mHealth 2030
We ask leaders from across mHealth: what will the next decade bring?
What will apps deliver by 2030? What will be the biggest barriers faced
by the industry? And what do governments need to do to contribute?



mHealth 2030
The last decade saw the start of the smartphone revolution. Ten years ago the iPhone was
just three years old, around a quarter of us owned a smartphone, and the term mHealth
was first coined. 2020 sees the start of a new decade where 79% of us own a smartphone,
and 100% of those ages 16 to 24 have access to the internet via a smartphone. 327,000
health apps have been created and 5 million health apps are downloaded every day.
But, whilst there has been an explosion within the fitness industry and uptake for GP online
services have seen fast growth, mHealth is not yet part of the fabric of the NHS, nor is it
widely adopted amongst those who could perhaps benefit the most.
We ask worldwide leaders from across mHealth: what will the next decade bring? What will
apps deliver by 2030? What will be the biggest barriers faced by the industry? And what do
governments need to do to contribute?
We spoke with:





Niels
Chavannes,
Professor of
Primary Care
Medicine, and
Founder of
National eHealth
Living Lab, the
Netherlands
Joe Kvedar,
Professor of
Dermatology,
Harvard Medical
School and MD,
Connected
Health
Heather Cook,
Chief Innovation
Officer, Brain in
Hand
Martijn de Groot
(Ph.D.), Radboud
University
Medical Center,
Director,
REshape
Priit Tohver,
Advisor for e-
services and
innovation at the
Ministry of Social
Affairs, Estonian
Government

We hope you find our look into the future thought provoking. To find out more, or start your
journey into the future of mHealth, get in touch.




Liz Ashall-Payne
CEO and Co-Founder, ORCHA





WHAT WILL APPS DELIVER IN 2030?


Apps are changing the health and social care industry. The
ubiquitous smartphone has found its way into the pockets of
nearly every clinician, care provider and patient in recent
years, and, by 2030, the development and integration of
apps will have helped transform the way services are
delivered.

By 2030, apps will have reached a mainstream position
sitting alongside traditional support services, having
established a solid evidence of reducing healthcare costs,
improving the efficiency of care delivery and enabling
greater access to high-quality care via telemedicine.
“Apps can be
pivotal in
elevating the
patient from
consumer to
partner in their
own care.”

mHealth will be prescribed, seen as an everyday toolkit that patients use alongside or
instead of drugs. Self-management with remote monitoring via a health app will be as
acceptable to a patient or care provider as traditional methods of care delivery are today.

In particular, with the ever-increasing number of people living with a long-term condition,
alternative ways of delivering improved outcomes has to accelerate – and the evolution of
apps, integrated into care pathways, will form part of the solution to meeting increased
demand.
Priit Tohver, Advisor for e-services and innovation at the Ministry of Social Affairs in the
Estonian Government, observes, “Apps can be pivotal in elevating the patient from
consumer to partner in their own care. By 2030, when planning the care journey of various
patient groups, we in the healthcare sector should feel comfortable maximizing how much
of this journey can be undertaken by the patient alone with their smart device in hand,
screening the appscape for suitable tools.”


USER-CENTRICITY WILL WIN

But which apps? The patient will be central to the success or failure of apps. Niels
Chavannes, Professor of Primary Care Medicine, and Founder of National eHealth Living
Lab, explains: “The current problem we face is that there are too many apps to choose
from and they do not evolve to keep the user’s interest.”

“In the future, only apps that meet a true need for the consumer will thrive. They will have a
unique selling point and make regular updates, driven by persuasive design seen today in
the gaming industry.”

Brain in Hand is an example of Digital Health designed to meet the needs of a clear set of
users: people with impaired executive functioning, such as autism. Its Chief Innovation
Officer, Heather Cook, agrees with setting a clear, defined mission: “We are driven to
increase the independence of our users. It’s what they and those who support them want.
We aim to put our users in control of their own support and offers the ability to interface
and collaborate with their support provider.”




WE’LL CRACK STICKINESS

However, attracting people isn’t enough - many of today’s apps face stickiness issues. Joe
Kvedar, Professor of Dermatology, Harvard Medical School and MD, Connected Health,
explains, “It’s extremely challenging to keep individuals adherent to their treatment regimen
or motivated to maintain healthy lifestyle choices. The always on, always available app, is
key to driving that behavior, and designers will get smarter about creating platforms that
keep individuals interested and even focused on their health.”

“Focus on
meeting the
user’s health and
entertainment
needs, must be
complemented
by science and
evidence.”
Our better understanding of the mindset of health
consumers will lead to new behavioural incentives to
maintain engagement. But, Chavannes warns, “This focus
on meeting the user’s health and entertainment needs,
must be complemented by science and evidence.
Research has found that some misjudged apps create an
immediate jump effect, but usage falls off, and can leave
the user less active than before using the app.”

One area we see good examples of gamification with
positive evidence is within the smoking cessation field.
Here, personalised messages, nudges and looks are
making the apps sticky and delivering life changing
results.

Increasingly, apps will follow this need + gamification + science approach.


ONE COMPLETE PICTURE

Another big change we anticipate is that data from apps will be aggregated. Liz Ashall-
Payne, CEO and Co-Founder, ORCHA, says, “We see that there will be a move from the
silos we see today, to an ecosystem of data. This will enable clinicians to access one
picture, pulling information such as blood glucose, exercise and diet, from a variety of apps
into one dashboard.” This extends the personalised, integrated, whole life proposition that
apps will offer.
Tohver adds, “When properly integrated, even simple technologies can be advantageous,
allowing pattern detection, and enabling patients to address their health needs and
questions swiftly and at the appropriate level, reassuring the patient while not
overburdening the professional.”
With improved integration, analytics and emerging technologies like AI and voice
recognition, we’ll also see more and more uses in the soft science of wellbeing. Kvedar
gives examples: “we will see apps being prescribed to address issues such as loneliness
and isolation in older adults, ‘silent killers’ that can significantly increase the risk of
cardiovascular disease and stroke, more rapid progression of Alzheimer's disease, and
other critical medical issues.”


WHAT ARE THE BIGGEST BARRIERS?

Today, there are five barriers faced by the industry:

1. Governance & risk management - The lack of clarity around the appropriate
evaluation and governance foundations brings uncertainty.

2. Trust & safety - the lack of a clear assessment regime prevents professionals from
being able to differentiate between safe and unsafe apps.

3. Systems & process - Professionals are not yet given the tools to embed digital
health into day to day working practices.

4. Awareness & habit - apps are not yet part of training and development or the day-
to-day management of conditions, and so inhibits confidence.

5. Return on investment - evaluation of impact remains a challenge and so inhibits
adoption.

These barriers will each be overcome over this next decade. Governments will set the bar
for standards, with a clear process for applying the criteria and an active programme to
raise awareness amongst professionals and consumers. This will be accompanied by a
drive to educate the workforce with training and education, in order to change the culture
and sentiment towards mHealth.


UPCOMING AND CHANGES TO REGULATION

The upcoming Medical Device Regulation (MDR) law which comes into effect this May
2020, is the issue at the forefront of most people’s minds. It’s one of the biggest
requirements app developers will face, as it is needed to get the CE mark required to
supply apps in Europe. Martijn de Groot (Ph.D.), Radboud University Medical Center,
Director, REshape, explains, “This law regards mHealth as a class IIb medical device and
so demands clinical evaluation. This will lead to even fewer products reaching the
healthcare system, especially from startups - to deliver such clinical evaluation demands
large-scale financial injections, achievable by large organisations, or those attracting
investment or government funding.”
De Groot adds, “That said, those that succeed may be of a higher quality, and this EU law
may have less effect in the UK after Brexit. In a no deal scenario the UK’s current
participation in the European regulatory network for medical devices would end, end the
MHRA would take on the responsibilities for the UK market currently undertaken through
the EU system.”
But Tohver questions if MDR will impact all health apps, saying “General wellbeing and
information apps shouldn’t be classified under MDR. Indeed, it has been one of our
questions when implementing the NICE framework: What is the overlap, so that we don’t
evaluate the same things twice? So far, we have concluded that there are significant
differences and that fewer mHealth applications fall under MDR.”


Today, most regulation still isn’t set up for the dynamic
pace of app software development. By the time a
product has passed or failed, the assessment is
irrelevant as the product has since evolved. To help
overcome this, Cook calls for standards to be in
proportion to a product’s purpose and impact: “Getting
the right balance of standards will be vital for the future of
the mHealth market. An overkill of standards, assuming
that apps should have the same level of standards as a
traditional device or care treatment plan, if not in
proportion to need, would be a major barrier to mHealth.”
“Getting the right
balance of
standards will be
vital for the future
of the mHealth
market.”
Tohver agrees: “There is definitely a need for a tiered approach to app assessment. A simple,
informative app should not undergo the same rigorous vetting process as a diagnostic or a
treatment support. This thinking has not necessarily made it to health technology
assessment schemes, meaning that small companies with simple, yet potentially useful,
applications do not have a feasible way to establish themselves within healthcare systems,
because they have to meet the same standards as certified medical devices.”
mHealth technology includes many layers that can affect data security, privacy, and
confidentiality. Cook highlights the public’s concerns about how their personal information
will be used, highlighting “Companies developing solutions need to ensure that sufficient
development time is set aside to analysing, identifying and protecting potential
vulnerabilities, alongside the need to demonstrate interoperability with providers and
commissioners of health and social care mHealth solutions.”
By 2030, however, our approach to regulation will take account of this. There will also be
less tension between regulation and innovation. Ashall-Payne reassures, “Today,
regulation is used more as a ‘stick’ than a ‘carrot’, but we will see a move to a more
proactive, positive approach, flagging to developers that if they can meet a requirement,
then they will be able to enter a market.”


HUMAN NATURE
An equally concerning barrier is physicians’ resistance to change, and their reticence to
adopting technology in care delivery. More will need to be done to ensure appropriate
digital training for clinicians, or a ‘knowledge gap’ will grow between current and future
staff. Cook sees this, sharing, “Even over the next decade, pockets of resistance to
disrupting human centric care provision with apps, will remain, but the wider growth in
patient-centred care models will, in part, help to overcome these barriers.”
“Digital health
should be part
of mandatory
staff training.”
To avoid a knowledge gap forming, alongside looking at our
future workforce, we should also look to the current front-
line staff. Here, digital health should be part of mandatory
staff training. Digital shouldn’t be bolted onto the
curriculum, but embedded throughout. Being pragmatic, to
start with, there should be at least one digital health module
in every pre-qualification curriculum.



Kvedar shares progress being made: “I’m pleased to be working with the Association of
American Medical Colleges (AAMC) Committee on Telehealth to change this dynamic by
including virtual care training into the medical school curriculum. A set of competencies will
help to prepare medical students and residents for this new kind of care delivery and make
it part of their mainstream practice.”


COMMISSIONING

The commissioning of health apps today is a
national lottery, fragmenting the market for
developers and access for patients. Over this
decade, however, the commercial arrangements
with developers will mature, with national tariffs
arranged for mHealth solutions, and a payment
system for developers that is linked to the point of
prescription. Ashall-Payne says, “This will be a
great improvement, putting more power in the
hands of the clinicians closest to the patient.”
“Commercial
arrangements with
developers will
mature, with national
tariffs arranged for
mHealth solutions.”

“In order to bring this scheme to fruition, national bodies will need to pump prime
investment into the system whilst the process is changed, with existing systems running in
tandem while the national scheme is established.”

HOW CAN GOVERNMENTS HELP?
When asked, our experts identified a range of ways in which Government action can help
manage and grow mHealth over the next decade.

They called for Governments to establish clearer guidance on technical and clinical
minimum standards thresholds, providing developers with the necessary support to
accurately meet its needs, including education on information governance requirements for
patient data, outlining acceptable ROI business cases, and clarifying the legislative and
regulatory requirements.

It was also recommended that Government bodies help providers to avoid the duplication
of public resources. Cook called Government organisations to “Provide support to health
and care providers to navigate the minefield of potential mHealth solutions, undertaking a
certain level of due diligence centrally so that commissioners feel more confident
integrating a new system into an existing health and care pathway.”







BLUEPRINTS AND INCENTIVES
Governments need to, above all, manage the change. Tohver shares, “Health apps are not
going anywhere, so how can we, as regulators, facilitate their integration with the
healthcare system to a reasonable degree? This requires educational efforts, testing
environments, new assessment approaches, reimbursement schemes and opening up e-
health systems, to name just a few key actions.”
Initial steps are being taken in forward-thinking countries. Over the past year, The
Netherlands has put in place steps to establish how the public and clinicians can find the
best and safest apps. Niels explains, “We have started with mental health, taking a
proactive and thorough programme in this area. Collaborating with all stakeholders, we
now have a library of mental health apps that everybody agrees are fit for purpose. Our
approach is now a blueprint that we will follow for other health categories.”

The majority of health apps are designed to avoid
attendance at a GP surgery or hospital, either
providing information or tools to stay well, aid
condition management, or help in recovery. As
such, alongside a blueprint, measures and
incentives must support change. Ashall-Payne
explains, “Most national health bodies provide no
incentive to today’s health providers to adopt
mHealth, as they’re paid upon seeing patients.
With overstretched health services, Governments
will need to fundamentally look at the complete
incentive system, compensating providers whose
patients are in good health and able to stay away
from the service. Rewarding good health, not
illness.”

“Governments will
need to
fundamentally look at
the complete
incentive system,
compensating
providers whose
patients are in good
health.”


AN INTERNATIONAL PERSPECTIVE

Experts share how governments can reconfigure a society to proactively create systems
and policies that positively impact citizens. Kvedar shares, “One example that I talk about
in my book, The New Mobile Age, is the way in which Japan is a perfect illustration of how,
with nearly 30% of its population over the age of 65, Japanese society has made
significant changes to accommodate this age group, from training social robots to assist
people in their homes, to changing supermarket design to make it more ergonomic for
older bodies. An increasing number of older people are returning to work or staying on the
job, not for financial reasons, but because they are needed in the workplace as the
younger population is dwindling. Japanese society also recognises that keeping people
engaged and productive correlates to maintaining health; it also makes economic sense to
keep people employed, rather than caring for an ageing, retired population.”

Supporting this view of looking on a worldwide basis for best practice in mHealth adoption,
Chavannes highlights that the Netherlands’ health challenges and user needs are not
unique. In order to make change to the world’s health on a large scale, he says, “I call


Governments across the world to team up to share best practice, drive mHealth standards
and so adoption. We often focus on our national differences, but there is more we can
share and learn from each other.”

“The real innovation will take place in continents such as Africa, where fewer systems are
already in place. Working together, we will all learn a lot.”




IN SUMMARY

Now is the time to
catch up and
takle the new
governance,
systems and
education
required.
We are at a pivotal point in time. Technological
advances have provided us with the opportunity to
include a wealth of new information and tools into our
personal lives and healthcare services. Today, the
market is unregulated, putting people at risk. Now is the
time to catch up and takle the new governance, systems
and education required. Enabling healthcare services to
harness the power and knowledge that apps can bring,
and inspiring developers to create genius products that
help solve our world’s health challenges, thereby
improving even more lives.