By Jill Parsons Burger, Ambient Insight Advisory Board
This article was originally published in the ASTD eLearning newsletter in May 2007. The information in the article is based on the report, "The US Healthcare Market for Mobile Learning Products and Services: 2006-2011 Forecast and Analysis."
Ambient Insight analysts track eight types of learning products, one of which is Mobile Learning. Ambient Insight restricts the definition of Mobile Learning to events, content, and applications accessed on handheld devices. Mobile Learning is starting to gain traction as growing numbers of U.S. workers and learners embrace mobile computing. But this has been a strong trend in healthcare for several years.
In the healthcare industry, mobile computing has a long history, a large number of users, and mobile devices are often integrated with both the education and the daily workflow of healthcare professionals. It is the one place where Mobile Learning can be researched over a relatively long time period.
Most applications in the healthcare market are being targeted at physicians and nurses--the power users. Consequently Ambient Insight analysts looked closely at their workflow, the Mobile Learning applications they use, their mobile device adoption, and into the money trail that supports and encourages that adoption. There are general types of Mobile Learning in use with very specific variations used in the healthcare sector.
Ambient Insight analysts have found that the healthcare sector accounts for 20 percent of the total U.S. market for Mobile Learning. It represents the largest single vertical niche of Mobile Learning adoption. A closer look at mobile device usage explains why and points to trends emerging in other industries.
The mobile user demographic is large and growing
The U.S. healthcare sector employs almost 13 million people, and 6.5 million are healthcare “professionals,” defined as those workers that provide direct medical care to patients. At least 18 percent of these 6.5 million people already use personal digital assistants (PDAs) or other mobile devices, such as handheld tablets and smartphones (cellular phones with PDA functionality). Nearly all new healthcare professionals entering the industry are experienced and dedicated mobile technology users, and many were required to use the devices during their schooling. They expect to use the technology in their practice.
More than 800,000 of these professionals are physicians, and on a percentage basis, they are the largest mobile device user demographic in the healthcare industry. Physicians are well-known early adopters of mobile technology. For example, the physician being beeped while on the golf course is an indelible image. Half of all physicians owned a PDA in 2004, according to the most recent survey by the American Medical Association. As of 2006, 55 percent (440,000) of physicians use handheld devices in their daily practice.
Physicians over 40 are slightly less likely to be early adopters of mobile technology than their younger counterparts. It is interesting to note that 90 percent of doctors under 30 use the devices. It is obvious that as the demographic ages, adoption will grow in tandem. Yet, physicians are not the largest demographic in terms of total numbers of users.
There are over 3 million nurses in the United States, and they are just beginning to use such handheld devices as Tablet PCs, RFID readers, and PDAs. As of 2006, 22 to 24 percent of nurses were mobile device users. That represents a 700,000 user demographic. Products designed for nurses are the fastest growing products.
Four types of Mobile Learning used in healthcare
Currently, there are four major types of Mobile Learning products in use in the healthcare sector: mobile continuing medical education (CME) and mobile exam prep, emergency medical decision support, clinical decision support, and medical and healthcare reference.
Decision support software in the healthcare sector is a very close analogy to performance support software (EPSS) used in the general corporate arena. This type of productivity tool lends itself very well to the healthcare sector where busy professionals need to access accurate, relevant data while on the go. Industry estimates have clinical decision support tools saving physicians anywhere from one to three hours a day, depending on their medical specialty.
It is interesting that while clinical decision support will be the dominant product type in terms of revenue over the next five years, it's also the slowest growing product type. While the other Mobile Learning products are generating significantly less revenue they are growing at a much faster rate. For example Mobile CME and exam preparation is expected to grow by 54.4 percent over the next five years.
Mobile CME and mobile exam preparation
Mobile CME and mobile exam preparation refers to Mobile Learning applications that can be run via a handheld computer, smartphone, or other mobile device (like a mobile media player). There is a difference between CME and exam preparation. Typically, CME is a test or a training experience in which credit is provided to the student upon completion. Exam preparation is content and practice tests that are almost always designed to help healthcare professionals pass their formal licensure exams. They are included together in this forecast because they share a common format: both are likely to be in the form of practice tests. Often, the completion of an exam preparation practice test can also result in CME credits.
Although most electronic and mobile CME appears to be free, there really is no such thing as "free" mobile CME. It's subsidized by advertising grants from pharmaceutical (and sometimes medical device) companies, bundled as a value-add to other mobile medical applications, or subsidized by specialty licensing organizations.
There is a complex supply and demand chain and many pricing pressures for mobile CME, but all indicators nevertheless point to hearty growth during the forecast period and many points of entry for firms with the desire to create mobile healthcare CME. The trick for suppliers of the mobile CME is to know who their true customer is: the licensing organization or the pharmaceutical and medical device companies.
Web-based CME is growing at a rate of 11.1 percent, while traditional meetings and conferences are declining by 14.6 percent over the forecast period. The robust growth of mobile CME indicates it will overtake both classroom and web-based CME in the next 10 years. By that time the distinction between web-based and mobile-based products will be indistinguishable, as most people will access the content with mobile Web browsers.
The CME market is a vibrant one, with some suppliers more readily embracing the opportunity to leverage the need for CME to cross-market their other offerings. The ePocrates model provides a good example of an alternative CME business model that works. The Mobile Learning supplier provides free CME as a way to "up sell" their fee-based clinical decision support applications.
As a result of this incentive-based strategy, one in four physicians subscribes to ePocrates, with pharmaceutical companies paying for at least 10 percent of subscriptions. Its mobile CME system delivered 100,000 CME certificates to over 30,000 healthcare professionals in the last six months of 2005. About 10 million U.S. healthcare employees must get annual CME credits to keep working. Additionally, they are required by licensing boards to train continuously, but have little time to accomplish those learning tasks. Mobile Learning is the most obvious solution to this dilemma.
Mobile emergency medical decision support
Mobile emergency medical decision support is a very specific type of Mobile Learning product that provides contextual performance support to emergency medical personnel based on the contextual needs and the input of the user. The demand for this product comes almost entirely from first responder and public safety organizations that employ emergency medical personnel. According to the Department of Homeland Security, there are more than 155,000 nationally registered emergency medical technicians (EMT).
Ambient Insight breaks this product out from the general healthcare clinical decision support (CDS) products because they tend to be very specific applications designed for specific situations and topics. Topics range from local laws, proper procedure, cardiopulmonary resuscitation (CPR), hazardous waste, bioterrorism, and first aid.
Over 20 first responder organizations in the state of Washington, including hospitals, fire and police departments, and decontamination units use a product from Iomedix called "MobileIRIS (Incident Response Information System)." They use the product to treat and track injured people that need medical treatment during emergencies. Emergency medical technicians use the system to record patient's vitals, injuries, location, treatment, and photo. The data is encrypted and beamed to participating hospitals and emergency operations centers.
The Georgia Tech Research Institute (GTRI) developed a mobile product called "Chemical Companion” with funding from the federal Technical Support Work Group. GTRI provides the product for free to first responder agencies throughout the United States. The software contains detailed information on 130 of the most common chemicals associated with hazardous materials (hazmat) situations.
The first responders use the tool to determine what protective clothing is required, what equipment is needed, the chemical reactivity of particular hazardous materials, the distances required to establish so-called protective zones, and the appropriate medical aid that is needed if people are contaminated.
Mobile clinical decision support
Mobile clinical decision support (CDS) refers to software that helps a physician or healthcare worker determine the best course of action based on a series of case specific inputs. These tools allow doctors to type in a patient's symptoms and receive a list of possible causes, helping to ensure that they consider some less obvious diagnoses that they may not be familiar with or consider familiar ones that they may have ruled out.
Clinical decision support products tend to be sold by suppliers directly and purchased by organizations as well as individuals. The products are often sold via subscriptions. Clinical decision support tools are the Mobile Learning product type most susceptible to pricing pressures. That is, the more features a supplier adds, the more costly they become, and in the end, this doesn’t necessarily translate into a higher ticket price. As it is, current pricing is enough of a barrier for buyers and wise suppliers know that they need to strike a balance for the market.
These tools differ from medical reference materials in that clinical decision support tools start at the same point clinicians and patients frequently begin; that is, they begin with clinical features (symptoms or test results) followed by the construction of a differential diagnosis. In contrast, reference materials require the healthcare professional to arrive at a diagnosis before beginning the information retrieval process.
Mobile medical and healthcare reference
Mobile medical and healthcare reference is now a fairly mature market, with known pure players like ePocrates, as well as large traditional publishers like Thomson and Reed Elsevier. There are several smaller best-of-breed suppliers such as Handheldmed, CollectiveMed.com, Healthy Palmpilot (owned by PDA Verticals), and Medical PocketPC. Handheldmed is unique in that it is physician-owned and develops original content. It should be noted that both Palm and Microsoft sell mobile medical and healthcare reference products in their online stores.
It is not uncommon for the traditional publishers to team up with the pure players. In April 2006, for example, Global publisher John Wiley & Sons announced a new agreement with ePocrates, to make its InfoPOEMs (Patient-Oriented Evidence that Matters) medical content available to ePocrates users. Under the terms of the agreement, ePocrates will integrate selected POEMs—daily summaries of the latest evidence-based medical research—into the free DocAlert medical news service.
Dozens of companies with well-known brands sell into this sector. What is significant is that major publishers are aggressively competing in this space now. One of the largest publishers of medical reference is Reed Elsevier. Reed Elsevier began offering mobile content in late 2003 and now has an imprint called First Consult that distributes Mobile Learning titles. Lexi-Comp is another major publisher and has partnered with Cerner, one of the largest healthcare providers in the US, to distribute mobile content. This market is characterized by the two different types of reference or content offerings—sometimes referred to as "push vs. pull." General practitioners like those in family practice or emergency medicine, search for information in response to cases they are seeing (pull). Specialists, on the other hand, tend to seek out the latest studies within their field (push).
The backbone is connected to the…
Mobile, wireless front-ends aren’t truly viable until the back end systems are in place and industry-wide initiatives that have the support of all the players—the regulators, the providers, the payers, the physicians and the patients—all point to IT solutions as a facilitator of these shared goals. Patient safety and error reduction is being driven from within the industry itself, which sees great opportunity to improve healthcare. Widespread adoption of any technology—but particularly knowledge management tools—usually happens when there is pressure from management, combined with grass roots efforts by users looking for improved working conditions and better workflow.
The National Coordinator for Health Information Technology estimates that simply by using electronic medical records (EMR) tools the US could save between 7.5 percent and 30 percent of the $1.6 trillion dollars now spent annually on healthcare. According to the 18th Annual Healthcare Information and Management Systems Society (HIMSS) Leadership Survey, 32 percent of healthcare providers report having a fully operational EMR system. In 2006, only 24 percent reported full operational status, and in 2005 that number was just 18 percent. With most of the remaining respondents somewhere in the process of an EMR implementation, only 8 percent of respondent organizations have no plans to implement an EMR. The backbone is all but in place for "always on" connected systems with wireless access.
Device manufacturers are ready as well. Palm, Microsoft, GE, RIM, Panasonic, Phillips, and Symbol all design handheld technologies that connect wirelessly to these backbones. All Tablet PC vendors aggressively market to the sector. New UMPC device suppliers like OQO and Dualcor expect the sector to be early adopters of their convergent devices. Panasonic’s new "wireless display" is a hybrid tablet and display device that has no application software whatsoever loaded on the device. Symbol designed their new MC70 device for healthcare professionals. The MC70 is a mobile computer with multi-mode communications including cellular voice, Wi-Fi, and Bluetooth, which the company says allows "healthcare professionals from students to nurses, to doctors, to administrators, real-time access to people via voice, Internet, and intranet."
Prognosis is good for Mobile Learning
All healthcare professionals are under extreme pressure to have accurate information, yet their work environments are still dominated by paper-based processes and inefficient workflow. Ironically, these quintessentially mobile professionals are under extreme time pressures, yet have an often unmet need to access clinical information as they travel from exam room to hospital to office to classroom. This is a demographic eager for solutions that offer measurable improvements in productivity, the bottom line, and higher quality patient care.
They are required by licensing boards to learn continuously but have little time to accomplish those learning tasks. Mobile Learning is the ideal solution to this problem and the most clear-cut demand in the general Mobile Learning market. Suppliers have a demographic that is mandated to learn continuously but has no time to attend classes or take e-learning in their off hours.
Busy healthcare professionals are already too strapped for time. They want to undergo their training as a part of their regular course of business, and even if Mobile Learning is an entirely new concept, most welcome the introduction of tools to help them to meet licensing CME requirements, while still being able to maintain or improve patient care. In 2007, we are in the “post-beeper” era of healthcare productivity. This new era promises to bring together best medical practice techniques, anytime-anywhere information availability, measurable quality assessment, and highly-contextual personalized learning. The prognosis is good for Mobile Learning.
Burger, J. P., (2006). "The US Healthcare Market for Mobile Learning Products and Services: 2006-2011 Forecast and Analysis."
Burger, J. P., Greer, T., (2006). The Next Generation of Mobile Learning - Healthcare Shows the Way. (MLearn 2006 Conference Presentation)