Over 200 million people have downloaded a healthcare application to their smartphone. However, only a small number of those downloaded apps are used regularly and, since most apps are free, even a smaller number of applications actually generate any revenue. With an estimated seven billion smartphones projected to be sold over the next few years, one of the primary considerations of smartphones and healthcare is the business model: how do companies create smartphone applications, products, and services that facilitate the improvement and transformation of healthcare while generating revenue?

There are an estimated 95,000 healthcare applications in the world today. Most of those do not deliver medical services or healthcare, but merely serve as point solutions to collect and present data or address a single aspect of health or wellness. Substantial value and revenue will be associated with applications that take a more holistic view of wellness, disease, therapy, or healthcare along with associated patient engagement. Healthcare providers, applications and systems providers, and patients all agree that patient engagement and empowerment is the primary goal of healthcare applications; without engagement, the application is useless. Furthermore, as healthcare systems move away from fee-for-service toward outcome-based models, patient engagement will be a critical element to a positive outcome, particularly in cases where chronic but manageable conditions are involved.

To achieve this goal, developers and providers must consider the audience and productive use case in the application and service design, particularly with regard to user experience. For example, specific patient conditions can imply demographics that should be considered in application and service design. An application that addresses adult onset diabetes or heart disease should have an interface appropriate to that demographic and it would be distinctly different than an application designed to teach children about good nutrition habits.

In addition to considering the audience and engagement of that audience with an application or service, developers and providers must account for the various devices their intended audience is likely to be using. With regard to smartphones, both the enterprise and healthcare ecosystems are increasingly becoming 'bring your own device' environments – where users provide their own devices and expect to access the applications and services they need on those devices. In a healthcare world, BYOD also applies to other medical devices such as blood glucometers, pulse oximeters, weight scales, blood pressure devices, and many others. The key point is to engage users on their terms, with a user experience that is familiar, friendly, and useful and using devices that are already in their hands, homes, and offices.

At first glance, the smartphone market might appear to be fragmented with various operating systems and versions of those systems specific to devices and device families, like Apple’s iOS vs. Google's Android, and a BYOD environment may seem to further complicate the situation, but perhaps it might be more productive to think of the proliferation of smartphones and their operating systems and other devices as opportunities rather than barriers. After all, smartphones and medical devices are personal devices involving personal choices and, often, brand and product loyalties. Why fight it when you can embrace it? The winners in this market with regard to engagement will be those who leverage the landscape as it exists and deploy rich, friendly, useful applications and services into that ecosystem.

To engage patients where they are already active and comfortable, developers and providers can think of smartphones and applications as channels for the delivery of a well-conceived product or service--regardless of the particular platform. From a business model perspective, it is helpful to consider applications on the smartphone as merely a component of an overall system that is deployed to end users or patients and to view the success of the application in terms of overall patient engagement.

Engagement can be measured in terms of increased positive outcomes as a result of the system. For instance, a system or application that encourages patients to monitor their own condition actively or that facilitates an ongoing connection between patient and provider with a resultant decrease in hospital (re)admissions would be a compelling demonstration of a positive outcome. A diet and exercise application that helps an obese person lose weight and adopt healthy habits could move that person into a different risk pool and lower costs of coverage. In both of these cases, the real dollars saved (as a result of engagement leading to positive outcome) would support a revenue model for the application or service provider.

When entire systems are considered instead of just simple point applications, distribution systems including carriers and ecosystems become increasingly important. Operators have distinct assets to help compete in this market and enable a comprehensive approach. They have existing customer relationships with both businesses and consumers, they are largely responsible for getting devices into the hands of end users, and they have vast infrastructure assets –connectivity, networks, and background applications – that can enable and speed the introduction of new services to market. Carriers are investing in focused healthcare groups and can be valuable partners and integrators of brought system based services.

Beyond considering the audience, business model, and technical issues, an overarching concern with respect to the deployment of medical and healthcare applications and services via smartphones is the regulatory environment. Some applications are clearly either within regulated or non-regulated territory, but there is a substantial gray area in between. The role of the regulatory bodies worldwide is ultimately to protect the user or patient. The regulatory environment today is somewhat ambiguous and evolving. In the US, it’s expected that the FDA will deliver clarifications on their guidelines in the near future, which aim to reduce the ambiguity and the size of that gray area.

The vast and rapidly growing landscape of deployed smartphones certainly presents an opportunity to transform healthcare with compelling applications and services designed to promote wellness, to assist in delivering better care to those that most need it, and to deploy limited healthcare resources most efficiently. Considering the audience, the desired successful outcome, and more than just merely a simple point solution is a good start. The organizations that successfully navigate the diverse smartphone and application regulatory environment along with creating compelling and engaging applications and services will enjoy a substantial competitive advantage with an opportunity to truly revolutionize the way we deliver and experience healthcare.