Previous title: “Morgan Stanley, April 2010: Mobile will be bigger than desktop. Discuss, re health.”

Thanks to @Rohal and others for tweeting about a talk on internet* trends Tuesday by Mary Meeker of investment banker Morgan Stanley, at their Future of Media conference. Those slides are here (PDF), but @Rohal steered me to an April slide deck that has more relevance to me. I’m not sure what to make of all this, so let’s discuss.

* I’ve adopted Pew Research’s house style – lowercase for the word internet. They feel it’s become a common noun.

Mary, if you’re out there, I’d welcome your thoughts. I’m well aware I don’t know your turf.

Our colleague Susannah Fox of the Pew Internet & American Life Project has done much research about trends in mobile, particularly about health. In contrast, Meeker focuses on overall big trends. She sees aspects I’ve never noticed, like what-all constitutes mobile: when I hear the term, I think handheld phones (iPhone, Droid, Blackberry), but she makes the case that mobile web access (and other wireless) is much more than phones.

As we think about how mobile can transform what’s possible in healthcare – especially access to health info and services for people globally who don’t have home PCs – this is important. Flip through the slides; my starter questions are below.

#7, Mobile internet ramping faster than desktop did: the chart overlays quarterly growth curves from the start of different technologies: iPhone/iTouch vs Netscape (browsers) and AOL. Cautiously I note that huge number of *phone* sales doesn’t necessarily equate to internet *use* – but, there’s no question they all do bring mobile internet access.

#12 -Social Media usage surpassing email usage: Fascinating pair of curves – the number of users of email isn’t far behind, but usage of socmed zoomed past three years ago. Question: how much of your inbox is stuff you want to keep, vs the more “champagne bubble” nature of social media – view / pop / gone?

Relevance for health thinkers: if we want to reach people we better be where they are. (See e-patient white paper, chapter 2, Seven Preliminary Conclusions.)

#13, Cloud Computing applications: Notice that just about everything is there, except our health data.  I bet that’s going to change, and a key driver may be parents wanting handy access to their kids’ medical info – the Mama Lion effect we’ve discussed here.

#17, Ten Year Tech Cycles – I’d note that the later decades are off by 5 years: PC/Mac started mid-decade (1984), browsers ’94, mobile browsing mid-2000’s. But the point stands.

#18, Reduced Usage Friction: This is the one that made me decide to write here. More power, better usability, more apps, more services => 10x more devices. True: I myself have just switched from a Blackberry to a Droid X. Why? On an 11 day speaking tour with my wife, time after time we got out her Droid because it could solve a problem that my BBY couldn’t.

That’s important: on the road we were more like people with no home broadband.

The Droid’s not an easy transition for me – it’s such a gadget that it’s not always obvious how  to answer the phone app when it rings. (For me to say that is going some.) BUT, as Meeker’s later slides show, what I now have in my hand is very different from a mere phone and email appliance.

But on the right side of the slide, look what Meeker includes in mobile:

  • iPad (which is not a phone)
  • Kindle (can access data (books, newspapers) but it’s not a Web browser)
  • MP3 players (at least the ones that can download media)
  • Car electronics – e.g. GPS that can access traffic data, gas prices etc)
  • Home entertainment (is Netflix mobile if it’s tethered to your Wii or cable??)

Combined with earlier slides on mobile’s market share, this made me remember: “internet” is not just web browsing. I knew that – my cancer patient listserv is internet but not Web – but it somehow had escaped my thinking about the future of mobile for health. Any mobile device that can get at data over the internet is mobile internet. Duh.

#19: Good summary of the evolution of how we use devices and what we use them for.

#31: Well executed infographic on the shift in how people spend time online. Facebook and YouTube rising, all others shrinking. But where do non-Web apps (see above) fit into this?

#35: cloud enterprise computing platform. READ THIS and understand it.

  • This is the sales & marketing management system that I managed at my last day job. I know this system. It’s usable, very powerful, and very very extendable with plug-ins and apps. (Not perfect, not easy, but usable and powerful.)
  • For a long time, big-iron system vendors like Oracle and Siebel poo-pooed Salesforce as not powerful enough for real companies. Within ten years it kicked their butt; in 2008 Cisco Systems bought a worldwide site license, pretty much ending any question about whether it’s powerful enough for “real companies.”
    • That is a classic example of Clayton Christensen’s “disruptive innovation” concept.
  • I’d bet my house that the same thing is going to play out in EMR / EHR systems. Watch. It may take ten years again, but watch.
  • btw, is a major investor in disruptive EMR/PHR vendor PracticeFusion. Watch.

#37ff – VoIP (voice over internet, e.g. Skype): just notice that the whole idea of what a “phone” is has come apart at the seams. There’s the thing that hears your voice (might be in your desk phone, your handheld, or desktop computer’s mic), the thing that emits the other person’s voice (same list), and the part that carries the sound might be heaven-only-knows-what. Cable modem, wifi, cell network, who knows.

And be aware that the same applies to video. As quality gets better, what does this mean about the concept of a doctor “visit”? How does the world change if your nurse can see you without you leaving home or office and waiting in her waiting room?

This doesn’t replace all office visits but it can replace some. As American Well has proven, it’s a tier of care, which people love – they’re growing like a weed. And yes, insurance pays for it.

#43: Mobile Web and app usage far outpaces share of devices sold. This bolsters the point that these devices in no way resemble a Blackberry (the “RIM” column). And that awakens me to the reality that an app phone is a completely different device.

Is it appropriate for us to talk about smartphones anymore? Seems to be the split is between app phones and non-app devices. This chart makes clear which is which.

#44: Changes in device share – another lovely infographic. RIM (Blackberry) is being crushed by app phones. (Note – this goes through Feb 2010; Android has grown more, and the new Windows Phone may change the mix.)

#54: ShopSavvy app – a spectacular example of mashups of data from different sources.

  • Imagine this kind of shopping power applied to finding treatment options. (Yes, this is blue sky, not around the corner. Imagine it. For your kid, your elders, your friends.)
  • Imagine the mashup possibilities when combined with the government’s Open Health Data initiative.

#63: Note that health is not yet on the radar.

#75 – Payment issues on desktop vs mobile – very important to the business future of these apps, and thus the investment future. Especially the first bullet: mobile has easy-to-use secure instant payment; desktop browsers don’t, and are open to widespread fraud. (My own experience taking payments by PayPal has taught me how big an issue this is – PayPal can get hobbled by its own security against hackers. This is a big impediment to growth.)


All in all this post popped my mind open to a new awareness of what mobile connectedness is – it’s not just phones with better browsers. Yeah, I know a lot of you knew that, especially iPhone users. Don’t yell at me; I give you credit for being quicker. :)

I didn’t take time to comment on everything; as it is, this took three hours. What do you see about the future of health, in light of all this?