West Wireless' Smith crusades for sustainability in mobile healthcare

with West Wireless Health Institute's Dr. Joseph Smith

Six months into his role as chief medical and science officer at the San Diego-based West Wireless Health Institute, Dr. Joseph Smith is shepherding the nonprofit's research and clinical-focused activities, which are aimed at leveraging wireless technologies to cost effectively advance human healthcare. Smith recently discussed his role as well as the institute's current activities in this exclusive interview with FierceWireless contributing editor Tammy Parker. For more articles on the growing mHealth market, check out this FierceWireless ebook.

FierceWireless: Please discuss your involvement in mHealth initiatives and the tasks entailed in your role at the West Wireless Health Institute.

Smith: I come to this space honestly, with a background as an electrical engineer and as a cardiologist. The intersection of technology and healthcare, I think, comes to me pretty quickly. After having a number of leadership roles in both the practice of medicine and then in the medical device industry, I could see that we were headed down a path where it was becoming increasingly difficult to provide valuable innovations that would be sustaining of the very large corporate entities that are responsible for much of the medical device industry, and our overall healthcare spend was on a pace to be readily unsustainable.

As the chief medical officer, I enjoy working with our engineers and business development group to assure that we're targeting the right opportunities in healthcare delivery, that we collectively think not only about the potential benefits of a candidate technology but also think all the way through the particular use cases and the settings so that we construct a workable solution which will in the end be attractive and valuable to patients, families, clinicians and the healthcare system as a whole.

As our chief science officer, I emphasize the importance of validation of the solutions that we talk about and envision by providing actual outcomes data. And here I'm speaking of validating not only the safety and efficacy of a potential solution as is quite familiar, but now more importantly perhaps validating the cost effectiveness of candidate solutions in real-world use.

As fully integrated, I really do enjoy the role and the challenge of being a bit of a change agent. In healthcare, we've long emphasized the disease conditions we could not treat, and then with therapies in hand we'd emphasize the patient populations we could not quickly identify. And now we have to give equal consideration to ensure that we do not have costs that we cannot bear.

FierceWireless: West Wireless says its goal is to lower the cost of healthcare "by innovating, validating, advocating for, investing in and helping commercialize wireless health solutions." Isn't that a rather huge mission?

Smith: Our mission, I believe is actually quite narrowly defined. We're about lowering the cost of healthcare. It's the toolset that we have available to us that I think actually is quite broad.

On the innovation front, while we've only begun in earnest, I think, some eight months ago. We've already nearly 20 engineers working on potential solutions, the most developed of which is a collaboration we have with the Carlos Slim Institute in Mexico in the area of maternal-fetal health. I think we're scheduled to unveil that in the next six weeks or so.

I spoke earlier about our role in validation. And at the moment this is more about our role in helping external startups with the design of clinical studies to demonstrate value and we've got a handful of those in various stages. We don't intend to be a clinical research organization but instead are willing and able to lend our expertise in clinical trial design. And with some healthcare economists now available to us, we are working with folks to help them demonstrate the ultimate value in the solutions that are being generated outside the institute.

Our work on advocacy has been particularly exciting. We've full engagement with the FDA and the FCC. We've had some testimony before Congress on opportunities to encourage innovation and remove some of the perceived obstacles. [We're] working here on creating regulatory clarity and removing some of the other issues with mobile health, like physician practice across state lines, and perhaps the need for safe harbor or appropriate tort reform when it comes to the liability that carriers and handset manufacturers may inadvertently experience as their devices are used in the application of healthcare.

FierceWireless: Tort reform doesn't seem to come up as much as some of the regulatory issues but it probably should.

Smith: I think there's some real hesitancy. The people at Apple are a good example. They are particularly anxious to avoid any liability that stems from the use of their products as a perceived medical device. I think in the moment, in the absence of clarity, that concern can be a little chilling on the engine of innovation. We've got to do a pretty good job of ensuring that when ubiquitous telecommunications devices carry medical data for medical decision-making that everyone understands what part is regulated by the FCC, what part is regulated by the FDA and where the liability is appropriately apportioned.

FierceWireless: What other thoughts might you like to share regarding what it will take to bring the vision of the West Wireless Health Institute to fruition?

Smith: We've been blessed with courageous benefactors in Gary and Mary West. It's in many ways their vision that drives us. As successful entrepreneurs, they saw that they could do many things in their business but when it came time to corraling healthcare costs, they simply couldn't. I believe a legitimate concern now is that our rising healthcare costs are going to make U.S. industry uncompetitive and are such a burden and a drain on our economy that they're limiting our overall success.

I think it takes that kind of courage and commitment. Perhaps more importantly, it takes this kind of structure where we can be a Switzerland and invite in the regulators, the for-profit entities, and we can have that discussion, and we can have it because we're targeted really at the patient, the families, our healthcare system and assuring the best outcomes we have in a system that can ultimately be affordable and sustainable.

I don't think that the large incumbents currently in the system can work for the kinds of solutions that we need. I think this is the right kind of effort, it's the right kind of capability and it's the right time.

For more on the burgeoning mHealth industry, check out the FierceWireless ebook, Delivering on the mHealth Opportunity.