updated March 29, 2015

The market for eHealth mobile apps and digital medical gadgets is growing very fast now and the big smartphone companies and venture capitalists are starting to take serious interest, as they see enormous business possibilites in the global personal health sector.

This is an extended version of my trendspotting talk during my session “Engaged Epatients” at the Digital Health Days conference in Stockholm. In its second year, this kind of conference is also a sign of the growing interest for digital health services.

Digital Health Days was hosted by the mayor of Stockholm and the Chamber of Commerce, they see Stockholm becoming a hub for eHealth development since we have a highly digitized health care system, a vibrant internet startup community and a smartphone-hugging population with many early adopters.

I have been involved in eHealth since the early 90s when I produced award-winning medical e-learning programs for pharmacists and doctors with interactive patient scenarios and 3D animations. Back then we could only dream of the technical infrastructure we have today with smartphones and wireless broadband internet everywhere etc.

This is enabling a very positive new force:

We are seeing the emergence of proactive and empowered citizens and patients that are much more in control of their health.

And it is driven by several trends that we can see growing now:

 Trend #1: eHealth startups galore

New venture capital funds and incubators are built all over the world to catalyze a flood of startups in many types of eHealth services and products.

Incubators specializing in eHealth startups are popping up, like these 3 examples: XL Health in Berlin, Rockhealth in San Francisco and Healthbox in London.

Trend #2: The enabling smartphone

eHealth is a key factor that enables patient-doctor collaboration based on individualized care, which is one of the corner stones of patient empowerment. This requires that the patients have access to tools and knowledge that are relevant to their personal needs and abilities. The key technology for this is of course the smartphone! A recent global survey shows that 80% of people would like to use their smartphones to interact with their health care providers.

Fitness and activity tracking smartphone apps like Runkeeper and LifeSum have in a few years evolved into sophisticated personal well-being assistants, utilizing the smartphone GPS and motion sensors and embraced by millions of people.

Trend #3: Self-tracking and wearables

Someone said “We will be the last generation that knows so little about ourselves”, meaning that we are now starting to gather health data about ourselves at an unprecedented scale, and finding ways to make that data useful for our personal health and well-being. 

There is a flood of new wearable gadgets and smart watches coming out now. Their sensors communicate with your smartphone, which enable continuous tracking of all sorts of health-related data, from fitness and well-being to chronic disease status. Individual access to these new tools and data sources is now giving health-concious citizens the ability to monitor their lifestyles and make smarter decisions about their health.

For patients with chronic conditions such as diabetes, high blood pressure, Parkinson or rheumatism, this means that they can monitor and self-manage their health every day instead of only during visits to their doctor. This will not only improve their health and quality of life, it will also save health care resources, when this is integrated into their work processes.

A catalyst for this trend is the Quantified Self movement, a non-profit community of local Meetup-groups around the world that discuss and test various kinds of self-tracking apps and gadgets. It is about learning more about yourself in order to improve your well-being, skills or health. I am a co-organizer of the Quantified Self Stockholm group, which currently has 400 members, you are welcome to join!

Trend #4: Self-screening tests online

The first stage in empowering people with access to health information was when a broad range of web sites appeared, ranging from published medical academic papers to patient organisations gathering knowledge data bases. The second stage is emerging now: interactive online tests where you answer questions about your symptoms and get advice about suitable self care or a recommendation to visit a doctor.

In the UK, the NHS is offering a broad range of Symptom checkers. Theses types of tests are based on established ways that the doctors interview patients, with a tree-structure leading to several possible outcomes.

Here is one of my eHealth projects, an online screening application for smartphones and computers, aiming to shorten the time from first symptoms of various types of joint pain to a diagnosis by a specialist in rheumatology.

I developed this concept together with specialists at the Karolinska institute and the Stockholm County Council. It is currently tested online and at several primary health care units. User interface and web design was developed by Ocean Observations in Stockholm.
Try it yourself: Ontilederna (Swedish)

Trend #5: Buy your own lab tests online

Thanks to the internet and entrepreneurial doctors, citizens can now order many kinds of lab tests online and go to a nearby medical lab to take the blood tests etc. The results are then appearing in a personal health journal online, together with information on how to interpret them.

WeRlabs is a Swedish company, run by a doctor and partnering with medical labs. Their tag line: “Health journal and your values on your terms”
You buy a test package online and go to the nearest lab to take your blood tests.
A day later you get a text message and access online to your results, together with a personal recommendation by a doctor.

Another Swedish company, YesNoTest, has a slightly different approach and different typs of tests: You buy a test kit online and get it by mail. Then you do the test yourself and you either get the results directly from the kit, or you mail it back for lab analysis. Your results are then available online.

Trend #6: Your own medical lab at home

Consumer medical devices are in rapid development, soon we can have palm-sized and affordable medical labs in our homes!

Cue is an American medical device, aiming to reduce trips to the doctor.
Cue is using spit, nasal swabs and blood to detect if you for example have an influenza or not.
Note the iPhone screen shot here that shows the Inflammation level. That is the CRP level, a routine test for many chronic diseases that is repeated at intervals to determine whether treatment is effective. This means that patients will be empowered to perform this test themselves, resulting in a better and more continuous collaboration with their doctors.

Here is a video with Cue’s vision of how their device will work at home:

Note that all this is technically possible today! The hard part is not the technology, it is of course the integration with health care. That’s where this video feels a bit like science fiction…

Cue is aiming for FDA approval and a launch in early 2015.

Another, very hyped device is the Scanadu Scout, a vital sign monitor that you simply hold onto your forehead. It analyzes, tracks, and trends your vitals by doing all of these tests. After around 10 seconds you can see the results on your smartphone.
Scanadu is also aiming for FDA approval.

I have a pre-release test unit of the Scanadu Scout and I have started a discussion forum for others in the test group.

Trend #7: Smartphone eHealth platforms

We are going to need a secure and convenient place to store all that personal health data that we are collecting via our apps, lab tests, body sensors and medical gadgets. This is of course a big business opportunity for the giants in smartphone and online services, so they are now scrambling:

Apple will launch an extensive development platform called HealthKit with the new iOS 8 in September 2014. This means that some 800+ million iPhone users can immediately start using these health apps.

Apple are partnering with big health players in the US, like the the Mayo Clinic and other health care providers.
And Apple has integrated HealthKit with Epic, the Medical Health Record system that is used for more than 50% or all Americans.

Google Fit is their eHealth platform for Android smartphones. Fitness companies such as Nike, Adidas, Withings and Runkeeper are involved from the start.

Samsung Simband is part of an ecosystem that enables collection of data from any type of device and deliver it to any type of application in real time.

For me, the key factor with these platforms is how convenient and securely they will let us gather, visualize and share our personal health data. And hopefully, these systems will be able to exchange data with each other.

Trend #8: Service design thinking

One of my key missions in eHealth development is to listen to and engage the users at the beginning of the project instead of at the end. This is the core of an overall methodology called Service design thinking

Patients are not a problem!

Most disruptive transformations are met with resistance, and sure enough, in the health care sector there are many arguments against these eHealth trends. To some degree this is the usual resistance against change, having to adapt to new ways of working. But we also often hear arguments from doctors along  the lines of:

• “Patients are not capable of interpreting and managing their own medical data”
• “Patients will be worried if they see their medical data”
• “Patients that are allowed to take medical tests themselves will over-consume them”

But there are no signs of any of these happening. On the contrary there are numerous reports of increased patient satisfaction when they are given good information tools and are allowed to engage themselves in their  health management.

Regarding patient capability; we are all handling our jobs, our families and personal economy as well as many other complex issues in life.  So why should we not be able to handle our own health data, if we are provided with the right tools for it? Especially if doctors become coaches and knowledge brokers for the patients. Also, motivation is the most important driving factor for learning. And most people are very motivated to manage their own health and well-being, especially those with chronic diseases.

Lack of revenue models is a problem!

There are numerous pilots launched for various types of eHealth services, most of them are financed by research grants etc. This is very good and valuable experiences are derived. But these pilot projects are seldom transferred into live services that can be used broadly. The biggest obstacle for this is the lack of eHealth revenue models.

The current revenue models in today’s health care systems are still based on physical patient visits and treatments such as medication or surgery. This means that there is no incentive for a doctor to treat patients remotely, for example by using online video conferencing. There is also no way for a developer of eHealth apps to  sell them to a health clinic, even if they would save them money and improve their patient satisfaction. So the patients are still required to show up physically for all kinds of health care.

It is very complex to create new revenue models in public health care, so we have had this discussion about eHealth for many years.

My eHealth revenue model  proposal

Creating new revenue models in health care is a very complex process and should take time. But since eHealth is very new and comes in many different types we need to start various types of real-life pilots now.

So my proposal is to start many pilot projects that run in parallel with the ongoing revenue investigations. Create a public fund and invite eHealth developers to apply for a year of testing their apps. A proper fee is negotiated per app, it could be per use, per patient or per month etc. Ensure that the eHealth services can be used with a minimum of system integration during the pilot period, ease of use for both the patients and the care givers should be a prime requirement. Encourage various typs of  health care providers such as primary care clinics, specialists, medical labs and home care organisations to try out these eHealth services and get paid for it.

Then create simple ways to track the usage and follow up the effects and experiences of the care givers, the patients and the economical results. At the end of the year this will provide very valuable real-life data that can be used to create a value-adding eHealth revenue model system.

Stay tuned for more about eHealth

I you find this interesting you might want to follow my blog as I will post more tips and thoughts about eHealth. And I promise that the next post will be shorter.

All kinds of feedback and follow-up questions are of course welcome!