Last week the smartphone turned ten. This device has revolutionised the way we interact with each other and more importantly with our own health. This week’s blog by Amen Sanghera, an analyst here at the Centre, takes a deeper dive into the key innovations that have enabled consumers to be more active participants in their own health and some of the challenges that still face the use of smartphone technologies in healthcare.
From the moon to your pocket: the astronomical growth of the smartphone
The NASA moon landing in 1969 represents one of the greatest achievements in mankind’s history. NASA was to launch a rocket into space, guide three astronauts around the moon, land two of them on the surface and return them all back safely to earth, all with the help of computers 120,000,000 times slower than the phone you are reading this post on.1, 2
Last week marked the 10th anniversary of the Apple iPhone which launched in 2007, a device that ushered in the smartphone era and brought with it a revolution in consumer behaviour through the innovations it bought to the market. Since its release, smartphone technology, and the applications running on it, have progressed to a point that, for most of us, makes it an essential, if not indispensable part of managing our day-to-day activities. Indeed, our obsession with smartphones is reflected in the high number and increasing market penetration of smartphones across the globe, these include:
- by the end 2017 there will an estimated 2.4 billion smartphones users, with more than 54 per cent of mobile phone users utilising smartphones3
- it is projected that more than a third of the global population will use a smartphone by the end of 20184
- smartphone penetration is estimated to have reached 77 per cent in the US5, 85 per cent in the UK6, and will reach 44 per cent worldwide by the end of 2017.7
The growing capability of smartphones enables them to capture, analyse and interpret complex information faster than ever before. This has changed many areas of our lives and, slightly late to the table, healthcare has recognised that to stay relevant, particularly with the next generation of patients, the industry must embrace mobile technology and use it to innovate. As a result, technology companies, healthcare providers, payers, pharma and independent developers are increasingly extending their capabilities to support consumer healthcare, disease management, primary care, secondary care and clinical trials.
Smartphones are enabling patients and the public to be more informed and better empowered to manage their own health than ever before. The key innovations ushered in during the smartphone era that have enabled this change include:
- The internet in your pocket: Thanks to the internet now being optimised for mobile, users are able to view web pages, videos and download content from the internet on the go. By October 2016, the percentage of users accessing the internet via mobile or tablets reached 51.3 per cent worldwide, surpassing the desktop for the first time.8 For healthcare, this has meant that people are can quickly search and view content on health and health conditions; find treatments recommended by others; and identify potential treatments that are going through clinical trials. They can also consult with other health enthusiasts, patients and doctors. Indeed, a 2016 survey of 2,000 Americans found that 58 per cent of smartphone owners reported using their smartphone to share information with a medical professional, via the internet on their device, mobile app or wearable device9
- App stores: As of March 2017, these stores had a collective app library of 5 billion apps (2.8 billion in the Play Store and 2.2 billion on the App Store).10 As far as healthcare is concerned, between 2015 and October 2016 some 100,000 mHealth apps were launched taking the total of mHealth apps in these stores to 259,000. Collectively, these apps generated 3.2 billion downloads.11 By sheer numbers alone, the consumer appetite for health applications appears veracious
- Creating an interoperable hardware and software ecosystem: Between smartphones and wearables there are a myriad of sensors that are now being utilised in novel ways as health aids. Developers have seen the potential of combining hardware and software to create ecosystems that can provide real time analytics on health activity and the management of health conditions.12, 13 In addition to these three core innovations, health apps also keep their users engaged through notifications and the gamification of health goals.14
With the mhealth market continuing to grow at pace there are a number of concerns that need to be addressed in order to protect consumers. These include:
- Regulation: given the vast number and proliferation of health apps regulators have struggled to provide adequate guidance on how to manage developer expectations, allow innovation to progress and protect the end consumer. For example, the current position of life science regulators results in the non-regulation of applications until they are given a defined medical purpose, which developers are left to self-assess from online decision trees.15, 16 With this self-assessment there is the inherent danger of applications getting into the market with little to no regulatory oversight. Moreover, this can lead to misleading claims and irresponsible privacy practices, as was recently demonstrated by The New York Attorney General's Office settling penalties totalling $30,000 with three app developers17
- Data safety: with the lack of clear regulatory guidelines for app developers there is the risk of the sensitive data held by these applications being vulnerable to attack. Indeed, in 2015 a 6 month review of 79 apps on the UK NHS’s Health Apps Library, found substantial data safety holes in the applications certified as clinically safe and trustworthy.18 As a result the App library was closed, the apps and processes for reviewing apps reviewed and the library re-opened in March 2017.19
The smartphone era has bought with it distinct changes that have enabled us to start to change our behaviour and relationships in general and, importantly, towards our own health. Indeed, our 2015 report ‘Connected health: How digital technology is transforming health and social care’ highlighted this trend and the potential mHealth has for health and social care. Moreover, our upcoming report ‘Pharma and the connected patient: How digital technology is enabling patient centricity’ looks at how the pharma industry is embracing digital technology through smartphone and web apps in order to become more patient centric and revitalise its business model. The smartphone ushered in an age of information wealth and digital connectivity at out fingertips, it shaped and strengthened multigenerational communication, but it is also led to many of us becoming more remote and distracted from each other. Now ten years on, we are beginning to see the innovations and benefits that intersecting healthcare and technology can have on our own health and healthcare systems; however, we must optimise the positives and remain vigilant to the downsides of smartphone technologies.
6 Deloitte Mobile Consumer Survey, Deloitte, 2017
18 Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment, Huckvale et al, BMC Medicine, 2015. See also: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0444-y
19 NHS app library to be launched this month, Digital Health, 2017. See also; https://www.digitalhealth.net/2017/03/nhs-app-library-launched-in-march/