There is a great deal of attention being paid to mobile health applications at the moment, especially in the context of wearable technology. For example, Samsung, Apple and even Google, have recently made clear the focus they will place on this exciting intersection of biology, medicine, healthcare and digital technology.
Although the cutting edge is in the development of applications for devices such as Google Glass and the rumoured Apple iWatch, the capacity to record and manage your health through your smartphone is the core of the mobile health movement in the developed world. The opportunity for self-tracking is enormous; there is even growing evidence with some medical health apps that self-tracking can directly impact clinical outcomes for patients.
This development, alongside the uptake of smartphones, is known as The Quantified Self movement. In reality, this idea is actually as old as the iPhone itself, with the editors of Wired talking in 2007 of "a collaboration of users and tool makers who share an interest in self knowledge through self-tracking." You can even watch Gary Wolf talking about this at Ted in 2010. The truth, however, is that the power of mobile health is coming with its ubiquity. Mobile health is no longer a novelty; even the Managing Director of PricewaterhouseCoopers, Christopher Wasden, stated back in 2012 that eventually mobile health will become core to the practice of medicine
The term ‘health application’ covers a broad range of tools, from fitness apps and training tools like Nike+ and Full Fitness, through to diet and nutrition-based tools like myfitnesspal . There are also quality of life applications such as Lift, and a whole host of pseudo and actual medical applications for every disease area imaginable. These range from mental health (the latest example being ThriveOn ), multiple sclerosis and cancer management. The truth is there are thousands of applications promising to serve the majority of medical conditions; the question is, do they deliver on this promise?
There is a fantastic opportunity for pharmaceutical companies to provide clinically effective solutions both as stand-alone interventions and as a means to revolutionise patient support. The ‘beyond the pill’ cliché is made real by effective development of mobile applications for medicine. However, having worked on mobile health apps now for a long time, it is obvious that most don’t work, or are not widely adopted by users. There is a great blog post titled ‘An Open Letter to Mobile Health App Developers and Their Funders’ that outlines nicely the dissonance between what patients need, and what developers are often delivering.
As always, there is merit in an element of caution. Some statistics suggest 90% of health apps are deleted or not used again after 10 days, so getting it wrong can be a terrible waste of investment. From my experience, there are four key principles that tend to define if an application in healthcare will work, and if it is likely to be used:
1. Is it linked to physical activity?
Interruptive communication in mobile health has been shown to be ineffective. The adherence alarm you set up today will develop into a very annoying and unwelcome intrusion tomorrow. By contrast, applications that are linked to an actual activity, such as running, are far more likely to be used than apps that focus on reminders to go to the gym. What this means in the medical environment is that even the process of ‘checking in’ to taking a medication at a particular time on an application is more likely to become an engrained behaviour than responding to adherence reminders. This is amplified when combined with motivational design thinking, the right feedback systems, and ‘rewards’ (no not badges!) that underpin all four of these principles.
2. Does your application solve a real problem and is it mentally stimulating?
This is very important. The question is not, ‘Does it solve a problem for the developer, or even the patient’s clinician?’ The real question is, ‘Does it help the patient directly?‘ If an application is in any way a hindrance, or adds any further time to the investment people must make into their healthcare, it will not be used. Quite often people say things like, ‘It would be great for the patient to enter their test results in here’; perhaps this would help metrics measurement, but what does the patient gain? The most successful health applications understand the real problems that come with living with a disease or condition, and offer something that genuinely helps.
3. Does your app have emotional resonance?
We are emotional creatures, and although pharma and digital agencies are mostly stocked with data geeks, most people are motivated by something other than numbers. Emotional resonance is fundamental. For example, a compliance application for patients after an organ transplant should reassure patients they are taking care of themselves, or give updates to those who care for them; rather than focussing on delivering statistics on treatment adherence percentages. I have seen a beautiful application in cancer (I cannot share unfortunately) that helped people who were looking to extend life by months and not years. This app helped individuals work towards a goal such as attending one of their children’s weddings. This type of application truly focusses on emotional resonance, not numbers, and clearly demonstrates how powerful this type of app can be when done right.
4. Does it have the right level of connectivity?
Applications in fitness and nutritional support often employ social features that allow competition or support in achieving goals. This may not be the right kind of connectivity in healthcare, but what matters is the symmetry of information. We know that patients are more likely to use an application if it is linked to their healthcare team. We also know that connecting people to what I term a ‘care network’ of individuals who have a real interest in supporting someone with their health can be very powerful. We can also use passive connectivity to track the communication patterns of patients with schizophrenia, providing an early warning system to families and mental health services if a possible relapse is predicted. In summary, if an app is not connected, it is less likely to work.
The potential for quality medical mobile health development is very high. As an industry, we now need to focus on delivering clinically effective tools that support patients, as well as supporting our products. So the next time someone pitches yet another application, think about the principles that underpin successful execution, and always design the right solution with the end user in mind.
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