Mhealth: Mobile Technology Poised To Enable A New Era in Health Care

mHealth
Mobile technology
poised to enable a
new era in health care
Contents “Smart mobile devices and applications, working in
concert with cloud computing, social networking
3 Introduction and big data analytics, will be at the core of global
health care transformation. These transformative
4 Overview
technologies will continue to lead with ways to help
15 Perspective on patients rein in cost, broaden access, change behaviors and
improve outcomes.”
23 Perspective on physicians Pat Hyek
Global Technology Industry Leader
29 Perspective on providers Ernst & Young
39 Perspective on payers
46 Are you ready?
48 Glossary
51 Source notes Note: all monetary references within this report are to US dollars.
mHealth: mobile technology poised to enable a new era in health care

Introduction
Mobile technology poised to
enable a new era in health care
Smart mobile technology is poised to transform global health care — with a little help from other technology
megatrends, such as social networking, cloud computing and big data analytics.
This is a grand statement, we know. Progressions presents a clear vision of how

“The first thing we ought to And many factors will influence the depth, behavioral change and moving health care
breadth and speed of health care’s badly out of hospitals and doctors’ offices to
recognize is that mobile is now
needed transformation, as costs escalate, wherever patients are will play key roles in
part of the fabric — every day the global population ages and the developing improving health care outcomes, expanding
in everybody’s life. So if you’re world demands better and more available access and lowering cost. In researching our
not looking at mobile solutions, access to care. Luckily, we’ve seen smart own report, we synthesized the insights of
mobility’s impact before. Again and again, our Global Technology Center professionals
then you’re not really looking in so many industries, smart mobile devices with extensive secondary research — and
at all solutions.” and their applications have transformed the again, we saw innumerable examples of the
Mal Postings way people live, work and play. This is smart mobile “linchpin” dynamic described
Global CTO — IT Advisory because mobile devices act as the linchpin above at work to bring about the Progressions
Ernst & Young for the other technology megatrends, vision of “health care everywhere.”
delivering into people’s hands the critical
information and insight they need in a given Technology companies able to bring to
moment, wherever they are. The information market products and services that accelerate
and insights may be produced via social the global health care industry toward that
networks, analytics or both; they may be vision may well be positioned to participate
processed and stored in a public or private in an historic technology-enabled solution to
cloud. And they’re delivered via smart one of humanity’s most pressing problems —
mobile devices and apps. as well as an historic growth opportunity.
With this in mind, we invite you to explore
This report complements the work done the results of our synthesis in the “Overview”
for Ernst & Young’s Global Life Sciences that follows and four subsequent drill-downs
Center’s study, Progressions, The third place: examining the effects of this mHealth
health care everywhere (see page 53, transformation on health care consumers —
“Source notes”). patients, physicians, providers and payers.
mHealth: mobile technology poised to enable a new era in health care 3

Overview
The coming global
mHealth transformation
Current situation
As a series of seemingly unmanageable challenges continues to plague global health care,

industry stakeholders — from patients to physicians, providers and payers — are increasingly
turning to mobile technologies to play a key role in the “cure.” Managing chronic disease
and related unhealthy lifestyle choices has left governments in developed nations to
struggle with unsustainable levels of health care cost, while millions in the developing world
suffer or die beyond the reach of traditional health care.
Meanwhile, behavioral change and treating patients outside the four walls of traditional
provider institutions have evolved as core to a health care industry vision of treating
patients wherever they are (the third place), 1 while enhancing patient outcomes and
lowering cost. This is where smart mobile technology comes in: its ubiquity (90% of the
world’s population was within reach of a mobile network in 2010)2 and the proven ability
of smartphones and tablets to effect behavioral change have placed smart mobility at the
center of an information technology-enabled vision of health care’s future.
Mobility leads multiple technologies ready “Health care’s stakeholders — governments,

to enable health care regulators, employers, payers, nonprofits —
In fact, multiple technology megatrends are aware that the system is broken and
support smart mobility’s health care role, that we need a new system for delivering,
including cloud computing (which could consuming and paying for care.”3
provide mobile access to health information
and applications), social networks (which Figure 1 (page 8) suggests the
have already begun to provide patient- unsustainability of the current health care
centric information sharing and peer model, with multiple stakeholders (who
support) and big data analytics (which can have differing incentives) and siloed
could provide anywhere, anytime diagnostic information flows. This is a global issue,
insights). And importantly, these even though the topic may be hottest right
technologies are ready to help now. Their now in the US, where health care costs have
value in support of the three primary goals reached 17.9% of gross domestic product
driving health care change — lowering cost, (GDP).4 But costs are at 8% to 9% of GDP
improving outcomes and increasing access — and growing in most European countries,
has been demonstrated in a multitude of and are already at 4.5% in China and
small pilots and related examples, although growing rapidly.5 The Progressions report
these generally lack the size and control cites the cost of chronic disease care as
group comparisons that health care the major global cost factor, accounting for
industry stakeholders require before 75% of health care costs. Other research
widespread adoption. suggests chronic care costs will continue to
grow from a substantial burden into “a
Health care approaching a tipping point staggering one over the next two decades.”6
Technology’s readiness to support the
rapidly evolving new global health care The sheer size of the population accessing
vision is important because the industry is health care is increasing as well, with
approaching a tipping point. According to growing incomes in emerging nations and
the Ernst & Young report Progressions, the expansion of health care coverage in the
4 mHealth: mobile technology poised to enable a new era in health care

US. There, for instance, health care procedures. Before electronic medical
legislation is in the implementation phase, records (EMRs) were adopted, even quality “At this moment in time many
with state and federal governments setting measures were measured by surrogate health care and technology
up health-insurance exchanges and other process markers such as the fact that a lab
mechanisms intended to bring coverage to [test] was done — not what the lab result
companies are looking for
an additional 30 million uninsured indicated,” says Dr. Bill Fera, Advisory — the right strategic partner
Americans.7 While no panacea, health Performance Improvement (PI), Health to develop and expand their
information technology (HIT) is increasingly Care, Ernst & Young.
mobile platform, while achieving
seen as one way to address the additional
demands this new population will place on Changing health care incentives could their strategic agenda.”
the already strained US health care system. boost mobile adoption … Sol Vairavan
Now, however, new forms of pay-for- Transaction Advisory — M&A
Throughout the health care system, performance health care models are Ernst & Young
questions of “who pays?” and “how much?” emerging, such as Accountable Care
are on the table. For instance, some are Organizations (ACOs) and patient-centered
seeing a shift in the purchase of medical medical homes, to incent outcomes-
devices from physicians to more cost- oriented behavior on the part of physician
conscious hospital buyers, requiring practices and larger health care providers
changes as far-reaching as design (i.e., hospitals and hospital networks).
simplification and cost-reduction.8 Mobile technology that enables remote
monitoring of patients and that provides
Policies encouraging generic drugs as a patients with rapid access to medical
matter of cost reduction are the subject of clinicians when questions arise is expected
continual legal battles — with some to play a key role in such organizations. For
pharmaceutical companies arguing that example, just such a telehealth trial in the
research and development funds hang in UK, where the government is the primary
the balance. There is also widespread payer and provider of health care, yielded a
acknowledgement that many health care 15% reduction in doctor’s office visits, a 20%
payment and incentive systems don’t work reduction in emergency admissions, a
because they encourage the “wrong” 14% reduction in the need for planned
behavior, particularly in the US where costs admissions and — most strikingly — a
are highest. There, pay-for-service models 45% reduction in mortality rates.9
likely have contributed to the high cost by
focusing medical professionals on actions “Patient satisfaction in that trial also was
that generate reimbursements, such as office very high,” notes Kenny O’Neill, Advisory —
visits, tests and surgical procedures, rather PI, Ernst & Young. “Some patients started
than outcomes — i.e., healthier health care calling the main unit their ‘little nurse sitting
consumers. “This system evolved, in part, in the corner,’ they liked it that much. It
because it rewarded activities that were gave them a bit of control back, where
tangible and easily measured by claims data before they were more reliant on their
such as encounters, admissions or caregiver,” explains O’Neill.
Ninety percent of the world’s

population was within reach
of a mobile network in 2010.

… and mobile adoption could boost Health and wellness apps are already
outcomes-oriented incentives driving mobile health technology adoption
But despite its critical role in improving While outcomes-oriented payment schemes
outcomes, technology’s ability to provide such as ACOs are still experimental, mobile
a digital record that demonstrates the health and wellness apps are being offered
relationship between care and outcomes by a wide range of organizations, from
is equally important. Explains Dr. Fera: sports apparel companies to hospitals. All
“The first time managed care was of these have the common aims of altering
attempted in the US, primarily as HMOs lifestyle choices like diet and exercise to
[health maintenance organizations], foster better health, or helping patients
most of the clinical record was on paper better manage chronic conditions. In a
and bonuses or rewards were based strictly recent US example, medical insurer
on spend. Essentially, I could be financially UnitedHealth Group announced alliances
rewarded if I were to withhold care. There with three mobile app providers: CareSpeak
was no quality aspect, because it could not Communications, whose app helps patients
be readily measured.” manage chronic disease and related
medication through two-way text
However, once outcomes-oriented messaging; LoseIt!, which helps manage
incentives are in place, “I can be financially weight; and Fitbit, whose wireless tracker
rewarded if I’m providing good care, which counts steps taken, stairs climbed and
is keeping my patients healthier and out of calories burned, and provides a link to a
hospitals. And I can prove that now through website to analyze the results and compare
the digital record,” Dr. Fera says. This is a them with peer groups.
key enabler of the envisioned transformation
from pay-for-service to pay-for-performance Such alliances draw on ancient wisdom. It
reimbursement and incentive models. was, after all, Hippocrates who famously
said, “If we could give every individual the
Further, tablets and smartphones can right amount of nourishment and exercise,
deliver patient information and diagnostic not too little and not too much, we would
“Technology companies now insights to physicians wherever they are — have found the safest way to health.”
have an opportunity before in their offices, on hospital rounds, in a Hippocrates, however, could not have
them to help solve what may be patient’s home or at 35,000 feet, as imagined that the knowledge and incentive
described in our “Perspective on physicians” necessary to achieve his vision could be
society’s biggest challenge of (page 23). constantly streamed to entire populations
this century. And if they do so, due to information technology and the
their growth opportunity could For all these reasons, “Technology ubiquity of smart mobile devices, which
companies now have an opportunity before have been shown to be powerful agents
be commensurate with the size
them to help solve what may be society’s of behavioral change (see page 15,
of that challenge.” biggest challenge of this century. And if “Perspective on patients”).
Ed Tomlinson they do so, their growth opportunity could
Advisory — PI be commensurate with the size of that Smart mobility’s power to effect change is
Ernst & Young challenge,” says Ed Tomlinson, Advisory — not limited to developed nations. Mobile-
PI, Ernst & Young. enabled health initiatives also have shown
important impact in the developing world. For
example, a simple messaging system (SMS)
application aiming to improve medication
adherence among antiretroviral patients in
Kenya improved adherence by approximately
25%, thus improving health and lowering
associated costs by up to 7%.10

The mobile-enabled health care vision wherever they happen to be — what the
Given the context, and the cornucopia of Progressions report calls “the third place.” “Once outcomes-oriented
health-related mobile technologies and By doing so, and by using mobile-delivered incentives are in place, I can be
applications already appearing, a near-term information to foster better lifestyle choices
financially rewarded if I’m
vision of mobile-enabled health care — or and improve medical outcomes, this
mHealth, as many have started calling it — evolving vision lowers health care costs to providing good care, which is
has begun to take shape. a sustainable level, while extending access keeping my patients out of
beyond the reach of traditional health care. hospitals. And I can prove that
The evolving mHealth vision is patient- The UK trial described earlier shows how
centric but with information services and such an approach can drive down cost, now through the digital record.”
data analytics at its core (see Figure 2, while improving outcomes. “What is more, Dr. Bill Fera
page 9). While this may sound contradictory continuous data from wearable and Advisory — PI, Health Care
at first, it isn’t. The vision is patient-centric implantable sensors could improve drug Ernst & Young
because the various evolving approaches adherence and could keep people out of
involve one or more of the following: hospitals by identifying patients who are
delivering information to the health trending toward hospitalization several days
consumer to empower him or her to make in advance,” says Stephen Oesterle, M.D.,
healthier choices; remotely monitoring Senior Vice President for Medicine and
(through mobile sensors or other Technology, Medtronic Inc.11
mechanisms) information from the patient
(such as vital statistics and blood glucose); In the US, however, where health care
or delivering information or insight payers and providers traditionally are
to clinicians at the point of care with the separate enterprises, this vision is leading
patient. It is this wealth of information, to a buildup of tension among certain
including both personalized, patient-specific stakeholders — for example, between
data and aggregated big data (appropriately providers and the government. In an April
analyzed) that come together to create the 2012 letter to the US Department of Health &
knowledge and insight that will lead to Human Services, the American Hospital
customized, improved medical outcomes. Association (AHA) expressed disagreement
with certain requirements the agency
“In this vision, mobile devices are the established under the American Recovery
nerve endings at the edge of a vast and Reinvestment Act of 2009 (ARRA).12
information network,” says Mal Postings,
Global CTO — IT Advisory, Ernst & Young. For example, the AHA specifically objected
“The patient data they provide feeds to providing patient access to medical
into the information services at the core, information via an internet portal. The AHA
alongside relevant databases encompassing letter states, “Our members are particularly
diseases, therapies, medical devices, concerned with the proposed objective to
procedures and related outcomes. Those provide patients with the ability to view,
information services, in turn, power mobile download and transmit large volumes of
health applications that deliver valuable protected health information via the internet
information or analytical insights that help (a ‘patient portal’). The AHA believes that
patients or their caregivers manage their this objective is not feasible as proposed,
medications, better control chronic diseases, raises significant security issues and goes
or improve their overall health and well beyond current technical capacity.”13
wellness.“ (See Figure 2, page 9.)
In the long run, Dr. Fera believes it is
Discharging health care from hospitals likely that hospitals in the US will be
and doctors’ offices re-engineered as more outpatient-oriented
A key element of this vision is to move institutions, and become more vertically
much health care activity out of high-cost integrated with payers.
venues, such as hospitals and doctors’
offices, and into patients’ homes or

The evolution of ecosystem “frameworks” Information technology at the core of
“When a consumer experiences Another element of the vision that we the vision
believe must rapidly evolve is a patient- As Ernst & Young’s Mal Postings points
the very best from an industry
centric mobile ecosystem “framework.” out, “Health care is fundamentally an
offering mobile solutions — take But a critical unanswered question is information business.” So it’s no surprise
mobile banking for example — whether such frameworks will be based that information technology is at the heart
they expect the same level of on public domain standards or will be of the evolving health care industry vision.
walled gardens offered by providers and Much of what needs to be done to achieve
quality from all other industries, payers. Such a framework would be the the vision is clear, in terms of the organization,
including health care.” main mechanism by which patients digitally analysis and dissemination of medical
Paul Chabot interact with all their clinicians, provider information and insight. What’s less clear is
Advisory — PI networks and payers. In a public domain who will do it: the IT departments of payers
Ernst & Young model, health care consumers would plug or providers, technology companies or
information services from their various governments. In our view, this, too, requires
providers into their framework, and grant an ecosystem of stakeholders with shared
permission for information access or cost and accountability.
sharing at their discretion. In a walled
garden model, the provider or payer would
make all those decisions and grant access
to the patient.
Figure 1: Where we are today — technology innovation poised to enable health

care transformation
Transformative technologies emerge:

ª Smart mobility
ª Social networking
ª Cloud computing
ª Big data analytics
Providers
Patients
Change drivers — Governments Change challenges:

the need for:
ª Privacy/security
ª Cost containment ª Customer experience
ª Increased access and change management
ª Better outcomes ª Incentives/compensation
and rewards
Physicians Corporations ª Liability/tort reform (US)
ª Inability to create value
from universe of data
ª Lack of standards/
interoperability
ª Need for integrated IT/
Regulators human capital talent
Payers
ª Siloed information
Enabling technologies arrive on the scene — offering promises and creating possibilities. For the first time,
the universe of data and traditional IT has the potential to be connected into a health care ecosystem that can
deliver actionable patient-centric information in a timely manner, overcoming the barriers of multiple data silos
across many platforms.
Source: Ernst & Young analysis.

What’s most clear, though, is the critical role For all of the reasons discussed, momentum
of IT expertise. In this regard, a February has begun to build for mainstream adoption “In this [mHealth] vision,
2012 paper resulting from a collaboration of mobile and related information mobile devices are the nerve
of two US and one Canadian university was technologies in support of the emerging
most illuminating. The paper demonstrated health care vision. The following sections endings at the edge of a vast
a correlation between IT expertise and the explore key factors that are accelerants or information network.”
costs associated with implementing EMRs. inhibitors to the grand mHealth vision. Mal Postings
Provider organizations that had deep IT Global CTO — IT Advisory
expertise or were in regions where they had Ernst & Young
access to IT expertise showed significantly
lower operating costs two years after EMR
implementation; those with little previous IT
experience or in regions where IT expertise
was lacking showed increased costs after
EMR implementation.14
Figure 2: Where we are headed: mHealth value pathway — enabling health care everywhere
Innovative technologies enable:

ª Personal health management
ª Remote monitoring
ª Chronic disease management
ª Medication management
ª Wellness care
ª Behavioral change
ª Urgent care
Customer-focused
change drivers: Integrated data / actionable information Resulting in:
ª Empowerment ª Better outcomes
ª Collaboration ª Broader coverage
ª Connectivity ª Lower cost
ª Interoperability Patients Physicians Providers Payers Governments Regulators Corporations
ª Risk management
ª Incentives and rewards
Information
services
ª Cloud computing
ª Smart mobility
ª Social networking
ª Big data analytics
The health care vision will be realized when the universe of previously siloed data is standardized by integrating traditional IT with innovative information services.
The result is integrated and actionable information that is private and secure and enables the delivery of health care efficiencies, positive customer experiences,
modified behaviors and improved outcomes everywhere.

Accelerating the vision
Demand for mobile services: Far and away, the most powerful force accelerating the global
health care industry toward this mobile-enabled vision is the grassroots demand generated by
health care consumers, as well as by physicians, nurses and other clinicians. This widespread
demand for mobile services is something we’ve seen before in many industries. “When it
comes to mobile, expectations don’t vary by industry. When a consumer experiences the
very best from an industry offering mobile solutions — take mobile banking for example —
they expect the same level of quality from all other industries, including health care. This sets
the bar very high for providers of mHealth solutions. To be competitive, they have to
leverage the same leading practices as the best mobile industries,” explains Paul Chabot,
Advisory — PI, Ernst & Young.
A sense of urgency: Although there is debate about the best solutions, there is widespread
agreement that in most developed nations the current health care system is not working,
that it is creating an unsustainable economic burden and that the scope of these problems
gets worse as populations age. This creates a sense of urgency to experiment with mobile-
enabled solutions. Research shows some 125 million Americans already living with one or
more chronic diseases, such as diabetes, heart problems or lung disorders.15
Social networks: From sharing best practices and peer-group support to encouraging and
Core health care change drivers: spreading positive behavioral change, social networks provide information flow and a
platform for patient-centric experimentation and collaboration among physicians. However,
• Cost containment research shows that physicians have so far preferred to avoid interacting with patients via
• Increased access social networks (see page 23, “Perspective on physicians”).
• Better outcomes Successful trials of mobile-enabled health solutions: Though they may not all meet the
requirements of government health regulators, innumerable trials (such as the UK and
Kenyan examples cited previously, various health and wellness applications shown to
positively change lifestyle behavior and other examples cited throughout the remainder
of this report) comprise a mounting body of evidence supporting further adoption of
mobile-enabled health. Most recently, Geisinger Health Plan reported a 44% reduction in
hospital readmissions for congestive heart failure patients, compared with a control group,
in a telemonitoring trial.16
Collaborative care models: Experiments that have begun in collaborative care models,
particularly ACOs, could become a catalyst for accelerating change in current
reimbursement paradigms, thereby helping to drive the mobile health revolution.
“Governments are exploring access to wellness care via multiple

channels — traditional, online, mobile, telemedicine — so a person’s
health can be forged in all the hours and days that their physicians
are not directly in front of them. That’s when people’s health is
really being determined.”
Aloha McBride
Advisory — PI, Government & Public Health Sector Leader
Ernst & Young

Inhibiting the vision
The big data challenge: This is really two challenges in one. First, a data quality and
integration challenge to cleanse and then stitch together each individual provider’s disparate “Where do you draw the
databases in a way that enables the seamless handoff of health information from one part of boundaries between knowing
the health care ecosystem to the next. Then, once data is seamlessly accessible, comes the
big data analytics challenge of deriving useful knowledge and diagnostic insight from the enough about a person and
huge volume of data. These steps are a prerequisite for developing an outcome-based delivery presenting just the right
model with the mobile-enabling information services at the core of the vision described above. options to them, and knowing
The IT departments of payers and providers are best positioned to address this challenge —
but if they don’t, technology companies are likely to step into the resulting vacuum.
too much and coming off like
Big Brother?”
Privacy and “Big Brother” concerns: Concern that mobile-enabled solutions will expose Catherine Zhou
otherwise private health care information to greater risk may slow adoption of the Advisory — Customer Insight & Analytics
information technology solutions. For example, Target Brands, Inc. made headlines recently Ernst & Young
as a result of using big data analysis techniques that caused maternity coupons to be mailed
to a teenager who had not yet informed her family that she was pregnant.17 Whether justified
or unfounded, there are questions about how much information consumers will be willing to
share if they believe it will be used to raise their health insurance rates, or demand behavioral
change against their will. “Where do you draw the boundaries between knowing enough
about a person and presenting just the right options to them, and knowing too much and
coming off like Big Brother?” asks Catherine Zhou, Advisory — Customer Insight & Analytics,
Ernst & Young.
The talent challenge: While there are many health care experts and many technology
experts, there are few individuals or even teams with sufficient depth in both arenas to
drive the development of mobile-enabled health care as rapidly as stakeholders would like.
That point is driven home by the university paper mentioned previously, which found that
IT expertise defined the difference between higher or lower hospital operating costs once
EMRs were deployed.
Security concerns: Information technology inevitably gives rise to information security

concerns. Notably, there are already examples, such as hackers breaking into remotely
monitored diabetes pumps. If not addressed with a high degree of confidence, security
concerns may slow adoption because mobile transmission inherently increases the risk
of data loss and security breaches. A full discussion of mobile security concerns is available
in the recent Ernst & Young report, Mobile device security: understanding vulnerabilities
and managing risks.18
mHealth gives rise to new security

concerns: already, hackers have
broken into remotely monitored
diabetes pumps.

Inhibiting the vision continued
Ecosystem competition: There’s a natural tendency for each provider, from hospital
networks to pharmacies to payers, to develop their own information ecosystem — absent a
government mandate for a general framework. If such walled gardens evolve instead of a
patient-centric ecosystem with interoperability standards that enable seamless information
sharing (when authorized), mobile health technology adoption likely will slow.
The current system of incentives: While there are many small experiments, health care
reimbursement paradigms in many developed countries still generally don’t accommodate
mobile-enabled care. “This is why even telephone calls — an effective and easy way to make
sure patients are doing okay and adhering to their medication plan, especially in between
the time they are released from the hospital and their next office visit — are grossly
underutilized,” says Dr. Fera.
The bring-your-own-device (BYOD) challenge: While not unique to health care, the
challenges enterprises face in securing sensitive information as physicians, nurses and
other providers bring their own devices to work is a particularly difficult one for health care
organizations. BYOD requires delivering applications that work across multiple platforms
with all the necessary security and privacy protections.
Overregulation: How regulators will treat various types of mobile-enabled applications and
services remains an open question. “If regulators treat too many things as medical devices
“We’re confident that data it will slow development. The viral growth would be interrupted,” explains Chabot. As this
report went to press, the health care and technology industries were awaiting the release of
of high quality is key to
final guidance from the US Food and Drug Administration (FDA) on regulation of certain
owning your future.” health and wellness apps that could add months, if not years, and significant cost to the
Heather Budd development and deployment of mHealth applications.20
Chief Operating Officer
Blackstone Valley Community Health Unknown liability: Given the newness of mobile-enabled health care approaches, the
Care (a federally funded community liabilities involved for different health care organizations are uncertain. This could impede
health center in Pawtucket, RI)19 adoption in certain litigious cultures (e.g., the US) unless blanket indemnification is
established (such as was the case in the UK telemedicine trial).
“Governments around the world are closely involved

in setting the direction and driving the development
of their health care systems. Technology companies
must remain closely attuned to the evolving
legislative and regulatory climate.”
Uschi Schreiber
Global Government & Public Sector Leader
Ernst & Young

Further exploring the mHealth vision
To explore the issues surrounding the mHealth vision, accelerators and
inhibitors in more depth, four drill-down discussions begin on page 15.
Each discussion explores the issues from the point of view of a different
stakeholder: patients, physicians, providers and payers.
Technology companies should review these drill-downs with an eye
toward evaluating where opportunities exist for their own company to
leverage its technology expertise to help enable mHealth for one or
more of these stakeholders.
“Superior health care delivery is fundamentally based on

information, timing, decision-making and consumer
involvement. Solutions in the arena of mHealth products
provide real-time experiences that enhance these fundamentals
to a great extent.”
Steven A. Matarelli
Chief Operating Officer, Administration,
Tawam Hospital, United Arab Emirates21

Forty-four million
health-related smartphone
apps were downloaded
worldwide in 2011.
“In a digital world where we can easily and securely access information about how
much money is in our checking accounts and renew a driver’s license online, patient
rights to access data are badly in need of a 21st century upgrade.”
Deven McGraw, Director of the Health Privacy Project at the Center for Democracy & Technology22

Perspective on patients
Consumers press for
health care everywhere
Current situation
Mobile technologies that have forever changed so many of the ways in which people live,
work and play are now poised to transform their health care, as well. Consumers are urging “Users need not only to
on the arrival of health care everywhere by demanding mobile service from their understand the possibilities
physicians, providers and payers. They already use smart mobile devices to trade stock,
arm and disarm their home security system, buy a car, find the nearest grocer, reserve a of eHealth tools, but they
trip around the world. But to date, they have lacked comparable health care information, also need to feel that they
applications and services. Now they are beginning to bring their increasingly mobile habits have control over how they
to bear in dealings with doctors, hospitals and payers — and in managing their own health.
interact with them.”
Worldwide, 44 million health-related smartphone apps were downloaded in 2011.23 And in European Union eHealth
the US, approximately 30% of survey respondents reported that they “always” or “frequently” Task Force Report32
turn to the internet to find answers to medical questions, with most adding this makes
them better patients.24 Four in 10 US consumers have used social media to find reviews of
treatments or doctors.25 Increasingly, access to this social and online health information is
via smartphones and tablets.26
Technology innovation enables improved Consumers test a range of

health care mHealth capabilities
Mobile networks now reach 90% of the One of the first big waves of patient
world’s population.27 Combined with empowerment is coming at the intersection
powerful transformative technology of mobile and social networking. On their
megatrends like smart mobility, social own, consumers already participate in
networking, cloud computing and big data billions of health-related discussions
analytics, these networks lay the groundwork online,28 more and more often using smart
for patients to get health care not only in mobile devices.29 On PatientsLikeMe.com,
expensive hospitals and inconvenient clinics just one of many health-related social
but in the communities and contexts in networks, nearly 150,000 registered users
which they live. Mobility in this “third place” share condition, treatment and symptom
(i.e., beyond the walls of the hospital or information on over 1,000 health issues.30
of a physician’s practice), as it is called in
Ernst & Young’s Progressions report, is not But despite all the numerous reports of
only a matter of technology. It is becoming emerging mHealth use, it’s important to
a core attribute of patients, practitioners, keep in mind that we are still very early in
providers and payers, equipping them to the adoption curve. A recent report shows
work together more effectively toward that only 23% of consumers have used
greater access to health care, lower cost mobile health solutions today — and that
and better outcomes. includes mobile phone calls to doctors’
offices. This falls far short of general mobile
usage patterns. For example, 64% of
consumers have sent a text message,
38% have used their phone to access
the internet and 27% use apps.31

mHealth apps increase patient access to Patients have not only used mobile
medical information applications, but used them effectively.
Smart mobility is enabling patients to gain In Kenya, for instance, WelTel provides a
more control of their electronic medical mobile text messaging service to monitor
records. In the US, Kaiser Permanente’s and support antiretroviral therapy, and
millions of patients were recently provided patients using it have shown a 25% greater
with a smartphone application to access adherence to their treatment regimens.40
health records through a mobile-optimized
website.33 Even prior to launching the Advanced mobile disease detection
mobile service, Kaiser’s patient portal and under development
personal health record, My Health Manager, More is on the way: with 70% of tobacco
was already being used by more than use occurring in developing countries, a
3 million members.34 Stanford University team recently developed
an award-winning application that links an
Patients use smart mobility to inexpensive device to a smartphone’s
enhance wellness … camera to screen patients for oral cancer
With their employers’ encouragement and instantly transmit the data to dentists
and independently, consumers have and oral surgeons.41 Increasingly, sensing
begun incorporating wellness and fitness devices such as blood pressure cuffs are
applications into their lifestyles. The list being connected directly or wirelessly to
of social-mobile fitness apps is long and smartphones. Such capabilities are also
growing. Some, such as the Nike + FuelBand,35 being built into the phones. For instance,
incorporate biosensors. Others, such as Korean researchers are developing bio-
Runmeter, Walkmeter and Cyclemeter, sensing capabilities for smartphone screens,
incorporate GPS capabilities.36 SoFit is a new to detect a range of diseases from a drop
gaming platform for mobile fitness.37 By of saliva or blood.42
mid-2012, there were expected to be 13,000
consumer health apps on the iPhone alone.38
… and to better manage chronic disease

Monitoring is another mobile application
that is growing in scale. Patients using
AT&T’s DiabetesManager enter blood sugar
information by internet and mobile phones,
and their caregivers provide coaching and
do tracking.39
“Nine million Kaiser Permanente patients can get their medical

record today on their iPhone, schedule appointments and
email their doctor. Patients love that level of connectivity.
They have it in other things that they do, and they’re going
to expect everyone else in health care to follow.”
George C. Halvorson
Chairman and Chief Executive Officer
Kaiser Permanente43

Figure 3: Technology innovation and the patient
Technology enabler Patient impact Emerging mHealth use Quote
Smart mobility Ability to do all of the following • China is expected to have the “The first thing we ought to recognize
from anywhere at any time: biggest mobile health market in is that mobile is now part of the
• Communicate with doctors 2017, bringing monitoring and fabric — every day in everybody’s
and hospitals diagnosis applications and life. So if you’re not looking at
• Access health-related information information to a widespread mobile solutions, then you’re not
to research conditions population with poor access really looking at all solutions.”
• Obtain health care from remote to health care.44 Mal Postings, Global CTO — IT Advisory,
Ernst & Young
and underserved communities
• Monitor and manage chronic
disease
• Fitness and wellness programs
and monitoring
Social networking Tap into peer-group knowledge to: • 23% of US internet users living “A fantasy baseball league
• Compare costs of different with chronic conditions have participant making decisions on
providers and physician practices gone online to find others who which players to select has more
• Compare outcomes performance might have health concerns data — by an order of magnitude —
of different providers and similar to theirs.45 than a patient choosing a brain or
physician practices heart surgeon.”
• Obtain peer advice on treatment Charles Kenney, author, The Best
Practice: How the New Quality Movement
and living with chronic conditions
is Transforming Medicine46
Cloud computing Enables: • Some 600 patients participating “It’s about making these powerful
• Delivery of “heavyweight” health in the Radiological Society of applications available on these
care services and information to North America’s Image Share lightweight mobile devices by
lightweight mobile devices project have reported finding leveraging cloud power.”
• Personal health care ecosystems, cloud technology to be a faster, Paul Chabot, Advisory — PI,
Ernst & Young
including secure storage of more efficient way to store and
patient information distribute their medical images.47
Big data analytics Enables: • A new US clearinghouse, “We’ve found that certain search
• Individualized health care services cognizant of patients’ privacy terms are good indicators of flu
• Targeted wellness and prevention concerns, uses a HIPPA-compliant activity. By counting how often we
• Cost comparison of different privacy framework to strip see these search queries, we can
providers patient identification from the estimate how much flu is circulating
data it is analyzing to track in different countries and regions
patterns of care and outcomes.48 around the world.”
Google49

Health care consumers wish for many improvements to the health care system: better access to doctors,
transparency in pricing, ownership of their own medical data, convenience in routine matters of scheduling and
testing, efficiency of treatment and, ultimately, better health outcomes at a lower cost. Delivery of any of these
via mobile technology should tend to accelerate their adoption of mHealth solutions for health care.
Consumer expectations: As patients grow increasingly comfortable with mobile

Core health care change drivers: technologies in other parts of their lives, they will look to the health care system to adopt
models from banking and retail that are more in tune with the hectic pace of their modern
• Cost containment lives. In fact, in online and social media settings, patients have reportedly shown a tendency
• Increased access to expect answers to inquiries within the hour — or at least the day — from health care
organizations unused to responding that quickly.
• Better outcomes
Growing cost consciousness: With patients seeing their health care costs continue to rise in
the form of medical bills, insurance rates and taxes, increasingly they are expected to turn
to such new alternatives as emerging online health insurance exchanges50 and commercial
cost-of-care sites such as Health in Reach.51
Social networks: Patients’ experiences sharing information on treatments and

diagnoses with peer groups in social networks are likely to encourage further adoption
of mHealth solutions.
“Today’s health care consumers are

better informed, technologically
savvy and expect more from their
health care system.”
Kevin Price
Global Technology Advisory Leader
Ernst & Young

Unlike other health care stakeholders, patients have relatively few factors inhibiting their adoption of mHealth
technologies. Essentially, their speed of adoption comes down to their perception of benefit versus risk. And while
patients are concerned with fewer risks than other stakeholders — they need not worry about legal liability,
regulatory compliance, IT talent acquisition, etc. — they have a significant privacy worry that their medical
information might be used against them, for example, in terms of health care access and cost.
Of course, governments hold many of the fiscal, policy and regulatory levers to set mHealth
in motion, given their responsibilities for health system budgets, economic stability and the
public good. But, “Ultimately, it will be the patient who decides how fast and how far the
system evolves,” says Ed Tomlinson, Advisory — PI, Ernst & Young. “If a patient feels that
an mHealth approach is going to be of benefit, give better health care, less intrusively, less
disruptively, then I can see fairly rapid adoption. If the patient feels that it’s going to be
more intrusive or give them a worse outcome or require them to go out of their way,
then there’s going to be a lot of resistance,” explains Tomlinson.
Privacy and security issues: The issues of privacy and security raise the loudest alarm
bells for patients. Health information exchanges among doctors, clinics and hospitals,
for example, have set off those bells for some patients, who fear their information could
be used to raise their insurance rates, impose unwanted behavioral change or otherwise
expose them to risk. Such concerns reportedly scuttled plans for a US national exchange of
this kind, although there are over 250 smaller exchanges in various stages of development.52
The Information Security and Privacy Advisory Board, meantime, is developing ways to
ensure the security of wireless medical devices and says that, “With increasing connectivity
comes greater functionality and manageability, but also increased risks of both unintentional
interference and malicious tampering.”53 This possibility, which could give pause to anyone
relying on such a device, was made all the more real with recent reports of hacking into
insulin pumps worn by diabetics.54
Health system limitations: It is still true today that few patients have access to their medical
data. In 2009, only about one in every five US physicians used even a basic electronic
health record (EHR) system, a figure that has since risen to 40%.55 Despite years of work
on these systems, in a letter to the US Department of Health & Human Services, the AHA
indicates that delays in making them available still continue.56 Without access to their own
medical data, patients will hardly be in a position to adopt mHealth.

Patient outlook
As the health system restructures itself to be more “patient-centric,”
patients are also pressing for changes in care that they feel is too costly,
inefficient, unaccountable and ineffective.
The profusion of mobile-social mHealth solutions delivered by cloud
computing and empowered by big data analytics, described earlier, is
just the beginning. New capabilities are being rolled out daily to address
the range of needs along the path toward the mHealth vision. “At the
moment there’s a whole proliferation of mobile services, not all of
which are thought through,” says Mal Postings, Global CTO — IT Advisory,
Ernst & Young. The consumerization of medical information and devices
is only getting started, as the Progressions study notes.57
Ultimately, though, the Progressions report suggests that patients
empowered with their own information in their own settings could
trigger huge efficiencies throughout the health system as they take
more preventive actions, engage in real-time monitoring, choose better
and more cost-effective options and live healthier lives.58
Opportunities for technology companies
• How can we make mHealth apps ever easier and more engaging to use?
• How can we alleviate concerns about security, privacy, reliability?
• How can we make medical devices work seamlessly with patients’ smartphones
and/or make smartphones themselves do some of the jobs now performed by
medical devices?
• How can we create applications that provide real-time comparative information to assist
patients in negotiating costs with their physicians?

Within one year
of the iPad’s
launch, 27% of
physicians
surveyed owned
tablet computers.
“The digital world — the internet and the cloud
and supercomputing and social networking —
are breaking medicine out of its cocoon. It’s a
superconvergence we’ve seen in other walks of
life but not in the health and medical sphere.”
Eric J. Topol, M.D.59

Perspective on physicians
Physicians avidly adopt mobile devices,
but concerns about specific uses remain
Current situation
Physicians have always had to be accessible — so they have been rapid adopters of the
latest in mobile technology. Years ago, answering services and call centers were the “Strong mobile security and
gatekeepers that could get your message to the doctor, if your emergency warranted it. patient privacy standards are
Then came beepers and, later, the first wave of voice-only mobile phones. Today, physicians
needed before physicians will
are rapidly adopting smartphones and tablet computers (for example, one research house
says 81% of US physicians use smartphones).60 be comfortable using evolving
patient-centric medical
But it’s still early in the adoption of smart mobile technology for health care, or what
International Data Corporation (IDC) calls “clinical mobility,”61 and there is a wide range of information ecosystems.”
mHealth uses for physicians. These begin with basic telehealth applications that provide David Kahan
voice or SMS access to medical advice from remote areas (with many examples in the Advisory — ITRA
developing world), and simple appointment-scheduling apps. More transformative uses Ernst & Young
have begun to appear as well, such as mobile telemetry apps that constantly gather and
transmit a person’s vital statistics in real time, or mobile e-prescribing apps. Still very rare
are emerging mobile collaboration apps that will eventually enable simultaneous real-time
access to the latest medical data, patient history and specialist video consultations.
The value of advanced clinical minimally trained Sky Care franchisees and For all these reasons, mobile device
mobility apps intermediately trained Sky Health Centre adoption statistics show rapid uptake
A true story from cardiologist franchisees. Mobile phones enable the among physicians.
Eric J. Topol, M.D., published in an article lesser-trained franchisees to send patient
by the American Medical Association information via text message to remote • An April 2011 poll of 5,490 primary care
(AMA), illustrates why mobile technology medical experts in urban centers, who and specialist physicians found 27% owned
is emerging today as a game changer for “make a diagnosis and then send a text tablet computers, a rate five times higher
physicians. During a cross-country flight, message back with a recommended than the general population — just one
he was brought to a passenger “in obvious prescription or a course of action.”63 year after the introduction of the iPad.66
trouble.” Typically, according to the article,
“Dr. Topol would have had to make an Smart mobility brings the potential of • Approximately 80% of 115 medical residents
educated guess and hope he could take health IT (HIT) to life in a Chicago hospital said their tablets
care of the patient until the plane landed. Stories such as these strike to the heart of made them more efficient, saving roughly
This time, though, he pulled out his why clinicians are rapidly adopting mobile an hour each day and often enabling
iPhone, and with an app that produces technology, even though they have long treatments and prescriptions to be
an electrocardiogram, he determined that been viewed “as computer-phobic Luddites, ordered earlier than they otherwise would.67
the patient was having a heart attack. The slow to adopt and benefit from health IT.”64
plane made an emergency landing while Mobility — and the easy usability of • 76% of small- to medium-sized physician
paramedics waited on the ground to take smartphones and tablets — has “caused and dental practices in a January 2012
the patient directly to surgery.”62 physicians to view health IT adoption as survey said they planned to buy tablets
something they want to do, as opposed to in the next 12 months.68
Simpler applications are significantly something they are being forced to do,”
improving medical care in rural areas of the according to another AMA article.65 For
developing world. An example is World example, it has caused many physicians to
Health Partners in India. This for-profit view EMRs more favorably by enabling
health care business has networks of instant mobile access to EMR data.

Figure 4: Technology innovation and the physician
Technology enabler Physician impact Emerging mHealth use Quote
Smart mobility Enables real-time, anytime, • 76% of small- to medium-sized “The realm of ‘mobile’ health, with
anywhere: US physician and dental practices the proliferation of smart apps and
• Access to patient information surveyed in January 2012 integrated, connected devices, soon
• Access to medical information planned to buy tablets in the to have elements of ‘artificial
databases next 12 months.69 intelligence’ to enhance prevention,
• Better ability to monitor tracking and compliance will have
chronically ill patients the biggest impact and ability to
• Higher revenue potential (e.g., improve outcomes at a lower price
can see more patients per day) in the next decade.”
and lower administrative costs Dr. Daniel Kraft, Medical Chair,
Singularity University70
(i.e., through find-a-doctor or
automated scheduling apps)
Social networking • Enables physician-to-physician • 87% of US physicians use social “If an outbreak occurs, transmission
collaboration media for personal purposes; of information about it can occur
• Provides rapid learning 67% use it professionally.71 worldwide in seconds [on social
environment media]. From a public health
• Enables patient-physician perspective, that’s an extremely
collaboration powerful tool.”
• Enables rapid dissemination Westby Fisher, M.D., Clinical Associate
Professor of Medicine, Pritzker School of
of public health information
Medicine, University of Chicago72
• Creates better informed, more
connected patients — with
impacts both good and bad
Cloud computing Provides platform for: • One company used the cloud to “The digital world — the internet and
• Collaboration integrate context-aware voice the cloud and supercomputing and
• Participation in health recognition into its EHR offering, social networking — is breaking
information ecosystems enabling doctors to fill out the medicine out of its cocoon. It’s a
• Hosted EHRs patient record by speaking words superconvergence we’ve seen in
• Advanced capabilities not into a mobile device.73 other walks of life but not in the
possible on local devices health and medical sphere.”
(e.g., voice-to-text translation) Eric J. Topol, M.D.74
Big data analytics Enables: • athenahealth, Inc., AT&T and “You’re going to start to see this
• Better patient-based outcomes the Massachusetts Institute of sort of big data effort on several
using diagnostic decision-support Technology’s H@cking Medicine [health care] fronts — partly because
information delivered via mobile magazine sponsored a “Health of supercomputing capabilities that
devices 2.0 Code-a-thon” in May 2012 we haven’t had until recently and
• Personalized medicine to showcase the potential of big also because of wireless devices
• Customized medical plans based data analytics in health care.75 that are increasingly being used to
on patient type of service transmit data.”
(e.g., face-to-face, email, remote) David Haussler, Director of the Center for
Biomolecular Science and Engineering,
UC-Santa Cruz76

What’s driving physicians to go mobile so fast is less the grand vision outlined in our “Overview” (page 4) and
more the direct impact on their practices and their patients of those aspects of the vision that are already possible.
Nonetheless, physicians’ rapid adoption could propel the health care industry toward the three underlying goals
of that vision — lower cost, increased access and improved outcomes.
Decision-making insight: The anecdote provided by Dr. Topol may represent the most
important accelerator: the ability for a physician to gain immediate diagnostic insight from Core health care change drivers:
a mobile tool, including access to patient record information, whenever and wherever they
are. “Mobile access to medical records, test results and real-time vital signs translates into • Cost containment
a direct improvement in treatment and outcomes,” says Paul Chabot, Advisory — PI, • Increased access
Ernst & Young. “From what I have seen among our health care clients, physicians are very
excited. They are asking for new mobile solutions and are very eager to start using them.” • Better outcomes
Anytime, anywhere collaboration: Another direct impact is that mobile devices can enable
information sharing that eliminates the time-consuming fax-and-phone-call process
physicians have traditionally used to collaborate. “As ACOs and other pay-for-performance
business models proliferate, the requirement for collaboration among physicians will
increase, so the value of mobile technology will increase as well,” says Chabot.
Managing costs and increasing revenue: Proliferating pay-for-performance models also

are expected to accelerate physicians’ interest in mobile remote monitoring and remote
consultation technologies. “When a physician is being paid to keep people well, it’s better to
check on patients remotely instead of via a high-overhead office visit,” explains Scott Ponder,
Advisory — PI, Health Care, Ernst & Young. “In addition, remote consultation solutions also
offer physicians a low-cost revenue opportunity — for example, neurologists already are
doing remote consultations called telestroke, which involves the application of telemedicine
for stroke victims,” Ponder says.
The mobile-social connection: Smart mobile devices tend to enable greater use of social
networks, and personal use of both mobile and social networks tends to drive subsequent
professional use. Indeed, 87% of approximately 4,000 US physicians surveyed in August
2011 said they used social networking sites for personal purposes and 67% said they used
them professionally.77 The same study said physicians primarily used physician community
sites for professional purposes, and tried to avoid patient interaction when using social
networks for personal purposes. However, “the genie is out of the bottle,” and two-way
doctor-patient communication via social networks is likely to evolve.78

Despite physicians’ rapid adoption of smart mobile devices, several
concerns are limiting their use of the most advanced mHealth applications.
Fear of litigation: In the August 2011 study mentioned on page 25, 73% of the 4,000
physicians responding listed “concerns about liability” as a top issue holding them back
from interacting with patients online (including mobile) — more than any other factor.79
Security and privacy: Protecting patient privacy was the second-biggest concern holding
back physician interaction with patients online in that August 2011 study, cited by 71% of
respondents. Solutions are available, but not in the kind of universal, standardized way that
inspires widespread confidence.80
Payment models must change: While the Progressions report describes a multitude of
experiments involving new incentives and reimbursement methods for remote care, these
are still only experiments — often only in rural areas where access is problematic — and
“Lack of reimbursement, haven’t been fully adopted yet.
concerns regarding patient
Data interoperability: To be most useful, physicians’ mobile apps must be able to integrate
privacy and fear of litigation data from multiple disparate sources to support rapid decision-making, and allow clinicians
are the three main factors to change the data and reflect those changes back to the source. But much of the needed
holding back physicians in the data is currently stored in multiple incompatible databases. A related issue is interoperability
among physicians’ mobile platforms. “If a physician’s mobile software doesn’t support the
US from more rapidly pursuing platforms of all the other doctors he or she is collaborating with, it may not be worth the
remote care via mobile devices.” physician’s investment,” says Ponder.
Dr. Bill Fera
Advisory — PI, Health Care Access to aggregated data: Further, while mobile EMRs make it possible for physicians to
Ernst & Young access their patient data, it’s not clear how individual practices will gain access to aggregated
data or the insights made possible by analysis of such data.

Physician outlook
Given the way physicians are embracing mobile technology, it’s no surprise
that at least one research organization believes community-based physicians
will be the ones driving hospitals to innovate around mobile HIT, rather
than the other way around.81
Indeed, physicians’ adoption of smart mobile devices and applications

for remote monitoring, diagnosis and information access is a critically
important first step toward a comprehensive mHealth future. These devices
and applications represent the initial infrastructure that makes possible
cloud-based information services that promise to empower future
physicians with tools to enable personalized medicine that is practiced
wherever a patient happens to be. It is not hard to imagine, for example,
a physician’s video portal that enables mobile access to Khan Academy-
style rapid learning sessions or instantaneous collaborations with a needed
expert somewhere else in the world. Such capabilities, taken together,
ultimately are what will lead to virtually universal access to health care
with lower cost and improved outcomes.
• Physicians have demonstrated a natural desire for mobility given their busy
schedules and ever-increasing demands on their time. How can we innovate with
technology to allow physicians to see more patients, more efficiently; enable data
analytics to support them; and yet reduce concern over patient privacy and fear
of litigation?
• Physicians are pragmatic — they won’t change easily without seeing tangible value.
How can we meet their expectations with demonstrable return on investment and mobile
user interfaces that make information intuitive, fast and easy to grasp?
• There aren’t enough doctors in the world. Can we build applications or services
that empower remote access, including empowering lower-level clinicians to perform
at higher levels through mobile-delivered information or real-time collaborations
with experts?
• New pay-for-performance business models anticipate increasing collaboration

among physicians. How can we build systems enabling real-time mobile consultations
and collaboration (including documentation for subsequent payment)?

Monitoring services
will account for 65%
of the global mHealth
market by 2017.
“Very few technologies have scaled down to even the remotest
village in sub-Saharan Africa. Cars haven’t, fridges haven’t, literacy
hasn’t. But mobile phones have.”
Joel Selanikio, M.D.
CEO and Co-founder, DataDyne Group LLC82

Perspective on providers
Reaching patients beyond
the hospital doors
Current situation
Hospitals are beginning to expand medical services beyond their four walls and out into
the populations they serve — pulled by mounting health care demand, pushed by public “To capture the opportunities
policy and powered by new technology megatrends, particularly smart mobility and social
made possible by big data
networking. As the cornerstones of community health care, hospitals are being turned to by
patients, governments and payers alike to help lead a global transformation to health care analytics, providers will have to
everywhere, with lower cost, greater access and better outcomes. The vision before them: overcome existing data silos,
expanding medical information and services to “the third place,” as Ernst & Young’s such as separate systems for
Progressions report puts it.83 In other words, beyond the hospital doors to wherever the
patient happens to be, thus paving the way for healthier lifestyles, fewer “heads in beds”
admissions, ER, cardiology, etc.
and patients empowered to better manage their own conditions in response to today’s It requires an integrated
worldwide epidemic of chronic diseases aggravated by aging populations and the rapidly enterprise view.”
growing health care demands of the developing world.
Mark Vreeland
It is a difficult role for hospitals to play — especially in the US, where “volume, not value, Advisory — PI, Health Care
is rewarded,” according to a multisector task force report produced by the Ewing Marion Ernst & Young
Kauffman Foundation.84 The report states: “What providers provide is not accountability for
a patient’s overall health but individual procedures, each separately coded and paid for —
which is a bit like buying a car one part at a time, without regard to how it drives.”
Health care everywhere models Cost is a rising issue for difficult choices between the up-front
challenge providers In the meantime, even though lower cost costs of mHealth innovations and their
New US policies attempt to flip that pay-for- and better outcomes have been urgent US promise of long-term cost reductions,”
service model, and have already begun priorities for years, costs are still rising at a notes Kenny O’Neill, Advisory — PI,
introducing value-based payment models faster rate than outcomes are improving.86 Ernst & Young.
that, in part, seek to keep individuals out of The average US hospital stay plus follow-up
expensive hospital facilities. The trade-offs costs $17,988.87 This, despite the fact that Cost-quality trade-offs are emerging in
are not lost on hospital administrators, competition is mounting, as the very developing regions
who do not necessarily see their finances definition of “health care provider” In developing countries, there is yet
improving as a result. Even as hospitals continues to evolve — ranging from the another set of trade-offs. On the one hand,
automate processes, pilot mHealth options established hospital, pharmaceutical and “Developing countries don’t have the
in their communities and implement EMR medical device companies up to and mature hospital infrastructures you find in
systems in the spirit of health care including more urgent care centers, retail the US or Western Europe — but they do
everywhere, “savings from these programs walk-in clinics, drugstore health care have mobile technologies and consumers
have the potential to be realized mostly by wings,88 outpatient surgical centers,89 who are actually more savvy using mobile
the payer if new financial arrangements are mobile medical vehicles, boutique in some ways. They can leapfrog the rest of
not established,” according to the AHA.85 To (sometimes, physician-owned) hospitals, the world,” says Catherine Zhou, Advisory —
the extent that the health care everywhere extended care facilities, community centers Customer Insight & Analytics, Ernst & Young.
movement does successfully migrate care and other nongovernmental organizations According to the World Health Organization,
beyond the four walls of traditional (NGOs). however, “Health systems worldwide are
providers, these providers will be challenged under increasing pressure to perform under
to reimagine how they do business. While cost is lower in the rest of the world, multiple health challenges, chronic staff
it is still a major issue for most countries. shortages and limited budgets, all of which
“In the UK, a national budget crisis makes makes choosing interventions difficult.”90

The pressures are mounting in a world • In China, kiosks and mobile phones are
“What providers provide is in which the sheer numbers of people used for consultations in remote regions.
not accountability for a requiring care are increasing — not only as For example, individuals can input
a function of the epidemic levels of chronic information such as blood lipid values
patient’s overall health but
disease, but because the global population into a One Stop Medical Report terminal,
individual procedures, each is growing and living longer, and whole new which returns reference values and the
separately coded and paid groups are now able to buy health care (for clinical significance of the patient’s input,
for — which is a bit like instance, Chinese citizens with rising along with a health assessment and
incomes and US citizens under the advice on actions to maintain or improve
buying a car one part at a government’s new policy for universal health. The terminal might indicate high
time, without regard to how health coverage). cholesterol or possible diseases, suggest
it drives.” that a hospital diagnosis is required and
Numerous mHealth pilots around the world facilitate appointment booking.95
Report by the Ewing Marion
are beginning to demonstrate how hospitals
Kauffman Foundation91
will be able to roll out mobile technologies • In the Middle East, Africa and elsewhere,
to make gains in public health. A national Emirates Telecommunications Corporation
UK teleHealth trial has shown reductions of (commonly known as Etisalat Group)
15% in emergency visits, 20% in emergency has been advancing maternal health
admissions, 14% in elective admissions, applications in alliances with various
14% in bed days and, ultimately, 45% in providers. A partnership with D-Tree
mortality rates.92 International, an NGO, has developed a
mobile phone app for African midwives
Providers’ choice: disrupt or be disrupted to screen pregnant mothers to identify
“Technically, there’s no As the vision for health care everywhere risks, find the closest health center and
difference in mobile security unfolds, hospitals must decide whether to identify a means of transportation to
harness mobile technologies’ promise of reach the clinic.96 In Saudi Arabia,
issues from industry to transformative innovation or watch as others expectant parents receive ultrasound
industry — it’s all data. But disrupt the health system around them. images and videos via multimedia
if my financial account is Hospitals are responding with innovation — messages to their mobile phones
though sometimes with pushback for more following visits to maternity hospitals in
compromised and used
time to revamp structures, systems and the Dr. Sulaiman Al-Habib Medical Group.97
fraudulently, the firm can procedures already in place93 — and also
reimburse me; if a health with partnerships. These alliances range And more is on the way, as providers look
care company loses my from working with fitness app providers to to exploit the big data, cloud computing,
joining large health care ecosystems of social and mobile technology megatrends
private information, they physicians, hospitals and clinics dedicated to reshaping all industries today. For instance:
can’t ‘un-lose’ it.” new value-based outcomes, such as ACOs.
Joshua Stabiner • Advocate Health Care, a large
Advisory — ITRA Their pilot mHealth implementations Midwestern US health system, will use a
Ernst & Young include: cloud solution to integrate its data silos,
including administrative and electronic
• Partners Healthcare, founded by health information, and then apply data
Massachusetts General Hospital and analytics to predict patient outcomes
Brigham and Women’s Hospital, has before they occur — with a goal of early
initiatives including Connected Cardiac interventions.98 Included is a team-based
Care, a TeleStroke Center, Diabetes model that manages patients across
Connect, Blood Pressure Connect and multiple sites of care.
text messaging for patients who are
pregnant or have skin problems. • The US government recently gave a
Partners reports a 48% reduction in $1.9 million Health Care Innovation
rehospitalization of cardiac patients, Award to George Washington University
who input vital information from home Hospital to develop clinical support and
and are coached and monitored daily by monitoring via the web for home kidney
a telemonitoring team.94 dialysis patients.99

Figure 5: Technology innovation and the provider
Technology enabler Provider impact Emerging mHealth use Quote
Smart mobility Ability to expand beyond hospital • Monitoring services (e.g., for “When I think about the biggest
walls to: chronic disease management) impacts, I think patient reminders …
• Partner with patients in fitness will account for 65% of the global the supply chain … and then online
and wellness programs mHealth market by 2017. digital records, where the high
• Handle administrative matters • Diagnosis services payoff will be vaccination coverage.
• Share EMRs (e.g., telemedicine and health ... Of course, because it’s new
• Treat patients at home call centers for isolated areas) technology, we should let a
• Monitor post-operative patients will account for 15%. thousand ideas blossom.”
• Monitor and manage chronic • Treatment services Bill Gates, Co-Chair,
Bill & Melinda Gates Foundation101
disease (e.g., adherence to medication
• Reach remote and underserved schedules)will account for 10%.100
communities
Social networking Establish real-time interactive • Nearly 1,200 hospitals across “Have #lupus? Be sun smart. UV
communications to: America have added some form rays can trigger a
• Engage more effectively with of social media, be it Facebook, flare.http://bit.ly/IldE6H
patients Twitter or blogs, to their #ArthritisAction #MayoClinic”
• Share knowledge and experience communications efforts.102 A tweet from the Mayo Clinic
with peers
• Market services
Cloud computing Enables: • Some 2,000 US hospitals and “Health IT is the foundation for a
• Delivery of “heavyweight” health 41,000 doctors have received truly 21st century health system
care services and information to $3.1 billion in federal incentive where we pay for the right care, not
lightweight mobile devices payments for ensuring just more care.”
• Networking with other hospitals, meaningful use of EHRs.103 Kathleen Sebelius, Secretary,
US Department of Health and
physicians, clinics, payers
Human Services104
• Sharing EMRs with patients
Big data analytics Enables: • The Seton Healthcare Family “We don’t want to take the intuition
• Establishing patterns of behavior hospital system in Texas learned and clinical decision-making out of
in patient populations from data analytics last year that the process. We want to facilitate it.”
• Individualizing health care a bulging jugular vein is a strong — Nicholas Morrissey, a surgeon at New
York-Presbyterian Hospital106
services and easily observed — predictor
• Developing preventive care that someone admitted for
• Understanding outcomes of congestive heart failure has
various types of interventions a higher chance of future
readmission.105

Drug and device providers
stand to benefit from mHealth
behavioral change
Pharmaceutical and medical device The embrace of these patient-centric

companies are mobilizing cutting-edge technologies by pharmaceutical and medical
information technology in the move toward device companies has implications for all
health care everywhere and encouraging four key groups analyzed in this report:
new behaviors in populations where chronic patients, physicians, providers and payers.
illness is epidemic. As they do, smart
mobility and social networking have become Patients, for instance, are already beginning
key agents of behavioral change, with a to use wireless-connected electronic pill
demonstrated ability to increase patients’ bottles and smartphone wellness apps,
adherence to treatment. Cloud computing making it easier to measure their behaviors
provides an environment in which EMRs and and providing the context for life sciences
clinical trial data can be shared across the and health care companies to launch
health care system, with big data analytics incentive programs and other behavioral
“ Life sciences and health care making sense of the increasing volumes of change initiatives.
companies are increasingly patient data to help pinpoint new and better
treatments. Physicians are increasingly using their
expected to demonstrate to
smartphones and tablets to review patients’
payers how their offerings For medical device companies like vital statistics, which are themselves
improve health outcomes and Medtronic, Inc., these converging uploaded from wirelessly connected medical
the efficiency of health care technologies will lead to mobile phones that devices to physician/clinician portals. In the
give patients control over programming and same vein, providers such as hospitals are
delivery. Reducing costs will running implanted devices, among other able to release post-operative patients and
ultimately require a greater advances, according to Stephen Oesterle, monitor their progress remotely, rather than
focus on preventing disease and M.D., Medtronic Senior Vice President for keep them in expensive hospital beds.
Medicine and Technology.107 Already, the Payers, for their part, see the cost benefit
influencing patients to better
company’s CareLink Network connects from fewer “heads in beds.”
manage their own health. cardiac device patients, whether at home or
Successful companies will seek away, providing clinicians with 24/7 internet Still, challenges to realizing these benefits
to extend their business models access and a smartphone application for range from potential medical liability to
monitoring them.108, 109 regulatory uncertainty to information
beyond the drug or device to security and privacy. In the US, for example,
offer payers, providers and Improving adherence to therapeutic regimes FDA draft guidelines issued in early 2012
ultimately patients more value — through mHealth technology promises a for pharmaceutical companies’ interactions
range of benefits for drug companies, in social media raised confusion in the
all of which will be accelerated
including lower probability of adverse industry.112 The guidance did not address
by mobile technologies.” events, side effects, reinfections, relapse the issue of companies’ liability for comments
Glen T. Giovannetti rates and the emergence of treatment- made by third parties — a concern that led
Global Life Sciences Leader resistant pathogens.110 In mid-2012 a unit of many pharmaceutical companies to shut
Ernst & Young Johnson & Johnson launched Care4Today down their social media pages in August
Mobile Adherence, a messaging platform, 2011 when their ability to shut off public
mobile application and website that work in comments was eliminated.113
concert to remind patients to take their
medicine, refill their prescriptions and see
their doctors.111

Medical device makers face similar • Where will consumers perceive the line
regulatory uncertainty. The US FDA is in the between encouraging behavioral change “We are moving toward a future
process of evaluating feedback to draft and invading privacy? with smaller implantable
guidelines it issued last year that expanded
the definition of a regulated medical device • Will privacy concerns and competitive
sensors, patient-controlled
to include certain mobile apps that are able interests block the open exchange of big mobile devices, real-time data,
to control a medical device, that display data for medical research? remote services that assist
data from a device or that can transform a
patients and caregivers and
mobile device into a regulated device, such The immediate ways in which mHealth
as an electronic stethoscope.114 “So far, the technologies stand to benefit medical device more.”
expectation is that if you’re using any companies are by creating standard wireless Stephen Oesterle, M.D.
mobile technology to diagnose, prevent, platforms for managing different medical Senior Vice President for Medicine and
monitor or treat a health condition, then it’s devices as well as for sharing the Technology, Medtronic Inc.115
going to be considered to be somewhere in information such devices generate.
the health care continuum and it will be
regulated,” says Ed Tomlinson, Advisory — • How can remote monitoring networks be
“... our vision [is for] enabling
PI, Ernst & Young. improved, with more rapid access to secure, real-time access to
patient data, while preserving security de-identified patient data
Opportunities for technology companies and patient privacy?
across the health care and life
The immediate ways in which mHealth
technologies stand to benefit • What products and services can be sciences ecosystem.”
pharmaceutical companies are from developed to help physicians and David A. Krusch, M.D,
improved outcomes resulting from better clinicians manage the potential Chief Medical Information Officer,
patient adherence to treatment and the “information overload” resulting from University of Rochester Medical Center,
potential to accelerate product development increasing mobile-device data? and Chairman of PACeR’s Project
while lowering cost. Leadership Committee116
• In what ways can we accelerate testing
• How can we build better tracking of drug and consumer feedback loops that lead
use compliance without violating patient to improved, simpler device user
privacy? interfaces?
• In what ways can big data analytics • How can cloud-based services facilitate
be applied to help pharmaceutical patient monitoring or remote device
companies identify patterns from large programming?
volumes of biometric data that suggest
not only new treatments, but also the • Will the consumerization of medical
best treatments for patients? devices create an opportunity for us to
leverage mHealth platforms to build
• How can we improve social networks products and services that compete with
among physicians, clinicians and medical device companies?
pharmaceutical companies so that they
contribute to identification of new
therapeutic regimes, faster product
development and lower development
costs — all while maintaining individual
patient privacy and security?

Factors ranging from strong consumer and physician demand to providers’
own experiences and government incentives are all driving the adoption of
mHealth technology.
Hospitals’ in-house mobility: Clinicians typically use 6.4 different mobile devices daily
within hospitals, by one account — primarily mobile point of care solutions on laptops,
tablets and “workstations on wheels.”117 These will increasingly expand outside the hospital
as well.
Consumer and physician demand: Easy-to-use mobile apps have improved consumers’ lives
in many areas, and they’ve begun to demand the same from health care. The Kauffman
Foundation report describes health care frustrations: “Running the gauntlet of specialists,
and tests and hospitals and offices, patients feel like mice in a maze of someone else’s
(or, worse, no one’s) devising, with little real responsibility for or control over the system of
which they are part.”118 As a result, health care consumers are increasingly turning to social
media and a host of new fitness, wellness and health applications on their smartphones
and tablets (see page 15, “Perspective on patients”), and hospitals are finding patients’
expectations mounting in these online settings. Likewise, physicians are finding valuable
utility in smart mobile devices (see page 23, “Perspective on physicians”). And all of this is
creating an environment to enable pharmaceutical and medical device companies to explore
new mHealth-related devices and drug compliance regimens.
Government policy and incentives: In the US, for example, initiatives such as the Medicare
and Medicaid EHR Incentive Programs use rewards (and by 2015, penalties) to advance
the meaningful use of EMRs shared across health care settings. The incentives contributed
to a 14.2% growth in US sales of EHRs in 2011, to $17.9 billion119 — and EHRs are
increasingly mobile-enabled.
Competition: Technology companies are all-too familiar with the importance of first-mover
advantage. Competition from early-moving providers as well as from software companies
offering mHealth apps is likely to spur more providers to adopt quickly. “An early mover
Core health care change drivers: edge might be going to software providers already in such lower-barrier markets as fitness
applications, and to telecom operators, internet service providers (ISPs) and cable companies,
• Cost containment who can reach into every home and wallet with their networks,” explains Tomlinson.
• Increased access Lower drug-development cost: Big data analytics and cloud collaboration hold the
• Better outcomes promise of reducing the typical drug development cost, estimated at $1.3 billion and a
10- to 15-year time-to-market.120

As mHealth adoption pushes providers closer to the health care everywhere
vision, everything from business models to workflow processes are in flux.
Resistance to changing these well-established practices is an overarching
inhibitor.
Business models: Hospitals are making big changes, whether merging horizontally or
vertically, developing networked niche specialties such as cancer care or otherwise “Given constrained staffing
rethinking their current business model in the transitioning health care market — all of at many providers, the
which will take time.
clinicians’ fear is that
Unknown liability: Technology changes of the scope imagined by the adoption of mHealth technology will add to their
carry risk, and the newness of mHealth means those risks are not yet well understood. workload without delivering
Hospitals’ risk-averse nature is only reinforced by the prevalence of malpractice litigation,
any benefit. Mobile devices
at least in the US.
that don’t complement clinical
Regulatory uncertainty: Pharmaceutical companies, medical device makers and technology practice and become business
companies moving into the mHealth app market — for example, as smartphones morph into as usual will add to the
diagnostic and remote monitoring devices — face uncertainty about which apps and devices
will and will not be regulated.
workload and slow adoption.”
Kenny O’Neill
Workflow and usability: “For the clinicians, there’s always a question around workload: Advisory — PI
‘Is this going to create more work in my daily job?’” says O’Neill. For example, telehealth Ernst & Young
units have to be integrated into the existing clinical pathways for treating a targeted
disease. “Given constrained staffing at many providers, the clinicians’ fear is that
technology will add to their workload without delivering any benefit. Mobile devices that
don’t complement clinical practice and become business as usual will add to the workload
and slow adoption,” O’Neill suggests.
Data integration issues: Hospitals typically have disparate and disjointed data silos across
departments, and the automated sharing of information across health care providers has
been slow to advance. This kind of sharing will be essential to the success of mobile access,
transparency of information and data mining in the interest of patient-centric care.
Lack of transparency: Hospitals have been slow in easing patient access to information, in
part because of these data integration issues and technology limitations — but compounded
by the medical practice’s sometimes inaccessible technical and legalistic language and
paternalistic posture toward the patient. The AHA stirred significant controversy with an
April 2012 letter to the US Department of Health & Human Services asking that pending
federal requirements for patient portals be scaled back, if not eliminated.121
IT department challenges: Provider IT departments are already overloaded and hard

pressed to adapt to new technology megatrends in addition to their many regulatory
compliance demands, such as EHRs. Even finding health care-savvy technical staff is a
problem (see page 4, “Overview”).
Device complexity: On average, consumers give up on new electronics items after only
20 minutes of trying. mHealth devices will need to be simplified for consumer acceptance
to scale.122

Providers outlook
Health care everywhere remains a future vision. But today we see strides
toward enabling the vision everywhere, as in the $14.2 billion (and
growing) global market for monitoring devices tracking blood pressure,
glucose, EEG and other vital statistics (of which home monitoring accounts
for a 38.3% and growing share).123 “Right now, providers across the health
care continuum are involved in thinking, planning and bracing for change —
and they’re experimenting,” says Zhou.
Adds Dr. Fera, Advisory — PI, Health Care, Ernst & Young, “Providers have
to assess where their organization is, find low hanging fruit where they can
get real reimbursement and return on investment today, and start putting
in place the infrastructure that will support further adoption tomorrow.”
The Kauffman report concludes that the health care system today is in
one of two places. First, “It might be forging ahead technologically but
mired structurally in the past.” Alternatively, “The system might be
at the doorstep of a gradual but eventually decisive transition to
improvement and efficiency. It might be at a place where previously
undreamt-of analytical tools, sifting through mountains of previously
inaccessible information, can give the system the knowledge about
effectiveness and the awareness of itself that it has lacked; where paths
beyond fee-for-service are clearly visible ahead; and where, in pockets of
innovation around the country, change is proving its mettle.”124
• Provider clinicians need universal access to patient and medical information. How can
we help providers accelerate toward the goal of system-wide access to all patient and
medical information for all clinicians who need it?
• Providers are re-imagining themselves in the health care everywhere paradigm. How can
we leverage technology innovation to help them profitably deliver health care services
beyond the four walls of the hospital?
• There’s a serious shortage of talent knowledgeable about both health care and
technology. What can we do to extend IT expertise to providers?

In February 2012, the UK’s
NHS began encouraging
physicians to prescribe
smartphone apps to
patients.
“A new generation of patients are demanding an increasing
understanding of their health needs. Yet despite the billions of
dollars spent on health care globally, we continue to fail to exchange
information that is mutually beneficial. The ability to connect
patients and clinicians with the information that truly improves
clinical outcomes is surely one of our greatest challenges.”
Gary Howe
Global Health Care Leader
Ernst & Young

Perspective on payers
mHealth experiments proliferate as payers
search for ways to foster behavioral
change and improve patient monitoring
Current situation
Health care payers around the world are prodigiously experimenting with mobile devices,
applications and programs as they strive to improve the health of their populations, better “The payers have a real financial
manage chronic disease, extend health care access and lower cost. This is true whether the
stake in keeping you healthy.
payer is a government, a government-backed insurer, a private insurer or an employer. But
in general, their use of mHealth technology is just beginning. After all, these are vast and So they’re taking the lead
complex systems, many of which are already struggling to reinvent themselves in a “pay- now … in order to identify the
for-performance” paradigm after having optimized their large bureaucracies over the best behaviors to encourage.”
course of many decades for the “pay-for-service” approach. In other words, they’re striving
Scott Ponder
to switch from being treatment-focused to being oriented around prevention, whether
Advisory — PI, Health Care
preventing a rehospitalization of a chronically ill patient or preventing a healthy individual
Ernst & Young
from ever needing care in the first place.
Pay-for-performance can lead to greater “The payers have a real financial stake in
customer engagement — enabled in part keeping you healthy,” says Scott Ponder, “We have invested heavily
by mobile technology Advisory — PI, Health Care at Ernst & Young. in a service-oriented
Payers’ emerging prevention orientation “So they’re taking the lead now in terms of
means they’re interacting directly with analytics, population management and
architecture as part of our
consumers about far more than just paying chronic disease management in order to business model and that
or denying claims. In this new paradigm, identify the best behaviors to encourage has allowed us to bring a
payers have financial incentive to educate and the best ways in which to express
lot of things to the web,
health care consumers to help foster that encouragement,” Ponder explains.
healthier lifestyle choices, directly That interaction can come in the form of to mobile and handheld
encourage healthy behaviors and better a mobile application. And increasingly, technology. The health
monitor chronically ill patients to avoid according to Ernst & Young’s Progressions care system is difficult to
costly hospitalizations. And payers are report, it comes as part of a more holistic
experimenting with smart mobile devices health care approach than has been
navigate, so we have been
as a key mechanism for such interaction traditional for payers. building tools that make it
because of their easy usability (which easier for customers to
simplifies access), their ubiquity in the
interact with the system.”
developed world and, in developing regions,
their ability to reach people beyond the Mark T. Bertolini
electric grid. Chairman, CEO and President
Aetna125

A cornucopia of mHealth apps Smart card technology lowers Taiwanese
The most comprehensive support of mobile health administration costs
technology we’ve seen from a payer so far A long-running example involving older
came from the UK government. In February mobile technology exists in Taiwan, where
2012, the UK’s National Health Service smart cards have been used since the
(NHS) announced that it was encouraging adoption in 1995 of near-universal health
physicians to “prescribe smartphone apps coverage through a national insurance
to patients” (as one UK news service put model with one government-run insurer.
it).126 The NHS has identified nearly 500 The smart card is used for billing and to
such applications for this purpose, including store each person’s medical history. Along
one that uses barcode scans to determine with the one-insurer system, the technology
packaged food ingredients in order to warn is credited with making Taiwan’s health
allergy sufferers, an app for diabetes care administrative costs the lowest in the
management, another that lets patients world.132 Many other nations, especially
obtain their medical records from all their in Europe, also have gained health care
clinicians and control who has access to efficiencies using smart cards. Today,
them and the government’s own NHS multiple organizations and alliances have
Choices app, which offers practical advice evolved to offer mobile payments and
and helps people find medical services. mobile wallet technologies on various
smartphone platforms. Once these mobile
US insurers also offer many mobile apps payment technologies are sufficiently
Also in February 2012, the US Surgeon mature, we can envision that integrating
“The question is, how can payers General ended her “Healthy App Challenge” them with a payer’s network could provide
contest by announcing four winning apps much of the benefit of the Taiwanese smart
open up all the information
and several additional recommended apps, card system.
they are always collecting and all of which are free and were judged to
transform it into an asset for make “the health-promoting activity fun.”127 The biggest impact of mHealth technology
the many third-party health However, in the US, private insurers are is yet to be felt
prodigious providers of mHealth apps, all All these examples of mHealth applications
care apps that appear on with the goal of improving people’s overall and governmental encouragement
mobile devices every day?” health through behavioral change, making demonstrate ample experimentation, but
Mal Postings health care more cost-efficient through the experiments are still generally small —
Global CTO — IT Advisory better information dissemination or mobile technology has yet to have a game-
Ernst & Young improving specific health care outcomes changing impact on health payers. While
through mobile-delivered medical diagnostic the cost, outcome and access benefits of
information. For example, Humana Inc. mHealth technology are becoming obvious,
offers several mobile apps that use gaming payers find their organizational infrastructures
approaches to encourage healthy still largely focused on the pay-for-service
activities;128 Aetna recently acquired the model; instead, they must figure out how
maker of iTriage, a rapidly growing medical to reimburse physicians and providers for
diagnosis app;129 Blue Cross and Blue Shield keeping people well. And just as pertinently,
of Florida offers an app that provides payers are still building various elements of
general health care information for any user the information technology infrastructure
and detailed plan-specific information to its necessary to integrate data from disparate
members;130 and UnitedHealth Group’s sources, apply analytics and deliver
Health4Me app lets users store their plan actionable information to the mobile
identification card, find a provider, get devices of patients and clinicians. Both
benefits information and track deductible these infrastructures — organizational
spending.131 All these US insurers also offer and technological — must change in order
multiple other mobile apps, including for payers to contribute positively to
various apps encouraging wellness. the evolving 24/7 real-time health
care everywhere environment that is
rapidly evolving.

Figure 6: Technology innovation and the payer
Technology enabler Payer impact Emerging mHealth use Quote

Smart mobility Enables: • The UK’s NHS is encouraging “Whatever your health problem, our
• Automated, real-time tracking of physicians to “prescribe interactive online symptom checkers
patient visits to doctors and smartphone apps to patients” are the fast and easy way to get
hospitals and has compiled a list of nearly expert advice on how to look after
• Better and lower cost 500 such apps for them to yourself ... If you prefer your health
management of chronic disease recommend.133 advice on the move, download our
patients free mobile app.”
• Lifestyle-improving behavioral NHS Direct134
change messages to reach
members anytime, anywhere
• Lower administrative costs and,
potentially, facility costs as well
Social networking Tap into public-domain information to: • “Aetna’s use of a social media “The transformation of health
• Accelerate innovation time-to- platform to gather and refine care is going to require behavioral
market ideas helps iterate innovation change, primarily by the consumers
• Deliver messages encouraging concepts quickly, uncovering of health care but also on the part
healthy lifestyle choices questions and new ideas that of those who deliver and pay for
• Identify new treatment could take months through health care. And I’m convinced that
approaches traditional processes. In addition the action of social media over
• Identify potential fraud to internal crowdsourcing, Aetna mobile networks will become one
also applies its platform to of the ‘silver bullets’ for enabling
collecting customer feedback, that behavioral change.”
ensuring ready access to Paul Chabot, Advisory — PI,
Ernst & Young
outside-in perspectives.”
Forrester Research135
Cloud computing Provides platform for: • UnitedHealth Group subsidiary “We’re going to make collaboration
• Health information ecosystems Optum announced an open-cloud possible in ways it is certainly not
for secure data sharing platform to allow developers possible today.”
• Applications promoting to create and host health care Andy Slavitt, Executive Vice President,
Optum137
behavioral change applications that enable multiple
• Mobility for claims processing, doctors and hospital networks
fraud and duplication identification to coordinate patient care.136
Big data analytics Yields: • Blue Cross Blue Shield Association “On the big data side, there is a big
• Predictive modeling of best spun off its data intelligence unit, question mark. The major health
treatment practices Blue Health Intelligence, into an care stakeholders are struggling
• Better identification of providers independent company in part to with how to deal with the large
and practices with best patient help make its data available to volumes of data that mHealth is
outcomes more industry stakeholders.138 going to create, how to analyze it
• Decision-making insights all and how to share the insights
• Personalized treatments • WellPoint said it plans to use that emerge.”
• Personalized wellness and IBM’s Watson big data technology Dave Nichols,
Americas IT Transformation Practice Leader,
prevention to help suggest treatment options
Ernst & Young
• Improved fraud detection and diagnoses to doctors.139

Perhaps nowhere is the “sense of urgency” accelerator felt more strongly than among those paying the health
care bills. Whether you’re a nation, a corporation or a private health insurance company, you need to find a way to
deflate the escalating cost of health care, while meeting the growing health care demands of developing regions
and of the developed world’s aging populations. Besides, you stand to benefit significantly from a healthier
workforce/population and better, lower-cost management of chronic diseases — two promises that mHealth
technology appears ready to fulfill.
Growth of collaborative care models: Likewise, the collaborative-care models that

Core health care change drivers: emphasize improved outcomes at lower cost tend to embrace mobile applications for
real-time collaboration among clinicians. So the growth of such approaches should also
• Cost containment accelerate payers’ use of mHealth technology.
• Increased access
Mobile demand, trials and social networks will also accelerate mHealth use: Of note, the
• Better outcomes other core accelerators (mobile demand, successful trials and social networks) are also
acting on payers — particularly the demand accelerator. Clinicians and patients all want
anytime, anywhere access to medical records and other diagnostic information, and the
payers are often the owners or managers of that data. In addition, payers are operating a
large number of mobile health technology apps (as described previously), and the results
from these experiments are likely to yield better, larger programs to come. And social
networking accelerates adoption by providing forums for mobile collaboration, sharing best
practices and even rapid product development, as US-based Aetna has done.140 The UK’s
NHS announced in May 2012 an organ donor program in partnership with Facebook, Inc.141
Lower facility costs: Realizing the health care everywhere vision through mobile and other
remote care technologies should lower facility requirements and related costs.
“ It’s an aggregation issue. We all feel the increased cost of health

care. But companies with large numbers of employees and
insurers — those organizations are feeling the sense of urgency
quite keenly.”
Ed Tomlinson
Advisory — PI
Ernst & Young

Because payers generally control so much patient data, the big data challenge described in the “Overview” is of
overriding concern. But that challenge — to bring together multiple databases and use analytics to derive useful
insights that improve patient outcomes — is only part of the data issue for payers. Payers must also decide
whether to share their data with providers, patients or other payers and, if so, how to enable access for each.
And however they do so, they must ensure adequate information security and privacy controls to comply with
the related regulation in all the jurisdictions where they operate and, especially, to foster confidence from their
patient and physician stakeholders.
Figuring out the right approaches to all these issues is likely to slow mHealth adoption.
However, this inhibitor has an opposite “potential accelerator”: successful approaches to “Most developed countries are
the big data challenges are likely to unlock value that could dramatically accelerate mHealth spending a disproportionate
technology adoption.
amount of their GDP on health
To help address the data challenge, insurers have begun to partner with or acquire data care — and it’s increasing and
analytics technology companies. US-based Humana, for example, acquired 12-year-old health it’s not sustainable. In many
analytics company Anvita Health in December 2011 for an undisclosed amount.142 And of those nations, it’s the
three US insurers agreed to partner with analytics company Lumeris, Inc. to acquire claims
management software as a service (SaaS) company NaviNet, Inc., in the expectation of government that is paying for
enabling deeper analytical insights, including recommendations and alerts for medical health care and has the most
clinicians.143 Interestingly, Lumeris is part of a trio of companies started or invested in by incentive to manage those
renowned technology venture capitalist John Doerr and his brother (a physician) as part
of a long-term experiment to apply information technology in a pay-for-performance health
costs.”
care paradigm.144 The others are a US health insurer and a health care software provider. Ed Tomlinson
Advisory — PI
IT talent challenge: As explained in the “Overview,” having IT know-how combined with Ernst & Young
knowledge of health care process and procedure is critically important to a health care
organization’s efficiency and, as a result, its costs. The shortage of such savvy talent is
likely to hold back mHealth adoption.
Historically adversarial relationship: Even though financial incentives are aligning to motivate
payers to act to improve the health of their members, past interactions with patients and
physicians have often involved claims or reimbursement disputes. Says Aloha McBride,
Ernst & Young Advisory — PI, Government & Public Health Sector Leader: “Even though I
see insurance companies assigning nurse case managers to support members, whether in
just finding a primary care doctor or managing a chronic illness, the patients sometimes
find it difficult to develop a trusting, open relationship with their insurer.” Continued lack of
trust could slow patients’ and physicians’ adoption of mHealth solutions offered by payers.
Current incentive/benefits system: Payers are experimenting with health and wellness
apps, but current reimbursement payments for mobile or remote care are largely limited to
remote rural areas. The transformation of that system of incentives from pay-for-service
to pay-for-performance is likely to take time and, therefore, slow mainstream adoption of
mHealth technology. Similarly, benefits explanations that appear arcane to consumers are
likely to hold back the speed of adoption; payers would do well to simplify these, thus
increasing information transparency.
Regulatory and liability unknowns: Likewise, where regulators decide to draw the line
about what constitutes a medical device is likely to have a big impact — which, if any, of
the many apps being offered by payers will ultimately be regulated? For now, the lack
of definitive guidance is an inhibitor. Likewise, barring tort reform or a specific liability
moratorium for mHealth technology, uncertainty surrounding legal liabilities involving
mHealth technology is an inhibiting concern.

Payers outlook
Despite the inhibitors, payers’ adoption of mHealth technology seems
inevitable — the only question is how fast or slow it will become
mainstream. We believe the inevitability comes from two overarching
factors: first, the health care industry’s focus on behavioral change and
improved patient monitoring to lower cost, while improving health outcomes;
and second, mobile technology’s ability to deliver behavior-changing
messages (or transmit patient monitoring information) to or from
wherever a person happens to be.
As a result, mobile technology likely will accelerate a trend among payers

to become more blended payer-providers, or to collaborate more closely
with providers. Payers’ financial interest in the health of their members
makes this change likely — even in the US, where insurers and payers have
remained more distinctly separate than in other regions despite a few
notable exceptions, such as the Kaiser Permanente health system.
“For the most part, insurers have been adopting mHealth technologies in
isolation from the provider,” notes Dr. Bill Fera, Advisory — PI, Health Care,
Ernst & Young. “The next step is to collaborate with providers to make
the services more powerful. Studies show that patients don’t always trust
their health plan as much as doctors to provide these kinds of services,
so working in conjunction with the provider community should enable a
lot more ‘buy-in’ from the patient community,” he notes.
• Payers have large databases of patient and medical information. How can we
leverage big data analytics capabilities to help payers transform their data into
valuable insights?
• Patients have trust issues with payers. Can we leverage technology-enabled

innovations to help them overcome those issues?
• Payers are in the midst of transformational business model change from pay-for-service
to pay-for-performance. How can we leverage technology innovation to accelerate — and
ease — this difficult and complex transition?
• In certain regions, payers and providers have begun vertically integrating. How can our
solutions help to better enable these alliances and organizational integrations?

Are you ready?
Don’t underestimate
the pace of change
Looking at the scope, complexity and large number of interdependent
stakeholders, many people assume that the health care everywhere vision
will take decades to unfold. But in the words of cardiologist Eric J. Topol,
Co-Founder and Vice Chairman of the West Wireless Health Institute,
“I shudder to think about waiting 10 or 20 years for this transformation
to occur.”145
And he may not have to. With 13,000 apps And as our Life Sciences colleagues say
“To make the health care already available for the iPhone alone,146 it’s in their latest Progressions report: “Move
everywhere vision of the clear that the mobile technology needed for quickly. Time is not on your side. Don’t
transformative innovation leading to health underestimate the pace of change.”
future work will require many care everywhere is already here. And as
technology megatrends working this report has described, the technology However, culture, governments and
in concert. It’s not just a cloud industry’s exponential change engine is institutions generally take much longer to
already focusing on technology innovations change than technology does to innovate.
thing, or a big data thing, or a that could lead to better health outcomes, But after decades of wrestling with
social networking thing or even broader access and lower cost. It’s doing so escalating costs and increasing demand,
a mobile thing. It is all of these not just altruistically, but also for profit — they, too, appear ready for change. In fact,
because that’s where value-creation lies. they’re already in motion — driven from the
things working together.”
See our “mobile-medical frontier” sidebar top down by stakeholders like governments
Dave Nichols (page 47) and consider that, with one and from the bottom up by patients. Today,
Americas IT Transformation Practice Leader notable exception, each of the science- the very sustainability of current models of
Ernst & Young fiction-sounding items described is already health care is being challenged by provider
here. As for the one exception, we don’t and payer alike. Patient-centric health care
think it will be long before a team claims the information ecosystems are beginning to
$10 million X prize for inventing a real-life emerge, incentive systems are beginning to
version of Star Trek’s tricorder. change, public-domain genome databases
are being established and “collective impact
alliances”* are starting to form.
*Collective impact alliances are small ecosystems of health care stakeholders partnering together to drive toward a
(relatively) narrowly defined common goal — at least when compared with the monumental task of remaking the
entire global health care industry.
“We need a Khan Academy for doctors: captivating 15-minute videos on genomics, on wireless
sensors, on advanced imaging, on health information systems. These things can revive the
excitement they felt as premeds, when they first decided to go into this field. If we can get
practicing physicians up to speed and really inspired, maybe we won’t have to wait a generation.
I shudder to think about waiting 10 to 20 years for this transformation to occur.”
Eric J. Topal, M.D.
Co-Founder and Vice Chairman
West Wireless Health Institute147

Within the context of narrower, well-defined This just in … from the mobile-medical frontier
goals, mobile health care technology can
help give patients the tools to be more In researching this report we encountered In May 2012 the US became the first
accountable, while helping physicians, numerous advanced health care examples country to propose reserving wireless
providers and payers to be more transparent, involving mobile and related technologies spectrum for Medical Body Area Networks
accessible and interconnected — in turn, that just made us stop and think, “wow.” (MBANs). As envisioned by the US
helping everyone work together to control We compiled the following brief subset. Federal Communications Commission
and contain cost. And by demonstrating (FCC), MBANs would deploy multiple
its value in the context of these small Research scientists in South Korea have sensors to monitor a person’s vital
ecosystems, mHealth technology illustrates developed a way to use the “capacitive statistics and communicate them
the potency it offers to help resolve the sensitivity” of smart mobile touchscreens wirelessly within a hospital.151
larger challenges facing the global health (their ability to detect minute electrical
care industry to increase access and current when you touch them) to analyze Smart mobile … horses? This technology
contain costs. blood or saliva. Because this technology is not so advanced: SMS texting. What
can detect biomolecules it could made us think “wow” was the human
Our mobile technology focus notwithstanding, theoretically diagnose a range of diseases, ingenuity. Africa’s mountainous Kingdom
however, smart mobility cannot enable from cancer to diabetes.148 of Lesotho has the second-highest
the health care everywhere vision alone. incidence of tuberculosis. Since 2010,
Technology companies offering other Researchers from the University of horse riders traveling to otherwise
transformative technology megatrends are California, San Diego and University of unreachable villages have collected
needed to join these ecosystems as well: Illinois at Urbana-Champaign have sputum samples for analysis, with the
clouds to host the “heavyweight” software developed a fetal monitor that is “a results being texted back to health
needed to deliver just the right information wearable patch of circuits, sensors and centers near the villages. To date,
experience to the device, social networks wireless transmitters that sticks to the skin they’ve analyzed 4,154 people, 307
to generate crowd-sourced knowledge like a temporary tattoo.” This electronic of whom tested positive for TB.152
and help disseminate valuable health care tattoo will “continuously measure and
information and big data analytics to mine monitor uterine contractions, fetal heart Announced in January 2012, the
the large volumes of health care information rate and oxygen, and maternal heart rate $10 million Qualcomm Tricorder X Prize
generated by all patient, physician and and body temperature.”149 will be awarded “to the team that
provider interactions. Working together in the develops a mobile platform that most
context of a health care ecosystem, these Programmers used big data analytics accurately diagnoses a set of 15 diseases
technologies can help to match a real-time techniques to demonstrate a correlation across 30 consumers in 3 days.” Inspired
patient requirement with the right clinician between poor sleep and increased risk of by the handheld device used by the
at the right place and in the right time. car accidents. The result won a “Health fictional Dr. Leonard McCoy on Star Trek
2.0 Code-a-thon” that showcased the and co-sponsored by the non-profit
For technology companies, all this means role of big data in health care and was X Prize Foundation and Qualcomm Inc.’s
that a very large window of market co-sponsored by athenahealth, Inc., Qualcomm Foundation, the competition
opportunity is opening for you to help AT&T and the Massachusetts Institute aims to stimulate the imaginations of
make the world — and its health care of Technology’s H@cking Medicine health technology entrepreneurs.153
industry — a healthier place. magazine.150
Considerations
• Are you moving quickly enough to

out-innovate the competition?
• How are you creating value for: Patients?

Physicians? Providers? Payers?
• Are you positioned to take full advantage

of health care everywhere?

Glossary
Accountable care organization (ACO) Electronic medical record (EMR)
Creates incentives for health care providers A digital capture of the paper charts
to work together to treat an individual in the clinician’s office, i.e., the medical
patient across care settings — including and treatment history of a patient in a
doctors’ offices, hospitals and long-term particular practice.
care facilities. The Medicare Shared Savings
Program rewards ACOs that lower growth in Food and Drug Administration
health care costs, while meeting performance (FDA or US FDA)
standards on quality of care and putting An agency of the US Department of Health &
patients first. Human Services, one of the US federal
executive departments. The FDA is
American Hospital Association (AHA) responsible for protecting and promoting
The national organization that represents public health through the regulation and
and serves all types of hospitals, health care supervision of food safety, tobacco
networks and their patients and products, dietary supplements, prescription
communities. Close to 5,000 hospitals, and over-the-counter pharmaceutical drugs
health care systems, networks, other (medications), vaccines, biopharmaceuticals,
providers of care and 40,000 individual blood transfusions, medical devices,
members come together to form the AHA. electromagnetic radiation emitting devices
(ERED), veterinary products and
American Recovery and Reinvestment cosmetics.
Act of 2009 (ARRA)
An economic stimulus package enacted Health care clearinghouse
by the 111th United States Congress and Organizations that process standard
signed into law on February 17, 2009, by transactions — may serve as an intermediary
President Barack Obama. to plans and providers.
Bring-your-own-device (BYOD) Health care payer

Refers to employees’ use of computing Includes HMOs, MCOs, Medicare, Medicaid,
devices — such as smartphones, laptops, CHAMPUS, Workers’ Compensation, COBRA,
tablets and personal digital assistants — self-paid, etc. — individual or group plans
in the workplace for use and connectivity that provide for or pay for the cost of
on the corporate network. health care.
Cloud computing Health care provider

Model for enabling convenient, on-demand Includes hospitals, clinics, nursing homes,
network access to a shared pool of individual professionals — and any other
configurable computing resources (e.g., person or organization that furnishes, bills
networks, servers, storage, applications and or is paid for the delivery of health care
services) that can be rapidly provisioned services in the normal course of business.
and released with minimal management
effort or service provider interaction.
Electronic health record (EHR)

Contains information generated by
encounters in any care delivery setting,
including patient demographics, progress
notes, issues, medications, vital signs,
medical history, immunizations, laboratory
results and radiology reports.

Health maintenance organization (HMO) Patient-centered medical home (PCMH)
Provides members with comprehensive Provides primary health care that is
health care, allowing members to select a relationship-based with an orientation
primary care physician who coordinates toward the whole person. Supports patients
that member’s care, including referral to in learning to manage and organize their
specialists in the HMO network. Care is own care at the level the patient chooses
provided to each plan member for a fixed and includes patients and families as core
amount, i.e., a capitated rate. members of the care team.
mHealth apps Pay-for-performance (P4P)

Application programs that offer health Offers financial incentives to physicians
care-related services for smartphones and other health care providers to meet
or tablet PCs. defined quality, efficiency, transparency
and other targets.
Mobile-enabled health solutions
Encompasses the use of mobile Smart card technology
telecommunications and multimedia Smart cards allow data and applications to
technologies as they are integrated within be securely stored and accessed on the chip
increasingly mobile and wireless health and enable secure data exchange. Smart
care delivery systems. card technology provides high levels of
security and privacy protection, making it
National Health Service (NHS) ideal for handling sensitive information such
Comprehensive government public-health as identity and personal health information.
service in Britain covering virtually the
entire population, established in 1948. Telehealth/telemedicine
Financed primarily by general taxes, most The use of electronic information and
services are free. General practitioners and telecommunications technologies to support
dentists are paid per patient registered with two-way, long-distance, real-time clinical
them and may also have private patients. health care, patient and professional
Hospital and specialist services are provided health-related education, public health
in government hospitals and other facilities and health administration.
by salaried professionals.
Non-governmental organization (NGO)

A nonprofit, voluntary citizens’ group
which is organized on a local, national or
international level.

Source notes
40
Overview Perspective on patients Christine Zhenwei Qiang, Masatake Yamamichi, Vicky
1
Progressions — The third place: health care everywhere, 22
“Hospital Association Fights Digital Data Access for Hausman and Daniel Altman, “Mobile Applications for
Ernst & Young, © 2012 EYGM Limited. Patients,” Center for Democracy & Technology, 2 May the Health Sector,” ICT Sector Unit, World Bank,
2 2012, © 2012 by Center for Democracy & Technology. December 2011.
The World in 2010, International Telecommunications
41
Union, © 2012 ITU. 23
“Telecommunications; Mobile Healthcare and Medical “Vodafone Americas Foundation; Vodafone Americas
3 App Downloads to Reach 44 Million Next Year, Rising to Foundation Announces 2012 Wireless Innovation
Progressions — The third place: health care everywhere,
142 Million in 2016, Finds Juniper Research Limited,” Project(TM) Winners,” Investment Weekly News,
Ernst & Young, © 2012 EYGM Limited.
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“In Hopeful Sign, Health Spending is Flattening Out,“ News via VerticalNews.com.
Factiva, © 2011 Telecommunications Weekly via
The New York Times, 28 April 2012, via Factiva, © 2012 42
VerticalNews.com. “Carrying a Doctor in Your Pocket — What’s the Future
The New York Times Company.
24
“New Study Shows Boom in Mobile Social Networking of Medicine? Tiny Health Monitors, Tailored Therapies —
5
“Supporting efforts to transform health care in China,” and the End of Illness,” The Wall Street Journal Asia,
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UC Davis, 27 March 2012, © 2012 UC Regents. 20 January 2012, via Factiva, © 2012 Dow Jones &
Jones & Company, Inc.
6
Prabhat Jha, Rachel Nugent, Stéphane Verguet, 25
Company, Inc.
“Healthcare Social Media: Time To Get On Board,” CMP
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via www.copenhagenconsensus.com, May 2012. Factiva, © 2012 Healthcare Financial Management.
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7
Ibid.
“US sets deadline for proposals on state healthcare 44
“Supporting efforts to transform health care in China,”
27
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45
28
“Mobile Healthcare’s Slow Adoption Curve,” Forrester
8
Christine Zhenwei Qiang, Masatake Yamamichi, “Healthcare Social Media: Time To Get On Board,” CMP
Research, November 2011.
Vicky Hausman and Daniel Altman, “Mobile Applications TechWeb, 13 July 2012, via Factiva, © 2012 United
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Business Media LLC. Charles Kenney, The Best Practice: How the New Quality
for the Health Sector,” ICT Sector Unit, World Bank,
29
Movements is Transforming Medicine, 22 July 2008.
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47
9 Ernst & Young, © 2012 EYGM Limited. “The Mount Sinai Hospital/Mount Sinai School of
“Whole system demonstrator programme: Headline
30
Medicine; ‘Cloud’ computing technology should make
findings — December 2011,” UK Department of Health, Accessed via www.patientslikeme.com, May 2012.
sharing medical images easier and more efficient,”
5 December 2011, © Crown 2012. 31
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Christine Zhenwei Qiang, Masatake Yamamichi, Research, November 2011. © 2012 Investment Weekly News via VerticalNews.com.
Vicky Hausman and Daniel Altman, “Mobile Applications 32
Redesigning Health in Europe for 2020, European Union 48
“MyMediConnect Offers Displaced Google Health Users
for the Health Sector,” ICT Sector Unit, World Bank, Task Force on eHealth, © European Union, 2012. Free, Simple Conversion Process for Transferring Personal
December 2011. 33
“Medical Records; Nearly 9 Million Kaiser Permanente Health Record Account,” Business Wire, 7 December 2011,
11
Progressions – The third place: health care everywhere, Health Records Securely Available on Mobile Devices,” © 2011 Business Wire.
Ernst & Young, © 2012 EYGM Limited. Information Technology Newsweekly, 7 February 2012, 49
Accessed via www.google.org/flutrends, May 2012.
12
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“US sets deadline for proposals on state healthcare
Tavenner, Acting Administrator, Centers for Medicare and 34
“Measuring the Impact of Patient Portals: What the exchanges,” Reuters News, 16 May 2012, via Factiva,
Medicaid Services, Department of Health and Human Literature Tells Us,” California HealthCare Foundation, © 2012 Reuters Limited.
Services, 30 April 2012, © 2006-2012 by the American May 2001, © 1996-2011 California HealthCare 51
Hospital Association. “Health In Reach merges with PriceDoc,” MarketLine,
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16 May 2012, via Factiva, © 2012 MarketLine, an
Ibid. 35
“NIKE+FUELBAND,” Australian PC User, July 2012, Informa plc business.
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“Health IT Groups Criticize Information Exchange
Health Information Technology, Northwestern University, 36
“Runmeter, Cyclemeter and Walkmeter Version 7.0 Now Regulation Plan,” CMP TechWeb, 5 July 2012, via Factiva,
Georgia Institute of Technology and the University of Include Training Plans, Stopwatch Pages and iCloud © 2012 United Business Media LLC.
Toronto,” Massachusetts Institute of Technology Support; New configurable Stopwatch Pages can now 53
Department of Economics, February, © 2012. Letter from ISPAB, Information Security and Privacy
display more than 150 workout statistics with a simple
15
Advisory Board, 30 March 2012, The National Institute
“Healthy Aging 2.0: The Potential of New Media and swipe,” GlobeNewswire, 19 April 2012, © 2012
of Standards and Technology (NIST).
Technology,” Medscape, 25 April 2012, © 1994-2012 GlobeNewswire, Inc.
54
by WebMD LLC. 37
“Insulin pumps vulnerable to attack by hackers,”
“New Audio Interview with Mr. Marc Askenasi, President
16
The Globe and Mail, 27 October 2011, via Factiva,
“Geisinger Health Plan and AMC Health Find Success with & CEO of InterAmerican Gaming Inc., is now at
© 2011 The Globe and Mail Inc.
Remote Patient Monitoring,” Business Wire, 28 February SmallCapVoice.com,” PR Newswire (US), 8 May 2012,
55
2012, via Factiva, © 2012 Business Wire. via Factiva, © 2012 PR Newswire Association LLC. “The Power of Electronic Health Records,”
17 38
US Department of Health & Human Services,
“Target Figures Out Teen Girl Is Pregnant,” Forbes, “Report: 13K iPhone consumer health apps in 2012,”
accessed via www.healthcare.gov, May 2012.
12 February 2012, © 2012 Forbes.com LLC. MobiHealthNews, 22 September 2011, © 2011 Chester
56
18 Street Publishing, Inc. Letter from the American Hospital Association to Marilyn
Mobile device security: understanding vulnerabilities and
39
Tavenner, Acting Administrator, Centers for Medicare and
managing risks, Ernst & Young, © 2012 EYGM Limited. “Wireless Technology Now Allows Diabetes Patients To
Medicaid Services, Department of Health and Human
19
“Arcadia Solutions’ Client Featured in Cover Article on Manage Their Disease Real-Time and On-The-Go; AT&T
Services, 30 April 2012, © 2006-2012 by the American
Priorities in Health IT,“ press release from Arcadia mHealth Solutions Presents DiabetesManager Launches
Hospital Association.
Solutions, 19 March 2012, © 2012 Arcadia Solutions, LLC. with AT&T and Health Care Service Corporation
57
Employees with Goal of Improving Healthcare Outcomes Progressions — The third place: health care everywhere,
20
“Stakeholders: Bullet List Of Legal Considerations,” Ernst & Young, © 2012 EYGM Limited.
and Reducing Costs,” ENP Newswire, 1 July 2011,
Mondaq Business Briefing, 29 May 2012, via Factiva, 58
via Factiva, © 2011 Electronic News Publishing. Ibid.
© 2012 Mondaq Ltd.
Further exploring the mHealth vision

21
“New mobile health category highlight of 2012 Middle
East,” M2 Presswire, 25 April 2012, via Factiva, © 2012
M2 Communications.

Source notes continued
81 101
Perspective on physicians “Doctors driving IT development with their mobile “Bill Gates Talks about Mobile Health,” 2010 Microsoft
59
“Why Doctors Need to Embrace Their Digital Future Now,” technology choices,” © 23 May 2011 American Medical Research mHealth Summit video, accessed May 2012
Wired Magazine, 31 January 2012, via Factiva, © 2012 Association, accessed via www.amednews.com, via Microsoft Research website, © 2011 Microsoft
Condé Nast. May 2012. Corporation.
102
60
“Doctors driving IT development with their mobile Perspective on providers “Harnessing the Power of Social Media in Health Care,”
technology choices,” © 23 May 2011 American 82
“Healthcare in Asia: The innovation imperative,” Healthcare Registration, 1 July 2012, via Factiva,
Medical Association, accessed via www.amednews.com, Economist Intelligence Unit — Executive Briefing, © 2012 Aspen Publishers.
103
May 2012. 30 May 2011, via Factiva, © 2011 The Economist “HHS secretary touts health IT initiative,”
61
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Investments for Mobile Point of Care,” IDC, December 83
Progressions — The third place: health care everywhere, © 2012 The Associated Press.
104
2011, © 2012 IDC. Ernst & Young, © 2012 EYGM Limited. “HHS Secretary Kathleen Sebelius announces major
62
“Everything in medicine is going mobile (HIMSS 84
“Valuing Health Care: Improving Productivity and Quality,” progress in doctors, hospital use of health information
meeting),” © 26 March 2012 American Medical Kauffman Task Force on Cost-Effective Health Care technology,” U.S. Health & Human Services Documents,
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105
63
“Healthcare in Asia: The innovation imperative,” 85
Managing Population Health: The Role of the Hospital, “The Health-Care Industry Turns to Big Data,”
Economist Intelligence Unit — Executive Briefing, Health Research & Educational Trust, Chicago: April 2012, Bloomberg Businessweek, 17 May 2012, via Factiva,
30 May 2011, via Factiva, © 2011 The Economist accessed via www.hpoe.org, May 2012. © 2012 Bloomberg L.P.
106
Intelligence Unit Ltd. 86
“Valuing Health Care: Improving Productivity and Quality,” Ibid.
64 107
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IT needs,” © 16 May 2011 American Medical Association, Innovation, April 2012, © 2012 Ewing Marion Kauffman Ernst & Young, © 2012 EYGM Limited.
accessed via www.amednews.com, May 2012. Foundation. 108
“Medtronic Introduces an Innovative Mobile Application
65 87
“Small and midsize practices planning tablet computer “Report: State’s Medicare costs are sixth highest for the CareLink(R) Network,” Business Wire, 28 June
buying spree,” © 16 January 2012 American Medical nationwide,” Record-Journal, 18 May 2012, via Factiva, 2011, via Factiva, © 2011 Business Wire.
Association, accessed via www.amednews.com, © 2012 Record-Journal. 109
Ibid.
May 2012. 88
Progressions — The third place: health care everywhere, 110
66
“Doctors cite ease of use in rapid adoption of tablet Ernst & Young, © 2012 EYGM Limited. Ernst & Young, © 2012 EYGM Limited.
computers,” © 18 April 2011 American Medical 89
“Research and Markets; 2012 Report on the $18 Billion 111
“Johnson & Johnson Unit Janssen Offers Mobile
Association, accessed via www.amednews.com, US Outpatient Surgical Centers Market,” Investment Medication Adherence Platform,” eWeek, 25 July 2012,
May 2012. Weekly News, 2 June 2012, via Factiva, © 2012 via Factiva, © 2012 Ziff Davis Enterprise Holdings Inc.
67
“Chicago hospital doctors say iPads raise their Investment Weekly News via VerticalNews.com. 112
“FDA issues first social media rules for drug companies,”
efficiency,” Reuters News, 12 March 2012, via Factiva, 90
Global eHealth Observatory Series, Vol. 3, World Health © 25 January 2012 American Medical Association,
© 2012 Reuters Limited. Organization, 7 June 2011, © WHO 2012. accessed via www.amednews.com, May 2012.
68
“Small and midsize practices planning tablet computer 91
“Valuing Health Care: Improving Productivity and Quality,” 113
Ibid.
buying spree,” © 16 January 2012 American Medical Kauffman Task Force on Cost-Effective Health Care 114
Association, accessed via www.amednews.com, “Stakeholders: Bullet List Of Legal Considerations,”
Innovation, April 2012, © 2012 Ewing Marion Kauffman
May 2012. Mondaq Business Briefing, 29 May 2012, via Factiva,
Foundation.
69
© 2012 Mondaq Ltd.
Ibid. 92
“Whole system demonstrator programme: Headline 115
70
“Q&A With Dr. Daniel Kraft, Director of FutureMed findings — December 2011,” UK Department of Health,
Ernst & Young, © 2012 EYGM Limited.
At Singularity University,” Singularity Hub, 3 January 5 December 2011, © Crown 2012.
116
2012, © 2012 Singularity Hub, accessed via 93
“Oracle Unveils Oracle Health Sciences Network,” ENP
Letter from the American Hospital Association to Marilyn
www.singularityhub.com, May 2012. Newswire, 26 June 2012, via Factiva, © 2012 Electronic
Tavenner, Acting Administrator, Centers for Medicare and
71
News Publishing.
“Doctors, Patients & Social Media,” QuantiaMD and the Medicaid Services, Department of Health and Human
117
Care Continuum Alliance, September 2011, accessed Services, 30 April 2012, © 2006-2012 by the American “The Second Wave of Clinical Mobility: Strategic Solution
via www.quantiamd.com, May 2012. Hospital Association. Investments for Mobile Point of Care,” IDC, December
72 94
2011, © 2012 IDC.
“Social media increasingly used to gauge public health. “Use of Remote Monitoring to Improve Outcomes in
118
The real-time data allow for quick dissemination of Patients with Heart Failure: A Pilot Trial,” International “Valuing Health Care: Improving Productivity and Quality,”
information to a global audience, health officials say,” Journal of Telemedicine and Applications, 19 May 2012, Kauffman Task Force on Cost-Effective Health Care
© 7 November 2011 American Medical Association, National Library of Medicine. Innovation, April 2012, © 2012 Ewing Marion Kauffman
accessed via www.amednews.com, May 2012. 95
Foundation.
“Asthma; China Unicom Enters Health Space through
119
73
“M*Modal Debuts Cloud-Based Speech Understanding(TM) Partnership with IDEAL LIFE and Novatech,” Journal of “EMR 2012: The Market for Electronic Medical Records,”
Platform With Extensive M*Modal ‘Fluency’ Family of India, 17 May 2011, via Factiva, © 2011 Journal of India PR Newswire (U.S), 28 June 2012, via Factiva, © 2012
Clinical Solutions,” Business Wire, 9 May 2012, via via VerticalNews.com. PR Newswire Association LLC.
120
Factiva, © 2012 Business Wire. 96
“GSMA Reports Winners of Global Mobile Awards,” “Technology Can Reduce Costs/Clinical Trial Failure Rates
74
“Why Doctors Need to Embrace Their Digital Future Now,” Entertainment Close-Up, 7 March 2012, via Factiva, for Hematological Cancer Drugs,” press release from
Wired Magazine, 31 January 2012, via Factiva, © 2012 © 2012 Close-Up Media, Inc. Medmeme LLC, 2 August 2012, © Medmeme LLC.
121
Condé Nast. 97
“COMPANY NEWS — Mobily launches baby ultrasound “Tavenner Acknowledges Health Care Industry’s Concerns
75
“Athenahealth Announces Winners of Health 2.0 Code- MMS service,” Saudi Economic Survey, 1 February 2011, on Stage 2,” American Health Line, 9 May 2012, via
athon and Kicks-off More Disruption Please Program,” via Factiva, © 2011 Al Sidra Media LLC. Factiva, © 2012 The Advisory Board Company.
122
Business Wire, 16 May 2012, via Factiva, © 2012 98
“Cerner and Advocate Health Care Take Bold Steps to Progressions — The third place: health care everywhere,
Business Wire. Improve Patient Health Outcomes and Safety,” News Bites — Ernst & Young, © 2012 EYGM Limited.
76 123
“Big Data Has Potential for Big Impact in Health Care Global Stocks, 19 April 2012, via Factiva, © 2012 News “Patient Monitoring Systems Market (2011–2016) —
Research, Delivery,” California Healthline, 14 May 2012, Bites Pty Ltd. Global Trends, End-user & Value-Volume Analysis,” PR
© Advisory Board Company & California HealthCare 99
“HOSPITALS, UNIVERSITIES WIN BIG WITH CMMI Newswire, 9 May 2012, via Factiva, © 2012 PR Newswire
Foundation 2009. INNOVATION CHALLENGE GRANTS,” Inside Health Association LLC.
77 124
“Nearly all U.S. doctors are now on social media,” Reform, 16 May 2012, via Factiva, © 2012 Inside “Valuing Health Care: Improving Productivity and Quality,”
© 26 September 2011 American Medical Association, Washington Publishers. Kauffman Task Force on Cost-Effective Health Care
accessed via www.amednews.com, May 2012. 100
“GSMA; GSMA Research Reveals Growing Opportunity Innovation, April 2012, © 2012 Ewing Marion Kauffman
78
“Doctors, Patients & Social Media,” QuantiaMD and the for Mobile Operators in Healthcare,” Investment Weekly Foundation.
Care Continuum Alliance, September 2011, accessed News, 16 June 2012, via Factiva, © 2012 Investment
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79
Ibid.
80
Ibid.

136 148
Perspective on payers “UnitedHealth to Launch Cloud-Based Data Platform,” “HEALTH; IN YOUR HAND; smartphones one day may
125
“LEADERS Magazine Interview with Mark T. Bertolini, The Wall Street Journal Online, 14 February 2012, via deliver bio samples to lab, scientists say BY PAUL MARKS
Chairman, Chief Executive Officer and President, Aetna,” Factiva, © 2012 Dow Jones & Company, Inc. Credit: NEW SCIENTIST MAGAZINE Handheld gadgets
Leaders Magazine, 4 October 2011, © 2011 LEADERS 137
“UnitedHealth Plans Cloud-Computing Platform,” could one day diagnose infections at the push of a button
MAGAZINE, INC. The Wall Street Journal, 14 February 2012, via Factiva, by using the supersensitive touchscreens in today’s
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“Doctors told to prescribe smartphone apps to patients;
138
via Factiva, © 2012 The Grand Rapids Press.
Doctors will be encouraged to prescribe smartphone apps “Healthier Intelligence,” CIO, 28 February 2012,
149
to help patients manage conditions ranging from diabetes via Factiva, © 2012 CXO Media, Inc. “University of California - San Diego; Tattoo-like devices
to depression, the Government has announced,” 139
for wireless pregnancy monitoring,” Telecommunications
“Bright Ideas: Innovation in 2011; The Year’s Inventions:
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From IBM’s ‘Jeopardy’-Playing Watson to a Replacement
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Heart Valve,” The Wall Street Journal Online, 30 December
150
127
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Challenge,” U.S Department of Human Health & Services, 140
Code-athon and Kicks-Off More Disruption Please
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Forrester Research, 5 April 2011.
128
© 2012 Contify.com.
“Obesity; Humana Teams with Video Game 141
“Friend on Facebook? Yes, and I will donate you my kidney 151
LeaderUBISOFT® to Promote Healthy Activity for People “FCC Approves Broad Spectrum for Wireless Medical
too; Partnership with NHS to encourage users to join
of AllAges,” Marketing Weekly News, 17 December 2011, Devices,” Device & Diagnostic Letter, 28 May 2012, via
transplant register,” The Daily Telegraph, 2 May 2012,
via Factiva, © 2011 Marketing Weekly News via Factiva, © 2012 Washington Business Information, Inc.
via Factiva, © Telegraph Media Group Ltd.
152
VerticalNews.com. 142
Finding and treating people with TB in Lesotho, Stop TB
“Humana Inc. — Humana Acquires Anvita Health, a
129
“Aetna buys Lakewood-based iTriage,” Denver Business Partnership, World Health Organization.
Leading Health Care Analytics Company,” Managed
153
Journal Online, 19 December 2011, via Factiva, © 2011 Care Weekly Digest, 19 December 2011, via Factiva, “Medical, Healthcare; X PRIZE Foundation and Qualcomm
American City Business Journals, Inc. © 2011 ManagedHealthcare.Info via NewsRx.com. Foundation Set to Revolutionize Healthcare With Launch
130
“Blue Cross and Blue Shield Ramps Up with GeoBlue and 143
of $10 Million Qualcomm Tricorder X PRIZE,” Journal Of
“John Doerr’s Patient Health Care Start-Up Gains
Mobile App,” Entertainment Close-Up, 28 May 2012, Robotics & Machine Learning, 23 January 2012, via
Momentum; Bits,” NYT Blogs, 14 February 2012,
via Factiva, © 2012 Close-Up Media, Inc. Factiva, © 2012 Journal of Robotics & Machine Learning
via Factiva, © 2012 The New York Times Company.
131
via VerticalNews.com.
“UnitedHealth launches new mobile app for customers,” 144
Ibid.
StarTribune.com, 27 February 2012, via Factiva, © 2012
The Star Tribune Company. Are you ready?
145
132
“Five Capitalist Democracies & How They Do It,” Frontline, “Why Doctors Need to Embrace Their Digital Future Now,”
PBS, ©1995-2012 WGBH Educational Foundation. Wired Magazine, 31 January 2012, via Factiva, © 2012
133 Condé Nast.
“GPs to ‘prescribe’ apps for patients,” 22 February 2012,
146
accessed via Department of Health website May 2012, “Report: 13K iPhone consumer health apps in 2012,”
© Crown 2012. MobiHealthNews, 22 September 2011, © 2011 Chester
134 Street Publishing, Inc.
Accessed via www.nhsdirect.nhs.uk/About/
147
SummerHealthAdvice, May 2012. “Why Doctors Need to Embrace Their Digital Future Now,”
135 Wired Magazine, 31 January 2012, via Factiva, © 2012
Innovation in Health Insurance Customer Experience,
Condé Nast.
Forrester Research, 5 April 2011.
For further information on this topic, download Ernst & Young’s Progressions report from the
EY Insights mobile app or go to www.ey.com/progressions
Progressions is Ernst & Young’s annual report on the global life sciences industry. Its 2012 edition,
titled The third place: health care everywhere, presents the challenges and solutions of life sciences
companies as the epicenter of the health care system shifts from the hospital and doctor’s office to
wherever the patient happens to be.

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Mhealth: Mobile Technology Poised To Enable A New Era in Health Care

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How will mobile technology transform healthcare?

How will mobile technology transform healthcare?

What other technologies will help enable mobile transformation of healthcare?

What other technologies will help enable mobile transformation of healthcare?

mHealth

46 Are you ready?

mHealth: mobile technology poised to enable a new era in health care

This is a grand statement, we know. Progressions presents a clear vision of how

mHealth: mobile technology poised to enable a new era in health care 3

As a series of seemingly unmanageable challenges continues to plague global health care,

Mobility leads multiple technologies ready “Health care’s stakeholders — governments,

4 mHealth: mobile technology poised to enable a new era in health care

Ninety percent of the world’s

mHealth: mobile technology poised to enable a new era in health care 5

6 mHealth: mobile technology poised to enable a new era in health care

mHealth: mobile technology poised to enable a new era in health care 7

Figure 1: Where we are today — technology innovation poised to enable health

Transformative technologies emerge:

Change drivers — Governments Change challenges:

Source: Ernst & Young analysis.

8 mHealth: mobile technology poised to enable a new era in health care

Innovative technologies enable:

Source: Ernst & Young analysis.

mHealth: mobile technology poised to enable a new era in health care 9

“Governments are exploring access to wellness care via multiple

10 mHealth: mobile technology poised to enable a new era in health care

Security concerns: Information technology inevitably gives rise to information security

mHealth gives rise to new security

mHealth: mobile technology poised to enable a new era in health care 11

“Governments around the world are closely involved

12 mHealth: mobile technology poised to enable a new era in health care

“Superior health care delivery is fundamentally based on

mHealth: mobile technology poised to enable a new era in health care 13

14 mHealth: mobile technology poised to enable a new era in health care

Technology innovation enables improved Consumers test a range of

mHealth: mobile technology poised to enable a new era in health care 15

… and to better manage chronic disease

“Nine million Kaiser Permanente patients can get their medical

16 mHealth: mobile technology poised to enable a new era in health care

Technology enabler Patient impact Emerging mHealth use Quote

Source: Ernst & Young analysis.

mHealth: mobile technology poised to enable a new era in health care 17

Consumer expectations: As patients grow increasingly comfortable with mobile

Social networks: Patients’ experiences sharing information on treatments and

“Today’s health care consumers are

18 mHealth: mobile technology poised to enable a new era in health care

mHealth: mobile technology poised to enable a new era in health care 19

Opportunities for technology companies

• How can we alleviate concerns about security, privacy, reliability?

mHealth: mobile technology poised to enable a new era in health care 21

22 mHealth: mobile technology poised to enable a new era in health care

mHealth: mobile technology poised to enable a new era in health care 23

Technology enabler Physician impact Emerging mHealth use Quote

Source: Ernst & Young analysis.

24 mHealth: mobile technology poised to enable a new era in health care

Managing costs and increasing revenue: Proliferating pay-for-performance models also

mHealth: mobile technology poised to enable a new era in health care 25

26 mHealth: mobile technology poised to enable a new era in health care

Indeed, physicians’ adoption of smart mobile devices and applications