​The rapid rise of smartphone health care

Smartphone health care is becoming a big business, with the global venture capital community pumping almost $300 million into the sector in Q1 2015, and the likes of Apple, Google, Microsoft, and the FDA all helping to facilitate its rapid rise.

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At the beginning of May, Australian medical doctor Ash Collins launched a new app-based telehealth service called MyOnlineClinic, a platform that Collins claims gives patients a completely portable medical service.

The cloud-based service is designed to not only provide the facilities to let users book an appointment and video conference with a doctor, receive a prescription, and see pathology and radiology results; it can also receive, chart, and store vital signs data from Bluetooth-enabled devices.

The app, which has been designed for iOS and Android, draws upon Australia's existing telehealth infrastructure, but adapts it to be used with smartphones.

While the MyOnlineClinic platform is still in its pilot period, Collins hopes to launch the service generally in several markets around the world, with Asia standing out as a region ripe for such a service.

According to Collins, many of the often elderly patients in Australia who have been using the existing telemedicine services in the country via their PCs are reasonably comfortable now with online consultations, but getting them to do the same thing on a smartphone could require a substantial change in behaviour for some people.

"Changing Australian behaviour is very difficult," Collins told ZDNet. "But we haven't restricted ourselves to the Australian market. One of our main focuses is international markets. We're deploying in Thailand, for example. In terms of changing behaviour, in Asian countries, it's much easier."

While Collins' platform, which is also available as a browser-based service, might require behavioural changes in patients before it is likely to be used predominantly as a mobile app-based system, Collins harbours no doubt that such interactions facilitated by smartphones will become the norm for many medical services in the near future.

"The prediction is that by 2020, only 20 percent of medical interaction will be done in the virtual space, but with the speed of the internet and technological development, I think more than half of interaction would happen online by 2020. I expect over half of those to happen via smartphones," he said.

Collins' prediction for the increased employment of smartphone health care is also shared by some of the world's biggest technology brands, such as Apple, Google, and Microsoft.

Apple jumped on the mobile health bandwagon last year with the release of its HealthKit app developers' tool, joining a swathe of other smartphone makers embracing health-focused functionality -- and not just for consumers.

In early October 2014, the company enabled an explore function within its App Store that lets doctors search for health apps according to their medical speciality. According to iMedicalApps contributor Iltifat Husain, this was the first time that either of the mobile OS giants, Apple and Google, allowed health-care providers to search in their app stores by medical speciality.

Meanwhile, Apple's new ResearchKit, which was generally launched in April, takes the company's foray into health care one step further. It is enabling medical researchers to quickly and easily leverage resources that would usually take much longer and far more effort to obtain.

In March, researchers at Stanford University in the United States discovered to their surprise that 11,000 people had signed up for a cardiovascular study using ResearchKit, less than 24 hours after it had been released by Apple, according to a Bloomberg report.

Stanford Cardiovascular Health medical director Alan Young suggested that it would normally take a year and 50 medical centres around the country to get even 10,000 people signed up to a medical study.

With Apple and the rest of the world's mobile players establishing health and fitness credentials via apps and peripherals such as smartwatches and Bluetooth-enabled heart rate monitors, there is clearly money to be made in the burgeoning mobile health space.

Certainly, PricewaterhouseCoopers thinks so. As early as 2012, in partnership with the GSM Association, the business consulting firm conducted research forecasting that worldwide mobile health revenue would reach $23 billion by 2017 across all stakeholders, including mobile operators, device vendors, health-care providers, and content makers.

The Touching lives through mobile health report (PDF) indicated that the majority of the revenue would come from telemonitoring services, which were expected to make up 65 percent of the global market.

More recently, in February 2014, US-based market research firm Grand View Research predicted that the global market for mobile health was expected to reach $49 billion by 2020, again with monitoring services set to remain the dominant and fastest-growing market segment. In 2012, monitoring services claimed 63 percent of market share, according to Grand View Research.

This contrasts with a study released in July by UK-based business intelligence firm Visiongain, which forecast that the mobile health market would reach $6.7 billion by the end of 2014, suggesting that austerity measures in global markets had forced health departments around the world to find more cost-effective methods of operation.

While Apple and Google have created mobile operating systems enabling health-care technology providers to utilise mobile devices for a range of medical-related purposes, BlackBerry is also plunging into the health-care technology space head first.

In April last year, the Canadian smartphone manufacturer bought a stake directly in cloud health-care IT company NantHealth, which wants to use BlackBerry's mobile technology to distribute its integrated clinical systems platform via mobile devices.

"BlackBerry's expertise is incredibly valuable to NantHealth as we expand our platform and make it available for wider deployment through a secure mobile device," said NantHealth's founder Soon-Shiong at the time. "The future of the health-care industry requires the ability to share information securely and quickly, whether device to device or doctor to doctor, anywhere and at any time.

"Providing actionable information at the time of need will significantly improve the efficiency of health care and, more importantly, the efficacy of care for the patient," he said.

From the perspective of BlackBerry CEO and executive chairman John Chen, the company's exploration of mobility in health care is nothing short of vital to its future success.

"BlackBerry's capabilities align closely with NantHealth's, and this investment represents the type of forward-looking opportunities that are vital to our future," said Chen. "Health care is one of the key industries in which we have unique advantages, and this investment reflects our commitment to maximise our opportunities there."

It seems that all the big mobility players are making moves into smartphone health care, with Microsoft also recognising the importance of mobile phone-based medical services. In August last year, it announced the winners of its 2014 Imagine Cup competition, a program aimed at promoting student technologists, developers, and aspiring entrepreneurs from around the world.

The winning "Imagine Cup World Champions" of the year's competition -- part of Microsoft's YouthSpark initiative -- were two final year medical students from Melbourne's Monash University, Jennifer Tang and Jarrel Seah.

The duo built a smartphone app designed to help users screen for anaemia. The app employs a smartphone camera to take a snap of a person's eye -- specifically, the tissue just inside the lip of the lower eyelid.

It takes a lot of the expense, time, and guesswork out of establishing a diagnosis using traditional channels -- particularly for those in developing countries where health-care facilities may be hard to get to.

The user can then compare the image to a colour chart using an algorithm based on the correlation between conjunctival pallor and the severity of anaemia, determining whether the subject is suffering from the affliction.

Although the app is still in development, with Microsoft's $50,000 prize money poised to speed the way for its commercial release, the win highlights the burgeoning use of smartphones in health care.

Given the global prevalence of anaemia -- the World Health Organisation estimates that up to 2 billion people globally are affected by it -- along with the ubiquity of smartphones, Microsoft co-founder Bill Gates thinks that the Eyenaemia team could genuinely leverage the relatively simple technology involved in order to affect a substantial impact in global health care.

"It's exciting to see bright young people like Jennifer and Jarrel applying their talents to problems that disproportionately affect the poor," said Gates on his Gates Notes blog site, after meeting with the two university students in September last year at his office in Seattle.

"As I told them, I could see a future version of Eyenaemia being used in developing countries, especially with pregnant women, since anaemia contributes to nearly 20 percent of deaths during pregnancy," he said.

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Gates noted in his post that the Eyenaemia team's idea is part of a promising trend that is seeing broadly accessible mobile technology being employed to assist in the diagnosis, and even the treatment, of widespread medical conditions.

"Researchers are studying whether cell phones can reduce the need for lab tests by detecting pneumonia, HIV, TB, and other conditions," he said.

In fact, one of the world's biggest killers, heart disease, is getting looked at by Australia's Commonwealth Scientific and Industrial Research Organisation (CSIRO), which has developed a smartphone app aimed at keeping people recovering from heart attacks on the path to better health.

The app features health and exercise monitoring tools, delivers motivational materials through text messages, and contains multimedia that educates patients about disease symptoms and management.

The CSIRO said it found through a clinical trial that cardiac patients who undertook rehabilitation in their own homes via the smartphone app were almost 30 percent more likely to take part in their rehab program than those who had to travel to an outpatient clinic or centre.

"The smartphone app offers another choice, overcoming one of the key barriers to patient participation and recovery," said the CSIRO's Dr Mohan Karunanithi. "By integrating rehab with a patient's daily life, they are more likely to complete the program and make their new healthy lifestyle permanent."

Perhaps the most convincing argument for the rising prevalence and broadening acceptance of smartphone health care is the increasing amount of money that investors are willing to pump into such technology.

According to research by Mercom Capital Group, mobile health care garnered $282 million in venture capital funding globally in the 2015 first quarter alone, with mobile health companies accounting for 36 percent of all funding into health-care information technology and digital health companies for the period.

(Image: Mercom Capital Group)

Mercom Capital Group's Q1 2015 Healthcare IT Funding and M&A Report revealed that although funding levels fell across all technology groups in the first quarter, mobile health was the only area where funding levels did not decline significantly compared to the previous quarter, with a total of 112 investors participating in mobile health funding rounds in the three-month period.

Within mobile health, smartphone app developers captured the largest share of investment, claiming $220 million in 35 funding deals, followed by wearable sensor makers, which claimed $42 million.

In fact, Mercom Capital Group's figures showed that mobile health companies have received more than $2 billion in over 500 deals since 2010, while mobile health apps, in particular, have received about $900 million in more than 280 deals since 2010.

To put this into perspective, PricewaterhouseCoopers' National Venture Capital Association MoneyTree Report, based on data from Thomson Reuters, estimated that venture capitalists invested $13.4 billion in 1,020 deals in the first quarter of 2015, with quarterly venture capital investment declining by 10 percent in terms of dollars compared to Q4 2014.

Meanwhile, the United States' Food and Drug Administration (FDA) is working to accommodate the influx of mobile health-care technology with its final guidance (PDF) on mobile medical apps, released in February, revealing a light, hands-off approach to regulating most mobile health apps.

According to the guidance, the FDA will apply its regulatory oversight only to those mobile apps that are considered to be medical devices, where the functionality could pose a risk to a patient's safety if the mobile app were to not function as intended.

Like the world's venture capital community, along with Apple, Google, and Microsoft, the FDA has welcomed and is actively encouraging the development of mobile-based health applications.

"The widespread adoption and use of mobile technologies is opening new and innovative ways to improve health and health-care delivery," the FDA said on its website. "The FDA encourages the development of mobile medical apps that improve health care and provide consumers and health-care professionals with valuable health information.

"Mobile applications can help people manage their own health and wellness, promote healthy living, and gain access to useful information when and where they need it," it said.

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