Is a freemium model the way to go for eHealth apps?
The proliferation of medical apps for disease prevention and health promotion has made healthcare ever more accessible. It is further facilitated by the ubiquity of smart phones and demand for better healthcare.
The number of digital health apps available in the market has reached over 300,000 apps on the top app stores worldwide, almost double the number available in 2015. Over 200 apps are added daily.
Sadly, many of these apps aren’t sustainable for more than a year, fail due to a number of reasons, including poorly structured revenue models. A number of the businesses I evaluated during my master’s research relied on fragmented funding from various sources such as donor organisations to support development of their products. When this funding is depleted, other revenue models need to be put in place to ensure sustainability.
Freemium is a popular model in which the basic application is free for users to download and use for as long as they like, though enhanced functionality is available at a price. Eventually, some of these satisfied, non-paying users will want to upgrade to a better version of the app or make in-app purchases, and hence become paying customers.
In order to generate revenue from freemium apps, these three attributes need to be fulfilled;Capture high market share - the market strategy needs to revolve around capturing as much of the market share as possible because only a small percentage will become paying consumers and support the cost of non-paying users.Have a strong competitive advantage - the free offering must fulfil a need for the user in order to create a positive buzz, and the paid version has to create added value for customers to induce them to upgrade.Continued value creation - the freemium product should continue to add value as the user uses it over time in order to encourage non-paying users to switch over, and to maintain a consistent base of paying users. This model works well for innovations that are highly adaptive and iterative. Motivation to become a paying consumer relies on the value that the product adds for the user. As soon as the value diminishes, interest in using the app wanes as well. The challenge for these companies becomes staying ahead of a rapidly evolving and innovative industry.
- 235 views
- May 21, 2019
- Ameera Hamid
Successful eHealth needs capacity building
Africa’s health-care system is undergoing an eHealth revolution. The technology is new, but it must be used by the existing health workforce.
A critical finding in my master’s research, is that eHealth needs better investment in educating and capacitating users of eHealth. Another report by the British National Health Service found that a lack of training for healthcare providers created barriers to eHealth care. In Africa, we face the same challenge.
Technology on its own, no matter how effective, cannot bring about healthcare revolution without acceptance and proper use by healthcare workforce. An implementation strategy which addresses the barriers to effective adoption of these technologies will be critical to their success.
Capacity development has multi-layer benefits;For staff it can increase overall job performance and satisfaction. For the healthcare organization or facility, it can improve effectiveness and profitability.Even at the societal level, training and development can increase the quality of the labour force, which in turn is a contributing factor to national economic growth.
By developing a workforce that is able to confidently use eHealth technologies and services, African countries could implement their national eHealth more successfully and move closer to achieving universal health coverage.
- 155 views
- May 06, 2019
- Ameera Hamid
Why eHealth needs business modelling
A substantial number of businesses and start-ups pursuing opportunities to bridge healthcare challenges with eHealth technologies are often confronted with “pilotitis” or failure to implement their technologies in a sustainable way. In my last article, I described some of the challenges eHealth businesses face.
Constructing a business model during the development of eHealth technologies can guide a value-driven evaluation of what is necessary and what is not, in order to overcome implementation failures. A review of the literature suggests that the business model canvas proposed by Osterwalder is a suitable business modelling tool for the eHealth industry.
The one-page canvas consists of nine building blocks that provides a conceptual framework to describe the business’ activities from four perspectives;Value offering – what need is being fulfilled by the business?Value communication and transfer – who are the customers and how does the business communicate with them?Value co-creation – what are the business inputs, including collaborating partnerships? Value capture – how does the business maintain profitability?
A key observation in my master’s study was that there is a strong focus on the value offering and value capturing activities of the business model, although little focus on value co-creation and value communication and transfer activities.
While eHealth businesses are aware of the importance of these activities, challenges of the environment create barriers to prioritising these activities. To overcome these challenges, transformation is required in both the micro and macro eHealth environment.
- 319 views
- April 24, 2019
- Ameera Hamid
Have your say on WHO’s draft Global Strategy on Digital HealthApril 2019 has been a busy month for global digital health, with two key announcements by the World Health Organization (WHO). One is the call for comments on the draft Global Strategy on Digital Health. It is the first strategy of its kind for digital health and an opportunity not to be missed. WHO invites consultation from all stakeholders in the digital health arena on a strategy aiming to help focus our efforts on digital health that achieves maximum impact. It identifies four strategic objectives: Work togetherHelp to accelerate the digital health agenda in countriesAddress global issuesSet the future direction for innovation and research.
The period for commenting closes 30 April 2019, 00:00 CEST. Inputs can be provided via a web-based accessible here or you can email WHO for more information.
A second pivotal event was last week’s publication of the WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening, a much anticipated and important milestone in digital health’s journey to maturity and health systems impact. It has emerged out of a group that developed guidelines on digital health interventions for RMNCAH and health systems strengthening.
As we invest in our African National Digital Health Strategies and implementation plans, global publications like these are timely and helpful. eHNA will unpack the contents and their implications for our African digital health initiatives over the next few weeks.
- 219 views
- April 23, 2019
- Sean Broomhead
Successful eHealth needs better business models
eHealth is a complex business type, integrating many stakeholders acting across interwoven networks. Yet the characteristics of successful business models remain understudied.
Despite the promise of eHealth to overcome healthcare access challenges, reduce costs and improve quality , successful implementation is low, especially in developing countries. In fact, over 50% of eHealth businesses find it difficult to sustain their implementations sustainably beyond the pilot phase. I have been investigating these dynamics and will be sharing them over the next few weeks in a series of eHNA pieces.
Recurring challenges of eHealth include;Financial institutions unwillingness to fund eHealth start-upsHigh start-up costs and ongoing maintenance costsRegulatory legislation that lags behind technology developmentResistance from end-users to adopt new innovationseHealth technologies lack user experience designPoor scalability of eHealth technologies after their pilot phasePoor ICT infrastructure in the environmentLack of leadership and political supportLack of research.
To overcome these challenges, change is required in both the micro and macro eHealth environment. I’ll be sharing ideas on what changes are needed in my next piece.
- 187 views
- April 08, 2019
- Ameera Hamid
A roadmap for AI in healthcare can help set its trajectory
It seems that AI’s popping up in lots of healthcare settings. It’s trajectory becoming a bit random? If it is, does it need a roadmap? An article available from xtelligence Healthcare Media says it does and describes several AI initiatives. It seems more a scan of AI’s horizon that how to reach it.
Eduardo Galeano, the Uruguayan journalist and writer, identified horizon’s dynamic that fits AI and eHealth. “Utopia is on the horizon. I move two steps closer; it moves two steps further away. I walk another ten steps and the horizon runs ten steps further away.”
AI in Healthcare’s perspectives and initiatives include:Tapping the value of data at the right place, in real time; top questions for healthcare leadersWelcome to the age of intelligence: matching mind and machineHealthcare researchers using AI: don’t let data access derail clinical breakthroughsAn inside-out look at AI in outpatient radiologyChallenges in AI for radiologyWhen will AI be added to radiology training?Enterprise imaging infrastructureGreenlighting medical AI appsInside healthcare’s research revolution.
Two important roles for AI are seen as:Personalised, precision medicineClinical research.
These are already transforming healthcare. The potential and opportunities need health systems to implement effective strategies forAI and eHealthHealth and healthcare transformation. AI reinforces the need for tight integration of eHealth strategies and health and healthcare strategies. It’s widely recognised as important. AI needs it strengthening. It’s a challenge for Africa’s health systems.
- 521 views
- January 07, 2019
- Ameera Hamid
WHO can help you keep up to date on global eHealth trends
Awareness of eHealth achievements and dynamics from other users is crucial in framing eHealth strategies, investment decisions, benefits realisation and mitigating risk exposure. Finding the information’s often a challenge. A new publication from Johns Hopkins University Bloomberg School of Public Heath in collaboration with WHO can help.
The first issue of Global Health: Science and Practice was supported by an Aetna Foundation grant. It deals with five themes:Establishing standards to evaluate eHealth’s impact on health systemsGovernanceFinancing UHC in low and middle income countriesWorkforceHealth service supply side and demand generation.
These themes fit into WHO’s eHealth themes of information and research, governance, financing, workforce and health services. Africa’s health systems can use the findings to support the sustainability and direction of their eHealth trajectories.
Within these, it’s important to avoid strategic mistakes identified by Rosabeth Kanter:Rejecting opportunities that initially seem too smallAssuming that new services and improved processes aren’t strategic goalsLaunching too many minor service changes the confuse stakeholders and increase internal complexity.
These are some of her innovation traps. Africa’s health systems don’t need them.
- 296 views
- January 02, 2019
- Tom Jones
Five strategies for your eHealth success in 2019
Closing off 2018, I am struck by how much eHealth has grown up. It’s entering 2019 as a confident, enthusiastic adolescent, emerging almost abruptly from a precocious childhood. With eHealth’s latest pseudonym “digital health” gaining traction, it’s a timely herald of a viable, lucrative and sustainable digital health industry.
If you are reading this, then securing a substantial piece of the expanding digital health pie is likely part of your organisation’s 2019 agenda. I’ve assembled five New Year’s resolutions to help:
1. There’s plenty to go around, and the spectrum of options is wide and growing, so find your niche and claim it
2. Take more time to identify and understand the needs and aspirations of your clients and stakeholders, then work with them closely to realise more health benefits
3. Use what you learn to develop a robust eHealth Impact Strategy that will provide a rudder for all your efforts through 2019 and beyond, locking onto core health benefits
4. Hire people who believe what you believe, then trust them and invest in them in line with your strategy
5. Find like-minded partners, growing your business through collaboration and cooperation, fulfilling your role as a unique member of the emerging global digital health community.
Choosing one or more of these, and succeeding, will be enough to make a big difference.
At African Centre for eHealth Excellence (Acfee) we have been monitoring the maturing eHealth landscape for more than a decade, examining the health-strengthening benefits, frustrated by the slowness of its arrival, and mindful that many critical foundation elements remained absent. Establishing the foundation more quickly has been a key focus of our work at Acfee, particularly:Developing eHealth leadershipBuilding eHealth capacityConstructing eHealth Strategies that create sustainable health impact.
Now that progress is tangible, plenty of work remains to nurture and guide the fervent eHealth teenager, so Acfee’s focus on leadership, capacity and strategies will continue, expanding our efforts to meet demands. Priorities for 2019 include to:
1. Establish the eHealth Investment Model for Africa (eHIMA) and disseminate its use across African countries to assist Ministries of Health to take good decisions about their digital health investments.
eHIMA is Acfee’s adaptation of the Digital Health Impact Framework (DHIF). The DHIF is driven by the Asia eHealth Information Network (AeHIN) with support from the Asian Development Bank (ADB). Development of DHIF and eHIMA have been led by Acfee’s Director of Strategy and Impact Tom Jones, providing a valuable bridge between Asian and African eHealth initiatives and challenges.
2. Expand eHealthAFRO, Acfee’s stakeholder engagement platform.
We will build on the successes of eHealthAFRO 2017 in Johannesburg and the 2018 2nd EAC Regional eHealth and Telemedicine Ministerial Conference in Kigali, both covered in eHNA. eHA2019 will be in South Africa again. Keep an eye on eHNA for details to be confirmed later this month.
3. Grow Acfee’s existing capacity building initiatives:
More support for academic programmes, such as:Rome Business School short courses on eHealth, including a DHIF short courseNew York University global public health master’s degree, which includes a collaboration with Acfee around a scholarship program to increase African participation Bespoke eHealth curriculum development for partnersAcfee’s eLearning and software development collaborations.
More support for regional capacity building, such as the role I played alongside Acfee Director Ousmane Ly, and others, on the faculty of the first ITU/WHO AFRO Digital Health Workshop in Lesotho in November 2018.
Re-launch of Acfee’s popular Future eHealth Leaders summer camps, to cultivate and advance the unique leadership skills and approaches needed for successful digital health.
“Growing old is mandatory; growing up is optional” says 1960's Jamaican-American baseball player, Chili Davis. As eHealth moves into its teens, ensuring that we get it right will certainly be a collective effort. I look forward to working with each one of you, and all my African colleagues, to succeed in 2019.
- 787 views
- January 01, 2019
- Sean Broomhead
AeHIN says good eHealth governance methodology can transform health systems
Information from eHealth investment’s reaches into many health and healthcare activities. Successful utilisation and benefits realisation needs effective governance.
Asia eHealth Information Network (AeHIN), with support from the Asian Development Bank (ADB) and CC and C Solutions, an ICT training firm, has crafted a set of governance and architecture methodologies. It aims to help health systems start the work needed to guide their eHealth projects at national scale.
In a blog on Standards and Interoperability Lab Asia (SIL-Asia), Alvin Marcello says nine countries agreed to create the Health Information Governance and Architecture Framework (HIGAF). It’s based on a simplified Control Objectives for Information and Related Technologies 5 (COBIT 5) framework.
HIGAF helps developing countries address their health sector needs. It complements the Convergence Workshop for Ministry of Health national eHealth strategies. Many developing countries are accelerating their eHealth investment, but have yet to work out their governance approaches.
The governance initiative is part of a long-standing series of AeHIN initiatives that include:WHO-ITU National eHealth Strategy Toolkit, introduced in 2012Training six countries in national eHealth strategy development in 2013Myanmar’s first Convergence Workshop to convene international NGOs, development partners, and the private sector in 2015 Guidance for Investing in Digital Health, 2018 Digital Health Impact Framework User Manual, 2018.
AeHIN’s sustained focus and support is a collaborative model for Africa’s health systems. A challenge is the raising the finance to achieve.
- 327 views
- December 20, 2018
- Tom Jones
SIL-Asia reports on the Digital Health Impact Framework (DHIF)
Economic and financial evaluations of eHealth investment options rely on modelling. The Digital Health Impact Framework (DHIF) User Manual and Illustrative Models, help health systems to set up and develop them. The DHIF is a ten-step methodology developed by Tom Jones, Peter Drury, Philip Zuniga and Susann Roth, for the Asian Development Bank (ADB).
A blog from the Standards and Interoperability Lab Asia (SIL-Asia) emphasises the value of using examples to help users. These appear in the manual and online models. The combination of techniques and examples are from six illustrative models:SMS for maternal and child healthmHealth for telemedicine for a current patient catchment areamHealth for telemedicine with an expanded catchment areasMalaria surveillance and interventionCapital and leasing finance for an EHRStrategic mix and choices.
The six models are not templates. DHIF is a generic methodology, with every DHIF model being bespoke.
The approach is practical and rigorous and provides a valuable foundation for our efforts at Acfee to develop an eHealth Impact Model for Africa (eHIMA). Acfee colleagues like Tom Jones, who has been involved in many related international initiatives, provide a critical overarching perspective that will help to ensure that the various frameworks emerging are both appropriate to their regions of development, while following a sound, common conceptual methodology.
Creating options is a DHIF core skill. The first four are single options for the initial stages of digital health projects. In practice, several options for each project are analysed in these early stages. The EHR example has two options and in practice would have more.
The blog shows two dimensions for options. They’re vertical and horizontal:
The vertical dimension is mainly incremental and thus, relatively easy to compile. Meanwhile, the horizontal dimension is more challenging. They have significant differences to options on the vertical dimension, and not incremental.
An illustrative model on strategic mix and choices shows positive socio-economic returns but have considerable risk exposure and affordability challenges. The comparison can support agreements on decision criteria for eHealth investment. Examples are:Maximum patient impactLowest riskHighest socioeconomic benefitLowest cost.
At the ADB workshop on 31 January 2018 in Bangkok, participants identified decision criteria they would use to select which of the six illustrative DHIF models they would retain in an affordable digital health strategy and why. Their ideas are set out in the DHIF User Manual.
Modellers new to DHIF should start small. Rome Business School has a short online DHIF course. It’s in English, and coaches modellers using their own digital health projects.
- 379 views
- December 19, 2018
- Sean Broomhead
Rome Business School eHealth Masters
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