Supported by the proliferation of smartphones and tablets, consumers and medical providers are snapping up medical technology via mobile apps and mobile sensors at an unprecedented rate. In the process, these early adopters are drawing tremendous attention to the mHealth space. This explosion of products and interest has brought the space to an inflection point: the emergence of mHealth 2.0. At this next stage, mHealth aims not just to provide information but to create meaningful behavior change in both patients and their medical providers. While the underlying idea is simple and the technology astonishing, it has been a challenge to deliver. I will argue that, going forward, the focus of players in the mHealth space must be on closing specific patient behavioral loops, building bridges between non-interoperable data systems, and permitting doctors to provide better care through deeper clinical insights—and all of this must happen without drowning doctors in a deluge of raw data. So how do we get there? The future lies in the aggregation of data from multiple sensors, analyzed and re-expressed as actionable insights for behavioral change. The winners will be those who can produce the most useful sensors (embedded in the most attractive and easy-to-use form factors) and marry them to cloud systems and intelligent algorithms that enable effortless analysis and sharing of insights that inspire action.

2. Moving from Idea to Impact:
the Emergence of mHealth 2.0
Luca M. Sergio
Managing Partner,
Ethis HealthTech, LLC
+1-201-744-3364
LSergio@EthisHealthTech.com
Twitter: @lmsergio
LinkedIn: www.linkedin.com/in/lmsergio/

3. how did I first come to mHealth?
• Catalyst and
commercialization of Topcon
Medical’s EyeRoute Synergy
mini-PACS system
• 1st mHealth platform for
ophthalmology
• Your diagnostic images,
anytime, anywhere
• Now assisting mHealth
companies with
commercialization

4. what makes up mHealth?

5. mHealth begins & ends with the patient
PATIENT
Data
App
Developers
Health
Social
Networks
Mobile
Sensor
Mfgs
Patient
Portals
RHIOs
Hospitals
HIEs CMS
Device
Mfgs FDA / CE
Pharma
EHR
EMR
PACS
RIS
Payers–
morphing
into svc
providers
MD
Associations
ACOs
Individual
Providers

6. what is so exciting today?
• Smartphones everywhere
• Increasing EMR adoption
• Focus on quality of care
• Consumerization of healthcare
is happening now
• Personalization of care
emerging
• New opportunities for
collaborative care
• Current healthcare spending is
out of control
• Care must be doctor and
patient driven

7. why mHealth 2.0?
mHealth 1.0 was an app for an app’s sake
What is mHealth 2.0?
• Marshaling data across silos to effect
behavioral change
• Closing behavioral loops with actionable data,
involving both doctor and patient
• Intelligent systems to handle the data deluge

8. why mHealth 2.0?
Where should we apply it?
Chronic diseases:
• Obesity
• Hypertension
• Diabetes
• Chronic heart failure
• Chronic obstructive
pulmonary disease
(>80% of US healthcare
spending)

9. why mHealth 2.0?
How should we apply it?
• Greater personalization of
medicine
• Move beyond fitness tracking into
medically accurate, pervasive
sensors
• The medical home, medication
adherence, collaborative
communications, and care plan
adherence
• Focus on giving a sense of control
to the patient
• Fill the gap between fitness
tracking and in-hospital care

10. why mHealth 2.0?
What is needed to make this happen?
• A unifying catalyst
• A player who enables behavioral change by
cementing a connection between patient and
doctor
• A player who combines sensors, with
standards, with cloud systems, with fun and
compelling UI/UX

11. questions to remember: how can mHealth…
1. Improve patients’ lives?
2. Enable doctors to profit?
3. Create efficient “systems
of care”?
4. Foster partnerships
between doctors and
payers to create patient
value?

12. essentials for the patient
Self care
information, but
connected to
valued partner:
the MD
24/7 access to
providers
Easily closing
compliance loop
for MD care
instructions
Smart,
contextual,
actionable
alerts
Seamless
communication
with broader
EHR systems
Passive sensors
should fade into
the background

13. essentials for the doctor
Instantaneous
view of patient
Mobilized, easy
workflow
Closing patient
compliance loops
Collaborative
communication
Minimizing
office visits
Freeing-up of
time to focus on
overall care

14. ecosystem today
Patients
• Consumerization is
driving the overall
transformation
• Expectation of
“anytime, anywhere,
any device”
• Need to move beyond
annual / episodic check-
ups
• Self-monitoring and
management
• Demanding new dialog
with MD
Doctors
• Less time than before
• Changing
reimbursement models
• Focus on quality of care
• Need to have greater
insight into patient
outside of office
• Fearful of change
• Not yet aligned with
consumer driven health,
but soon…
Hospital
Systems
• Consolidations with
disparate IT systems
• Competition to offer
services
• Managing tremendous
info complexity
• Focused on reducing
readmissions

15. ecosystem today
Payers
• Emergence of Payer /
Provider systems (Kaiser
Permanente)
• Emergence of value-
based care
• Difficult for Payers to
add patient value
• Open to new technology
solutions to drive quality
or cost
• Morphing into service
providers (United
Healthcare, Aetna,
Cigna, Wellpoint)
Big Pharma
• Medication adherence
• Initial focus on
educational apps
• Large budgets, but
constrained by
regulatory agencies
(FDA)
• Some focus on
improperly prescribed
medications
Tech
Players
• Initial focus on apps &
fitness sensors
• Realization that tech
alone is insufficient:
must build services
• Many copy-cat sensor
companies, but few that
close an important
patient loop or integrate
into broader HealthIT
system
• Many players ignorant of
standards and
integration requirements

16. ecosystem today
Government
• Affordable Care Act
• Meaningful Use Stage 2
• ICD-10 coding
• New FDA Guidance on
mHealth
• Proposed SOFTWARE Act
in Congress
• Blue Button Initiative
• HIPAA Omnibus Rule
• Studies emerging (VA
and NHS in UK)
evidencing cost
reductions via mHealth
Finance & Exits
• Health IT VC funding
topped $737M in Q3
2013
• AthenaHealth’s
acquisition of ePocrates
for $293M in Q1 2013
• Basis smartwatch
received $11.5M and
celebrity advisors
Deepak Chopra and
Esther Dyson
Other Players
• mHIMSS
• mHealth Alliance
• The Clinton Health
Matters Initiative and
Wellable (wellness
incentive company)
• Johns Hopkins Global
Health Initiative

17. barriers to widespread adoption
MD apathy
Tension between
MD & ePatient
Lack of
interoperability
with existing
Health IT
systems
Reimbursement/
business
models/
nonalignment of
incentives
Need for
medical
relevance &
accuracy
Poor
signal-to-noise
ratio because of
data overload

18. problems to avoid
Sensors not easy
to integrate into
consumers’ lives
Sensors & apps
not easily
feeding data to
doctors
Non HIPAA
compliance
(data privacy)
Wasting time
to learn a
nonintuitive
interface
Adding
complexity to
MD workflow
Creation of
new data silos

19. future trends
delivery of
care:
 Home health
care/remote
patient
monitoring
 Pharmaceutical
adherence
 Reduction of
hospital
readmissions
 Explicit cloud
services linked to
Mayo Clinics…
tech itself:
 Sensors
everywhere
(wearable,
ingestible,
implantable)
 Wearables in the
operating room
 Middleware cloud
systems to
integrate
disparate data
silos
doctors:
 MDs will have still
less time
 Collaborative
care will become
essential (also
with patient)
 Clinical education
support systems
 Intelligence
dashboards (just
essential info)

20. future trends for patients
Overall: shifting
of monitoring
and action into
autopilot
Easy sending of
factual summaries
to doctors from
our devices (small
data)
Ongoing
communication
with providers,
outside of
hospital
Easy sending of
actions taken
with intelligent
alarming to MDs
Easy access to
detailed health
records
Personal
genomics

21. how to realize the vision?
via technology:
 Own the
communications
on-ramps
 Build a better
data highway
 Essential apps in
smartphones
(medical image
viewer, secure
communications)
 Novel sensors
via
partnerships:
 Tie into Payer
systems (cost
reduction +
member benefits)
 Establish mHealth
innovation centers
in NYC and San
Diego
 Empower certain
ePatient groups–
PatientsLikeMe.com
via services:
 Tech alone is not
enough
 A choke point:
data systems
integration
 Medically
accurate sensors
with smart alert
cloud platform to
avoid data deluge

22. how to realize the vision? – the consumer
general consumer requirements:
• Provide truly actionable intelligence without reminder
fatigue
• Be demographically appropriate
• Sensors, apps, cloud, and wireless communications
need to work 99.9% of the time
• A fun, compelling UI/UX
• Incorporate elements from behavioral psychology
• Facilitate secure, encrypted, HIPAA compliant
conversation
• Make the technology “disappear”

23. how to realize the vision? – the consumer
medical problems to address:
• Obesity
• Hypertension
• Diabetes
• Chronic heart failure
• Chronic obstructive pulmonary disease
• Adherence to medication

24. how to realize the vision? – the consumer
points of consumer data interaction:
• Creation of personalized health plans with EHR
integration and lab results (going beyond patient
portals)
• Sharing of electronic data
• Self monitoring/documentation
• Remote patient monitoring (diagnostics, Rx
compliance)
• Secure communication with healthcare providers
• Provider “prescribed” educational materials
• Self education on symptoms

25. how to realize the vision? – the consumer
wearables:
• Easy, elegant, unobtrusive, and doesn’t necessitate 12
clicks
• Differentiate via medical accuracy of sensors
• Sell not only via retail/online, but also MDs, health clubs,
corporate environments (“I lost my husband to Fitbit…”)
• If MD is paid based on how a patient performs post-
discharge, he’ll slap a wearable monitor on his wrist…
• Data analysts to help make sense of the tide of small
data
• Insurance premium reductions for good behavior

26. mHealth 2.0: making an impact
The future will lie in aggregation of data from multiple
sensors, analyzed and re-expressed as actionable insights for
consumer behavioral change.
Open question: who can own both the most interesting
sensors, in the most compelling and easy-to-use form factor,
and then who can gather, store, analyze and share/integrate
the data, incorporating a patient feedback loop?
Luca M. Sergio
Managing Partner,
Ethis HealthTech, LLC
+1-201-744-3364
LSergio@EthisHealthTech.com
Twitter: @lmsergio
LinkedIn: www.linkedin.com/in/lmsergio/