Who will prescribe mHealth Apps?

If you’ve been reading the mHealth blogs and analyst reports over Christmas and the New Year, you’ll have realised that medical smartphone applications (apps) are being promoted as being the next big thing. In fact you could even be forgiven for thinking that by 2015 we’ll have given up on conventional medicine and GPs themselves will have become the primary source of these apps.  
    
This may be fanciful, but there are a number of reasons why the health application market is very different to the consumer application market: complexities of medical regulation, issues of connectivity to worn medical sensors and attitudes in the medical profession itself.      

The buzz around apps
The bulk of doctors are only just discovering apps for themselves – is it really likely that they will be able to move from that position to one of informed provider in just a few years, particularly given the number of other pressures they face with current health reorganisations?
    
The headline figure that got everyone excited was a report from Kalorama estimating that the medical mobile apps market had grown from £25 million in 2009 to £52 million in 2010. The inference is that 2011 will be the start of a massive growth, with untold riches in the years to come.  
    
There is no doubt that the growth of apps stores has seen a surge in health applications, even if a definition of ‘health’ often stretches seamlessly into lifestyle, sports and fitness.      
    
Another analyst – Distimo, released a report covering all phone apps that were released in 2010. This indicated that health and wellness is attracting plenty of interest. It’s the second fastest growing area for applications for the iPhone, and the fifth fastest for both BlackBerry and Android. Windows and Symbian users are either much healthier or spending their time doing something else. These figures don’t merely reflect the hopes of developers.          

Pyramid research has been looking at key players in the mobile healthcare chain and report that 70 per cent of users would like to have a mobile application on their phone.  

Before getting too carried away by the analysts, we need to bear in mind that only 20 per cent of phones currently being bought are classed as smartphones. That means there’s a mismatch here: the bulk of research participants don’t understand the question or are a narrowly selected portion of the population. That skew isn’t unusual.
    
However, these projections are only ever going to come true if people can make money out of writing apps. It’s possible that they will be produced altruistically (and the NHS could be a good source for that), but it’s unlikely to result in a massive shift in the industry.  

Who is writing the apps?
Hence the question: who will make money from mobile health apps? The heady days of boys in their bedroom writing apps that make them a million has gone. Already developers are increasingly relying on advertising revenues, in-app purchases, or just being paid to write apps for larger companies. And even that last option is getting less profitable as more apps developers come online and development tools make it easier to write them. So mHealth apps are unlikely to produce a golden path to riches.
    
Various reports on the size of the market look shaky because they don’t ask the questions of who will be writing health applications, and why. One of the early sectors, perhaps not surprisingly, has been pharmaceutical companies, particularly in the US where they can promote their products to the public. As they are using apps to hook users onto drugs (in a responsible way), these are invariably free.  But even paid-for health apps are generally cheap. According to another analyst, vFluence, the average price for a health app is under $2. Apps sold to doctors average $15 but includes textbooks and medical references.     
    
The $2 figure sets a price-point for consumer health apps which the market will find difficult to increase. So anyone entering this market needs to work out a business model built around the provision of free apps.  
    
Of course there may be ways to get people to pay. There has to be a market for celebrity health apps. Next time Britney has a sore throat or Heston has a health problem, you could expect to see a premium-priced celebrity heath app on a phone near you. But how many GPs would want to be associated with that?

Consumer interest
What has been interesting to observe is the range of views about where users will purchase health applications. Analyst firm, Research4Guidance, has been surveying customers about this in Berlin. Although consumers use apps stores today, the research participants expect this to change.  By 2015, 65 per cent expected to get apps from their doctors, 68 per cent from clinicians and 56 per cent from specific health websites.  Their survey is clearly about “traditional” health, as the main therapeutic areas that were mentioned by respondents were the classic long term chronic conditions – diabetes, obesity, hypertension, asthma and COPD, with a strong showing for chronic heart disease as well.
    
Of course, the big question is how doctors will make the transition from dispensing pills to dispensing apps? The survey highlights a dichotomy facing the GP – first of choosing apps for their own work, to help them to manage better, and then choosing apps to ‘sell’ to their patients as part of their treatment. Some analysts like Pyramid see a role for the network providers here.

Utilising the mobile phone
I was much more impressed by a company I met while chairing the Mobile Healthcare Industry Review at the King’s Fund before Christmas.  It was a new company called Devices 4 Ltd.  
    
Structured as a non-profit organisation, it has been working closely with the healthcare industry so is very aware of both parts of the problem. They ran a survey of health professionals in the UK and found that only 18 per cent run a medical or health application.   

They were told that figure would double if the phone was provided to them with work related apps. Over half of respondents, believed that they “would be more productive if they had a mobile phone for use at work.”          
The survey also highlighted that within the UK, using a mobile phone in a medical environment is still not allowed, or is frowned upon for over a third of those surveyed.

The survey went on to reveal that over a third of health managers still see no benefit to medical staff using mobile phones. Even where they are allowed or tolerated, there’s no coordination about which phone or network to use, or which applications might be relevant to which job. Individual health workers are left to make that decision themselves. Devices 4 is aiming to be the glue that brings that together, allowing information and best practice to be shared and to act as a group purchasing organisation for UK healthcare professionals.
    
I suspect that things will move much more slowly than the analysts predict and most GPs won’t have patients coming to them for phone apps in their lifetime. But you never know; they may be right. If you’re one of that sizeable percentage of GPs without a smartphone, take note of the smartphone deals on offer at the moment. It could be time to upgrade your contract.

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