Perhaps the most visible element of mHealth is the profusion of phone apps, especially ones related to fitness and wellness. Tens of thousands are already available, and different market research firms have issued predictions for global downloads in 2012 that vary widely from just over 40 million to nearly 250 million.

Other data, however, suggest that all will not be clear sailing for the fitness and wellness market. The Pew Internet & American Life Project found that in the year ending August 2011 the increase in the number of adults in the US who had ever downloaded an mHealth app for their phones was insignificant.

More worrying for the industry is the immense drop-out rate. The survey fielded by the Economist Intelligence Unit shows that, discounting respondents who had just started, 67% of respondents who have used an mHealth wellness or fitness app with manual data entry discontinued it in the first six months. For automated apps that took information from other devices, the figure was even higher (74%). This is consistent with the experience of many interviewees.

High drop-out rates highlight two particular weaknesses of these apps. First, on their own they lack value. George Poste, professor at Arizona State University, says that most “are intriguing, but won’t have any impact because they are not inter-operable and not actionable.” Integration with healthcare systems, however, will be problematic. Prof. Chris Taylor, director of the University of Manchester’s mHealth Innovation Centre, notes that “healthcare professionals don’t currently treat as credible any data that are being created [through lifestyle apps]”.

The second challenge is understanding efficacy. Very few studies have been conducted evaluating the impact of mHealth applications on care, let alone their return on investment. Misha Chellam, Chief Operating Officer of Scanadu, an mHealth device company, explains that while his company is working on finding appropriate measures, “people are ignoring it because it is hard”.

Patricia Mechael, executive director of the mHealth Alliance, a multi-stakeholder group seeking to advance mHealth, sees this as one of the biggest barriers in the field. The mHealth Alliance is working with its partners, including the World Health Organisation (WHO) and Johns Hopkins University in Baltimore, Maryland, on the Global mHealth Initiative, to identify and promote the types of mHealth programmes that are, in fact, effective.

There may well be surprises. To date, studies tend to show that remote monitoring can lead to substantial declines in the use of other healthcare assets. The US Veterans

Administration, for example, found that overall the practice cut hospitalisation by 30% and admissions for heart failure by 40%, more than paying for the programme. In contrast, a recent major study of telemedicine in the UK found that such services did little or nothing to reduce hospitalisation rates.

But these issues are not confined to health self-management apps. Such products may show some of mHealth’s difficulties most clearly, but others suffer similar weaknesses:

61% of patients surveyed by the EIU discontinued using mHealth services that allow better communication with healthcare professionals within the first six months, while 70% stopped using the devices that automatically send data to health providers.

Clear efficacy data could speed mHealth’s adoption, but their absence may matter less than one might expect. Jennifer Dixon, Director of the Nuffield Trust, notes that, as with the advent of computers, mHealth “is probably going to happen anyway; there is an inevitability about it, so people aren’t looking carefully.”

In itself, this may not be bad. She notes that even if banks did not do cost/benefit analyses when introducing online banking, this technology has allowed the restructuring of numerous processes that would have been impossible otherwise. Society may, then, simply expect such change in healthcare, and the issue will be how to use it most effectively. As Bakul Patel, a policy adviser at the US Food and Drug Administration (FDA), says, “Hype or not, it is becoming part of life.”