Mobile health (mHealth) – the practice of medicine and public health with support from mobile devices – is a growing segment of a health care sector that already makes up 10% of the global economy, according to the World Health Organization. With applications ranging from data collection and practitioner education to real-time remote monitoring of patients’ vital signs, mHealth has the potential to change how providers deliver services and measure outcomes, how doctors diagnose disease and how patients take responsibility for their own well-being.
“THERE ARE PRIVACY CONCERNS, BUT ALSO MUCH EXCITEMENT ABOUT HOW GLOBAL HEALTH HAS AN OPPORTUNITY TO GET BETTER OUTCOMES FROM MORE REAL-WORLD DATA.”KATHY HUGHES
VICE PRESIDENT, AVALERE HEALTH
Approximately 2.8 million patients worldwide were already using home monitoring devices with built-in connectivity at the end of 2012, according to the analyst firm Berg Insight, a market research and advisory service based in Sweden that focuses on mobile-to-mobile connectivity and the Internet of Things. The company projects that such devices will reach 9.4 million connections by 2017. Health-related smartphone apps, meanwhile, are predicted to reach 500 million patients in 2015, according to estimates published in the Journal of the AHIMA in 2013.
Observable trends include the growing influence of consumer electronics companies promoting fitness wearables, doctors using smartphone apps and research programs that analyze data from multiple sources. Experts are particularly interested in mHealth technology’s potential to improve treatment of underserved populations, such as home-bound elderly patients and remote villages in emerging economies, where the widespread adoption of cell phones offers the potential to serve areas that lack local doctors.
“We cannot improve the safety of patients and the quality of their care without understanding what happens to them,” Tim Kelsey, national director for Patients and Information, National Health Service (NHS) England, wrote recently in his blog. “Data sharing has the power to transform health services.”
Internationally, however, progress varies. “In the US, the Affordable Care Act has the potential to provide the funding for this leap to mHealth, but there’s no guidance from government about standards,” said Robert Havasy, vice president of Personal Connected Health Alliance (PCHA), which includes Continua, a US-based mHealth organization where Havasy is executive director. “Denmark began the first programs in Europe, followed by the rest of the Nordic countries. Significant work also is happening in the Middle East and Southeast Asia. Apart from the US, governments are setting guidelines and boundaries for development.”
DATA PRIVACY CONCERNS
Despite its potential benefits, electronic sharing of patient data raises privacy concerns. The UK Parliament’s Care Act legislation, for example, seeks to protect patient privacy by dictating that a person’s data can only be shared and analyzed when there is a benefit to health care and that all such uses must be scrutinized by an independent statutory body. Similar legislation is in effect or under consideration in virtually every developed country.
While public concern about the misuse of private patient data is widespread, attitudes are changing. In a US poll conducted by National Public Radio, for example, only 53% of those surveyed said they would be willing to share information anonymously with health care researchers. But respondents younger than 35 were less privacy focused; 61% said they’d be willing to share their data.
“There are privacy concerns, but also much excitement about how global health has an opportunity to get better outcomes from more real-world data rather than trial data,” said Kathy Hughes, vice president at Washington, DC-based consultancy Avalere Health, which is staffed with business and policy analysts who work directly with health care organizations.
INSIGHTS FROM SHARED DATA
As health services win their customers over to the idea of collecting anonymous data, the result will be a valuable increase in the understanding of population health, according to the National Institutes of Health, part of the US Department of Health and Human Services. As a result, health care providers will be better able to target their resources – if they can develop a system that is interoperable.
“There are no technical or regulatory reasons to stop (IT in health care) from being open,” Havasy said, “but health care around the world is a hybrid of high tech and individual person-to-person customer service.” To help bridge the technology gap, Continua is focused on helping governments and companies implement mHealth according to open standards such as IEEE and ISO, to ensure interoperability.
“70%”To control spiraling costs, 70% of health care organizations will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018.
“FUTURESCAPE: WORLDWIDE HEALTHCARE 2015 PREDICTIONS,“IDC
In “FutureScape: Worldwide Healthcare 2015 Predictions,” global market intelligence firm IDC reports that “to control spiraling costs, 70% of health care organizations will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018.”
By encouraging healthier lifestyles, governments hope mHealth could be a factor in relieving both cost and access pressures. For example, the UK’s NHS is working on three digital tools: GP Choice and Urgent Care Finder, which are both search engines, and Symptom Checker, which enables patients to check their symptoms and ask questions via a webchat system.
Ricky Bloomfield, director of Mobile Technology Strategy and assistant professor of Internal Medicine & Pediatrics at Duke University in Durham, North Carolina, predicts that wearable technologies and connectivity will result in an unprecedented flow of data from patients to health care systems.
“We know the more data we get, the better informed we’ll be to make better decisions, but we don’t have that data yet,” Bloomfield told delegates at the mHealth Summit in December 2014. “So this is just one more way to open one more door.”
Education may prove as valuable as data, Avelere Health’s Hughes said. “One very popular app among pregnant women, for example, explains what is happening to them at different stages of pregnancy,” she said. “The women are experiencing something natural but new, and the app helps their understanding.”
Health education programs in developing countries, meanwhile, can exploit the ubiquity of mobile phones to educate remote populations. At a recent conference in New Delhi, organized by nongovernmental organization (NGO) IntraHealth International, IntraHealth adviser Girdhari Bora explained the feasibility and effectiveness of mSakhi, an mHealth application that improves the counseling skills of accredited community health workers on critical maternal, newborn and child nutrition issues.
mHealth also has potential to empower the health consumer. “Improved shopping tools are crucial to help consumers make informed choices based on more than just premiums,” said Kelly Brantley, senior manager at Avalere Health. “Patients with chronic diseases need to be able to predict their health care costs in various plans to select coverage that best fits their needs.”
The shared patient health record is one trend where self-monitoring and professional care may merge, for example, to alert nursing staff to a change in biology that requires a review of medication. Medical staff will also use mobile hands-free devices to get easier access to the complex information they need during diagnosis and treatment. Doctors, for example, immediately saw the benefit of doing drug-dosage calculations on their smartphones instead of returning to their desks or scouring a hospital in search of a terminal.
At the Advanced Medical Technology Association (AdvaMed) conference in October 2014, the panel on strategies to capitalize on mHealth identified heart attack prediction, respiratory health monitoring, wearable sensors for the patients and mobile access for the doctors as promising applications. Connecting data from medical instruments such as a glucose monitor or a dialysis machine extends mHealth to diabetes management and renal care.
“There are different business models – business to consumer and business to business,” Avalere’s Hughes said. “Mobile technology companies are selling directly to consumers, to employees, to pharmacies and to insurance companies, who give their customers devices to see if they are beneficial.”
A major challenge, Havasy said, is developing devices appropriate for use in a clinical environment, where cost, infection control and interoperability are paramount.
“WE KNOW THE MORE DATA WE GET, THE BETTER INFORMED WE’LL BE TO MAKE BETTER DECISIONS, BUT WE DON’T HAVE THAT DATA YET.”RICKY BLOOMFIELD
DIRECTOR, MOBILE TECHNOLOGY STRATEGY
“The manufacturer is making something like a Swiss Army Knife, which people will use for many different things,” Havasy said. “There are already checks and balances in the medical establishment so, in the hands of doctors, the use of these devices is always under appropriate supervision.”
The health systems of developed and developing countries place different demands on IT systems and equipment, and draw on different levels of resources.
For example, where mHealth can do the most good – such as in remote villages in developing nations – patients’ limited resources make flexible, low-cost devices a must. One example is mHero, a SMS-based health worker communication and coordination system which UNICEF and a consortium of partners, including IntraHealth, continue to develop.
A mobile medical device also may have to connect to other equipment in a sophisticated operating room or be ruggedized to survive use in the field.
Médecins Sans Frontières (Doctors Without Borders) aid workers in Ebola treatment centers in Sierra Leone, for example, are recording patient details without the risk of spreading infection by using a tablet that can be sterilized in a solution containing chlorine. Previously they were forced to shout information from behind a fence to another colleague who would record it.
“The magic is that there’s a local server on a postage-stamp-sized computer that runs on 5 volts so that whatever you enter on a tablet in the high-risk zone, you can then read that information in the low-risk zone from another tablet or laptop,” Ivan Gayton, a Médecins Sans Frontières field worker and technological innovation adviser, told BBC Radio during a recent interview.
Volunteer engineers from Google Crisis Response and other tech companies helped develop the equipment. “It doesn’t matter if the electricity goes off for a while or there’s no Internet, that’s the real key,” Gayton said. “That architecture, with a server and a client, is normally very difficult to implement in a sub-Saharan field setting.”
AS GOOD AS A GROCERY STORE?
Whatever the device or connection, mobile technology has the potential to provide access to a cloud-hosted knowledge base and collaboration tools that are appropriate to its function.Shared information helps efficiency, freeing up the valuable time of doctors and nurses to treat patients rather than complete paperwork.
The learning curve can be steep, but clinical professionals see the advantages. As a nurse interviewed recently by BBC Radio said: “If I go shopping at a major supermarket, they know what my shopping habits are for the last six months, but I struggle as a nurse in an NHS hospital to see a patient’s records and know what their last medication change was.”