Why ‘one app to rule them all’ is not the future of digital health


Chris Hogg is a digital health advocate interested in how new forms of health data are changing the relationship between physician and patient. As CCO of Propeller Health, he leads the company’s San Francisco office and oversees the pharma BD, health system and payer sales, clinical and medical affairs and data science teams.

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“One app to rule them all” is a compelling idea if you’re a healthcare giant.

In this imagined model, patients flock to one comprehensive user experience for all their healthcare needs, from insurance and scheduling to lab results and disease management. And the healthcare giant, which has developed or acquired its way to market dominance, now has the ability to guide patients to their preferred providers, treatments and services.

But “one app to rule them all” is flawed. Not only does it ignore the way people use technology, it puts the patient experience second. Forcing patients to use one app for every healthcare interaction disregards the complexity and specificity of individual diseases and patient profiles.

Until now, we haven’t had to reckon with the “one app” problem, because most healthcare experiences have been relatively disparate. But as payers, providers, pharmacies, pharma and digital health all race to create digital experiences and solidify their offerings, we will soon have to confront this question: Will we end up with separate disease management apps that work together in a best-of-breed ecosystem model, or will several large players dominate with one app to rule them all?

How we got here

Up until now, the question of who would control the user experience wasn’t a material issue in the market. Most apps didn’t have a large enough user base to impinge on their competitors, and organizations created “single function” experiences for a specific problem space.

Payers created tools to let you look up coverage and find providers, health systems allowed you to book appointments and see your EMR and lab data, pharmacies allowed you to refill prescriptions, pharmaceutical companies made apps to support their specific medicines and most successful digital health companies have focused on individual diseases and specific use cases.

But now that digital health has taken root and patient adoption is expanding, these “single function” experiences are starting to bump into each other. And organizations are reacting to this change in different ways.

Many health systems and payers recognize this as an opportunity to create an ecosystem model, taking best-of-breed solutions for each core patient need and connecting them through identity and data linking so they work seamlessly together.

But alarmingly, some large organizations see this as an opportunity to assert more control over the patient experience.

They’re attempting to develop “one app to rule them all” solutions, with one user experience covering all patients with all possible diseases.

At Propeller, we recently “broke up” with a customer who couldn’t see past their vision for a single dominant app to rule the marketplace.

It was a tough decision, but one I felt we had to make. Here’s why.

Why “one app to rule them all” results in a worse patient experience

The advantage to “one app to rule them all” is obvious on its face. Patients would have fewer apps to download and engage with, advantages that seem more pronounced in more complex and comorbid patients. Organizations would also be able to guide patients to their preferred providers, treatments and services via a single app.

But there’s a significant problem with this approach.

When one platform tries to excel in a vast number of areas, it usually ends up doing them all badly. If you’ve used a leading marketing software platform that I won’t name, you know this to be true. And healthcare is even more difficult, because it’s at once more complex and more personal. It turns out it is pretty easy to build a complex and complicated product, but it is very hard to build a simple one, especially with a multitude of inputs and use cases.

Healthcare isn’t fast food.

All my experience in digital health has told me this: It’s very difficult to build an engaging and useful user experience in one disease state, let alone across multiple disease states within one experience.

Enrolling users is hard. Keeping them engaged is hard. Improving specific clinical outcomes — and proving it continuously — is especially hard. Making a great product requires an obsessive focus on a specific user and problem space, as well as relentless experimentation and iteration. When you don’t have that singular focus, the needs of the patient are deprioritized compared to the needs of the organization, and the user suffers.

To make this approach worthwhile, you’d have to believe that the convenience of one app would make up for a worse user experience by driving higher enrollment or retention rates. You’d have to believe that user experience simply doesn’t matter as much as the convenience of an all-in-one platform.

I don’t believe that. Healthcare isn’t fast food. People’s humanity, dignity and lives are at stake, and they deserve our obsessive focus on an experience built specifically for them.

Why a “best of breed” ecosystem approach is best

We’ve learned a lot in the last 20 years about how people prefer to use technology. If you want evidence that “best of breed” is the future, you only need to look to the other industries experiencing digital transformation.

For example, look at Software-as-a-Service (SaaS). It’s dominated by a large number of specific solutions that work together through identity (OAuth) and data integrations (APIs).

It’s a similar story in consumer apps. There is no single fitness app, travel app or communication app. In entertainment many tried to become the “one app,” but instead we have witnessed a proliferation of vertical content providers with individual subscriptions, such a Netflix, HBO, Disney and ESPN, all of which work together seamlessly on your Apple TV. Even when a major company acquires or develops new solutions, they often keep the solutions separate in terms of user experience. For example, Facebook has unbundled Messenger, Instagram and WhatsApp instead of bundling them all as Facebook.

We as consumers are comfortable using specific solutions to solve specific problems, and want them all to work together with ease. Often, we find that when a major player branches into more and more solutions because they want our total business, each solution becomes more shoddily made, less intuitive and more poorly supported.

Now, this situation is not necessarily universal. In China, products like Tencent’s WeChat have expanded across multiple healthcare verticals, backed by very different market dynamics (both in healthcare and in technology). Yet even WeChat looks to third parties with best of breed solutions to grow their ecosystem, in addition to building multiple solutions themselves.

What the future looks like

The future I envision may not feature a single app, but neither is it complicated.

In this future, patients use a core clinical app, likely provided by their health system or primary care provider, that takes care of clinical interactions like scheduling, clinical data, reminders and follow-ups.

Beyond that, patients use a set of specific apps that specialize in particular health issues — for example, respiratory disease, diabetes, mental health, increasing activity or improving sleep. Those apps will rise to the top because they’re the best on the market at managing those issues. The experience of managing your mental health will feel different than managing your diabetes, just as using Instagram feels different than using Facebook.

In this ecosystem model, the patient’s core clinical app will link out to and connect to the problem-specific solutions. Health systems and physicians will adopt a small number of specialized platforms and products to focus on large clinical domains like cardiovascular, diabetes, respiratory and mental health. Data from these solutions will integrate back to the provider’s organization and will be available in the EMR and for population health management.

We’ll end up with a diverse ecosystem of solutions, each the best in their vertical, delivering a tailored user experience based on the needs of the specific patient and provider type.

And patients will be better off for it.

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