Telehealth Soapbox: Healthcare apps – welcome to the Piranha tank

Peter Kruger, owner of the Steinkrug consultancy and founder of Alphadaugters explores the dilemma that faces developers of health-related software. This item is re-published, with kind permission, from the Alphadaughter’s blog.
‘Information wants to be free’ so stated Stewart Brand, founder of the Whole Earth Catalog, back in 1984. Over the next two decades, thanks to the Internet and personal computers, a significant amount of the world’s imprisoned information was liberated. Now something similar is about to happen to healthcare: or at least the part of healthcare that is digital. This has been bought home graphically by the recent collapse of yet another online healthcare service: the sleep coach company Zeo.

It perhaps no coincidence that some healthcare IT companies are struggling just we see the release of a new generation of mobile technology. The Samsung Galaxy S4 has, as standard, a number of features mobile health companies previously had to build into their proprietary platforms. It will not be long before Samsung’s eye tracking feature appears in mhealth applications running on the Galaxy and other consumer mobile handsets. (Already Fujitsu has announced software that can check a person’s pulse rate through a tablet or smartphone camera.) Any company that has waited until their customers pressed for Apple and Android versions of their mhealth service has probably left it too late. And for those who have already ditched their proprietary platforms in favour of consumer mobile devices; welcome to the Piranha tank.

Here are some trends to watch as your business model dissolves before your very eyes. Firstly the advanced features built into Android and Apple OS devices will lead to a further expansion of the repository of software available in open source libraries. This, along with the availability of programming tools such as Eclipse, will encourage increasing numbers of small companies and individuals to produce mobile health apps. The biggest challenge for your business will be mobile health applications supplied free by individuals motivated by emotion rather than money. Quite often we hear the death of a loved one has encouraged someone to produce a software tool that ensures ‘no one ever again will suffer as a result of late diagnosis.’ Here financial gain is not the driver: the developer is merely alleviating feelings of guilt and impotence in the face of a tragic loss. Success is measured in column inches in the press rather than cash flowing into a bank account. Most of these applications fall below the standard of your company’s product, however some do not.

As an incumbent mobile health company you will find yourself entering the apps war with one hand tied behind your back. Health providers are limited in the amount of diagnosis they are willing to undertake by the capacity of their treatment clinics. However, once the link between diagnosis and treatment is broken this limit disappears – for the app developer, not you. The app provider has no knowledge of the number of patients their software diagnoses as having a medical condition. They do not have to find beds for patients and can identify heart problems until they are blue in the face. At some point healthcare providers will stop buying proprietary mobile health diagnostic devices – why bother if people are self-diagnosing free of charge using their own mobile devices and apps that cost nothing? And where diagnosis goes, so post treatment monitoring will follow.

What are your options? You could defend your market position with patents. On the other hand every day your software engineers spend with a patent lawyer is a day they are not trawling open source repositories looking for algorithms and code your competitors are about to deploy. There is regulation, which did little to slow the growth of healthcare websites. You could argue that consumer mobile devices are too complicated for elderly patients and charging sockets are too small. Difficult to sell, as many elderly people seem to overcome these problems after discovering tablet and note computers can be used to Skype with their grandchildren.

You could break with the healthcare provider and sign up with an alternative partner. Perhaps a deal whereby a retailer rebadges your service and distributes your hardware. The white label of death business model that sees you lined up with bakery product suppliers and farmers waiting to have a deal squeezed out of you. Don’t forget all those people providing free healthcare apps for iPhones – written in memory of their departed parents – will be standing with you in the queue.

There is the business model that saw information itself set free; but even the key liberator of content, Google, had rather less success with healthcare.

As a last resort there is always the app store. Yes, we are back to the Piranha tank. Luckily you will be off to a good start with a reputation and an established user base. You might be able to squeeze a premium price out of users: perhaps as much as £1.99 for a download (you can forget the monthly subscription model). Your app will certainly warrant the four stars. But then so will others below you in the list of similar apps. Except their apps will cost nothing to download.

Healthcare, free at the point of click.

Peter Kruger
March 2013

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