From the mHealth Summit 11/10/10

One thing you can say about the mHealth Summit: they give you your money’s worth in terms of long days with minimal downtime. Today, for example: it was straight through from 9:30 a.m. until 4:30 p.m. with just one five-minute break (even the lunch was all presentations).

They just can’t figure out the whole refreshment thing, though: the one-and-only concession stand that had mile-long lines yesterday was CLOSED today. The only food in the entire building was two levels down at an overwhelmed Starbucks. Man, that was annoying – the food and drink markup is insane, but even then you can’t get anyone to simply show up and sell you the stuff.

I wanted a soda, but of course there are no machines in the building since that would compete with those kiosk people who couldn’t be bothered to actually show up, so I finally worked up the nerve to go outside among the boarded-up buildings and street people to find an incredibly dumpy place willing to part with a dented and off-tasting can of Diet Pepsi for $1.50.

I also noticed that many of the convention center outside doors were locked, the water fountains I tried didn’t work, and some of the bathroom faucets didn’t either, all of which makes me wonder how well maintained the place is. It’s not a bad-looking building and it’s comfortable and well laid out, but the iffy neighborhood on three sides, lack of maintenance, and signs pointing to non-existent food stands left a somewhat negative impression. 

The first speaker came out with his real-time streaming physiologic data displaying on the big screen, collected by a tiny Bluetooth-enabled monitor in his shirt pocket going to a cheap cell phone (blurry, artificially sharpened photo courtesy of the crappy iPod Touch camera). It was pretty cool, but the real-world problem is tougher: who’s going to read that data and react to it? He mentioned that doctors aren’t interested because they don’t have the time to watch data that’s usually meaningless, plus malpractice attorneys would have a field day dragging them to court if they missed something.

That’s the big unanswered challenge: the world is short nearly every kind of healthcare worker, so any mHealth solution would ideally reduce their workload, not increase it.

Ted Turner was an early keynote. I had a snarky comment involving his trying to coerce Hanoi Jane into having three-ways (since he got unwanted PR when she divulged that in her book), but I’ll let that pass. Ted was pretty cool, very low key. I actually thought his answers were all going to be of the yes-no variety until he finally got warmed up and started talking a little. I saw no evidence of the infamous “Mouth of the South” from his younger years (he’s 71 now).

Ted was kind of all over the place, most of it not health-related, but he was still entertaining. He of course gave the UN $1 billion and told a fun story about that. The US was refusing to pay $1 billion in UN dues, so Ted was going to pick up the tab, but the UN wasn’t allowed to take the money directly from him. He said he originally toyed with the idea of buying the debt from them for 80 cents on the dollar, then doing what the UN couldn’t do in suing the US for the unpaid balance, which would have netted him $200 million with minimal work. What he really did was to set up a foundation to support the UN and to do charitable work, some of which involves health (lots of it involves elimination of nuclear weapons and war, which as he cleverly points out, can make all the health gains obsolete if people are killing each other intentionally).

So I didn’t get much healthcare stuff out of Ted, but I loved this story that he used to illustrate the point that conventional wisdom is often wrong. After he started CNN, he also started The Cartoon Network, which everybody told him was stupid since the experts assumed nobody watches cartoons. He said that The Cartoon Network now draws an audience 2.5 times the size of CNN’s, but nobody admits to watching it. As he said, “Bugs Bunny is still funny.”

Carolyn Clancy of AHRQ spoke for a few minutes, but all I wrote down was a couple of not-too-interesting projects at Denver Health and Vanderbilt and this link to a list of innovative projects. She also said the mHealth should be part of Meaningful Use, but didn’t elaborate on that.

Several speakers made these points: the industry needs to move away from single-focus projects that try to beat out a competitor. The way to win is through collaboration. Nearly all of them seemed amazed at the number of attendees since I guess it was a pretty sparse band of research geeks that attended last year’s inaugural conference.

This was a good point made in a morning session. The goal of mHealth in developed countries is to increase the efficiency of care delivery that’s already happening. In developing countries, it’s to provide access to care that doesn’t exist, leapfrogging the phase we’re in here. An example given was SMS appointment reminders that can be cancelled by replying.

One of the best speakers was Patricia Mechael from Columbia, who did a Letterman-like list of things the industry needed to do to hold itself more accountable. As she said in calling for better outcomes research, sending a million text messages doesn’t necessarily change behaviors.

I went to a session in which technologies were shown that send information back to providers. The first was PhiloMetron’s PTMS, the “Patch That Measures Stuff.” This was pretty darned cool, a bandage-like disposable patch (seven-day lifespan) that can track several measures. The most interesting thing they’re working on (gathering the data for FDA review) is auto-sensing of calories take in and calories burned (don’t ask me how they do that – in fact, don’t ask them because they won’t say). They’re planning to use the patch to drive dietician counseling. A variant detects the formation of wounds, like pressure ulcers. The company says the patch can be sold for around $30 at scale, so for $1,500 a year, you are wired 24×7 like an astronaut or something.

A UCLA researcher reviewed his cell phone microscope for cytology, which was cool because to get the size and price down (it’s the size of a quarter, 35 grams, and around $10 to make) it has no lenses. It does some kind of cell-level shadow analysis that allows the cell image to be reconstructed on the back end by software running on a laptop or server. It was nearly perfectly accurate from the pictures shown. I think he said it could be used for water safety and field testing for diseases by experts (not regular citizens, in other words).

Vitality showed its smart pill bottle and the compliance improvements resulting from its use. That’s another of those problems technology alone can’t fix – if patients won’t even take their prescribed meds, then what do you do? At least it has a business model – drug companies make more profit when patients take more pills, so maybe they’ll pay for the gadgetry.

So then it was lunch with Bill Gates, which had people ganging up at the ballroom entrance well in advance. Bill would have felt the pressure to be highly informative and entertaining had he known how bad the lunch was given its $75 ticket price (which I hope went to Bill’s foundation and not the caterer). My table had a spirited debate about whether the hideous drink in the pitcher was iced tea or fruit punch, which was an equal split until I postulated that it tasted like really bad fake lemonade with really bad iced tea from concentrate dumped in.

Bill seemed genuinely humble and introspective, speaking clearly and patiently like a really good teacher. Maybe age does that to you since both Bill and Ted (no Excellent Adventure pun intended) were a lot less animated than in their youth. Bill is amazingly well versed in healthcare and his big thing is reducing mortality of children under 5, which means Bill is a vaccine man big-time. He likes the idea of registering all births so that vaccine reminders can be given.

I found this fascinating: you would think that saving all of those babies would increase world overpopulation, but Bill says no – studies have shown that there is no such thing as a country with good health and a high population growth. For some reason, saving those babies actually reduces the population. He also said that nearly all of the world’s overpopulation is coming from urban slums.

He also likes the idea of digital currency to avoid having the local despots stealing the aid money intended for needy citizens. Apparently it can be handled purely by cell phone.

He brought up again that you can send all the reminders you want and people can pass tests showing they understand what they should be doing, but that doesn’t mean they will actually do it. He proposed for obesity that cell phone sensors should detect a lack of movement, then shake to remind the person to exercise. If they don’t, he said, don’t allow them to make calls until they do five push-ups (pretty funny guy, that Bill). As he put it, it’s been shown that you can take someone who exercises 80% of the time and get them closer to 100%, but for the large majority doing 0%, reminders don’t seem to work.

He also mused that the problem with public health problems is that they take years to develop, which makes people ignore risky behaviors since the time between exposure and suffering is long. He said that it would be better if AIDS killed people instantly because they would have an immediate incentive to avoid risky behaviors (as he said, they would know from the piles of bodies outside bars and brothels not to go inside).

The moderator asked him to name one technology that will be the next big thing after communications tools. He said robots, saying that computers can already see, listen, and move around. He observed that it would be tough to program a robot to help an elderly patient out of bed and to the toilet, for instance, but once the programming was done, the robot would be tireless and consistent.

Bill Gates is the man. I thought so before, but now I’m convinced. Rubber chicken or not, I got my $75 worth.

Aneesh Chopra was next up. The US CTO is a White House position, which was obvious since much of his pep talk involved bragging on the Obama Administration’s healthcare IT accomplishments. He talked up the VA’s telemedicine projects, the Blue Button initiative, and Meaningful Use. He bragged on the wisdom of making EHR certification modular, saying it would allow niche vendors to complete in specific areas of functionality.

He mentioned something about Project SMArt, a universal API into legacy hospital systems that will be available in the spring.  I found its Web page here. Apparently that mention today was its coming out party, according to the page. It was mentioned previously as an iPhone-like front end to legacy systems and there’s a developer contest involved. This could be interesting, so we’ll see where it goes.

I met with Travis Good of HIStalk Mobile after the lunch and then called it a day since I had to meet someone. The conference runs through tomorrow, but like most conferences, I would expect the last day to be less interesting and less well attended.

My summary is this. mHealth is not very well defined. Is it doctors reviewing PACS images by smart phone? Personal health records? Sending SMS text messages to moms-to-be? Using mobile devices to function as remote microscopes and medical devices? Offering face-to-face telehealth consults? Remotely controlling medication dispensing?

This conference focused on global health, primarily patient education and reminders. Most of the rest of what you might logically call mHealth wasn’t really covered since this is a meeting of mostly researchers and public health people. There wasn’t much here for you if your interest is in medical services delivery (hospitals and practices).

If anything, that kind of global health work is probably more noble and impactful than trying to sell EMRs to HITECH-yearning providers who don’t really see reason to change. There isn’t much money in global health. The meetings tend to be academic focused – no motorcycle giveaways or bribes to visit the vendor booths. They also tend to involve countries other than this one, either (a) those that are well ahead of the US in that area or (b) those who can’t provide even basic medical care services to their citizens.

What will be really interesting is to see how next year’s conference shapes up (December 5-7, 2011). Will many of this year’s attendees decide that the content wasn’t relevant to their work, even if seeing Ted Turner and Bill Gates in the ads convinced them to show up this year? Or will word spread and the conference grow to cover more of what could be defined as mHealth? And most of all, will the realization that this kind of global health-focused mHealth is probably never going to be profitable leave it as the domain of grant-funded researchers running endless pilot projects that sound great but don’t impact outcomes?

Beats me. I’m glad I came this time, but I don’t think I’ll be back next year unless I’m somehow improbably more involved in mHealth than I am now. We have our own problems in hospitals and practices and it seems to me that the players, the methods, and the rewards are so vastly different that this group of mHealthers have nearly nothing in common with us HITers, so I found little to learn and little to offer that was relevant. I admire the work they are doing, though.