2015: mHealth’s breakout year–or more of the same sideways?

click to enlargeAdopting or Ditching It? We’re barely into September, yet the first 2015 prediction-of-a-sort is on the record from Center for Connected Health‘s Dr. Joseph Kvedar in The eHealth Blog. Does Apple HealthKit+Samsung‘s SHealth’s iterations+Google Fit+smartwatches everywhere (including LG’s G Watch R) equal $7.2 billion in wearables alone by 2018 as part of a mHealthy $49 billion by 2020? He’s optimistic, yet he hedges his bets with the caveat

“The challenge in health care is that, though we know what patients/consumers need to do to improve their health, most of them don’t want to hear about it.”

Which indicates that Dr. Kvedar has joined our small group of Thinkers puzzling out why health apps haven’t taken off beyond their Quantified Selfer early adopters and what Parks Associates termed ‘Healthy and Engaged’ [TTA 11 Aug]. With 1/3 of the purchasers of activity trackers putting them in the drawer after six months and the unstickiness of apps (80 percent are abandoned after a shocking two weeks), the winning combination isn’t obvious. But is it ‘focus on engagement’ and ‘personal, motivational and ubiquitous’? Certainly key factors, but how do we get the ‘Challenged but Mindful’ with a chronic condition–or two or three–to track and reward their real progress, even on a bad day–which an activity tracker which constantly presses you to exceed your performance has trouble gauging.

Here’s an example from HealthSister/Ethical Nag Carolyn Thomas, who has been tracking her activity with a simple pedometer prescribed to her after her 2008 heart attack, plus a wall calendar with small stickers ‘rewarding’ her for each hour of activity. Her new Fitbit gift and those nifty graphs it generates? Underwhelming. Most of all, it cannot reward her overcoming those really bad, close-to-nonfunctional days for which even a little exercise qualifies for a special, shiny, sparkly sticker. With people like her, who truly need tracking and are ‘trying harder’, Fitbit’s limitations and ‘reward’ methodology can have the opposite effect as an ‘instrument of self-torture’ (quoting Alexandra Carmichael).

“In other words, I and other people living with chronic and progressive illness simply do not care how many badges, rewards, bells and whistles a Fitbit or other digital device offers when I’m too ill to do more than I am able to do. The digital tracking devices/apps that are much loved by the worried well of the Quantified Self movement may have just the opposite effects on others by making us feel bad about what we’re not able to do.” (Editor’s emphasis)

Self-tracking device? Got it. Tried it. Ditched it.

For another perspective, read Kim Bellard’s I Hate Apps (not a Luddite, he “just hate(s) how they’re doing it”) and his tale of a man with a weight problem plus diabetes plus a peanut allergy–not that unusual–who is using 11 apps to track his health: diet, exercise, high blood pressure, glucose levels, allergen levels, safe places to eat, PHR, health system…a Battle of Stalingrad Without End, and that doesn’t include his chronic conditions.

And who’s making money? 2 percent of developers take in 50 percent of all app revenue. 47 percent make virtually no money from their apps. Mr Bellard looks forward to a ‘post-app future’ where tracking is platform independent (not dependent on a device), context-driven (where used) and fully integrated.

The skeptics even encroached on Silicon Valley at last Thursday-Saturday’s Stanford University’s Medicine X conference. At Stanford Coordinated Care, they have conceded that the patient’s POV is “We don’t want to be managed, we want to be supported” and to cut down the 40 percent of premature deaths attributed to patient behavior, it’s a supportive across-the-team approach and ‘intense engagement’ that’s needed. MedCityNews.

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