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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.
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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.