mHealth


mHealth
Medical nurse uses a mobile phone in Accra, Ghana

mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information.[1] mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).[2]

While mHealth certainly has application for industrialized nations, the field has emerged in recent years as largely an application for developing countries, stemming from the rapid rise of mobile phone penetration in low-income nations. The field, then, largely emerges as a means of providing greater access to larger segments of a population in developing countries, as well as improving the capacity of health systems in such countries to provide quality healthcare.

Within the mHealth space, projects operate with a variety of objectives, including increased access to healthcare and health-related information (particularly for hard-to-reach populations); improved ability to diagnose and track diseases; timelier, more actionable public health information; and expanded access to ongoing medical education and training for health workers.[1]

Contents

Definitions

Malaria Clinic in Tanzania helped by SMS for Life program which uses cell phones to efficiently deliver malaria vaccine

Mobile eHealth or mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery. The term mHealth was coined by Professor Robert Istepanian as use of "emerging mobile communications and network technologies for healthcare."[3] A definition used at the 2010 mHealth Summit of the Foundation for the National Institutes of Health (FNIH) was “the delivery of healthcare services via mobile communication devices”.[4]

While there are some projects that are considered solely within the field of mHealth, the linkage between mHealth and eHealth is unquestionable. For example, an mHealth project that uses mobile phones to access data on HIV/AIDS rates would required an eHealth system in order to manage, store, and assess the data. Thus, eHealth projects many times operate as the backbone of mHealth projects.[1]

In a similar vein, while not clearly bifurcated by such a definition, eHealth can largely be viewed as technology that supports the functions and delivery of healthcare, while mHealth rests largely on providing healthcare access.[4] Because mHealth is by definition based on mobile technology such as IPhones, healthcare, through information and delivery, can better reach areas, people, and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare.

Motivation of mHealth

MHealth is one aspect of eHealth which is pushing the limits of how to acquire, transport, store, process, and secure the raw and processed data to deliver meaningful results. mHealth offers the ability of remote individuals to participate in the health care value matrix, which may not have been possible in the past. Participation does not imply just consumption of health care services. In many cases remote users are valuable contributors to gather data regarding disease and public health concerns such as outdoor pollution, drugs and violence.

The motivation behind the development of the mHealth field arises from two factors. The first factor concerns the myriad constraints felt by healthcare systems of developing nations. These constraints include high population growth, a high burden of disease prevalence,[5] low health care workforce, large numbers of rural inhabitants, and limited financial resources to support healthcare infrastructure and health information systems. The second factor is the recent rapid rise in mobile phone penetration in developing countries to large segments of the healthcare workforce, as well as the population of a country as a whole.[6] With greater access to mobile phones to all segments of a country, including rural areas, the potential of lowering information and transaction costs in order to deliver healthcare improves.

The combination of these two factors have motivated much discussion of how greater access to mobile phone technology can be leveraged to mitigate the numerous pressures faced by developing countries’ healthcare systems. Both factors are discussed here.

Healthcare in low- and middle-income countries

Disability-adjusted life year for all causes per 100,000 inhabitants in 2004.[7]
  no data
  less than 9250
  9250-16000
  16000-22750
  22750-29500
  29500-36250
  36250-43000
  43000-49750
  49750-56500
  56500-63250
  63250-70000
  70000-80000
  more than 80000

Middle income and especially low-income countries face a plethora of constraints in their healthcare systems. These countries face a severe lack of human and physical resources, as well as some of the largest burdens of disease, extreme poverty, and large population growth rates. Additionally, healthcare access to all reaches of society is generally low in these countries.

According to a World Health Organization (WHO) report from June 2011, higher-income countries show more mHealth activity than do lower-income countries (as consistent with eHealth trends in general). Countries in the European Region are currently the most active and those in the African Region the least active. The WHO report findings also included that mHealth is most easily incorporated into processes and services which historically use voice communication through conventional telephone networks. The report[1] was the result of a mHealth survey module designed by researchers at the Earth Institute's Center for Global Health and Economic Development, Columbia University.

The WHO notes an extreme deficit within the global healthcare workforce. The WHO notes critical healthcare workforce shortages in 57 countries—most of which are characterized as developing countries—and a global deficit of 2.4 million doctors, nurses, and midwives.[8] The WHO, in a study of the healthcare workforce in 12 countries of Africa, finds an average density of physicians, nurses and midwives per 1000 population of 0.64.[9] The density of the same metric is four times as high in the United States, at 2.6.[10]

The burden of disease is additionally much higher in low- and middle-income countries than high-income countries. The burden of disease, measured in disability-adjusted life year (DALY), which can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability, is about five times higher in Africa than in high-income countries.[11] In addition, low- and middle-income countries are forced to face the burdens of both extreme poverty and the growing incidence of chronic diseases, such as diabetes and heart disease, an effect of new-found (relative) affluence.[1]

Considering poor infrastructure and low human resources, the WHO notes that the healthcare workforce in sub-Saharan Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration.[12]

The WHO, in reference to the healtcare condition in sub-saharan Africa, states:

"The problem is so serious that in many instances there is simply not enough human capacity even to absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.” [12]

Health and development

The link between health and development can be found in three of the Millennium Development Goals (MDGs), as set forth by the United Nations Millennium Declaration in 2000. The MDGs that specifically address health include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water.[13] A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis.[14]

Mobile Technology in Low- and Middle-income Countries

Mobile technology has made a recent and rapid appearance into low- and middle-income nations.[15] While, in the mHealth field, mobile technology usually refers to mobile phone technology, the entrance of other technologies into these nations to facilitate healthcare are also discussed here.

Mobile Phones

Penetration and Drivers of Growth
Mobile phone subscribers per 100 inhabitants 1997–2007

Mobile phones have made a recent and rapid entrance into many parts of the low- and middle-income world, with the global Mobile phone penetration rate drastically increasing over the last decade. Improvements in telecommunications technology infrastructure, reduced costs of mobile handsets, and a general increase in non-food expenditure have influenced this trend. Low- and middle-income countries are utilizing mobile phones as “leapfrog technology” (see leapfrogging). That is, mobile phones have allowed many developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump to modern mobile technology.[16]

The number of global mobile phone subscribers in 2007 was estimated at 3.1 billion of an estimated global population of 6.6 billion (47%).[17] These figures are expected to grow to 4.5 billion by 2012, or a 64.7% mobile penetration rate. The greatest growth is expected in Asia, the Middle East, and Africa. In many countries, the number of mobile phone subscribers has by-passed the number of fixed-line telephones, this is particularly true in developing countries.[18] Globally, there were 4.1 billion mobile phones in use in December 2008 . See List of countries by number of mobile phones in use.

While mobile phone penetration rates are on the rise, globally, the growth within countries is not generally evenly distributed. In India, for example, while mobile penetration rates have increased markedly, by far the greatest growth rates are found in urban areas. Mobile penetration, in September 2008, was 66% in urban areas, while only 9.4% in rural areas. The all India average was 28.2% at the same time.[19] So, while mobile phones may have the potential to provide greater healthcare access to a larger portion of a population, there are certainly within-country equity issues to consider.

Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are, on average, getting wealthier in low- and middle-income nations.[20] Vendors, such as Nokia, are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100, such as Sun's Java phone). Non-food consumption expenditure is increasing in many parts of the developing world, as disposable income rises, causing a rapid increase spending on new technology, such as mobile phones. In India, for example, consumers have become and continue to become wealthier. Consumers are shifting their expenditure from necessity to discretionary. For example, on average, 56% of Indian consumers’ consumption went towards food in 1995, compared to 42% in 2005. The number is expected to drop to 34% by 2015. That being said, although total share of consumption has declined, total consumption of food and beverages increased 82% from 1985 to 2005, while per-capita consumption of food and beverages increased 24%. Indian consumers are getting wealthier and they are spending more and more, with a greater ability to spend on new technologies.[21]

Technology

Basic SMS functions and real-time voice communication serve as the backbone and the current most common use of mobile phone technology. The broad range of potential benefits to the health sector that the simple functions of mobile phones can provide should not be understated.[22]

The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place.[23][24] This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people, faster. As a result of such technological advances, the capacity for improved access to information and two-way communication becomes more available at the point of need.

More advanced mobile phone technologies are enabling the potential for further healthcare delivery. Smartphone technologies are now in the hands of a large number of physicians and other healthcare workers in low- and middle-income countries. Although far from ubiquitous, the spread of Smartphone technologies opens up doors for mHealth projects such as technology-based diagnosis support, remote diagnostics and telemedicine, web browsing, GPS navigation, access to web-based patient information, and decentralized health management information systems (HMIS).

While uptake of Smartphone technology by the medical field has grown in low- and middle-income countries, it is worth noting that the capabilities of mobile phones in low- and middle-income countries has not reached the sophistication of those in high-income countries. The infrastructure that enables web browsing, GPS navigation, and email through Smartphones is not as well developed in much of the low- and middle-income countries.[25] Increased availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world.[26]

Mobile Health - A doctor doing house calls.

Beyond mobile phones, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed for use in the mHealth field. Many of these technologies, while having some application to low- and middle-income nations, are developing primarily in high-income countries. However, with broad advocacy campaigns for free and open source software (FOSS), applications are beginning to be tailored for and make inroads in low- and middle-income countries.

Some other mHealth technologies include

  • Patient monitoring devices
  • Mobile telemedicine/telecare devices
  • MP3 players for mLearning
  • Laptop computers
  • Microcomputers
  • Data collection software
  • Mobile Operating System Technology

Mobile Device Operating System Technology

Technologies relates to the Operating Systems which orchestrate mobile device hardware while maintaining confidentiality, integrity and availability are required to build trust. This may foster greater adoption of mHealth Technologies and Services, by exploiting lower cost multi purpose mobile devices such as tablets pcs and smart phones. Devices in this class may include Apple's iPad 1&2 and Motorola's Xoom. Operating systems which control these emerging classes of devices include Google’s Android, Apple’s iPhone OS, Microsoft's Windows Mobile, Nokia Symbian OS and RIM's BlackBerry OS.

Operating Systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user, while managing display real estate, power consumption and security posture. As advances in capabilities such as integrating voice, video and Web 2.0 collaboration tools into mobile devices, significant benefits can be achieved in the delivery of health care services. New sensor technologies such as HD video and audio capabilities, accelerometers, GPS, ambient light detectors, barometers and gyroscopes[27] can enhance the methods of describing and studying cases, close to the patient or consumer of the health care service. This could include diagnosis, education, treatment and monitoring.

Air Quality Sensing Technologies

Environmental conditions have a significant impact to public health. Per the World Health Organization, outdoor air pollution accounts for about 1.4% of total mortality.[28] Utilizing Participatory sensing technologies in mobile telephone, public health research can exploit the wide penetration of mobile devices to collect air measurements,[27] which can be utilize to assess the impact of pollution. Projects such as the Urban Atmospheres are utilizing embedded technologies in mobile phones to acquire real time conditions from millions of user mobile phones. By aggregating this data, public health policy shall be able to craft initiatives to mitigate risk associated with outdoor air pollution.

Data has become an especially important aspect of mHealth. Data collection requires both the collection device (mobile phones, computer, or portable device) and the software that houses the information. Data is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to “tag” voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.

mHealth and Health Outcomes

The mHealth field operates on the premise that technology integration within the health sector has the great potential to promote a better health communication to achieve healthy lifestyles, improve decision-making by health professionals (and patients) and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication in places where this was not previously possible.[29][30] It follows that the increased use of technology can help reduce health care costs by improving efficiencies in the health care system and promoting prevention through behavior change communication (BCC). The mHealth field also houses the idea that there exists a powerful potential to advance clinical care and public health services by facilitating health professional practice and communication and reducing health disparities through the use of mobile technology.

Efforts are ongoing to explore how a broad range of technologies, and most recently mHealth technologies, can improve such health outcomes as well as generate cost savings within the health systems of low- and middle-income countries. In some ways, the potential of mHealth lies in its ability to offer opportunities for direct voice communication (of particular value in areas of poor literacy rates and limited local language-enable phones) and information transfer capabilities that previous technologies did not have. Overall, mobile communication technologies are tools that can be leveraged to support existing workflows within the health sector and between the health sector and the general public.[31]

Within the mHealth space, projects operate with a variety of objectives, as stated by the UN Foundation and Vodafone Foundation's report on mHealth for Development:

  • increased access to healthcare and health-related information (particularly for hard-to-reach populations)
  • improved ability to diagnose and track diseases
  • timelier, more actionable public health information
  • expanded access to ongoing medical education and training for health workers [1]

Applications in the mHealth Field

While others exist, the UN Foundation and Vodafone Foundation[1] report presents six application categories within the mHealth field.

  • Education and awareness
  • Helpline
  • Diagnostic and treatment support
  • Communication and training for healthcare workers
  • Disease and epidemic outbreak tracking
  • Remote monitoring
  • Remote data collection

Each application category as well as specific project within the category will be described.

Education and awareness

Education and awareness programs within the mHealth field are largely about the spreading of mass information from source to recipient through short message services (SMS). In education and awareness applications, SMS messages are sent directly to users’ phones to offer information about various subjects, including testing and treatment methods, availability of health services, and disease management. SMSs provide an advantage of being relatively unobtrusive, offering patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo. Additionally, SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education, health clinics, and a deficit of healthcare workers[1].

Below is a list of mHealth Education and Awareness projects:

Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role
Mexico Vidanet Vidanet gives People Living With HIV (PLWHIV) the ability to register to receive messages to help improve their adherence to their specific treatment. The main objective of this Project for ICS is to develop a strategic model of educational communication by promoting projects involving a telecommunication revolution in favor of health. With these tools they can generate changes in attitude towards a self-health care, health risk prevention, and adherence to specific prescribed treatments assigned to PLWHIV. Voxiva has partnered with the Instituto Carso de la Salud (ICS)
Mexico Cardionet Voxiva, along with ICS, has developed CardioNet, a solution in self-health care, health risk prevention, and adherence to prescribed treatments. Individuals complete a questionnaire asking them questions such as sex, age, weight, height, other health problems they have (i.e. diabetes or smoking) as well as blood pressure and cholesterol if known. Based on these answers, the individual is evaluated according to the standards set by the World Health Organization (WHO). From this assessment the individual begins receiving educational messages encouraging him/her to exercise and eat healthy. Examples of health foods and exercise are given to increase the messages effectiveness. Voxiva has partnered with the Instituto Carso de la Salud (ICS)
Rwanda/Uganda ResultsSMS.org ResultsSMS is an open-source platform compatible with OpenMRS designed to disseminate test results, patient education, follow-up appointments and adherence reminders to patients via SMS. ResultsSMS is a partnership between GPAS, FrontlineSMS and Support for International Change with seed funding from the Harvard Initiative for Global Health
India Freedom HIV/AIDS [32][33] 2005 In the first phase, ZMQ launched four games on Reliance Infocomm - one of the largest mobile operators of India and was able to reach out to over 9 million handsets. Later, the games were made available on other mobile carriers taking to 30 million handsets. In a span of 15 months, there have been a download of 10,3 million game sessions Freedom HIV/AIDS comprises four mobile games targeting different mindsets and psychology of mobile users. The games are deployed on low-end black/white to sophisticated high-end colored devices. Freedom HIV/AIDS is a social initiative of ZMQ Software Systems (A Technology for Development Social Enterprise). The initiative is supported by Delhi State AIDS Control Society and was launched by Chief Minister of Delhi Shrimati Sheila Dikshit. Games are free for download through the corporate social responsibility program of ZMQ[34]
South Africa Project Masiluleke [1] 276 Million text messages –one million per day –being sent (2008–2009). 1,060,000 calls answered. Messages in local languages are especially well received. Build awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread. Stigma is a major barrier, causing people to only seek care very late in the illness. SMS message campaign promoting HIV/AIDS awareness resulted in nearly a tripling of call volume to a local HIV/AIDS helpline. Praekelt Foundation, iTeach, National Geographic, Nokia Siemens Networks, MTN, Ghetto Ruff, Children of South African Legacies, Aricent, PopTech!, frog design and National AIDS Helpline ‘Please Call Me’ service -free text messages. 95% of South Africa uses prepaid cellular plans, and can send “please call me” message. There is 120 empty characters left in a “please call me” SMS message. MTN has allowed program to use total inventory of “please call me” messages.
Uganda Text to Change [1] 15,000 mobile phone subscribers in rural Uganda sent the quiz in the three month pilot test HIV/AIDS awareness via an SMS-based multiple choice quiz in exchange for free airtime; correct answers provided; participants encouraged to come in for testing (fee waived for participants) 40% increase in the number of patients who came in for HIV/AIDS testing. Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymou. Celtel, AIDs Information Centre (AIC), Merck, and the Dutch Ministry of Foreign Affairs SMS-based quiz in exchange for free airtime
India PaDiSys (NowPos M Solutions) -- Patient Reported Outcome data capture and treatment adherence system via text messaging -- -- --
Uganda, Tanzania and Kenya in Eastern Africa, and Malawi, Mozambique and Namibia in Southern Africa [35] Africa Reach Program [32][33] 2006 In the first phase, ZMQ launched four games on Reliance Infocomm - one of the largest mobile operators of India and was able to reach out to over 9 million handsets. Later, the games were made available on other mobile carriers taking to 30 million handsets. In a span of 15 months, there have been a download of 10,3 million game sessions Freedom HIV/AIDS introduced two HIV/AIDS awareness games to countries in Africa. Apart from English, the games have been developed in local languages - Swahili and Shen. Freedom HIV/AIDS is a social initiative of ZMQ - A Technology for Development Social Enterprise. Africa Reach Program supported by Hivos, a leading Dutch development organization, and KPN, the largest Dutch telecom company, under the "Star Programme" Games are free for download through the corporate social responsibility program of ZMQ
Many countries FrontlineSMS [32] Free open source software that turns a laptop and a mobile phone into a central communications hub that enables users to send and receive text messages with large groups of people through mobile phones, without requiring an internet connection
UNICEF/Georgia [32]
Mobile4Good [32]
New Zealand Vensa Health Coverage includes the whole country of 4 million plus New Zealanders receiving daily messages from their GP doctors and Hospitals Improve access to primary care services and hospital appointment attendance in accordance to Ministry of Health targets. Daily text messages sent to patients to improve appointment attendance, Immunisations rates of children, Cervical Smear Screenings, Breast screening, Flu Vaccinations and more... On average GP Surgeries and Hospitals achieve 50% reduction in missed appointment rates and achieve 6 time greater response in recall / pre-call activities with patients District Health Boards, Primary Health Organisations and General Practice around New Zealand Patients receive the messages for free from health organisations

Helpline

Helpline typically consists of a specific phone number which any individual is able to call to gain access to a range of medical services. These include phone consultations, counseling, service complaints, and information on facilities, drugs, equipment, and/or available mobile health clinics [1]

Below is a list of mHealth Helpline projects:

Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role
Australia National Health Call Centre Network or healthdirect [36] 2007 Government-sponsored
Australia HealthDirect (Western Australia) [36] 1999 Government-sponsored
Australia HealthDirect (Northern Territory) [36] Government-sponsored
Australia Nurse-on-Call (Victoria) [36] 2006 Government-sponsored
Australia HealthDirect (South Australia) [36] 2006 Government-sponsored
Australia Health First (Australia Capital Territory) [36] Government-sponsored
Bangladesh Healthline [36] 2006 10000 Calls per day Phone consults, information on facilities, drugs, test result interpretation, discounts on hospital visits. Mission: be a first reference point to complement conventional health solutions. Top health complaints: Chronic diseases (40%), ENT, early pregnancy, malaria, pneumonia (each 8%), diarrhea (7%) MNO-sponsored: Telemedicine firm and MNO For profit. Service is US$ 0.21 (BDT 15) for 3 minute call Marketing and promotion, Billing and revenue collection, Voice bearer
Canada Fonemed (for USA callers) [36] 1999 Government-sponsored
Canada Telehealth (Ontario) [36] 2001 Government-sponsored
Colombia Telemedic [36] Independent
Dominican Republic Telemed [36] Independent
India HMRI [36] 2007 50000 Calls per day Phone consults, counseling and complaints, information on facilities, drugs, mobile health clinics (vans). Mission: create platform to enable 1 billion virtual and 1 billion physical service contacts. Top health complaints: Recurring abdominal pain (13%), back pain (9%), knee pain (8%) Government-sponsored: Government and a private charity Not for profit. Service is free. Voice bearer
Mexico Telemedic [36] Independent
Mexico MedicallHome [36] 1998 10000 Calls per day Phone consults, information on facilities, drugs, discounts at clinics, pharmacies. Mission: be the first choice in private health services. Independent: Call center entrepreneurs For profit. Subscription: unlimited calls for US$ 5.00 monthly Shareholder, Billing and revenue collection, Voice bearer
New Zealand Healthline [36] 2006 Government-sponsored
Pakistan Teledoctor [36] 2008 1000 Calls per day Phone consults, information on facilities, drugs. Mission: provide cheap, easy access to experienced doctors. Top health complaints: Diarrhea and vomiting (gastro-enteritis), Gynecological ailments and obstetrics, Fever (usually associated with respiratory tract infections) MNO-sponsored: Telemedicine firm and MNO For profit. Service is US$ 0.30 (PKR 24) for 3 minute call Marketing and promotion, Billing and revenue collection, Voice bearer
Philippines Fonemed Asia-Pacific [36] planned Independent
South Africa Eastern Cape Health Call Centre [36] 2007 Government-sponsored
Trinidad and Tobago MedStar Health Information [36] 2004 Independent
United Kingdom NHS Direct [36] 1999 Government-sponsored
United States MedicareBlue PPO [36] Healthcare provider-sponsored
United States FirstHelp Nurse Advice Line [36] Healthcare provider-sponsored
United States Telemed (Puerto Rico) [36] Independent
United States Informed Health Line (Aetna) [36] Healthcare provider-sponsored
United States Teladoc [36] 2007 Independent
United States MedicallHome USA [36] Independent

Diagnostic support, treatment support, communication and training for healthcare workers

Diagnostic and treatment support systems are typically designed to provide healthcare workers in remote areas advice about diagnosis and treatment of patients. While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnosis, other projects provide direct diagnosis to patients themselves. In such cases, known as telemedicine, patients might take a photograph of a wound or illness and allow a remote physician diagnose to help treat the medical problem. Both diagnosis and treatment support projects attempt to mitigate the cost and time of travel for patients located in remote areas[1]

mHealth projects within the communication and training for healthcare workers subset involve connecting healthcare workers to sources of information through their mobile phone. This involves connecting healthcare workers to other healthcare workers, medical institutions, ministries of health, or other houses of medical information. Such projects additionally involve using mobile phones to better organize and target in-person training. Improved communication projects attempt to increase knowledge transfer amongst healthcare workers and improve patient outcomes through such programs as patient referral processes[1]

Below is a list of mHealth projects for both diagnostic and treatment support, and communication and training for healthcare workers

Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role
India Tele-Doc [32][37] 2003 Launched as a pilot project in 15 villages in Haryana in April 2003 TeleDoc provided handheld mobile phone devices to village health workers in India, permitting them to communicate with doctors who use a web application to help diagnose and prescribe for patients. TeleDoc was a project of Jiva Institute, an India-based non-profit. Supported by the Soros Foundation. The approximate cost of the entire TeleDoc process was 70 rupees (US$1.50) per consultation.
India mQure [38] 2010 Services operational across India mQure provides innovative solutions to make healthcare more accessible, convenient and at the lowest possible cost. Patients can get medical help on their mobile phone 24x7 or second opinions, information on latest hospital bed availability. Patients can also manage their chronic conditions or remember to take their medicines on time via Med Reminders. Relevant health content is made available to patients to take care of chronic conditions such as diabetes, heart conditions or pregnant mother/newborn care. Over 10,000 active clients across India Independent entrepreneurs Social venture with services starting as low as $1 per month
Peru Nacer [32][39] Nacer is a phone- and web- based information and communication system for maternal and child health that allows health professionals in remote locations to communicate and exchange critical health information between themselves, medical experts, and regional hospitals. All reported data is recorded in a central database, and is available to health officials in real-time for analysis and decision-making. Health workers in locations without Internet connectivity can access the system using any phone (satellite, fixed-line, mobile, or community pay phone). The USAID-funded Pathfinder International program and Voxiva worked with the Regional Health Directorate of Ucayali and the Peru Ministry of Health
Rwanda TRACnet [32][40] TRACnet is Rwanda’s dynamic Information Technology solution designed to collect, store, retrieve, and disseminate critical program, drug, and patient information related to HIV/AIDS care and treatment. The system was implemented to support the Rwandan Government’s vision of rapidly scaling up HIV/AIDS clinical services in a variety of health care settings. Under the leadership of the Ministry of Health and the Treatment Research and AIDS Centre (TRAC), TRACnet is being deployed to increase the efficiency of Rwanda’s HIV/AIDS program management, and enhance the quality of patient care. Voxiva and The Rwanda Ministry of Health
Uganda, Mozambique AED Satellife [32][41] Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS, malaria, child and maternal health, and health systems management programs.

Disease surveillance, remote data collection, and epidemic outbreak tracking

Projects within this area operate to utilize mobile phones’ ability to collect and transmit data quickly, cheaply, and relatively efficiently. Data concerning the location and levels of specific diseases (such as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or ministries of health or other organizations identify outbreaks and better target medical resources to areas of greatest need. Such projects can be particularly useful during emergencies, in order to identify where the greatest medical needs are within a country[1]

Policymakers and health providers at the national, district, and community level need accurate data in order to gauge the effectiveness of existing policies and programs and shape new ones. In the developing world, collecting field information is particularly difficult since many segments of the population are rarely able to visit a hospital, even in the case of severe illness. A lack of patient data creates an arduous environment in which policy makes can decide where and how to spend their (sometimes limited) resources. While some software within this area is specific to a particular content or area, other software can be adapted to any data collection purpose.

Below is a list of mHealth disease and epidemic outbreak tracking projects, and data collection software. There is also a list of mobile phone-based data collection software, from a practical perspective, at this link (the list is maintained by DataDyne.org but each developer organization mentioned has edit access, in order to provide current information on their product)

Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role
Brazil Name? [1] 400 test results gathered by 20 field professionals in two days, all with GPS information Containing the spread of the Dengue virus. Customized questionnaires distributed to field health agents’ mobile phones. Health data and GPS location information are integrated to enable immediate analysis and identification of areas with high infection levels. Data collection times dramatically reduced (paper-based system would have taken 2–3 months for lesser information). End-user acceptance very high. Nokia, Amazonas State Health Ministry
AESSIMS [32][43] AESSIMS is designed to build health capacity at the field level by enabling front-line health workers to report disease incidence through an innovative combination of telephone and web based technology that leverages available infrastructure. AESSIMS enables health officials to better understand the scope of disease impact and strategically allocate resources to areas with the highest prevalence and need. PATH, Voxiva, and the Government of Andhra Pradesh (GoAP)
Kenya and worldwide EpiSurveyor.org 2003 Since moving from older, PDA-based version to online version, more than 3500 users from hundreds of organizations in more than 170 countries have uploaded more than 150,000 completed data records from phones (updated stats here) EpiSurveyor is an online system developed by DataDyne.org that allows rapid development of forms which can then be downloaded to mobile phones for data collection: user can go from concept to fully functional mobile data collection system in hours. Used in more than 170 countries worldwide for outbreak investigation, disease surveillance, drug stock tracking . . . as well as health and economic surveys, veterinary studies, even the tracking of mountain gorillas in Uganda: if you are collecting data on paper, you could be using EpiSurveyor, regardless of the topic. Development and support based in Nairobi, Kenya. Winner of Wall Street Journal Technology Innovation Award, Lemelson-MIT Award for Sustainability, Stockholm Challenge Award, and Tech Museum Award, and covered by Wired, the Economist, the Guardian, Voice of America, and others. Major insight: if you make an easy-to-use tool available to anyone online, many people will find and use it. EpiSurveyor is not a "project" or a "pilot": it is a fully, functional system for creating mobile data collection systems, and it is available to anyone, for free, right now. "Like Gmail for data collection" :-) Developed with funding from the United Nations Foundation, the Vodafone Foundation, and the World Bank Basic service, used by 99% of users, is completely free and requires "no money, no meetings, and no MOU". Premium version available. More info
Voxiva Health Watch [32][44] Voxiva HealthWatch is an integrated surveillance platform used by public health agencies around the world to support integrated disease surveillance, syndromic surveillance, and coordinated response.
InSTEDD [32]

Treatment support and medication compliance for patients, including chronic disease management

Remote monitoring and treatment support allows for greater involvement in the continued care of patients. Within environments of limited resources and beds—and subsequently a ‘outpatient’ culture—remote monitoring allows healthcare workers to better track patient conditions, medication regimen adherence, and follow-up scheduling. Such projects can operate through either one- or two-way communications systems. Remote monitoring has been used particularly in the area of medication adherence for AIDS and diabetes[1]

Below is a list of mHealth treatment support and remote monitoring projects:

Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role
Kenya Weltel[45] 2008 1 year clinical trial. ~500 participants. HIV-positive patents were sent weekly text messages inquiring about their well-being. Patients responded to these message by saying everything was OK, or they had a problem. If there was a problem, a Health Worker would call back to assist them. Positive results showing that mobile phones can be a useful tool in supporting HIV-positive patients. The US Centers for Disease Control and Prevention (CDC) - PEPFAR Public Health Evaluation (PHE) and the International Development Research Centre's Africa Health Systems Initiative Support to African Research Partnerships (AHSI-RES)
Mexico Diabediario Voxiva, along with ICS, has developed Diabediario, a solution for changing diabetics’ lifestyles and for controlling and improving their adherence to their diabetic treatment. Any diabetic person, who has a TelCel cell phone, can participate in the program. Diabediario uses telecommunication to generate changes in attitude towards risk prevention and adherence to prescribed treatments. Diabediario does not replace doctor’s visits or pills but is meant to act as a supplement to outside care. This system empowers the patient to take control of their health by taking all the necessary steps to control their diabetes. Voxiva has partnered with the Instituto Carso de la Salud (ICS)
Peru Cell-Preven [1] Cell-Preven health workers use mobile phones to send SMS messages with real-time data on symptoms experienced by clinical trial participants. This enables immediate response to adverse symptoms Powered by Voxiva
Thailand Name? [1] TB patients were given mobile phones and called daily with a reminder to take their TB medication 90% of patients took their medication.
United States mCare 2009 US Army Medical Department mobile phone messaging application for the case management of reintegrated wounded soldiers. SMS-based wellness tips, appointment reminders for US service members returning from duty. Ported content from "afterdeployment.org" to a cell phone. HIPAA compliant. US Army Medical Department
 ? DIMA Dietary Intake Monitoring Application 2009 6-week pilot study with 20 participants. Mobile health application for dietary insight for a chronically Ill, low-literacy diabetic population The device has a voice recorder and a bar code scanner. By the end of the study the participants were only using the voice recorder. Patients use "beam" bar code scanner more easily than pen bar code scanner. The device was not stigmatizing, rather seen as a status symbol.
United States Web-based Mobile Support for the Washington D.C. Tobacco Quitline 2009 Currently updating the system to take real time patient smoking cessation data and "close the loop" feedback to improve adherence. Adding web interface to integrate with telephone quitline Many behavior change things are characterized by success and relapse. Measuring real time behavior, along with context and psychological factors. "Are you feeling happy?" Legacy Foundation
United States MAHI Mobile Access to Health Information 2009 49 participants, recently diagnosed with diabetes. 5 month study. Each time a diabetic patient used a glucose meter the phone would give them a call to gather data on why they were using it. Nokia or any java-enabled cell phone. Used bluetooth glucose meter. ndividuals record several messages per day. Data that were typically collected: pictures of food, pictures of confusing food labels, voice notes with specific problems. Outcomes: significant fraction of participants switched from "external" to "internal" locus of control, which meant they felt more in charge. Participants became better problem solvers with the condition, and better achieved dietary goals. Georgia Tech, CDC, Google Health, Siemens Corporate Research
Virtual Health Pet [32]
On-Cue [32]
SIMpill [32] SMS appliance that monitors medicine compliance by sending a text message when the patient takes medicine.
Cell-Life [32] SMS data gathering applications

Emerging trends and areas of interest in mHealth

  • Emergency response systems (e.g., road traffic accidents, emergency obstetric care)
  • Human resources coordination, management, and supervision
  • Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians[46]
  • Clinician-focused, evidence-based formulary, database and decision support information available at the point-of-care[46]
  • Pharmaceutical Supply Chain Integrity & Patient Safety Systems (e.g. Sproxil and mPedigree) [47]
  • Clinical care and remote patient monitoring
  • Health extension services
  • Health services monitoring and reporting
  • Health-related mLearning for the general public
  • Training and continuing professional development for health care workers
  • Health promotion and community mobilization
  • Support of long-term conditions *[2], for example in diabetes self-management [48]

According to Vodafone Group Foundation on February 13, 2008, a partnership for emergency communications was created between the group and United Nations Foundation. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world.

Being connected by mobile health services, different novel networking among various entities, (which were previously isolated) directly or indirectly related to health care delivery mechanism, are on the verge of development. This networking is now being known as mHealth Ecosystem.

See also

References

  1. ^ a b c d e f g h i j k l m n o p q Vital Wave Consulting (February 2009). mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. United Nations Foundation, Vodafone Foundation. p. 9. http://www.vitalwaveconsulting.com/pdf/mHealth.pdf. 
  2. ^ Germanakos P., Mourlas C., & Samaras G. "A Mobile Agent Approach for Ubiquitous and Personalized eHealth Information Systems." Proceedings of the Workshop on 'Personalization for e-Health' of the 10th International Conference on User Modeling (UM'05). Edinburgh, July 29, 2005, pp. 67-70.
  3. ^ Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S., eds (2005). M-Health: Emerging Mobile Health Systems. Springer. ISBN 978-0-387-26558-2. 
  4. ^ a b Torgan, Carol (November 6, 2009). "The mHealth Summit: Local & Global Converge". caroltorgan.com. http://www.caroltorgan.com/mhealth-summit/. Retrieved July 29, 2011. 
  5. ^ The Global Burden of Disease 2004 Update 2008
  6. ^ Global Mobile Phone Subscribers to Reach 4.5 Billion by 2012. Cellular-news.com. 4/1/2010
  7. ^ "WHO Disease and injury country estimates". World Health Organization. 2009. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Retrieved Nov. 11, 2009. 
  8. ^ World Health Organization, The World Health Report 2006: Working Together for Health. 2006, WHO: Geneva.
  9. ^ Kinfu, Y., Dal Poz, M., Mercer, H., Evans, D.B., The health worker shortage in Africa: are enough physicians and nurses being trained? Bulletin of the World Health Organization, Vol. 87, No. 3, March 2009, 225-230
  10. ^ UNData. Statistics Physicians density (per 10 000 population). WHO Data
  11. ^ The Global Burden of Disease 2004 Update 2008,
  12. ^ a b Kinfu, Y., Dal Poz, M., Mercer, H., Evans, D.B., The health worker shortage in Africa: are enough physicians and nurses being trained? Bulletin of the World Health Organization Vol. 87, No. 3, March 2009, 225-230
  13. ^ United Nations, United Nations Millennium Declaration (General Assembly Resolution 55/2). 2000, United Nations: New York.
  14. ^ United Nations, The Millennium Development Goals Report. 2006, United Nations: New York.
  15. ^ Economist. “The power of mobile money”. The Economist 14 Sept, 2009.
  16. ^ Economist. Leaders: The limits of leapfrogging; Technology and development. The Economist: 2008
  17. ^ Global Mobile Phone Subscribers to Reach 4.5 Billion by 2012. Cellular-news.com. 4/1/2010 http://www.cellular-news.com/story/29824.php
  18. ^ ITU (2003). Mobile overtakes fixed: Implications for policy and regulation. Geneva: International Telecommunications Union
  19. ^ Kathuria, R, Uppal M., Mamta (2009). An econometric analysis of the impact of mobile. Case paper in India: The impact of mobile phones. Vodafone Group Plc. The Policy Paper Series. November 2009
  20. ^ Global Economic Prospects 2007: Managing the Next Wave of Globalization. World Bank report.
  21. ^ McKinsey&Company (2007). The ‘bird of gold’: the rise of India’s consumer market. McKinsey Global Institute
  22. ^ Mechael, P. (2006). Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study, Public Health & Policy (p. 264). London: London School of Hygiene and Tropical Medicine
  23. ^ Agar, J. (2003). Constant Touch: A Global History of the Mobile Phone Cambridge: Icon Books Ltd.
  24. ^ Ling, R. (2004). The mobile connection: The cell phone's impact on society London: Morgan Kaufmann
  25. ^ Mechael, P. (2006). Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study, Public Health & Policy (p. 264). London: London School of Hygiene and Tropical Medicine.
  26. ^ Istepanian, R. (2004). Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-care Connectivity. IEEE Transactions on Information Technology in Biomedicine, 8(4), 405-413.
  27. ^ a b Lane, Nicholas; Miluzzo, Emiliano, Lu, Hong, Peebles, Daniel, Choudhury, Tanzeem, Campbell, Andrew (NaN undefined NaN). "A survey of mobile phone sensing". IEEE Communications Magazine 48 (9): 140–150. doi:10.1109/MCOM.2010.5560598. 
  28. ^ Ostro, Bart (2004). Outdoor air pollution : assessing the environmental burden of disease at national and local levels (null ed.). Geneva: World Health Organization, Protection of the Human Environment. ISBN 9241591463. 
  29. ^ Shields, T., A. Chetley, and J. Davis, ICT in the health sector: Summary of the online consultation. 2005, infoDev.
  30. ^ World Health Organization, eHealth Tools and Services: Needs of Member States. 2005, WHO: Geneva.
  31. ^ Malhotra K, Gardner S, Rees D. (2005). Evaluation of GPRS Enabled Secure Remote Patient Monitoring System. ASMTA 2005, Riga, Latvia, 41-48.
  32. ^ a b c d e f g h i j k l m n o p q UN Foundation, Vodafone Foundation, Vital Wave Consulting, mHealth for Development, 2008.
  33. ^ a b Freedom HIV/AIDS An HIV/AIDS awareness initiative using mobile phone games
  34. ^ ZMQ - A Technology for Development Company http://www.zmqsoft.com
  35. ^ Freedom HIV/AIDS - Serios Games Initiative to COmbat HIV/AIDS
  36. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z GSMA Foundation, A Doctor in Your Pocket: Health Hotlines in Developing Countries
  37. ^ Tele-doc India
  38. ^ [www.mqure.com]
  39. ^ Voxiva Case Study: Peru Nacer
  40. ^ Voxiva Case Study: TRACnet
  41. ^ AED-Satellife Center for Health Information and Technology Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS, malaria, child and maternal health, and health systems management programs in Uganda and Mozambique
  42. ^ MIP: the Mobile Information Platform. DataDyne.org. Retrieved on 2010-08-14.
  43. ^ Voxiva Case Study: AESSIMS
  44. ^ Voxiva Website: Health Watch
  45. ^ Home. weltel.org. Retrieved on 2010-08-14.
  46. ^ a b Mechael, P. "WHO mHealth Review: Towards the Development of an mHealth Strategy." August 2007.
  47. ^ Ghana News :: West African Innovation Hits Global Stage ::: Breaking News | News in Ghana | features. News.myjoyonline.com (2010-05-14). Retrieved on 2010-08-14.
  48. ^ Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. (2011). Features of mobile diabetes applications J Med Internet Res.;13(3):e65. PMID:21979293

Further reading



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