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The Role of an Analyst Firm

May 17, 2012 by John

The 2012 HIE Report was released last week and sales have been brisk – thank you. But in spite of those brisk sales and even during the process of creating that seminal report on the Health Information Exchange market, there are times when it seems that a significant proportion of the market does not understand the role of an analyst firm.

For example, prior to publishing the report, we allowed vendors to review their profile for fact checking. They could also refute some of our findings but we were under no obligation to comply. One vendor profiled in the HIE Market Report tried to have us completely change their profile write-up (actually they rewrote their profile for us and submitted it). Their write-up was an abomination – it sounded more like something in a conference brochure under list of sponsors than an objective review. Needless to say we rejected their request outright and threatened to throw them out of the report altogether. They quickly complied to our original request. Then there was another vendor who after purchasing the report, could not believe that we did not accept all the changes they asked for and demanded that we “correct” their profile. We politely declined.

The reminders below hope to set the record straight.

An analyst firm strives to provide an objective, informed analysis of the market(s) it studies.
We are not a Public Relations firm, we are not a magazine or trade journal. We are a research firm that conducts in-depth research to determine how a market will develop, how well vendors within a given market are serving current and future market needs and what may be some challenges as well as successes in the adoption of a given technology and best practices for adoption. We strive not to play favorites with Any Stakeholders in a given market, be they users of technology, providers of such or even regulators/government agencies. To us, all are fair game for fame and shame.

So vendors, when we do a report such as the recent HIE Market Report and we ask you to fact check your profile for factual accuracy, please try to keep your comments limited to such. And when you do believe it necessary to refute one of our findings, rest assured, we will take it under advisement but we are under no obligation to agree with you.

An analyst firm is a business- this is what we do for a living.
We are like any other business, we work hard and for that hard work, we expect and receive compensation. So why is it that some organizations approach us thinking that we’ll just give them a report for free? Seriously folks, do you have any idea what kind of work goes into producing a 100+ page report such as the HIE report? That report took months of work, countless interviews, a lot of hard thinking. One could liken it to doing a graduate level thesis – many have said as much. So it is insulting when an organization comes to us, typically with far, far greater resources than this small analyst firm, and asks for a free copy. You put me in a bad mood when you do that and that is not a good thing.

Then there are those that we may interview as part of the primary research stage of a report who come back and say: Aren’t we going to get a free copy – to which we typically answer; No.

Trust me, we really really do appreciate your input during the interview or your response to our questionnaire. Your thoughts and experiences are invaluable to us. In turn, hopefully over the course of the interview we were able to provide you with some valuable feedback that we may have picked up from interviews previous to yours – in a sense, that is our payment back to you. But please remember, that interview we had took maybe 30-45 minutes out of your day. For a report we will interview many more just like you, we’ll also do a significant amount of secondary research and then digest it all and ultimately produce a cogent report. For a small report, we’ll invest 100 or more hours of hard work by highly skilled, extremely talented analysts. As mentioned before, a large report is many times that amount. So please, if you want us to succeed, help us to stay afloat and allow us to make a living at this by ponying up the modest fees we charge for what are some of the best research reports being produced for this market.

In closing, just want all to know that we here at Chilmark Research are extremely passionate about wanting to help the healthcare industry move forward by successfully adopting and using healthcare IT. Every one of us believes that there is a huge untapped potential to truly improve the quality of care delivered through the effective use of IT. It is our hope that through our published research reports, subscription, and consulting services, we will provide objective analysis of what is a very critical market for the health of our nation and others.

Posted in HIE | 2 Comments »

At Last, It’s Here: 2012 HIE Market Report

May 10, 2012 by John

This morning we announced the release of our latest report: 2012 HIE Market Report: Analysis and Trends of the Health information Exchange Market. As we found in last year’s report, the HIE Market and the vendors that serve it continues to be a very dynamic.

In little over a year we have seen several vendors exit the market, several others enter and the acquisitions of Carefx by Harris and MobileMD by Siemens. We also saw Microsoft pull completely out of the clinical market by turning over all its HIT assets (except HealthVault) to the new joint venture with GE, Caradigm.

Yet in spite of all this turmoil, the market continues to see spectacular growth in excess of 40% in 2011. The big news with all this growth is that only a small portion of it is coming via the HITECH Act and the various statewide HIE contracts that were awarded. No, the big market that literally all HIE vendors are now targeting is the private, “enterprise” market. Healthcare organizations (HCO) of all sizes are now looking to deploy HIE technology to not only meet Meaningful Use requirements, but respond to the pending changes in reimbursement, moving from a fee for service model to one that is based on outcomes.

To be successful under these new payment models, HCOs must better manage operations and the complete care cycle of a patient across care settings. In a community of heterogeneous EHRs, HCOs are adopting HIE technology at an accelerated rate to unlock the data silos of EHRs across the community to enable higher quality of care.

Arguably, the 2012 HIE Market Report’s most significant finding is…

The healthcare sector is rapidly moving to the post-EHR era. The value of patient data is not in the data silos of EHRs but in the network that an HIE supports.

The report provides the most comprehensive overview of the market and what are the significant trends that are driving this market forward. The report also provides a deep dive review of 22 leading HIE vendors, including product capability assessment and market presence. This information, compiled through in-depth research and countless interviews, provides all HIE stakeholders with the most accurate view of the market today.

It is our sincere hope that the information contained in this report will contribute to furthering the success of HIE deployments in the future as we strongly believe that only through health information exchange (the verb) can we improve the quality of health delivered within a community and ultimately, the nation.

Posted in ACO, CCD, CDA, Cloud Computing, EHR, HealthVault, HIE, HIT, HL 7, Microsoft, PCMH, standards | 1 Comment »

Hunkered Down on HIE

May 2, 2012 by John

Been pretty quiet here on the Chilmark Research site for the simple reason – we are doing one heck of a lot of research which you’ll be seeing the results of in the not so distant future.

Primary among those research efforts is the update to the 2010 HIE Market Report. The last report was extremely successful and highly regarded among those in the know. For example, a CEO from one of the top HIE vendors told us:

By far, Chilmark Research has done the best research on the increasingly critical HIE market – no one else has come close to providing the in-depth research that is contained in the 2010 HIE Market Report.

And it is not just the HIE vendors who appreciated the report as we sold quite a few to healthcare organizations who have been using the report to assist them in their strategic decisions and ultimately vendor selection process.

But the HIE market is evolving quite quickly and thus the need to provide a refresh of the report. For example, of the 21 vendors profiled in the last report, 7 will not show up in the next edition. Even with that change, there are more entrants into what has become a lucrative market (albeit still relatively small) and in the 2012 report we will have in-depth profiles of 22 HIE vendors.

To give you some brief insight into the report, following is the intro to Chapter 3.

“The more things change, the more they stay the same.”

This French proverb accurately characterizes the state of the HIE market and the vendors who serve it. In last year’s report we commented on how the market was becoming increasingly crowded and competitive. We profiled 21 vendors in that report and a third of them did not make it into this report. Some exited the market (ICW, MedPlus, MEDSEEK, Misys, PatientKeeper, Telus), others acquired (Carefx and MobileMD) and then there is the folding of the HIE assets of GE and Microsoft into the new entity Caradigm. This year we have 22 vendors profiled including: Caradigm and Microsoft (still difficult to know what will become of their joint assets, but we provide some guidance), Harris, who had acquired Carefx, Siemens, who picked up MobileMD and some new entrants including 4medica, Certify Data Systems, the young start-up GSI Health and HealthUnity. We even broke from tradition, if you can call one year a tradition, and profiled one of the leading EHR vendors, Cerner, who contrary to prevailing EHR vendor wisdom, or at least strategy, is creating an open HIE platform.

The market is as competitive as ever with a monumental shift towards the enterprise market. Some vendors have been serving this market all along, others, whose focus has been the public market are to varying degrees of success making the transition to the enterprise market. But despite this overwhelming shift to the enterprise market, the HIE market remains no less mature than it was last year. The solutions on offer vary significantly and in our interviews with vendors, consultants and end users we found a market that really has not defined a clear set of requirements for the HIE. There is always the ubiquitous desire to facilitate orders, referrals and distribution of results but beyond that, the needs of a given HCO can vary greatly, which has subsequently led to continued market confusion as to what an HIE is and is not.

With this report, Chilmark Research once again has applied its deep research methodology (see Appendix B) to provide a clearer picture of where this market and the vendors who serve it are today and where it is heading. The profiles contained in this report are not meant to provide an exhaustive analysis of each vendor’s solution and business strategy. Rather, their purpose is to provide a concise overview of leading HIE solutions in the market today, their strengths and weaknesses, what sector(s) of the market that the vendor has had particular success in and provide insight as to an HIE vendor’s future direction. Armed with this information, the reader will gain a clear picture of currently available solutions enabling one to create a short-list of those worthy of more in-depth internal review and follow-up for their own HIE initiatives.

In our opinion, we are slowly but surely beginning to enter the post-EHR era. The U.S., federal government’s push for physician and hospital adoption of EHRs, via the HITECH Act, appears to be having the intended affect. The recent Robert Wood Johnson Foundation study published in the April 2012 edition of Health Affairs has physician adoption and use of EHRs now at 57 percent. But the value of those electronic patient records is not in the data silo of a given EHR, but in how patient data can be aggregated and used to facilitate care coordination across care settings and subsequently improve the quality of care a patient receives. This is the province of the HIE and where the real value of electronically recording a patient’s health will reside, not in the silo of the EHR, but in the network of the HIE.

Please bear with us and our lack of frequent posts. We are working hard here at Chilmark Research, which can make it a challenge to find that extra bit of time to write for the public. Once the HIE Report is released (next week), we should be getting back to a more regular schedule of posts to this website. Stay Tuned.

Posted in EHR, HIE, Microsoft | Tagged | 1 Comment »

mHealth: There When You Need It

April 18, 2012 by John

A couple of weeks back, Neil Versal wrote an interesting article for mobihealthnews on mHealth App development and adoption trends. While agreeing with some of the thesis of his argument, that many Apps have little relevance to the broader populace and seem to be more focused on the Quantified Self geeks, there are a couple of points he made that give a false impression of what our research and personal experience have found in this emerging market.

First, there was the argument that those who may be in the greatest need of using an mHealth App to manage a chronic condition may not have the wherewithal to identify and use an App. This is true for pretty much the entire population and not only those with a chronic disease. Our research for the upcoming report, mHealth for Provider-Patient Engagement, found a market where most mHealth App developers struggle to get users, particularly those with chronic illnesses, to continuously use an App.

Where an mHealth App has seen success is when it becomes a critical component of a care management process and a patient receives periodic feedback from a clinician. Such was the case in an urban, predominantly poor neighborhood in Washington D.C. wherein diabetic patients actively engaged in the use of an App to record their glucose readings for they were getting feedback from clinicians. Therefore, our thesis is that the issue is not whether the App has been designed for a given populace but its potential use (success) rests more with how and more importantly who deploys the App. The vast majority of the populace needs that clinician guidance and support in use of an App to manage a chronic condition – it will not work in a vacuum, it must become a part of the care management process.

However, in our conversations with a number of physicians we found a common theme that most are struggling to figure out how enabling their chronic disease patients with such tools and follow-on monitoring will fit into their existing workflow. We see this as code for: “How will I be reimbursed for this effort?”

Good question. The impending changes in reimbursement and subsequent move towards capitation may provide the path forward without the requisite CPT codes. There remains the challenge of how EHRs may accept such patient entered data from an mHealth App as today we do not know of any that can support this capability but that is a topic for another post. The important point we wish to make is that mHealth can play a role an important role in the care process, it just needs a advocate to drive its use, that advocate being a clinician/care management leader to help guide and support he patient.

The other issue we wish to raise is the oft-cited numbers that are thrown about of how people download various mHealth Apps and then rarely, if ever use them.

All of us who have a smartphone likely have a few Apps that we have maybe used once or twice and have forgotten about or tossed them for they did not appeal to us. But that does not necessarily mean lack of use equates to lack of value. Some Apps are not meant to be used frequently, iTriage is one of them, but I sure am glad I have it on my phone.

Now I have been a fan of iTriage from its early founding and was happy to hear that they found a willing suitor in Aetna when they were acquired last year. Their solution, while a little intimidating at times, is one of the better mHealth Apps out there in doing self-diagnosis, which is what I had the opportunity to do last month when visitng my parents.

Late one evening (actually about 3am) I awoke not feeling quite right. Next day I learned that I was not the only one as both my sister-in-law and father where also feeling under the weather. After a couple of days, my sister-in-law and I began to feel better. Such was not the case for my father. After some exploratory questions, came to the conclusion that we all suffered from some form of food poisoning. As my father’s health declined I asked him more specific questions about his symptoms. He was suffering from loose stools, weakness, fever and painful urination (sure sign of UTI). Using the iTriage App I triaged my father eventually settling on the likely culprit: E. Coli poisoning.

Knowing this was a very nasty disease (yes, it kills), you don’t waste time getting treatment. Took father to the local ER where they immediately put him on an intravenous feed of some pretty strong antibiotics and to hydrate him. The attending physician took a culture and stated they would have an answer  in some 36 hrs as to what was at the root of his symptoms. Sure enough, when the physician got back to us he confirmed that it was indeed E. Coli poisoning.

Prior to this event, when was the last time I opened up the iTriage App? Really can’t recall but it was likely to demo it to someone and probably more than six months prior. But this is not an App designed to be opened and used frequently, it is designed to be used when you need it. And that is part of the problem with a lot of these broad pronouncements about the use, or lack thereof, of mHealth Apps: some of these Apps simply aren’t meant to be used frequently but you’re sure glad you have them when you need them. The mHealth App market is far more nuanced and most do not dig deep enough prior to making broad pronouncements instead painting the whole sector with one stroke of the brush which is a disservice to this emerging sector.

As to my father, he has made a full recovery and one of the first things he asked me when he got home from the hospital was: What was that App you used? Can I put it on our iPad? Done. Now if only iTriage would make an iPad version of their App then my father, and maybe others would be even more delighted.

Posted in consumer health, mHealth, policy | Tagged , , | 12 Comments »

mHealth Apps & Patient Engagement – Moving Beyond Transactions

April 12, 2012 by John

Despite a constant buzz around the idea of using mobile technologies for patient engagement, the depth and breadth of these solutions has remained consistently thin and frankly dated. Today, healthcare organizations who are adopting and deploying engagement solutions are focusing these efforts on marketing/patient retention (e.g., simplifying transactional processes such as appointment scheduling, prescription refills, etc., online access to lab results & records) and accelerating payments (online bill-pay). Despite all the talk about using mHealth for care provisioning, our research for the upcoming report that will be released later this month, mHealth Adoption Trends for Provider-Patient Engagement, finds a market that is still in an early, embryonic stage of development.

So why the disconnect between the hype of mHealth for care provisioning and reality? Of the many potential reasons, there are two that are dominant: a lack of solutions with proven clinical efficacy and few financial incentives to drive adoption.

While there is little argument that increasing the interaction between a care team and their patients is a good thing, the best means for accomplishing this feat are still unclear. A year ago, Group Health published results from an internal study testing just what impact this increased communication may have on outcomes and patient satisfaction. What they found comes as no surprise to us as trusting advocates of patient engagement. In this study, Group Health provided patients suffering from depression a relatively simplistic form of engagement wherein patients were able to communicate with their care team through the EMR portal. The results, impressive: antidepressant medication adherence increased 33%, overall depression scores decreased, and satisfaction with treatment improved 61%.

While this study fostered communication via a computer/portal, it is not too big a stretch to see such communication readily migrate to a smartphone modality wherein a patient would not be tethered to a computer and could communicate from virtually any location. But that is part of the problem. This study, which was published only last year, uses a relatively old model of communication (portal), which has been used to varying degrees in the healthcare sector for years. And if there is a paucity of clinical evidence for the efficacy of portals, for mHealth Apps it will approximate a vacuum. Sure, basic logic tells you that increasing patient-provider communication should lead to better outcomes, but the healthcare community can be a bit odd at times in its demands for stacks and stacks of clear evidence before it is willing to take the plunge, either providers adopting such models of care and more importantly, payers will to reimburse for such models of care.

Therein lies the crux of the problem – reimbursement.

Now we don’t mean to be crass but physicians are like the rest of us. We are dedicated to our work, we work hard and at the end of the day we receive compensation for those efforts. For physicians, who seem to be perpetually overbooked, their time is particularly precious and adding another activity (patient communication outside of the exam room) without compensation, is a non-starter. There is also the issue of how does one bring mHealth data into an existing HIS let alone into the daily workflow of a physician is not without costs. Who will shoulder those costs when there are few if any reimbursement models in place to support such? This idea scares away investors and many innovators.

And that creates a Catch-22. Without clear reimbursement models there is little incentive to support the adoption of mHealth for care provisioning and therefore, little financial upside for innovators and subsequently creating an unstable market. To date, no mHealth engagement solution for care provisioning has been able to gain enough traction (relates back to financial) in the market to make a significant impact and thus are perceived as risky partners by healthcare organizations. There is ample proof for such concern as there remains a tremendous amount of churn in the mHealth market. For example, two startups in the space were recently ‘acquired’ by other startups: Pipette by Ginger.io and WellApps by Medivo (both in the same week no less!), yet far more start-ups simply fold-up their tents and move on. But without having healthcare organizations willing to take a chance, how are these young companies going to demonstrate clinical efficacy. Yes, Catch-22 indeed.

But all is not lost.

As we’ve written before, reimbursement models are migrating away from the traditional fee for service model and one that is structured around value-based outcomes. These new reimbursement models will in-turn lead to more capitated models of care where healthcare organizations will take on greater responsibility for managing patient risk. To effectively and efficiently do so, these organizations will need to create new models and processes of care delivery that extend beyond the confines of the exam room and actively engage the patient as a critical member of the care team (where they are capable of course). This has the potential to create a “Golden Age” for such new technologies as mHealth. But like all new market opportunities, a big question is timing – just when will the inflection point occur that will truly launch this market. In that forthcoming report we mentioned previously, we intend to provide some insight into that question as well.

Stay Tuned.

Posted in ACO, consumer health, EHR, EMR, mHealth, PCMH, telehealth, telemedicine | Tagged , , | 4 Comments »

Hurdles to Accessing One’s PHI

March 26, 2012 by John

What is a fair price to charge a consumer to provide them a copy of their records? That is a question I’ve been pondering since a friend of mine showed me the bill from the local Steward IDN which is owned by private equity fund, Cerebus.

My friend is switching doctors due to a change by her employer in health plans. As a result, she requested a copy of her records to bring with here to her new physician. Seems like a pretty simple, straight-forward request. Steward was more than happy to provide those 10 pages of records and following is the cost breakdown they wished to charge her:

Clerical fee: $18.04
Cost/pg: $0.61
Mailing cost: $1.16

Total Cost:  $25.30

Two dollars and fifty cents a page – Outrageous!

When I asked for a full copy of my pet’s records, about 20pgs, the Vet was more than happy to oblige, for free. When I asked for  full copy of my car repair records (5yrs worth) as I was selling the car, my local mechanic was more than happy to oblige, again for free. So why is that when one asks for a copy of their medical records, which frankly they already paid for in their office visit charges, a company like Cerebus/Steward feels they have the right to charge such an exorbitant sum? Creating such hurdles to a patient’s ability to access their own personal health information (PHI) does nothing to improve healthcare delivery. Its time to put an end to such charges once and for all.

Sad thing about this whole story though is that under Massachusetts statute, Steward is allowed to charge up to $25.00. They discounted the bill $0.30 and lowered the bill to $25.00  Needless to say, I advised my friend to ignore the bill.

Posted in consumer health, PHR, policy | 14 Comments »

300 Million Asthmatics and the Future of Respiratory Monitoring

March 15, 2012 by Cora Sharma

A few years ago my daughter began developing asthma-like symptoms brought on by reactions to pollen, cat dander, and other triggers.  I can still remember the panic I felt in my chest the first time she ran to me wheezing and crying that she couldn’t breathe.  Thankfully, her wheezing episodes are mild, have decreased over time, and she never received the ‘Asthma’ diagnosis.

Serious health events such as a severe asthma attack produce such a strong, albeit negative demand for health care that the patient often winds up in the ER.  In this respect, asthma is unlike other chronic conditions with more deferred consequences (e.g. ‘diabesity’).

Clay Christensen wrote about this phenomenon in his book, “The Innovator’s Prescription”. Despite the significant behavioral change required (carrying inhalers, taking medication, tracking symptoms, following Asthma Action Plans), asthmatics and their caregivers have good reason to be engaged and compliant with treatment – immediate consequences (relief) to severe attack drive behavioral change (see figure).

A Growing Problem [a Growing Market]

In the US, the CDC reports that 1 in 12 people have asthma. There has also been an unexplained increase in rates among African American children – an almost 50% increase in the past decade.

[Note: Why are asthma rates soaring? Possible causes are not fully understood within the scientific community.  The ‘hygiene hypothesis’ blames ultra-clean western societies that suppress the natural development of the immune system. Other research refutes the hygiene hypothesis and points to western lifestyles/obesity as culprits. There have also been more Asthma diagnoses due to improvement in diagnostic methods over the last few decades.  Further reading on possible causes can be found at Scientific American.]

Given that asthma is a severe, chronic disease affecting a large percentage of the population, it is easy to make the case for investment in asthma-related products.  The American Academy of Allergy Asthma and Immunology (AAAAI) estimates 300 million people worldwide are currently affected – almost 5% of the population, with incidence rates on the rise.

Segmenting the US asthma market by age provides a model to understand key engagement models:

  • Asthma Moms are continually engaged in their child’s care.  They oftentimes take information, tips, and questions to the blogosphere.
  •  Adolescents manage their condition with Mom’s guidance, though they are not as vigilant in adhering to treatment plans.
  • Adult Asthmatics no longer have Mom looking over their shoulder, but are nonetheless motivated to keep symptoms at bay.

Devices to Monitor & Prevent Asthma Attacks

When my daughter was having frequent wheezing episodes, I would have found piece of mind in a technology that could detect and predict when she was going to have an attack… or at least warn of nearby environmental triggers.

Taking a quick look at the Apple App Store, there are almost 100 asthma-related Apps available.  These range from free educational Apps to diary-style Apps that require data entry to track peak flow and symptoms. Do Asthma Moms, especially those whose children have low-severity asthma, really have the time and motivation to write asthma diaries? Not to mention adolescents and adult asthmatics?

One company, iSonea, is building technologies to avoid this tedious (and possibly erroneous) data entry.  iSonea is currently making a big bet that consumer and provider appetite for asthma monitoring technologies will grow in the coming years.

iSonea

iSonea is a recently restructured and re-branded company that has been developing proprietary acoustic respiratory monitoring (ARM) devices for years. These devices are equipped with sensors and software that detect acoustic markers such as wheezes, rhonchi and cough.

Note: iSonea was formerly KarmelSonix, a medical device company consisting of a joint partnership between Israel and Australia.

I had the opportunity to speak with the new CEO of iSonea, Michael Thomas, who sees iSonea transitioning from a device-centric company to one that is software-based (guarding the castle with already-acquired IP).  In a future filled with Smartphones,   iSonea will try to reach those 300 million asthma patients through mobile Apps rather than through proprietary, expensive devices.

Imaging breathing into your Smartphone, which will analyze and quantify your wheezing in the audio.   Or, imagine your Smartphone setting off an alarm as it detects nearby environmental triggers, crowd-sourced in almost real time by nearby asthmatics.

iSonea is looking at the following revenue streams:

  • App downloads and upgrades. The first version of their AsthmaSense™ App will be released in 2012 with a subscription service.
  • Data. Anonymized patient data will be up for sale (iSonea is partnering with Qualcomm Life to get data out of devices and into the cloud). If a statistically significant number of asthmatics use the iSonea App, this data becomes valuable to a host of buyers.
  • Ads. Products and services could be marketed to the user based on usage patterns.  For example, coupons for therapy drugs could be displayed, etc. (This remains a sensitive area – iSonea needs to find the right amount and types of ads, if any)

Emerging Technologies to Engage Consumers

Another topic I discussed with Mr. Thomas and his VP of Marketing, Michael Cheney,  was the issue of how to make the Smartphone App ‘sticky’, or compelling to use.  All of us mobile-addicted folks know the feeling -  when out of the blue your brain sends you a signal to take your phone out of your pocket and start slinging angry birds.

Will the healthcare space tolerate consumer engagement strategies that have shown success elsewhere?   For example, can we social-ify and game-ify healthcare apps and expect higher user engagement?  I remain hopeful that, treading carefully, healthcare apps that use social media and gamification strategies can indeed achieve higher engagement rates, especially among  digital natives (youths).   App developers are already starting to wade into these waters. One interesting example is the DiaPETic App, where users are rewarded via their pet avatar for sticking to a glucose testing plan, much like the popular children’s online game, webkinz.

Who knows, maybe iSonea’s App will indeed spread virally as users encourage their friends to start “playing along” with them as they manage their symptoms and avoid attacks. Engaging adolescents in this manner would especially be appealing to Asthma Moms, who could do with a little less stress in their lives. But iSonea will need to take their existing mHealth App a bit farther than they have to date to enable such viral attraction among adolescents.

Anyone Else Out There?

There is a surprising dearth of competitors to iSonea, which means that either iSonea is particularly early and/or the space is an especially risky one – with no worn paths to tread.

One company that may morph into a company more like iSonea is Asthmapolis.

Asthmapolis is based out of Madison, Wisconsin and founded by Dr David Van Sickle, formerly of the CDC. They manufacture GPS-enabled devices that attach to inhalers, tracking when and where an asthma puff was needed. Recently, Asthmapolis announced a partnership with Dignity Health (formerly Catholic Healthcare West) where doctors will monitor patients’ inhaler use via a mobile App.

Like iSonea,  Asthmapolis will make asthma data available to patients and clinicians, and sell it to public health agencies and scientists.  Asthmapolis is also developing mobile Apps to receive and display this data, but is not currently (or publicly mentioning) any intent to move beyond GPS-inhalers and towards Smartphone-based asthma monitoring, which is a little surprising in this day and age when just about anyone that is considering a mobile App, typically ahas a smartphone strategy associated with it.

Market Analysis

How will iSonea (and Asthmapolis) defend their strategic positions if the market revs up and new competitors race to the honeypot? Will iSonea’s IP be strong enough? Will they have enough cash to hire good patent infringement lawyers?

Or, maybe this market will really be about the data and network effects.  The service to garner the most momentum early on will become exponentially more valuable until the market tips.  I wonder if Dr Van Sickle’s relationships with the CDC and medical researchers are strong enough so he has first dibs on selling data for population health management.

It will also be interesting to see when and where pharma will step in here (GlaxoSmithKline comes to mind).  Better daily monitoring leads to improved medication compliance, which will help fill pharma coffers.  I’m sure iSonea/Asthmapolis are already entertaining numerous solicitations for partnerships from Big Pharma.

Towards the Utopia of ACOs

The improved monitoring and prediction of asthma attacks definitely has a role to play in a post fee-for-service, ACO/PCMH world.  No doubt these technologies will help shift the patient’s perceived role from passive recipient of care to a more empowered consumer of health, resulting in less ER visits, less readmissions, and ultimately lowered healthcare costs. The social/crowd sourcing component may prove to be especially valuable – with asthma sufferers steering clear of various dangerous locales where several “attacks” occurred. There is, of course the whole privacy debate and clearly, patients should be given an option as to whether or not they wish to have their data shared. More than likely, most will choose to share their anonymized data, but that should be their choice and not that of the vendor of such solutions.

Of course there is no guarantee that consumers will adopt these technologies en masse. Will this be a technology that consumers ‘pull’ rather than it being pushed on them by providers? Will they adopt without a physician’s order or feedback and without FDA approval? One remaining issue is how to monitor children who can’t be trusted to carry a smartphone – either they need to wear some form of (expensive) proprietary device or then again mobile platforms such as the Apple iTouch with a simple data plan may fill this gap.

On a personal level, I would nevertheless like to see asthma monitoring stand out as a poster child for remote monitoring success.  If we can figure out a way to engage Asthma Moms, adolescents (with Social/Gamification strategies), and adult sufferers, then moving on to other chronic conditions on Dr. Christenson’s 2×2 matrix will begin to look more achievable.

Just this morning my daughter told me that she had trouble breathing last night. I look forward to the day when instead of me learning of her symptoms after-the-fact, a phone can wake me up in the middle of the night to warn me to check on her immediately.

Posted in ACO, consumer health, mHealth, PCMH, Privacy | Tagged , , , | 5 Comments »

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