Rob Havasy is executive director of Continua and vice president of the Personal Connected Health Alliance. Prior to joining PCHA, he served as team lead for Products and Technology at the Center for Connected Health, part of Partners HealthCare. Before joining Partners, he held a variety of positions in sales, marketing and services with Enterasys Networks (now part of Extreme Networks), culminating as service operations manager. He began his career as a chemist at Leeman Labs, a manufacturer of laboratory instrumentation. He holds a B.S. degree in Environmental Science from Keene State College and an M.S. in Health and Medical Informatics from Brandeis University.
Q. What’s the one promise of mHealth that will drive the most adoption over the coming year?
A. The realization by providers, payers and governments that there is a wealth of information in mHealth data that can better help them understand risk and allocate resources effectively to better manage chronic diseases and improve clinical outcomes. The adoption or acceptance by these parties will create the network effect needed to really spur patient and consumer adoption.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. Underlying healthcare systems are not quite ready to accommodate the integration of patient-generated data on a large scale, so I expect that they will take baby steps and the first systems to become common will facilitate the basic transactions of healthcare. Mobile appointment scheduling and reminders, mobile EHR access for patients and providers and basic sharing/display of test results will be the first technologies to gain widespread use. This will be followed by widespread tracking of basic activity and fitness as hardware and software vendors bake this functionality into handsets and mobile operating systems and Bluetooth Smart becomes more common in handsets to make pairing with wearable trackers easier.
Q. What’s the most cutting-edge application you’re seeing now? What other innovations might we see in the near future?
A. The convergence of powerful sensors on small chips and the low power demands of Bluetooth Smart are leading to some very innovative devices. Heart monitoring is really interesting now – both continuous heart rate monitoring in consumer devices targeting the fitness market and small wireless patches standing up against Holter monitors for diagnosis and monitoring of atrial fibrillation and other conditions are really pushing mHealth into new areas. Even more cutting-edge may be using mobile phones as signal processors and analytic engines to do real-time analysis. This technology is being applied to things like voice patterns for depression screening.
Another example is the meta-pattern analysis Ginger.io is doing with basic smartphone data – drawing valuable health conclusions from data not traditionally considered health-related. This kind of pattern analysis will surely be an area of intense innovation as the market finally learns to work with the volume of data we are generating on a daily basis.
Q. What mHealth tool or trend will likely die out or fail?
A. I think that most smartwatches, even those that incorporate some kinds of fitness technology, will ultimately fail. Dedicated fitness trackers worn on the wrist have a better chance, but probably not much. The wrist is an incredibly convenient place to put a small display or tracker for a variety of reasons:
- It is one part of the body usually uncovered by clothing, so a display can be seen;
- It is very flexible to accommodate a variety of viewing angles;
- A device can stay on your wrist for extended periods of time, so forgetting to wear it is less of a problem; and
- Human physiology means that arm movement correlates with most exercise pretty well.
But the trade-off is that real estate is limited, and this is where most smartwatches fail. They try to do things on a sub 2-inch display that are best done on larger screens. Steve Wozniak said of one such watch: “I want my smartphone (on my wrist), but I really want the whole thing. I don’t want just a little Bluetooth connection to the smartphone in my pocket because then it’s just an intermediary, an extra thing I buy to get what I already have and have to carry anyway.” I think this will always be a limiting factor.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. Perhaps the most surprising thing I’ve seen in the last few years is the traction gained by mHealth companies and apps connecting patients with doctors, like Healthtap, American Well, MDLive and Zoc Doc. We are told every day that there is a severe physician shortage, yet these companies are seemingly able to connect people to physicians with ease. Either the provider shortage isn’t yet real, these companies are truly driving new efficiencies (by using slack time in traditional physician scheduling), or something else is at work and these virtual visits are displacing the availability of care for other segments of the population. But their continued success and the entry of new players into this space (with Walgreens, for instance, announcing a partnership with MDLive) seems to say that the system has the capacity to absorb this.
Q. What’s your biggest fear about mHealth? Why?
A. That our quest for new and cool devices first, with concerns about data left for later, has opened a Pandora’s box. The very same technologies that allow companies to draw valuable health conclusions from seemingly disparate data unrelated to healthcare means that organizations could do the same for nefarious reasons. The sheer volume of data generated by individuals, which can allow governments and healthcare providers to assess risk and make the current healthcare delivery system more efficient, can also be used to learn much more about people than they believe they are revealing.
Doc Searls and David Weinberger, two of the original authors of the Cluetrain Manifesto in 1998 (one of the most important writings about the Internet, in my opinion) just published 121 New Clues and said in number 87: “With a probability approaching absolute certainty, we are going to be sorry we didn’t do more to keep data out of the hands of our governments and corporate overlords.” Near the end of 2014 we saw one of the first documented cases of mHealth data being used in court. This is something that the industry will need to come to grips with before it’s too late. Building products based on open standards is a solid first step – at least allowing users to understand what their devices are collecting. But there is much more to be done on a system level.
Q. Who’s going to push mHealth “to the next level” – consumers, providers or some other party?
A. Getting costs under control is the key to driving adoption in healthcare since neither healthcare providers, governments, nor chronically ill patients can afford to deploy the current mHealth solutions at any significant scale. We are finally seeing high-end smartphones for only a couple of hundred dollars at this year’s CES and companies are beginning to import low-cost mHealth devices with sufficient margin that they don’t have to build their business around selling data to survive. Low-cost devices that users can combine into the solutions they need for their particular conditions and lifestyles will be the catalyst needed to push mHealth to the next level.
Q. What are you working on now?
A. At the Personal Connected Health Alliance we are working on several fronts. Continua is preparing to release an updated version of our guidelines and we are working with governments, companies and interested parties around the world to promote open standards for the capture and exchange of patient-generated health data. Together, the PCHA is giving a voice to patients and individuals and bringing them together with the premiere manufacturers around the globe to ensure that people have the ability to send their health data wherever it needs to go.
Date: February 20, 2015