David Kerr: A bump on the road to mHealth utopia?

david_kerr_2015picA recent clinical trial’s finding that digital health technology (also known as mHealth) failed to reduce healthcare costs is raising eyebrows on this side of the Atlantic. For naysayers the results will most certainly reinforce their belief that mHealth is a fad, which distracts from the real business of medicine, and that more investment in staff is preferable to wasting time on smart new shiny things. On the other side of the argument, however, the study had major flaws: it had a small number of participants (3998), had a very short duration, and was already out of date when it started—given the rapid pace of technology development.

Where I live on the west coast of the US, only a few hours’ drive down from Silicon Valley, there is indeed a widespread belief that technology will change the future and much sooner than for previous generations. The release of new smartphone applications and wearable devices capturing a multitude of physiological measurements continues, as does the enthusiasm for the new science of big data, whose “scale, diversity, and complexity will require new architecture, techniques, algorithms, and analytics to manage it and extract value and hidden knowledge.”

However, when it comes to a revolution in healthcare, there are still unknowns that need answering: will that technology be used by the target population (not just west coast hipsters) and over a long time, and is there evidence of its success—whether that means, for example, patients taking prescribed medicines more often or a positive behavior change that reduces rates of new diabetes. For startups in mHealth, their business plans are also often not thought through enough to maintain their survival in the industry—patients nowadays think like consumers and are unlikely to be wooed by a subscription to a smartphone app for a medical condition that is often asymptomatic.

A recent New York Times book review made the potentially heretical point that the current “techno-optimism that saturates our culture, with its constant assertion that we’re in the midst of revolutionary change” is actually underwhelming. The article suggested that many so called technological innovations, including smartphones and the internet, were entirely predictable and that their impact has been much less groundbreaking than those nowadays more mundane developments, such as electricity, urban sanitation, or the internal combustion engine.

For many the reality is that despite a digital revolution, rates of common non-communicable diseases continue to rise, and the main financial burden for any healthcare system remains heavily weighted towards the beginning and end of life—a time when mHealth is likely to be especially unappealing. Healthcare’s “Internet of Things” appears to be fixated on recording changes in physiology and signs, rather than capturing the more subjective and subtle alterations in patients’ perception of existing symptoms or the onset of new ones—both of which more often herald the onset of disease.

Mobile health is in the midst of an identity crisis and health technophilia needs some therapy. However, this particular condition is not in terminal decline on the basis of this single study. It was especially noteworthy that despite the billions of venture capital dollars being poured into mHealth development, when it came to proving its value, the study investigators reported major difficulties raising sufficient funds for their project. Perhaps we need to take a new development breath and spend more time on evaluation, rather than revolution?

David Kerr wears many hats—physician; editor of Diabetes Digest; and founder of DiabetesTravel.org, a free service for travellers with diabetes, and Excarbs.com, which focuses on exercise and insulin. He is director of research and innovation at the William Sansum Diabetes Center in Santa Barbara, California, and mHealth lead for the Diabetes Technology Society (unpaid). You can follow him on Twitter (@GoDiabetesMD).

Competing interests: The author has no relevant competing interests to declare.