowly but surely

moving in this direction.

What implications do mobile devices and apps have on

how healthcare providers deliver patient care? As a starting

point, let’s consider three trends that are driving mobile

disruption in healthcare.

1 Small, powerful sensors. Ever-smaller, more powerful

sensors are embedded into mobile devices, enabling them

to soon be able to monitor critical-care grade health metrics

continuously, in real time, in everyday life. Take blood

pressure for example: it is now possible to measure blood

pressure by optically detecting blood volume changes in

blood vessels instead of using an inflatable cuffii.

2 Health professionals believe in mobile. Healthcare

professionals and consumers are becoming more

comfortable using mobile devices and apps to complement

direct patient care. For instance, in a recent survey of

500 health professionals by Research Now, 76% believed

that apps will help patients manage chronic conditions

more effectively, 46% believed that apps will improve their

relationship with their patients, and 46% plan on using

mobile apps in the next five years.

3 mobile can shift care delivery from reactive to

proactive. The significant burden that chronic disease

places on society and the health system is well known.

At the same time, there is great optimism that digital

health and mobile devices can improve how we identify,

prevent and manage chronic conditions by shifting care

from a reactive to proactive focus.

Vincent ng BScPhm, MBA, Health Business Consulting Senior Manager TELUS Health

Three mobile trends healthcare providers need to know

July 2015 Edition

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From health tracking apps to health monitoring devices

Patients are increasingly using mobile apps and devices to

participate in their care and, from an app standpoint, there are

an estimated 70,000 medical or health and fitness apps active

in the Apple App store alone. When apps are combined with

physical attachments, smartphones can be transformed into

health monitoring devices – for example, an ECG monitoring

device with an AliveCor case, or an otoscope to detect ear

infections with a Cellscope attachment.

Meanwhile, worldwide shipments of wearable health devices

(e.g. Fitbit) are forecast to total 34 million units in 2015, almost

three times the number of just two years agoiii. And, the market

seems set to continue growing: 39% of consumers surveyed

recently by Accenture indicated that they intend to purchase a

wearable health device within the next three-to-five years.

However, despite consumers’ initial enthusiasm, more than half

of respondents in one survey said that they no longer used their

activity tracker after a year, and a third of those stopped using

the device within six monthsiv.

A key reason is that consumers often do not see tangible,

positive health or wellness outcomes from using fitness

trackers alone. Having a device and data is not enough to drive

the sustained behavior change that is essential to achieving

better health outcomes. Instead, data needs to be translated

into understandable, actionable insights that are meaningful

to users. And, to move forward with new behaviors requires

guidance, support and encouragement from others, including

their healthcare providers.

Sharing data means collaborative care

Most of the data generated from mobile apps and devices is

never shared and a significant barrier to data sharing is the lack

of interoperability between mobile apps and the IT systems used

by healthcare providers.

Conversely, US clinicians surveyed by PwC in 2014 were

not yet comfortable using patient data streamed from health

apps or devices. Seventy-four percent were uncomfortable

using patient data from a mobile app that can check for ear

infections. There are several legitimate reasons for this

reluctance, including the lack of quality evidence supporting

the efficacy of health apps and devices, uncertainty over data

privacy and security, and wariness of too much data of limited

clinical relevance.

Consequently, early generations of mobile health apps and

devices have focused on enabling patients to better self-monitor

and self-manage their wellness and medical conditions. While

valuable, there remains consumer appetite for apps and devices

that do more – that facilitate interactions with a healthcare team.

As noted in a 2010 Ipsos Reid poll commissioned by Canada

Health Infoway, the top digital health solutions desired by

Canadians surveyed were: “Request Prescription Renewal”,

“View Lab Test Results”, “Make Appointments Online” and

“Consult Providers Securely Online” – all functionalities that

enable interactions with healthcare teams.

Mobility to enhance – not replace – patient-provider interactions

The transformative potential of mobile devices and apps in

healthcare lies not in the ability to eliminate clinicians in favour

of self-care, but in the ability to elevate patients to be active

participants within the healthcare team, whenever and wherever

they are.

…there remains consumer appetite for apps and devices that do more — that facilitate interactions with the healthcare team.

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This idea is not new. The Wagner Chronic Care Model,

developed in the early 2000s, is the foundation of many

Canadian provinces’ chronic disease management strategies.

It postulates that enabling productive interactions between

informed, active patients (and their caregivers) and prepared,

proactive care teams leads to improved outcomes.

The proliferation and enthusiasm for mobile apps and devices

can catalyze these productive interactions because patients are

The transformative potential of mobile devices and apps lies in the ability to elevate patients to be active participants within the healthcare team, whenever and wherever they are.

armed with tools to make healthy choices, to track the resulting outcomes, and to share them with their care teams electronically or

during face-to-face interactions.

However, consumer enthusiasm is not the only factor at play. Leading healthcare providers see mobile health as a business imperative

and there are signs that this idea of using mobile devices and apps to enhance patient-provider interactions is being absorbed into

new business and care delivery models.

Mobile driving new business and care delivery models

Retail pharmacies, especially in the US, have been aggressive in evolving their digital health offerings from facilitating self-management

only, to enabling self-care, and to enhancing collaborative care.

Walgreens is a prime example of embracing digital care delivery, making it easy for clients to engage with the pharmacy team online.

telushealth.com

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i Planet of the Smartphones, The Economist, February, 2015ii I. Henry, D. Bernstein, M. Banet, J. Mulligan, S. Moulton, G. Grudic, V. Convertino, Body-worn,

non-invasive sensor for monitoring stroke volume, cardiac output, and cardiovascular reserve. Proc. 2nd Conference on Wireless Health, La Jolla, CA (Association for Computing Machinery, New York, 2011), pp. 1–2.

iii Shipments of healthcare wearables worldwide from 2013 to 2015 (in millions), Statistica, 2015iv Inside Wearables: How the Science of Human Behavior Change Offers the Secret to Long-Term

Engagement, Endeavor Partners, January, 2014v Neil Versel, Mobile Health News, May, 2013

Walgreens has long provided customers with the ability to

manage and order prescription refills online or through a mobile

app, which has enjoyed significant success. By 2013, more than

half of all online refill requests came through a mobile appv.

Subsequently, they launched their Balance Rewards program,

which awards participants points for self-care activities such as

logging weight, and tracking blood pressure and glucose levels.

These points can be used for discounts within the store. People

can also automatically upload data from their health devices to

a patient dashboard, making it easy to view, analyze and share

their progress with the pharmacy team.

Most recently, their new mobile and digital health initiatives have

focused on enabling collaborative care, such as combining the

Balance Rewards program with 24/7 telephone access to a

Walgreens pharmacist, who acts as a Digital Health Coach to

provide health advice, interpret results from a client’s Balance

Rewards dashboard, and to collaborate on action plans based

on those results.

Similarly, Walgreens partnered with WebMD to create “Your

Digital Health Advisor”, a virtual wellness-coaching program to

create customized goals and action plans that support lasting

lifestyle changes.

As retail pharmacies in Canada and the US seek to differentiate

from their competitors and increase consumer loyalty, they have

placed big bets on digital health technology as a vehicle to

extend and deepen customer engagement.

Early data from Walgreens suggest that engaging customers

in an omnichannel fashion is good for business – they have

reported that customers who interact with Walgreens in-store,

online and via mobile apps spend six times more than those who

interact in-store only.

Can mobility usher in the golden age of chronic disease management?

A ‘perfect storm’ of factors to transform how chronic conditions

are managed is brewing. That is, consumers are clamouring to

actively participate in their care, advances in technology are

putting ever-smaller and more powerful computers in people’s

pockets, and commercially-driven healthcare providers are

competing to engage consumers 24/7.

These trends have the potential to enable informed and

motivated consumers to have regular, productive interactions

with their care team who are more prepared and proactive.

As a result, consumers will increasingly look to their healthcare

team to be prepared to discuss and translate the metrics that

they’re tracking into jointly developed action plans with outcomes

that they can measure, track and share until the next appointment.

Are healthcare providers in Canada ready to participate in this

new, always-on, mobile-enabled world?

In order to provide better care of chronic conditions, and for

commercially-driven providers to thrive, they will have no choice

but to be ready.