Generally speaking, doctors stopped making house calls around the 1970s.
But mobile devices are helping doctors to make house- and anywhere-calls as never before possible — with better information, higher patient throughput, and often lower costs.
From the moment Apple demonstrated iPhone 3G-connected blood pressure and glucose monitors at its 2009 World Wide Developer Conference, the Web has been abuzz regarding the future of mobile medicine, or mHealth.
Advocates envision a future in which patients self-perform an EKG with the results automatically uploaded for physician review, where doctors administer comprehensive smartphone physicals, and ophthalmologists can capture high resolution photos of the inner eye without dilating pupils.
All these technologies exist today, thanks to the mobile revolution. The market is already sizeable and the market potential is enormous.
But how are medical professionals receiving the changes and will regulatory requirements hamper progress?
In a new report from BI Intelligence, we take a look at mobile medicine: the top applications, the perspectives from across the medical professional landscape, regulatory issues, and how the market will grow.
Click here for all the charts and data sets associated with this report in Excel »
Click here for the PDF version of this report »
Sizing the mobile medical market: Specific estimates for market size vary, but the consensus is that mobile medical applications, devices, and services represent a multibillion dollar opportunity.
Patient self-management applications: This is currently the key category. Sometimes the apps connect doctor and patient, sometimes they are simply used for self-evaluation.
Professional applications: While lesser in number, apps are cropping up to help doctors and other medical professionals within the workplace.
Physician acceptance: Medical professionals have generally been keen to embrace mobile health, but many doctors foresee slow adoption rates.
Regulatory issues: The FDA is set to offer its final guidance on app regulation, but developers haven't seemed shaken by the regulatory uncertainty — development has continued undeterred.
The future: The market’s next phase will seek to integrate numerous and disparate sources of data into a holistic view of both individual and group-level health.
Note: this report will cover health apps made possible by smart devices, including smartphones and tablets. It will not cover traditional desktop or laptop-based medical work that has been replaced or augmented by smart devices.
Sizing the Mobile Medical Market
In the United States alone, total health care expenditures put the domestic health care industry somewhere around the fifth-largest economy in the world.
Mobile health care will account for a tiny slice of that amount — no one is advocating for smart devices to perform major surgeries. But the sheer size of the health care market suggests a large opportunity for mobile applications and customized, purpose-built devices.
The key to all the interest in mobile for medicine is that the U.S. health care industry is cost-obsessed. And rightly so: The country already spends more per-capita on health than any other country, and health costs continue to rise.
Policymakers, health providers, and insurers are all searching for ways to lower costs without compromising quality of care.
Research from MarketsandMarkets estimates that global revenues from the mobile health industry will eclipse $6 billion in 2013.
The research firm also projects a compound annual growth rate exceeding 30% through 2018, when the market will reach a robust $23.5 billion.
A separate report from research2guidance is slightly more aggressive, projecting the market will grow to reach $26 billion by 2017.
Less formal findings from PwC — based on what survey respondents would be willing to pay for mobile health services — brackets these figures.
PwC estimated the addressable market at $7.7 billion to $43 billion.
Consumer Acceptance And Adoption
App store-based mobile applications will drive some of the growth. There are already roughly 100,000 health applications available in major app stores, and the top 10 mobile health applications generate up to 4 million free and 300,000 paid daily downloads.
Consumer adoption of mobile health apps will proceed apace.
By 2017, research2guidance estimates that over 50% of mobile users will have downloaded at least one mobile health app.
A recent study suggested that 90% of chronic patients would readily accept a prescription for a mobile app compared to just 66% willing to accept a prescription for medication.
Hardware adoption has also been impressive. We estimate that we'll see 43 million unit shipments in fitness, health and activity monitoring devices in 2013, and 77 million in 2014.
Fitness devices such as the Fitbit, Jawbone UP bracelet, and the Nike+ FuelBand have seen respectable sales and mainstream consumer acceptance, as our recent report on wearable devices indicated. They have paved the way for more sophisticated medical use cases.
There is also a lot going on at the intersection of the business-to-business market with behavior modification and health.
One of the largest revenue opportunities for mobile health care may come from the enterprise sector.
That's particularly so in the U.S., where employers are at the center of health insurance schemes. Large U.S. employers constantly grapple with the high cost of health insurance premiums, employee absenteeism, and lost productivity linked to chronic health issues.
Companies such as Lockheed Martin and Northrop Grumman have adopted a wearable device and companion app, Virgin Health Miles, to drive employee wellbeing and health. They're spurring participation by offering rewards to employees who achieve certain goals.
An April 2013 survey from Bloomberg West found that consumers chose medical devices as the category of wearables they were most interest in, over wristwear and smart eyeglasses. (See chart, above, at the top of this section.)
In Canada, 80% of patients would be comfortable using a device or app-facilitated monitoring service for a chronic condition, according to a PwC report.
Mobile Platforms And App Stores
What mobile operating systems support mobile health usage?
Anecdotal findings suggest that the top apps are being developed for both iOS and Android.
Separately, medical schools at the University of Pennsylvania and Harvard University conducted a survey to find what the most-favored apps were among students.
The collective findings yielded ten unique app names, all of them available on both major platforms.
The trend toward dual iOS and Android compatibility will likely continue for the major health apps (barring a significant change in platform development economics).
Developers of mobile health apps will aim to maximize their reach. Health problems cut across demographics and it's unlikely that an app helping patients manage any medical issue will capture its addressable market with a platform-specific strategy.
Are health apps paid or free? Unlike many app categories in which free apps dominate, a substantial minority of health apps are paid.
Here are some key stats on the health app market:
Forty-two percent of apps rely on a paid business model, according to research2guidance.
Only 15% of apps target health care professionals, and the balance aims at consumers.
App download revenue accounts for only about 9% of total market revenue in the next five years, according to research2guidance.
Most revenue in mobile health will come from services and hardware, such as sensors.
Paging Doctor Self
Estimates vary, but around 85% of apps are designed for primary use by the consumer or the patient. These perform a wide range of functions from simple to complex but may be broadly categorized as follows:
Physical Fitness And Personal Health.
Self-Measurement.
Health Information Management.
Self-Testing – Physical Specimen.
Self-Testing – Sensors.
These apps may interface with or attach to sophisticated auxiliary medical equipment.
Or, they may simply rely on out-of-the-box device features (e.g., using the device’s accelerometer).
Typically, apps belonging to the fitness, measurement, and information management categories focus on empowering the individual to monitor or assess personal health, set and pursue fitness goals, or take measurements such as weight or temperature.
That is, they are a one-way street for self-evaluation.
On the other hand, the self-test categories normally establish a portal between patient and doctor or specialist. While the patient may self-perform a test, results are transmitted to qualified medical professionals for interpretation.
These apps sometimes require a prescription.
How do these apps connect with doctor's offices, and with the rest of the mobile ecosystem?
Many apps require auxiliary equipment, which typically connects to smartphones and tablets through one of two routes: wirelessly via Wi-Fi and Bluetooth, or through a physical connection.
The more sophisticated apps, such as those requiring a doctor to analyze data and test samples submitted by patients, tend to rely on equipment that directly connects to the smart device.
An example of this is Mobisante’s ultrasound app, which is covered later in this report.
Other apps, such as AliveCor’s Heart Monitor, feature both forms of connectivity. The device, which allows users to capture their own ECG rhythms, records the results and then wirelessly transmits them for review.
Streamlining the Medical Practice
Doctors play a critical role, even in apps that patients administer themselves, as results must still be interpreted by professionals.
Remote monitoring can drive significant efficiency and cost-savings.
From the doctor’s perspective, these apps help prioritize patients — an uploaded EKG with only a slight irregularity can be circled as “needs follow up,” while a wild irregularity can be flagged for an immediate visit.
This means doctors can ensure that patients who are in the clinic or hospital need to be there, and avoid having to spend half of their day attending false alarms.
There are also apps aimed at helping doctors in terms of their own tasks, apart from their interactions with patients.
These may be broadly categorized as:
Equipment Supplementation And Replacement: Smartphones and tablets either with built-in features or that are connected to auxiliary equipment to supplement or replace clinical equipment. An example is Mobisante’s smartphone- and tablet-enabled ultrasound.
Equipment-Augmented: When smartphones or tablets enhance existing medical device categories. An example is Welch Allyn’s iExaminer, which connects an ophthalmoscope to an iPhone to make use of its high-resolution display and camera capabilities.
Professional Information Management: Mobile apps aid professionals in diagnoses, treatment, and care. An example is ePocrates, an app for identifying drug doses and potential interactions.
Administrative: Apps that streamline workplace administrative processes, such as records-keeping or billing.
These apps will likely gain greater acceptance as they are proven in clinical settings, once they drive real results in terms of cost-cutting, and once younger tech-centric populations age into the workforce.
Already, we’re seeing major medical universities, such as the University of Chicago and Johns Hopkins among others, issuing tablets to medical residents. Scholarly journals have begun to explore the issue of technology in the workplace.
A study conducted by the University of Chicago revealed that the use of tablets improved perceived and actual medical efficiency.
Studies with similar findings will help foster awareness and ultimately drive adoption.
The Professional Response
For all the efficiency gains, technological progress brings with it growing pains, especially when disrupting long-established professional practices.
But so far, the response in the medical professional community has been largely positive.
As recently as 2009, though, it wasn’t as positive. A survey conducted then by CTIA indicated that only about a quarter of doctors and specialists felt that patients would benefit from mobile services.
Fast-forward to 2013 and that number has jumped to more than 90%, according to a survey conducted by eClinicalWorks.
Eighty-nine percent of those physician respondents indicated they were likely to recommend a mobile app to a patient.
That represents a significant shift in mindset in only a few years’ time.
Most doctors believe mHealth is inevitable, but that adoption will come slowly.
Physicians have proven themselves to be relatively tech-savvy: research from nearly 2 years ago indicates 80% of physicians owned a smartphone and 58% owned an iPad or planned to buy one in the coming year.
Both figures are significantly higher than penetration rates in the broader population today.
We think doctors' openness to new mobile technology will breed familiarity and ultimately drive mobile app adoption rates higher. Doctors are data-driven in their professional outlook. Mobile health will find its way into their exam rooms and offices once the data corroborates improved patient engagement, clinical outcomes, and operational workflow.
The Regulators
The health care industry in the U.S. — and most of the world — is highly regulated with new medicines and devices often requiring an extensive screening and approval processes.
In 2011, the Food And Drug Administration issued draft guidance on mobile apps, indicating that it intended to regulate apps under its definition of a regulated device.
Per the guidance, this includes apps that function as extensions of existing medical devices, as well as apps that emulate the functions of those devices.
In that time, the FDA has reviewed and approved apps, including Mobisante (ultrasound) and iExaminer (the ophthalmoscope that can accommodate an iPhone).
According to Wired, the FDA has been generally positive and seems to support all the mobile health innovation taking place.
However, mobile health app developers would be wise to pay careful attention to the final regulations the FDA announces.
Another issue mHealth must face is app reliability and credibility.
Apple and other platform operators that run app stores develop hardware and software — not medicine. While apps will undergo customary review before hitting the marketplace, it's not the job of software or hardware companies to evaluate a health app’s efficacy.
Health is a sensitive area. Consumers may lead a backlash against mobile health apps if too many turn out to be quack solutions, or if mediocre apps make it into the main stores.
A third-party vetter of mobile apps might be one solution. Happtique is one such service. It publishes an app's credentials as part of a certification program health apps must undergo to be Happtique-listed.
This and similar efforts may serve as leading indicators for apps that will ultimately undergo FDA review.
At the very least, establishing clear credentials and standards will help doctors and patients in evaluating apps, and may help weed out any bad software that could give mobile health software a bad name.
Looking Ahead
We are still early in the mobile health revolution. If we look at mobile health adoption as proceeding in three stages, we can say we're just arriving at the second stage.
The first stage was led by consumer-friendly products — particularly those tied to fitness and general wellbeing (like the Jawbone UP band that syncs with a smartphone). They laid the foundation for mobile as a platform for personal health monitoring, and pointed to future directions for innovation. Google Glass, for example, has already been tested in surgical settings.
The second stage, which we have just entered, will see apps and mobile-connected devices permeate the medical field.
The most recent solutions are paving the way for remote mobile diagnoses and efficient communications between physician and patient. Other apps bordering on the stuff of science fiction — smart diapers that can detect viruses in babies for instance — are in the works.
The third stage will occur once these trends — mobile, wearables, and data-collection devices — mesh together and provide the backbone for optimization and customization of preventive health, medical treatment, and hospital processes.
Soon, we will find ourselves at the intersection of mHealth and big data. Big data and personalization still haven't shaped this market to the extent they no doubt will in the future.
Look for companies such as Open mHealth to compete as they try to integrate disparate and massive amounts of data to provide a holistic health view of individuals and populations.
At the individual level, this data will be collected by various sources: An active diabetic who is a running junkie may want to understand how his blood glucose levels vary with physical activity, and turn to the iBGStar glucose monitor and Nike+.
How will he fuse the two data sources?
The same user might add numbers from regular self-administered EKGs and other cardio data. An integrated snapshot and visualization of all these data streams will be possible, for viewing by medical professionals and patients. As venture capitalist and Sun Microsystems co-founder Vinod Khosla said: “The fundamental change in health care is the transfer of power to the consumers, and helping them become the CEO of their own health.”
On the professional side, the sourcing of new and more continuous data, and its analysis at the macro level, may help doctors and researchers uncover new relationships between patients, drugs and the environment. These insights may lead to better and safer treatments, and perhaps new disease-curing discoveries.
THE BOTTOM LINE
Market size estimates reveal a great deal of variance, but no matter how it’s cut, the mobile health market represents a multibillion dollar opportunity.
The key to growth and investor interest in mobile health is that it affords the possibility of savings and greater efficiency to a cost-burdened medical industry.
In the U.S., regulation has not yet proven to be a major obstacle — at least not in the sense that it has for drug manufacturers. Regulators have embraced mobile health.
Some apps and devices are already being prescribed by physicians in the course of treatment and patient management. Patient self-monitoring is the top category in mobile health.
Mobile health apps are beginning to exhibit a high level of sophistication but plenty of innovation is likely in store, particularly in the realm of personalization, aggregate data analysis, and optimizing patient management.
Click here for all the charts and data sets associated with this report in Excel »
Click here for the PDF version of this report »
Join the conversation about this story »