Washington, DC is pretty nice this week given that (a) it was a bit chilly and windy on Sunday but nicer today, and (b) it’s getting dark really early now with the time change (that’s not just Washington’s problem, but since I was here on the day of the time change, I’m blaming them). I like the city, to be honest, even though I loathe the politicians, lobbyists, lawyers, and federal contractors that crawl all over it.
I’m staying in the Grand Hyatt Washington, which hurts a bit less now that I’ve seen it than when I first saw that I would be paying $181 per night out of my pocket. It’s a really nice hotel, two blocks from the White House in Penn Quarter, just down from the main entrance to Chinatown and Verizon Center. It’s also close to lots of funky restaurants, which is a plus. Even the $30 per day self-park fee didn’t seem so bad once I saw what parking cost at the nearby open surface lots. It’s just a couple of blocks from the convention center, an easy walk across a parking lot and up one street.
A friend met me here Sunday, so we took a nice stroll by the White House and down the mall to the Capitol. I took her to Clyde’s of Gallery Place just down the street from the hotel for dinner, which is was what I modestly expected, but with low happy hour prices and a clubby atmosphere that made it quite nice — the $6 empanadas and mussels were good, the $2 PBRs were cold, and the pumpkin bread pudding was pleasantly fall-ish. If you’re looking for someplace cheap and unchallenging near the Convention Center, it’s a safe walk and it feels nicer than the prices would suggest.
About the conference: it’s rather the anti-HIMSS, which I’ll explain as follows. Suppose you really like Las Vegas, with the noise, the glitz, the fakery, the conniving thieves at every turn, and the general sense that lots of people there are expending their pent-up immorality a safe distance from home where nobody knows them. That’s HIMSS.
mHealth Summit has 2,400 attendees (less than a tenth of the HIMSS crowd), most of whom seem to be academics, global health people, federal workers, and people from other countries that are way ahead of us in mHealth (and that’s quite a lot of countries). Vendor presence is minimal. Many of the attendees are young and idealistic, trying to solve big world problems (hunger, infectious disease, etc.) instead of landing their dream job working for a vendor and walking around self-importantly with smart phone in one hand and a mirror in the other. It is, therefore, quite un-HIMSS like – serious people getting serious education mostly working for noble causes underwritten by government money.
Here’s the interesting part: as non-commercial as it is, you might not like it. I felt way out of my comfort zone not seeing the same faces, the neon sprawl of the exhibit hall, and the presenters claiming they had finally reached healthcare Nirvana just by implementing version 26.2 of some vendor’s 1980s clinical system. I recalled that old National Lampoon story about two guys who found an alternate universe version of Las Vegas where the slots paid out freely and the hookers and drunks were absent, but all they could think of was going back to the real, gritty, sleazy Vegas. That’s how I felt today – I kind of missed the debauchery and shallowness.
Logistically, everything was mostly very well done. This was a long day, with the first session starting at 9:30 a.m. and the last one ending at 6:30 p.m. (without those big scheduling blocks that HIMSS leaves open to force you to the exhibit hall – you had to really dig to even tell when the exhibit hall was open). Lunch was scheduled for an hour, but somehow the planners slipped big-time in offering what was optimistically described as, “Lunch On your Own, concessions stands will be available.” Make that “stand” in the singular: 2,400 attendees were cut loose simultaneously from the one and only keynote, only to find ONE single-line concession stand from which to buy $9 salads and $7 sandwiches. It looked like starving refugees threatening to overwhelm a UN aid truck, to use a global analogy. The line was huge, even at the end of the scheduled hour, and people were still trying to get food well into the next session. The convention center had several signs indicating that food was available elsewhere, but I looked all over the building and there was none. Somebody really goofed. I could have quit my hospital job if I’d had a hot dog cart on the sidewalk just below the window where the line ran.
It was clear from the beginning that this conference was thinking bigger than HIMSS, which fixates on vendors and in-hospital productivity applications to the exclusion of population health. I sketched this on my agenda:
US hospitals < acute care services delivery < US healthcare system < US population health < global population health
HIMSS is mostly in the leftmost category and entirely in the first two (inside the walls of providers almost entirely because that’s the vendors that pay them richly). mHealth Summit is mostly in the rightmost category and entirely in the last two. If you don’t like hearing about charity-funded SMS messaging projects in Kenya and Tanzania presented by volunteers, you should probably stick with HIMSS.
The 2,400 attendees hail from 48 countries. There are 125 exhibitors, a couple of hundred press people, and a ton of poster presentations. The big sessions are in the ballroom, which was nice because it has tables in the round (a place for your laptop, in other words) and free (slow) WiFi.
This site has a lot of information about various mHealth projects. Also mentioned was this site, which will have a cool summer internship program up soon. I jotted down the Web address of this Hopkins-led global health program and this interesting health information project from the Bloomberg School of Public Health at Hopkins.
I liked this quote: “Global is not the opposite of domestic.”
HHS CTO Todd Park was one of the early keynotes. He was pretty good, although he went a little bit too fast for me to be able to follow him. He mentioned that over 100,000 expectant mothers have signed up for the Text4Baby service. He says HHS will be launching similar SMS messaging services for obesity and childhood health. He also said that the HHS-led change in reimbursement will make mHealth a viable business (a feeling not shared by any of the speakers I heard, but I digress).
The next session was a panel, with a couple of speakers standing out. A doc from India said mHealth is important because there’s no way they’ll ever have enough doctors to deliver the care that’s needed. They also don’t have enough broadband penetration, but they do have 675 million cell phones. Allen Hightower from the CDC gave a lot of information, but it sounded to me like they’re doing nothing more than collecting survey information in the field with smart phones. He seemed to bristle a little when the moderator summarized his talk in that way, but that’s what it sounded like to me.
David Gustafson from University of Wisconsin got spontaneous applause a couple of times for saying that mHealth is not ready to scale up because nobody knows what patients and families need and want, the available information is often conflicting and of unverified reliability, and the smart phone form factor has significant limits for many people (small screen and keyboard.) He said research is taking too long and needs to reach the field faster. He expressed his believe that mHealth should be regulated as a medical device (that part didn’t get him any applause – everybody else thinks it’s the Wild West, but will settle down on its own without getting the regulators involved).
Nearly every session addressed the mHealth business model, or rather the lack of one. You get the feeling that maybe it’s not really going to fly given these common speaker opinions that I wrote down:
- Nobody has any idea whether mHealth really affects outcomes because it hasn’t been formally studied.
- There is no business model for mHealth. Companies and programs are almost entirely funded by grant money or by governments that are in the healthcare delivery business.
- Most mHealth applications are interesting and cute, but they don’t fit into the workflow of clinicians or the lifestyle of people. If your app requires going to some dedicated Web site to see or input information, nobody’s going to use it (they didn’t mention PHRs, but all the arguments seemed applicable).
- Doctors either don’t know about mHealth apps or don’t recommend them because they might affect their incomes.
- The only commercially successful mHealth application is Nike Plus, which has two million users who share exercise data via social networking and apparently buy a crapload of Nike stuff.
- One speaker said the conference will be obsolete within three years because broadband will be ubiquitous and SMS messaging apps will be ancient history.
We’ll hear from Bill Gates tomorrow, but one speaker quoted Bill’s take on mHealth, which you might expect to be gung ho since he’s both a technology guy and a world health leader. He’s not fooled into thinking that sending SMS pill reminder messages will change the world, however. “Bathroom scales have been around a long time, but we still have obesity.” In other words, technology doesn’t automatically change behaviors, and it’s behaviors that are often the problem (people don’t take their medicines, don’t stop risky behaviors, and ignore advice).
I jotted down a couple of interesting items. One researcher said there’s precious little research data on chronic disease management since it takes place in the home. She’s thinking that data sent in via mHealth apps in those homes could be very useful in looking at disease management. Also mentioned was that some countries (not ours, of course) are building a cloud-based PACS image sharing backbone for smart phones to avoid the cost of having each provider buying their own. And a third, which wasn’t surprising: most of the mHealth innovation isn’t happening in the US, but rather in China, India, and Africa (if you’re uncomfortable when anyone suggests that the US is not the world’s admired and envied leader in everything, that’s another reason to not attend this conference – the folks here are a bit more globally objective).
Probably the best speakers were Denis Gilhooly from Digital He@lth Initiative and Joseph Smith of West Wireless Health Institute. They both had short presentations in a panel discussion, but I thought they were objective and authoritative.
I wish the conference used the technology that Inga talked about from MGMA where you texted your questions to the speakers instead of hogging the aisle microphone. The conference allowed long Q&A sessions and as happens every damn time, eager beavers darned near sprinted to the microphones, droning on and on from their written notes, clearly in love with the sound of their voices that were wasting the time of a huge roomful of eye-rolling attendees who wondered if indeed there was a question somewhere in their long monologue (and for a couple, there clearly was not). Starting with the third session, I just started walking out as soon as Q&A was announced, which was for the safety of the microphone droners because I wanted to body-slam them Terry Tate, Office Linebacker-style.
The exhibit hall was low key, mostly non-profits it seemed, with a few vendors. The oddest was a lady in a rather lurid booth selling herbal products, boasting of such medicinal miracles as “Virgin – Again,” herbal Viagra, and “Cleavage Enhancer.” Either she showed up at the wrong event or she has insight into the particular needs of people who attend mHealth events. I can’t quite see strolling up among peers and casually asking for those products, which may have been a shared opinion since people were steering a wide berth around her booth as though there had been a chemo spill. The evening reception was in the exhibit hall, so maybe she’ll get some takers after the drinks have flowed for awhile.
So my takeaway is this: mHealth is not and probably never will be profitable. Insurance companies may pay a little something here and there for some simple apps that might save them a few dollars, but the bottom line is that even if mHealth apps improve health outcomes (which seems debatable), the funding model just isn’t there to turn it into a business. For that reason, it makes sense that the conference attendees are mostly global health people, who I admire (and would admire more if they would do more work in this unhealthy country instead of focusing only on everybody else’s). mHealth, like global health, is a worthy cause that makes a poor business for most of the people in it, who largely self-selected that calling without worrying about cashing in anyway. Kudos to them.
Tomorrow is Ted Turner, Bill Gates, and another long day of sessions. I’m leaving Wednesday morning, so that will be my last report from here.