Global Progress in Mobile Health Applications

"Health apps will be normal in 20 years time"- - but what do we do in the meantime?

The adoption of mobile health is a global phenomenon, not only in the United States.

"The mHealth app industry has created a lot of hype recently. The number of mHealth apps has surpassed the 100,000 mark, big players like Apple and Samsung have announced new enabling platforms, sensor-integrating mHealth business models have caught a lot of press coverage and investors are lining up to push money into the market."

Still, the number of solutions that are integrated into the daily routines of healthcare professionals and that are reimbursed by payer organizations is limited. So what is the actual status of the mHealth industry and where will it be in 5 years?

Attributions:  research2guidance

Mhealth is developing not only in clinical medicine but also in allied health and non-health industries.

Analysis reveals several suprises despite 'hype' about mobile health and other mobile apps.

"Today’s mHealth app publishers and Wannabes predominantly target chronically ill patients (31%) and health and fitness-interested people (28%). As primary users, physicians are targeted by 14% of app developers. mHealth app publishers could be categorized into 6 main groups: traditional healthcare players, helpers, mobile app specialists, connectors, medical and fitness specialists. Out of these groups, traditional healthcare players like Pharma and hospitals have the longest way ahead of themselves to find their role in the mHealth app ecosystem. mHealth app publishers have released an average of 7 mHealth apps. The majority (36%) have entered the market only recently (2013&2014). An mHealth app publisher typically hires 3-10 (23%) or 11-100 (23%) employees. The vast majority of mHealth app publishers (82%) generated less than 50,000 downloads with their mHealth app portfolio last year, whereas the top 5% reached more than 500,000 downloads. 68% of mHealth app publishers make less than USD 10,000 or no revenue. The middle income group, which makes between USD 50,000 and USD 1m, represents 17% of the publishers. The top 5% makes more than USD 1m. The most relevant revenue stream is linked to services which are offered via the apps."

The mHealth developer's 2014 Survey  outlines the progress thus far for the industry, and a 2015 survey by research2guidance is available online.  

2015 mHealth Survey--Online

      The study 

represents around 

     10% of 

 mHealth apps

The report also looks at the future trends, drivers and barriers of the mHealth app market. This includes the changes in distribution channels, the preference of app categories and mobile operating platforms, the impact of wearable and other types of sensors and the target groups which offer the highest business potential in the next 5 years. See how experts from all around the world rate what impact mHealth apps will have on healthcare costs and on how healthcare is going to be delivered in a 5-year time span. 

With 2,032 respondents from all over the world the fourth mHealth App Developer Economics study is by far the largest of its kind.

Sponsorship options for 2015 research programme available now. Get on front of the global mHealth app decision maker community Infos at www.mHealthEconomics.com

The relatively late market entry of a large proportion of the mHealth app publishers is one of the reasons why 50% of the publishers have by far released one or two mHealth apps only. There are also mHealth app publishers with more than 50 mHealth apps in their portfolio, but they represent only around 5% of the total mHealth publisher base. Today’s mHealth app publishers and Wannabes predominantly target chronically ill patients (31%) and health and fitness-interested people (28%). As primary users, physicians are targeted by 14% of app developers. The “Other” category includes nurses (2%) and health insurers (2%) as well as still different, but significantly smaller target groups.

Which mHealth platform ?

The preferred mobile operating platforms for mHealth app publishers today are Android (83%) and iOS (81%). All other platforms are far behind. The importance of the second tier platforms like WindowsPhone and HTML5 is significantly higher among Wannabes. 51% and 45% of future app publishers plan to release mHealth apps for WindowsPhone or HTML5. 

In the much diversified landscape of mHealth app publishers, there are six groups which stand out in terms of their goals and market approaches. 

1. Traditional healthcare players: This group includes Pharma, hospitals, health insurance and Med-tech companies, representing 3.4% of the total number of app publishers. They usually belong to the mHealth app publishers with > 5,000 employees. Their primary objective is to raise brand awareness. They have published the largest number of mHealth apps, but their average reach, in terms of downloads, is far below the average. App publishers from this group are so far the least satisfied with the achievements in the mHealth app market. The use of tools and APIs to improve the efficiency of the app development process and app monitoring as well as the value of the app is below its competitors. 

2. App specialists: App specialists are small companies with typically 3-10 employees. They have entered the mHealth app market to benefit from the revenue potential. They have an app developer background and are familiar with the available development tools. The medical experts’ share on board is the lowest of all the mHealth app category share Chronically ill people 31% Health and fitness interested people 28% Physicians 14% Temporarily ill people 8% Hospitals 7% Others 12% Source: reserch2guidance mHealth App Developer Economics survey 2014, n=2032 © research2guidance 2014 18 research2guidance’s mHealth App Developer Economics 2014 groups under consideration (40%). This group represents 14% of the total mHealth app publisher community. 

3. Helper: Helpers are companies or individuals with the primary motivation of publishing mHealth apps in order to help others. Revenue generation is a minor factor. In terms of goal achievement, Helpers outdo all the other groups and sometimes even state to have over-achieved their goals. Helpers are typically small companies of 3-10 employees. They represent 32% of the market. Their download profile shows the highest share of companies (61%) which attracted less than 5,000 downloads last year. 

4. Medical specialists: Medical specialists leverage their medical know-how to develop mobile apps. Similar to the Helper group, Medical specialists have a large share of members who publish apps to help others. Usually by now, they have partly reached their goals. They have the highest share of companies that made more than USD 1m with their mHealth app portfolio. They represent 20% of the market. 

5. Fitness specialists: This group of app developers represents around 10% of the total mHealth app developer community. They primarily develop fitness apps with a clear objective to generate revenue. They connect more often to medical databases and sensors and their use of app development tools is above average. The typical company size is 11-100 employees. 

6. Connecters: This group of mHealth app publishers represents 18% of the total mHealth app developer community. Their strategy is to create value-rich apps by enabling connection to other apps, sensors and databases. This group generates the highest average revenue and has the highest achievement level of their goals.  

All mHealth app developer groups have similar platform preferences with iOS being the number one platform and Android the second ranked. Connectors and Medical Specialists have the highest platform preference for iOS (62%). Fitness and App Specialists have the highest share of companies which choose Android as their primary app platform (34% and 32%). Established Healthcare Players have the highest share with a WindowsPhone preference (13%). 

Comments: Downloads and revenue in 2013; Download numbers refer to a) less than 5,000 downloads b) more than 1 million downloads in 2013 across all platforms; API usage includes APIs that provide access to medical info, personal health data, medical devices and Health&Fitness tracking devices; Tool usage includes tools supporting app analytics, cross platform development, storage, test, ads and social network integration 

Source: reserch2guidance mHealth App Developer Economics survey 2014, n=2032 Establ. Health Players Helpers Medical Specialists Connecters App Specialists Fitness Specialists Brand awareness Revenue Help people Help people Revenue Revenue Goal of apps Downloads (<5k/ >1m) 67%/ 3.2% 25.7%/ 7.8% 42.7%/ 9.1% 51.4%/ 5.1% 39.4%/ 7.4% 39.0%/ 8.9% Revenues (0/ >1m) Goals achieved APIs usage low average average average high all low average average high Very heavy Tool usage high 13.5 7.4 10.7 7.5 11.3 11.3 # of mHealth apps mainly not partly partly mainly yes mainly yes mainly yes # Ø $ Percentage of total % 3,4% 14,3% 20,2% 32,3% 10,2% 18,0% 57,6% 40,1% 100% 47,5% 43,7% 49,7% Medical expert in team ✚ Ø Typical company size 5,000+ 3-10 3-10 3-10 11-100 11-100 53.1% / 7.7% 44.6% / 7.4% 58.6% / 6.3% 61.2% / 5.8% 60.1% / 6.4% 43.3% / 6.7% © research2guidance 2014 20 research2guidance’s mHealth App Developer Economics 2014 It seems that traditional healthcare players put much effort into the mHealth app business, but have not found the right strategy yet. If they did, it would accelerate the market’s development, or as a survey participant puts it: “I feel if there were more corporate involvement in these apps that more people could be reached out to.

Publishers, Who are the most successful >

Lessons from successful mHealth app publishers 

Given the diverse set of goals mHealth app publishers pursue, success could be defined in many ways.  

The question is: What do mHealth app publishers who are economically successful do differently as compared with those who are not?

Economically successful publishers are defined as companies which have generated more than USD 1m revenue in 2013 (Millionaires). They are juxtaposed with Low Earners who earned less than USD 10,000 and Zero Earners with no income generated in the last year. 

There are six areas where Millionaires show significant deviations. These have been the distinguishing factors based on the survey results: 

1. The size of the mHealth app portfolio 

2. The preferred revenue model 

3. The number of years in the market 

4. The current use intensity of tools 

5. The current and planned usage of medical databases and devices (APIs) 

6. The platform preference Millionaires have a significantly higher share of app publishers with a considerable app portfolio. 

35% of Millionaires have released more than 20 mHealth apps. In contrast, Low & Zero Earners focus on one or two apps. 

The analysis also shows that within the group of Millionaires a single-app strategy is not the preferred approach. A larger app portfolio offers relatively larger cross selling potential and helps companies balance the risks in case of unsatisfactory performance of an individual app. As a result, such a company can better care for the overall economic performance of its mHealth app portfolio. 

Millionaires have Service 

  Sales as their primary 

  source of revenue. 

 Low Earners bet 

on Paid Downloads.

Millionaires also differ in their business model preference. As much as 35% of Millionaires state that their top revenue source are Service Sales. On the other hand, 31% of Low Earners state that their 1st rank revenue source are Paid Downloads

The strongest mobile health developers are already involved in other SAAS or HIT applications and the mHealth apps are only a portion or additon to their business line.

In fact, Millionaires have been involved in mHealth app publishing for 3.9 years on average, whereas Low & Zero Earners for 2.4 and 2.2 years respectively. Millionaires also make more use of tools to support development, performance monitoring and monetization of their apps. These tools include Ad Network (e.g. Admob, inMobi, Apple), Analytics (e.g. Flurry, Distimo, Localytics), Cross Platform (e.g. Marmalade, Unity, Adobe AIR), Performance (e.g. Crashlytics, Testflight, Hockeyapp), Social Network (e.g. Facebook, Twitter) and Storage tools (e.g. Dropbox, Box, Google Drive). 

The gaps in use levels are getting even more noticeable with regards to the way publishers connect/plan to connect to medical databases, devices and apps via APIs. There are four groups of APIs that companies make use of at a different level:  Medical info APIs: APIs that provide access to general health information databases for e.g. drug, food, disease, device information (MyNetDiary Food Search, FatSecret)  Personal health data APIs: APIs that provide access to personal health databases e.g. calorie intake, steps, weight, blood pressure (MyFitnessPal, Withings)  Medical device APIs: APIs that provide access to a medical device of a third-party vendor e.g. glucometer, blood pressure monitor (Accu Check, Freestyle, Withings)  Health & fitness tracking device APIs: APIs that provide access to health tracking devices of a third-party vendor e.g. heart rate monitoring belts, step tracking bracelets, scales (Fitbit, iHealth)

Further details are available in the complete report

Sections of the report include:

API development

This development will lead to an explosion of health and fitness data collected by an increasing number of app and sensor users. Three different categories of vital parameters are captured today. 

1. Health & fitness tracking data: The majority of today’s metrics are activity and weight information like steps, kg/pounds and calories. The Connected Elite focuses on these measures. 

2. Patient monitoring data: The second category of vital signs belongs to apps which support the continuous management of a chronic condition. Apps which support this group of use cases allow for storage of a much broader range of different metrics such as vital signs, blood pressure, blood oxygen, blood glucose and brain waves, but have a substantially lower app user adoption. 

3. Medical examination data: The third category of vital signs is related to medical examinations. Patients/doctors capture the data with the help of an app or a sensor on a case-by-case basis. The number of different vital signs which fall into this category is much more extensive than those of the first two groups, but user adoption is much lower. Examples of vital signs and examinations in this group are respiratory rate, lung air volume, ECG, EEG, blood tests, color tests, urine tests and ultrasound imaging. 

The first group has the highest number of users who actively track vital signs and the lowest number of parameters. In contrast, the third group has the lowest number of users and the highest number of collected parameters. 

Outlook: What will be in 5 years time Before looking ahead what will happen in the next 5 years, it is worthwhile to look back to where the market started 5 years ago. 

In 2009 smartphones are just starting to play a role in the global mobile phones market. Only 13 % of all handsets shipped in Q1 2009 are smartphones. The vast majority of mobile phones that are purchased in this quarter are simple feature phones such as Nokia’s 63 series handsets. The most dominant mobile operating 

system for smartphones at that time is Symbian with an almost 50% market share (shipments). iPad is to be launched only one year later. 

Today Google and Apple dominate the operating systems market for mobile phones. The formerly leading market player Nokia and its operating system Symbian have been sold or disappeared altogether from the market. Smartphone shipments are projected to reach USD 1.2bn2 in 2014. This means that smartphones have become the global, No.1 connected device and, in addition, tablets are sold even more than laptops. 

The app market is developing with exceptional speed - 15 times faster than the growth rate of stationary internet users. 

What does this mean for the mHealth app market and its potential impact on the delivery of healthcare in 2019? First of all, with a few exceptions in developing regions (e.g. some in Africa), almost everybody in the world will have a device which could be targeted with an mHealth solution. 

The likelihood that soon doctors and patients will meet in the doctor’s office to talk about apps which could support medical treatments is very high, given the high penetration rate of smartphones and tablets among doctors and the interest app users/patients show in mHealth apps3 . 

It also means that not only will new players such as sensor vendors or mHealth data aggregators enter the healthcare market, but also that they will become the dominant participants. Traditional healthcare players need to understand what impact e.g. health API and data aggregators will have on their business models. A clear understanding of the growing connected mHealth app market is indispensible for those traditional healthcare players who do not wish to be left out from the new ecosystem. 

Finally, even though there are and will be good arguments that mHealth apps will not have a big impact on the way healthcare is delivered given the high resistance by traditional healthcare players, consumers will set the pace and the market will need to follow. 

On the other hand, the majority of app developers who concentrate on mHealth have not had a successful market entry yet. The hesitant activities of traditional payers like health insurers and companies, still slows down the overall development of the market. It will take a while until mHealth apps become as widely used as a thermometer or as a survey participants envisions it: “In 20 years, mHealth apps will be the normal way of managing health” Survey Participant.

During the past five years the annual HIT hype is about mHealth. The reality is it hasn't happened yet.