Large tech companies have been virtually lining up to announce their foray into the digital health space recently. Industry analysts have long suspected that an incumbent industry with a strong customer base could come in and disrupt the nascent mHealth sector. Retail, fashion, financial, and ISP companies have all been considered potential disrupters. Now it appears the information technology titans have determined this is the time to strike.

Small sensors and monitors have created a boom for new age health and fitness monitors that are easy to use and interface with smartphone apps. Sales of fitness trackers and other wearable sensors are expected to reach 17 million units in 2014. By 2017, that number is expected to hit 45 million.

However, just as 2014 was being declared the year of the wearable, other voices were arguing that the wearable is dead due to challenges all too common in the tech world – engagement, integration and scale. And, as is so often the case, these challenges have created opportunities.

Let’s start with engagement.

It’s become clear that the average user quickly tires of the novelty of keeping track of how many steps they take in a day or how far they ran on the weekend. A study by Endeavor Partners noted that within 18 months, customer engagement with their wearable device fell to fifty percent.

Go to any digital health event, and you will hear about the imperative to make user generated data meaningful and actionable in order to keep users engaged. Gamification is a neologism that refers to addictive attraction of apps such as "Angry Birds" or "Candy Crush," a characteristic that mHealth companies aspire to achieve and one that is well understood in tech quarters.

But healthcare is more than a game. Data has to be meaningful and actionable to patients and caregivers. That brings us to the second challenge: integration.

To make any data really useful to either the user or the platform provider, it has to be integrated. Social media companies are always encouraging users to ‘like’ or ‘fan’ or ‘favorite’ things so that they can integrate users interests and needs and provide more valuable feedback – a technique familiar to Amazon users who are regularly advised: ‘you may also like’.

In the case of healthcare data, the initial challenge for platform providers is integrating user-generated data from different devices into one dashboard. But the bigger opportunity lies in the integration of conventional health data such as blood pressure, heart rate and glucose with lifestyle data such as diet, sleep and exercise – especially in the era of chronic disease management.

Ultimately, the digital health revolution will be realized when user-generated data, life style data and provider generated data can be combined in a Big Data environment that will generate both predictive and preventative information. When we achieve this, we will move from a system that is based on treating disease to a system based on maintaining health.

Which brings us to the challenge of scale. Any system that is going to rely on Big Data, requires scale, and scale has been a significant problem for the healthcare incumbents.

Within the industry, major healthcare payers and providers have all launched platforms for their patients or employee groups and have been aggressively partnering with mHealth app developers to integrate user-generated data. But there have been several challenges facing these efforts.

Many patients don’t trust a portal with sensitive information, particularly one affiliated with their employer. There is the burden of users learning and managing yet another interface. And finally, people tend to change health care plans frequently, so there may be limited opportunity to build familiarity or loyalty among users.

But the biggest challenge is scale. Big Data has significant potential in healthcare both on a population level and an individual patient level. But payers and providers have relatively small populations of users. For example, United Health is the largest health insurance provider in the U.S. with 70 million members. Kaiser Permanente, a leading integrated healthcare system, boasts just over 9 million members.

In contrast, information technology companies have huge user bases. On the social media side Twitter has 255 million users and Facebook has 1.28 billion worldwide. IT firms understand the value of scale and have huge established user bases who already trust them with everything from family photos to financial data.

For the tech companies, managing health portals provides them with more data on their users. Even if they are limited in how they can use data subject to HIPAA and other privacy restrictions, there is still enormous value there. On the other side, by providing a health platform the tech titans have the opportunity to expand their relationship with users as patients become consumers.

The remaining challenge is to find a way for these newly launched platforms to integrate with the desk-bound legacy electronic medical record (EMR) systems that will allow platforms to integrate with providers.

Since the EMR business is dominated by a small number of large providers, scale will help the IT entrants in this respect as well. EMR providers would be wise to wait for a standard to emerge. There need not be only one winner when it comes to standards, but there probably won’t be more than three or four.